Summary: Miss X complained on behalf of her mother, Mrs Y, about the way the Council assessed her needs and finances. She also complained about the way the Council dealt with her complaints about this. She said this had a significant impact on Mrs Y’s health and wellbeing and her finances. We find the Council was at fault in some areas but dealt with this appropriately at the time, and there is no outstanding injustice.

The complaint

1. The complainant, whom I shall refer to as Miss X, complained on behalf of her mother, Mrs Y, that the Council:
• Carried out a flawed care needs assessment.
• Over charged Mrs Y and did not consider all relevant disability related expenditure.
• Did not deal with her complaint about this properly and belatedly credited almost £5,000 without explanation.
2. Miss X says the flawed assessment meant Mrs Y was charged for more care than she needed. Additionally, this caused Mrs Y to be confined to her bed in her living room without access to a toilet or bath since October 2018. She spent all her savings on securing the roof of a suitable room so she could have a tracking hoist but the Council refused to allow this as disability related expenditure. This meant she could not afford to make the necessary adaptations to the room. She was in bed for over a year and as a result has experienced mainly irreversible wasting of her muscles.
3. Miss X says she would like the Council to acknowledge that Mrs Y needs included access to a toilet and bath. She says Mrs Y should have been entitled to spend her own, limited, funds on this and says the Council should suspend the incorrect invoices she has received. Once the work is completed, it can reassess Mrs Y.

Back to top

The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
5. 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)
6. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). Mrs Y has given her consent for Miss X to make this complaint on her behalf.
7. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended). We have exercised our discretion to consider this complaint back to 2018 as this is a late complaint. This is due in part to some incorrect information given to Miss X by the Council.

Back to top

How I considered this complaint

8. I considered information from the Complainant and from the Council.
9. I sent both parties a copy of my draft decision for comment and took account of the comments I received in response.

Back to top

What I found

Background

10. The Care Act 2014 (the 2014 Act) sets out local authorities’ duties around adult social care. The Care and Support statutory guidance sets out how the Care Act should be applied.

Assessment, eligibility, and support planning

11. Sections 9 and 10 of the 2014 Act say local authorities “must assess” the needs of any adult who appears to need care and support. Authorities must do this regardless of whether they think the person has eligible needs and regardless of the person’s finances. They must involve the person and their care worker or any other person they might want involved.
12. Local authorities must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. They should tell the individual when their assessment will take place and keep the person informed throughout the assessment. An assessment must always be appropriate and proportionate.
13. Where a local authority determines that a person has eligible needs, it must meet these needs. It must also give the person a copy of its decision.

Charging and disability related expenditure (DRE)

14. 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).
15. Disability related expenditure (DRE) can include the cost of any privately arranged care services and only costs incurred due to disability that someone without a disability would not incur.

Daily living equipment and minor adaptations

16. The statutory guidance to the 2014 Act says the local authority must not charge for certain types of care and support which must be arranged free. This includes community equipment (aids and minor adaptations). “Aids must be provided free of charge whether provided to meet or prevent/delay needs. A minor adaptation is one costing £1,000 or less.”. Community equipment is wide ranging but might include shower chairs, bed raisers, stand aids, hoists, raised toilet seats, ramps, rails or lighting.

Disabled facilities grants

17. Disabled Facilities Grants are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Council’s have a statutory duty to provide grant aid to disabled people for certain adaptations. Before approving a grant a council must be satisfied the work is necessary and suitable to meet the disabled person’s needs and also reasonable and practicable.
18. The maximum amount of a grant payable by a council is £30,000. A council can award other discretionary help if it thinks it is necessary. The amount a council of grant will pay is subject to a means test.

Continuing healthcare

19. Continuing healthcare (CHC) is a package of care arranged and funded solely by the health service. CHC is for people whose main care need is health related, who are not in hospital and who have complex ongoing health needs. It is fully funded by the health service and the person pays no contribution.

What happened

20. Mrs Y lived at home with her husband in a privately owned property. She had a progressive genetic disorder which causes increasing weakness and wasting of muscles. It primarily affects muscles in the upper part of the body and usually progresses slowly. At the time these events began, she had been known to the Council for some time mostly through an occupational therapist’s (OT’s) input. Mrs Y has several family members who have been involved. Where it was important to highlight the different family members involved, I have done this. However, for the most part, where I use Miss X, this may refer to either Miss X and/or another member of the family.
21. Mrs Y experienced a sudden, severe decline in her health condition which significantly affected her mobility and increased her care and support needs.
22. I have considered much information which is not represented here and have tried to restrict this to the most significant events and contacts as there were many.

Assessment and care

23. At the end of September 2018, the short term support and rehabilitation team (STSR) visited Mrs Y. Her GP had asked them to help her with personal care and transfers in and out of bed. Mrs Y advised that she did not need help with personal care; she had also declined this the previous month. She said she only needed two care workers to help her in and out of bed, and with the stair lift. The STSR team advised it could not help with transfers only and said the OT should assess her. It also said her profiling bed (which has adjustable sections to enable a variety of positions) would be delivered the next day. They advised her family to clear some space and that she may have to sleep in her chair that night. About two days later, Mrs Y advised the Council that she did need some help with washing and dressing. However, she later changed her mind again and decided to think about it for a few days. Again, the GP referred Mrs Y to the Council, and it visited but Mrs Y did not want care.
24. In mid October 2018, the GP referred Mrs Y for urgent care following the sudden worsening of her symptoms; she could no longer use the stair lift. The STSR team provided 1 x 30 minute call a day until the Council could arrange a long term package of care. The STSR team noted that Mrs Y held on to her husband for support to get in and out of bed. They advised that Mrs Y would need to wear pads as they could not assist in this way. When the long term package of care began towards the end of October 2018, the Care Provider asked for an urgent OT assessment. A few days later, the Council increased Mrs Y’s package of care to 3 x calls and then to 4 x 30 minute calls a day following further contact from Miss X.
25. In early November 2018, the Council allocated Mrs Y a senior social care practitioner (SSCP) who completed a care needs assessment on 22 November. The care and support plan set out three visits per day, one hour in the morning, 45 minutes in the afternoon and 45 minutes in the evening. These visits included hoisting Mrs Y and emptying and cleaning the commode.
26. In January 2019, the Council reduced Mrs Y’s support to 3 x 30 minute calls a day.
27. In April 2019, the SSCP completed a review of Mrs Y’s support plan.
28. In September 2019, Miss X asked for a copy of the support plan that the SSCP said had been updated in April. She also asked for a list of questions that the SSCP would ask at the upcoming review.
29. In October 2019, Mrs Y authorised three family members to deal with the Council on her behalf. The Council responded to their complaint advising that the inflatable bathing equipment should be collected, and Mrs Y should have flannel washes instead. Mrs Y wrote to the Council. She said “the [inflatable bathing equipment] is my life-line” and “there is nothing better than having a bath and feeling clean once a week when one is bed-bound”. She said she was “appalled” at the suggestion she should make do with a flannel wash instead. Miss X asked the Council to ensure that its records reflect that Mrs Y wished to only have visits for the minimum length of 30 minutes. She also asked the Council to ensure that the specialist physiotherapy was included in Mrs Y’s care needs assessment.
30. In early November 2019, Miss X emailed the SSCP to ask why Mrs Y was charged for 45 and 60 minute calls when the calls should be the minimum amount of 30 minutes per visit. The SSCP contacted the Care Provider to ask about the number of hours it was charging for and asked for the care notes back to October 2018. The SSCP telephoned Mrs Y to arrange a review of her support plan and to complete the CHC checklist. Mrs Y said she wanted her daughters present, and they arranged the review for early December.
31. A manager attended the review with the SSCP. Miss X asked why Mrs Y did not have a care needs assessment. The manager explained about the model the Council uses and that the assessment is incorporated into the support plan. Miss X gave feedback that there was not enough information about what an assessment involved, and the manager acknowledged this. Miss X also raised the privately funded physiotherapy which was not funded by the NHS and said this should be included in the care and support plan. The SSCP asked Mrs Y about the care being provided. Mrs Y and Miss X said the care was “really good” and the care workers were “attentive”. The SSCP could not complete the review as Mrs Y was sleepy, so suggested she send questions to Miss X so she could discuss them with Mrs Y. The SSCP asked Miss X to forward copies of all reports related to Mrs Y’s health conditions to inform the support plan and sent questions to Miss X as agreed.
32. At the beginning of January 2020, the SSCP arranged an increase in Mrs Y’s support to 4 x 30 minute calls a day.
33. At the beginning of February 2020, the SSCP sent Mrs Y a copy of the support plan.
34. In April 2020, Mrs Y reduced her support to 2 x 30 minute calls a day. The Care Provider contacted the Council and arranged to reinstate one call because it was too long for Mrs Y to go without personal care. Mrs Y and Miss X fed back that the support plan reflected Mrs Y’s current needs.
35. In May, Miss X asked for this to be increased to 4 x calls a day and the Council arranged this.
36. In December 2020, the Care Provider asked the Council to cancel the lunch call as Mrs Y no longer needed it. The Council had concerns about this and agreed with Mrs Y that it would continue.
37. In March, the Care Provider contacted the Council as Mrs Y had cancelled the lunch call regularly. The Council checked with Mrs Y, and she confirmed she did not have any pressure sores currently and did not want any support at lunchtime. The Council arranged for a review due to the risks of Mrs Y staying in her chair all day. The Care Provider confirmed that Mrs Y’s skin was good and it had no concerns about reducing the calls as Mrs Y had cancelled regularly.

Equipment

38. In September 2018, Mrs Y requested a disabled facilities grant (DFG) for a powered step lift to give her safe, wheelchair access to her home. The panel agreed she needed this. It recommended the Council explore a ground floor extension to create a bedroom, ensuite shower and toilet rather than a through floor lift as Mrs Y had requested.
39. An occupational therapist (OT) assessed Mrs Y and found a hoist was not feasible due to the high ceiling where she slept and a lack of floor space. Mrs Y also tried a stand aid but this was not suitable. Therefore, Mrs Y was cared for in bed until the works were completed to allow her to move to another room. The OT provided advice about rearranging the living space so Mrs Y’s bed was in a larger room which would have space for a mobile hoist. The Council provided Mrs Y with a profiling bed, a riser chair, and an adjustable height commode. It referred her for a lifeline service and to the fire service for a home safety assessment. It also referred her for an urgent powered wheelchair assessment and a specialist assessment for foot support.
40. The Council referred to an OT for a hoist. Both Miss X and the Care Provider asked the Council for an update on the hoist request as Mrs Y could no longer weight bear so could not transfer to the commode. The Care Provider also asked for an urgent OT assessment. Miss X asked for a bedpan and the Council advised her to use pads.
41. In November 2018, an OT noted concerns about Mrs Y spending most of the day in bed and that this would “contribute to further deconditioning”. Mrs Y declined a portable overhead hoist, and the OT noted the physiotherapist had ruled out using a sturdy walking frame and a stand aid because of the way Mrs Y moved. The OT also noted that Mrs Y’s husband had a chronic back complaint from years of helping Mrs Y and could no longer do so. Mrs Y declined the physiotherapist’s offer of an assessment for a tripod stick as she did not like it and felt it would be no use.
42. In December 2018, a means test found Mrs Y was not eligible for a DFG and would need to self fund any adaptations. As the property needed extensive works in addition to the adaptations, the OT gave her information about its Home Improvement Loan scheme. Miss X advised they were undertaking repairs and refurbishment to the property to provide a ground floor bedroom, level access shower and toilet. The OT provided information on an independent OT service should they need support with the adaptations. The OT also arranged inflatable bathing equipment for the family to use with Mrs Y as a temporary measure while she waited for the adaptation. This was not standard equipment usually supplied by the Council. Its equipment provider dealt with this and arranged training in its use from the supplier, for the family. The Council advised Mrs Y to contact the Council for an assessment of her hoisting and long term seating needs once her situation changed.
43. In April 2019, Miss X asked to appeal the DFG decision and asked for advice about installing a hoist if the family was responsible for doing this. The OT said they had already considered standard equipment such as mobile hoists, and it was not suitable. The OT advised how they could appeal the means test outcome. Miss X also asked who would train the care workers on use of the inflatable bathing equipment as the Care Provider would not accept Miss X as trainer. She said it took five hours to set up the inflatable bathing equipment, complete the wash, clean, and put away the equipment and needed two or three people. Also, that there was a lot of moving and handling of Mrs Y involved but the family were not trained in moving and handling. The OT advised that, as Mrs Y was self funding, they should contact the supplier of the inflatable bathing equipment for training. With regards to the training of care workers, the OT said the service had gone “the extra mile” in providing the inflatable bathing equipment and training for family. It could not accept responsibility for providing training to others and the family should contact the supplier direct about any issues. The OT gave the minimum size for the shower area and said they should contact the Council for a sling assessment when the shower and hoist were installed. Miss X said Mrs Y would prefer a bath. The OT advised that moving and handling someone into a bath is a specialist and complex process and recommended consulting the independent OT service.
44. Miss X contacted the Council. She said the Council had advised Mrs Y to purchase a hoist privately, but other councils provided hoists free of charge. The OT service advised that the reason for this was that Mrs Y needed a ceiling track hoist and adaptations to be made to the home to enable this. A ceiling track hoist would cost more than the maximum £1,000 for minor home adaptations which councils provide free of charge. Mrs Y had declined the mobile tracking hoist.
45. In September 2019, the physiotherapist contacted the OT to advise the family had now made changes to the property so Mrs Y could now be moved to the other room. They were concerned about Mrs Y being in bed for so long and said the move would also enable space for a motorised wheelchair.
46. In early October 2019, the OT and private physiotherapist completed a review of Mrs Y’s needs. The OT completed a moving and handling risk assessment and provided advice including about equipment. The OT offered an assessment for an “in chair” sling to Mrs Y. “In chair” slings are designed to minimise the risk of damage to the skin as they are not removed after hoisting to reduce handling of the person. Usually, slings are intended to be used during hoisting only. Mrs Y did not respond to this offer, so the OT did not complete the assessment. As Mrs Y was sleeping next to a gas fire; the OT also advised this was unsafe and advised her to move to the other room. The OT trialled the hoist, but space was limited so the OT recommended Mrs Y would also benefit in this respect from moving Mrs Y’s bed into another room.
47. Towards the end of October, Miss X contacted the OT to clarify the recommended room set up for Mrs Y to be hoisted to her chair. A week later, the OT reviewed the home environment with the Care Provider as Mrs Y had declined to move into the other room. The Council’s records note that Mrs Y remained in a small room where she could not be hoisted into her chair.
48. In early December, the SSCP spoke with the Care Provider who advised the care workers had been able to hoist Mrs Y onto her chair that afternoon. It said there was not enough time to do this in the mornings and Mrs Y did not want to increase the call length. This meant care workers would hoist Mrs Y to her chair during the afternoon visit and back to bed during the evening visit.
49. Miss X asked about the inflatable bathing equipment which needed repair. The Council had advised it would take it away and would not repair it, but Mrs Y was adamant she did not want it removed. Mrs Y confirmed that her ideal scenario was to have care workers trained with the inflatable bathing equipment and to have time to do this.
50. In mid December, Mrs Y stopped being hoisted as she found it uncomfortable sitting in her chair. The OT recommended they use cushions to fill the gap between her body and the chair. Miss X asked for a review of the chair.
51. In January, the OT completed an assessment and confirmed that Mrs Y’s chair met her postural needs. They recommended that Mrs Y increase her time sitting out gradually. The OT gave Mrs Y information about small aids that would help. The Council agreed to arrange a repair to the inflatable bathing equipment and Mrs Y agreed to move into the larger room.
52. In March 2020, Miss X asked the SSCP about the repair to the inflatable bathing equipment as they were “desperate” to replace the equipment they were using. The inflatable bathing equipment was collected for repair but was not repairable. The Council ordered new inflatable bathing equipment. The Care Provider declined to use this because it was time consuming and not essential. The Council advised Miss X that the family were solely responsible for providing this support to Mrs Y.

Charging

53. Mrs Y said she had never met the SSCP and was not told about the financial assessment procedure. However, during the assessment in November 2018, Mrs Y signed to confirm receipt of information about the financial assessment. This set out information about the capital limits and that a financial assessment would be needed for help with paying for care. It listed the documents needed for a financial assessment, gave examples of DRE and advised that receipts or bills would be needed to evidence this. Mrs Y told the SSCP that she did not have savings over £23,250 and agreed to a financial assessment. the Council sent out a financial assessment form for Mrs Y to complete and return within two weeks.
54. In January 2019, the SSCP explained to Miss X that they must complete and return the financial assessment. Miss X said Mrs Y had not received the paperwork. A family member went to the Council offices to pick the forms up. The following day they asked the Council for an extra two weeks to complete the forms. The Council advised Miss X that whatever the outcome of the financial assessment, Mrs Y would be invoiced for the full cost of her care, or a contribution. The following day, Miss X said they would cancel some of the care because they could not afford it and were concerned about getting a large invoice. The Council advised that Mrs Y would be charged from 22 October, when the STSR team input ended, and the commissioned service began. The following day, another member of the family discussed the same issues with the SSCP and said they would cancel the care as they could not afford it.
55. In mid February, the Council wrote to ask Miss X to return the financial assessment by 8 March. At the end of February, the family advised they had not yet received the bank statements needed but would try and submit by the given date. The Council advised that if it did not receive the form by then, Mrs Y would be charged full cost.
56. Mrs Y telephoned the Council on 8 March and said she had still not received her bank statements. The Council extended the deadline to 18 March. On 11 March, Miss X submitted the financial assessment and some supporting documents but no bank statements. The Council extended the deadline to 27 March and agreed to accept a print out of transactions from the Bank, but said it would still need the bank statements. By 1 April, the family had provided the statements up to March.
57. In June, the Council wrote to Mrs Y to advise that she would be self funding as her savings were over the capital limit. It issued invoices for the full cost of Mrs Y’s care to mid August 2019, totalling over £15,000. It said it would be about 18 weeks before the Council would help with funding. The family advised that Mrs Y did not have £23,000 in her bank account as assumed by the Council. The Council asked for statements to evidence this.
58. The financial assessment form stated shares were jointly owned by Mrs Y and two daughters however, the shares only showed Mrs Y’s name. The Council asked for evidence of the shares and statements of savings. Mrs Y advised these would arrive in a few days.
59. In mid August 2019, Mrs Y paid £9,000 of the outstanding costs. The family also wrote to query the disability related expenditure. At least four family members, other than Mrs Y, made several contacts with the Council throughout the rest of August disputing the financial assessment. They asked for funds to be included as DRE as they were earmarked for works to the property. The Council advised that it could not do this. It asked for evidence of the planned work. The family submitted some receipts relating to the other DRE Mrs Y was claiming.
60. In September 2019, Mrs Y received 3 x 30 minute calls a day from two carers; a total of 21 hours per week. The Care Provider told the Council she owed over £7,000. The Council wrote to Mrs Y to advise that she had to contribute £217.79 per week from 29 March 2019 and £228.54 from 8 April 2019. Miss X telephoned the Council nine times on one day to discuss the financial assessment and exchanged several emails a few days later.
61. In October, the Council emailed Miss X to submit bank statements from June to October 2019. It sent several reminders over the next few weeks and Miss X submitted these to the Council towards the end of December. She also provided information about the specialist physiotherapy costs which she asked to be allowed as DRE in the financial assessment.
62. In November, Miss X asked why Mrs Y was being charged for 2 x 45 minute sessions and one 60 minute session per week. She said Mrs Y was not having sessions of this length and Miss X had repeatedly asked for the minimum time of 30 minutes.
63. In early December, at the review, the SSCP explained that Mrs Y could have a personal budget of £800 - £1,000 per week. If her assessed contribution was £300, she would only pay that, and the Council would pay the rest.
64. At the beginning of February, Miss X submitted the medical evidence. The SSCP chased the Care Provider for the care notes since 2018 which had been archived.
65. In March 2020, Mrs Y asked the SSCP why she was paying so much for her care and why no one had explained the financial aspect to her. She said it was very expensive and she could not afford it. The SSCP agreed to ask someone from the finance team to arrange a home visit to discuss this with Mrs Y.
66. In June, following the uprating of Mrs Y’s assessment, Miss X asked why the Council still showed that Mrs Y had £23,000. This was because the Council had completed the assessment without all the bank statements. A reassessment was needed once the Council received that information. Mrs Y paid just over £2,700 and the debt recovery officer said they could look at a payment plan as she said she did not have the funds to clear her debt.
67. In August 2020, the Council advised Miss X that it would revise the DRE when it received all the bank statements. It said she should submit the rest of the receipts which she had previously withheld if she wanted them considered.
68. Throughout August and September, Miss X continued to communicate with the Council about the financial assessment. The Council had no response to the issue of an overcharge yet because it had not seen the documents. This was because the COVID-19 pandemic had significantly impacted the Care Provider and the documents needed had been archived. Miss X said they remained dissatisfied about the Council's decision not to disregard funds used for the roof in March 2019.
69. In September 2020, the Council advised Miss X that Mrs Y had been overcharged by £143.60 which the Care provider would refund. Miss X wrote to the Council and disagreed about the amount. She said Mrs Y was charged £628.75 a week for 2 x 45 minute sessions and 1 x 60 minute sessions but Mrs Y only received a maximum of 30 minutes. The Care Provider agreed to waive £251.30 weekly for just over 18 weeks. This was a total of £4,559 for the period from the date of the care needs assessment until the end of March 2019. This reduced Mrs Y’s outstanding debt from around £11,700 to just over £7,000. The Council advised her of this.
70. In March 2021, the Council reassessed Mrs Y’s finances. It asked Miss X to review the assessment and return by the end of the month with bank statements for all accounts over the last six months. It advised Miss X that Mrs Y owed £5,346 and Miss X paid this but queried the amount.
71. At the beginning of May, Miss X submitted the financial assessment without the up to date bank statements. The Council also asked for proof of shares held. It chased for the bank statements over the next few months but had not received them at the end of July when it sent me the information I requested for my investigation.

Complaint handling

72. In March 2019, Miss X contacted the Council asking why the SSCP had not called Mrs Y back. The SSCP said she had been unwell and not in the office for three days. Miss X did not accept this and questioned whether the SSCP had ever seen Mrs Y. The SSCP said they had visited in November 2018 and had arranged the visit with Mrs Y’s husband. Miss X complained no one else had been present and said there should always be a member of the family present. The SSCP checked whether Miss X had concerns about Mrs Y’s capacity, which she did not. Miss X complained that the care and support plan from that time set out three visits per day, one hour in the morning, 45 minutes in the afternoon and 45 minutes in the evening. These visits include transferring Mrs Y and “emptying and cleaning commode”. However, none of this was possible because there was no hoist or commode. She said Mrs Y never used the commode because she could not be transferred, so it had been returned. She said care workers often logged the full time but were not present for the full time. In April, the SSCP completed a review of Mrs Y’s care and support plan and updated it.
73. In April 2019, Mrs Y wrote and spoke to the OT service with her complaints. The Council responded apologising if the process was not explained clearly and advised:
• No OT needs were outstanding, and no OT was allocated to Mrs Y.
• The OT had explained what works were needed to make the ground floor habitable for Mrs Y and provided information about the Council’s home improvement loan scheme. Mrs Y would be cared for in bed until the changes were made and the family should request a review when the work was done.
• Mrs Y would have to pay over £140,000 towards the works so was not eligible for a DFG. It gave the details of how to request a review of the means test.
• The independent OT service provide moving and handling advice and training and could support the progress of the adaptations if they wanted help.
• They should contact the Council’s equipment provider about problems with specially ordered equipment ordered through the Council’s equipment provider.
• Equipment use was explained on delivery, in the users’ manual and during training provided by the supplier. It was not the OT service’s responsibility.
74. In mid June 2019, Miss X complained again to the Council; it responded at the beginning of July.
75. Towards the end of August 2019, the Council received a five page letter from Miss X disputing various elements of the financial assessment. A few days later, it received two complaint letters from Miss X’s family. The Council responded to this in early September 2019. Miss X complained again in mid September. Mrs Y asked the Council to speak to her niece about her finances. The Council suggested to her that the family had one point of contact with the Council because of the number of contacts with different family members.
76. In mid October, Miss X met with two other members of her family and three Council officers to discuss the issues.
77. At the end of October, the Council wrote to Mrs Y about the complaint she made in mid September. The letter is lengthy, and repetitive in places, running to 16 pages. It appears to quote much of Miss X’s lengthy complaints, but this was not clear. I found the letter difficult to follow however, in summary, the letter said:
• The Council had decided it would not allow for capital to be disregarded pending works to be completed because of the delay in completing the works. It also felt there had been other options.
• When capital falls below £14,250, it no longer affects the financial assessment. However, this does not mean the Council should not require payment of invoices which take the capital below this amount.
• The DRE had been “carefully considered”. The cost of wipes was based on the receipts received and could be revised on receipt of further evidence. Additional costs incurred by family members could not be covered by DRE as set out in the Council’s DRE policy. The Council based the rates of DRE allowed on the National Association of Financial Assessment Officers rates. Also, that the additional physiotherapy sessions cannot be included in the care and support plan as these are a health care need not a social care need. It suggested approaching Mrs Y’s GP again if this was essential.
• Mrs Y declined the OT’s original advice to reconfigure the room to enable a safe space for mobile hoisting equipment. The OT considered several options and advised Mrs Y to contact the OT when the space was available. Miss X later contacted the Council to advise that space was available. The Council allocated an OT within 7 working days who found some more space but not the changes recommended. The OT ordered, and successfully trialled, a mobile hoist. However, the OT said Mrs Y could still not be safely hoisted to her riser recliner chair due to space restrictions.
• Mrs Y was not eligible for a DFG because she would have to pay the first £148,500 towards any works and the maximum DFG is £30,000.
• The Council does not have a discretionary DFG policy and cannot offer funds to assist. It offered information about its flexible home improvement loan.
• In September 2019, Miss X advised the Council that work would start on the level access shower for Mrs Y in October 2019, but this had not happened.
• The inflatable bathing equipment was not meant for long term use and was leading to moving and handling concerns and care needs. It said this equipment had not supported Mrs Y adequately and it had not benefitted her. It said it should be collected and Mrs Y supported with flannel washing to meet hygiene needs.
• It apologised “if you feel” the council was less than clear in the information it provided about the financial assessment. It was only in October 2019 that Mrs Y confirmed the Council could discuss matters with other family members. Both the financial assessment team and social care team received multiple, overlapping communications from various family members which they tried to respond to clearly.
• The assessor was a senior social care practitioner (SSCP) not a social worker. The assessor had “a number of telephone discussions with [Mrs Y and Miss X]” about the financial assessment process, and the inaccuracies in the support plan. “I am satisfied that the correct information was provided in each of these contacts”. It acknowledged that adult social care can be difficult to navigate, and support was needed. It apologised “if you do not feel this has been your experience”. It said, “I have discussed your concerns with [the SSCP] who acknowledges a further home visit to clarify points would have been helpful.”.
• Mrs Y requested a review of her care needs in August 2019, but this had not been arranged. The SSCP was waiting for the OT assessment and equipment to be provided before doing this. It apologised and said this was not necessary and the SSCP will contact Mrs Y directly to arrange a convenient time. Any inaccuracies in the care and support plan would be amended through this review and would also be an opportunity to discuss concerns about the care provided. The SSCP would also complete a CHC checklist as requested.
• It apologised and said more care should have been taken with the wording of letters and “detail surrounding decisions made”.
• It apologised and said some of the information given at the meeting in mid October was incorrect. In trying to give an estimate of when Mrs Y’s capital may drop below the £23,250 limit, the financial assessment team added to the confusion. It said an 18 week limit was used and this was not normal practice and it would ensure all staff are clear about this in future. This meant the Council assumed Mrs Y’s capital dropped below the £23,250 limit from the end of March 2019 but had no evidence to confirm this. It asked Mrs Y to provide current bank statements urgently. It said if it did not receive these within one month, it would assume her capital remained above the limit and she would be considered self funding. As it was the Council’s error, it would not backdate this.
• As Mrs Y did not pay the full amount invoiced, she was treated as having more capital than she should have had if she had paid these invoices. This was Mrs Y’s choice not to pay the invoices and the Council does not agree this should lead to a reassessment.
78. At the end of November 2019, Miss X appealed the outcome of the financial assessment. She said the care needs assessment of November 2018 had not included Mrs Y or her family. It included “numerous errors” which affected the amount of care Mrs Y was charged for. She also said it led to the Council’s incorrect decision not to earmark funds to pay for necessary adaptations. Miss X said the care needs assessment had not addressed Mrs Y’s need for a bath or toilet and the Council had denied this.
79. In December 2019 and January 2020, appeal panel hearings considered the care needs assessment, inaccurate care charges, and financial assessment. In mid January, the Council wrote to Mrs Y with the outcome. The panel found:
• The care needs assessment was not fully explained or understood. It was “light touch” but not “erroneous” and a copy was delivered with other documents. The outcome would not have been any different had it been more robust.
• The Council had not previously been advised that Mrs Y had spent over £14,000 on adaptations by 29 March 2019. It had not received any receipts to evidence this save one for a £3,000 deposit. The panel requested evidence of this expenditure which it would then account for in the financial assessment. It did not agree to earmarking the funds from November 2018 as it believed the delay was too long. The panel also advised that if Mrs Y provided details of work to be completed from those contracted to do so in future, these may be disregarded. However, if not used for such work within six months, the funds would be included in the financial assessment retrospectively.
• The Council’s policy referred to a delay of two weeks but the delay in this instance was six months.
80. In January 2020, the Council wrote in response to Miss X’s further complaints and challenge of the appeal findings. It re-stated the findings of the appeal panel regarding ear marking funds. It also said:
• The Council had provided or offered the means to hoist Mrs Y if she took the OT’s recommended action to enable safe use of a mobile hoist. Mrs Y chose not to do this.
• Following the meeting, the OT service would obtain quotes to repair the inflatable bathing equipment to enable Mrs Y to use this until adaptations were complete.
81. Miss X complained to us in March 2021.

Was there fault which caused injustice?

Assessment

82. It is not my role to decide if a person has social care needs, or if they are eligible to receive services from the Council. My role is to establish if the Council assessed a person’s needs properly and acted in accordance with the law and guidance.
83. The panel considering Mrs Y’s appeal concluded that the care and support plan was not wrong but could have been more robust. It did not specifically address the care and support plan instruction that care workers should hoist Mrs Y to the commode although she had no hoist. I concluded this was not likely to change the outcome. This was an evolving situation, and the OT and physiotherapist were trying to offer a solution to Mrs Y’s mobility related needs. At the time the SSCP completed the care and support plan, she may have understood that Mrs Y would have a hoist. However, since Mrs Y did not have a hoist at the time this care and support plan was written, hoisting should not have been included. This was fault. A new care and support plan would have been needed when the circumstances changed, and Mrs Y was to be hoisted.
84. The panel also concluded that the assessment process was not adequately explained and that a copy was delivered with other documents. Miss X disputes that they received a copy. However, once Miss X raised this and concerns about the assessment, the Council completed a review and provided a copy of the revised plan. Miss X and Mrs Y were both noted to be happy with the revised plan. The Council did acknowledge that the assessment process was not adequately explained; the actions it has already undertaken should avoid this in future.
85. The panel also found the care put in place would not have been different. In respect of the visits being longer than necessary, I have concluded on the balance of probabilities, this was not necessarily so. Mrs Y was previously receiving four visits a day at the request of Miss X. Also, in September 2020, the Care Provider waived £251.30 weekly for just over 18 weeks from the date of the assessment.
86. Although there was some fault in the assessment and in the way it was explained, I am satisfied this did not cause significant injustice. Mrs Y and her family were provided with much information about the assessment process. The number of people asking the Council for information and discussing the issues caused confusion; the Council did not identify that no one fully understood.

Care and equipment

87. Miss X also complained that the care needs assessment failed to deal with Mrs Y’s need for a bath and toilet. She said the Council failed to provide this. In fact, the OT’s assessment properly dealt with this, and, in December 2018, the OT advised Mrs Y that she needed to self fund the necessary adaptations. That other equipment options were not available to Mrs Y because her condition worsened rapidly, was not linked to the care needs assessment. The OT provided, offered, and trialled many items, not all of which were suitable or wanted. Mrs Y needed to follow the OT’s advice, both about rearranging the living environment and the adaptations before hoisting became an option. Once Mrs Y agreed to move rooms and had the necessary work done to enable this, the OT provided a mobile hoist. Further options around bathing depended on Mrs Y having the adaptations completed. Mrs Y was not eligible for financial support with funding adaptations to her property, due to her financial circumstances. The Council was therefore not responsible for arranging the adaptations or the repairs to the property The Council provided what equipment it could and provided information about alternative funding options. Miss X says the hoist could have been provided sooner. Mrs Y declined the mobile tracking hoist and the OT’s assessment was that a standard mobile hoist was not appropriate. It is not my role to decide whether this is correct or not but whether the Council properly considered the issue and dealt with it properly. I found the OT supported her decision with an appropriate assessment and clear reasoning. The lack of adaptations and hoist impacted on the care that could be delivered and Mrs Y remained in bed. I found no evidence that the OT’s consideration was flawed and therefore, no fault in the Council’s actions here.

Charging

88. It is not my role to decide what a person should be charged. My role is to establish if the Council followed the law and guidance in deciding what Mrs Y should pay.
89. A financial assessment is based on fact and councils are entitled to require evidence of finances to assess them properly. The Council had significant difficulty in completing an accurate financial assessment for Mrs Y. This was due to delays in receiving information such as bank statements and receipts. These were eventually provided but by the time this happened the Council needed more up to date information. This was challenging for Mrs Y and her family, but this is necessary to receive funding from the Council. The Council provided sufficient information about the financial assessment in 2018 and in numerous phone calls and emails since.
90. In respect of the DRE, the Council has made it clear that, on receipt of the evidence it requested, it will allow for some of the expenditure as requested. However, it has declined to earmark funds for works which have not yet been confirmed and to which Mrs Y is not yet committed. This is not fault.
91. The Council was at fault in some ways, including incorrectly assuming Mrs Y’s capital had dropped without evidence of this. However, once it became aware, it reconsidered and adjusted the financial assessment. It also apologised for the delay in advising the outcome of the financial assessment once it had received the bank statements. This was a suitable way to deal with these issues and there is no outstanding injustice here.
92. The Care Provider reduced Mrs Y’s invoice by £4,559. The reduction applied to the period from the date of the care needs assessment until the end of March 2019. This was for the period when Mrs Y’s care plan was for 60 minute and 45 minute visits. Miss X had said Mrs Y did not need this and care workers did not always stay the full time. This was a suitable response to the complaint and there is no outstanding injustice.

Complaint handling

93. The Council dealt well with the volume of contact but it became confusing for both sides with so many individuals involved. The Council and the family would have benefitted from a more robust management of the contact. For example, firmly restricting contact to one member of the family and one, senior, Council officer who could convey information about all issues.
94. For the most part, the Council dealt adequately with the complaints but in places it delayed, and the contact reflected the confusion. For example, the Council’s response to the complaint at the end of October was poor and only served to raise more issues. This was fault but I cannot say it caused significant injustice because the Council had already explained and responded to the issues. Mrs Y and her family felt strongly that the Council was wrong in its approach to the charging and care provision, but this was not so.

Summary

95. I found some instances of fault in respect of the issues Miss X complained about however these were incidental to the fundamental issues about which she complained. They were also resolved appropriately by the Council before Miss X came to us.
96. On the main points of the complaint:
• The care needs assessment was not good but, on balance of probabilities, this did not affect the care Mrs Y received.
• There was no fault in the way the Council considered the disability related expenditure or the financial assessment.
• The Care Provider waived a significant proportion of its charges in September 2020.
97. Between 2018 and March 2021, when Miss X brought Mrs Y’s complaint to us, the Council identified some faults. These issues were all resolved appropriately by the Council long before Miss X came to us, and there is no injustice outstanding. Therefore, I make no recommendations.

Back to top

Final decision

98. I have completed my investigation and do not uphold Miss X’s complaints that the Council:
• Carried out a flawed care needs assessment.
• Over charged Mrs Y and did not consider all relevant disability related expenditure.
• Did not deal with her complaint about this properly and belatedly credited almost £5,000 without explanation.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman