Summary: Mr X complained the Council failed to notify him that he would be responsible for the full cost of residential care after 30 September 2021 meaning he incurred considerable costs. There is no evidence of fault by the Council other than its failure to keep full and clear records to show exactly what information it provided.

The complaint

1. Ms Z, on behalf of Mr X, complains the Council failed to notify him that he would be responsible for the full cost of residential care after 30 September 2021.
2. Mr X is now being pursued for care costs he did not know he was required to pay and doing so will cause financial distress.

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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. As part of the investigation, I have:
• considered the complaint and the documents provided by the complainant’s representative;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with the complainant’s representative;
• sent my draft decision to both the Council and the complainant and taken account of their comments in reaching my final decision.

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What I found

Discharge to assess funding

6. Discharge to assess is funding is provided to people who cannot go home straight from hospital. It supports people to leave hospital and into a residential setting where their care and assessment can continue out of hospital. This is NHS funding and is time limited, normally a period of two to six weeks.
7. In July 2021, the Council assessed Mr X’s care needs and agreed to provide care twice a day to assist with meal preparation and to give medication. A care provider was identified and were due to start visits on 3 August. However, Mr X’s daughter notified the Council that Mr X had been admitted to hospital on 1 August after falling and fracturing his shoulder.
8. While in hospital, Mr X found out he would have to leave the accommodation he had been living in as the property owner needed to sell it to pay for their own residential care. Mr X was medically fit for hospital discharge on 12 August but there were concerns about his fluctuating mental capacity.
9. A mental capacity assessment was completed which found Mr X unable to demonstrate insight into his care needs. It was decided he needed a short term interim residential care placement with a long term plan to move to sheltered accommodation. It was agreed to fund the placement using NHS Discharge to Assess funding.
10. Mr X moved into a residential care home on 2 September 2021. The funding was to end on 30 September and so a social worker carried out a care assessment on 29 September. The assessment found that Mr X did not require a residential care home placement but he agreed to remain there until his family was able to arrange suitable accommodation for him. The Council verbally notified the family that Mr X would be a self-funder after 30 September and they would need to discuss payment with the care home. No letter was sent to either Mr X or his family to confirm this or to provide any information about what it meant to be self-funding.
11. The Council also says it told members of the care home staff that Mr X’s funding ended on 30 September and that Mr X would be self funding from that date due to his level of capital. There is no record of this discussion in the case notes. I have made enquiries to the care home about this and the staff members do not recall any conversation with the social worker about funding for Mr X’s placement.
12. No further payments were made by the Council to the Care Home in respect of Mr X’s placement. In February 2022, following email correspondence between the Care Home and the Council, it confirmed that Mr X’s placement was privately funded following the expiration of the NHS Discharge to Assess funding on 30 September 2021. In response to a query from the Care Home about why it had not been notified of the cessation of the funding, the Council said it did not know who would be responsible as the funding was provided by the NHS. Shortly after this exchange, the Care Home sent Mr X an invoice demanding payment for charges of over £21,000.
13. Ms Z made a complaint to the Council on behalf of Mr X. It says that it discussed finances with Mr X and his daughters. It says it established that he had more than £23,250 in savings and therefore would have to pay privately for services received after 30 September. The Council says its officer spoke with staff at the Care Home on 24 September but the names of the staff were not recorded. It also said that no formal letter was sent to the Care Home advising that his stay would be privately funded from 1 October as this was not a routine action at that time. It says that its finance team is looking into how such information will be shared with care providers in the future. It also said it had reminded staff of the importance of making proper records. It concluded that it was not responsible for payment of any amounts owed to the Care Home.

Analysis

14. Mr X complains the Council failed to notify him that he would be responsible for the full cost of residential care after 30 September 2021. The information provided shows the Council had been working with Mr X before he was admitted to hospital in August 2021. As part of his assessment for domiciliary care, there was discussion about finances and the Council was aware Mr X owned one property and had a share of another. It therefore concluded he had capital above the savings threshold and so would be considered a full cost payer. Information provided by the Council shows there were discussions about this with Mr X and his daughters.
15. The Council secured NHS discharge to assess funding for Mr X and, in line with the procedures, carried out an assessment of Mr X’s needs as this funding was coming to an end. This assessment established that Mr X did not require residential care but he agreed with his family that he would stay in the home until sheltered housing could be secured in the area near his daughters’ homes.
16. I am satisfied the Council explained to Mr X and his family that he would be responsible for the cost of the care. However, I note there were concerns about Mr X’s mental capacity and so I cannot be certain that Mr X understood the implications. The Council also says it told staff at the care home that Mr X would be responsible for the full costs. Staff have no recollection of this conversation and the notes made by the Council have limited details meaning it is not possible to know with certainty if such information was passed on and understood. It is also noted that no formal notification to either Mr X or the Care Home was sent setting out the financial situation from 1 October onwards.
17. While I cannot be certain what information the Council passed onto Mr X, his family and care home staff or what they understood, there is nothing to suggest the Council ever indicated that it would be responsible for funding the placement from 1 October onwards. The Council’s failure to properly record this information and to provide it formally to both Mr X and the care home is fault. Ensuring proper records of decisions are kept is fundamental to good administrative practice. Proper record keeping would have eliminated any confusion and ambiguity in this case.
18. While I have found fault by the Council, I do not consider the injustice claimed by Mr X was as a direct result of this fault. I am aware the care home did not bill Mr X for his stay for five months and that he then immediately gave notice and left. I am also aware that when Mr X asked care home managers about payment it told him he had nothing to pay. Mr X has made a separate complaint to the care home. However, I do consider the Council could take action to improve its record keeping as the failure to do this caused confusion for Mr X.

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Agreed action

19. To remedy the injustice caused to Mr X as a result of the fault identified in this case the Council will, within one month of my final decision, take the following action:
• Apologise to Mr X;
• Review its guidance on record keeping for social care staff and ensure it is fit for purpose and that staff are aware of what is required; and
• Complete the review into information sharing between its finance team and care providers.
20. The Council should provide us with evidence it has complied with the above actions.

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Final decision

21. I have completed my investigation with a finding of fault for the reasons explained in this statement. The Council has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman