Summary: The Council failed to record its reasons for reducing Mr X’s relative’s care provision, delayed reviewing the care plan and communicated poorly and unclearly with Mr X regarding the cost of the care. This fault caused Mr X avoidable distress, frustration and uncertainty. In recognition of this, the Council has agreed to apologise, pay Mr X £250, carry out a new financial assessment and make service improvements.

The complaint

1. Mr X complained the Council:
1. reduced the amount of days his relative, Mr Z, attended his day service without considering the impact this would have on Mr Z;
2. failed to carry out a review of Mr Z’s care when it said it would; and
3. failed to inform him of additional care charges in a timely way.
2. Mr X says the Council’s faults have caused Mr Z’s mental and physical health to deteriorate and they have both been caused frustration and distress.

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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. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
6. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
7. 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)
8. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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How I considered this complaint

9. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
10. Mr X and the Council are given an opportunity to comment on a draft decision and any comments made are considered before making a final decision.

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What I found

Law and guidance

Care needs assessments

11. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.

Care plans

12. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

Reviews of care plans

13. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Charging for social care services

14. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-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 have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)

What happened

Background

15. Mr X’s relative, Mr Z, has a learning disability and has care needs for which he requires support.
16. Before September 2024, Mr Z lived in an accommodation which provided onsite care, Housing Provider A. The Council referred to this accommodation as ‘extra care housing’. Mr Z also attended an external day centre for four days each week.
17. The Council last financially assessed Mr X in April 2024 and concluded he did not need to make any financial contribution to his care costs.

Key events

18. The Council reviewed Mr Z’s care plan on 11 September 2024. Mr X supported Mr Z during the review. The Council said it planned to move Mr Z to a different accommodation – Housing Provider B – as Housing Provider A no longer provided the kind of support he required. Mr X agreed with this move.
19. The review considered Mr Z’s care needs at that time including but not limited to, the support he required around health, personal care, his relationships and accessing the community.
20. Regarding accessing the community, it noted Mr Z attended his day centres as his main form of community engagement and that he “was happy with this arrangement”. It noted Mr Z “will decline” joining any other opportunities for accessing the community.
21. The care plan review did not mention any plans to reduce Mr Z’s provision at the day centre. However shortly after, the Council informed Mr X that Mr Z’s day centre provision would be reduced from four days a week to two. It said this would begin once he moved into Housing Provider B.
22. The Council agreed to review the care plan again within six weeks of Mr Z moving to Housing Provider B, to see how the new care arrangements were working.
23. Mr Z moved to Housing Provider B on 18 September 2024. Within a week of Mr Z moving, his day centre provision was reduced. The Council did not carry out a further review of the care arrangements within six weeks, as agreed.
24. Mr X complained to the Council about its decision to reduce Mr Z’s provision at the day centre. He said Mr Z had been attending day centres as part of his routine and as a means of building relationships for years and cutting the provision at this time was causing him distress.
25. Mr X said in addition to this, Mr Z’s parent had recently died, Mr Z had been admitted to hospital in August 2023 and he had moved placements several times since then, so he was already unsettled and this was the wrong time to be reducing his day centre provision.
26. The Council said in its complaint response that it agreed it had failed to communicate properly about the reduction in Mr Z’s day centre provision. It also agreed that the change in care package had initially had a negative impact on Mr Z. However it said it was satisfied that Mr Z was now settling into Housing Provider B and it maintained this was the best arrangement to meet his needs. It said it would carry out the delayed six-week review of his care plan as soon as possible.
27. The Council still had not completed its six-week review, eleven weeks after Mr Z moved to Housing Provider B so Mr X complained to the Council again. Mr X also complained he had received a bill charging Mr Z a contribution towards his two days per week at the day centre.
28. The Council carried out its review of Mr Z’s care plan six weeks later than it said it would, in December 2024. The review recorded that Mr Z did not like living at Housing Provider B and staff at Housing Provider B said he was subdued, could become angry and was not engaging with other residents.
29. Regarding the recent charges for the day centre provision, the Council recorded in the review that it had begun charging Mr Z because the Council previously chose to waive Mr Z’s care contribution. If the Council had not chosen to waive the fees, it said Mr Z would have been contributing towards the cost of the day centres before then. It had decided to no longer waive the fees.
30. The review concluded that Housing Provider B was suitable and met Mr Z’s needs. However it said on the days when Mr Z was not attending the day centre, it would explore other activities for him to access the community.
31. The Council responded to Mr X’s second complaint. It said Mr X was informed of its decision to start charging Mr Z for the day service provision from 10 October 2024, when it sent Mr X a letter. As he was not informed before then, the Council apologised and said it would waive any day centre contributions charged before that date.
32. Regarding the day centre provision reduction in hours, it said Housing Provider B was a housing with care provision, meaning Mr Z had access to community and social opportunities within the residential setting. It explained this was the reason it reduced Mr Z’s day centre provision.
33. Mr X was unhappy with the complaint responses and came to the Ombudsman.
34. Since Mr X complained to the Ombudsman, the Council has offered to carry out a new financial assessment for Mr Z. It offered to apply the charging system it used when Mr Z was living at Housing Provider A to his care costs while he is living at Housing Provider B. The Council said it believed that if it re-assessed Mr Z’s finances in this way, his care contribution charge would likely reduce to nil.

My findings

Day centre provision

35. The Council decided to reduce Mr Z’s day centre provision from four days a week to two. It failed to demonstrate how it had considered the impact of this decision on Mr Z through its September 2024 care plan review. This was fault.
36. Later the Council clarified that it reduced the day centre provision, because at Housing Provider B, Mr Z could access community and social activities on site. It therefore said it considered that a reduction in day centre provision gave a better balance between external activities and activities within his accommodation. This was a decision the Council was entitled to make and it considered Mr Z’s needs in making this decision. It’s fault was in failing to record this through its care plan review and in failing to communicate its reasons properly to Mr X. This fault caused Mr X uncertainty, frustration and distress.

Delayed care plan review

37. The Council said it would carry out a second review of Mr Z’s care plan six weeks after he moved into Housing Provider B. The Council took twelve weeks to do this and only after Mr X raised two formal complaints because of the delay. This was fault by the Council. This fault caused Mr X further distress, uncertainty and frustration.

Care contribution charges

38. The last in force financial assessment for Mr Z in April 2024 concluded that he did not need to contribute financially towards his care costs. The assessment does not show that the Council had agreed voluntarily to waive any care contributions. Instead it showed Mr Z’s income was such that he should not be paying towards the cost of his care. This financial assessment was carried out in line with the 2014 regulations and the Care Act statutory guidance.
39. The Council began charging for a contribution towards the cost of his two days per week day centre provision from mid-September 2024 but did not inform Mr Z or Mr X about this until 10 October. When it informed Mr X that it was going to start charging Mr Z a contribution, it did not provide an updated financial assessment outlining its calculations.
40. The Council has failed to communicate properly with Mr X and Mr Z regarding Mr Z’s care contribution charges and this is fault. The Council has also failed to properly record its decision making which is further fault. These faults have caused Mr X uncertainty about whether Mr Z is being charged correctly for his care.
41. Since Mr X complained to the Ombudsman, the Council has said it is willing to carry out another financial assessment for Mr Z, applying the same charging system that it applied in April 2024. It said if it applied this, it expected this would reduce Mr Z’s care contribution charges back to nil.
42. The Council’s offer to carry out another financial assessment is welcome. However the only approach it should apply is the one set out in the 2014 regulations and the Care Act statutory guidance.

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Action

43. Within one month of the date of the final decision, the Council has agreed to:
1. apologise to Mr X for the injustice caused by the faults in this case;
2. carry out a new financial assessment for Mr Z – in line with the Care Act statutory guidance and the 2014 regulations - and calculate what Mr Z should be paying towards his care costs and send a copy to Mr X explaining its reasons;
3. ensure the new financial assessment assesses what, if anything, Mr Z should have been charged for his care from September 2024 onwards when he began living at Housing Provider B. If the amount is different to the amount Mr Z was charged during that time, the Council has agreed to consider how to ensure Mr Z is not at a disadvantage due to the Council’s fault, including considering whether to waive any charges during this period; and
4. pay Mr X £250 to recognise the frustration, distress and uncertainty he has been caused by the Council’s faults in this case.
44. Within three months of the date of the final decision, the Council has agreed to:
1. Consider what led to the delay in reviewing Mr Z’s care plan and demonstrate it has taken action to prevent recurrence of the fault in future;
2. Remind officers that where the Council decides to change or reduce a person’s social care provision, it must record its reasons and considerations for doing this as part of its care plan reviews; and
3. Remind officers that where the Council makes changes to a person’s care contribution, it must demonstrate its reasons for this through an updated financial assessment and notify the person ahead of the changes being made.
45. The Council has agreed to provide us with evidence it has complied with the above actions.

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Decision

46. I find fault causing injustice. The Council has agreed to actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman