Summary: There was fault by the Council. The Council failed to ensure that Occupational Therapy equipment was delivered for reablement care. It is not possible to remedy this injustice now, other than apologising, as the complainant is in a different care situation. The Council’s reassessment and decision to charge for care at home after the complainant was no longer reaching the goals needed for reablement care was without fault.

The complaint

1. The complainant, who I shall call Mr X, complains the Council has charged him for care from 24 October to 13 November 2022, which should have been free as reablement care.
2. Mr X says this has caused him to pay for care which he feels should have been free and he would like this refunded.

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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 how the organisation made its decision, 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 Mr X’s representative.
6. I considered the Council’s comments about the complaint and any supporting documents it provided.
7. Mr X’s representative 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. Mr X had a stroke and was in hospital. He was discharged to his home on 25 September 2022, with a care package of four visits a day and Occupational Therapy (OT) equipment.
9. Mrs X told the Council on 5 October that they were still waiting for equipment, including a grab rail and shower seat. On 5 October 2022 the Council emailed Mr X’s representative to say ‘when a client has enablement at home they work towards goals and at the end of the intervention if further care is needed this will be arranged’. The email also said ‘I can see from case notes added by the enablement team that things have been going well. There were concerns about Mr X needing the bathroom frequently and this was causing stress when the carers were not there’.
10. A case note dated 6 October said the enablement carers were struggling to manage as calls were taking 1.5 hours as Mr X needed the bathroom every few minutes. The notes explained that Mr X was, understandably, anxious about this. The notes recorded the Council had told Mr X that 4 calls a day was the maximum they could offer or a placement in a short term chargeable bed.
11. At a weekly ongoing care meeting of 11 October 2022, the Council said that Mr X had eligible ongoing care needs. Notes said that Mr X needed a chair which hadn’t been ordered.
12. The social worker visited on 17 October 2022. On this visit Mr X asked the social worker to help him to the toilet. On the way back, he walked independently and fell, so an ambulance was called.
13. The notes of 20 October 2022 say that Mr X had agreed to go back to respite/residential care for a few weeks as he had had 2 falls and Mrs X had said she could not cope.
14. The Council wrote to Mr X on 17 October 2022 to say the period of reablement would end on 24 October 2022 and it would charge him for care from this date.
15. Mr X‘s representative complained to the Council that:
• All the OT equipment had not been delivered.
• The 4 care calls a day were inadequate.
• Regulation 3 (2)(b) of the Care and Support (Charging and Assessment Resources) regulations 2014 said that ‘reablement support services for the first 6 weeks of the specified period or, if the specified period is less that 6 weeks, for that period’ are to be free of charge.

Mr X’s representative said that as the reablement care started on 25 September, his period of reablement (during which the Council did not charge Mr X for care) was being reduced to 4 weeks.

16. Mr X went into respite/residential care on 10 November 2022. The Council charged Mr X for his care from 21 October onwards.

My analysis

17. The Council accepts that all the OT equipment was not delivered to Mr X. This was fault, as the Council’s reablement protocol refers to the provision of equipment. The equipment was originally ordered by the hospital OT and they could have also followed this up. This had an impact on Mr X, but from what I can see would not have been the sole reason the period of reablement was not successful. Mr X is now living at a new address, with a different care package, and so this part of the complaint cannot be remedied by delivering the missing equipment.
18. Mr X’s representative’s main point is that the Council brought the reablement care to an end prematurely. The argument is that the Council should have allowed the full 6 weeks before deciding what happened next. This would have meant that Mr X did not have to pay for care from 24 October to 13 November 2022, as reablement care is free.
19. Having looked at the care notes I can see why the Council carried out the review on 11 October. The care agency had told them that Mr X’s calls were taking longer than the time assigned. Mrs X was also struggling to care for Mr X when the carers were not present and was asking for help. Mr X had fallen twice and had agreed to go into respite/residential care. I cannot see any evidence of fault in making a decision before the end of the 6 weeks that Mr X required ongoing care. Mr X agreed to go into respite/residential care.
20. Mr X’s representative also argues a point of law. The legislation they refer to is the Care and Support (Charging and Assessment of Resources) Regulations 2014. Part 2 refers to the power of the Council to charge for care and support. In section 3 it says ‘a local authority must not make a charge for intermediate care and reablement support services for the first 6 weeks of the specified period or, if the specified period is less than 6 weeks, for that period’.
21. The guidance says the Council can provide reablement support free of charge for less than 6 weeks. There is no guidance to say whether the specified period can change after a re-assessment.
22. In this complaint, the Council’s decision to reassess the care needs before the end of the 6 weeks was without fault, given the concerns of the carers and Mr X’s wife. Mr X continued to receive care at home but this no longer had the goal of reablement. Mr X was then required to pay a financial contribution towards the cost of the care.
23. The Council’s reablement care protocols are clear. They say ‘Enablement is a time limited assessment service which is provided free for up to 6 weeks; the duration being determined according to individual need. The service aims to support individuals to reach agreed goals……’.
24. In response to my enquiries, the Council said ‘Enablement protocols for the service say that a period of reablement can be as long as six weeks but can also end sooner, and is considered to have ended once a person’s ongoing needs have been identified, and/or they are felt to have achieved the goals agreed at the start of the intervention.
25. I can find no evidence of fault in the Council’s decision to end the reablement care and charge for the care at home until Mr X went into respite/residential care. The Council reassessed Mr X and determined that he was no longer suitable for reablement care before the end of the 6 week period. Once the Council decided that Mr X was no longer suitable for reablement care, then it follows the Council could charge Mr X for his care as the reablement care had ended.

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Agreed remedy

26. Within one month of the date of the decision on this complaint the Council should:
• Apologise to Mr X. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
27. The Council should provide us with evidence it has complied with the above actions.

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Final decision

28. I have completed my investigation of the complaint. This complaint is upheld as I have found evidence of fault by the Council, which is remedied by an apology from the Council.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman