Summary: Mr X complained the Council increased the cost of his wife’s care package without advising him of the change in cost. Mr X says he settled the charges owed with the Council, but the Council then increased the charges. Mr X says he would have changed the care package had he known the extent of the cost. The Ombudsman found fault with the Council’s delay in telling Mr X about the correct care charges. The Council agreed to the Ombudsman’s recommendation to reduce the care charges to £733.39.

The complaint

1. Mr X complained the Council increased the cost of his wife’s care package without advising him of the change in cost.
2. Mr X says he settled the charges owed with the Council, but the Council then increased the charges. Mr X says he would have changed the care package had he known the extent of the cost.

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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. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34H(3) and (4), 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)

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How I considered this complaint

6. I have considered all the information Mr X provided and discussed this complaint with him. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
7. I have considered the Council comments on my draft decision before making my final decision. Mr X accepted my draft decision.

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What I found

Relevant legislation and guidance

8. The Care Act 2014 (the Act) is the legislation that sets out local authorities’ powers and duties in respect of adult social care services. The Department of Health and Social Care also produces statutory supplemental guidance for local authorities on how to discharge these duties. This is called the ‘Care and support statutory guidance’ (the Statutory Guidance).
9. Section 14 of the Act gives a local authority the power, with certain exceptions, to charge for care and support it arranges to meet an adult’s needs.
10. Section 17 of the Act explains that, where a local authority decides to charge for care and support, it must assess the adult’s financial resources to calculate the amount (if any) the adult would be likely to be able to contribute towards the cost of the care and support.
11. In carrying out a financial assessment, the local authority must follow the ‘Care and Support (Charging and Assessment of Resources) Regulations 2014’ (the Charging Regulations). The Charging Regulations set out how local authorities should treat an adult’s income and capital for the purposes of calculating care contributions.
12. The Guidance says that a personal budget should specify the amount the service user will have to pay towards the cost of the care, based on the financial assessment. It explains that a personal budget is the mechanism, in conjunction with the care and support plan, that enables the person to exercise greater choice and take control over how their care and support needs are met.
13. A financial assessment should be completed as soon as reasonably practicable. The Ombudsman would expect a financial assessment to be done within four weeks of a care assessment. A care assessment and financial assessment are part of one process.
14. Paragraph 8.2 of the Guidance says that when a council decides to charge for care it should be “clear and transparent, so people know what they will be charged”.

Events before July 2020

15. Mr X’s wife, Mrs X, had a stroke in 2017 and entered hospital. Mr X became Mrs X’s sole carer following her return from hospital.
16. In December 2019 Mrs X started to experience severe back pain. Mr and Mrs X sought help from the Council’s urgent care team. The Council arranged an emergency package of support for Mrs X.
17. Shortly after the Council arranged this care, Mrs X went into hospital.
18. The hospital discharged Mrs X to a nursing home in January 2020. Mrs X moved to a care home in March 2020 and was self-funded at the care home.
19. Mr and Mrs X discussed with the Council about the prospect of Mrs X moving back home from March 2020.
20. Events from July 2020
21. The Council discussed the matter with Mrs X and an advocate on 22 July 2020 followed by a meeting with both Mr and Mrs X on 29 July 2020. During the conversation with Mr and Mrs X on 29 July 2020 the Council confirmed the care package it would look to procure. The Council says Mr and Mrs X agreed to the following care package:
• Two carers for 45 minutes at 8am.
• Two carers for 15 minutes at 12noon.
• Two carers for 15 minutes at 4pm.
• Two carers for 30minutes at 9pm.
22. The notes for the conversation on 29 July 2020 do not confirm the Council confirmed the cost of this care package with Mr and Mrs X on this date.
23. On 12 August 2020, the Council finalised Mrs X’s care assessment and made a request to the panel to agree funding of £368.97 per week for Mrs X’s care package. This request confirmed that Mrs X was self-funding her care. The Council did not share the care assessment with Mr and Mrs X.
24. Mrs X moved back into her home at the start of September 2020. The Council started Mrs X’s care package from the date she returned home.
25. The Council completed Mr and Mrs X’s financial assessment on 19 December 2020. The Council wrote to Mr and Mrs X to confirm they would need to contribute £184.73 per week for the cost of care from the week starting 31 August 2020. The Council also detailed an annual administration cost of £286.50. This letter advised the Council was only providing one carer for Mrs X’s care. It also advised changes to Mrs X’s care will cause change to the contribution Mr and Mrs X would need to make.
26. The Council charged Mr and Mrs X £2850.12 for Mrs X’s care charges up to 20 December 2020. The Council also billed for the administration cost for the first 12 months at £286.50.
27. Mr X paid the care charges of £2850.12 on 5 January 2021. Mr X did not pay the administration fee.
28. Mr and Mrs X stopped the care package from the end of 8 January 2021.
29. The Council recognised it should have charged Mr and Mrs X £369.46 per week for Mrs X’s care. The Council rebilled Mrs X’s care charges on 19 January 2021 at the correct rate. The Council billed as if it had provided care from 31 August 202 to 17 January 2021. This left a balance of £4,086.68 to pay plus the administration fee of £286.50, totalling £4373.18.
30. On 28 January 2021, the Council applied a credit to Mrs X’s account of £105.56 to reflect the care it did not provide on 9 January 2021 and 10 January 2021. The Council also applied a credit of £369.46 for care it did not provide in the week starting 11 January 2021. This reduced the balance owed to £3898.16.
31. Mr X contacted the Council about the increased charges for Mrs X’s care.
32. The Council wrote to Mr X on 9 February 2021 to advise it had underbilled for the care from the start. The Council advised Mr X it should have charged £369.46 per week due to Mrs X receiving two carers. However, the Council had only billed for one carer. The Council explained it had backdated charges to 31 August 2020 to reflect this.
33. The Council recognised it had also charged Mr and Mrs X for missed care calls. The Council applied a credit to the account for £150.80 to reflect this. The Council also recognised it had provided care for less than six months meaning it should only have charged a six-month administration fee and not the 12-month administration fee. The Council applied another credit of £143.25 to reflect this. This reduced the balance owed to £3604.11.
34. Mr X made a formal complaint to the Council on 25 February 2021 about it backdating the care charges.
35. The Council sent Mr X a Stage 1 complaint response on 23 March 2021. The Council said:
• It was at fault for only noting one carer on Mrs X’s financial assessment on 19 December 2020 despite Mrs X having two carers.
• This fault meant the Council only charged Mr and Mrs X £184.73 per week when it should have charged double at £369.46 per week.
• It was correct to charge Mr and Mrs X for the full cost of the care the Council provided.
36. Mr X contacted the Council on 25 March 2021 to dispute the Stage 1 response. The Council advised Mr X’s dispute did not meet the threshold for a Stage 2 response so directed Mr X to the Local Government and Social Care Ombudsman.

Analysis

37. The care records show the Council made Mr and Mrs X aware of the Care and Support plan for Mrs X. The Care and Support Plan included details of the number of care workers and frequency of visits.
38. The Council’s social care notes and care assessment both confirm Mr and Mrs X were aware of their status as “self-funders” during Mrs X’s time at the care home. Mr X has also accepted he was expecting to contribute towards the cost of the care package for Mrs X. There is no fault by the Council in ensuring Mr and Mrs X were aware they would need to contribute towards Mrs X’s cost of care.
39. As part of my enquiries of the Council I asked it to provide evidence of when the Council first confirmed the exact cost of care to Mr and Mrs X. The Council said it confirmed the full cost of the care during the meeting on 29 July 2020 and it provided the case notes for this meeting.
40. The case notes provided by the Council, which are similar to the notes in the care assessment, confirm the Council advised Mr and Mrs X about the level of care. However, neither the Council’s case notes for this meeting nor the information in the care assessment about this meeting provide details about the exact cost of this care to Mr and Mrs X.
41. The Council has detailed the cost of the care within Mrs X’s care assessment compiled on 12 August 2020. But, the Council did not share this care assessment with Mr and Mrs X.
42. A council should provide a person with all information it has available at the time of the care assessment. A personal budget should be clear and transparent so that a person can understand the cost of their care. The Council cannot expect a person to know cost of care based on the level of support provided alone.
43. The Council did not explain what care costs might look like for a person in receipt of Mrs X’s level of care. That was fault by the Council.
44. The Council did not complete its financial assessment of Mr and Mrs X until 19 December 2020. This was the first instance the Council provided a monetary value for the cost of care to Mr and Mrs X.
45. The Council took slightly over 18 weeks, from the date of the care assessment on 12 August 2020, to provide Mr and Mrs X with confirmation the care costs would be £184.73 per week.
46. Additionally, the Council failed to confirm the correct charges on 19 December 2020. It was not until 19 January 2021 the Council invoiced for the correct care charges. These care charges were double the care charges confirmed on 19 December 2020. This added four-week delay was also fault by the Council.
47. The Ombudsman would expect the Council to take no longer than four weeks to complete a financial assessment following a care assessment. This 14-week delay in completing the care assessment was fault by the Council.
48. Mr and Mrs X cancelled the care package on 8 January 2021. Cancelling the care package is unrelated to the letter of 19 December 2020. This is because Mr and Mrs X have not disputed the original care charges by the Council and were aware they would need to contribute to the cost of the care package.
49. It is unlikely Mr and Mrs X would have cancelled the care package earlier had the Council confirmed the charges of £184.73 per week sooner. Therefore, the Council’s delays in confirming the cost of £184.73 per week has not caused Mr and Mrs X an injustice. The Council is entitled to charge this amount per week for the care it provided despite it delays.
50. However, Mr X has disputed the Council’s doubled-up care charges applied on 19 January 2021. As noted in paragraphs 45 and 46, the delay in confirming the correct care charges was fault. To remedy the faults identified, the Council should remove any charges above £184.73 per week except for the first four weeks’ worth of charges from the date of the care assessment.
51. The Council completed the care assessment on 12 August 2020. This means the first four weeks run until 9 September 2020. The Council can charge the doubled-up care charges for these first four weeks. The Council charged £79.17 for the week starting 31 August 2020 and £84.96 for the three days of 7 September 2020, 8 September 2020 and 9 September 2020. The Council can charge an extra £164.13 up to 9 September 2020 above the charges raised on 20 December 2020.
52. Mr X has also not paid for the 6-month administration fee or for any care charges after 20 December 2020. The 6-month administration fee cost £143.25. The cost of care at £184.74 per week from 20 December 2020 to 10 January 2021 amounts to £554.19.
53. However, the Council did not provide care on 9 January 2021 and 10 January 2021. The Council previously applied a credit of £105.56 to reflect these overcharges. The Council based this credit on a weekly cost of £369.46. The Council would only need to apply a credit of half this at £52.78 to reflect the missed care on these two dates using the lower weekly care costs.
54. The Council also previously applied a credit of £150.80 for missed care calls from 4 January 2021. Again, the Council based this on weekly charges of £369.46. The Council would only need to apply a credit of half this at £75.40 for these missed calls using the lower weekly care costs.
55. The Council can recover total charges of £164.13, £143.25 and £554.19 for unpaid care fees, minus the credits of £75.40 and £52.78. This reduces the balance Mr X owes the Council to £733.39.

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Agreed action

56. Within one month of the Ombudsman’s final decision the Council will:
• Reduce the balance owed for Mrs X’s care charges to £733.39 because of the delay in confirming the correct cost of care with Mr and Mrs X.

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Final decision

57. There was fault by the Council as the Council has agreed to my recommendation, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman