Summary: Mr X complained about charges for his father, Mr Y’s, care. He also complained the Council delayed the assessment process and failed to update him with the outcome of its safeguarding investigation. We found fault with the Council. The Council agreed actions to remedy the injustice to Mr X and Mr Y.

The complaint

1. Mr X complained on behalf of his father Mr Y. Mr X complained about charges for Mr Y’s stay in a care home when he was discharged from hospital. Mr X also complained about the care Mr Y received in the care home and the Council’s safeguarding investigation.
2. Mr X complained:

• They were not told Mr Y would be charged for his stay.
• The financial assessment was delayed.
• The care assessment was delayed.
• Mr Y did not want to stay at the care home he was only there because the Council failed to arrange suitable care for him to be able to return home.
• The Council failed to update him with the outcome of the safeguarding investigation.

3. Mr X said Mr Y suffered financial loss and distress from his stay at the care home. Mr X also experienced the time and trouble of pursuing his complaint and frustration with the safeguarding investigation process.

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What I have investigated

4. I investigated the complaint set out above. I did not investigate Mr X’s complaint about the care Mr Y received. I set out my reasons at the end of this statement.

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The Ombudsman’s role and powers

5. 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)
6. 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)
7. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

8. I spoke to Mr X and considered the information he provided with his complaint. I made enquiries with the Council and considered its response with relevant law and guidance.
9. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Law and guidance

Charging

10. The Care Act provides a single legal framework for charging for care and support under sections 14 and 17. It enables councils to decide whether or not to charge a person when it is arranging to meet a person’s care and support needs or a carer’s support needs.
11. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)
12. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, s. 14 (1, 4))
13. Councils should develop and maintain a policy setting out how they will charge people for the cost of care in settings other than care homes. This should include how they will apply their discretion within the charging framework locally. (Department of Health & Social Care, ‘Care and support statutory guidance’, 2016)
14. Councils must assess a person’s finances to decide what contribution he or she should make. (Care Act 2014, s.17 (1))
15. Under the Care Act, Council’s have responsibilities to provide information and advice about people’s care and support.
16. Information and advice is fundamental to enabling people, carers and families to take control of, and make well-informed choices about, their care and support and how they fund it. (Department of Health & Social Care, ‘Care and support statutory guidance’, 2016)

Safeguarding

17. Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. (Department of Health and Social Care, care and support statutory guidance)
18. The Care Act 2014 provides the key legal framework for adult safeguarding. It gives Councils the lead responsibility for managing safeguarding concerns, determining safeguarding duties and undertaking safeguarding enquiries.
19. The care and support statutory guidance tells council’s how to respond to safeguarding concerns. Council’s must make enquiries, or cause others to do so, if it believes an adult is experiencing, or is at risk of, abuse or neglect. An enquiry should find out whether any action needs to be taken to prevent or stop abuse or neglect and if so, by who. Council’s should involve any relevant partners (for example, the Police or NHS) and other persons relevant to the case.
20. The adult should be involved from the beginning of the enquiry unless there are exceptional circumstances that would increase the risk of abuse. If the adult has substantial difficulty in being involved, and where there is no one appropriate to support them, then the Council must arrange for an independent advocate to represent them for the purpose of facilitating their involvement.
21. Once enquiries are completed, the Council should decide with the adult what, if any, further action is necessary and acceptable.

What happened

22. What follows is a brief chronology of key events. It does not contain all the information I reviewed during my investigation.
23. Mr Y was admitted to hospital in November 2020 following a fall at home. He was discharged to Care Home A for reablement care. The reablement period ended on 17 December 2020.
24. In early January 2021 Mr X raised concerns with the Council about Mr Y’s care and recovery at Care Home A.
25. The Council assessed Mr Y in January 2021 and used its discretion to fund a further eight weeks at Care Home A until 10 February. The Council decided Mr Y had not made enough progress to return home safely. His recovery had been delayed by recurring urinary tract infections (UTI’s) and COVID-19.
26. In February the Council started to look for a suitable care provider to provide home visits to support Mr Y to return home. On 10 February the Council spoke to Mr X about home care for Mr Y. It told him they would need to complete a financial assessment and sent him the forms and information. Mr X repeated his concerns about the care Mr Y was receiving at Care Home A.
27. Mr Y returned home with a package of care in place from 24 February.
28. The Council completed the financial assessment. It wrote to Mr X about Mr Y’s assessed contribution on 10 March. It said Mr Y was assessed to pay a contribution of £70.67 per day from 17 December 2020 for his stay a Care Home A. Mr X was unhappy about Mr Y being charged for the time he spent in Care Home A. He complained to the Council about the charges and the care Mr Y received at Care Home A.
29. In response to the complaint the Council offered to reduce Mr Y’s outstanding bill by removing the charge from December 2020 to February 2021. It also offered a repayment agreement for the outstanding balance.
30. In July the Council made a safeguarding referral based on the issues Mr X raised in his complaint. It decided it met the criteria for a section 42 investigation. It asked Care Home A to investigate the complaint issues Mr X raised. A social worker visited Mr Y to discuss the complaint.
31. The Council responded to Mr X’s complaint in August. It said:

• Mr Y initially declined to go into rehabilitation care, but his return home was unsuccessful because he was unbale to mobilize. He then accepted a place at Care Home A and he had capacity to make that decision.
• There was a clear rationale why Mr Y remained in Care Home A for longer than the six-week reablement period. The Care Act assessment was completed as soon as it was appropriate and safe to do so. The Council kept Mr X informed during this time.
• Mr X’s concerns about the standards of care at Care Home A were being investigated under the section 42 process and would be responded to separately.
• There was a delay between the financial assessment and issuing an invoice. The Council made improvements to its internal process to prevent future delays.

32. Mr X was unhappy with the Council’s response and complained to the Ombudsman.

My findings

33. I have summarised my findings under the main headings of Mr X’s complaint.

Charging and financial assessment

34. I found fault with the Council. It failed to give Mr X and Mr Y advice and information about the funding arrangements and financial implications of his stay at Care Home A.
35. The Council knew the reablement funding would end on 17 December 2020. It did not provide any information about the financial assessment until 10 February 2021. There was further delay between the outcome of the assessment in March and the invoice in July 2021.
36. The lack of timely information denied Mr X and Mr Y of the opportunity to understand the financial implications of his stay.
37. In response to our enquiries the Council offered to reduce Mr X’s outstanding balance and remove the charges it applied up to 10 February 2021. This is a suitable remedy for the injustice to Mr Y.
38. The Council said the delayed financial assessment and charging issues did not form part of Mr X’s original complaint. It said it only found the fault in its process because of our investigation. This was not correct, Mr X raised the charging issue in February 2021 and it formed part of his complaint in July 2021.
39. The Council had an opportunity to address this complaint in its own complaint investigation, but it failed to do so. This caused Mr X additional time and trouble bringing it to us.

Care assessment

40. I did not find fault with the Council. There was no evidence of unnecessary delay assessing Mr Y.
41. It was unfortunate that Mr Y’s UTI and COVID-19 slightly delayed the completion of the Care Act assessment in early 2021, but that was not because of fault by the Council.
42. I also did not find fault with the Council for failing to arrange home care for Mr Y. The assessments and case recording reflect Mr Y’s desire to return home. But they also show the concerns about whether Mr Y was well enough to return home safely.
43. Once the Council felt Mr Y was able to return home it did not delay arranging a suitable package of home care.

Safeguarding

44. I found fault with the Council. It failed to communicate the outcome of its section 42 safeguarding investigation with Mr X and Mr Y.
45. The Council asked Care Home A to carry out enquiries as part of the section 42 investigation. It is entitled to do this but still has the lead responsibility for managing the investigation and decision making.
46. It failed to demonstrate how it considered the information from Care Home A and what decisions it made as a result. It also failed to produce a final report and share this with Mr X and Mr Y for their comments.
47. This caused Mr X and Mr Y uncertainty about the investigation and frustration because they did not achieve an outcome through the Council’s process.

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Agreed action

48. Within one month of my final decision the Council agrees to:

• Apologise to Mr X and Mr Y for the faults identified in this statement.
• Pay Mr X £150 for the uncertainty, time and trouble it caused him.
• Reduce Mr Y’s outstanding balance to remove the charges from 17 December 2020 to 10 February 2021.
• Provide Mr X and Mr Y with the outcome of the safeguarding investigation.

49. Within two months of my final decision the Council agrees to review its section 42 safeguarding procedure to ensure it includes:

• The format for ‘others’ to provide the information from enquiries.
• How the Council retains oversight and responsibility for the enquiries that it asks ‘others’ to conduct.
• How the Council reviews the information from ‘others’ and records its consideration and decision making.
• How it communicates the outcome with the adult (and/or their representative).

50. The Council should provide the Ombudsman with evidence it has completed the agreed actions.

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Final decision

51. I found fault with the Council causing injustice. I completed my investigation.

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Parts of the complaint that I did not investigate

52. I did not investigate the complaints about the care Mr X received at Care Home A. This formed part of the section 42 investigation. I reviewed the Care Home report and information from the Council. I decided it was unlikely I could achieve more by further investigation. I also decided that further investigation would be unlikely to lead to a different outcome because of the remedy already offered.

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Investigator's decision on behalf of the Ombudsman