Summary: Miss X complains the Council has not provided her mother, Mrs Y, with the care set out in her care plan. Miss X says the Council failed to adjust the care plan or the charges made once they pointed out Mrs Y was receiving less than her specified hours. I have found the Council at fault for failing to reduce Mrs Y’s care package in June 2022. The Council has agreed to apologise to Mrs Y and Miss X, backdates the charges, makes a symbolic payment and service improvements to remedy the injustice caused.

The complaint

1. Miss X complains the Council has not provided her mother, Mrs Y, with the care set out in her care plan. Miss X says the Council failed to adjust the care plan or the charges made once they pointed out Mrs Y was receiving less than her specified hours. Miss X says she complained to the Council about the above matters in June 2023, but the Council’s complaint response failed to address these issues.
2. Miss X says this has caused Mrs Y significant distress and has had a detrimental impact on her finances.

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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 considered the information provided by Miss X. I made enquiries of the Council and considered its response.
6. Miss X and the Council had the opportunity to comment on my draft decision. I considered all comments received before reaching a final decision.

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What I found

Care and support

7. Councils must carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and must also involve the individual and where suitable their carer or any other person they might want involved. It must carry out the assessments over a reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment. (Care Act 2014, section 9 and 10)
8. If a council identifies the person has eligible needs for care, it has a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has.
9. A council has a duty to arrange care and support for those with eligible needs. A council can choose to charge for non-residential care following a person’s needs assessment. Where a council has decided to charge for care, 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.

Mental capacity

10. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established, they lack capacity. A person should not be treated as unable to make a decision because they make an unwise decision.
11. If a council thinks a person may lack capacity to make a decision or a plan, it should carry out a capacity assessment. For example, it may assess whether the person has the capacity to decide whether family members should be involved in their care planning. (Care & Support Guidance, para 10.63) If it finds the person lacks capacity to decide, it should make a best interest decision (as set out in the Mental Capacity Act) about who should be involved.

What happened

12. Below is a brief chronology of key events. It is not meant to show everything that happened.

Background

13. Mrs Y is in her 60’s and lives at home. Mrs Y has some mental health issues and finds it difficult to carry out personal care and maintain her home.
14. In 2020, the Council arranged support from Initial Care Services Southeast Limited (the Care Provider). At the time Mrs Y was receiving 2.5 hours support, three times per week.
15. The Council wrote to Mrs Y in February and explained that care and support provided through the Council was chargeable. The letter explained that the Council would arrange a financial assessment to see how much Mrs Y would need to contribute. The Council enclosed a booklet providing further information. Mrs Y confirmed she had received a copy of the letter.
16. The Council completed a financial assessment and advised Mrs Y that she would need to contribute to the cost of her care.
17. In April 2021, the Council sent Mrs Y a letter advising her that her contribution had increased to £90.13.

Events from June 2022

18. The Council completed a care needs assessment with Mrs Y in June. Mrs Y was deemed to have mental capacity to make decisions about her finances and support needs. Mrs Y said she was aware she had to pay for her social care and had £5000 of arrears with the Council for the care she had already received. Mrs Y said she would sometimes forget to pay her bills and accrued debt because of this. Mrs Y told the social worker she wanted to reduce her care package.
19. The Council sent Mrs Y a letter in September, stating there an outstanding balance of £9,569.85 on her account.
20. On 6 December, the Council’s finance team contacted Mrs Y about the outstanding debt. Mrs Y said she did not have the money to pay the charges. The Council asked Mrs Y to provide three months bank statements.

Events in 2023

21. The Council’s records show that by March, Mrs Y had accrued a debt of £11,816.25.
22. On 14 March, the Council visited Mrs Y at home and completed a review of her care and support needs. Mrs Y was still receiving 7.5 hours support, three times a week. Mrs Y asked again for her support to be reduced. She said that sometimes the care worker only stayed for 30 minutes. The social worker noted that Mrs Y had asked for her care hours to be reduced multiple times, however, it was felt that the support was required to prevent self-neglect. The social worker requested call records from the Care Provider.
23. In May, Miss X complained to the Council. Miss X said Mrs Y was not aware that she would be charged until she received a letter notifying her that she was in over £7000 of debt. Miss Y said Mrs X had previously asked the Council to terminate the care package, but her request was declined. Miss X said the care worker only attended for 40 minutes per visit, but Mrs Y was being charged for 2.5 hours. Miss X asked the Council to reassess the charges.
24. Miss X said the debt was putting a huge strain on Mrs Y’s mental and physical health. Miss X acknowledged that her mother required some support but not three visits per week. Miss X requested a reassessment of Mrs Y’s care and support needs.
25. The Council spoke to Miss X about her complaint. Miss X confirmed that Mrs Y had received the letters from the Council’s finance team. Miss X said Mrs Y managed her own finances and would pay her bills when she received them. The Council agreed to carry out a review of Mrs Y’s care and support needs with a view to formally reducing the package of care. The Council also agreed to obtain records from the Care Provider and investigate the length of calls.
26. On 1 August, the Council responded to Miss Y’s complaint and said Mrs Y had signed and returned the charging letter and therefore understood the charging process. The Council said it would request a review of the care and support package. Miss X remained unsatisfied and said the Council had failed to respond to all aspects of her complaint.
27. The Council contacted the Care Provider about Mrs Y’s support hours and length of calls. The Care Provider said the care worker attended each call for 2.5 hours.
28. In October, Miss X contacted the Council about her complaint. Miss X said the issues around length of calls had not been responded to and the issues were ongoing.
29. In December, the Council completed a review of Mrs Y’s care and support plan. Miss X was present for the review. Mrs Y asked for her care package to be reduced to one hour, two times a week. The Council agreed.

Council’s response to the Ombudsman

30. The Council accepts there was a delay in carrying out a review of Mrs Y’s care and support needs. The Council also accepts that had a review taken place in a timely manner in March 2023, it would have avoided any uncertainty about what care was necessary to meet Mrs Y’s eligible care and support needs. The Council has agreed to backdate Mrs Y’s client contribution to reflect her receiving two hours of care a week from 14 March, as it recognised this was a failing on its behalf and there was a level of uncertainty in the number of hours care and support Mrs Y may have required at the time.
31. The Council has also offered to pay Miss X and Mrs Y £200 each for the distress and time and trouble caused.

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Analysis

32. I am investigating this complaint from May 2022.
33. The evidence shows that Mrs Y was aware that she would be required to pay for her care. Mrs Y was also aware that she was in debt due to the care charges not being paid.
34. Mrs Y asked the Council to reduce her care package in June 2022. The Council did not reduce the care package at the time and that was fault. The Council felt Mrs Y required the support to prevent self-neglect. However, the Council’s records show Mrs Y had the capacity to make her own decisions about her care and support. The legislation is clear that people are entitled to make decisions even if they may be unwise. Mrs Y said she wanted to reduce the care package. The evidence shows that Mrs Y did not change her mind and asked for the package to be reduced again in March 2023. The fault has caused Mrs Y distress and a financial injustice.
35. Based on the above, I recommend the Council should backdate Mrs Y’s client contribution to reflect her receiving two hours of care a week from June 2022. This remedies the financial injustice caused to Mrs Y.
36. I am concerned about how the Council managed Mrs Y’s debt. Mrs Y has mental health issues and was vulnerable. There was a lack of communication between the finance team and adult social care team and consequently the Council has allowed the debt to build with no evidence of support being offered to Mrs Y. This is fault and has caused Mrs Y significant distress. The Council’s offer of £200 is appropriate to remedy this injustice.
37. Mrs Y and Miss X both raised concerns about the length of call visits and tasks completed by the care worker. The Care Provider confirmed that Mrs Y’s calls were for 2.5 hours. However, the Council did not take any action to verify this. The Council told Miss X that it would investigate her concerns but failed to do so. This is fault. Although, I do not consider an investigation is now necessary, as the recommendations set out below will offset any injustice caused by any fault identified with the Care Provider.
38. I am satisfied that Miss X experienced significant and undue stress and frustration because the Council did not properly deal with her complaint. The Council’s offer of £200 is appropriate to remedy this injustice.

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Agreed action

39. Within one month of my final decision the Council will:
1. apologise to Mrs Y and Miss X for the faults identified in this statement;
2. backdate Mrs Y’s client contribution to reflect her receiving two hours of care a week from 8 June 2022 and issue a revised invoice; and
3. pay Mrs Y and Miss X £200 each for the significant distress caused by the faults identified in this statement.
40. Within two months of my final decision the Council will consider how it can improve communication between the finance team and adult social care team, with a view to prevent a similar situation arising again. The Council will produce guidance for staff about managing debt for vulnerable adults.
41. The Council should provide us with evidence it has complied with the above actions.

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Final decision

42. I have found fault by the Council causing an injustice to Mrs Y and Miss X. I have completed my investigation on this basis.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman