Summary: Mr Y complained about the way the Council charged for the domestic care services delivered to his father-in-law, Mr X. We found fault in the way the Council charged Mr X. The Council failed to provide information on its charging and to send documents following Mr X’s care needs assessment. The Council also significantly delayed Mr X’s financial assessment. The Council’s fault caused injustice to Mr X as he was not aware he would be charged for his care and how much he would need to pay. The Council has agreed to apologise and waive some of Mr X’s care charges. It has also agreed to carry out some service improvements.

The complaint

1. Mr Y, acting for Mr X, says the Council failed to carry out the right process when charging Mr X for the care services delivered to him from June 2023. He says the Council failed to:
• tell Mr X and his wife (Mrs X) about the change in who commissioned care services after the first six weeks from Mr X’s discharge from hospital and provide any written information to them;
• provide adequate and understandable information about financial assessments and charging;
• explain that Mr X would need to pay for care services provided to him after the first six weeks of free care;
• carry out a financial assessment for Mr X in a timely manner;
• complete a Mental Capacity Assessment for Mr X;
• stop care services quickly after Mr X’s request.
2. Mr Y says the Council’s failings caused distress and financial worry to Mr X, as he incurred debt of over £2,000.

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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. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
5. 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

6. I considered evidence provided by Mr Y and the Council as well as relevant law, policy and guidance.
7. Mr Y 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

Legal and administrative background

Intermediate care

8. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for continuing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Financial assessments and charging

9. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
10. Where a local authority has decided to charge, it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person. This could be provided alongside a person’s care and support plan or separately, including via online means. (Care and Support statutory guidance paragraph 8.16)
11. Financial information and advice is fundamental to enabling people to make well-informed choices about how they pay for their care. When providing financial information and advice the local authority service should include:
• understanding care charges
• ways to pay
• money management
• making informed financial decisions
• facilitating access to independent financial information and advice
• the cap on care costs, when preparing for its introduction in 2020 (Care and Support statutory guidance paragraphs 3.36 and 3.41)
12. Councils should ensure that information supplied is clear. Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it. Information and advice provided within the service should be accurate, up-to-date and consistent with other sources of information and advice. (Care and Support statutory guidance paragraphs 3.19 and 3.20)

Mental Capacity

13. The council must assess someone’s ability to make a decision when that person’s capacity is in doubt. How it assesses capacity may vary depending on the complexity of the decision.

The Council’s “Fees and Charges Policy for Adult Social Care”

14. The Council believes it is important that people pay the charges to their care costs that they are responsible for. In deciding to charge for care the Council adheres to a number of important principles including:
• transparency and clarity - the policy sets out in a clear and straightforward way so that everyone can understand how their contributions have been calculated, will know what their contributions might be at an early stage and be able to judge whether or not the policy has been applied correctly in their individual case;
• empowerment - the policy supports the overall goal of the Council to support people to have more choice and control over their resources and the way these are utilised, so that they can live their lives in the way they want and feel included in their community.

What happened

15. The below is a summary of the events which are relevant for this decision rather than an account of everything that has happened.
16. At the end of March 2023 Mr X was hospitalised. Before taking him to hospital the ambulance service found out Mr and Mrs X had been struggling to cope at home without support. The ambulance service sent a safeguarding referral to the Council.
17. Hospital records show Mr X was assessed as having mental capacity and expressing wishes about his medical treatment. He asked that his wife would be involved in any decision-making.
18. Mr X was discharged from hospital in April 2023. He started receiving a package of support consisting of 30-minutes care visits three times a day.
19. In mid-May the Council carried out Mr X’s care needs assessment and found he had eligible care needs for a long-term package of care once a day. For most of his care needs Mr X would be supported by the members of his family and this support would be “Non-Council Funded”. Mr X’s support for his personal care would be delivered once a day by a care agency and would be “Council Funded”.
20. At the beginning of June 2023 the Council’s Adult Social Care team noted that a reablement service was supporting Mr X at home. The Council decided to carry out a short-term support review.
21. During a short-term support review the Council recorded Mr X’s improvement since the discharge from hospital. Mr X could complete his personal care in the mornings with carers on hand. The Council reduced Mr X’s support from three 30-minutes visits to one morning visit per day.
22. At the end of June 2023 the Council prepared a care and support plan for Mr X. The Council said it had sent this document to Mr and Mrs X. The Council stated Mr X’s support package had started in the second week of June 2023. The cost of the package was £69.30 a week.
23. Mr X’s medical records from the end of July 2023 show a marked improvement in his health and mobility since March 2023.
24. At the beginning of August 2023 the Council called Mr and Mrs X as part of the safeguarding referral opened in March 2023. Mrs X confirmed Mr X was doing well at home. He was receiving daily morning visits from his carers and weekly visits from district nurses. Mrs X said she and her husband were well supported and did not need any further support from the Council. A family member, who normally lived abroad, was visiting for a few weeks and providing extra help. The Council’s officer talked also to Mr X, who confirmed everything his wife had said. The Council decided to close the safeguarding concern.
25. At the end of January 2024 the Council contacted Mrs X advising it would carry out a financial assessment for him following his recent care needs assessment.
26. A few days later Mr Y asked the Council to end care services for Mr X. According to Mr Y, Mr X was not aware the Council had carried out his care needs assessment. Mr Y said that for some time Mrs X had been trying to stop the carers’ visits as they were making Mr X anxious.
27. Following Mr X’s financial assessment, at the end of March 2024 the Council sent him an invoice with care charges.
28. At the beginning of May 2024 the Council’s debt recovery team told Mr X to pay £2,633 as overdue charges for the care services provided to him.
29. Mr Y complained about the way the Council dealt with charging for the services delivered to Mr X. In its stage two response the Council accepted it had delayed ending Mr X’s care package and waived the overdue care charges from the beginning of February 2024. The Council confirmed Mr X owed £2,356 from mid-June 2023 up to the beginning of February 2024.

Analysis

30. When charging for care services councils should ensure their service users understand what they will pay for and how much. They should have enough information to make informed decisions about their care.
31. Before starting charging Mr X for the care services arranged for him, the Council should have:
• told Mr X the services provided to him would be free only for the first six weeks from his discharge from hospital;
• sent Mr X a copy of his care needs assessment and support plan;
• carried out a financial assessment for him and told him how much he would be asked to pay.
32. The Council said it had referred Mr X to its financial team in mid-May 2023, which would suggest financial information was given to him. This is not enough evidence the Council sent documents or information to Mr X. In view of Mr and Mrs X’s reaction to the Council’s correspondence about a financial assessment at the end of January 2024 and their immediate request to end the care package, it is more likely than not that they did not receive any advice on the Council’s rules for charging.
33. The Council also said it had sent a copy of Mr X’s support plan to Mr and Mrs X but I have not seen any evidence that this had happened. Mr and Mrs X insisted they had not received any documents about Mr X’s care needs. As there was no follow up discussions or mention of anything included in the support plan, it is more likely than not that the Council had failed to provide this document to Mr X.
34. The Council significantly delayed carrying out Mr X’s financial assessment. It started charging Mr X from the second week of June 2023, issued Mr X’s care and support plan two weeks later and only at the end of January 2024 started assessing his finances.
35. The lack of information and advice for Mr and Mrs X about financial aspects of the care delivered to Mr X, the Council’s failure to send them Mr X’s care needs assessment and his care plan as well as its significant delay in carrying out Mr X’s financial assessment are fault. This fault caused injustice to Mr X as for many months he was unaware that he would be charged for the services he was receiving. In the circumstances he did not have enough information to decide whether he wished for his care services to continue. Mr and Mrs X were upset when in spring 2024, after many months of receiving services with no mention of charging, they found out they owed the Council over £2,600.
36. Having reviewed the Council’s case notes about a telephone call with Mr and Mrs X at the beginning of August 2023 I do not consider the Council should have stopped care services for Mr X following this call. During the call Mr and Mrs X stated Mr X’s health had been improving and he was doing well. No need for any further support is not equivalent to giving up support already in place. On the balance of probabilities it seems likely, however, that if Mr X had known at the time he would have to pay for these services, he would have stopped them. This is because from summer 2023 Mr X’s health had been steadily improving and by the beginning of August 2023 he was much more mobile and independent. At this time Mr and Mrs X also had some extra help from a family member who was visiting for a few weeks.
37. The Council has already accepted it had delayed ending delivery of Mr X’s care package. It offered a suitable remedy for this fault by waiving Mr X’s care support charges from the beginning of February 2024.
38. The Council did not fail in its duties under the Mental Capacity Act 2005. In the documents about his care the Council noted Mr X had mental capacity, this position was also reflected in his medical records. Under the relevant legislation we assume people have mental capacity to take decisions about themselves, unless there are specific reasons to think this may not be the case. Although supported by his wife, Mr X was actively involved in making decisions about his care and I found nothing that should have triggered the Council’s duty to carry out a detailed assessment.

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Action

39. To remedy the injustice caused by the faults identified, we recommend the Council complete within four weeks of the final decision the following:
• apologise to Mr and Mrs X for the injustice caused to them by the faults identified. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended;
• waive care charges incurred by Mr X from mid-August 2023.

The Council will provide the evidence that this has happened.

40. We also recommend the Council within three months of the final decision:
• review process of arranging care needs assessments and preparing support plans to ensure social workers:
1. provide comprehensive information on the Council’s rules for charging early in the process and during the care assessment at the latest;
2. after completing care needs assessments and support plans send them to the residents;
• review timeliness of financial assessments to ensure they are concluded and sent to the residents with relevant advice before the Council starts charging for care services.

The Council should provide us with evidence it has complied with the above actions.

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Decision

41. I find fault causing injustice. The Council has agreed my recommendations, so this investigation is at an end.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman