Summary: The Council was at fault. It delayed Mrs Y’s financial assessment and did not clearly explain Mrs Y’s care charges and initially overcharged her. It did not update Mrs Y’s care and support plan when there was a change in care hours agreed and it communicated poorly with a family member, Mrs X. The Council has already recredited payments it should not have charged Mrs Y. It will also apologise and pay a symbolic payment to Mrs X and Mrs Y to acknowledge the frustration, confusion and distress caused. The Council will review its services to prevent a repeat of the faults.

The complaint

1. Mrs X complained on behalf of a relative, Mrs Y, about incorrect charging for her Council arranged care provision between late July 2024 and early September 2024. Mrs X says her relative had been charged in excess of the care hours agreed and provided and that the Council’s records of care hours received by Mrs Y and charged was incorrect. Mrs X also complained about poor communication. She said as a result it caused distress, frustration 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. 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(1), as amended)

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How I considered this complaint

4. I considered:
• the information Mrs X provided and spoke to her 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.
5. Mrs 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

6. 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.
7. 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 to decide what a person can afford to pay. People who have over £23,250 of eligible capital have to pay for the full cost of their care fees.
8. 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. (paragraph 8.2 Care and Support Statutory Guidance).
9. Reablement care is a short-term support service funded by the council or National Health Service (NHS) focused on people regaining independence with daily living skills after a life change, illness or injury. This typically lasts for six weeks.

Care Planning

10. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan, which 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.
11. Section 27 of the Care Act 2014 gives an expectation that local authorities should conduct a review of a care and support plan at least every 12 months. The authority should consider a light touch review six to eight weeks after agreement and signing off the plan and personal budget. Section 13, paragraph 13.13 of the Care and Support Statutory Guidance states there can be an unplanned review of a care and support plan which results from a change in needs or circumstances.

Complaints Handling

12. The Council follows a one stage complaints process for adult social care complaints. The Council said it would acknowledge complaints within three working days and aim to respond within 20 working days.

What happened

13. Mrs Y rented her home from the Council and lived with her son Mr Z. In April 2024, Mrs Y’s relative Mrs X contacted the Council about getting care and support for Mrs Y. The Council assessed Mrs Y’s needs. Mrs Y’s needs assessment noted information and advice was provided about the six-eight week review and financial assessment that needed to take place. Mrs Y received Council commissioned care of just over 12 hours a week in her home from late April 2024, Mr Z helped Mrs Y between care visits.
14. Mrs X said the Council told her it would not charge Mrs Y for her first six weeks of care (reablement care), until early June 2024, and then it would be reviewed.
15. The Council said between April 2024 and late July 2024 Mrs Y received a Recovery and Progression package which is a six-week short-term service focused on maximising independence. It said no financial assessment was completed or applied and this was a non-chargeable service so no invoices were raised for care provided between April 2024 and late July 2024.
16. In early July 2024 Mrs X emailed Mrs Y’s Council social worker, Officer 1 and asked when it would undertake Mrs Y’s financial assessment. Two days later the Council’s financial assessment team sent Mrs Y a letter based on information it obtained from the Department of Work and Pensions. It set out Mrs Y’s financial assessment explaining how it calculated her weekly charge. Mrs Y did not have over the upper capital limit of £23,250 of eligible capital. It assessed Mrs Y should contribute up to £234.76 towards the weekly cost of her care and she would be charged either the full cost of the service or the assessed contribution amount, whichever was lower from late July 2024. Mrs X was unaware Mrs Y had received the financial assessment letter.
17. A few days later Mrs X chased Officer 1 again for a financial review and Officer 1 agreed to arrange an online meeting to include Mrs X and Mrs Y. Officer 1 clarified the reablement services were free for up to six weeks. Mrs X wanted the Council to carry out a financial assessment and said she was told a full financial assessment and service care plan review would be undertaken before Mrs Y had to pay for her care. Officer 1 explained Mrs Y would only need to contribute to her care package depending on her savings and income level.
18. A Council record showed a review meeting took place on 5 August 2024 with Officer 1, Mr Z, Mrs X and Mrs Y and it was agreed to reduce Mrs Y’s care visits and for them to be more focused. The Council also updated Mrs Y’s care and support plan the same day. This said Mrs Y needed help with personal care, meal preparation, help with medication and dressing. It said Mrs Y had a weekly personal budget of £59.94 for help from a single carer for four hours of support a week. It noted Mrs Y was able to make her own decisions.
19. The Council reviewed Mrs Y’s financial assessment in mid-August 2024 and revised the start date for Mrs Y’s assessed contribution to start on 5 August 2024. The Council’s second financial assessment for Mrs Y assessed her contribution as £141.96 per week.
20. Mrs X told me between late July 2024 and early September 2024 Mrs Y received four hours of care per week.
21. On 12 August 2024 a Council social worker, Officer 2 emailed Officer 1. Officer 2 said ‘I had a call on duty from the service user (Mrs Y) who advised that her care package of care has been reduced to one call from three calls a day. She advised that the lunchtime call is very much needed’. Officer 2 asked Officer 1 to contact Mrs Y. A Council ‘amend service record’ dated 12 August 2024 noted from 13 August 2024 Mrs Y needed a total of 7 hours 30 minutes care visits per week.
22. In mid-August 2024 Mrs X emailed the Council about Mrs Y’s care package and weekly contribution and asked for a review of Mrs Y’s financial assessment. The Council responded the same day and said Mrs Y’s weekly charge may vary depending on the level of service she received and the cost to the Council. It said it would be up to the maximum weekly amount of £141.96. It also confirmed Mrs Y’s care charges would now start on 5 August 2024. It said an invoice would be sent every four weeks for the cost of the care package based on care received if it was less than her assessed contribution of £141.96.
23. The Council invoice for late July 2024 to mid-August 2024 charged for Mrs Y’s care between 22 July and 4 August 2024. The amount was £325.92. It also charged Mrs Y for:
• 9.35 hours for the week of 5 to 11 August 2024 at a cost of £141.96;
• 7.27 hours of care between 12 to 18 August 2024 at a cost of £116.32; and
• 5.48 hours of care between 19 to 25 August 2024 which cost £87.68.
24. On 21 August 2024 Mrs X emailed the Council and requested Mrs X’s care package was amended from week commencing 26 August 2024 to four hours per week as family would provide support at other times. This was confirmed in a Council ‘amend service record’ for Mrs Y to receive four hours of care per week from 26 August 2024.
25. In early October 2024 Mrs X queried the first invoice with the Council. The Council’s Brokerage Team did not respond to Mrs X. In November 2024 Mrs X said she had asked the Council five times to consider Mrs Y’s disputed invoice and called the Council as well to discuss her concerns. She said Mrs Y was receiving demand for payment letters weekly which were causing distress and Mrs Y and Mrs X had to redirect Mrs Y’s mail to Mrs X’s address. The Council Debt Recovery Team told Mrs X it would put a block on debt recovery action whilst the invoices were in dispute, but Mrs X said the letters were still sent.
26. In early 2025 Mrs X made a formal complaint to the Council. She queried the cost of Mrs Y’s first invoice covering the period 22 July 2024 to 11 August 2024 which totalled £467.88 when her care plan said she would receive 4 hours of care per week at a cost of £59.94 per week.
27. In late March 2025 the Council sent its final complaint response to Mrs X. It said:
• Mrs Y’s care plan was based on a variable contract, agreed with the social worker. It said it meant the hours of care were not fixed and could vary week to week depending on Mrs Y’s needs;
• the invoice reflected the actual hours of care provided, which may have exceeded the originally anticipated four hours per week; and
• it apologised for any confusion caused and apologised for the time taken to respond to Mrs X’s query and gave her our contact details if she remained unhappy.
28. Mrs X remained unhappy and contacted us.

The Council’s response to my enquiries

29. In response to our enquiries the Council said due to a lag in the system update, the Council initially invoiced Mrs Y from 22 July 2024. The Council provided evidence it recredited Mrs Y £325.92 for the period between 22 July 2024 to 4 August 2024.
30. The Council said the invoices did not align with the care and support plan as Mrs Y’s invoices were based on actual hours delivered by the provider and not the commissioned hours in her care and support plan. The Council provided Mrs Y’s care records which showed when she received care and how long each visit lasted.
31. The Council apologised for the Council’s Brokerage Team’s poor communication and for the poor communication around Mrs Y’s demand letters. It said the demand letters stopped but the invoices were still sent and this should have been explained more clearly to Mrs X.

My findings

Financial assessment

32. The Council was at fault when it did not review Mrs Y’s reablement care within six to eight weeks and failed to involve her or her representative in the initial financial assessment. The Council undertook a first financial assessment a month later than it should have done in mid-July 2024. It then undertook a second financial assessment in August 2024 and issued Mrs Y’s revised care and support plan on 5 August 2024. The delays and poor communication between the Council and Mrs X relating to Mrs Y’s financial assessment and review was fault. The faults caused Mrs X frustration. Mrs Y was not caused an injustice because she received free enablement care provision at this point.

Care fees

33. The Council was at fault when it initially charged Mrs X for her care between 22 July 2024 and 4 August 2024 which it said it would not do because it was under the free recovery and progression package. This error was made due to a Council system error. This was fault and caused Mrs X frustration and confusion. However, the Council recredited Mrs Y’s account for this two-week period which remedied the injustice caused to Mrs Y.
34. Three requests were made by Mrs X and Mrs Y to change Mrs Y’s hours of care which she received in August 2024. The Council agreed to change Mrs Y’s care hours from four and a half hours on 5 August 2024 to seven and a half hours on 12 August 2024 at Mrs Y’s request. It then reduced these to four hours from 26 August 2024 at Mrs X’s request as family agreed to support at other times. The Council was not at fault in changing Mrs Y’s support hours in response to family requests. However, it failed to update Mrs Y’s care and support plan to reflect these changes. This caused Mrs X confusion.
35. In addition the Council made adjustments on Mrs Y’s invoices to show the actual care hours Mrs Y received and not the hours agreed in her care and support plan. The Council did not initially explain to Mrs X or Mrs Y that it would provide fluctuating or variable care and that Mrs Y would be charged for the actual hours of care she received. There is no mention of this in her needs assessment or support plan. I have seen Mrs Y’s care records and the amount charged aligned with the care she received. As Mrs Y needed additional care it was appropriate that she received this and was charged for it. However, the Council only explained this to Mrs X in an email in mid-August 2024. This was fault which caused Mrs X confusion. The variable care hours did not cause Mrs Y an injustice because she received the care required for her needs.

Communication and complaints handling

36. The Council has acknowledged its Brokerage Team communicated poorly with Mrs X between October 2024 and November 2024 when Mrs X raised concerns about Mrs Y’s invoices but did not receive a response. This was fault and caused Mrs X frustration. The Council also acknowledged the Council Debt Recovery Team communicated poorly with Mrs X about stopping its demand letters but still sending Mrs Y’s invoices. This poor communication was fault and caused Mrs X frustration and Mrs Y distress.
37. Mrs X complained to the Council in mid-January 2025. The Council responded in late-March 2025. This was a delay of approximately five weeks and caused Mrs X frustration. The Council has already apologised for the delayed response which was an appropriate remedy for the injustice caused.

Service Improvements

38. The Ombudsman has already made service improvement recommendations to this Council on similar cases. As a result of earlier complaints to us, the Council has agreed to review its complaints handling procedure and provide training to relevant officers and reminded all relevant staff of the need to ensure all care plans are reviewed within six-eight weeks after they are signed off. On this basis no further service improvements on these issues were needed.

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Action

39. Within one month of the final decision the Council will:
1. apologise and pay Mrs X a symbolic payment of £300 to acknowledge the frustration and confusion caused by the faults in communication found in this investigation. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology;
2. apologise and pay Mrs Y £100 for the distress the demand letters caused her;
3. ensure there is clear information provided at the start of a care package. This will show how and when the Council will charge for care provision and when and why it will charge a variable amount for care provided. If the care package is variable this will be documented in the care and support plan; and
4. provide guidance to relevant staff to ensure where there is an agreed change in care hours the care and support plan is updated to reflect the change.
40. The Council will provide us with evidence it has complied with the above actions.

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Decision

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

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Investigator's decision on behalf of the Ombudsman