Summary: Mr Y complains the Council handled Mr X’s care poorly. He complains the Council did not confirm care home fees Mr X was liable for and delayed allocating him a social worker. We find the Council at fault which caused Mr X injustice. The Council has agreed to make a issue an amended invoice and take service improvement action.

The complaint

1. Mr Y complains the Council handled Mr X’s care poorly. Specifically, he complains the Council:

1. did not confirm the fees payable by Mr X before he moved into the care home;
2. failed to complete a financial assessment in time;
3. did not properly inform Mr X of his payable fees;
4. did not properly inform Mr X of the increase in fees;
5. failed to provide a contract for Mr X’s stay at the care home; and
6. did not provide Mr X with an allocated social worker for a period of time.

2. Mr Y says the Council’s actions prevented Mr X making an informed choice about his care and impacted his finances. He says the delay in assigning another social worker increased Mr X’s stay in the care home.
3. Mr Y also complains the Council delayed responding to his complaint. He says the delay in the Council’s complaint handling caused him unnecessary and avoidable distress and uncertainty.

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The Ombudsman’s role and powers

4. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
5. We investigate complaints about councils and certain other bodies. We cannot investigate the actions of bodies such as Integrated Care Boards. (Local Government Act 1974, sections 25 and 34(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)

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What I have and have not investigated

7. Mr Y complains the Council failed to provide Mr X with a contract for his stay at the care home. The stay was arranged by an Integrated Care Board (ICB) and therefore the ICB was responsible for arranging a contract. The Ombudsman cannot investigate the actions of bodies including Integrated Care Boards.
8. Therefore, I have not considered part e of the complaint.
9. I have only considered part a, b, c, d and f of the complaint.

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How I considered this complaint

10. I considered the information and documents provided by Mr X and the Council. Mr X and the Council have had an opportunity to comment on the draft of this decision. I have considered all comments received before making a final decision.
11. I also considered the relevant statutory guidance, as set out below. I have also considered the Ombudsman’s published ‘Principles of Good Administrative Practice’ guidance and published guidance on remedies.

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What I found

What should have happened

Financial assessment and charging (parts a, b, c and d of the complaint)

12. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt a permanent admission is required. The person’s stay should be unlikely to exceed 52 weeks, or in exceptional circumstances, unlikely to substantially exceed 52 weeks. A decision to treat a person as a temporary resident must be agreed with the person and/or their representative and written into their care plan.
13. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.
14. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person can get council support to meet their eligible needs. People who have over the upper capital limit must pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees. Where a person’s resources are below the lower capital limit they will not need to contribute to the cost of their care and support from their capital.

Delay allocating another social worker (part f of the complaint)

15. The Care Act 2014 give local authorities a duty to provide information and advice. The duty to provide information and advice underpins any contact or intervention that the local authority has with the individual. Local authorities need to provide comprehensive information and advice about care and support services in their local area. This is to help people to understand how care and support services work locally, the care and funding options available, and how people can access care and support services.
16. The Act clearly sets out that they must provide information on:

• what types of care and support are available – e.g. specialised dementia care, befriending services, reablement, personal assistance, residential care etc
• the range of care and support services available to local people, i.e. what local providers offer certain types of services
• what process local people need to use to get care and support that is available
• where local people can find independent financial advice about care and support and help them to access it
• how people can raise concerns about the safety or wellbeing of someone who has care and support needs

17. All information and advice must be provided in formats that help people to understand, regardless of their needs. This may include a range of different types of information, and include working with partners to provide information on different services together.

Complaint handling

18. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The council should include in its complaint response:

• how it considered the complaint;
• the conclusions reached about the complaint, including any required remedy; and
• whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• details of the complainant’s right to complain to the Local Government and Social Care Ombudsman.
  (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

19. The Council’s website states it will acknowledge adult social care complaints within three working days. It states in its acknowledgement it will also provide a time scale for its investigation.

What happened

Financial assessment and charging (parts

20. In July 2022, Mr X was medically ready to be discharged from hospital. The hospital arranged for him to be discharged to a care home temporarily whilst action was taken to make his home safe.
21. In August, Mr X was discharged to the care home. Upon discharge, the NHS funded Mr X’s care fees through its Discharge to Access scheme. This is where the NHS pays for someone’s care while their longer-term care and support needs are assessed. Mr X did not have to contribute to his care fees during this time.
22. In late September, the NHS found Mr X was not eligible for NHS Continuing Healthcare funding. The care home began charging £2000 per week for Mr X’s care. Mr X was not informed about the charge.
23. Mr X told his social worker he wanted to move to his own home with a package of care and support. He told them he needed additional weeks respite care at the care home to make his home suitable. His social worker told him he needed to complete a financial assessment for the Council to calculate his care contributions towards his respite care. The social worker gave Mr X the form to complete.
24. In early October, Mr X completed the financial assessment form.
25. In early November, Mr X’s social worker transferred his case to a new team and ceased working with him. The Council also sent Mr X a letter with the outcome from his financial assessment. It told him he would be liable to pay the full amount of care costs. It did not detail the cost of his care.
26. In late November, the care home increased its fees for Mr X’s care from £2000 to £2500 per week. Mr X’s new social worker visited him to complete a needs assessment. They told him he was liable to pay the full amount of £2500 per week for his care.
27. In January 2023, Mr X passed away. He was still living in the care home.
28. In February, the Council sent invoices for Mr X’s outstanding care fees. Mr Y made a formal complaint.
29. In April 2024, the Council responded to Mr Y’s complaint. It did not uphold any parts of his complaint.
30. To date, Mr X’s care home fees have not been paid.

Analysis

Lack of confirmation regarding fees prior to discharge, communicating payable fees and increase in fees (parts a, c and d of the complaint)

31. The Council says it did not have enough information available about Mr X’s finances at the time of his discharge from hospital to tell him about the cost of his care. I accept the Council could not be expected to assess Mr X’s contributions towards his care prior to a financial assessment. However, the Council could have explained to Mr X that if his savings were above the upper capital limit, he would have to pay full costs of his care. The Council could have told Mr X the details of care costs in the care home he was discharged to. If the Council were not aware of the care costs of the specific care home, it could have researched and told Mr X. This would have provided Mr X with the detail he needed to make an informed decision. The Council is at fault for not providing this information.
32. At the time Mr X was discharged his care home contributions were being paid by the NHS. The NHS paid his contributions for six weeks. The Council not informing Mr X about the care home fees upon discharge meant he could not make an informed decision about prioritising works to make his home safe during this time.
33. At the beginning of November, the Council sent a letter to Mr X with the outcome of his financial assessment. The letter told Mr X he was liable for paying the full amount towards his care at the care home. However, the letter did not detail the care homes fees, which at this time were £2000 per week. Mr Y says Mr X did not receive this letter. In any case, as the letter did not inform Mr X of the care fees he was being charged, he still could not make an informed decision. This is fault which caused Mr X avoidable and unnecessary uncertainty.
34. The Council sent Mr X another letter at the end of November. It detailed the care home fees from mid-September as £2000 per week, and told him it was increasing his fees to £2500 per week from the end of November. Mr Y says Mr X did not receive this letter. Mr Y says Mr X first knew about the fees when his social worker told him during a visit in late November. In any case, Mr X became aware of the fees at the same time he should have received the letter; therefore any injustice caused to Mr X by not receiving the letter is limited.
35. I consider the injustice to Mr X to be limited. This is because once Mr X received all information about the care home fees he was liable for, he made an informed decision to remain in the care home. He made this decision knowing about the increase in his fees. Therefore, it is likely he would have made the same decision to stay in the care home had he known about the fees earlier, at which point would have been £500 less per week. I consider the lack of information from August to the end of November caused him unnecessary and avoidable uncertainty.

Delay in completing financial assessment and (part b of the complaint)

36. There is no mandatory timescale for a Council to complete a financial assessment. This said, in any case I do not find the Council taking two months to complete the process to be a significant enough delay to make a finding of fault. However, I would have expected the Council to provide general advice to Mr X about the cost of his care if it found his capital exceeded the upper limit.

Delay in allocating another social worker (part f of the complaint)

37. Mr Y says the delay in the Council allocating another social worker impacted Mr X’s ability to plan to move home. The Care Act 2014 sets out the legal responsibilities of the Council. There is no legal requirement for Councils to allocate social workers to individuals in its adult social care service. I consider a period of three weeks without a social worker is not significant enough to make a finding of fault. In any case, I consider the injustice to Mr X to be limited because Mr X made an informed decision to remain in the care home until he passed away.

Complaint handling

38. The Council took 14 months to issue its final response after receiving Mr Y’s complaint. The Council apologised to Mr Y for the delay in issuing a full response. It explained its reasons for the delay which were his complaint had firstly been assigned to the wrong department, and due to the complexity of the complaint it took time to find and process information for its investigation. This delay is fault which caused Mr Y uncertainty. I consider the sincere and detailed written apology the Council provided to Mr Y has remedied the injustice caused by its delay.

Invoices

39. The invoices I have seen include a request for payment for a period of 10 days in September 2022 during which time the NHS was funding Mr X’s care. This is fault.

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Agreed action

40. Within four weeks of my final decision, the Council has agreed to:
1. issue an amended invoice for the outstanding care home fees minus fees for the 10 days in September 2022 for which the NHS were liable.
2. review its policy and/or training to relevant staff with consideration on how to improve the provision of timely information about the potential cost of a placement prior to undertaking its financial assessment process.
3. review its processes so that it can identify when complaint responses have become delayed, and ensure complainants are kept informed on progress.
41. The Council should provide us with evidence it has complied with the above actions.

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Final decision

42. I have completed my investigation. I find the Council at fault and this caused injustice. The Council has agreed to issue an amended invoice and take service improvement action.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman