Summary: Mr X complains about the standard of care received from a care provider the Council had arranged. He complains the carers were inadequate, did not know how to use necessary equipment, often did not provide all the care outlined in his care plan, and was early/late to calls. He also complains about the Council’s financial assessment. We find fault with the Council for failing to back date its financial assessment. We also find fault as care was not provided to Mr X in line with his care plan. We have made recommendations.

The complaint

1. Mr X complains about the standard of care received from a care provider the Council had arranged. Mr X complains the carers:
• Were inadequate as his long-term carers had to show all the carers how to provide the care he needed.
• Did not have, and did not know how to use, necessary equipment to provide appropriate care to him.
• Often did not provide all the care outlined in his care plan.
• Were often early/late for calls.

Mr X also complains the Council provided confusing information about how much he needed to contribute towards the cost of his care. He says the Council did not provide a copy of the financial assessment completed for him, or a full breakdown of the care provider’s charges.

2. Mr X is represented by his long-term carer, Ms Y.

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The Ombudsman’s role and powers

3. 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)
4. 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)
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 spoke with Ms Y and considered the information she provided.
7. I made enquiries with the Council and considered the information it provided.
8. I sent two draft decisions to Ms Y and the Council and considered their comments.

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What I found

Legislation and guidance

9. Councils must undertake an assessment for any adult with an appearance of need for care and support, regardless of whether the council thinks the individual has eligible needs or their financial situation. Councils must consider all the adult’s care and support needs, regardless of any support being provided by a carer.
10. An assessment identifies an individual’s needs, how they impact on their well-being and the outcomes the person wants to achieve in day-to-day life. The assessment process starts from when the Council begins to collect information about the person.
11. Councils can make charges for care and support services they provide or arrange. (Care Act 2014, s. 14 (1, 4))
12. Councils must assess a person’s finances to decide what contribution he or she should make. (Care Act 2014, s.17 (1))
13. The Council must give a written record of the financial assessment to the individual to whom it relates. (Care Act 2014, s. 17 (6))

What happened

Care and support

14. In April 2020, Mr X asked the Council for help with his care needs as Ms Y, his long term carer, was struggling to care for him. The Council completed a light touch assessment to identify Mr X’s eligible needs and made a referral to the Occupational Therapy (OT) team.
15. In May 2020, the OT team sent Mr X some equipment to aid with his care and support needs. Mr X also told the Council in May that his condition had worsened and so his care needs were greater. Pending the full care assessment, the Council arranged for Mr X to receive seven hours of care a week in the mornings. This compromised of one hour every morning to help Mr X get out of bed, showering, dressing, and to mobilise safely to the living area.
16. The Council commissioned a care agency to provide the care to Mr X. The Council provided the care agency with a copy of Mr X’s care plan before commissioning the service. The care agency started providing care to Mr X on 22 May 2020.
17. The Council completed its care assessment for Mr X at the end of May 2020. The council identified Mr X had eligible care needs. The Council agreed to increase the time of the morning calls to 90 minutes and to introduce two calls a week for domestic support and carer respite. The case record noted both Mr X and Ms Y were happy with the care plan as discussed. The Council completed a new care plan to reflect the increased care hours.
18. After the completed assessment, Mr X told the Council his condition had declined again and that he was struggling to clean himself after using the toilet and that he was not able to complete chair transfers independently.
19. In June 2020, Ms Y raised concerns with the Council and the care agency about a member of staff. Ms Y was unhappy about the care provided to Mr X by the care worker. She said the worker did not appear confident and did not seem to know what they were meant to be doing. She also felt the worker was not strong enough to deal with Mr X. The care agency’s records showed the carer had contacted the office to note Mr X’s mobility was very poor and that Ms Y had to help him move Mr X to and from the bathroom.
20. The records showed the Council asked the care agency not to send this care worker again. This was agreed by the care agency.
21. The records showed the care agency told Ms Y its care workers were not allowed to lift clients. The Council provided evidence of the training completed by all workers who had attended Mr X’s calls. The training history showed all carers had completed manual handling training. The record did not show what was covered in the manual handling training.
22. The Council completed an OT assessment in June 2020. After the assessment, the OT recommended further equipment for Mr X. Mr X declined some of the recommendations, such as a profiling bed. The OT arranged for a wheeled commode, handling belt, and slide sheet to be delivered to Mr X.
23. The records showed Ms Y turned one carer away as she thought they were an hour early. Ms Y thought the call was for 11.45am but the call was down on the carer’s rota for 10.45am. The care agency’s attendance records showed all calls were attended to within 15 minutes of the arranged call time either side. Mr X’s contract with the care agency noted a 15 minute window of time was allowed before or after the arranged call time.
24. The care agency stopped providing Mr X with care on 17 June 2020. This was because Mr X had been admitted to hospital.
25. The records reflect Ms Y was positive about two care workers and was happy with the care they provided. The care agency’s attendance records showed it arranged a total of 24 care calls during the period it was commissioned to provide care to Mr X. The two workers Ms Y was complimentary about completed 18 of those calls. This was 75% of the total calls.
26. The Council confirmed there were no daily care notes available as the care agency had not been able to retrieve the care notes from Mr X’s home before the care was stopped.
27. In response to our draft decision. Ms Y provided a copy of the daily care notes completed by the care workers between May and June. The notes showed most of the calls were for one hour.

Financial assessment

28. The Council completed a provisional financial assessment in June 2020. The Council wrote to Mr X to outline his provisional assessed contribution to be £41.16 a week. The Council asked Mr X to provide some information to enable it to complete a full financial assessment. The Council asked Mr X to provide the information as soon as possible.
29. The Council sent Mr X two invoices in June and July 2020. The invoices showed Mr X was only charged £41.16 per week for his care during the period 22 May to 17 June 2020. The total charge was just over £205.
30. In August 2020, the Council wrote to Mr X with a new financial assessment. The Council noted it had not received the information it requested in June 2020 and so it had completed the financial assessment based on the information it had. The Council noted Mr X’s assessed contribution to be £182.52 a week.
31. Ms Y contacted the Council to note she had received the new financial assessment. Ms Y apologised to the Council for not sending the information requested and said she would send the information as soon as possible.
32. The Council sent Mr X another invoice at the end of August 2020. The invoice outlined the charges for each week, with the total charge now just over £297.
33. In November 2020, Ms Y contacted the Council on behalf of Mr X to outline some further expenses he now had to pay for. Ms Y asked the Council to consider the new expenses and to complete another financial assessment.
34. In December 2020, the Council completed another financial assessment. The assessment now noted Mr X’s assessed contribution to be £64.30. The Council’s letter noted this charge would apply from October 2020.
35. In response to our enquiries, the Council acknowledged it had failed to backdate the December 2020 financial assessment to the period of May – June 2020. The Council apologised for this oversight and has offered to honour its provisional assessed charge for this period of just over £41.
36. The Council has also offered Mr X a payment of £250 to recognise any confusion and distress for the error with the financial assessment.

Analysis

37. There is some evidence Ms Y did help a care worker with Mr X during a call in June 2020. There is also evidence Ms Y raised concerns about the capability of the care worker on the same day.
38. An OT assessment was completed for Mr X the day after the issue with the care worker was raised. The result of the assessment was that Mr X needed more equipment. This suggests Mr X did not have appropriate equipment in place to safely meet his care needs.
39. Therefore, while Ms Y did have to help the carer, it is likely on balance the reason she had to help was because Mr X did not have all the appropriate equipment needed to allow the carer to safely provide the care to Mr X.
40. I do not consider there was any fault by the Council for not identifying Mr X needed more equipment sooner. This is because the records showed Mr X’s condition declined quite rapidly. Therefore, the Council assessed Mr X as soon as it became aware Mr X’s needs might have changed. Further, the equipment Mr X needed was provided without delay after the OT assessment.
41. The records also showed Ms Y was positive about two care workers and was happy with the care they provided. These care workers attended 75% of the calls arranged for Mr X. There was also no further contact from Ms Y, at the time, raising any further concerns about any other care workers.
42. With regards to the use of equipment, all care workers who attended Mr X’s calls had completed their manual handling training. While there is no record of what this training covered, it is more likely than not it would have covered the use of equipment to assist with manual handling. Therefore, on balance, I am satisfied the care workers would have known how to use the equipment Mr X had.
43. Mr X’s contract with the care agency allowed for a 15-minute window of time before or after the arranged call time. The records showed the care workers attended all calls within this grace period. Therefore, I do not consider there to be any fault.
44. Ms Y provided evidence the care workers did not attend the care calls for the full 90 minutes, as outlined in Mr X’s June 2020 care plan. The evidence showed the care workers only attended for one hour for most of the calls between May and June 2020. Therefore, it is likely the care workers were not able to provide the full care Mr X needed in the one hour they stayed since Mr X was assessed as needing 90 minutes of care. This is fault.
45. I consider the fault identified caused Mr X some distress. This is because it is likely, on balance, he did not receive the full care he was assessed as needing. I also consider the fault caused Ms Y some distress. This is because it is likely she needed to provide further care to Mr X once the care workers left.

Financial assessment

46. The evidence shows the Council did send Mr X information about his charges and financial assessments in June, July, and August 2020.
47. It is also clear Mr X was not able to send the information the Council requested in June 2020, which led to the financial assessment in August 2020 that resulted in a higher assessed contribution.
48. There is no fault with the Council completing another financial assessment in December 2020 because it received new information from Mr X.
49. However, the Council has recognised it failed to backdate the new assessed contribution to May 2020. This is fault. The fault will have caused Mr X and Ms Y some confusion and distress because it would not have been clear how much he needed to pay towards his care for the period May – June 2020.

The Council has offered to remedy this by charging Mr X the provisional assessed charged of £41.16. The Council has also offered Mr X £250 in recognition of the distress and confusion caused by the fault. I consider this remedy offer to be appropriate in the circumstances.

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Agreed actions

50. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following:
• Apologise to Mr X for the injustice caused by the faults identified.
• Issue a new invoice to Mr X outlining the total amount he needs to pay towards the cost of his care for the period 22 May and 17 June 2020. The total should be £205.80.
• Pay Mr X £350 in recognition of the confusion and distress caused by the faults identified. The Council can offset this against the amount Mr X has to pay towards his care costs. The Council should pay Mr X the difference.
• Pay Ms Y £100 in recognition of the distress caused by the faults identified.
51. The Council should complete the above within two weeks of the final decision.

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Final decision

52. I find fault with the Council for failing to backdate Mr X’s financial assessment. I also find fault as Mr X did not receive care in line with his care plan. The Council has agreed to my recommendations. Therefore, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman