Summary: Mr X complained about how the Council communicated an increase in care costs and overcharged for his late mother’s care. Mr X also complained his mother Mrs Y received care from one carer instead of two in the weeks before she passed away. The Council was at fault for giving wrong information on Mrs Y’s increased care charges, delay in providing a breakdown of care charges, the time taken to credit an overpayment and for not updating Mrs Y’s care and support plan. The Council has already apologised for the wrong charging advice and credited the overpayment. However, it caused Mr X avoidable distress and time and trouble. The Council will apologise and pay Mr X £300 to acknowledge the distress, delay and time and trouble caused and review its procedures for updating care and support plans.

The complaint

1. Mr X complained on behalf of his late mother, Mrs Y. He complained about how the Council communicated an increase in Mrs Y’s care costs and that it overcharged her for her care. Mr X also complained Mrs Y received care from one carer instead of two in the weeks leading up to her death. Mr X managed Mrs Y’s finances and said the Council's actions caused him distress and meant he went to undue time and trouble to try and resolve the matter.

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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. 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)
3. 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

4. I have considered:
• the information Mr X provided and discussed the complaint with him;
• the Council’s comments about the complaint and the supporting documents including records from the care provider; and
• the Council’s policies, relevant law and guidance and the Ombudsman's guidance on remedies.
5. Mr X and the Council had the opportunity to comment on the draft decision. We considered their comments before making a final decision.

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What I found

Relevant law and guidance

The Care Act 2014 and charging

6. In 2014, the Government introduced the Care Act. This legislation replaced all previous guidance about how councils assess and provide care for adults in need. It includes guidance on charging for care.
7. The Care Act states councils have discretion to charge people for the care they receive. If a council decides to charge for care, it must complete a financial assessment. People who have over £23,250 of eligible capital have to pay for the full cost of their care fees.
8. Councils should clearly discuss with the person or their representative at the outset that care and support is a chargeable service and that where the person has been assessed as being able to afford to do so, they will be required to contribute to the cost of that care. They should ensure any subsequent fee changes are clearly communicated to the person or their representative.

Care planning

9. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment of any adult who appears to need care and support. They must assess anyone, regardless of their finances or whether the council thinks they have eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must involve the individual and where appropriate their carer or any other person they might want to be involved.
10. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan, which should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.
11. Section 27 of the Care Act 2014 gives an expectation that local authorities should conduct a review of a care and support plan at least every 12 months. The authority should consider a light touch review six to eight weeks after agreement and signing off the plan and personal budget. It should carry out the review as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. As well as the duty to keep plans under review generally, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult's behalf asks for one or if it becomes aware it is no longer meeting a person’s needs.

Council Adult Social Care Complaints Policy

12. The Council’s Adult and Social Care Complaints Policy says:
• it will acknowledge a complaint within three working days;
• if the complaint is made orally, it will write it down and provide a copy of the written complaint to the complainant;
• it will contact the complainant and agree the best way to deal with the complaint and agree a timescale;
• if there are delays it will inform the complainant;
• all complaints will be completed within six months; and
• in its final response it will tell the complainant they can contact the Ombudsman if they remain unhappy.

What happened

13. Mrs Y received care in her own home for many years. In June 2020, the Council reassessed Mrs Y’s finances and decided she needed to pay the full cost for her care as she had over £23,250 in capital. She received 25 hours of care per week, which Mr X paid on her behalf.
14. In August 2020, the care provider told the Council it felt Mrs Y needed an extra three and a half hours of care per week. The increase was for double handed care (visits by two carers instead of one) to support Mrs Y to move from her bed to her chair, to relieve pressure on her skin. The Council discussed the proposed increase with Mr X. Mr X said he was concerned the extra care would mean higher costs. The care provider’s handwritten daily visit records show from August 2020 it provided 28.5 hours a week of support to Mrs Y.
15. In mid-August 2020, the Council told Mr X the extra hours of care would not increase Mrs Y’s fees. Mr X agreed to the extra hours on that basis and said Mrs Y would welcome more time in her chair. Records show the care provider began providing 28.5 hours of care per week in mid-August 2020.
16. As part of her support plan Mrs Y received two two-hour visits a week to support with domestic tasks. In error, from mid-August 2020 the Council charged Mrs Y for double handed care for this support which was undertaken by one carer. Mrs Y was therefore paying for 30.5 hours of care and not 28.5 hours of care which she received.
17. In November 2020, the Council sent Mr X a backdated invoice for Mrs Y’s care charges which showed the weekly charge had increased because of the extra care provided since August 2020. Mr X was unhappy because the Council had previously told him there would be no fee increase. Mr X stopped paying Mrs Y’s care fees and asked the Council for a full breakdown of costs.
18. In December 2020 Mr X complained to the Council. He said the Council failed to:
• provide comprehensive information about Mrs Y’s care costs and charges; and
• provide a breakdown of the charges.
19. The Council responded in May 2021, it said:
• it accepted it wrongly told Mr X that Mrs Y would not need to pay for the extra three and a half hours of care per week. It apologised and said it learnt from the error, addressing it with the relevant Council team;
• it had accidentally charged Mrs Y for 30.5 hours of care per week since August 2020 as it had wrongly charged for two carers (doubled handed care) instead of one carer for the domestic care hours. It reduced Mrs Y’s debt to reflect the overpayment;
• it had spoken to the Occupational Therapist and care provider to establish if care could potentially be provided with a single carer using adaptations; and
• it would give Mr X a breakdown of costs.
20. At the end of May 2021 the Council sent Mr X an email which attached a 50 page invoice and spreadsheet detailing Mrs Y’s care fees. Mr X said this was still unsatisfactory as it still did not make the charges clear. He said it only showed the total weekly charges, which did not allow him to check it charged Mrs Y properly for each visit.
21. In mid-September 2021 the social care records show the care provider contacted the Council’s Occupational Therapist. The Council’s social care records state the care provider advised the Occupational Therapist Mrs Y was refusing to use equipment to assist her out of bed and wanted to remain in bed. The notes stated Mrs Y was now provided with all her care in bed. ‘Care has also changed and is now AM 1 hour x 1 carer, lunch 1 hour x 1 carer, tea 1 hour x 1 carer and evening 30 minutes x 1 carer’. With the additional two, two-hour visits for domestic support the care package still equated to 28.5 hours per week. The care provider’s electronic records of visits also show one-hour visits were provided by one carer at lunchtime and teatime from mid-September 2021. The care provider says two carers attended but only one showed on the electronic record due to a system glitch. I have seen no evidence Mr X was advised of any changes or that the Council updated the care plan.
22. Mr X remained unhappy and complained to the Ombudsman. Mr X complained:
• he had been asking the Council for over a year for Mrs Y’s detailed care charges;
• his complaint emails were ignored for months;
• the Council said the care charges would be capped but he received a backdated bill with no consultation;
• Mrs Y’s care package reduced towards the end of her life to one carer instead of two on a lunchtime and teatime but the Council had not reduced her fees accordingly; and
• he still could not settle the charges made.
23. Mrs Y died in October 2021.
24. The Council, in response to our enquiries, has confirmed, there is an outstanding balance owed of around £21,000.
25. In response to our enquiries the Council sent the care provider’s electronic daily care attendance records for Mrs Y and the handwritten daily care notes. There was however an inconsistency in the electronic attendance record which showed on some occasions carers did not sign in or out when logging visits with Mrs Y, although the daily care records evidenced that visits took place.

My findings

Information on care costs

26. From June 2020 the Council was entitled to charge for care Mrs Y received. In mid-August 2020 Mrs Y’s needs increased from 25 hours per week to 28.5 hours per week and it advised Mrs Y would not incur any extra charges as a result of the increased package of care. Mr X was not aware Mrs Y would have to pay for the extra care until the Council sent Mr X an invoice in November 2020 with the extra care costs.
27. Mr X was unhappy about the extra charges but the evidence shows Ms Y required the support to enable her to be moved from the bed to chair to relieve pressure on her skin. As Mrs Y was a full cost payer with savings over £23,250 she was required to pay for the full cost of her care.
28. The Council has accepted it gave Mr X wrong information about the extra care cost. This was fault. It has already apologised to Mr X for the error and it said it has learnt from the mistake which partially remedies the injustice caused. However, the invoice caused Mr X distress at that time as it was unexpected.

Overpayment

29. From mid-August 2020 Mrs X was charged for double handed care for domestic help for two hours two days a week when this was undertaken by a single carer. This was fault. In May 2021 the Council admitted its error and apologised. The Council also credited Mrs Y’s account with the overpayment. However, it took Mr X time and trouble between October 2020 and May 2021 to get the Council to credit the overpayment.

Communication

30. At the end of November and in mid-December 2020 Mr X complained to the Council about Mrs Y’s care charges and asked the Council for a breakdown of Mrs Y’s care costs. In mid-May 2021 the Council responded to his complaint and at the end of May 2021 the Council emailed Mr X a copy of Mrs Y’s invoices and a weekly breakdown of the costs.
31. Although the Council’s formal response was completed just within 6 months, it is unclear the extent to which Mr X was kept updated about progress.
32. The Council provided Mr X with a weekly breakdown of care costs in late-May 2021, six months after he first asked for it. The cost breakdown was enough to work out Mrs Y’s care costs but there was delay in providing him this information about how the charges were calculated. This was fault and will have caused Mr X frustration. I agree with the Council’s calculations for Mrs Y’s outstanding care costs and do not find fault with that part of Mr X’s complaint.

Care Records

33. The care provider says two carers always attended Mrs Y at lunchtime and teatime. However, the electronic records of visits show one carer attended. The care provider says this was a computer glitch. However, the social care records noted Mrs Y received care from one carer for an hour visit at lunchtime and teatime in the last month of her life as she was cared for in bed. This was not in line with Mrs Y’s care plan which said she should have two carers for 30 minutes at lunchtime and tea time. Whilst overall Mrs Y continued to receive 28.5 hours of care per week and so was charged appropriately, Mrs Y’s care plan was not amended and the change was not communicated with Mr X. This was fault and will have caused Mr X confusion.

Care visit recording

34. The Council provided copies of the carers' attendance records and daily care notes. The daily care notes recorded carers did visit Mrs Y but this was not always recorded accurately on the electronic carers attendance record sheets. The Council said the discrepancies will have occurred when carers did not log in and out. There was fault in the record keeping but the daily care records show Mrs Y’s carers did attend and Mrs Y did receive care in line with her care needs assessment and support plan so this fault did not cause an injustice. I have seen no evidence Mrs Y was overcharged.

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Agreed action

35. Within one month of the final decision the Council has agreed to apologise to Mr X and make a symbolic payment to him of £300 to acknowledge the frustration, distress, delay and time and trouble he was put to by the Council’s faults.
36. Within three months of the final decision the Council has agreed to:
• review its processes to ensure care and support plans are updated when changes are made;
• remind relevant staff of the need to update representatives when changes to care and support plans are agreed;
• ensure the care provider accurately records all care visits.

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Final decision

37. I have completed my investigation. I have found fault leading to personal injustice. The Council has agreed to take action to remedy that injustice and prevent recurrence of the fault.

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Investigator's decision on behalf of the Ombudsman