Summary: Mr X complained about his care charges and the support provided to him by a support worker regarding a rent increase and care workers who he said failed to support him in line with the support plan. There was no fault in the way Mr X was supported by the support worker or care workers. The Council was at fault for charging Mr X for double handed care without explaining why this was necessary or the impact of this on his care charges and for failing to properly consider Mr X’s disability related expenditure. This caused Mr X uncertainty and frustration. The Council has agreed to review Mr X’s care charges and disability related expenditure.

The complaint

1. Mr X complained:
1. the Council failed to adequately support him with paying a rent increase.
2. the Council arranged a care package when he had made it clear he could not afford to pay for care. He said he was surprised to receive a bill and immediately cancelled the care.
3. the care workers failed to support him in line with his care plan and cut the visits short.
2. Mr X said this caused him stress and anxiety and left him without adequate support. He said he is worried about debt collection and how he can pay his debts.

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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 significant injustice, or that could cause injustice to others in the future 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.
6. I have considered the Council’s response to my enquiries and the relevant law and guidance.
7. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
8. I gave Mr X and the Council the opportunity to comment on a draft of this decision. I considered any comments I received in reaching a final decision

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What I found

The relevant law and guidance

Assessment of Needs

9. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve.

Charging for care

10. The Care Act 2014 sets out the legal framework for charging. Councils can make charges for care and support services they provide or arrange. They must do so in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014. Charges may only cover the cost the council incurs.
11. Councils must assess a person’s finances to calculate how much an individual should contribute to the cost of their care. The assessment must comply with the principles in law and guidance, including that charges should not reduce a person’s income below Income Support plus 25% (also known as the minimum income guarantee).
12. The Care and Support Statutory Guidance sets out key principles councils should take into account when making decisions on charging. The principles include that the approach to charging should be clear and transparent, so people know what they will be charged.

Disability Related Expenditure

13. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included. What counts as DRE should not be limited to what is necessary for care and support. For example, above average heating costs should be considered.
14. The Care and Support Statutory Guidance says ‘it may be reasonable not to allow for items where a reasonable alternative is available at lesser cost. For example, not to allow for the private purchase cost of continence pads, where these are available from the NHS.’

What happened

15. In April 2021, the Council allocated Mr X one hour of support per week from a support worker to assist him with managing a rent increase from his housing provider. The records show there were 13 calls/visits of which five were unanswered. The support worker made four calls to other agencies liaising on Mr X’s behalf. They supported Mr X to submit a housing benefit application.
16. In July 2021, the support worker noted they had called Mr X and advised him they had closed his case as they had addressed his identified outcomes as far as possible. They had supported Mr X to complete an application for a discretionary housing payment (a payment for those on housing benefit struggling to pay their full rent).
17. In December 2022, the Council completed a social care needs assessment for Mr X. This noted he needed support with keeping his home tidy, putting the bins and recycling out, feeding his dogs and with social interaction. He had become socially isolated and needed help and support to socialise. They noted Mr X felt a social call from a care agency would be a good starting point to prevent further isolation.
18. The social worker noted Mr X requested a 15 minute call around 11am and 30 minutes around 7pm. The support plan noted the care provider would provide double handed care commencing 6 January 2023. This cost approximately £177 a week. The Council did not provide Mr X with a copy of the needs assessment or support plan.
19. The Council wrote to Mr X on 12 January 2023. The letter set out that ‘From the 6 January 2023 your weekly charge will be £116.18 based on the information regarding your current level of service’. The Council said it also sent Mr X a leaflet on non-residential care charges.
20. The records show two care workers visited twice a day. The morning call was generally 15 minutes long and the evening call 30 minutes long. The records show the care workers fed the dogs and also took out recycling or bins, brushed/mopped the floor and occasionally washed dishes. On two occasions the staff noted the visits were cut short as Mr X was going out.
21. On 25 January 2023, an officer from the care provider called the Council on Mr X’s behalf. Mr X had received bills for his care package and said he could not afford to pay. The officer spoke to the finance team who considered Mr X was correctly financially assessed but Mr X disagreed. Mr X suspended his care calls. He said he wanted the care but could not afford it.
22. In early February 2023 an officer spoke with Mr X and staff from the care provider. The notes record Mr X was unhappy with the cost of his support and said he could not afford it. Mr X explained he used his personal independence payment to pay for private therapy. The officer noted they explained this could not be considered in his financial assessment as it was a private arrangement. The officer asked if the NHS could provide this service, it would not come at a cost to Mr X. The notes record Mr X said he had asked his doctor but they would not listen. Mr X believed he should not have to pay towards his support. Another officer called Mr X several days later and confirmed his financial assessment was correct and he was required to pay towards the cost of his care package.
23. Mr X complained to the Council about the care charges and support he received managing his rent increase. The Council responded to Mr X’s complaint in March 2023. It said Mr X had achieved all the outcomes agreed with the support worker in relation to his rent increase. In relation to the care charges, an officer had met with Mr X and discussed Mr X’s concerns. Mr X had asked to cancel the care package however, he was required to pay any outstanding care charges. Mr X remained unhappy and complained to us.

Council enquiry response

24. I asked the Council to explain why Mr X received double handed care. The Council said that in 2019 Mr X received support from a care company. It cancelled the care package in October 2019 after its relationship with Mr X broke down due to Mr X’s behaviour towards staff. The Council said it was unable to find another care provider who would accept the care package with one care worker. It updated Mr X’s care plan to show he required two care workers at each visit and identified a new care provider which supported Mr X from December 2019 to April 2021 with two care workers at each visit until Mr X cancelled the support.

Findings

Support with the rent increase.

25. The records show the support worker agreed outcomes with Mr X then worked towards these. They supported Mr X with applying for housing benefit and a discretionary housing payment. There is no evidence of fault in their actions.

The charges for care

26. The Council assessed Mr X’s needs and recommended he receive support twice a day. The records show Mr X agreed to this. The Council is entitled to charge for the care and support it provides. The Council said it provided Mr X with a leaflet about charging for care but has not provided any evidence to show when this was supplied to Mr X. However, the records show the Council completed a financial assessment. The Council wrote to Mr X on 12 January 2023 setting out his required contribution to his care charges so he was aware he would be required to pay towards his care costs. Mr X had also received care in the past and so he was aware he would be required to contribute. The Council was not at fault for charging Mr X a contribution towards his care costs.
27. The Council calculated Mr X’s contribution to his care charges in line with the relevant statutory guidance and regulations. However, Mr X’s financial assessment includes no allowance for disability related expenditure. Mr X pays for private therapy. The Council told Mr X as this was a private arrangement it was not recognised as disability related expenditure. The Ombudsman cannot question a decision that is properly reached. However, I have not seen any evidence to show the Council properly explored whether Mr X’s therapy should be considered as disability related expenditure. It suggested Mr X may be able to get this on the NHS for free but did not fully explore with Mr X whether this was a feasible option or ask him to provide evidence from his therapist as to why the therapy was necessary to support his disabilities. This is fault and caused uncertainty over whether Mr X’s contribution to his care charges was properly calculated.
28. Two care workers attended Mr X at each visit. This therefore increased the cost of Mr X’s care package. Mr X’s needs assessment made no reference to why Mr X needed two staff at each care visit. Although the support plan showed the Council commissioned a care package for two care workers at each visit, the Council failed to provide Mr X with a copy of the support plan. Mr X said he questioned the Council why two staff attended at each visit and was told it was for his safety. The Council failed to clearly explain to Mr X the reasons two staff attended at each visit and that this would increase the cost of the care package. This was fault and caused uncertainty over what Mr X understood about the care charges.

The support provided by the care workers.

29. The care provider’s records show the length of visits was around the time agreed. There were two occasions when visits were cut short as Mr X was going out. The notes show the care workers carried out tasks in line with the needs assessment and support plan. There is no evidence of fault in the support provided to Mr X.

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Agreed action

30. Within one month of the final decision, the Council has agreed to:
1. Apologise to Mr X for the frustration and uncertainty caused by it not properly considering his disability related expenditure and for charging him for double handed care without explaining why or the impact this would have on his care charges.
2. Review Mr X’s disability related expenditure to consider whether his private therapy should be considered as a disability related expense.
3. Revise Mr X’s care charges to reflect the cost of a single handed care package and issues an amended bill to reflect this (and the recommendation above if this affects his care charges).
31. The Council should provide us with evidence it has complied with the above actions.

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Final decision

32. I have completed my investigation. The Council was at fault causing injustice which it has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman