Summary: Mr X complains that the Council wrongly assessed Mrs Y’s finances, failed to provide adaptations and to deal effectively with his complaints about this. It also continued to provide carers after they caused injury to Mrs Y. He says this caused much anxiety, later assessments were incorrect and Mrs Y was trapped in the house and had to pay privately for adaptations. The Ombudsman found the Council was at fault in the way it dealt with Mrs Y’s finances and the quality of care it provided. It has already remedied the injustice.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains on Mrs Y’s behalf, that the Council:
1. Wrongly assessed Mrs Y’s finances and failed to correct it so later assessments were also affected.
2. Provided care which was poorly delivered and caused Mrs Y harm.
3. Failed to deal properly with Mrs Y’s needs for equipment and adaptations to her property so she had to pay for this privately.
4. Failed to deal effectively with Mr X’s complaint about this.
2. Mr X says the Council treated Mrs Y as a permanent resident although they had been clear that she was to return home as soon as possible. He also had to build a ramp himself so Mrs Y could attend a medical appointment as otherwise she was trapped in the house. Mr X says every time they have provided information, the Council has asked for something else and he has repeatedly had to provide the same information.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. If we are satisfied with a council’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)
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
6. In this case, Mrs Y has consented to Mr X complaining on her behalf.

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How I considered this complaint

7. I considered information from the Complainant and from the Council.
8. I sent both parties a copy of my draft decision for comment and took account of the comments I received in response.

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What I found

9. The Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance 2014 set out the charging rules. Local authorities must follow these rules when completing a financial assessment to calculate how much a person must pay towards the costs of the stay. Local authorities can charge the person under the temporary residential charging rules or the non-residential charging rules.
10. A temporary resident is someone whose stay in a care home is unlikely to exceed 52 weeks. Because a temporary resident is expected to return home their main or only home is usually disregarded in the assessment of whether and what they can afford to pay. Certain housing-related costs are also disregarded in the financial assessment

Property disregard

11. Local authorities must disregard the value of the person’s main or only home in certain circumstances. This includes where:
• the person receives care and is not in a care home.
• The person is a temporary resident in a care home and intends to return to the property.
12. The regulations aim to prevent people having to sell their home at a time of crisis. Local authorities must therefore disregard the value of a person’s main or only home for 12 weeks when a person first enters a care home as a permanent resident. This provides the space to consider whether this is the right course of action before selling their home.

Deferred payments scheme

13. Local authorities must offer a deferred payment to people who meet the following criteria:
1. “person is ordinarily resident in the local authority area or present in the area but of no settled residence; or ordinarily resident in another local authority area but the local authority has determined that they will or would meet the individual’s care needs under section 19 of the Care Act if asked to do so”.
2. “person has needs which are to be met by the provision of care in a care home. This is determined when someone is assessed as having care and support needs which the local authority considers should be met through a care home placement”.
3. “person has less than (or equal to) £23,250 in assets excluding the value of their main or only home (for example, in savings, other non-housing assets and housing assets other than their main or only home)”.
4. “person’s home is not disregarded; for example, it is not occupied by a spouse or dependent relative as defined in regulations on charging for care and support (for example, someone whose home is taken into account in the local authority financial assessment and so might need to be sold)”.
14. The Council pays the difference between the actual assessed client contribution and the amount that would be assessed if the value of the home were disregarded. The Council takes a legal charge on the home so it can be sold later, and the Council repaid from the proceeds. The property must be sold on the person’s death if it has not already been sold.
15. Local authorities should assure themselves that residents will be able to pay back the deferred amount including any top up when their property is sold.

Disabled Facilities Grants

16. Disabled Facilities Grants are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to provide grant aid to disabled people for certain adaptations. Before approving a grant a council must be satisfied the work is necessary and suitable to meet the disabled person’s needs and also reasonable and practicable.
17. The maximum amount of a grant payable by a council is £30,000. The amount of grant a council will pay is subject to a means test.
18. A council should give the applicant a decision on a grant application as soon as reasonably practicable. This must be within six months of the grant application. If a council refuses a grant it must explain why. Once the work is complete, the council must pay the grant in full within 12 months of the date of the grant application.
19. Home improvement agencies (HIAs) are not-for-profit organisations which can help people with DFGs.

Continuing healthcare

20. Continuing healthcare (CHC) is a package of care arranged and funded solely by the health service. CHC is for people whose main care need is health related, who are not in hospital and who have complex ongoing health needs. It is fully funded by the health service and the person pays no contribution.

What happened

21. In 2016, following a hospital admission, Mrs Y was discharged to a nursing home funded through CHC.
22. In March 2017, Mrs Y’s social worker requested a financial assessment as her CHC funding was soon to end.
23. In April, the Council visited Mrs Y in the residential care home to help Mrs Y’s daughter complete the necessary form.
24. The assessment assumed Mrs Y would stay in residential care. The Council applied a 12 week disregard and provided information about the deferred payment scheme. The assessment found Mrs Y should pay the full cost of her care from the end of the 12 week period. This is because it took the value of her home into account.
25. In July 2017, Mrs Y returned home with a package of care. The Council completed another financial assessment and assessed Mrs Y should pay £43.57 per week.
26. In September, the Citizen’s Advice Bureau (CAB) wrote to the Council on Mrs Y’s behalf. However, the letter did not arrive in the correct finance department until 7 November as it was addressed to another department.
27. On 3 October, the social worker advised the finance department that Mr X and Mrs Y had complained that Mrs Y was charged the full cost of her residential stay. She asked for a joint visit to reassess. The finance department advised that a joint visit would not be necessary as the assessment information was correct. It said it just needed paperwork to show the stay was temporary not permanent, as this meant it had included the value of the property.
28. On 4 October, the OT completed an assessment as Mr X and Mrs Y wanted to install a ramp for wheelchair access to the property. Mr X also considered a stairlift, but the OT advised this would not be suitable for Mrs Y due to her breathlessness and safety transferring to and from a wheelchair. The OT identified problems with access to the bathroom and bedroom and noted difficulties with access to the property at the front and rear. The door had a raised threshold and a step up to it, and the driveway sloped steeply. She noted at least a 1m drop between the step and pavement level and a ramp might not be feasible. Mr X considered a temporary ramp but the OT advised this was likely to be unsafe. She advised Mr X and Mrs Y that a steplift was a potential solution but this, a through floor lift and level access shower, might exceed the £30,000 maximum grant. It could also take up to a year. The OT suggested they consider whether a move to ground floor accommodation might be more suitable. She agreed to continue with the application for a DFG while they considered the suggestion. She requested a level access shower, ramped front and rear access to the property, and a through floor lift. She also asked for advice from a surveyor on the feasibility of a ramp or steplift, and potential costs. She left the financial questionnaire with Mrs Y to complete and return to the HIA.
29. On 5 October, the OT submitted a referral to the Home Improvement Agency and asked for advice on feasibility of the adaptations and potential cost. She asked for a second opinion on the ramp and was advised temporary ramps would be unsafe.
30. On 6 October, the CAB wrote and asked the Council for a reassessment. It included several documents and said the Council had used an incorrect figure for savings. It said this meant Mrs Y had to pay full cost for her home care and for a DFG. The Council said the evidence of savings showed some large withdrawals that needed explanation before the reassessment. The letter also advised the residential care she had received was not satisfactory.
31. Mr X arranged the installation of a stairlift.
32. On 1 November, the social worker confirmed the residential placement paperwork should have said it was a temporary stay.
33. On 10 November, Mr X asked for help completing the DFG finance questionnaire. The Council offered to help over the phone and Mr X said a family member might be able to help.
34. On 29 November, the Council recalculated Mrs Y’s financial assessment for the time she spent in residential care and disregarded the property for the whole stay.
35. In December, the Council wrote to Mrs Y asking that she return the DFG finance questionnaire within 14 days. Mr X asked for help to complete the form. The Council arranged a home visit with the HIA to help.
36. On 24 January 2018, an officer from the HIA visited with an officer from the Council and completed the finance form. The Council sent a letter to Mrs Y to advise her the initial calculation showed that she would be eligible for £275 in grant funding.
37. On 31 January, the CAB wrote to the Council querying the savings used in the calculation. The following week, the Council responded asking for information about the large withdrawals which totalled around £11,000. Mr X says the CAB had supplied receipts to the Council in 2017 to evidence expenditure on three main items – a mobility adapted car, stairlift and front door with double panel disabled access. Mr X says this was to enable Mrs Y to get to hospital for treatment to injuries caused by the Care Provider arranged by the Council.
38. On 15 February, an occupational therapist visited Mrs Y at home; Mr X was also present. Mr X had built a temporary ramp at the rear but the OT advised this would not be safe or suitable due to the height of the rear step. Mr X had also got a quote for a level access shower and a ramp at the front of the house. They discussed options:
1. A DFG using the HIA which was likely to take around ten months;
2. A DFG making private arrangements for the work and managing the project themselves;
3. Arranging the work privately without financial help; and
4. Rehousing.
39. The OT agreed to give them time to consider the options and to contact them in a few days to find out how they wished to proceed.
40. On 26 February, the OT telephoned Mr X and he advised that the DFG process was too long so did not want to go ahead. The OT closed the case.
41. On 22 March, the Citizen’s Advice Bureau (CAB) wrote to the Council on behalf of Mrs Y, with a formal complaint about:
• Including the property in the assessment.
• Miscalculating her savings.
• Overcharging for her care.
• Failing to support Mrs Y to find alternative accommodation as promised.
• Failing to provide a ramp so Mrs Y can leave the house unaided.
42. On 24 April 2018, the Council wrote to the CAB advising the financial reassessment for finances during the residential stay was complete. However, it still needed information about the large transactions to complete the current financial assessment. The CAB wrote to Mrs Y to update her. It said the Council had now corrected the fees to the amount she should have paid as a temporary resident. The Council had also correctly assessed her finances and as the savings of £19,000 were below the threshold, they had not been included. The Council had now correctly calculated her contribution at £43.57 and had provided a table of what she owed. The CAB recommended Mrs Y now pay the outstanding amount of £5,752.72 as soon as possible.
43. On 3 October, the Council received an email from the CAB enclosing receipts previously requested. The Council responded and advised that it would review Mrs Y’s contribution to her home care once it had received more information about the withdrawals.

Was there fault which caused injustice?

44. The Council was at fault when it assessed Mrs Y as permanently in residential care. This was caused by incorrect information passed to the finance department, a small error, easily resolved, but the Council took about six months to put this right. This caused Mr X distress, time and trouble and affected later assessments.
45. However, the Council could not review the later assessments because it did not have the information about the withdrawn £11,000. Mr X says the Council had this but the Council says it did not. I saw no evidence that the Council had this information although this does not mean it had not received it. Mrs Y also had not paid the outstanding amount for her residential care although the Council had corrected its assessment. This would have reduced her savings and therefore affected the assessment, but not until it had actually been paid.
46. The Council apologised for the error and put right what it could. I have decided the injustice caused was not enough to need further remedy.
47. Although this is a difficult and clearly stressful situation for Mrs Y and Mr X, the Council was not responsible for the difficulties in providing suitable adaptations. It advised about the feasibility of ramps and suggested moving to more suitable accommodation. It should not arrange temporary ramps if these would be unsafe. The Council could not continue with the DFG process as Mr X said they did not wish to continue with it. Mr X and Mrs Y chose to fund adaptations privately, this was not the Council’s fault.
48. The Council was slow to deal with Mr X’s complaint but it was hampered by the delay getting information it had requested. I have decided the Council did not cause significant injustice here.

Final decision

49. I have completed my investigation and uphold Mr X’s complaint that the Council:
1. Wrongly assessed Mrs Y’s finances and failed to correct it so later assessments were also affected.
2. Provided care which was poorly delivered and caused Mrs Y harm.
50. I have not upheld Mr X’s complaints that the Council:
1. Failed to deal properly with Mrs Y’s needs for equipment and adaptations to her property so she had to pay for this privately.
2. Failed to deal effectively with Mr X’s complaint about this.
51. I have not made recommendations as I have not found enough injustice still needing remedy.

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Investigator's decision on behalf of the Ombudsman