Summary: Mrs Y complained the Council restricted the family’s choice of respite placement and failed to make clear in advance that her mother, would need to contribute towards the cost. We find no fault in relation to the placement options offered. However, we do find the Council at fault for failing to clearly record or demonstrate that Mrs Y understood the potential financial costs before respite began, which caused uncertainty and avoidable distress. The Council has already provided an appropriate remedy, so I make no further recommendations.

The complaint

1. Mrs Y complains about the Council’s handling of discussions relating to her mother, Mrs X’s, respite stay. Specifically, she says that:
1. The family was initially offered only one option for a respite facility;
2. The Council did not inform the family that Mrs X might be required to contribute towards the cost of the respite stay; and
3. Mrs X’s assessed financial contribution was not shared until after she had already started the respite placement.
2. Mrs Y states that, had this information been provided in advance, Mrs X would not have agreed to the respite stay. She says the situation has caused significant stress for both her and her mother.

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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(1), as amended)

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How I considered this complaint

5. I considered evidence provided by Mrs Y and the Council as well as relevant law, policy and guidance.
6. Mrs Y and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant legislation and policy

Charging for temporary residential care

7. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt a permanent admission is required. The person’s stay should be unlikely to exceed 52 weeks, or in exceptional circumstances, unlikely to substantially exceed 52 weeks. A decision to treat a person as a temporary resident must be agreed with the person and/or their representative and written into their care plan.
8. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.
9. Councils should carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process. (Care and Support Statutory Guidance, paragraph 6.29)

Third party top-up

10. Third-party top up fees apply where a resident chooses a care home with fees exceeding the amount the council is willing to pay, and a relative, friend or other party (not the resident) agrees to cover the difference in the care fees. The top-up payment must always be optional and never the result of commissioning failures leading to a lack of choice.

The Council’s Charging Policy

11. The Council’s policy states that a financial assessment should normally be completed before care begins so the person or their representative understands the assessed weekly charge and can make an informed decision.
12. If the financial assessment is completed after services have started, charges will be backdated to the start date of care.
13. If a person is admitted to hospital while in a care home placement and their room is kept available, they remain liable for the assessed weekly charge during that period.

The Council’s Choice of Accommodation Policy

14. Where a person is assessed as needing a particular type of accommodation, they have the right to choose between suitable providers, provided the placement meets their assessed needs, is available, costs no more than the personal budget, and the provider agrees to contract with the Council.
15. The Council must ensure at least one suitable and affordable option is available within the personal budget. If a person chooses a more expensive placement, the additional cost must be met through an optional third-party top-up.

What happened

16. Mrs X lives alone and receives a package of care arranged by the Council.
17. On 12 May, following her second hospital discharge in a short period, a district nurse contacted the Council to suggest respite care. Mrs Y had been staying with her mother but needed to return home. Mrs X had become physically weaker and required additional support, including occasional support at night, which the family could not sustain.
18. The Council spoke with Mrs Y on 12 and 13 May. It discussed the process for arranging respite and three possible placements: Placement A (the family’s preferred option), Placement B (a previous respite placement), and Placement C. Mrs Y explained why Placements B and C were not suitable. She said Mrs X was willing to go into respite and wanted Placement A. Mrs Y also said she would be willing to pay a third-party top-up if necessary. She emphasised that respite was needed urgently and ideally within a week.
19. The Council advised that if respite was arranged, a financial assessment would be required. It also explained the brokerage process and that Placement A might not be the chosen provider, however as per the choice of accommodation policy, if they were unhappy with the chosen provider, they could choose another placement of equal cost or pay a third-party top-up for a more expensive placement.
20. On 14 May, the Council made a brokerage referral. On 16 May, the placement at Placement A was confirmed. Mrs Y agreed to pay a third-party top-up and Mrs X moved into the respite placement that day.
21. On 19 May, the Council arranged for a financial assessment to be completed. Before this took place, on 20 May, Mrs X was admitted to hospital.
22. The financial assessment was completed on 22 May. Mrs Y was informed by telephone and in writing of the amount Mrs X would need to contribute towards the cost of the respite placement. Mrs Y told the Council that Mrs X would not return to respite following discharge from hospital.
23. On 23 May, Mrs Y confirmed that Mrs X would in fact return to Placement A when discharged. Mrs Y explained that the family remained unable to sustain the level of informal support previously provided. On 28 May, she asked whether the respite placement could be extended if required.
24. Mrs X returned home from respite on 30 May. The following week, the Council confirmed that Mrs X’s mobility and independence had improved and that her existing care package was meeting her needs.
25. Mrs Y complained to the Council. She said she had initially been told only one placement was available and that she had not been made aware in advance that Mrs X would have to contribute towards the cost of respite. She said this information might have affected Mrs X’s decision to accept the placement.
26. The Council responded. It said a financial assessment had been discussed on 13 May but acknowledged its records did not show that Mrs Y fully understood that Mrs X would be required to contribute. It apologised for the lack of clarity and offered £100 in recognition of this fault. It did not agree to waive the assessed contribution because Mrs X received the respite care as arranged.

My findings

Placement options

27. The records show the Council discussed three possible placements with Mrs Y on 12 and 13 May. Mrs Y expressed clear reasons why Placements B and C were not suitable and confirmed a preference for Placement A. The Council then progressed brokerage and secured the preferred placement.
28. I have seen no evidence the Council restricted Mrs X to only one option. I do not find fault in relation to the availability of placement choices.

Information about charging and financial assessment

29. Councils have discretion to charge for temporary residential care but must carry out a financial assessment in accordance with the relevant regulations and statutory guidance. The Council’s own policy states that financial assessments should ordinarily be completed before care begins so individuals can make an informed decision.
30. The Council says it informed Mrs Y on 13 May that a financial assessment would be required. However, it accepts its records do not demonstrate that Mrs Y clearly understood that Mrs X would be required to make a financial contribution, nor that explicit consent was obtained on that basis before the placement began.
31. The financial assessment was not completed until 22 May, after Mrs X had already entered respite on 16 May. While I accept the Council was responding to urgent circumstances and prioritised securing a placement quickly, its records should clearly show that Mrs Y understood the financial implications before the service started.
32. The Council has accepted this lack of clarity was fault and apologised. I agree this amounts to fault. Clear communication and accurate record-keeping are particularly important where financial liability is involved.

Injustice

33. The fault caused avoidable distress to Mrs Y and Mrs X. They did not have confirmed information about Mrs X’s assessed contribution until after the placement had begun.
34. However, once informed of the assessed contribution on 22 May, Mrs Y made an informed decision about whether Mrs X should continue with respite. Although she initially indicated Mrs X would not return following hospital discharge, she confirmed the next day that Mrs X would return to the placement. She also later asked whether the respite could be extended.
35. This shows that once the financial position was clear, the family chose to proceed with the respite arrangement. Mrs X received the agreed care and there is no evidence she would ultimately have declined respite had the contribution been known earlier. I therefore do not consider it appropriate to recommend the waiver of the assessed charges.
36. I am satisfied the Council’s apology and offer of £100 appropriately recognises the uncertainty and distress caused by the lack of clarity. This is a proportionate remedy in the circumstances.

Service improvement

37. The Council has confirmed it is reviewing its policies and practice guidance to ensure:
• financial information is communicated clearly;
• officers ensure understanding is confirmed and properly recorded; and
• explicit consent is obtained and recorded before services begin where the outcome of a financial assessment is not yet known.
38. Given these planned improvements and the remedy offered, I do not consider further recommendations are required.

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Decision

39. I find fault causing injustice. The Council has already provided an appropriate remedy.

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Investigator's decision on behalf of the Ombudsman