Summary: Ms X complains about an invoice she has received for care for her father Mr Y. We have concluded our investigation having made a finding of fault by the Council. Although Mr Y is liable for the care fees, we found the Council failed in its duty to appropriately inform Ms X about the liability. The Council have made a satisfactory award to Ms X to acknowledge the impact this had on her, and has made service improvements to prevent similar occurrences. We have therefore not made any further recommendations to the Council, and there is no further action to take.

The complaint

1. Ms X, who is acting as a representative for her father Mr Y, complains about an invoice she has received for care. Ms X says her father’s care was extended due to a safeguarding issue and that she was not informed that he would need to fund the care. Ms X also says the Council indicated it would cover the costs itself in emails it sent to her. Ms X would like the Council to cancel the invoice, and award an improved remedy for the distress caused.

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The Ombudsman’s role and powers

2. 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)
3. 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, sections 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I discussed the complaint with Ms X and considered the information she provided. I also considered comments and information provided by the Council in response to my enquires. I invited Ms X and the Council to comment on my draft decision. I considered any comments made before making a final decision.

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What I found

Relevant law and guidance

Charging for care and support

5. The Care Act 2014 provides a single legal framework for charging for care and support under sections 14 and 17. It enables a council to decide whether to charge a person when it is arranging to meet a person’s care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
6. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person has to pay towards the cost of their residential care.
7. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person is entitled to access council support to meet their eligible needs. People who have over the upper capital limit are expected to pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees. Where a person’s resources are below the lower capital limit they will not need to contribute to the cost of their care and support from their capital.
8. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt a permanent admission is required. The person’s stay should be unlikely to exceed 52 weeks, or in exceptional circumstances, unlikely to substantially exceed 52 weeks. A decision to treat a person as a temporary resident must be agreed with the person and/or their representative and written into their care plan.
9. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.
10. The Guidance also says that financial information and advice is fundamental to enabling people to make well informed choices about how to pay for their care. Councils are required to establish and maintain information and advice services, to include financial information. This includes a duty to provide information on what a person may have to pay, when, why and how.

What happened

11. I have included a summary of some of the key events below. This is not intended to be a comprehensive account of everything that took place.
12. Mr Y was admitted to hospital in December 2021. A week later, Mr X was discharged into the care of Provider A. Ms X was informed this would be 6 weeks respite to get Mr Y’s strength up. This was due to end at the end of January 2022.
13. In early January 2022, Provider A called Ms X to inform her of a safeguarding concern which had led to a decline in Mr Y’s mental health. Following this, a safeguarding referral was made. The safeguarding investigation was completed toward the end of January 2022.
14. At the end of January 2022, Mr Y’s stay was extended by two week up to mid-February 2022.
15. Toward the end of February 2022, a Care and Support needs assessment was completed.
16. Ms X reports that she received an email from the Council at the beginning of March 2023 informing her the Council had commissioned Mr Y’s placement at Provider A until mid-March 2022. Ms X also discussed with the Council that as Mr Y has savings in excess of the threshold, he would be required to fund his own care.
17. In May 2022, Mr X received a letter from the Council raising an invoice for approximately £2,300, for Mr Y’s care between February and March 2022. Ms X says she was never informed of any costs associated with this period of care.
18. Following this, Ms X complained to the Council. In response, the Council undertook an independent investigation, partially up-holding Ms X’s complaint. The investigation concluded that it had informed Ms X that Mr Y would have to pay care costs for the period in question but acknowledged that the wording was not clear. Further to this, that delays in completing a financial assessment also impacted upon the situation.
19. The outcome of the investigation recommended an award for the distress caused to Ms X as a result of receiving a large and unexpected bill.

Analysis

Was Mr Y’s stay in care extended as a result of safeguarding issues?

20. I have not seen any evidence to suggest Mr Y’s extended stay in care was a result of any safeguarding issues raised with the Council. I therefore cannot say that Ms X nor Mr Y have been financially disadvantaged as a result of this.

Did the Council inform Ms X of Mr Y’s duty to pay his care fees?

21. I have not seen any evidence of any prior discussion regarding a care fee liability, or how fees would be paid for the period of care between February and March 2022, until after the second extension for Mr Y’s bed had lapsed. The Council missed an opportunity to discuss this with Ms X, or to inform her of any possible liability Mr Y may have to pay care fees for the period.
22. I recognise that when care fees were discussed with Ms X in March 2022, it was not clear, and there was room for confusion and uncertainty about Mr Y’s liability for care fees and here I have made a finding of fault. The Council failed in its duty to provide accurate and clear information on what a person may have to pay, when, why and how. This caused an injustice to Ms X, as she would have been distressed having received a large bill from the Council that she was not completely aware of.
23. It is possible that, had Ms X and the family known Mr Y was being charged for care for all that time, they may have reconsidered his care and how to fund it. However, on balance I cannot say that the Councils shortcomings has caused Mr Y’ to be liable for more in care fees than it would have been had the Council given clear charging information. For this reason, I have not recommended that the Council waive the fees or meet part of these itself.
24. As part of the independent investigation carried out by the Council, it recommended a financial remedy for Ms X to acknowledge the distress caused by delay and an unexpected large bill. The Council awarded Ms X an amount of £250. This is in line with our guidance on remedies, and I therefore do not consider that there is scope for a further financial remedy.
25. Since Ms X’s complaint to the Council, it has created an information sheet for individuals to sign, explaining its role and the processes surrounding liability for care fees. The Council has added this to its process, which will confirm that individuals have been informed about what a person may have to pay, when, why and how. As the fault identified within this complaint was regarding how the Council informed Ms X about Mr Y’s liability for care fees, I am satisfied that the action already taken by the Council will help mitigate against any future uncertainty that individuals may face with respect of care fees.

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Final decision

I have concluded my investigation having made a finding of fault by the Council. Although Mr Y is liable for the care fees, I found the Council failed in its duty to appropriately inform Ms X about the liability. The Council has since made a satisfactory award to Ms X to acknowledge the impact this had on her, and it has made service improvements to prevent similar occurrences. I have therefore not made any further recommendations to the Council, and there is no further action to take.

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Investigator's decision on behalf of the Ombudsman