Summary: There is evidence of some fault in the way the Council communicated the outcome of a financial assessment of Mrs Y’s domiciliary care charges. Consequently, there was a missed opportunity to make an informed decision about the cost of care.

The complaint

1. Ms X complains the Council delayed completing a financial assessment and informing her of the cost of her mother, Mrs Y’s, domiciliary care package. Consequently, Ms X, who manages Mrs Y’s financial affairs was unable to make an informed decision about accepting the care.

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The Ombudsman’s role and powers

2. 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 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)
3. 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)

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How I considered this complaint

4. I have:

• considered the complaint and the information Ms X provided;
• considered correspondence between Ms X and the Council, including the Council’s responses to the complaint;
• made enquiries of the Council and considered the responses;
• considered relevant legislation;
• offered Ms X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 and the Care Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support, and its powers to charge.
6. Councils should develop and maintain a policy setting out how they will charge people for the cost in settings other than care homes. Councils must carry out a financial assessment to make a decision about the charges. This will assess the person’s capital and income.
7. Once a council completes the financial assessment, it must give a written record of the assessment to the person. It should explain how the assessment has been carried out, what the charge will be, how often it will be made and if there is any fluctuation in charges, the reason
8. Reablement care is a structured programme of care provided for a limited time to help a person maintain or regain the ability to live independently. It can be provided in a residential setting or in a persons’ own home. Reablement is a type of intermediate care which has a focus on helping the person regain skills and reducing their needs through providing services in the home. (The terms reablement, rehabilitation and intermediate care are often used interchangeably.) (Care and Support Statutory Guidance (CSSG) Paragraphs 2.12 to 14)

Key facts

9. Mrs Y is elderly and has health issues and her daughter, Ms X provides support.
10. Prior to a hospital stay in January 2024, Mrs Y lived in her own home with support provided by Ms X.
11. Following a needs assessment in hospital, Mrs Y was deemed to need reablement care on discharge from hospital. The hospital assessor recorded she “…had advised Enablement will be free of charge. However if long term services is required following Enablement, this will be means tested. Daughter and son have agreed, financial assessment handed to them on the ward to complete and return. Financial policy discussed”. Mrs X signed to say she agreed to a financial assessment.
12. The notes of discussion between Ms X and the hospital social worker were passed to the Council on Mrs Y’s discharge.
13. Mrs Y was discharged from hospital on 26 January 2024. She went to stay with Ms X temporarily, with reablement care in place.
14. The Council’s records show Ms X contacted the Council on 27 February 2024. Ms X was concerned the period of reablement care was coming to an end, and that no review had taken place. The officer recorded that Ms X had been informed the package of care would continue until a review of Mrs Y’s needs had been completed.
15. Ms X did not hear from the Council, so she contacted it again on 4 March 2024, to chase a review. She also said she wanted to reduce care visits from twice daily to once daily; and that no care was required on Sundays. Ms X said she would inform the care company of the change.
16. An officer from social services contacted Ms X on 4 March 2024 to complete a short-term review. Ms X says the call was unexpected. The notes of the conversation, show Ms X said the care package was working well, and she requested a long-term care package for Mrs Y. The officer noted financial forms had been given to Ms X in February 2024.
17. Mrs Y’s reablement care ended and the care became chargeable from 9 March 2024.
18. The Council conducted further financial checks on 13 March 2024, a letter was sent to Ms X at the correct address requesting additional information needed to complete an accurate financial assessment concerning property.
19. The Council assessed Mrs Y’s provisional contribution to be £131.20 per week and informed Ms X in writing on 20 March 2024. The letter was incorrectly addressed so Ms X did not receive it. The Council says final assessment was dependant on the information requested about Mrs Y’s property. It says the information was never received as the service was subsequently cancelled.
20. Ms X received an invoice from the Council on 11 April 2024 for £466.88 for care in March 2024. She received a further invoice in May for care up until 14 April 2024. Ms X says the invoice was incorrect because it charged for care until 14 April 2024, when the care ended on 12 April 2024. She also said the Council have wrongly charged for Sundays, a day when care was not delivered.
21. Ms X telephoned the Council the same day she received the first invoice to query the charges and point out the inaccuracies in the invoice. Later the same day the Council sent Ms X an email with a breakdown of the cost / dates of the charges, following which Ms X contacted the Council to suspend the care. She then wrote to the Council’s finance team setting out her dissatisfaction, she cited a lack of transparency and misleading information. She said she had been informed that no charges would be levied until after a review had been completed, and that she expected to be informed of the charges prior to commencement of long-term care to enable her to make an informed decision.
22. Ms X cancelled the care on 11 April 2024 and submitted an appeal against the charges on 12 April 2024. The Council declined the appeal.
23. When matters could not be resolved by the finance team, the complaint was forwarded to the Council’s complaints team in May 2024; to be dealt with under the Council’s formal complaint’s procedure.
24. Ms X received a written complaint response on 12 July 2024. The author of the letter acknowledged Mrs Y had been wrongly charged for care after the care had been terminated. She (author) apologised and confirmed an amended invoice had been sent to Ms X. The author gave a breakdown of the charges, and corresponding dates. She explained the Council aimed to review care within six weeks of commencement of reablement, but due to workload pressure / competing priorities it had been unable to do so. The author referred to Ms X’s contact with the Council on 27 February 2024, in which she expressed concern about Mrs Y’s care ending, and the subsequent assurance from the officer, that the care would continue until Mrs Y’s needs had been reviewed.
25. Ms X was dissatisfied and exchanged further correspondence with the Council. The Council responded in writing in September 2024 reiterating its position and provided a brief chronology of the financial assessment process.

Analysis

26. The law and guidance do not specify a timescale for completing a financial assessment, however, councils are expected to complete financial assessments in a timely manner and inform service users of the costs of care.
27. Although the Council did not inform Ms X about the exact cost of Mrs Y’s care before the care started, it informed her that long-term care would be chargeable. This was before Mrs Y started receiving long-term care. I find Mrs X was made aware Mrs Y might have to contribute towards her care charges.
28. Mrs Y’s long-term care commenced on 9 March 2024; Ms X received an invoice on 11 April 2024. Although this is not a significant delay, there was a missed opportunity for Ms X to make an informed decision because she was unaware of the exact cost. This was exacerbated by the Council’s error in incorrectly addressing an earlier charging letter, but for this fault, Ms X would have been aware of the cost of care sooner. This added to Ms X’s uncertainty.
29. The Council acknowledged the inaccuracies in the invoice, apologised and rectified the error. In respect of charging for care on Sundays, although this was inaccurate, it did not affect the level of Mrs Y’s contribution towards her care.
30. I appreciate Ms X was upset by the receipt of a bill after Mrs Y started receiving her long-term care package. But I have no grounds to direct the Council to write off the outstanding care charges. This is because it is within the Council’s right to charge for the care services provided to service users. Mrs Y got the benefit of the care service and as stated earlier, Ms X was aware there might be a charge for the service provided to Mrs Y.

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Agreed action

31. The Council should, within four weeks of the final decision;

• apologise in writing to Ms X and make a symbolic payment of £150 to acknowledge the avoidable upset and uncertainty caused to her by the Council’s failings set out in paragraph 28 above. The apology should be in accordance with our guidance, Making an effective apology
• provide us with evidence it has complied with the above actions.

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Final decision

32. There is evidence of some fault in the way the Council communicated the outcome of a financial assessment of Mrs Y’s domiciliary care charges. Consequently, there was a missed opportunity to make an informed decision about the cost of care.
33. The recommendation above represents a suitable remedy for the injustice caused.
34. It is on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman