Summary: Mr X complained the Council failed to advise he or his stepmother about care charges before his stepmother passed away. Mr X complained the Council only provided first notice of the balance owed a year after his stepmother passed away. The Ombudsman found fault with the Council for a lack of transparency in billing for respite care and overcharging for residential care. The Council agreed to the Ombudsman’s recommendation to reduce the residential care fees by £232.00 to reflect the overcharge and apply a further reduction of £100, with an apology, to reflect the inconvenience and distress experienced.

The complaint

1. Mr X complained about the Council care charges for his late stepmother’s, Ms Z’s, residential care charges.
2. Mr X says neither he nor his stepmother received any billing for his stepmother’s care charges before his stepmother’s death on 18 May 2020. Mr X says the first bill he received was on 21 May 2021 when the Council’s collection team contacted him.

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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 an organisation’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 have considered all the information Mr X provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
6. Mr X provided comments on my draft decision which I considered before reaching my final decision.

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What I found

Assessment of needs

7. Councils must assess anybody in their area who appears in need of care services. Following an assessment, the Council must decide which needs are eligible for their support. If the Council provides support, it must produce a written Care Plan.
8. Where a council assesses a person’s needs and agrees to provide care, it should set a personal budget in a care and support plan. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, section 26)
9. A financial assessment decides who will pay for the eligible care needs. Councils can charge for care services. The Council should provide clear information about charges and how it assesses them at the time it finds out care needs. If a person refuses a financial assessment they must self-fund their care.
10. Persons who have over £23,250 of eligible capital will be expected to pay for the full cost of their care home fees. However, once their capital has reduced to less than £23,250, they only have to pay an assessed contribution towards their fees. (The Care and Support (Charging and Assessment of Resources) Regulations 2014; Care and Support Statutory Guidance 2014 (CSSG))

What happened

11. Ms Z had respite care outside her home from 28 May 2018 to 9 July 2018.
12. The Council sent a bill of £505.20 to Ms Z’s partner for Ms Z’s respite care charges up to 24 June 2018. The Council charged £126.30 a week.
13. On 1 August 2018, the Council arranged a Support at Home appointment for Ms Z for 9 August 2018 to discuss her needs. The Council attended this appointment and completed a financial assessment with Ms Z.
14. The Council wrote to Ms Z on 14 August 2018. The Council told Ms Z it had her assessed her as needing to pay £0.00 a week towards the cost of non-residential care provided from 2 July 2018. The Council advised that Ms Z’s respite or short-term care costs would be £138.10 a week.
15. On 15 August 2018, the Council sent Ms Z’s partner a further bill of £252.60 for the respite care costs from 24 June 2018 up to 9 July 2018. The Council charged £138.10 a week for this respite care cost.
16. The Council sent a further bill on 11 September 2018 charging £70.80 for “homecare”. The Council sent this bill for the undercharge for respite care from 28 May 2018 to 24 June 2018.
17. Ms Z entered respite care again on 24 October 2018 until 5 December 2018 before moving into residential care immediately following this.
18. The Council sent bills to Mr X on 5 December 2018 and 11 January 2019 for the cost of Ms Z’s respite care from 24 October 2018 to 5 December 2018 charging £138.10 a week. This totalled £848.33.
19. On 10 January 2019, the Council provided Mr X with financial assessment forms for Ms Z so it could complete a financial assessment of Ms Z for her residential care. Mr X returned the completed forms on 11 January 2019.
20. The Council completed a financial assessment of Ms Z and confirmed on 22 February 2019 that Ms Z’s residential care cost would be £109.59 a week.
21. On 27 March 2019, the Council issued the first invoice for Ms Z’s residential care charges covering the period 7 December 2018 to 17 March 2019. This produced charges of £1,581.23. The Council also wrote to Mr X to advise of the outstanding balance of £1,676.93 owed for the respite care charges since 28 May 2018.
22. Mr X queried the charges on 2 April 2019. The Council confirmed it would look into these charges for Mr X.
23. On 22 May 2019, the Council completed a financial assessment of Ms Z for her respite care from 24 October 2018 to 5 December 2018. The Council determined that Ms Z’s respite care should have cost £109.09 a week rather than £138.10 a week. The Council produced a credit note of £178.21 for the respite care charges on 17 June 2019 reducing the balance to £670.12 for the charges from 24 October 2018 to 5 December 2018.
24. Mr X contacted the Council to query the outstanding charges. The Council provided Mr X with copies of the invoices and discussed the accounts with Mr X on 23 July 2019. Mr X paid the residential care charges up-to-date but not the respite care charges.
25. The Council wrote to Mr X on 15 August 2019 to confirm Mr X had paid the residential care charges up-to-date except for the latest invoice produced today on 15 August 2019. The Council reminded Mr X that Ms Z still owed £1,498.72 for the respite care charges.
26. The Council continued to send Mr X monthly bills for Ms Z’s residential care charges. Mr X paid these charges on receiving the bill.
27. On 11 March 2020, the Council wrote to Mr X to remind him about the outstanding balance of £1,498.72. Mr X did not respond to this contact.
28. Ms Z passed away on 18 May 2020. The Council billed up to 15 March 2020 before this date which Mr X had paid in full.
29. On 27 August 2020, the Council produced the final charges for Ms Z’s residential care charges from 16 March 2020 to 17 May 2020. This produced a final balance owed of £1,188.21. Mr X paid £473.21 towards this balance.
30. The Council wrote to Mr X on 2 September 2020 to request payment of the outstanding balance of £1,498.72 for Ms Z’s respite care and £715.00 for Ms Z’s residential care. The Council requested Mr X settled this before disbursement of the estate.
31. The Council chased Mr X for payment of the balances owed on 27 January 2021, 25 March 2021 and 13 May 2021.
32. Mr X contacted the Council 17 May 2021 to dispute the outstanding balance. Mr X said the Council could not hold him responsible for the time periods before he became power of attorney and complained the Council failed to advise him of the balance owed sooner.
33. The Council responded to Mr X on 18 May 2021 and said it had issued a final account on 2 September 2020 to Mr X and sent chasers for payment since this point. The Council also advised it was claiming against the estate and not Mr X personally.
34. Mr X and the Council discussed Mr X’s complaint and the Council agreed to pass Mr X’s concerns for review. Mr X also disputed the final eight weeks of residential care charges as Ms Z was in hospital during this time. The Council completed an initial review and told Mr X it considered the care charges valid as it did not agree for care to be non-chargeable.
35. Mr X requested the Council consider the matter as a formal complaint on 3 June 2021. The Council acknowledged receipt of the complaint on 9 June 2021.
36. Mr X contacted the Council on 10 September 2021 and 5 October 2021 to chase up response to his complaint.
37. The Council provided a response to Mr X’s complaint on 3 December 2021. The Council said:
• A resident is liable for the full charges of residential care unless a resident provides four week’s notice to terminate a contract.
• It will reduce a resident’s charges to 80% for any hospital stay over 8 days.
• Ms Z was in hospital for two periods in 2020 but only one of these was for more than 8 days. However, Ms Z was entitled to a discount of £232.00 for this time in hospital which it had not applied.
• It will issue a new bill to Mr X which included the £232.00 discount.
• Mr X could approach the Local Government and Social Care Ombudsman with his complaint.

Analysis

May to July 2018 respite care

38. Ms Z received respite care from 28 May 2018 to 9 July 2018. The Council is entitled to charge for providing respite care on a non-means tested basis. The Council outlined the charge for respite care for Ms Z was £138.10 a week on 14 August 2018. The Council sent this letter to Ms Z and I am satisfied the Council made her aware of the cost.
39. The Council also sent Ms Z’s partner invoices for the respite care costs on 24 July 2018 and 15 August 2018. These invoices detailed the respite care charges from 28 May 2018 to 9 July 2018 totalling £757.80. The Council has told Ms Z about the charges for respite care and provided invoices to detail these charges. I do not find fault with the Council.
40. While the Council has showed most of the respite care charges within the invoices dated 24 July 2018 and 15 August 2018, the Council undercharged for the respite care in the invoice dated 24 July 2018. This meant the Council needed to produce a catch-up bill for the undercharges. The Council did this on 11 September 2018. I do not find fault with the Council issuing the catch-up bill.
41. But, the Council has noted this catch-up bill as “homecare” and used the time period 23 July 2018 to 19 August 2018 for these charges. This bill is misleading and does not provide transparent billing for Ms Z. The Council failed to provide any explanation to support this invoice. This was fault.

October 2018 to December 2018 respite care

42. When Ms Z received respite care from 24 October 2018 to 5 December 2018 the Council charged respite care at its standard rate of £138.10. The Council sent bills to Mr X on 5 December 2018 and 11 January 2019 detailing the cost of this care. The Council has set out the cost of care and provided invoices to Mr X to pay this care. I do not find fault with the Council.
43. The Council subsequently completed a financial assessment of the respite care charges and reduced the charges to £109.09 a week. The Council did this because Ms Z entered residential care immediately following the respite care. The Council has acted correctly to bring Ms Z’s respite care charges into line. This has worked to Ms Z’s benefit by reducing the balance owed to £1,498.72, and I do not find fault.

Respite care charges conclusion

44. The Council has applied the correct charges for Ms Z’s respite care. While the Council initially under-billed the period 28 May 2018 to 24 June 2018 and overcharged the period 24 October 2018 to 5 December 2018, the Council corrected these issues and issued amended invoices by 17 June 2019. The Council also confirmed in writing that Ms Z owed £1,498.72 on 15 August 2019.
45. The Council has presented these outstanding balances to Mr X well before Ms Z passed away. Ms Z is liable for the these charges and I do not find fault with the Council for raising these.
46. I do find fault with the Council for initially underbilling Ms Z from May 2018 to June 2018 and failing to provide clarity on the billing when it produced the catch-up charges. This has caused confusion and a lack of transparency.

Residential care charges

47. The Council completed the financial assessment for Ms Z’s residential care costs on 22 February 2019 and started to bill Ms Z from 27 March 2019 for these costs. The Council has completed the financial assessment shortly following Ms Z entering formal residential care. The Council has completed the initial financial assessment and started billing in a suitable timescale and I do not find fault.
48. When Mr X first contacted the Council to query the residential care charges, the Council looked into the matter for Mr X. By 23 July 2019 Mr X had agreed to pay the residential care fees. Mr X has paid the full residential care fees from December 2018 through to 15 March 2020 since this point. The Council responded to Mr X’s concerns in suitable time and explained the situation to Mr X in such a way that he paid the residential care charges without further query. I again do not find fault with the Council.
49. Following Ms Z passing away, it took the Council three months to produce the final charges for Ms Z’s residential care charges from 16 March 2020 to 17 May 2020. I do not consider that three months is such a delay in producing these charges that would be fault from the Council had these charges been accurate. The Council failed to consider the time Ms Z spent in hospital when considering these charges and tried to overcharge Ms Z for this care. This is fault.
50. The Council has now recognised its fault and promised to credit £232.00 for its overcharge. I consider this is an appropriate response from the Council. Had Mr X not complained about the care charges, the Council would not have noticed its fault and until May 2022 the Council has not corrected the outstanding balance owed.
51. Despite the £232.00 overcharge, the remaining residential, and respite, care fees remain outstanding to date. The Council has shown it contacted Mr X for payment of this balance on many occasions since 2 September 2020. I do not find fault with the Council that Mr X has not settled this balance with the Council sooner.

Complaint handling

52. The Council took from 3 June 2021 until 3 December 2021 to handle Mr X’s complaint through its complaints process.
53. The Council’s complaints procedure for adult social care complaints says it will take a maximum of six months to resolve complaints of a “more complex nature” but will look to handle complaints expediently. The Council responded to Mr X’s complaint in exactly six months so met its maximum timescale set out in its complaint’s procedure.
54. This matter required the Council to review Ms Z’s billing history, time in hospital and charges for both respite and residential care. I would consider this constitutes a complaint of a more complex nature and would therefore not find fault with the Council.

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Agreed action

55. Within one month of the Ombudsman’s final decision the Council should:
• Confirm in writing it has applied the £232.00 reduction to Ms Z’s residential care charges balance for her time in hospital.
• Provide Mr X with an apology and apply a reduction to Ms Z’s residential care charges with £100. This addresses the initial undercharging of respite care charges and lack of transparency when producing the catch-up bill and for overcharging Ms Z’s residential care which went unnoticed by the Council for two years.

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Final decision

There was fault by the Council as the Council has agreed to my recommendation I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman