Summary: Mrs X complained the Council failed to tell her when her free care package ended. Mrs X also complained the Council has charged a management fee as well the care charges. We found fault with the Council. The Council has already removed the management fee which addressed the fault and injustice caused.

The complaint

1. Mrs X complained the Council failed to tell her when her free care package ended. Mrs X says the Council continued to complete care visits for a further three weeks and only sent an invoice for the care charges three months later.
2. Mrs X also complained the Council has charged a management fee as well the care charges.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34H(3) and (4), as amended)
5. 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

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

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What I found

Relevant legislation and guidance

8. The Care Act 2014 (the Act) is the legislation that sets out local authorities’ powers and duties in respect of adult social care services. The Department of Health and Social Care also produces statutory supplemental guidance for local authorities on how to discharge these duties. This is called the ‘Care and support statutory guidance’ (the Statutory Guidance).
9. Section 14 of the Act gives a local authority the power, with certain exceptions, to charge for care and support it arranges to meet an adult’s needs.
10. Section 17 of the Act explains that, where a local authority decides to charge for care and support, it must assess the adult’s financial resources to calculate the amount (if any) the adult would be likely to be able to contribute towards the cost of the care and support.
11. In carrying out a financial assessment, the local authority must follow the ‘Care and Support (Charging and Assessment of Resources) Regulations 2014’ (the Charging Regulations). The Charging Regulations set out how local authorities should treat an adult’s income and capital for the purposes of calculating care contributions.
12. The Guidance says that a Personal Budget should specify the amount the service user will have to pay towards the cost of the care, based on the financial assessment. It explains that a Personal Budget is the mechanism, in conjunction with the care and support plan, that enables the person to exercise greater choice and take control over how their care and support needs are met.
13. A financial assessment should be completed as soon as reasonably practicable. The Ombudsman would expect a financial assessment to be done within four weeks of a Care Assessment. A Care Assessment and financial assessment are part of one process.
14. Paragraph 8.2 of the Guidance says that when a council decides to charge for care it should be “clear and transparent, so people know what they will be charged”.

Care and support planning policy

15. The Council’s policy outlines that before it can provide care for a person it must complete an assessment of the person’s needs. This Care Assessment will form the basis for the person’s Care Plan which will detail all aspects of care and support.
16. If a person is eligible for care and support from the Council, the Council will calculate the cost of this care through a Personal Budget.
17. The social care practitioner completing the Care Assessment and writing up the Care Plan should explain to the person if they need a financial assessment. The social care practitioner should also explain the person may need to pay for some, or all, of the cost of their care and support.

Adult social care contribution policy

18. The Council’s policy says it will start a financial assessment once a social work practitioner has assessed a resident as likely to need a Personal Budget.
19. The Council will tell a resident of the need to complete a financial assessment and help them in completing the financial assessment.
20. Following completion of the financial assessment, the Council will confirm in writing how much a person needs to contribute towards the cost of their Personal Budget.
21. The Council’s policy says if a person does not complete a financial assessment, they will be liable for the full cost of care until such a time they complete a financial assessment.
22. If the Council decides a person is liable for the full cost of their care, they will be liable for a one-off charge of £305 as a set-up fee for the provision of care. The person is also liable for a yearly charge of £254 as a management fee. This information is provided in the financial assessment factsheets provided as part of the financial assessment.

Council complaints policy and statutory adult’s complaints process

23. The Council’s complaints policy says it will accept a complaint made through various mediums such as using its online complaints form, by email or through a person’s Member of Parliament (MP). The Council has said that when it receives a complaint through an MP it will provide its response to the MP to pass onto the constituent.
24. There is one stage for the statutory adults’ services complaints process.
25. The Council’s policy says it will provide a full response to a person’s complaint within 20 working days. However, if it needs further time to complete the investigation it will send an interim response in 20 working days providing an update on timescales.
26. The Council’s policy outlines a person has a right to approach the Local Government and Social Care Ombudsman (the Ombudsman) after it has provided its complaint response.

What happened

27. Mrs X entered hospital on 25 November 2021 for surgery. Mrs X daughter helped Mrs X during her time in hospital with liaising with the Council.
28. The Council assessed Mrs X following her entering hospital and decided Mrs X would benefit from three visits each day following her discharge from hospital. The Council approved an interim care package for up to four weeks under Covid-19 pandemic funding.
29. On 2 December 2021, the Council spoke with Mrs X’s daughter and sent her an email following this call confirming what they discussed. The Council confirmed:
• Mrs X was entitled to a Care Assessment.
• The Council would complete a financial assessment following the care and needs assessment to decide Mrs X’s contribution towards the cost of care.
• If Mrs X had over £23,250 in savings the Council would require her to cover the full costs of her care.
• Care would be free for four weeks from the date of discharge under Covid-19 funding rules.
• If Mrs X decided to continue with Council care it charged £17.95 per hour with an initial set up fee of £305 and a yearly management fee of £254.
30. The Council confirmed with Mrs X’s daughter that Mrs X’s care would start on 6 December 2021 consisting of three 30-minute visits per day totalling 10.5hours per week.
31. Mrs X left hospital on 3 December 2021 and the Council put care in place as planned. Mrs X signed the completed Care Plan on this date detailing the outcome of her Care Assessment but no details of her Personal Budget or care charges.
32. On 24 December 2021, the Council completed the Personal Budget for Mrs X detailing a cost of £188.48 per week starting from 2 January 2022 when the four-week Covid-19 free care ended. The Council did not share this with Mrs X or her family.
33. The Council started a financial assessment for Mrs X on 7 January 2022.
34. On 12 January 2022, the Council told Mrs X her four weeks of free Covid-19 care had now expired and it needed to complete a financial assessment. The Council sent Mrs X a financial assessment form and requested return by 26 January 2022.
35. Mrs X cancelled the care package on 21 January 2022 and said she did not agree to pay for her care. Mrs X reiterated this to the Council on 25 January 2022 and said she would not be completing the financial assessment form.
36. The Council wrote to Mrs X on 25 January 2022 to confirm it would charge £17.95 per hour for home care visits from 3 January 2022 which was the full cost of care. The Council invited Mrs to complete a financial assessment if she still wanted. Mrs X declined this offer.
37. On 8 February 2022, the Council sent Mrs X a bill for £510.78 for the cost of her care and £305 for the set-up fee.
38. Mrs X complained to the Council on Saturday 12 March 2022 about the care charges. Mrs X also complained to her MP. Mrs X’s MP passed on her complaint to the Council on 14 March 2022. The Council received both complaints on 14 March 2022 as this was the first working day since 12 March 2022.
39. The Council provided its Stage 1 complaint response to Mrs X’s MP on 26 April 2022. The Council said it would remove the £305 set-up fee but maintain the £510.78 in care charges from 3 January 2022 to 21 January 2022. The Council did not direct Mrs X to the Ombudsman.
40. Mrs X contacted her MP for an update on 12 May 2022 who asked the Council for an update. The Council responded to Mrs X’s MP to advise it had reached the end of its complaint process and Mrs X could approach the Ombudsman with her complaint.

Analysis

Care assessment and charges

41. By 6 December 2021, the Council made Mrs X aware of the Care Plan for Mrs X and provided details of the general cost of care to Mrs X’s daughter. The Council also told Mrs X’s daughter that Mrs X would get free care for four weeks because of Covid-19 funding rules.
42. Mrs X’s Care Plan included details of the number of care workers, frequency and duration of visits including the total time of 10.5hours per week for visits.
43. The Council gave enough information to Mrs X for her to know that her free care ended on 2 January 2022. The Council did not have a duty to remind Mrs X of this on the date.
44. The Council also gave enough information to Mrs X for her to know from 3 January 2022 she would need to pay for her care at £17.95 per hour with a set-up cost of £305.
45. The Council provided care to Mrs X from 3 January 2022 until 21 January 2022. Since the Council provided this care to Mrs X it is entitled to charge for it. As soon as Mrs X sought cancellation of the care, the Council ended it and stopped charging. The Council is only asking Mrs X to pay for the care she received.
46. I do not find fault with the Council asking Mrs X to pay for the care it provided in these circumstances.
47. While the Council is entitled to seek payment for the care it provided, the Council has not acted without fault. While Mrs X, and her daughter, had the information available to complete their own calculations about cost of care, the Council did not finalise Mrs X’s Personal Budget until 24 December 2021. The Council also failed to confirm the cost of the Personal Budget with Mrs X or her family at this time.
48. A Personal Budget should be clear and transparent so a person can understand the cost of their care. The Council had provided all the individual elements of the information needed to calculate the cost of care but it did not confirm the exact cost of care with Mrs X. This was fault.
49. The Council also did not complete its financial assessment of Mrs X until 25 January 2022. The Council took 6 weeks, from the date of the Care Assessment on 6 December 2021, to complete the financial assessment. The Ombudsman would expect the Council to take no longer than four weeks to complete a financial assessment following a Care Assessment. This 2-week delay in completing the financial assessment was fault by the Council.

Complaint handling

50. Both Mrs X and her MP registered a complaint with the Council on 14 March 2022. This was the first working day following submission of both correspondence. Since the Council received complaints from both Mrs X and her MP on the same date about the same matter, I would not find fault with it only registering one of these complaints.
51. Since the Council registered the MP complaint, the Council acted correctly to provide its complaint response to Mrs X’s MP. It would not be the fault of the Council if Mrs X’s MP did not pass on the complaint response on receipt.
52. While the Council was not at fault for how it registered and responded to the complaint, it was at fault for failing to adhere to the complaint timescales. The Council should have provided its Stage 1 complaint response in 20 working days. The Council only provided a response on 26 April 2022 which was 10 working days outside the complaint response timescales.
53. The Council also failed to direct Mrs X’s MP to the Ombudsman to pursue the complaint further in the Stage 1 complaint response. Given this was the next course of action in the complaint process, we would expect to see information provide about how a person can escalate a complaint. Failure to include this information or respond within the complaint timescales was fault.

Conclusion

54. The Council failed to confirm Mrs X’s Personal Budget with either her or her family and delayed by two weeks in completing a financial assessment outside what the Ombudsman would expect.
55. The Council also delayed in provision of its Stage 1 complaint response by two weeks outside timescales and failed to direct Mrs X’s MP to the Ombudsman to escalate the complaint.
56. While the above was fault, the Council has provided enough information to Mrs X and her family about when care is chargeable and given them the information need to calculate at what cost.
57. The Council decided to remove the set-up fee of £305. The Council was entitled to charge this fee. I consider removal of this fee is suitable to address the fault in this complaint.

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Final decision

58. There was fault leading to injustice. As the Council’s actions were already sufficient to address the injustice caused by this fault I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman