Summary: The Council was at fault for not providing Mrs X with information about the care process and explaining how the care assessment would work when she asked for care for her mother. As a result, her mother paid for private care and did not realise she could have received help towards the costs of care. The Council agreed to apologise, make a payment, and ensure it has procedures in place to give people information about the care system when they initially approach the Council for assistance.

The complaint

1. Mrs X complains the Council did not tell her that her mother, Mrs Y, could receive direct payments to assist her with the costs of her care and as a result the family ended up paying for home care themselves.

Back to top

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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
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)

Back to top

How I considered this complaint

5. As part of this investigation, I considered the information provided by Mrs X and discussed the complaint with Mrs X over the telephone. I made enquiries with the Council and considered the information received in response. I sent a draft of this decision to Mrs X and the Council for comments.

Back to top

What I found

Information and advice

6. Councils must ensure that they provide information and advice is provided on the care and support system locally and how the system works. This includes:
• An outline of what the ‘process’ may entail and the judgements that may need to be made.
• Specific information on what the assessment process, eligibility, and review stage is, how to complain or make a formal appeal to the authority.
• How to access the care and support available locally – where, how and with whom to make contact, including information on how and where to request an assessment of needs, a review or to complain or appeal against a decision.
• The choice of types of care and support, and the choice of care providers available in the local authority’s area – including prevention and reablement services and wider services that support wellbeing. Where possible this should include the likely costs to the person of the care and support services available to them.
• How to access independent financial advice on matters relating to care and support – about the extent of their personal responsibilities to pay for care and support, their rights to statutory financial and other support, locally and nationally, so that they understand what care and support they are entitled to from the local authority or other statutory providers.

Assessments

7. 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. It must also involve the individual and where suitable their carer or any other person they might want involved.
8. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Carer’s Assessment

9. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
10. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

Refusal of assessment

11. An adult with possible care and support needs or a carer may choose to refuse an assessment. In these circumstances councils do not have to carry out an assessment. Where a council identifies that an adult lacks mental capacity and that carrying out a needs assessment would be in the adult’s best interests, it must do so.

Carer’s Budgets and Respite

12. The Care Act 2014 says the council may meet the carer’s needs by providing a service directly to the adult needing care. The carer must still receive a support plan which covers their needs, and how the council will meet them. The carer’s personal budget must be an amount that enables the carer to meet their needs to continue to fulfil their caring role. It must also consider what the carer wishes to achieve in their day-to-day life. Part of the planning process should be to agree how the carer will use the personal budget to meet their needs. (Care and Support Statutory Guidance 2014)

What happened

13. In June 2021, Mrs Y suffered a fall and was taken into hospital. After returning home Mrs Y received care from the NHS urgent care and reablement team along with care from her two daughters, Mrs X and Mrs Z.
14. Mrs Y was initially referred to the Council’s social care team in July 2021. At this time Mrs Y was put on the list for SSTMI. The Council said this was a short-term service which it puts in place prior to a Care Act assessment being completed. The Council said following a period of normally up to 6 weeks of receiving the service, a Care Act assessment is undertaken to determine any ongoing long-term support needed.
15. In July 2021 the Council started a strengths and needs assessment which found Mrs Y had eligible care needs and drew up a support plan for her. This was to be implemented while she temporarily went into respite care so her daughters could have a break from providing care.
16. Mrs Y went into the care home on 5 August 2021 and came home on 1 September 2021.
17. When Mrs X returned home the Council had arranged a SSTMI package of care for her for 6 weeks. This consisted of four calls per day from carers.
18. On 2 September 2021, Mrs X telephoned the Council as the morning carer had not turned up. Following this Mrs X said she had concerns about carers not being able to confirm when they would arrive to provide care for Mrs Y. Mrs X wanted to know when carers would visit Mrs Y as both herself and Mrs Z would care for Mrs Y while carers were not visiting Mrs Y.
19. On 6 September 2021, Mrs Z emailed the Council and said she was looking into the possibility of private care for Mrs Y as she had finished her respite care in the care home. Mrs Z asked the Council if there was any financial assistance with this. The Council responded and told Mrs Z if it was arranging the care the social worker would arrange for a financial assessment to decide what costs she would have to pay.
20. On 14 September 2021, Mrs X told the Council she was arranging carers for Mrs Y. The notes from the telephone call said she was pleased with the carers but Mrs Y was not engaged with the service and the family would arrange private care. Mrs X said the family arranged care for Mrs Y as the carers arranged by the Council did not come on time and could not tell her or Mrs Z what times they would visit.
21. The Council closed Mrs Y’s case. Mrs X said neither she nor Mrs Z were made aware the Council had closed the case.
22. In March 2022, Mrs X contacted the Council to ask for respite care for Mrs Y in a care home as Mrs X and Mrs Z were struggling with supporting Mrs Y. Mrs X said during her telephone call with the Council, the Council officer asked her if Mrs Y was receiving Direct Payments for her package of care. Mrs X said she did not know what Direct Payments were. After the Council officer explained what they were, Mrs X discussed direct payments with Mrs Y’s social worker.
23. Mrs X made a formal request for Direct Payment funding for Mrs Y’s package of care and placement in respite on 26 April 2022.
24. Mrs Y went into the care home for respite care in May 2022. The Council approved Mrs Y for direct payments for her respite care (£1,776.12) and her package of care at home (£274.84 per week) on 27 May 2022.
25. Mrs Y’s stay at the care home was extended and in September 2022 it was decided she would remain here permanently.

Mrs X’s complaint

26. In September 2022, Mrs X complained to the Council that it did not tell her Mrs Y could receive direct payments to assist her with the costs of her care and as a result care was paid for privately. Mrs X said:
• The carers the Council put in place after she came out of respite care could only arrive between a wide band of hours. Mrs X had concerns that if Mrs Y was left for too long on her own she would dehydrate or have an increased chance of falling.
• The Council did not tell her she could receive financial help for care costs.
• After finding out about direct payments she requested these for Mrs Y.
• She wanted the Council to reimburse the family for the direct payments Mrs Y would have received had she known about them.
27. The Council responded to Mrs X’s complaint in October 2022. The Council said:
• When Mrs X ended the SSTMI service because of timings of the care calls, the Council was not provided with any further opportunities to discuss any options or asked further queries about ongoing support. The Council said it then closed Mrs Y’s file.
• It had no evidence of any discussions taking place regarding request for financial support.
• It could only commit to funding for care following a Care Act assessment being completed for Mrs Y.
• It could not provide any financial support to Mrs Y without a Care Act assessment to establish Mrs Y’s eligible needs. The Council said it could not reimburse the family for any funding.
28. Mrs X remained dissatisfied and complained to the Ombudsman. Mrs X said she did not know what a Care Act assessment was or whether the Council were completing this for Mrs Y. Mrs X said once she found out about direct payments she asked the Council for these and would have asked sooner had she known the process. Mrs X also said Mrs Z asked about financial assistance with Mrs Y’s care costs in September 2021.
29. In response to my enquiries the Council said it did not discuss direct payments with the family as a Care Act assessment had not been completed for Mrs Y and the family were making their own arrangements for Mrs Y’s care.
30. The Council said it put in place SSTMI which is a short term enabling/prevention service to maximise independence as far as possible. The Council said during this service the Council would carry out a Care Act assessment to determine a person’s long term care needs, however the family said they would make their own arrangements and did not need adult social care input.

Analysis

31. Mrs Y was first referred to the Council in July 2021 after being taken to hospital. While the Council did arrange for a package of care for Mrs Y after she returned home, it did not provide Mrs Y or her daughters with any information about the Care Act assessment process or information on how to pay for care. This is fault.
32. The Council said it did not carry out a Care Act assessment as Mrs X had found a new care provider for Mrs Y. The case notes the Council provided do not show anywhere that Mrs X refused a Care Act assessment or asked for this to be ended. The case notes also do not show the Council discussed the consequences of moving Mrs Y to a new care provider and that this would mean the Care Act assessment would stop. When Mrs X complained to our service she was not aware of what a Care Act assessment was. In addition, I have not seen any evidence to show Mrs X and Mrs Z were told the Council had closed Mrs Y’s case after Mrs X told the Council she had found a new care provider. This is fault.
33. As I have found fault I need to consider whether this has caused any injustice. I am satisfied that on balance Mrs X would not have wanted Mrs Y’s Care Act assessment to end and did not refuse an assessment. Had the Council explained the care assessment process to Mrs X and how the financial assessment process works I am satisfied on balance she would not have paid privately for Mrs X’s care, or she at least would have discussed options with the Council to continue to carry out a Care Act assessment to receive financial help. Had Mrs X known about the financial options available for Mrs Y, I am satisfied she would have asked the Council for direct payments much earlier.
34. In deciding whether the Council should backdate Mrs Y’s direct payments I cannot see that Mrs Y’s care needs had significantly changed from September 2021 to May 2022. This is on the basis that, in July 2021, the Council considered Mrs Y had eligible care needs as outlined in her strengths and needs assessment. If anything Mrs Y’s care needs have increased as she now lives in a care home. It is therefore appropriate that the Council backdate Mrs Y’s Direct Payments as on balance she would have received these earlier but for the Council’s fault.

Back to top

Agreed action

35. Within one month of my final decision, the Council agreed to carry out the following:
• Apologise to Mrs X for not giving her information about how the care assessment process works and for not telling her it had closed Mrs Y’s case.
• Pay Mrs X, for the benefit of Mrs Y, the backdated amount of Mrs Y’s Direct Payments from 1 November 2021 to 27 May 2022. I have put 1 November 2021 as a start date as this would have been an appropriate time for the Council to have completed its assessments by.
• Ensure that it has procedures in place to give people information about the care system and how it works when they initially approach the Council for assistance.
36. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

37. I have completed my investigation and found the Council was at fault which caused injustice to Mrs X and Mrs Y. The Council agreed to the above actions to remedy the injustice caused.

Back to top

Investigator's decision on behalf of the Ombudsman