Summary: Mrs F complained about the Council’s actions in respect of the payment of fees for care in a residential care home for her father (Mr G). We found the Council failed to keep Mrs F informed of its actions and gave inaccurate information in its initial response. The Council has agreed to make a symbolic payment of £400 to Mrs F and to improve its procedures for the future.

The complaint

1. Mrs F complained on behalf of her late father, Mr G, that Durham County Council (the Council):
• failed to inform the care home (the Home) that Mr G was self-funding his care;
• paid the outstanding care home fees directly to the Home without consulting or informing Mrs F;
• gave incorrect reasons for paying the fees; and
• delayed in responding to Mrs F’s concerns and queries about the matter.
2. This caused Mrs F significant distress and inconvenience at a very difficult time. She also said it prevented her from taking action against the Home for alleged poor care of her father before he was admitted to hospital.

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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 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)
4. 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

5. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Mrs F and the organisation had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Charging for social care services: the power to charge

6. 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)

How to assess; Thresholds; DRE

7. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.

Safeguarding

8. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

Care providers

9. We can investigate complaints about adult social care providers. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:

• it is unlikely we could add to any previous investigation by the care provider; or
• it is unlikely further investigation will lead to a different outcome; or
• we cannot achieve the outcome someone wants.

What happened

10. Mrs F’s father, Mr G went into the Home in June 2023. He had savings above the threshold and was self-funding his care. The Council’s social worker advised Mrs F to contact the Council’s financial assessment team when his savings dropped close to the threshold. The social worker assumed Mrs F would contact the Home and make private arrangements to pay. The Council later confirmed that the social worker should have informed the financial assessment team who would have sent a letter to the Home informing it that Mr G was a self-funder. As it was, the Home assumed the Council was paying the charges for Mr G’s care and he was making a contribution to the Council.
11. In mid-August 2023 the Home was concerned about Mr G’s food and fluid intake. It contacted the GP who advised they would see Mr G on their weekly rounds. Five days later the GP visited. Mr G was sleepy and would not tolerate food or fluids. The GP advised the home to stop the diuretic medication and monitor his food/fluid and weight. His bloods were taken and the GP said they would review him again the following week.
12. The following day Mr G refused food and fluids, but his observations were all normal. The Home advised Mr G’s wife that it would contact the GP the next day. The next morning his condition had deteriorated, and the Home called an ambulance. Mr G was admitted to hospital. Mrs F said a doctor at the hospital said Mr G was severely dehydrated which was preventable.
13. Mrs F said that Mr G was not returning to the Home due to poor care. The hospital raised a safeguarding concern with the Council over Mr G’s condition on admission. Mr G was discharged to a different care home at the beginning of September 2023.
14. The Council started a safeguarding enquiry. It spoke to Mrs F, the manager of the Home and the hospital. The hospital said it would never be able to say exactly what had caused Mr G’s dehydration.
15. The Council obtained copies of the Home’s care records including the food and fluid charts. It noted there were gaps in the charts. The Home said this was when Mr G had refused food/fluids.
16. The Council arranged a referral to its practice improvement team to support the Home with accurate case-recording. It also referred the Home to the Care Quality Commission. It closed the safeguarding enquiry with no further action required, concluding that Mr G’s condition had been discussed with the GP in the ward round and actions taken as recommended. The Home had continued to take observations of Mr G and sought medical attention when he deteriorated. The Home had also taken steps to improve its case recording.
17. In October 2023 the improvement team reviewed the Home’s practices and noted it had no concerns.
18. On 19 October 2023 the Home sent a bill to Mrs G for the outstanding fees. On 21 November 2023 the Home contacted the Council to say it had not received payment of Mr G’s fees.
19. On 23 November 2023 the Council spoke to Mrs F about the fees. She said she had received a payment schedule from the Home shortly after Mr G’s admission, but the costs were unclear, and she was not willing to sign the document. She said she then mislaid the document and asked for a copy but did not receive one.
20. At the end of November 2023, the Council spoke to the Home about the safeguarding enquiry. It confirmed it had made changes to the recording sheets for food/fluid intake and adopted a more robust procedure to ensure charts were checked and signed off daily.
21. The Home also commenced an internal investigation into the concerns raised by the hospital and Mrs F. It met with Mrs F to discuss the concerns she had raised.
22. On 8 December 2023 the Home contacted the Council to say it had sent an invoice for the fees to Mrs F, but she had refused to pay due to the alleged poor care. The Home said it had no contract with Mrs F for payment because it was not aware Mr G was a self-funder. The Council agreed to pay the fees to the Home and seek to recover the money from Mrs F who had lasting power of attorney for Mr G in respect of his finances.
23. Mr G died shortly after this. The Council told Mrs F that it had paid the fees to the Home and sent an invoice for the outstanding amount.
24. In January 2024 the Home issued its investigation report. It concluded that there had been concerns about the consistency of the case recording on the food and fluid charts, but an overall assessment had been documented every day. It said it had put measures in place to ensure improvement in this area, including nursing and senior supervision of documentation on a daily basis.
25. In respect of Mr G’s condition, it said it was evident that staff had raised concerns about Mr G’s food and fluid intake with the GP who then visited Mr G. The GP did not raise any concerns about hospital admission but gave advice which the Home followed. When Mr G’s condition deteriorated staff called for an ambulance.
26. On 11 January 2024 Mrs F telephoned the Council to dispute the invoice due to poor care by the Home and asked for clarity on the amounts charged. The Council tried to call Mrs F back on 26 January 2024, but did not speak to her and was unable to leave a message. On 9 February 2024 the Council confirmed the charges stood and advised her to make a complaint about the care to the Home.
27. On 16 February 2024 the Council advised Mrs F that the decision to pay the Home had been made at senior management level as the Home had not received any payment for fees due to the Council’s original error and its duty of care meant it did not want to put the placement at risk. Mrs F made a formal complaint on 26 February 2024.
28. The Council sent a formal complaint response on 12 April 2024. It did not uphold the complaint about the safeguarding enquiry. It was satisfied the Council had spoken to all parties involved, the Home had appropriately sought medical advice from the GP and followed the advice given. The hospital could not confirm the admission to hospital was the result of negligence by the Home, so there was no further action the Council could take.
29. It partially upheld the complaint about the payment of the fees. It agreed that the social worker had not followed the correct procedure when Mr G went into the Home, so the Home was unaware that Mr G was self-funding his care. It agreed that the Council should have informed Mrs F that it was going to pay the fees and recover the money from her. It apologised for the failure to do so.
30. However, it said there were no grounds to waive the charges as medical professionals could not categorically confirm that Mr G’s admission to hospital was due to poor care by the Home. The Council considered the Home had taken proportionate action in relation to the safeguarding concerns.
31. The Council also upheld Mrs F’s complaint about the delay in responding to her queries about the fees. It said it had delayed and not made sufficient attempt to contact her when its initial telephone call had been unsuccessful.

