Summary: Ms X complained the Council failed to advise her, or her father, about her father’s care charges for seven months after the Council started to provide him with care resulting in a large backdated bill. We found fault with the Council for delays in completing Ms X’s father’s financial assessment. The Council agreed to reduce Ms X’s father’s charges by 50% from 14 September 2021 to 31 March 2022.

The complaint

1. Ms X complained the Council failed to advise her, or her father, about her father’s care charges for seven months after the Council started to provide him with care.
2. Ms X said after seven months the Council provided a backdated bill for more than £6,000.
3. Ms X also complained the Council issued the backdated bill without any covering letter or explanation.

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The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. 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 investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34H(3) and (4), as amended)
6. If we are satisfied with a council’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

7. I have considered all the information Ms X provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
8. Ms X and the Council had opportunity to comment on my draft decision before I made my final decision.

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What I found

Relevant legislation and guidance

9. The Care Act 2014 (the Act) is the legislation that sets out local authorities’ powers and duties in respect of adult social care services. The Department of Health and Social Care also produces statutory supplemental guidance for local authorities on how to discharge these duties. This is called the ‘Care and support statutory guidance’ (the Statutory Guidance).
10. Section 14 of the Act gives a local authority the power, with certain exceptions, to charge for care and support it arranges to meet an adult’s needs.
11. Section 17 of the Act explains that, where a local authority decides to charge for care and support, it must assess the adult’s financial resources to calculate the amount (if any) the adult would be likely to be able to contribute towards the cost of the care and support.
12. In carrying out a financial assessment, the local authority must follow the ‘Care and Support (Charging and Assessment of Resources) Regulations 2014’ (the Charging Regulations). The Charging Regulations set out how local authorities should treat an adult’s income and capital for the purposes of calculating care contributions.
13. The Guidance says that a Personal Budget should specify the amount the service user will have to pay towards the cost of the care, based on the financial assessment. It explains that a Personal Budget is the mechanism, in conjunction with the care and support plan, that enables the person to exercise greater choice and take control over how their care and support needs are met.
14. A financial assessment should be completed as soon as reasonably practicable. The Ombudsman would expect a financial assessment to be done within four weeks of a Care Assessment. A Care Assessment and financial assessment are part of one process.
15. Paragraph 8.2 of the Guidance says that when a council decides to charge for care it should be “clear and transparent, so people know what they will be charged”.

Statutory adult’s complaints process

16. The complaints process for adult’s social care complaints is laid down in statute in the Local Authority Services and National Health Service Complaint (England) Regulations 2009.
17. At step 1, the Council says it will try to talk with a person in the first instance to resolve a complaint. If the Council cannot resolve the matter immediately it will pass a matter to a relevant manager for early resolution. The Council should offer an early resolution by the end of the working day following the initial contact or progress to step 2 of its process.
18. At Step 2 the Council will write to a person to let them know when it will provide a complaint response.
19. The Council will provide its written complaint response at Step 3 of the Council’s process. If a person is dissatisfied with a Council’s complaint response they can request a review of the response. Following the review, the Council will provide a final response letter. This letter will detail a person’s right to approach the Local Government and Social Care Ombudsman (the Ombudsman) after the Council has provided its complaint response.
20. The Council says it should provide a complaint response within 20 working days unless there are exceptional circumstances. This 20-day complaint response is from receiving the complaint to issuing the final response letter.

What happened

21. On 15 August 2021, the Council completed a care assessment of Ms X’s father.
22. In August 2021, the Council made a referral for a financial assessment of Ms X’s father.
23. The Council started to provide Mr X with care on 8 September 2021.
24. The Council provided Ms X with an “Agreement to pay” form in September 2021. This form detailed that:
• Ms X understood her father would need to pay towards the cost of care provided by the Council.
• Any payment due would be based on a financial assessment.
• If Ms X’s father had more than £23,250 in savings he would not be able to get any help to pay towards the cost of care.
• Ms X’s father may have to pay a backdated charge from the date he started to receive care from the Council.
25. Ms X told the Council that her father did not have savings in excess of £23,250 and signed and returned the form to the Council.
26. On 31 March 2022, the Council completed a financial assessment for Ms X’s father. The Council wrote to Ms X to confirm her father’s maximum contribution would be £1,055.19 a week, with a likely cost of £226 per week.
27. The Council sent a backdated bill for Ms X’s father’s care on 14 April 2022 for the care provided since 13 September 2021. This bill exceeded £6,000.
28. Ms X contacted the Council on 26 April 2022 to query the backdated bill. Ms X said her father had less than £23,250 in savings and since she had not heard from the Council for seven months assumed he did not need to pay for his care. Ms X said she now understands her father needs to pay for the cost of care and would do so moving forwards. Ms X complained about the Council backdating these charges to September 2021.
29. In June 2022, the Council sent a further backdated bill for the care charges from 8 September 2021 to 13 September 2021. Ms X asked the Council to place this bill on hold while the Council investigated her complaint. The Council agreed to place the bill on hold.
30. On 10 October 2022, the Council provided a complaint response to Ms X. The Council said:
• It apologised for the delayed response to her complaint.
• It received the request for a financial assessment in August 2021 but “due to various issues” it could not complete this until March 2022.
• Following its assessment in March 2022, it concluded Ms X’s father was liable for the cost of care and the backdating bill amounting to £6212.92.
• It usually sends letters in advance of a backdated bill and apologised for failing to do this.
31. On 1 November 2022, Ms X requested a review of her complaint. Ms X said she understood her father needed to pay for his care but was unaware of this cost before March 2022.
32. The Council responded to acknowledge that it failed to provide Ms X with specific information about the cost of her father’s care until March 2022. The Council also said that when it knew the financial assessment would be delayed it should have told Ms X about this.
33. Ms X asked for a review of her complaint.
34. The Council provided its final response letter on 18 November 2022. The Council said It upheld its initial complaint response issued on 10 October 2022. The Council said it could not provide Ms X with details of what Ms X’s father should pay until it completed its financial assessment. The Council said Ms X agreed to backdated charges by signing the “Agreement to pay” form. The Council directed Ms X to the Ombudsman.

Analysis

Delays in completing financial assessment

35. The Guidance outlines that a council should detail the cost of a person’s care in a Personal Budget following a care assessment. The Council completed Ms X’s father’s care assessment on 15 August 2021. The Council failed to tell Ms X, or her parents, about Ms X’s father’s Personal Budget. This meant neither Ms X nor her parents had any knowledge of what Ms X’s father’s care costs might be.
36. None of the information the Council provided to Ms X, or her parents, provided any details about what Ms X’s father’s care costs might be. This includes the “Agreement to pay” form or leaflets.
37. Additionally, before the Council completed the financial assessment Ms X may not have been aware that her parents would need to contribute towards the cost the care. This is because Ms X’s parents did not have savings about the £23,250 threshold which she confirmed with the Council. The “Agreement to pay” form provided by the Council also does not reference income and is specific about savings and investments about £23,250.
38. Paragraph 8.2 of the Guidance says that when a council decides to charge for care it should be “clear and transparent, so people know what they will be charged”. The Council failed to provide clear or transparent information to Ms X or her parents at the time of completing the care assessment. This was fault.
39. The Council requested a financial assessment for Ms X’s father in August 2022. There is no statutory timescale for completion of a financial assessment. The Ombudsman would expect the Council to take no longer than four weeks to complete a financial assessment following a Care Assessment.
40. Four full working weeks from 15 August 2021 would be 14 September 2021. The Council did not complete its financial assessment of Mrs X until 31 March 2022. The Council took 33 weeks, from the date of the Care Assessment on 15 August 2021, to complete the financial assessment. The Council delayed for 29 weeks beyond the expected four-week timescale in completing the financial assessment. The Council has provided no good reasons for this delay. This was fault by the Council.
41. While the Council was at fault for these delays, on providing the cost of care to Ms X on 31 March 2022, Ms X’s father has continued to receive the care. Ms X has confirmed her father needs this care and has acknowledged they are happy to pay for this care moving forwards. If the Council had completed the financial assessment without fault, it is likely Ms X, and her parents, would have agreed to receive and pay for the care in 2021.
42. Since the Council has provided Ms X’s father with care, and he would have paid for his care without the Council’s fault, it is not appropriate to remove the entire care charges because of the Council’s fault. The Council should remove half the care charges from four-weeks after the care assessment date up to 31 March 2022 to reflect its fault.

Service standards

43. The Council issued a large backdated bill in April 2022 without a covering letter or prior notification of large backdated bill. The Council has acknowledged its fault in failing to send this prior notification within its complaint response of 10 October 2022. This fault caused distress to Ms X and her parents.
44. Ms X requested the Council investigates her complaint on 26 April 2022. The Council did not resolve Ms X’s complaint through Step 1 or Step 2 of its complaint process. As such, the Council moved into Step 3 of its complaints process. Step 3 of the Council’s complaint process says it should provide a complaint response within 20-working days unless there are exceptional circumstances.
45. There are no exceptional circumstances in Ms X’s complaint. The Council should have provided its final response to Ms X’s complaint by 25 May 2022. The Council failed to meet this deadline and only issued its final response on 18 November 2022, 123 working days (nearly six months) past the deadline. This was fault by the Council.

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Agreed action

46. Within one month of the Ombudsman’s final decision the Council should:
• Remove 50% of the charges for Ms X’s father’s care costs from 14 September 2021 to 31 March 2022.
• Provide a direct payment of £100 to Ms X for the distress, frustration and inconvenience caused through the Council’s poor handling of her complaint and failure to send notification of the backdated bill in advance.
47. The Council should provide us with evidence it has complied with the above actions.

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Final decision

48. There was fault by the Council as the Council has agreed to my recommendations, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman