Summary: Mr C complained that the Council was at fault for its failure to provide him with support in his dealings with a private care provider and for the failures of that supplier. He also said the Council failed to process his application for financial assistance with the cost of his care. The Council accepted it was at fault for a failure to provide Mr C with support and assessment while he was receiving his care. This fault caused injustice to Mr C in the form of distress and anxiety. The Council has agreed to apologise to Mr C and pay him a sum in recognition of that fault. It will also review its procedures to ensure that similar fault does not happen again.

The complaint

1. The complainant, Mr C, says the Council is at fault for:
1. Failures of a care company that provided care on the Council’s behalf such as:
1. Failures and poor practice in the administration of medicine;
2. Failures and poor practice in care;
3. Failures to respond to complaints about the service received;
4. Failure to provide copies of the care plan or contract on request;
2. The Council’s failure to make it clear to him that he was entitled to ongoing professional support and an annual review of his care while he was in care provided by a private care provider and
3. The Council’s failure to carry out a financial assessment of Mr C and to contribute to the funding of this adult social care.
2. Mr C says that this fault caused him injustice in that the Council did not oversee the care he was providing and the care provider overcharged him and provided inadequate care.

Back to top

What I have investigated

3. I have investigated Mr C’s complaints that are within the Council’s control. I have set out the parts of his complaint I have not investigated at the end of this decision.

Back to top

The Ombudsman’s role and powers

4. We investigate complaints about ‘maladministration’ and ‘service failure’. 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. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.
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)

Back to top

How I considered this complaint

7. I spoke to Mr C’s brother, Mr D who is Mr C’s representative. Using the information he provided, I wrote an enquiry letter to the Council. I considered the Council’s response alongside any other information I had gathered
8. Mr D and the organisation had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

What should happen

Charging for adult social care

9. Councils have a duty to arrange care and support for those with eligible needs, when asked to do so, even for those who pay for their own care.
10. People with savings above a certain level (‘the upper capital limit’ currently set at £23,250) must pay for their own adult social care. If their savings fall below that level, they can ask the Council to pay for their care or to pay a contribution towards it.
11. Even if a service user pays for their own care, councils should still be aware of their care needs. They should be ready to provide support if needed.
12. Where a council decides to charge a service user, it must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
13. The Council’s website states that, if someone wants assistance with the costs of social care, it will carry out an assessment of need. If they meet the national eligibility criteria, it will agree what kind of care and support they need and ask them to complete a financial assessment to assess how much they will have to pay towards the cost.
14. The website says it will ask applicants for evidence of their income, savings and expenditure. It adds, “please note, if you do not send us evidence of your financial circumstances, we cannot complete your assessment and you will have to pay for the full cost of your care.”

What happened

15. Mr C is a man with disabilities which required him to move into a sheltered housing scheme in 2018. The Council helped him find this accommodation. Mr C also has mental health problems.
16. The Council was aware of Mr C’s chronic health problems. It carried out an assessment of his care needs in 2017 which showed that Mr C had complex needs and required ongoing care. At that time, the Council committed to carrying out an annual review of his care needs.
17. Mr C’s needs increased and it became necessary for him to move into a sheltered housing scheme in summer 2019. The Council helped him find a suitable sheltered housing facility which was only open to those recommended by the Council. It also recommended a private care company to provide him with daytime care there. (night-time was provided by a Council contractor).
18. At this time, Mr C had more than £23,250 in savings and therefore paid for his daytime care. in August 2018, a Council officer wrote to Mr D and told him that he would close Mr C’s case as his savings were above the threshold.
19. In early 2019, a care provider, (‘the Company’) took over the night-time care at the sheltered housing complex.
20. During 2019, Mr C’s condition worsened and he asked his brothers, Mr D and Mr E, to help him organise his affairs. Mr D has acted as his representative in this complaint.
21. In early 2020, the COVID-19 pandemic spread and, in March 2020, the country entered lockdown. At this time, Mr C’s daytime care provider said it could no longer provide care. From this point on, all care, both at night and at day, was provided by the Company.
22. At about the same time, Mr C’s savings dropped below the upper capital limit and Mr E, who represented Mr C in financial matters, wrote to the Council asking for a financial assessment and assistance with his care costs.
23. The Council says that, on receipt of this request, it commissioned a care needs assessment and sent financial assessment forms to Mr E. It asked him to fill them in and return them. The Council says it did not receive the completed forms and so never completed a detailed financial assessment of Mr C. Mr D says that Mr E could not complete the forms because the company did not give him the information he needed to do so. Then, later in 2020, Mr C inherited some money which took him back above the self-financing threshold.
24. Mr D says the family asked the Council for a care assessment frequently during 2020. The Council says it received no such requests.
25. Mr D and Mr E were dissatisfied with the care that Mr C received from the Company. Mr D says that, on occasions when he visited Mr C, he found items he needed had been left beyond his reach. His commode was left full of items which meant it could not be used. There were many other problems, he says. They were also concerned that the Company’s charging was not sufficiently detailed and they were concerned that Mr C was being charged for care he did not receive.
26. In early 2021, an arrangement whereby the Company began to administer Mr C’s mental health medication began. The arrangement ran smoothly for several months but, in April and May 2021, there were several irregularities in the administration of the medication. The Company informed Mr D who was alarmed at failures and, in early May, raised a formal complaint using the Company’s internal complaints procedure.
27. Unfortunately, the Company delayed in responding to Mr D’s complaint. He did not receive a response until late-June 2021. The Company upheld some of his complaints but he did not feel that it had dealt with the entirety of the complaint. He appealed. Following a further delay the Company responded.
28. Mr D was still not satisfied with the Company’s response, He complained to the Ombudsman. We told him that he would have to complete the Council’s internal complaints procedure before he could complain to us.
29. Therefore, Mr D complained to the Council in mid-September 2021. He complained about:
1. The failure of The Company to provide a care plan or a copy of the care agreement between September 2020 and June 2021;
2. the failures in care provided by The Company and its failure, in his eyes, to investigate his concerns adequately. He also stated that, because Mr C had been self-financing, he had received no support from the Council.
30. The Council responded in November 2021. It said:
1. Although Mr C had paid for his own care he had been entitled to, and should have received, ongoing support from the Council. It apologised for this oversight and said this support would be available in future.
2. Mr C had made an application for financial assistance with the costs of his care in April 2020 but the information required to complete it was never provided. The Council completed a care assessment in May 2020. The Council apologised for the delay and for any worry this may have caused.
3. The length of time that The Company had taken to provide a care plan had been unacceptable and the Council would raise this with the provider. Reviews should take place at least once a year.
4. The Company had also failed to address Mr D’s requests to see the care agreement. The Council said it would raise this with the Company.
5. The Company had followed the correct procedures after identifying medication errors. The Council would liaise with the Company to ensure that any concerns would shape future monitoring of the agency.
6. The Company had accepted that there had been errors in the investigation of Mr C’s complaint and this had led to delay but, otherwise, the investigation had been adequate.
31. The Council said it would ensure that adult social care staff would be encouraged to provide clear and accurate information to those who self-funded their care that they were entitled to professional support and would pass on his concerns to the Council’s Provider Development Team to help improve services in future.
32. Having received this response, Mr D, still dissatisfied, came to the Ombudsman. On receipt of his complaint, we decided that we should split his complaint into two parts, one a complaint against the Company and the other against the Council.

Was there fault causing injustice?

Failure to inform Mr C of right to support

33. The Council says it was not aware of the fact that Mr C was receiving adult social care. It says Mr C commissioned the care privately and did not inform the Council that he was having it until April 2020.
34. Mr D has provided evidence to show that this was not the case. The Council helped Mr C move into the sheltered accommodation and helped him find its care. The Council had then closed its file for Mr C in August 2018.
35. As the Council accepted in its complaint response, “even if someone self-finances their home care provision, they remain entitled to ongoing professional support and an annual review of the care provision”. The Council now accepts that it had that duty to Mr C and that it failed in that duty from 2019 onwards. In fact, it had had that duty since, at the latest, 2017. It should have overseen his care over that period. The fact that Mr C did not receive this support was fault.
36. This fault caused injustice as it contributed to the anxiety that Mr C felt during his care by the Company. Mr C had problems with the Company and, when he went to the Council, they denied any knowledge of his care and denied having had any involvement with it although they had. This must have been frustrating. Had the Council been aware of its involvement, it might have been able to intervene in Mr C’s dispute with the Company.

Failure to carry out financial assessment

37. The Council says Mr E wrote to the Council and requested a financial assessment in April 2020. The evidence shows that this is correct. The Council says it then carried out a care needs assessment and sent Mr E the forms for a financial assessment. It says it never received the completed forms.
38. I have seen no evidence that Mr E sent the forms to the Council. Therefore, the Council was not at fault.

Other parts of the complaint

39. I have not found the Council at fault for the failings of the care provider as it provided care independently of the Council. The Council has, though, in its response to Mr D’s complaint, said that it would raise the issues brought to light by the complaint with the Company.

Back to top

Agreed action

40. The Council has agreed that, within four weeks of the result of this decision, it will:
1. Write to Mr C and apologise;
2. Pay him £400 in recognition of the fault found; and
3. Speak to Mr E about the financial assessment, if it has not already done so.
41. The Council has agreed that, within eight weeks of the date of this decision, it will write to the Ombudsman setting out what steps it has taken and intends to take to ensure that it provides the support it should provide to self-funding recipients of adult social care.
42. The Council has also agreed to contact Mr C (or E) about commencing a financial assessment of Mr C. It should backdate any assessment to May 2020.

Back to top

Final decision

43. I have made a decision that the Council was at fault. The Council has accepted my recommendation of a remedy. I have closed my investigation.

Back to top

Parts of the complaint that I did not investigate

44. Mr C’s original complaint concerned alleged failures of the Company. I have considered these allegations, which are set out in paragraph 1a) above, in another decision about the Company.

Back to top

Investigator's decision on behalf of the Ombudsman