Analysis

32. Dealing with each part of the complaint in turn:

failed to inform the Home that Mr G was self-funding his care

33. The Council accepted that it did not follow the correct procedure when Mr G went into the Home and as a result the Home was not aware that Mr G should be self-funding his care. So, the Home did not enter into a contract with Mrs F in respect of payment of the fees. This was fault which meant that Mrs F was not aware of who was going to pay the fees or how they would be paid and the Home incorrectly assumed that the Council was paying the fees, allowing a debt to build up.

paid the outstanding care home fees directly to the Home without consulting or informing Mrs F

34. The Council accepted it should have informed Mrs F that it was going to pay the fees to the Home. The failure to do so was fault which caused Mrs F distress and uncertainty as she wished to challenge the Home on the level of fees, due to the allegation of poor care of Mr G.

gave incorrect reasons for paying the fees

35. When the Council did explain its actions to Mrs F it gave a wholly inaccurate reason for paying the fees, saying that it did not want to put Mr G’s placement at risk. Given that Mr G had not lived there for four months this was an inadequate reason for taking the action it did. This was fault which caused Mrs F confusion and distress.

delayed in responding to Mrs F’s concerns and queries about the matter

36. The Council agreed its communication with Mrs F was poor regarding payment of the fees, especially after her initial enquiries. This was fault which exacerbated an already difficult situation. But the Council did not delay in dealing with her formal complaint.

Allegation of poor care

37. It is not our role to decide whether poor care led to a deterioration in a person’s health. That is a matter for the courts to decide. However, we can conclude that fault caused distress and uncertainty at a difficult time.
38. In Mr G’s case the Council carried out a safeguarding enquiry in response to concerns raised by the hospital. It found deficiencies in the case-recording but did not uphold the concern that Mr G was admitted to hospital due to poor care. I am satisfied that the Council carried out a thorough enquiry and I am unlikely to reach a different conclusion. The Home has taken steps to improve its recording procedures, and the Council had no further concerns. The Home’s own investigation concluded that staff sought medical advice appropriately and followed that advice until Mr G’s condition deteriorated. It then called for an ambulance. Again, I am unlikely to reach a different conclusion and so I have not started an investigation into the Home.

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Agreed action

39. In recognition of the injustice caused to Mrs F by the fault identified above, I recommended the Council within one month of the date of the final decision:
• Apologises to Mrs F and makes a symbolic payment of £400.
40. I also recommended within three months the Council ensures:
• all social work staff are aware of the correct procedure to follow when a person goes into residential care.
41. The Council has agreed to the recommendations and should provide us with evidence it has complied with the above actions.

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Final decision

42. I consider this is a proportionate way of putting right the injustice caused to Mrs F and I have completed my investigation on this basis.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman