Summary: Mrs X complained the Council failed to provide full information about her financial assessment and the costs of her care. She also complained about the actions of the care provider, Embracing Care. The Ombudsman found there was fault causing injustice when the Council failed to provide enough information about charging. The Council agreed to a suitable remedy.

The complaint

1. Mrs X complained the Council failed to provide full information about her financial assessment and the costs of her care before she started receiving care from a new care provider, Embracing Care (the care provider). She said her financial assessment did not take place until a month after her care started.
2. Mrs X also complains about the care provider. She did not receive any information about her care package, she does not think proper records were kept, and she was bullied by the care provider to try to make her accept a male carer.
3. Mrs X suffered distress when she found out she must pay the full cost of her care, and through the actions of the care provider.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

7. As part of the investigation I have considered the following:
• The complaint and the documents provided by the complainant.
• Documents provided by the Council and its comments in response to my enquiries.
• The Care Act 2014.
• Care and Support (Charging and Assessment of Resources) Regulations 2014.
• Care and Support Statutory Guidance 2014.
8. Mrs X 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

9. If a person has been in hospital, they may need temporary care to help them stay independent and get back to normal. This is known as intermediate care or reablement care.
10. Local authorities must not charge for intermediate or reablement care for the first six weeks. After six weeks local authorities may charge for it.
11. The Care Act 2014 (the Care Act) sets out councils’ powers and duties in respect of adult social care services. Section 14 of the Care Act allows councils to charge for care and support it arranges. Section 17 of the Care Act requires councils to assess an adult’s financial resources if they intend to charge them a fee, to decide what contribution they should pay.
12. Once a council decides a person has eligible care and support needs, it must carry out a financial assessment to see what contribution the person may have to pay towards the cost of their care. The amount a person may pay is based on what they can afford and will take account of their income and assets. A council cannot charge more than the cost it incurs.
13. The law does not set a timescale for local authorities to complete an assessment. However, statutory guidance says it should be carried out over an appropriate and reasonable timescale.
14. When carrying out a financial assessment, councils must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 (the Regulations). This sets out how councils should treat an adult’s income and capital when calculating their care contributions.
15. The Regulations set an upper capital limit of £23,250. If an adult has capital or assets above the upper limit, they are considered to be a self-funder. This means they must pay the full cost of their care and support.
16. A Council may be satisfied a person can afford any charges due when that person has property clearly worth more than the upper capital limit.
17. Councils must ensure information and advice is available in a format easy to understand, making clear what contributions people must make. This is part of its duty under the Equality Act 2010.

What happened

18. Mrs X was in hospital in September 2019 after breaking her thighbone. When doctors considered Mrs X was ready to start her rehabilitation they referred her to the Short Term Support Service (STSS) for reablement care at home.
19. The Council met with Mrs X on 26 September and she agreed to four daily calls from carers to support with personal care, meals, and mobilising up and down the stairs.
20. The Council carried out a review with Mrs X for the fifth week of her reablement care, on 23 October 2019. At that point, Mrs X was having two calls from carers each day. One morning call and one evening call. Mrs X agreed for the Council to put her forward for long term care after her reablement care finished. The Council told Mrs long term care could be stopped at any time and booked a needs assessment for her.
21. The Council carried out Mrs X’s needs assessment at her home on 28 October 2019. Mrs X’s son was also present. The assessment identified Mrs X had eligible needs for care and support. In particular, she needed support:
• Meeting her toileting needs.
• Preparing, serving meals and maintaining a healthy nutritional intake.
• Moving around her home and getting in and out of her home.
22. The Council’s records indicate it told Mrs X about having a financial assessment and the charging process. Mrs X agreed to have a financial assessment. She also agreed for her new services to start once reablement care ended, even if her financial assessment had not been completed.
23. Following the needs assessment, the Council sent an urgent request for a financial assessment. It also drafted a care and support plan for Mrs X, proposing:
• Seven 30-minute mid-morning calls each week at 10am.
• Seven 30-minute evening calls not before 9pm.
24. Mrs X’s indicative personal budget for the cost of her care was estimated to be £4,365 a year, or £83.75 per week. A final budget was to be confirmed later. Her care plan states she may have to pay all or part of this cost, subject to a financial assessment.
25. The Council approved Mrs X’s care and support plan on 29 October 2019. It sent Mrs X a copy by post and telephoned her to confirm this. It told Mrs X the new care provider was Embracing Care. Initially, the Council told Mrs X the care provider would start her care package on 4 November 2019. It also said it would ask the STSS to visit on the same day to do a handover to the care provider.
26. The Council then told Mrs X it got the dates wrong. The care provider would start on 11 November 2019. The STSS would continue to provide care in the meantime but Mrs X would have to pay for this service from 4 November. Mrs X agreed.
27. A finance officer from the Council contacted Mrs X on 5 November 2019. They arranged to carry out a full assessment on 14 November.
28. Mrs X telephoned the Council on 11 November 2019. She was concerned about the transition to the new provider. A carer had visited in the morning but there was no file to handover. Mrs X felt poorly informed and was worried about answering the door to a stranger in the evening.
29. The Council telephoned Mrs X to apologise. It told her it spoke with the care provider who confirmed a file was on its way later that day for carers to sign in and out at visits.
30. The provider visited Mrs X that afternoon to complete her assessment and care plan, which Mrs X agreed to and signed. The provider left Mrs X with a log book for carers to complete when they visited.
31. Mrs X telephoned the care provider on 13 November 2019. She said she did not want male carers. The care provider could not make many changes to its rota for the next two weeks but said it would try to remove male carers where possible. It gave the dates male carers were scheduled to work. Mrs X said she may cancel visit on those dates.
32. The care provider told the Council, who in turn spoke to Mrs X. Mrs X cancelled visit by male carers scheduled for 18 and 19 November and 1 and 5 December 2019.
33. A finance officer telephoned Mrs X on 14 November 2019, but she did not answer. The assessment was rearranged for the following day.
34. On 15 November 2019, a finance officer completed Mrs X’s financial assessment. Mrs X provider her bank balances and said she owned a second house which she rented out. The finance officer told Mrs X that because she owned a second house she would have to pay the full costs of her care. Mrs X was unhappy and wanted to cancel her care plan. She was not happy care started before the financial assessment took place and she wanted to complain.
35. Mrs X telephoned the Council and said she wanted to cancel her care plan as she could not afford it. She was also unhappy the care provider was due to send a male carer later that day and she wanted to cancel all care visits immediately.
36. Mrs X telephoned the care provider to say she did not want a male carer to call that evening. The care provider said it looked at the package as much as possible but there are occasions only male carers are available. Mrs X understood this. The care provider said it would ensure only female carers from 25 November onwards.
37. The Council spoke to the care provider. There had been difficulties providing only female carers for Mrs X and she cancelled some of her visits when a male carer was scheduled. The care provider confirmed it would ensure female carers in future from next week. The Council said it did not think that was the reason for cancelling. The care provider said it needed 48 hours’ notice by email to cancel services and charges would be incurred for that period.
38. The Council then spoke to Mrs X again. She was tearful and said she could not afford her care package, even if it was reduced to only one visit a day. Mrs X was unhappy care started before the financial assessment. Initially, she was only asked if she had savings over £23,000, she was not asked if she had a second home. Mrs X agreed to keep the care package in place until her care worker could call her on 18 November 2019.
39. Mrs X met her care worker on 18 November. Mrs X said she did not know having a second home counted as a second income. She said no one asked her about this in her initial assessment. She said she would not have agreed to her care package if she had known the cost. Mrs X’s care worker apologised and agreed to cancel the care package.
40. The Council cancelled the care package with the care provider. An end date of 20 November was confirmed.
41. Mrs X telephoned the Council on 20 November 2019 because carers continued to visit. She said two carers turned up the previous night when she was in bed, including a male carer.
42. The Council spoke with the care provider to ensure the care package had ended. The provider said Mrs X cancelled visits from male carers on 15 November and 17 November. It received notice to cancel the care package on 18 November. It needs 48 hours’ notice, meaning the last care visit is on the evening of 20 November. Mrs X cancelled the last scheduled visit on the evening of 20 November.
43. Mrs X complained to the Council on 26 November 2019. She said:
• The care provider harassed her to accept male carers on a daily basis to suit their rota.
• The care provider gave permission for a male carer to enter her home without warning on 16 November (fortunately he swapped the visit as he knew Mrs X did not want male carers).
• She cancelled her care on 15 November so the care provider should not have sent any more carers.
• Her financial assessment was not done until 15 November. When she was told she had to pay the full cost of her care, she cancelled her care package.
44. The Council sent its complaint response on 10 January 2020. It said:
• Its records show Mrs X understood she would have to contribute to the cost of her care from 4 November 2019, even though her financial assessment was not yet complete. It posted a copy of Mrs X’s needs assessment to her on 29 October 2019. This summarises the discussion Mrs X had with the assessor about charges.
• The financial assessor decided Mrs X had to pay the full cost of her care because she owns a second home. The Council has an information sheet about charging which confirms the value of additional properties a person owns will be taken into account. Unfortunately, Mrs X’s assessor could not recall whether he gave this information sheet to Mrs X. The assessor has been reminded of the need to do this and to keep a record. It will also be raised with team managers at their next meeting.
• There was a handover from an STSS carer to a carer from the care provider on the morning of 11 November 2019. Unfortunately, the care provider could not complete an initial visit to carry out an assessment until 13 November.
• When Mrs X learned a male carer was due to visit over the weekend of 16 and 17 November 2019, she cancelled those calls and the care provider ensured her only female carers would carry out visits from 25 November onwards.
• Every care provider has an annual visit from the Council to ensure it is meeting standards about documents, staff files, policies and procedures. Any issues are discussed with the care provider.
• Mrs X asked to cancel her care package on 15 November but agreed to continue it over the weekend until her allocated worker returned to the office on 18 November, when Mrs X repeated her wish to cancel her package. The Council apologised for the subsequent visits on 18 and 19 November and confirmed Mrs X would not be charged for them, or the visits over the weekend of 16 and 17 November.
• The finance team would send an invoice for the outstanding charge of £204.40 for the care PA received between 4 November and 15 November 2019.
45. Mrs X brought her complaint to the Ombudsman on 16 January 2020. She considered it was unacceptable the Council was asking her to pay for the care she received when it did not give her full information at the outset.

Response to my enquiries

46. The Council told me it sent Mrs X a copy of her care plan prior to services starting, and she was aware she would be charged.
47. It contacted the provider about Mrs X’s bullying complaint and was assured by the provider that no bullying had taken place. The provider took steps to meet Mrs X’s request for female carers.
48. The Council said, unfortunately, its complaint response is wrong about the date of the provider’s initial visit and assessment. The Council apologised for the error.
49. I also received comments from the provider. It was not aware Mrs X did not want male carers until she contacted them on 13 November. The Council’s referral did not mention this, nor did Mrs X’s support plan. It is not a question the provider asks when completing their own plan. However, going forwards the provider will change its template of questions to include that it has male and female staff. It will also change its service user guide to add this information.
50. The provider said at no time did it harass or bully Mrs X to accept male staff. It changed her rota as much as possible and made Mrs X aware of four dates male staff would be visiting. Mrs X cancelled those calls.
51. The provider said it is normal practice to bring all paperwork out of the service users house after the last call. Mrs X cancelled the last call, so this was not done. Normally a manager would go to pick up the paperwork. As the manager is male the provider thought it best not to do so. On the return of the deputy manager (who is female), the provider contacted Mrs X, but she could not find the paperwork.

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Analysis

52. When the Council told Mrs X she would have to contribute to the cost of her care. from 4 November 2019, before the financial assessment, Mrs X agreed.
53. However, in its complaint response, the Council acknowledged it should have given Mrs X more information about charging. The assessor could not remember giving out information leaflets, and did not record this, so there is clear administrative fault.
54. The fact Mrs X cancelled the care package immediately after finding out she would have to pay the full cost shows she would not have gone ahead with the care package if she had known the full details about charging from the outset.
55. The financial assessment did not happen as quickly as Mrs X wanted, or before her care package started. There were 18 days between the needs assessment and the financial assessment. I do not consider that was an unreasonable delay.
56. The handover from STSS to the provider was not as smooth as Mrs X expected. However, I do not consider she suffered any significant injustice here. The Council sent Mrs X her care plan before her care started and was on hand to answer her questions. It contacted the care provider the same day the service started to ask about the assessment and records. The care provider visited Mrs X and completed her assessment the same afternoon.
57. I have not seen evidence Mrs X made the Council or the care provider aware she only wanted female carers before her care package started. I consider it would be unfair to expect the provider to have asked Mrs X if she minded having male carers.
58. Likewise, I have not seen evidence the provider bullied Mrs X or tried to force her to accept male carers. When Mrs X told the care provider she did not want male carers it did its best to accommodate only female carers. It was not always possible due to staffing levels. Mrs X was able to cancel those visits.
59. To its credit, the provider plans to tell future service users from the outset that it employs a mix of male and female carers.
60. Mrs X questioned the care provider’s record keeping after it left her daily logbook with her when her care package ended. She questioned how the Council can check the care provider’s records in these circumstances. While I am satisfied with the care provider’s explanation that Mrs X cancelled the last visit, and it did not want to send a male carer round to collect the records, I appreciate the point Mrs X made. There is no way for the Council, or the Ombudsman, to check suitable care was given without the records. This is something the Council and the care provider should review so there is no repeat of logbooks being unobtainable or misplaced.
61. The circumstances around Mrs X cancelling the care package are a little confusing. Despite cancelling the package, it appears she was still contacting the care provider to express her unhappiness with having male carers attend. I have not seen evidence anyone told Mrs X when the package would end or when the last call would be. This should have been confirmed more clearly. This is something the Council and the care provider can look at in future.

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Injustice

62. When Mrs X discovered her second home would be considered as part of her financial assessment, and that she was therefore liable to pay the full costs of her care, she suffered avoidable distress and frustration. This is her injustice.

Agreed action

63. Within four weeks of my final decision, the Council agreed to:
• Repeat its apology for failing to provide Mrs X with enough information about the charging process.
• Waive the invoice of £204.40 for the care Mrs X received.
• Provide evidence of action taken to remind staff about providing full information on charging and keeping a suitable record.
• Review the way the care provider’s daily care logbooks are kept and stored.

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Final decision

64. I have completed my investigation. There was fault causing injustice when the Council failed to provide enough information about charging.

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Investigator's decision on behalf of the Ombudsman