Summary: Mr X complained on behalf of his mother Mrs Y, the Council failed to clearly set out and explain Mrs Y’s care charges and adjustments. The Council was at fault. It will recalculate Mrs Y’s care charges for early October 2022, apologise and pay Mr X a symbolic payment for the confusion and uncertainty caused by the backdated invoices and adjustments made. It will also provide evidence of the service improvements it has already put in place.

The complaint

1. Mr X complained on behalf of his mother Mrs Y. Mr X complained the Council failed to clearly set out his mother’s care charges and adjustments between early October 2022 and late February 2023 and was concerned the charges were incorrect. Mr X also complained about poor complaints handling. He said this caused confusion, uncertainty and avoidable time and trouble.

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The Ombudsman’s role and powers

2. 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)
3. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, 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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What I have and have not investigated

5. Mr X complained to us in late March 2024 about his mother’s care charges from October 2022. Paragraph 3 above explains late complaints are when someone takes more than 12 months to complain to us about something a Council has done. I have used my discretion to look back to October 2022 when Mrs Y was discharged from hospital. Mr X only became aware of the issue when he received an invoice in February 2023. Mr X raised the complaint as soon as possible and there was an eight month delay in the Council responding to him which was outside of his control. Mr X complained to us in the same month he received the Council’s final response and could not have reasonably complained to us sooner.

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How I considered this complaint

6. I considered:
• the information Mr X provided and spoke to him about the complaint;
• the information the Council provided and its response to my enquiries;
• relevant law and guidance, as set out below; and
• our guidance on remedies, published on our website.
7. Mr X and the Council had an opportunity to comment on my draft decision. I considered comments received before making a final decision.

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What I found

Relevant law and guidance

The Care Act 2014 and charging

8. In 2014, the Government introduced the Care Act. This legislation replaced all previous guidance about how councils assess and provide care for adults in need. It includes guidance on charging for care.
9. The Care Act states councils have discretion to charge people for the care they receive. If a council decides to charge for care, it must complete a financial assessment. People who have over £23,250 of eligible capital have to pay for the full cost of their care fees.
10. Councils should clearly discuss with the person or their representative at the outset that care and support is a chargeable service and that where the person has been assessed as being able to afford to do so, they will be required to contribute to the cost of that care. They should ensure any subsequent fee changes are clearly communicated to the person or their representative.

Council Complaints Policy

11. The Council follows a two-stage complaints process:
• Stage 1 – the complaint should be acknowledged within five working days and allocated to the most appropriate person to investigate. A full response should be provided within 10 working days of being acknowledged. For complex complaints response timescales can be extended by a further 10 working days and this should be explained to the complainant;
• Stage 2 - escalation to stage 2 should be acknowledged within five working days. A full response should be provided within 20 working days of being acknowledged.

What happened

12. Mrs Y lived in her own home. In 2020 the Council completed Mrs Y’s financial assessment for her non-residential care and support services. A detailed financial assessment was not carried out because it was confirmed Mrs Y had over the upper capital limit of £23,250. She was therefore required to pay the full cost of her care and support plus an additional administration fee. Mrs Y received 14 hours daytime care per week.
13. In early October 2022 the hospital discharged Mrs Y home following a fall, with some additional support of 14 extra hours of care per week during the day and a night-time care visit (3 and a half hours a week) on top of her existing care package. The Council invoiced Mrs Y for the care and she paid her care charges.
14. In early January 2023 the Council sent Mrs Y an invoice with amended care charges. As Mrs Y had been in hospital in early October 2022, the additional hours of care for the first four weeks following her hospital discharge should have been funded under ‘discharge to assess’ funding (whereby additional care is funded on a short-term basis so that a person’s longer term care needs can be established). From January 2023 Mrs Y was invoiced for 14 hours of care per week.
15. In late February 2023 the Council issued an amended support plan for Mrs Y. The Plan said Mrs Y would be provided with 28 hours of daytime care per week and three and a half hours of night-time care per week, a total of 31 and a half hours of care. Mrs Y’s daily provision included:
• half an hour call daily in the morning, lunchtime, late afternoon and evening by two carers assisted with all daily needs including assistance with feeding and incontinence checks; and
• quarter of an hour call daily in the night, call by two carers to check continence, change pad and position.
16. The Council backdated the care charges to four weeks after Mrs Y’s discharge from hospital. From this date the Council charged Mrs Y for 31 and a half hours per week. This generated a large care bill which Mrs Y received in late February 2023.
17. Mr X complained to the Council in May 2023. He said Mrs Y had paid for her care since 2020 and her care package was changed when she was discharged from hospital in early October 2022. He said Mrs Y’s invoices had not been clear since she was discharged from hospital. He said adjustments were made in early January 2023 and late February 2023 but the adjustments were not clearly explained and he was concerned the invoices were incorrect.
18. Mr X chased the Council for a response to his stage 1 complaint in July 2023 and October 2023 with no response from the Council.
19. In November 2023 the Council produced a written report which set out Mrs Y’s care charges and adjustments. It provided the report to Mr X. He said the report was unclear and caused more confusion.
20. In early February 2024 the Council responded to Mr X’s complaint and said:
• the Council looked at Mr X’s bill query in November 2023 and there was miscommunication between different Council teams about who would respond to Mr X and apologised;
• when Mrs Y was discharged from hospital on 6 October 2022 she was charged for 28 hours day time care per week and 3 and a half hours night time care per week which was incorrect. It said 14 hours of the daytime home care and night calls should not have been charged for up to four weeks until 4 November 2022. It said this was additional care following Mrs Y’s hospital stay to what she was assessed as needing before her hospital stay which was under the discharge to assess policy which was non chargeable. The mistake was rectified in early January 2023;
• in late February 2023 authorisation was given to charge Mrs Y for 31 and a half hours per week backdated to 4 November 2022 and the changes in Mrs Y’s care required adjustments to be made on Mrs Y’s statements; and
• it apologised that a covering letter was not sent with the February 2023 statement and had already sent an email to relevant officers to ensure a letter of explanation for a change in charges was sent with the invoice to customers.
21. In mid-February 2024 Mr X responded to the stage 1 complaint and said he still did not understand the adjustments made to the invoices and wanted a further explanation.
22. In early March 2024 the Council sent its final response. It said the adjustment report written in November 2023 explained the comments Mr X raised about the fees and adjustments and it had nothing further to add. It said if Mr X remained unhappy he should complain to us, which he did.

Enquiries

23. In response to my enquiries the Council accepted it delayed sending Mr X the stage 1 response. It said this was because the Council needed to take additional time to gather the necessary information to ensure it was accurate and up to date. It also said a number of teams were involved and there was some miscommunication around who would respond to Mr X which delayed the response. It said new steps had been put in place to reduce the risk of similar delays in the future.
24. The Council provided us with a spreadsheet detailing the invoices and charges made to Mrs Y between October 2022 and February 2023. The spreadsheet showed how the adjustments to Mrs Y’s care charges had been invoiced.

My findings

Care fees

25. Before Mrs Y went into hospital she paid for 14 hours of care per week in her home. When Mrs Y left hospital she should have continued to pay for 14 hours of care per week until 3 November 2022 whereas the Council charged her for 31 and a half hours of care. It sent Mrs Y an amended invoice in January 2023 but failed to explain the changes. This was fault.
26. The spreadsheet the Council provided to us showed the Council amended the charges. However, for the week between 3 October 2022 and 9 October 2022, it appears to show Mrs Y was charged for 18 hours of care. The maximum Mrs Y should have been charged this week was for 14 hours of care. However, given Mrs Y was in hospital part of this week, the charge should have been for less than 14 hours. The care fees charged for this week were incorrect and this was fault. This caused Mrs Y to pay for more care than she received.
27. The Council records show Mrs Y has correctly paid for the 31 and a half hours of care she received between 4 November 2022 and late February 2023. However the invoices and adjustments made to the invoices in this period were confusing and meant the charges were unclear. The Council provided no explanation of these adjustments at the time. This was fault. In addition, the adjustment report provided to Mr X was also unclear. This was further fault and together caused Mr X confusion and uncertainty as to whether Mrs Y was paying the correct fees.

Complaints handling

28. Mr X complained to the Council in May 2023 and the Council did not reply to his stage 1 complaint until early February 2024, this was a delay of eight months. In its response to my enquiries the Council accepted delay in responding to Mr X and said it took additional time to gather the information together from various Council teams and there was miscommunication on which team would respond. The Council apologised for the Council teams miscommunication in its stage 1 response. This delay was fault and caused Mr X frustration and uncertainty. The Council has also put in place steps to reduce the risk of similar delays happening in the future.

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Agreed action

29. Within one month of the final decision the Council will:
1. recalculate and reimburse the overpayment for Mrs Y’s care fees for 3 October 2022 to 9 October 2022;
2. apologise and pay Mr X £200 for the confusion and uncertainty caused by the unclear backdated invoices and adjustments between October 2022 and late February 2023 and frustration and uncertainty caused by the delay in responding to his stage 1 complaint;
3. provide evidence of the reminder sent to relevant staff to provide a cover letter of explanation alongside invoices when adjustments are made to bills; and
4. provide evidence of the steps put in place to avoid stage 1 response delays when different Council teams are involved in the complaint response.

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Final decision

30. I have completed my investigation finding fault causing injustice. The Council has agreed to take action to remedy the injustice and prevent reoccurrence of the faults.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman