Summary: There was no fault in the way the Council conducted the financial assessment or arranged a care package, although there was poor communication about the process. However, the care visits by the Council’s commissioned care provider did not meet Mrs X’s needs. The Council agrees to waive the charges as the records show care was not regularly given. The Council acknowledges it could have offered a copy of the care and support plan before the financial assessment was completed and has reminded staff to do so from now on.

The complaint

1. Ms X (as I shall call the complainant) complains about the Council’s failure to give her a copy of her mother’s support plan, failure to explain the financial assessment and the lack of care provided by the Council’s commissioned agency.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
3. We have powers to investigate adult social care complaints in both Part 3 and Part 3A of the Local Government Act 1974. Part 3 covers complaints where local councils provide services themselves, or arrange or commission care services from social care providers, even if the council charges the person receiving care for the services. We can by law treat the actions of the care provider as if they were the actions of the council in those cases.
4. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.

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How I considered this complaint

5. I considered all the information provided by Ms X and the Council. We spoke to Ms X. Both Ms X and the Council had an opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

6. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
7. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14)
8. Councils must assess a person’s finances to decide what contribution he or she should make to a personal budget for care. The scheme must comply with the principles in law and guidance, including that charges should not reduce a person’s income below Income Support plus 25%. The Council can take a person’s capital and savings into account subject to certain conditions. If a person incurs expenses directly related to any disability he or she has, the Council should take that into account when assessing his or her finances. (Care Act 2014 Department for Health, ‘Fairer Charging Guidance’ 2013, and ‘Fairer Contributions Guidance’ 2010)

What happened

9. Ms X moved in to look after her mother Mrs A in May 2019 when Mrs A, who has dementia, showed increasing needs. Ms X has also provided support for her disabled sister for some years. She holds power of attorney for her mother’s affairs.
10. Mrs A was diagnosed with mixed dementia in May 2020. Ms X says a feature of her mother’s illness at the time was that she “does not believe there is anything wrong with her and has no understanding whatsoever of the changing limits of her abilities. For example, she does not know if she has eaten and does not know when she has had a drink and frequently forgets to do both”. Ms X contacted the Council for help in August 2020 after an episode when her mother climbed out of the bedroom window in the night.
11. On 11 September a social worker telephoned Ms X and carried out the assessment of Mrs A’s needs over the telephone rather than in person, due to the Covid 19 procedures in place. Ms X says she was confident at the end of the conversation that the social worker “understood our concerns and needs, and she discussed my mother and her behaviours with me at length. She concluded and advised me that it was her assessment that my Mother needed carers in twice a day, in the morning and evening for half an hour. We also discussed what the nature of this care would be the goals were;

Building a consistent relationship to gain trust and a willingness for carers to assist her with personal care.

Assistance and prompting to enable effective personal care with washing /showering.

Checking she had eaten and drank at regular intervals.

She also needs to be reminded to dress appropriately.

Supporting her enablement and encouraging independence.

Ensuring her personal safety from risk”.

Ms X says she understood the next step would be the Council would send her a letter to sign and then a financial assessment would take place.

12. The Council’s records note “assessment details taken from daughter (Ms X). (Ms X) lives with her mum and is going to university at the end of September and her mum has dementia and is at risk of self-neglect. (Ms X) is happy to keep looking after her mum but needs support to do this. care package suggested to include respite”. A note on the Council’s file from the social worker asks for a finance letter to be posted to Ms X.
13. The Council wrote to Mrs A on 17 September. The letter noted Ms X was dealing with Mrs A’s affairs. It explained the financial assessment would be conducted and the contribution calculated according to Mrs A’s income and any savings. It said, “the assessment will be completed after agreement of your care and support… your charges (contribution) start from the first day of your care and support: this means there will be an accrued debt in your first invoice.” Ms X returned a signed copy of the letter as requested on 25 September.
14. Ms X said that a manager from a care agency called her next and said the Council had arranged for her staff to provide care for Mrs A. She says they had a productive conversation about Mrs A’s needs and agreed “what my mother needed. The importance of the continuity same people coming at the same times, that they would encourage her and prompt her and assist her if necessary, in particular to ensure that she ate and drank etc. This call reflected the call I had had with (the social worker), so I felt confident that these people understood the needs of my Mother”. Ms X says no mention was made of charges. She says she did not agree to pay care charges with either the agency or the Council and presumed this was an interim arrangement funded by the Council. She says she was surprised to hear from the care agency before the financial assessment.

The care package

15. Ms X says there was no document provided to show what care would be expected or had been provided. She says carers’ times of attendance varied significantly between 09.00 and 11.30 and so failed to achieve one of the primary aims of the care, to ensure Mrs A ate and drank regularly and was washed and dressed. She says carers failed to try and reach a rapport with Mrs A; one carer scarcely spoke to Mrs A but used her mobile phone all the time she was at the house; another generally sat with her coat on, complained about the cold and let Mrs A make her a hot drink. She says although she herself was not always present, neighbours and friends visited and reported the same.
16. Ms X says after she contacted the Council in October and asked why she had not had a financial assessment, she received a letter arranging an assessment for 19 October. The Council then wrote to her explaining Mrs A would be liable for the full cost of her care. She contacted the Council to say she might cancel the care package as she was unhappy with the assessment.

The appeal and the complaint

17. Ms X says she received a bill from the Council for £268 for the care agency. She cancelled the care package. She wrote to the Council in November to complain that it had “commissioned this care package without any prior discussions with us as to when it would commence, what would be provided, and most importantly without any prior agreement from myself as POA or my Mother that we would be liable for the cost of this interim care.”
18. Separately Ms X appealed against the outcome of the financial assessment.
19. An officer telephoned Ms X to discuss the complaint. She noted Ms X’s concern about the complexity of the financial assessment process and that she felt “unable to make educated decisions on the nature of her mother’s care nor did it enable her to understand prior to the financial assessment what it is she COULD be paying.” She noted Ms X’s concerns that she did not have a copy of a care plan before the care began, so could not challenge any poor practice, and the care agency did not have a book in place recording what they had done.
20. In December the Council wrote to Ms X confirming the assessed contribution but arranging for a disability-related expenditure assessment to consider whether Mrs A should receive more than the standard £17.00 allowance.
21. The Council also responded to Ms X’s complaint. It said the financial assessment process had been carried out properly. It said Mrs A was entitled to a copy of her care and support plan.
22. The Council said the care agency had placed a copy of its service user guide to the electronic record system it used at Mrs A’s house but “Further evidence indicates that the system was not utilised by yourself, suggesting you may not have knowledge of it. The notes on Meritum’s electronic care system indicate (Mrs A) was offered personal care on each visit but this care was declined. The Care Plan is available to all carers who attend to provide care to your mother.” It said the care agency agreed care staff had been late on two occasions. Finally it said social workers had been reminded of the need to offer everyone a copy of their care and support plan.
23. Ms X responded to the Council. She said it had missed the main points of her complaint: that the care was put in place without any agreement to the costs; that no-one had ever told her about a service user guide or said where it was; that no-one had told her (the main carer) that her mother was consistently refusing care.
24. Ms X complained to the Ombudsman.
25. The Council says the social worker wanted to send an up-to-date care and support plan (with the financial details included) so delayed in issuing or offering a copy until the financial assessment was completed. In the event the care package was cancelled and so the care and support plan was never sent: it agrees this was fault and has reminded staff to offer the plan.
26. The social worker says she would have read out the finance letter (which was subsequently sent on 17 September) to Ms X during the telephone assessment as this was her normal practice.
27. In respect of the care agency’s records, the Council says, “The care notes are recorded on an electronic system called PASS…. PASS allows the carers to use a telephone handset to log in when they enter a client home and follow set task as laid out in the care plan. They can record all activities and observations, and this information can provide an audit trail of time spent and activity. PASS has the ability for family members to access the system to view the notes in real time with their own unique log in. Access must be agreed by the client and only gives access to their family members notes.

This information regarding the PASS system is noted and placed in a prominent

position either on the front cover or just inside the folder Meritum place in the

clients’ home”.

28. The care agency manager says she had a conversation with Ms X on 27 September 2020 and explained the PASS system. She says Ms X was made aware that a folder would be brought to their home and she would be able to read through the information and access the system should she wish. The care agency notes for 1 October record, ‘Also discussed with (Ms X) the PASS system and that a folder will be brought out to the home for her to be able to read and have access to if needed.’ Ms X says there was no such folder brought to the house. The Council says it can neither confirm or deny it was brought as it has no evidence.
29. In respect of the lack of care given, the Council says Ms X suggested carers should build up a rapport with her mother and that she acknowledged Mrs A was reluctant to accept care. The Council says it did not carry out its planned 6-week review of the care provision as by that time Ms X had already cancelled the care package. It also says neither Ms X nor the friends who visited raised concern about the lack of care given.
30. The care agency case records show the care given between 28 September (the start of the care package) and the end of the care package was one record of a cup of coffee being made on 15 October, and temperature checks being taken at each call. The notes record carers chatted with Mrs A.
31. The Council says the carers attempted to build rapport during the visits and care and support was offered, but on certain occasions Mrs A declined support. It says the provider failed to confirm to Ms X or the Council Mrs A’s reluctance for assistance with personal hygiene: therefore the Council was unable to amend the care and support plan or change the timings of the calls.

Analysis

32. The Council acknowledges it should have given Ms X a copy of the care and support plan. The failure to do so meant that Ms X was unable to check what had been agreed with the carers and so felt unable to challenge them. The Council has reminded its staff of the need to offer a copy of the care and support plan to service users.
33. That failure was compounded by the apparent failure of the care agency to place the PASS folder in the home and explain its usage and access. The care agency says that it did so: however, it seems unlikely that Ms X would have missed a folder placed prominently in her home. On the balance of probabilities I find it likely this did not happen.
34. The Council properly informed Ms X of the financial assessment and wrote to her with an explanation of the process, and there is no evidence the assessment itself was carried out with fault. The Council offered a disability-related expenditure assessment appropriately after Ms X appealed the outcome. There was some poor communication about the timeline for the start of the care package before the financial assessment had been arranged, however.
35. It is plain from the care agency records that the carers did not provide care at the level anticipated. Although Ms X had discussed with both the social worker and the care agency what her mother’s response was likely to be, there is no evidence much attempt was made to provide any of the promised care or properly build a rapport to enable Mrs A to trust the carers. That was fault which caused injustice to Mrs A and anxiety to Ms X. In my view Mrs A should not pay the care charges.

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Agreed action

36. Within one month of my final decision the Council will apologise to Ms X and waive the outstanding charges;
37. The Council has already taken action in respect of communication about care and support plans so I make no further recommendations there.

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Final decision

38. I have completed this investigation on the basis there was fault which caused injustice to Mrs A and Ms X.

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Investigator's decision on behalf of the Ombudsman