Summary: The Council failed to deal with the charging for Mrs Y’s care properly. It charged for more care hours than she received, gave inaccurate information about hourly care rates, and generated inaccurate invoices. It failed to properly investigate the discrepancies highlighted by Mrs X and failed to provide an adequate complaint response.

The complaint

1. Mrs X complains on behalf of her late mother, Mrs Y. She says the Council failed to deal with the charges for her mother’s care properly.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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)

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How I considered this complaint

4. I have:

• considered the written complaint;
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 (updated 2017) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s power to charge
6. The upper capital limit to be eligible for funding for social care support by the local authority is currently set at £23,250. Below this level, a person can seek means-tested support from the local authority.
7. The Guidance sets out the overarching principles which underpin charging for adult social care services. These are (among others):

• Ensure that people are not charged more than is reasonably practicable for them to pay
• Charging should be clear and transparent, so people know what they will be charged.

8. Where a local authority has decided to charge, except where a light touch assessment is permissible, it must carry out a financial assessment of what the person can afford to pay and, once complete, it must give a written record of that assessment to the person. 
9. Where a person’s resources are below the lower capital limit of £14,250 they will not need to contribute to the cost of their care and support from their capital.

Background

10. During the events complained about Mrs Y lived at home with her husband, Mr Y. Because of a previous stroke, and other health issues, she required support with all aspects of daily living.
11. Mr Y was Mrs Y’s sole carer until November 2020, when he became unwell himself. The Council commissioned homecare services. From 4 November 2020 Mrs Y received four care visits a day with two carers at each visit, a total of five billable care hours a day.
12. The Council completed a financial assessment of Mrs Y in December 2020. At the time Mrs Y was just over the financial threshold for assistance with care fees and was therefore classed as a self-funder. The Council commissioned the care and Mrs Y paid the full cost directly to the Council.
13. The Council says a social worker advised Mrs X to contact the Council when Mrs Y’s savings fell below the capital threshold.
14. The Council completed a second financial assessment in February 2021. The assessing officer recorded Mrs Y’s savings as unchanged, and that she remained just over the capital limit. The Council says in such situations it “…sometimes completes a capital estimate to determine when the service user's savings will fall below. However, we have never been able to verify Mrs Y's savings therefore Mrs Y's daughter was advised that in order for a reassessment to be completed we would need to verify savings via copy bank statements”.

On 21 January 2021, Mr & Mrs Y requested the evening care visit be removed. The reduction meant Mrs Y received 2 hours care a day with two carers at each visit, a total of 4 billable care hours a day.

15. Mr Y received an invoice for Mrs Y’s care, the invoice incorrectly recorded Mrs Y to be receiving 8 care hours per day and charged her accordingly.
16. On 16 February 2021, Mrs X contacted the Council’s finance team to dispute the invoice and clarify the amount of care hours Mrs was receiving. Mrs X told the Council it had charged Mrs Y for 8 care hours a day, when she was receiving four. The finance team sent an email to the Council’s income management team asking it to investigate.
17. The Council spoke with Mrs X and the Care Provider. The hours recorded by the Care Provider did not match those recorded by the Council. Mrs X says the support plan confirmed Mrs Y received 2 hours care each day with two carers at each visit. She agreed to send the Council a photograph of Mrs Y’s care plan. She also said the carers agreed this to be correct.
18. Mrs X contacted the Council 23 times between 15 February 2021 and 18 March 2021. In one email she reported the Council sent details of another service user to Mr Y with the same surname as Mrs Y on three occasions.
19. In response to my enquiries the Council says the Care Provider’s understanding of the agreed care hours did not match that of Mrs Y “…(and finance was therefore, "stuck in the middle" and unable to reconcile the issue we followed normal procedure and passed the query to social worker, [office’s name], on the 19 February to investigate and arbitrate as this usually resolves the matter successfully. Unfortunately, social care's understanding of the POC composition also differed from [Mrs X] and the care agency”.
20. The social worker contacted Mrs X and the Care Provider again in March 2021 to clarify the care hours. The Officer asked “…for the agency to have a conversation with daughter, [Mrs X], regarding the invoice, charges and hours worked”.
21. Mrs X says she was “…passed from one person to another having to repeat myself over and over again dealing with people who are at first involved to some degree and then pass on responsibility to another”. She says the process was stressful and frustrating.
22. The Council acknowledges the case “…was passed between teams…” It says its finance team could not deal with the matter because of the differing opinions about the agreed care hours, so it passed the matter to social services for clarification, which the Council says, usually resolves such matters. In this case social services understanding differed from that of Mrs Y and the care agency.
23. In March 2021, Mr Y received notification from the Council that the hourly rate for care had increased to £15.90 per hour. Mrs X contacted Mrs Y’s social worker. The social worker said she was no longer the case worker for Mrs Y and referred Mrs X back to the finance team.
24. The Council says a council officer confused the hourly rate it paid to the Care Provider with the hourly rate charged to service users. In response to my enquiries, the Council said, “The confusion here was caused by social care colleagues incorrectly communicating to [Mrs X] the hourly rate Lancashire County Council pays the agency, not the rate that is charged in terms of client contributions”. 
25. Mrs X did not submit a formal complaint to the Council, instead she made a complaint to this office in March 2021. As the complaint had not been through the Council’s formal complaint procedure we deemed it premature. Mrs X submitted a formal complaint to the Council on 12 March 2021.
26. The Council provided Mrs X with a written complaint response on 28 April 2021. The letter gives a brief overview of events, and says, “There appears to be some discrepancies between what the contract of care is and the actual hours that are being provided and how this has been communicated”. There was no apology for the error, nor any acknowledgment of the time and effort Mrs X had invested in attempting to resolve the issues, or the distress caused to Mr Y.
27. Mrs X was dissatisfied and resubmitted her complaint to this office.
28. In response to my enquiries, the Council said, “…there was an error made with the total number of hours commissioned. Instead of 28 hours being inputted on the CPLI, 42 hours were inputted. This is where the discrepancy appears to have been… the account has been, "on hold" since February 2021 in terms of care contributions due to an inability to reconcile the correct POC composition…”
29. During this investigation, Mrs Y sadly passed away, on 7 September 2021.

Analysis

30. There is evidence of confusion and poor communication throughout this complaint.
31. The Council’s handling of the matter was poor. Mrs X was passed around departments and officers. There appears to have been no thorough investigation by the Council until this investigation was underway.
32. In her attempts to clarify the situation Mrs X sent the Council a copy of Mrs Y’s care plan, I am unclear why she should have had to do so. The Council held a copy of Mrs Y’s care plan on file. It could and should have referred to it.
33. The Council acknowledges that officers in social services gave Mrs X inaccurate information about the hourly care rates This demonstrates the level of confusion and poor communication throughout. Mrs X’s frustration is understandable.
34. The incorrect recording of Mrs Y’s care hours resulted in incorrect invoices being generated, which Mr Y received. Mr Y is in his nineties, and he was at the time caring for Mrs Y. He was caused unnecessary stress and worry at an already difficult time.
35. I also note the Council failed to respond when Mrs X alerted it to the fact Mr Y had been sent information about another service user on three occasions with the same surname as Mrs Y.
36. In its response to my enquiries, the Council clarified the reason for the discrepancy in the care hours and explained it clearly. It is not clear why it could not have done so sooner. Had it done, and had it clearly explained this in its complaint response, then Mrs X would have been saved the time and trouble of bringing her complaint back to the Ombudsman. Not only does the complaint letter fail to adequately explain the errors, it also fails to acknowledge the effort Mrs X invested in dealing with the matter, instead referring only to “several emails from yourself…”. It offered no apology, or remedy.

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Agreed action

37. The Council will within four weeks of the final decision:

• provide Mr Y with a written apology for the failings above, and pay him £250 to acknowledge his stress and worry
• provide Mrs X with a written apology and pay her £250 to acknowledge the time and trouble she has been put to pursuing the complaint
• provide Mr Y/Mrs X with a clear breakdown of the care hours and a revised invoice.
• complete a fresh financial assessment, and establish if, and when, Mrs Y funds fell below the capital threshold and adjust the charges accordingly
• provide evidence of the above to this office.

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Final decision

38. The Council failed to deal with the charging for Mrs Y’s care properly. It charged for more care hours than she received, gave inaccurate information about hourly care rates, and generated inaccurate invoices. It failed to properly investigate the discrepancies highlighted by Mrs X and failed to provide an adequate complaint response.
39. The above recommendations are a suitable way to address the injustice caused to Mr Y and Mrs X.
40. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman