Summary: Mr X complained, on behalf of his grandmother Mrs Y, about the Council’s failure to provide information on care home charges, poor communication and delay. We found the Council at fault. We recommended it apologise to Mrs Y, pay £200 for distress and act to prevent recurrence.

The complaint

1. Mr X complains, on behalf of his grandmother Mrs Y, about the Council’s failure to provide charging information about care home fees for his late grandfather, Mr Y. This meant Mrs Y did not understand there would be a charge for Mr Y’s respite stay and it caused stress from an unexpected bill she could not plan for.
2. Mr X also complains about poor communication from the Council and a delay in the Council completing a needs assessment for Mr Y. This caused uncertainty and stress for Mrs Y, and further care home fees.

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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 spoke to Mr X, and I reviewed documents provided by Mr X and the Council.
6. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Assessment

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person 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.
8. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs.
9. The Ombudsman expects councils should complete assessments in a timescale that is proportionate to the complexity of the issues, and normally within 28 calendar days.
10. Councils should tell the individual how long their assessment will take and keep them informed about this throughout the process. If it is a particularly complex assessment, then the council should tell the person how long is likely to take.
11. If, during an assessment, it becomes clear more time is needed, the council should explain this to the person.
12. The Care Act 2014, the Care and Support Statutory Guidance 2014 (updated 2017) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s powers to charge. The Council also has its own policies.
13. The Guidance sets out the overarching principles which underpin charging for adult social care services. These are (among others):
• Ensure that people are not charged more than it is reasonably practicable for them to pay.
• Charging should be clear and transparent, so people know what they will be charged.
14. Where a local authority has decided to charge, except where a light touch assessment is permissible, it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person. 

Council’s charging policy

15. The Council’s charging policy explains:
• It has the power to charge for meeting a person’s care and support needs from the moment it starts to meet those needs.
• Where the financial assessment has not been completed at the time that care starts the Council will backdate any outstanding charges to the date when it started meeting the person’s care and support needs.
• There are no set timescales in law and guidance to complete a financial assessment, however, the Council will aim to complete an assessment as soon as reasonably practical after receiving all the required information and proofs.

Principles of good administrative practice

16. In 2018 the Ombudsman published its ‘Principles of good administrative practice’ guidance for local authorities. One of the core principles is an expectation local authorities will act on:
• ‘being open and accountable’ by keeping proper and appropriate records.
• ‘informing service users of what they can expect and what the organisation expects of them’.

What happened

17. On 24 March 2021, Mr X contacted the Council by phone to ask about support for his grandparents. Mr Y suffered with dementia and Mrs Y was struggling to care for him alone at home.
18. The Council called Mr X later the same day, to obtain more information about the situation. The Council decided from the information provided and due to the strain on Mrs Y, Mr Y would benefit from a Care Act assessment, to assess his needs, and requested this on 25 March.
19. On 26 March the Council called Mrs Y to offer Mr Y emergency respite or home care. Mrs Y asked the Council to speak with Mr X.
20. Council records show it explained the assessment process to Mr X. It told him someone would be allocated to Mr Y to visit and assess him at home; however, it could not tell him when the allocation or assessment would take place.
21. Council records show it advised Mr X it could offer home care or emergency respite that day. Mr X said he would discuss the emergency respite and home care options with the family.
22. After discussing the options with his family Mr X called the Council back the same day and sought a care home placement for Mr Y.
23. The Council identified a care home with availability and spoke to Mr X on the telephone who agreed for the placement to go ahead for a period of 2 weeks. Mr Y went to the care home that evening.
24. There is no Council record of any discussion with Mr X, or other family members, regarding charging for respite care at this time.
25. Mr X said the Council told him there would be no charge, until it completed the assessment on Mr Y’s dementia and support needs and a financial assessment completed. Mr X said the Council told him an assessment would take approximately two weeks and then a plan would be put in place to support Mr X.
26. Mr X contacted the Council on 29 and 30 March and 6 April asking for an update on the assessment and what was going to happen next with Mr Y.
27. On 6 April Support Worker C telephoned Mr X to discuss Mr Y’s needs. They booked a visit to see Mrs Y and her family, including Mr X, at home on the 9 April.
28. Before the visit to Mrs Y and Mr X on the 9 April, Support Worker C called the care home to discuss an incident on the 2 April. The staff confirmed Mr Y had moved to a more secure and higher staffed unit at the care home. Council records note Mr Y would need long term and ongoing care intervention.
29. Support Worker C visited Mrs Y at home on 9 April, Mr X was also there. Council records from the meeting say the ‘care at the care home is understood to be on as assessment basis’. The notes say this may change and it would send Mrs Y the residential financial assessment to determine care costs.
30. Support Worker C also said the Council was waiting for the mental health team involvement with Mr Y and it could then start planning for appropriate care and support.
31. Mr X said, Support Worker C explained what would happen when the assessment was complete. Mr X said he was told the family would have options and Mr Y might be able to come home on certain medication, with a home care support package. Mr X said he was told, until the assessment was complete, the family would not know all the options.
32. Mr X also said the Support Worker C told him the care for Mr Y was recorded as respite care and chargeable. Mr X told the support worker that was not his understanding, and he was told the care would be free until the assessment was completed. Mr X said the support worker agreed with him the care should be free, and they planned to raise it with the service manager.
33. There is nothing in the Councils records, on this date, to indicate Support Worker C agreed, the care for Mr Y should be free. However, the records do indicate it was something they were planning to raise with the service manager due to Mr X understanding the respite care was free.
34. The Council posted a residential financial assessment form and care funding booklet to Mr X on 12 April. The Council said the booklet explained the respite was chargeable.
35. On the 13 April Support Worker C emailed Mr X explaining a two-week extension to the respite had been agreed for Mr Y, allowing longer for the Council to complete the needs assessment. They had enquired about the respite being an ‘assessment bed’ and confirmed since care started for Mr Y it was respite. It also confirmed the respite was chargeable from the day Mr Y went to the care home.
36. Support Worker C spoke with Mr X on the telephone the same day to discuss the earlier email regarding charging and mental health involvement with Mr Y.
37. Later the same day Support Worker C emailed Mr X explaining mental health involvement was expected soon for Mr Y and they planned to discuss Mr Y’s placement with the service manager.
38. Support Worker C spoke with Mr X on the telephone on 16 April and advised a further assessment for Mr Y from the mental health team would be needed. It also confirmed again to Mr X the care home placement was a respite care and was chargeable.
39. Council records show Support Worker C remained in regular contact with the care home during April to progress the needs assessment, but due to Mr Y’s changing health needs, and input required from mental health, the assessment remained incomplete.
40. Support Worker C spoke with Mr X on the telephone on 26 April to ask if he had returned the financial assessment paperwork. Mr X advised he would do it by the end of the week when he received the power of attorney paperwork. The Council emailed Mr X on the 18 May as the paperwork had still not been returned.
41. Council records show on 28 May the care home requested an Approved Mental Health Professional assessment for Mr Y as his needs remained complex and challenging. This was completed the same day and Mr Y was admitted to hospital.
42. Mr X said he then heard nothing from the Council for a month, until he emailed on the 18 June, asking what would happen next.
43. Support Worker C said they were no longer allocated to Mr Y. They explained to Mr X that when the hospital had fully assessed Mr Y, the hospital would then contact the Council for social work involvement.
44. Mr X returned the financial paperwork to the Council at the end of May and the Council then completed the assessed charge for Mr Y’s care. It recorded respite care from 26 March and then a permanent residency from 21 May until Mr Y moved to hospital on 28 May 2021.
45. Mr X was unhappy with the charges and complained to the Council on 15 June. The Council responded on the 15 July and said:
• It could not find any evidence of a conversation held with Mr X about the Care Act Assessment being completed within two weeks.
• There was no indication Mr X was informed the respite placement would attract a nil charge until the completion on Mr Y’s Care Act assessment.
• The emergency respite placement and the charging were never dependent on the Care Act Assessment being completed.
• It could find no evidence that indicated the placement at the care home was not chargeable and that it was an assessment bed.
• It had started Mr Y’s Care Act Assessment; however, it could not complete it as thoroughly as required due to Mr Y’s needs constantly changing. It apologised for not completing it and explained Mr Y had been awaiting the finalisation of all health interventions relating to his mental health.
46. Mr X was unhappy with the Council’s response and sent an email on the 9 August highlighting issues he was unhappy with. The Council responded on the 27 August and maintained the respite care remained chargeable. It did acknowledge Mr Y’s respite stay was temporary for the whole duration and said it would amend the two weeks of permanent resident charges to temporary resident charges.
47. Mr X remained unsatisfied with the Council’s response and brought his complaint to the Ombudsman.
48. Mr X told me, had the family known about the care home charges they could have looked at other options for Mr Y’s care or got reassurance from the Council the stay would only be for two weeks so they could financially plan. He said he may have decided to manage the care of his grandfather himself, with other family members, until the Council completed the assessment
49. Mr X said he believed Mr Y’s stay in the care home was planned for two weeks, then Mr Y would receive care at home.
50. Mr X also said the Council’s invoice of £1,400 was unexpected for Mrs Y, which caused her financial difficulty and stress. She also had to pay for Mr Y’s funeral costs as he had since passed away.

Analysis

51. I have looked at Council case records and spoken with Mr X and on balance it appears some miscommunication occurred during the initial telephone call with the Council.
52. Council records and information from Mr X evidence discussion during the call about the Care Act assessment to assess Mr Y’s needs, financial assessment and respite care for Mr Y.
53. Mr X understood there would be no charge for Mr Y’s care until the needs assessment was complete. However, it is possible the Council was referring to the financial assessment and not the needs assessment, in line with its policy. If this was the case, this would be correct. There would be no charge, until the Council completed a financial assessment and then charges backdated to the start of the respite. Given there is no recording or other written evidence in support of Mr X’s recollection, I am unable to find, even on balance, that the Council told Mr X there would be no charge. I therefore cannot find fault.
54. Council notes say it offered emergency respite care to Mr Y, initially for a period of two weeks, the notes do not say it told Mr X the respite would be free. Respite care is chargeable, and the Council is entitled to make an assessed charge for this. Mr Y also had the benefit of the respite care provided and therefore the charges are correct and payable.
55. There is, however, no evidence the Council provided information to Mr X or Mrs Y, from the outset, about what charges to expect. The Council provided no information in writing and there is no record of charges being discussed with Mr X. In line with our principles of good administrative practice as indicated above in this statement, the Council are at fault for not providing this information to Mrs Y or Mr X until it sent the financial assessment paperwork on 12 April.
56. This fault led to distress and uncertainty. Had the Council provided this information at the first contact with Mr X, Mrs Y would know the respite was not free and either planned for an assessed charge or discussed other options with the Council. However, I cannot say with certainty that Mr Y paid more for his care than he would have done. This is because there is not enough evidence to say the family would have found and taken any cheaper alternative.
57. Mr X also said he was told the Council planned to complete a needs assessment in two weeks. However, Council notes from the initial telephone call, say it could not tell Mr X when the assessment would take place. The Council notes are specific in this regard; they were made at the time and are a contemporaneous record of what was said during the telephone call. On balance, I am satisfied this is evidence of what Mr X was told and I do not find the Council at fault.
58. Council records show Support Worker C was in regular contact with the care home to gather information for the needs assessment, records also indicate Mr Y had complex needs, and other services were involved in his care. While the Council never fully completed Mr Y’s needs assessment, the evidence suggests his needs were complex. I find no undue delay by the Council and so do not find fault.
59. However, there is no evidence Mrs Y or Mr X were told about any delay in the needs assessment process and reasons for this. The Care Act 2014 says councils should tell people when their assessment will take place and keep them informed throughout the assessment. There is no evidence the Council did this, and this is fault.
60. This fault caused Mrs Y and her family further distress and uncertainty.

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Agreed action

61. To remedy the fault set out above I recommend the Council carry out the following actions:
62. Within one month of the date of my decision:
• Provide a written apology to Mrs Y for the failings identified:
• Pay Mrs Y £200 for the distress and uncertainty arising from fault identified above.
63. Within three months of the date of my decision:
• Remind Adult Social Care staff of the need to discuss care charges with service users before costs are incurred and that they should keep a written record of the discussion.
64. The Council has accepted my recommendations.

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Final decision

65. I have found fault by the Council. This fault caused Mrs Y injustice the Council has agreed to my recommendations therefore I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman