Summary: We will not investigate this complaint about care services for the complainant’s mother. That is because there is not enough evidence of fault to justify investigating and to call on the Council to waive the charges.

The complaint

1. The complainant, Mr B, complained that his mother was charged for care services which they understood would be free for six weeks and the services did not meet her needs.

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The Ombudsman’s role and powers

2. The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or may decide not to continue with an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, or
• any injustice is not significant enough to justify our involvement, or
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants. (Local Government Act 1974, section 24A(6))

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How I considered this complaint

3. I considered information provided by the complainant and the Council.
4. I considered the Ombudsman’s Assessment Code.
5. The complainant has had an opportunity to comment on my draft decision.

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My assessment

6. Mr B told us, after being in hospital, his mother, Mrs C, received a letter saying the first six weeks of care would be free. Mr B said his mother was not able to speak and her mental capacity and cognitive understanding was limited. Mr B said the care service his mother received did not meet her needs. He decided to arrange residential care for her which she self-funded. But the Council then sent his mother a bill for the care she received before she went into residential care. Mr B said his mother had not agreed in writing to pay the charges.
7. Mr B complained to the Council on his mother’s behalf and then complained to us. To put things right Mr B told us he wants the Council to review its procedures and waive the charges.
8. A social worker, officer Z, recorded in her case notes a home visit to Mrs C on the day before the Council started charging her for care services. Officer Z noted Mrs C had said she wanted to stay in her own home, she agreed she needed an increased care service and she understood she would have to pay the full costs. Officer Z said Mrs C could make her own decisions and she had no concerns about Mrs C’s mental capacity. Officer Z completed an assessment of Mrs C’s care needs. In the assessment Officer Z recorded Mrs C understood she would be charged the full cost of her care and so she declined a referral for a financial assessment. Officer Z noted Mrs C understood the cost implications of needing two carers for every call.
9. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and are free of charge for up to six weeks. That means this free care can end before end of the six-week period if the Council has reassessed a person’s needs. Mrs C had declined a referral for a financial assessment so the Council did not do one before she moved into residential care. That meant the Council did not write to her to confirm what she would pay for her care while she remained in her own home.
10. The Council’s records are evidence that the Council discussed Mrs C’s needs with her, she agreed the care arrangements following her hospital discharge were not sufficient to meet her needs and she would be charged for the care she needed. There is no indication the Council told her the care in her own home would continue to be free of charge. For these reasons there is not sufficient justification for us to call on the Council to waive Mrs C’s care costs for the period before she went into residential care.
11. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established they lack capacity. The Council could not simply assume Mrs C lacked capacity because of her medical diagnosis. It must assess someone’s ability to make a decision when that person’s capacity is in doubt. How it assesses capacity may vary depending on the complexity of the decision. There is no indication of fault in the way the Council’s officer assessed Mrs C’s mental capacity during her home visit.

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Final decision

12. We will not investigate Mr B’s complaint because there is not enough evidence of fault to justify investigating and to call on the Council to waive the charges.

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Investigator's decision on behalf of the Ombudsman