Summary: We uphold Ms X’s complaint about home care, charging and carers’ support. The Council failed to give appropriate information and advice, failed to review Ms Y’s care and support plan when Ms X raised concerns about the Care Provider and delayed issuing a first invoice. It also failed to process a carers’ direct payment. This caused avoidable confusion, shock and distress. The Council will apologise, agree a repayment plan and make the payment to Ms X set out in this statement.

The complaint

1. Ms X complained:
1. There was a delay providing information about the cost of her mother Ms Y’s care.
2. Home care was poor, for example tasks were not completed, care workers did not turn up or were late, so Ms Y was left a long time between visits.
3. She did not receive any support as an informal carer.
2. Ms X says this caused avoidable distress and inconvenience. Ms Y cannot afford to pay the accrued charges and she missed out on an opportunity to contest the charge at the time.

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The Ombudsman’s role and powers

3. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
4. We can investigate Cathrolls UK Limited (the Care Provider) as the Council commissioned it to provide care for Ms Y in line with duties and powers in the Care Act 2014.
5. 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)
6. 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

7. I considered the complaint to us, the Council’s responses to the complaint and documents described later in this statement. I discussed the complaint with Ms X. I took into account comments from the parties on a first draft of this statement.
8. Ms X and the Council 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

What should have happened

9. Where a council agrees a person has care and support needs which meet national eligibility criteria, it must issue them with a care and support plan which sets out their needs, explains which is an eligible need and says how much funding the person is entitled to. It should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
10. Statutory Guidance explains a council should review a care and support plan at least every year, upon request or in response to a change in circumstances (Care and Support Statutory Guidance, paragraph 13.32)
11. Councils must be transparent so people know what they will be charged. There should be enough information available so they can understand any charge. (Care and Support Statutory Guidance, paragraphs 8.2 and 8.3)
12. Councils should provide or signpost to advice and information when people come into contact with them. They should provide information to help people understand what they may have to pay, including an explanation of the charging framework (Care and Support Statutory Guidance, paragraph 3.43)
13. Adult social care is chargeable, apart from reablement care which is free for up to six weeks. Councils have the legal power to charge for care which isn’t reablement care. If they do so, they must carry out a financial assessment to determine how much the person should pay.
14. For home care, the law says a person should be left with a certain income after any charge. This is called the minimum income guarantee (MIG). The financial assessment looks at a person’s income from benefits, salary and pensions and any savings they may have. It disregards some disability benefits and reduces the charge if the person has disability expenses (disability related expenditure or DRE).
15. For residential care, people pay most of their income towards the charge. They must be left with a personal expenses allowance which is about £25.
16. A council must carry out a carer’s assessment where it appears a carer may have needs for support. The assessment must include an assessment of the carer’s ability and willingness to continue in the caring role, the outcomes the carer wishes to achieve in daily life and whether support could contribute to achieving those outcomes (Care Act 2014, section 10.)

Summary of key events

17. Ms Y lived with her daughter Ms X. Ms X provided informal care and managed Ms Y’s finances for her. Ms Y went into hospital in May 2022 and then into a rehabilitation unit. When she came home in June, the Council arranged reablement care with the Care Provider.
18. Ms Y’s reablement care ended in July 2022. The Council’s social care team made a referral to the finance team for a financial assessment.
19. The Council commissioned the Care Provider for long-term home care for Ms Y. This was three calls a day (45 minutes in the morning and 30 minutes at lunch and tea-time.)
20. The case notes show a social worker spoke to Ms X about care charges in July. The social worker noted they “explained although the current funding was ending, Ms Y would not be left without care. If her savings are less than the threshold, she will be handed to the council to support. If over, then she would be self-funding.”
21. The Council sent Ms X a blank financial form to complete and return in July. It told me it sent copies of leaflets about charging at the same time, although it cannot provide evidence of this. The Council sent a reminder to Ms X to return the form at the end of August.
22. Ms X returned the finance form to the Council in the middle of September. She completed all the relevant sections, including a list of Ms Y’s DRE.
23. The finance team wrote to Ms X in September explaining the charge for Ms Y’s care, including a DRE allowance and an allowance for housing costs. The letter included a break down of how the Council had worked out the charge.
24. Ms X called the social care team in September saying she was at crisis point. She said she felt Ms Y needed residential care. Ms X went on to say:
• Home carers often stayed only three minutes at lunch;
• They did not wash Ms Y in the evenings or make food. Ms Y would be without food the whole day if she was not there;
• The Care Provider had no care plans; and
• She was unhappy with the charge.
25. Ms X also spoke to a finance officer saying she was unhappy with the Care Provider only staying between 10 and 15 minutes in the morning and 3 to 5 minutes at lunch and tea.
26. The social care team called the Care Provider which said Ms X worked from home and never let carers support Ms Y. The Care Provider said it would arrange a meeting with Ms X. There is no record of any follow-up by the social care team to check whether the meeting took place and if so, whether Ms X’s concerns were resolved.
27. The Council’s care and support plan for Ms Y set out her eligible needs and how these were to be met. It commissioned the Care Provider to provide 12 and a half hours a week of care to meet those needs. The Care Provider was to support Ms Y with:
• Providing meals
• Personal care
• Changing her catheter bag
• Dressing.
28. The Council completed a carer’s assessment for Ms X in November. The outcome was she was eligible for carers’ support. The Council told me Ms X was eligible for a direct payment that she could have used towards paying a cleaner or for a sitting service for her mother. However, the referral was not processed until after Ms Y went into residential care and so Ms X was no longer eligible for carers’ support.
29. The Council arranged for Ms Y to have respite care in a care home for two weeks in January 2023. The Council did not charge her for this. It explained this was an error as there had not been a residential financial assessment.
30. Ms X visited a care home with a vacancy in February 2023; she liked it. The Council arranged for Ms Y to get a permanent placement there.
31. Ms X told a social worker she was worried she had not paid any care costs for her mother’s home care.
32. An internal email in March indicates the income team had not sent out any invoices for Ms Y’s home care.
33. The finance team wrote to Ms X in March 2023 to confirm the charge for home care and said it took effect from July 2022. The letter included Ms Y’s personal budget statement. And a first invoice for care from July 2022 for £6300.
34. Ms X called the finance team having received the invoice. She said she felt robbed of making an informed decision about Ms Y’s care. She said she did not think the cost was proportionate to the care given. She said Ms Y could not afford to pay the invoice.
35. In April 2023, the finance team wrote to Ms X setting out the charge for Ms Y’s residential care. Ms X returned an agreement with the Council. She put on the agreement that she had not received a copy of the Council’s leaflet “Charging Information for Residential and Nursing Care.”

The Care Provider’s records

36. I asked the Council to let me have copies of the Care Provider’s care plans for Ms Y and for evidence of how it resolved the issues Ms Y raised about call timings. The Care Provider told me it had devised care plans and these were in the client’s home.
37. The Council’s records show Ms Y’s social worker liaised with the Care Provider three times about home care. On one occasion, the Care Provider said Ms Y often did not want to have her hair washed. The social worker said staff were to encourage hair washing. Care workers also reported that Ms X worked from home and had often done all the tasks on the care plan; they were happy to provide care, but Ms Y needed to allow it.
38. The Council highlighted that Ms X said in her carer’s assessment that she made meals for her mother and emptied her catheter bag.

The Council’s complaint response

39. Ms X complained twice to the Council. I have summarised the responses:
• It was sorry for the delay completing the financial assessment and for the failure to explain charging policies. The delay was due to staff shortages.
• It addressed the issues with call timings with the Care Provider.
• There was a referral for Ms Y to have a direct payment to support her in her caring role. But there was a waiting list because of high demand and as Ms Y had moved into residential care, Ms X was no longer eligible.
• It had addressed her concerns about the home care service with the agency. The minimum call time was half an hour though the call may not always take that long to complete.
• Respite care is chargeable. Ms Y’s respite stay was not financially assessed. The Council would waive the charge.
• It had removed charges between 17 July and 15 September 2022 as a goodwill gesture.
40. The Council told me it had recruited additional staff for the finance team to address the shortage.

Was there fault?

There was a delay providing information about the cost of her mother Ms Y’s care

41. There is fault by the Council. There is no evidence the Council provided leaflets about charges for home care or residential care. The information given to Ms X by phone in July 2022 was incomplete and suggested care may be free if Ms Y had savings ‘below the threshold.’ This was not in line with Care and Support Statutory Guidance which says councils should provide information about charging so people can make an informed choice. The lack of decent advice and information at the right time caused Ms X avoidable confusion.
42. The Council completed the financial assessment promptly in September 2022 when Ms Y returned the form. So she was aware of the exact charge for home care from September 2022 and could therefore have challenged it at the time or cancelled Ms Y’s care if she felt it was not affordable. She did not.
43. The Council did not send a first invoice until March 2023. Although the Council had informed her about the charge, it should have sent the first invoice in September at the same time as the charging letter. This delay of six months was fault. Receiving an invoice of over £6000 out of the blue and six months after getting a letter about the charge, would have come as a shock for Ms X.

Home care was poor, for example tasks were not completed, care workers did not turn up or were late, so Ms Y was left a long time between visits.

44. The Council’s response to Ms X’s concerns about the Care Provider was inadequate. It liaised with the Care Provider and there was some conflicting information about whether carers were allowed to complete the tasks on the care plan. The Council left it to the Care Provider to meet with Ms X. The Council was at fault in failing to follow up the issue with Ms X and the Care Provider. It should have checked the meeting had taken place and matters had been resolved. It should have considered an urgent review of the care and support plan. This was a failure to act in line with Paragraph 13.32 of Care and Support Statutory Guidance which was fault causing avoidable distress and inconvenience. The failure to arrange a review of the care and support plan meant there was a missed opportunity to discuss the Care Provider’s service with Ms X, to adjust call times and durations and to review the tasks the carers were and were not completing.
45. The Care Provider does not have copies of Ms Y’s care plans and says these are left in Ms Y’s home. Ms X says there were no care plans. We would expect the Care Provider to retain copies of care plans on its own records. It was fault not to retain these key records. It makes it difficult to establish what was or was not agreed between the Care Provider and Ms X for Ms Y’s care.

Ms X did not receive any support as an informal carer.

46. The Council carried out a carer’s assessment and decided Ms X was eligible for a carer’s direct payment. The records indicate there was a waiting list for direct payments for carers. I would expect the Council to action a direct payment within a reasonable time frame and the delay was fault. Ms X’s carer’s assessment was in November 2022 and Ms Y did not go into residential care permanently until the end of February 2023. Taking three months to process a carer’s assessment and direct payment was too long and was fault. However, the Council arranged and fully funded two weeks of residential respite care for Mrs Y in January which enabled Ms X to get a break from the caring role and served the same purpose as the carer’s direct payment would have done.

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Agreed action

47. The Council has already waived three months of the weekly home care charge. This is over £1500. This is an appropriate remedy to reflect the distress caused by the failure to review Ms Y’s care and support plan when Ms X raised concerns about call lengths and other matters.
48. The Council has accepted my recommendations to provide, within one month:
• An apology to Ms X for the avoidable distress, confusion and shock caused by poor information about charging and the delay in issuing the first invoice and a payment of £150 to recognise this and
• A repayment plan for the outstanding money.
49. The Council should provide us with evidence it has complied with the actions in paragraph 48.

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Final decision

50. We uphold Ms X’s complaint about home care, charging and carers’ support. The Council failed to give appropriate information and advice, failed to review Ms Y’s care and support plan when Ms X raised concerns about the Care Provider and delayed issuing a first invoice. It also failed to process a carers’ direct payment. This caused avoidable confusion, shock and distress. The Council will apologise, agree a repayment plan and make the payment to Ms X set out in this statement.
51. I completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman