Summary: There was no fault by the Council in a complaint that alleged fault with the Council’s handling of social care and financial matters involving the complainant’s late mother in law.

The complaint

1. I refer to the complainant here as Mrs X. Mrs X complains about the Council’s handling of social care and financial matters involving her late mother in law. Mrs X says:
• A social worker kept telling them her mother in law’s care was funded.
• Continuing health care (CHC) and financial assessments were done without the family’s knowledge.
• In December 2020, she was told her mother in law did not have capacity and so she rang the social worker to tell him on the same day. Despite this, the Council had no concerns about capacity which is not true.
• The social worker emailed her to say her mother in law had been allowed an extra six weeks funding but then sent a message two weeks later to say the Council had changed its mind and the family had to pay.
• The Council sent a letter saying her mother in law was due to have a review six weeks after her assessment and she would then sign to give notice on her rented home which means she was not actually permanent but she passed away before the assessment took place.
2. Mrs X wants the Council to cancel the invoices for her mother in law’s care and rent because the CHC and financial assessments were done behind their backs whilst the social worker assured them her mother in law was fully funded.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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)

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How I considered this complaint

5. I examined the complaint and background information provided by Mrs X and the Council. I sent my initial thoughts on the complaint to Mrs X and the Council. I considered Mrs X’s comments.

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What I found

Government guidance on application of the Care Act 2014

6. The Care and Support Statutory Guidance 2014 (Care Act 2014) provides guidance on steps a council must take to assess a person’s needs for care and support; decide what needs are eligible for council support; and assess the person’s financial resources.
7. Section 6.29 of the Guidance states:
• An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Local authorities should inform the individual of an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process.
8. Section 17 states:
• a council must assess the person’s financial resources and any amount the person would be likely to pay towards the cost of meeting the needs for care and support once it has decided on eligibility under section 13.

Government guidance on funded nursing care

9. An NHS screening assessment will establish whether a person has nursing needs. If they do, the NHS will pay for the nursing element of care in a nursing home. This is referred to as a Funded Nursing Contribution (FNC) to the overall cost of the care. Funded Nursing Care is the amount the NHS pays for nursing care in a care home.  In some circumstances, the NHS is responsible for meeting the full cost of someone’s care in a home: this is referred to as NHS Continuing Health Care (CHC) or fully funded health care.

Background to the complaint

10. Mrs X’s mother in law lived in a rented home. She was admitted to hospital in September 2020. She was assessed as requiring full time care in a nursing home setting while in hospital. When discharged, she was initially placed in a nursing home with funding through a government scheme to support timely hospital discharges as a result of the Covid19 pandemic. The funding was for up to six weeks during which time the Council was expected to assess her long term needs under the Care Act 2014.
11. Mrs X’s mother in law had nominated a neighbour as a contact for financial matters in September 2020. The Council therefore wrote to the neighbour with an explanation of the placement and the fact that funding was in place for six weeks under the covid19 scheme. The letter also stated the Council would contact the neighbour again if Mrs X’s mother in law required services which incur charges. The Council says the social worker conveyed the same information to Mrs X orally when the Council started the care assessment process.
12. The Council started the care assessment process in October 2020. It found Mrs X’s mother in law had eligible care needs. It concluded she had care needs which could be best met in a nursing home.
13. As the Council identified care needs, the next step in the process was a financial assessment. The Council completed the financial assessment in November 2020. It asked Mrs X’s mother in law to make a contribution towards the cost of her placement in the care home.
14. Mrs X’s mother in law’s tenancy at her home was still in place. Possibly prompted by Mrs X or the family, the social worker made a request to the management of the Adult Social Care team as well as the Benefits and Assessment team for the rent and council tax to be waived during a notice period. The management accepted the request.
15. However, the Council later identified that Mrs X’s mother in law was in receipt of pension credit and housing benefit which meant she did not pay rent herself. It said this prevented it from making allowances for rent and council tax. It therefore proceeded with the rent and council tax that had been due.
16. As part of the care assessment process, the Council used a continuing health checklist which involved consideration of NHS continuing healthcare funding. Mrs X’s mother in law was found to be eligible for funded nursing care (FNC).
17. The Council says Mrs X’s mother in law was able to engage with the care assessment process in October and November 2020. It conducted a deprivation of liberty assessment in October 2020 and found her mother in law had capacity to consent to her placement in the care home. It says the social worker also conducted a mental capacity assessment while her mother in law was in the nursing home. The social worker was satisfied she had capacity to decide to remain at the home.
18. The Council says Mrs X’s mother in law did not feel the support of her family was necessary and so it respected her wish not to contact her family. It says it was in contact with her neighbour who was the nominated point of contact.
19. Mrs X contacted the Council to say her mother in law did not wish to remain at the care home. It appears her mother in law also stated she did not wish to remain there. The Council says it explored other care home options in December 2020 but it did not proceed with a full review because Mrs X’s mother in law was admitted to hospital in early December 2020. Mrs X’s mother in law died in hospital.

Finding

A social worker kept telling them her mother in law’s care was funded

20. The evidence I have seen satisfies me that the Council explained the funding process to Mrs X’s mother in law as well as her nominated person.
21. The Council says the social worker explained the process to Mrs X orally. There may have been some confusion in terms of the social worker’s oral explanation to Mrs X. This may explain Mrs X’s reference to the social worker saying the care was funded possibly at all times when she queried the funding arrangements.
22. However, the Council followed the correct care assessment and then financial assessment process. Given the explanations given to Mrs X’s mother in law and nominated person, I do not now find any possible defects in oral explanations given by the social worker to Mrs X amount to fault by the Council.

Continuing health care (CHC) and financial assessments were done without the family’s knowledge

23. The Council did not expressly contact Mrs X or her family to inform them of continuing health care and financial assessments because it had a nominated person who acted on behalf of Mrs X’s mother in law. It is better to keep a family informed but this was not fault by the Council.

In December 2020, she was told her mother in law did not have capacity and so she rang the social worker to tell him on the same day. Despite this, the Council had no concerns about capacity which is not true

24. Mrs X’s mother in law was admitted to hospital in December 2020. Mrs X says she received a telephone call from someone who said her mother in law did not have capacity.
25. I am satisfied the Council carried out mental capacity assessments at the relevant stages of the care assessment process before Mrs X’s mother in law was admitted to hospital in December 2020. I do not therefore find that the Council unreasonably or improperly concluded Mrs X’s mother in law had capacity despite Mrs X telling the social worker that she did not.

The social worker emailed her to say her mother in law had been allowed an extra six weeks funding but then sent a message two weeks later to say the Council had changed its mind and the family had to pay

26. Although Mrs X refers to six weeks funding this point probably refers to the Council’s decision to levy the rent and council tax charges despite its initial agreement to waive them following the social worker’s request.
27. The agreement to waive the charges was a discretionary one. That is to say the Council was not bound to waive the rent and council tax that had been due for a statutory or other legal reason. It later reneged on the agreement. While I consider the Council should keep to the commitment it made, I cannot find there was fault because it reneged on the commitment. It gave a cogent explanation for its change of mind. Whilst not ideal, this was not fault.

The Council sent a letter saying her mother in law was due to have a review six weeks after her assessment and she would then sign to give notice on her rented home which means she was not actually permanent but she passed away before the assessment took place

28. The Council was due to review the nursing placement before Mrs X’s mother in law had resided there for six weeks. The review could not take place because her mother in law was admitted to hospital and the admission interrupted the process.
29. Mrs X’s reference to her mother in law as not actually permanent is not a material point. The care assessment had identified her mother in law needed 24 hour care in a nursing home setting.
30. A six week review would consider whether her needs were being met in the nursing home or whether she needed a new home. It would have also considered whether there was an improvement in her health such that she did not need the same level of care in a nursing home setting. I do not find reference to a permanent or temporary placement establishes fault by the Council.

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Final decision

31. I closed this complaint because I did not find fault by the Council.

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Investigator's decision on behalf of the Ombudsman