Summary: There was delay by the Council in carrying out a financial assessment. This caused uncertainty, as the complainants were not told in writing of the charge for non-residential care services until 2 months after they started using the service. The Council also took the charging start date from the date of assessment rather than 28 days after the request for the service. A payment, towards the financial loss and uncertainty, remedies the injustice caused.

The complaint

1. The complainant, who I shall call Mrs X, complains her family were not informed they would need to contribute towards day centre costs for Mrs Y, her mother, until after the care had been started.
2. Mrs X says they thought the Council would pay Mrs Y’s day centre costs in October 2022. They only became aware in December 2022 that they would have to make a financial contribution towards them.

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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 consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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 read the papers put in by Mrs X and discussed the complaint with her.
6. I considered the Council’s comments about the complaint and any supporting documents it provided.
7. Mrs X and the organisation 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

8. Mrs Y attended a day centre for a couple of years. This was arranged privately by her family and they paid the £10 a day cost directly to the centre.
9. The Council carried out a financial assessment in October 2021, but the family chose to use services privately.
10. Mrs X says the day centre increased its costs to £30 a day, then £50 a day.
11. The family applied to the Council to fund the costs in September 2022.
12. The Council has notes from the social worker dated 18 October 2022 which say ‘I explained that her mum will be assessed to pay a contribution towards the day care, and this will be calculated by the finance team who will be in contact as soon as they can. I advised that this will be backdated to when it was agreed that we will fund.’ Mrs X says that the Social Worker did not mention Mrs Y having to make a contribution towards day care.
13. The Council says the service package was originally £150 per week from 20 October 2022 to 2 November 2022. There was a new service from 14 November 2022 at £267.50 per week. The Council says this was due to increase in Mrs Y’s needs as she was moved on to a higher tier by the Day Centre provider. This increase in service fee did not affect the amount charged to Mrs Y’s family, as they paid the amount calculated after the financial assessment.
14. The Council carried out the financial assessment on 20 December 2022, based on the information it had from the assessment in October 2021. The Council said it used updated benefit figures and asked the family to provide updated information on Mrs Y’s capital and Council Tax.
15. The Council assessed Mrs Y as contributing £71.90 per week from October 2022, increasing from April 2023 to £83.66 per week, in line with the annual benefit increase.
16. The Council said in response to my enquiries ‘while the financial assessment team will always aim to complete a financial assessment before services start, unfortunately this is not always possible’.

My analysis

Respite care

17. Mrs X complains that Mrs Y was charged for attending the day centre but she didn’t go while she was in respite for 4 weeks.
18. The Council has explained that its policy is that for any short-term residential care services with a duration of less than four consecutive weeks the community-based contribution will be charged, not the residential contribution rate. For stays with a duration of longer than four weeks, the residential charge will be applied from week 5. As Mrs Y attended respite for two weeks, although she was not attending the day centre, community-based charges still applied for the respite services.
19. I find no fault on the charges continuing which Mrs Y was in respite care, this was in accordance with the Council’s policy.

September to October 2022

20. The Council has identified it was at fault as it received the request for financial support on 6 September 2022 but the Council funded from 20 October (date of assessment). The Council said ‘having looked at the scenario we could have offered an early start date rather than starting the service from the actual assessment date. Therefore, it is reasonable to say the day centre payment could have started from the 4 October. This is allowing 28 days from 6 September to complete the assessment process.  The Council has proposed to offer a refund of payments from 4 to 20 October. This is 12 days x £30= £360. The Council has said that it will also not raise the assessed charge for this period so in principle the financial reward will be higher than the refund.

October to December 2022

21. We would normally expect a Council to carry out a financial assessment before a service starts, so the service user is aware of the charges before the service starts. However, sometimes this is not possible, especially in situations such as this, as Mrs Y was already using the day centre, albeit for less time.
22. Mrs X says the family was not aware they would have to contribute financially towards the day centre charges. So, they would like the charges refunded from 20 October to 20 December 2022, when the Council wrote to them about the charges. They believed the Council would fully fund the cost, due to the language used i.e. Council funded, fully funded.
23. The Council says they told the family that they would need to contribute financially after the financial assessment. I have seen the Council’s file note of 18 October 2022 which says ‘I (social worker) explained that her mum will be assessed to pay a contribution towards the day care and this will be calculated by the finance team who will be in contact as soon as they can. I advised that this will be backdated to when it was agreed that we will fund’.
24. I was not present on 18 October, so I cannot know for certain what the social worker said. But the Council’s records show the social worker knew the Council would carry out a financial assessment and that Mrs Y would need to contribute financially. So, I cannot see why she would not have told the family this. While I can appreciate Mrs X disagrees the family were told, I do think it is likely the social worker told them about the financial contribution then.
25. There was a delay in carrying out the financial assessment. If this delay had not occurred then the family would have got the information they needed about the charges sooner. Mrs X asked for help on 6 September and the Council did not carry out the financial assessment until 20 December. I consider this delay is fault and caused uncertainty to the family, as they were not clearly told in writing of the financial contribution they needed to make until after Mrs Y had increased the days she spent at the day centre. While it does not seem likely they would have made the decision for Mrs Y not to attend the day centre when they became aware of the charges, they were not clearly aware of the financial cost when arranging the increased day centre use.
26. I do not consider a refund of the day centre charges from 20 October until 20 December is a suitable remedy in this case. This is because Mrs Y used the service and the Care Act 2014 says that users should pay towards the cost of services. There is some evidence the social worker told the family of the charge and it is not certain they would have refused the day centre service if they had been aware of the charges. However, I think a remedy payment of £100 towards the uncertainty caused by the delay in the financial assessment is appropriate.

20 December onwards

27. Once the Council carried out the financial assessment, the family were aware of the charges. So, if they did not wish to use the service they could have cancelled. After this point, there was no fault by the Council.

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Agreed action

28. Within one month of the date of the decision the Council should:
• Pay Mrs Y £460.
29. The Council should provide us with evidence it has complied with the above actions.

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Final decision

30. I have completed my investigation of this complaint. This complaint is upheld as there was delay and fault by the Council. A payment remedies the injustice and uncertainty to the complainant.

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Investigator's decision on behalf of the Ombudsman