Summary: Mr X complained about the Council charging him a personal care contribution and complaint handling delays. The Council did not incorrectly charge Mr X for personal care or fail to complete a financial assessment review. However, we find it failed to respond to Mr X’s request for a Care and Support plan review and delayed its response to his complaints. The Council will apologise to Mr X and pay him £200 in recognition of uncertainty, frustration and inconvenience caused. It should also make a decision about Mr X’s Care and Support plan review request and advise him of the outcome.

The complaint

1. Mr X complains the Council:
1. Charged him for personal care that he did not agree or receive between February 2022 and February 2023.
2. Did not complete a financial assessment review and update his Care and Support plan.
3. Delayed managing his complaint.
2. Mr X says he consequently suffered financial loss, uncertainty, distress, and inconvenience trying to resolve his complaint with the Council.

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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 the information provided by Mr X and discussed the complaint with him on the phone. I have considered the Council’s response to my enquiries and relevant law and guidance.
6. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before reaching a final decision.

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What I found

Legal and Administrative background

7. Councils must carry out an assessment for any adult with an appearance of need for care and support. (Care Act 2014, sections 9 and 10)
8. A council has a duty to arrange care and support for adults with eligible needs, and a power to meet both eligible and non-eligible needs in settings other than care homes. (Care Act 2014, sections 8, 13 & 18)
9. Council’s must prepare a care and support plan that sets out how the adult’s care needs will be met. The council can meet the person’s eligible needs by arranging for a care provider to provide care and support. (Care Act 2014, section 24 and 25)
10. A council has discretion to charge for non-residential care following a person’s needs assessment. Where a council has decided to charge, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. (Care Act 2014, sections 14 and 17)
11. Where a Council meets an adult’s care needs under section 18 of the Care Act 2014, by providing or arranging accommodation of a specified type, it may charge the person for some or all of the additional Care Costs. (Care Act, section 30 subsections 1 and 2)
12. Care Costs are all costs charged to a person by a care provider, including any top-ups and core care costs. This includes the costs associated with the provision of supported accommodation. (Care Act Statutory Guidance, section 9.1)
13. A Council is required to keep care and support plans under periodic review. The adult can also make a reasonable request to have a review and the Council should consider the request if it is deemed reasonable. If the Local authority declines to complete a review it must set out its decision in writing to the person making the request. (Care Act 2014, section 27)

The Council’s Adult Care Charging policy

14. The Council’s policy follows the Care and Support Regulations and the Statutory Guidance issued under the care Act 2014. It says:
• The Council will complete financial assessments to determine an individual’s personal contributions.
• There is a right to a first stage review if someone disagrees with the outcome of a financial assessment or if their personal circumstances are not properly reflected. The Council will write to the person with an outcome. If the person remains dissatisfied, they may also appeal at the second stage to an independent panel, who will make a final decision and also provide a written outcome.

The Council’s Complaints policy

15. The Council will initially seek a quick and informal resolution of service complaints before implementing its two stage complaints process. At stage one the Council will acknowledge the complaint within three working days and a provide full written reply within 15 working days. If the customer remains dissatisfied with the stage one outcome, at their request the Council will arrange for the complaint to be reviewed at stage two by a more senior manager. The customer request will be acknowledged within three working days and a full written reply sent within 20 working days.

What happened

16. The Council placed Mr X in supported accommodation in 2020. His Care and Support plan said he required help with meal preparation, maintaining cleanliness of his living environment and emotional support. The records show the Council obtained Mr X’s agreement to the Care and Support plan and his financial contribution.
17. In early February 2022, the Council completed a telephone review of Mr X’s Care and Support plan. The records show:
• The reviewing officer spoke with Mr X and a care home manager (‘CM’).
• Mr X confirmed he was happy with his accommodation and the support provided. It was noted Mr X was independent with personal care tasks but needed support with other non-personal tasks due to health issues.
• The Council obtained Mr X’s agreement to continue with the plan and sent him a copy by post and email.
18. A few weeks later Mr X contacted the Council with the CM’s assistance and requested a financial assessment review. The records show the Council sent Mr X the relevant forms which he then submitted in late February.
19. In late March the Council sent Mr X a financial assessment outcome letter saying his weekly contribution had increased. It refers to the contribution being for ‘..the cost of any assessed care’. This is a reference to the agreed support as set out in his care and support plan review and does not mention any personal care. The letter also sets out the financial information considered by the Council in calculating Mr X’s new contribution.

Mr X’s complaint

20. In late July 2022, the CM submitted an online complaint to the Council on Mr X’s behalf. It said, Mr X believed:
• The Council was sending him incorrect payment demands for his financial contribution. He was only receiving support and did not understand why he was paying a care contribution.
• His Care and Support plan should be reviewed to reflect his actual situation.
21. The records do not show any response from the Council. Mr X said he continued to receive payment demands from the Council which caused him distress.

Mr X’s further complaint

22. In mid- September, Mr X went to the Council’s office and delivered a further complaint letter. He also sent a copy by post which said:
• The Council failed to respond to his earlier (July) complaint, and he had now received enforcement letters causing him further distress.
• He was not receiving any personal care and it was unlawful for the Council to charge him a personal contribution.
• He wished to escalate his complaint to stage two, and the Council should place any enforcement action on hold.
23. The records show the Council received Mr X’s September complaint but there is no record of the Council acknowledging or sending Mr X a written response. Mr X said he felt very anxious about the care charges and believed the Council was ignoring him.
24. In October the Council discussed Mr X’s complaint with the CM. The CM then emailed a further complaint to the Council on Mr X’s behalf. It said:
• Mr X wanted an explanation for his financial contribution as queried in his September complaint.
• Mr had not previously received any information about the charges when he moved into supported accommodation.
• Mr X wanted debt enforcement action to be held off until his complaint was resolved.

The Council’s complaint response

25. In its November complaint response, the Council said:
• It was legally within its rights to charge Mr X for supported accommodation. And Mr X was financially assessed to pay a contribution towards his care package in line with the Council’s charging policy.
• If Mr X’s care needs had changed, he could request a review. If the review found he did not require any support, he could apply for social housing and be moved so he did not have to pay the financial contribution for supported accommodation.
• It had provided Mr X with information about the care charges following his financial assessment.
• Mr X could also contact the Council if he wished to discuss a review of his financial contributions and/or email the complaints team for further advice. The response did not confirm if the Council would delay further enforcement action.
26. Mr X said he lost confidence in the Council’s complaints process because of the continued delays and lack of a clear explanation for his charges. He therefore decided to approach the Ombudsman.
27. In response to our enquiries the Council:
• Accepted delays in responding to Mr X’s complaint. It said it had implemented a new complaint tracking system to prevent recurrence.
• Explained Mr X was not charged for personal care but for support as set out in his care plan (paragraph 16). And the Council never advised Mr X he was contributing towards personal care.
• Confirmed it sent Mr X copies of his care and support plan and financial assessment after the February 2022 telephone review. It also provided records of Mr X’s care needs and financial assessments in 2020.

Was there fault and did it cause injustice?

i) Mr X says the Council charged him for personal care that he did not agree or receive between February 2022 until February 2023.

28. The evidence shows the Council completed a telephone review of Mr X’s Care and Support plan in February 2022. The review records confirm Mr X remained independent for personal care tasks but still needed help with some daily activities. The records confirm Mr X agreed to continue with the plan in supported accommodation and the Council sent him a copy of the review document which would be effective until February 2023. Based on the evidence, the Council acted in line with its review duties as explained in paragraph 13 (above). It correctly identified Mr X’s needs and decided these could be met in supported accommodation. I do not find fault in relation to this point.
29. Mr X’s February 2022 Care and Support plan review document and the Council’s late March financial outcome letter (paragraph 19) do not mention Mr X needing any personal care. It is therefore unclear why Mr X reached the conclusion he was being charged a personal contribution for this service. Based on the evidence, the Council financially assessed Mr X and only charged him for the support as set out in his agreed care and support plan. This was in line with Care Act (paragraphs 11-12) and the Council’s charging policy (paragraph 14), which say the Council can charge a personal contribution for supported accommodation following a financial means assessment. I do not find the Council charged Mr X for personal care he did not agree or receive between February 2022 and February 2023.

ii) Mr X says the Council did not complete a financial assessment review and update his Care and Support plan.

30. The Council’s charging policy allows financial assessment review requests. The records show Mr X submitted his review forms in late February. The Council then reviewed Mr X’s financial contribution in line with its charging policy and sent him an outcome letter in late March. Mr X had the right to appeal the outcome, but the records do not show he pursued this course. I do not find the Council at fault for failing to complete Mr X’s financial assessment review request.
31. In his July 2022 complaint, Mr X asked the Council to update his care and support plan. He believed it was out of date and his personal situation had changed. I appreciate Mr X’s request was in an online complaint, but in my view the Council should have processed it in line with its review duties as set out in paragraph 13 (above). This required the Council to either consider his request or write to explain its reasons for declining the review. The Council could have also used this opportunity to clarify Mr X’s earlier Care and Support plan review in February in case he had misunderstood its contents. The records do not show any response from the Council. This is fault which caused Mr X avoidable uncertainty and distress as he believed his Care and Support plan did not reflect his actual support needs and was impacting his personal contribution. This is injustice.

iii) Mr X says the Council delayed managing his complaint.

32. Mr X complained to the Council in July, September, and October 2022. Based on the evidence, the Council logged the complaints but failed to acknowledge or respond to Mr X’s July and September complaints. Its failure to process and respond in July and September was fault and inconsistent with its complaints policy (paragraph 15). The policy says the Council will acknowledge complaints within three working days and provide a written outcome within 15 working days. The Council therefore failed to address Mr X’s concerns about his financial contribution and Care and Support plan review as explained at paragraph 31 (above). This caused Mr X avoidable uncertainty and distress as he was unsure if his complaint was being properly managed. Mr X also went to further inconvenience of hand delivering his September complaint and having to complain again in October. This is further injustice.
33. The evidence shows the Council responded to Mr X’s October complaint with a brief explanation for his financial contribution. I accept the Council was entitled to charge Mr X. However, the Council should have provided a clearer explanation setting out why it was entitled to charge and the steps it had taken to establish Mr X’s financial contribution. This was important given Mr X’s multiple complaints and attempts to understand this issue, The Council’s failure to do so was poor communication and resulted in Mr X losing confidence in the Council’s complaints process and approaching the Ombudsman. This is further injustice.
34. I also note the Council advised Mr X he could request a review of his care placement if his circumstances had changed. But Mr X had already raised this issue in his July complaint letter when he asked for a review of his Care and Support plan. The Council’s complaint response also did not address Mr X’s request to place debt enforcement action on hold. The Council’s failure to identify these two issues was poor customer service which caused Mr X frustration and distress as he did not think his complaint was understood and he would face further debt enforcement action. This is further injustice.

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Agreed action

35. The Council said it has now implemented a complaint tracking system to prevent future delays to complaint handling. This is a partial remedy.
36. Within one month of my final decision the Council should also:
1. Apologise to Mr X for:
1. Its failure to provide a response to Mr X’s request (in July 2022) for a Care and Support plan review and any avoidable uncertainty and distress caused.
2. Its failure to respond to Mr X’s July and September 2022 complaints in line with its complaints policy and any avoidable uncertainty, distress and inconvenience caused.
3. Its failure to fully address Mr X’s October 2020 complaint issues in its response and any avoidable frustration and distress caused.
2. Make a decision about Mr X’s Care and Support plan review request and write to him with an outcome. If it decides to accept Mr X’s review request, it should make the review arrangements and advise Mr X accordingly.
3. Make a payment to Mr X of £200 to reflect the avoidable uncertainty, distress and inconvenience caused to him.
4. Provide us with a copy of its new complaint tracking system procedures explaining how it will identify and prevent future complaint handling delays.
37. The Council should provide us with evidence it has complied with the above actions.

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Final decision

38. I find fault which caused Mr X injustice. I have made recommendations to remedy the injustice which the Council has agreed.
39. I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman