Summary: Mrs H complained a Care Provider wrongly told her that her mother, Mrs G, would not have to pay for care she received at home for six weeks. We did not uphold the complaint. While there was some evidence to support Mrs H’s account and some poor complaint handling by the Provider, this did not cause Mrs G or Mrs H an injustice.

The complaint

1. Mrs H complained on behalf of her mother, Mrs G. The complaint concerned advice Mrs G and Mrs H received in August 2024 from Global Caring Coventry (the ‘Care Provider’), part of the Global Caring Group. The Council had commissioned the Care Provider to provide Mrs G with care in her own home. Mrs H said the Care Provider told her and Mrs G, that Mrs G would not have to pay for the care it provided for the first six weeks of its service. Mrs H said only later did she learn from the Council this advice was wrong.
2. Mrs H said because of this wrong advice, Mrs G did not cancel sooner some of the care the Care Provider gave. At the time it gave the advice Mrs G received four visits a day from the Care Provider. But once Mrs G learnt of the charges for its service she reduced the care package to two visits a day.

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The Ombudsman’s role and powers

3. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, sections 24A(1)(A) and 25(7), as amended).
4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. In addition, 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
6. If we are satisfied with an organisation’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)
7. Under our information sharing agreement, we will share this decision with the Office for Standards in Education, Children’s Services and Skills (Ofsted).

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How I considered this complaint

8. I considered evidence provided by Mrs H and the Council as well as relevant law, policy and guidance.
9. I gave Mrs H and the Council chance to comment on a draft version of this decision statement. I took account of any comments they made in response, before issuing this final version.

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What I found

Legal and policy considerations

10. A council has a duty to arrange care and support for those with eligible needs, in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and take account of the Care Act statutory guidance. It must also carry out a financial assessment. (Care Act 2014, section 14 and 17)
11. A financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. People who have capital over the upper capital limit must pay the full cost of their care.
12. Intermediate care and reablement support services are short-term services provided for people usually after they have left hospital. They aim to help a person to preserve or regain the ability to live independently. A National Audit of Intermediate Care lists four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently, provided in the person’s own home by a team of mainly care and support professionals.

13. There is no charge for intermediate care and reablement for up to six weeks. (Regulation 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

The Council’s contract with the Care Provider

14. The Council has a contract with the Care Provider that includes a section on how the Provider should deal with complaints. It says the Provider should have a complaint policy acceptable to the Council. It must also compile records of the complaints it receives and notify the Council of this monthly. It requires the Provider to co-operate with the Council’s own investigations into complaints and any investigation undertaken by this office. The Council says it considers the Care Provider’s complaint handling as part of its contract monitoring.

The key facts

15. The events covered by this complaint began on 20 August 2024. Mrs G was in hospital but nearing readiness for discharge. The hospital told the Council Mrs G would need a package of support when she returned home, where she would live with her husband, Mr G. The referral suggested Mrs G needed reablement care.
16. Next, on 21 August 2024 a Team Leader from the Council’s Homecare Assessment and Reablement Team assessed Mrs G in hospital. They agreed Mrs G needed a package of support to live at home. They recommended four visits a day from two care workers. But they identified this would be a “maintenance package” of care and not reablement care.
17. On 23 August the Council recorded speaking to Mrs H. Its notes recorded that the Council told Mrs H that Mrs G’s care package would be “chargeable”. Also, that Mrs H did not know if Mrs G had savings above the threshold level.
18. So, on the same day, the Council sent a letter addressed to Mrs G, inviting her to complete a financial assessment. The letter said the Council needed to carry out a financial assessment to decide if she should contribute to the cost of her care. And if so, how much she needed to contribute. The letter advised that if Mrs G had savings above the upper capital limit she would need to pay the full cost of her care.
19. On 24 August, the Care Provider began to provide care to Mrs G.
20. On 27 August, a Care Co-Ordinator for the Care Provider completed an assessment of Mrs G’s needs for the Provider’s records with Mrs H present. Mrs H says at this assessment, the Co-Ordinator told her and Mrs G there would be no charge for Mrs G’s care for the first six weeks of her care. Mrs G says this advice led the family not to reduce Mrs G’s care package, despite concern she may not need four visits a day. The assessment paperwork does not record any discussion about how Mrs G’s care would be paid for.
21. On the same day, and the next day, the Council recorded speaking to the Care Provider. It said the family had discussed the extent of the care package needed by Mrs G. The Care Provider said even though Mrs G had support from Mr G during the day, they decided to keep to having four visits a day. This was because of concerns for Mr G’s welfare when supporting Mrs G.
22. On 12 September, a Council Community Support Worker completed a review of Mrs G’s care, including a financial assessment. The Council recorded Mrs H saying the Care Provider had told her Mrs G would receive the first six weeks of care free. But the assessor said Mrs G’s care had been chargeable from the outset. Further, because Mrs G had assets above the upper capital limit, she did not qualify for financial help from the Council. She had to pay the full cost of her care.
23. At this point the Council stopped arranging Mrs G’s care. It invoiced Mrs H, on Mrs G’s behalf, for the care received up to 12 September 2024 which Mrs G went on to pay.
24. Mrs H then arranged for the Care Provider to continue to provide care to Mrs G under a private contract. At this point Mrs G reduced her package of care to two visits a day.
25. At the same time Mrs H made a complaint about the advice she said she had received from the Care Provider. In early October 2024 a manager from the Care Provider sent a message to Mrs H saying: “I apologise for any inconvenience caused by the misinformation”. They said the Care Co-Ordinator “mistook your mum's package pathway for another”.
26. Then at the end of October 2024 the manager wrote to Mrs H. In this letter they said the Care Co-Ordinator had not given wrong advice. Instead, they reported the Co-Ordinator saying that “in some cases” the first six weeks of care is free. The manager said their earlier message was “merely for the complaint you lodged and not to acknowledge you were misinformed”.
27. In reply to an enquiry from this office, the Care Provider has confirmed that it considers its Care Co-Ordinator did not give wrong advice to Mrs G or Mrs H.

My findings

28. Mrs H’s complaint centred on their discussion with the Care Co-Ordinator on 27 August. The Care Provider kept no record suggesting there was any discussion of the payment for Mrs G’s care. However, it did not dispute the subject arose, saying its Care Co-Ordinator gave general advice that some recipients of care do not pay for up to six weeks.
29. Beyond that, the accounts of the Care Provider and Mrs H differed. The Care Provider said they did not give advice specific to Mrs G’s case. So, on its account of events, Mrs H misunderstood. But Mrs H said the Care Provider told Mrs G she would not have to pay for the first six weeks of care she received. This would mean Mrs H received wrong advice.
30. I lacked evidence to make a finding about exactly what the Care Co-Ordinator said because of this difference in accounts. But I noted there was supporting evidence for Mrs H’s account, in the content of the Care Provider’s message to her sent in early October 2024. This appeared to recognise the Provider gave Mrs G and Mrs H wrong advice, despite its later statements to the contrary. While, the Care Provider later said its apology was only in recognition of Mrs H’s complaint I could not interpret it that way.
31. First, because the Care Provider clearly apologised for “misinformation”. They did not use a form of wording implying it was an apology to Mrs H for having cause to complain because of alleged misinformation. There was no qualifying wording in its apology.
32. Second, the message then explained why the Care Provider gave Mrs G and Mrs H “misinformation”. It said the Care Co-Ordinator confused Mrs G’s case for another. To me, that sounded a credible reason for why someone might give wrong advice. And it was hard to think of an explanation for why the Care Provider would say that, if it were not true. At the very least, the Care Provider had caused some unnecessary confusion to Mrs H when it gave this response.
33. But this was not the only evidence I needed to consider. I also read through the Council’s case notes. These provided confirmation Mrs H and the Care Provider discussed how many daily visits Mrs G needed, around the time the Care Co-Ordinator visited. But the notes did not suggest the cost of care factored in this discussion. Instead, the notes provided some detail about concerns for Mr G’s wellbeing if Mrs G received fewer visits.
34. These notes could not help me come to a view on whether the Care Provider gave Mrs G and Mrs H wrong advice. But they suggested Mrs G did not want to reduce her care package at that time, for reasons unrelated to cost.
35. In addition, there was clear evidence kept by the Council that it told Mrs G and Mrs H that it could charge for Mrs G’s care before the Care Co-Ordinator visited. It kept a record of a telephone call to Mrs H where it said it explained this and it put that advice in writing.
36. There would be no reason for Mrs H to have therefore preferred the Care Co-Ordinator’s advice to what the Council told her. Or else she could have checked the Care Co-Ordinator’s advice contemporaneously, given it contradicted what the Council had told her and Mrs G.
37. Taking all the above into account, I could not uphold Mrs H’s complaint. Because even though the evidence suggested the Care Provider at fault for giving wrong advice, I could not find it caused Mrs G injustice. She had other information telling her she may have to pay towards the Care Provider’s service. And the records suggested she wanted four care visits a day around the time the Care Co-Ordinator visited.
38. However, I would encourage the Care Provider to be more careful in how it responds when acknowledging complaints. I would also encourage the Council to review this area of the Care Provider’s service, when it next reviews its contract.
39. Another point I wanted the Council to consider here, was the need for signposting. I noted the Care Provider’s letter to Mrs H answering her complaint did not direct her to this office, or the Council’s complaint procedure as an alternative. This is something we expect to see in a reply to a complaint. It is also something the Care Quality Commission expects, as explained in guidance which accompanies the fundamental standards of care (see: Regulation 16: Receiving and acting on complaints - Care Quality Commission).
40. However, I again could not find any fault here caused Mrs G or Mrs H injustice. This was because they could still contact this office and have their complaint investigated and were not disadvantaged in doing so.

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Final Decision

41. For reasons set out above I did not uphold this complaint as I did not find fault by the Council or Care Provider caused injustice to Mrs G or Mrs H. I therefore completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman