Summary: Miss X complained the Council overcharged for her mother, Mrs Y’s care package, delayed pursuing unpaid invoices and failed to issue amended invoices even after she complained. The Council charged Mrs Y for more care than she needed and delayed issuing revised invoices following Miss X’s complaint. The Council has agreed to apologise, make a payment to acknowledge the distress and frustration caused and issue revised invoices.

The complaint

1. Miss X complained the Council overcharged for her mother Mrs Y’s care package, delayed pursuing unpaid invoices and failed to issue amended invoices even after she complained. This has caused distress and uncertainty over what Mrs Y owes the Council.

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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. 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

4. I have considered information provided by Miss X and discussed the complaint with her on the telephone. I have considered the Council’s response to my enquiries and the relevant law and guidance.
5. I gave Miss 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

Relevant law and guidance

Assessment of Needs

6. 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

7. 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.
8. Where a council has decided to charge, it must carry out a financial assessment to decide what a person can afford to pay. If a person has more than the upper capital limit (£23,250) the council must meet their eligible needs if requested but they will be expected to pay the full cost of their care and will not receive financial assistance from the council. In calculating their capital, the council must not include the cost of the property in which someone receiving care is living. The council must also make clear that they may be liable for an arrangement fee to cover the cost of putting the care and support in place and any administration costs incurred.

What happened

9. Mrs Y has physical health conditions. Following a hospital operation and period of rehabilitation, the Council carried out a needs assessment. This recommended Mrs Y receive three 30-minute visits a week to assist with showering and personal care. The Council carried out a financial assessment in June 2022 which found that as Mrs Y had over £23250 in savings she would need to pay the full cost of her care. The costs included a weekly administrative fee. The Council says it sent the invoices to Mrs Y husband, Mr Y’s email address. The records show the family paid all the invoices up to and including January 2023.
10. In April 2023 Miss X contacted the Council to request additional support for Mrs Y as she was struggling with housework because her physical health had deteriorated. Mr Y provided a lot of support but was unable to do so following a recent operation. A Council officer carried out a home visit in early April 2023. The notes record Mrs Y wanted additional support with preparing meals, medication, light domestic tasks, laundry and ironing. The care provider that was already supporting Mrs Y agreed to take on the additional calls. Miss X understood that Mrs Y would receive one hour of support in the mornings and evenings with one hour of additional support for laundry/domestic tasks per week. The April 2023 care plan listed Mrs Y’s previous care package of 1.5 hours per week for personal care support. It also listed an additional care package of a one hour call each morning and evening to support with meals, medication and light domestic tasks plus an additional hour per week for ironing and other domestic tasks. Miss X says she never received a copy of the new care plan.
11. In mid April 2023 the Council says it sent Mr Y, via email, a reminder for the February invoice which had not been paid. It followed this up later that month with a ‘letter before action’ setting out that if they did not pay the debt the Council would apply for a County Court Judgement. In May 2023 the Council’s notes record ‘I left a message to pay the invoices’. The notes do not indicate who the message was left with.
12. Each month between May and September the Council says it sent Mr Y an invoice, a reminder letter and ‘letter before action’ for that month’s bill via email. The invoices showed a weekly administrative fee, a charge for 15 hours of care at home per week and a separate charge for 1.5 hours per week.
13. In late September 2023 Miss X contacted the Council about the debt. She says they received a letter threatening court action. She says Mr Y had not received the invoices up to that point, and so she was unaware of the increasing debt. The Council’s notes record a finance officer spoke with Miss X in late September 2023. The notes do not say what was discussed. In late October 2023 Miss X telephoned the Council to complain the social worker had failed to attend a meeting they had arranged. She said the social worker had not removed the old care package from the care plan when it was changed in April 2023 so Mrs Y was being charged too much for her care. She said Mrs Y received 14 hours of care and they were being charged for 15 hours plus the cost of the old care package. She asked the Council to send her copies of the invoices which it did.
14. In November 2023 Miss X submitted a complaint to local councillors that there had been a lack of response to her concerns. Her concerns included that the Council had not emailed invoices to Mr Y since February 2023 and there were discrepancies between the invoices sent and the care provided. Miss X said they received a letter for a debt of over £7000 and the threat of a county court judgement. Miss X said a finance officer had since arranged for the invoices to be sent to her however she had yet to receive corrected invoices, removing the old care package, which was causing stress and inconvenience and affected their budgeting ability.
15. An officer responded to Miss X’s concerns in late November 2023. They said the care provider confirmed it provided three 30-minute shower calls a week, plus seven one hour morning and evening visits plus an additional hour for domestic tasks. Miss X remained unhappy and asked that the response be reviewed.
16. A manager reviewed the complaint response and wrote to Miss X in January 2024. The manager said the Council was not aware of any delays in sending invoices, which it said were emailed to Mr Y at the same email address used previously. It had then forwarded the invoices to Miss X at her request.
17. The manager said the Council had billed Mrs Y in line with the care plan. However, they considered there was potential miscommunication. The records indicated the old care package would remain with an additional hour in the morning and evening seven days a week. The manager had reviewed the care logs which showed care workers stayed beyond one hour three days a week but there was no evidence of them providing an additional one hour per week for domestic support. The manager concluded the Council should have reviewed the care plan when Miss X raised her concerns about the care package. The manager said they had discussed this with the officer concerned and had highlighted the need to resolve matters promptly.
18. The manager recommended an urgent review of the care plan and that the care plan be amended to reflect ‘the duration on the daily call logs retrospectively from April 2023’. They also requested the time allocated for domestic tasks be amended as there was no evidence this had been provided. They requested an updated care plan be shared with Miss X and Mrs Y and that the finance team review the care charges.
19. Miss X replied to the manager. She requested a new social worker going forward, corrected invoices for 14 hours per week and a payment plan to pay the outstanding invoices. Miss X was unhappy the invoices were allowed to go unpaid for so long. She said she had checked, and Mr Y had not received any invoices after February 2023. She said the response suggested Mrs Y needed both care packages but this was untrue. She said Mrs Y never received the one hour per week of domestic support and never needed more than one hour each morning. She said on the days Mrs Y did not get a shower, care calls often took around 25 minutes and she never needed a one and a half hour visit.
20. Following this Miss X gave the Council notice to cancel the care package after some issues regarding care delivery. Miss X said care workers wrote down longer times than they were actually doing. The Council confirmed Mrs Y would not be charged beyond 31 January 2024.
21. The Council has yet to provide Miss X with amended invoices. In response to our enquiries it said it had amended the service provision on its system to end the original care package with effect from April 2023 and removed the one hour domestic support.

Findings

22. When Miss X contacted the Council to request additional support for Mrs Y it reviewed her care plan in a timely manner. However, there was a lack of clarity over exactly how much additional support Mrs Y required. The care provider’s logs show on the days Mrs Y required a shower it generally stayed over one hour. However, it is unclear whether this additional time was actually necessary. This lack of clarity was fault and meant, on balance, Mrs Y was charged for more care than she required.
23. In late September 2023, when Miss X first raised her concerns with the Council about the charges, it failed to review Mrs Y’s care plan. This was fault and meant Mrs Y continued to be charged too much for longer than was necessary. In the complaint response the manager advised they had already taken action and discussed this with the officer concerned. This should prevent a recurrence of this fault and so no further action is necessary.
24. When the Council reviewed Miss X’s complaint it accepted there was confusion and that Mrs Y had not received the additional hour of domestic support originally recommended. It agreed to retrospectively review the care charges. This was appropriate but there is no evidence this happened until the Council responded to our enquiries.
25. Miss X says Mr Y did not receive any invoices after February 2023 and she was unhappy the debt got so large before the Council sent a letter. The Council says it sent invoices to Mr Y via email. For each unpaid invoice it also sent a reminder and then a ‘letter before action’ which suggests the Council took appropriate action to follow up the debt at that time. The finance notes also record an officer left a message in May 2023 regarding unpaid invoices but the note lacks detail as to who the message was left with. I cannot resolve why Mr Y did not receive these letters and it is unlikely I could achieve anything more through further investigation of this issue.

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Agreed action

26. Within one month of the final decision on this complaint the Council has agreed to:
1. Apologise to Miss X and Mrs Y and pay them £100 each to acknowledge the frustration and distress caused by the Council’s faults.
2. Reissue the invoices from April 2023 when Mrs Y’s care package increased, until 31 January 2024 when it ended, charging Mrs Y for 14 hours of care per week.
3. Provide a clear account statement to Mrs Y showing the amount owed and how this is calculated.
4. Agree a repayment arrangement to enable Mrs Y to repay the debt over 12 months.
5. Offer Mrs Y a financial assessment if she considers the repayment could take her capital to below the financial limit.
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. There was fault causing injustice which the Council has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman