Summary: There is no evidence of fault in the way the Council completed a financial assessment of Mr Y. It properly considered two appeals for his personal allowance to be increased. As there is no evidence of fault in the process, I cannot comment on the merits of the decision reached.

The complaint

1. Mr X complains that following a financial assessment to determine his father’s contribution towards his care home fees, the Council has not left him with enough funds to cover his expenses.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I have considered the written complaint and the correspondence between Mr X and the Council. I have also taken account of relevant legislation. Mr X and the Council have had the opportunity to comment on a draft of this document.

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What I found

Relevant legislation

5. The charging rules for residential care are set out in the “Care and Support (Charging and Assessment of Resources) Regulations 2014”, and the “Care and Support Statutory Guidance 2014”. When the Council arranges a care home placement, it has to follow these rules when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
6. 8.35 of the Guidance says, People in a care home will contribute most of their income, excluding their earnings, towards the cost of their care and support. However, a local authority must leave the person with a specified amount of their own income so that the person has money to spend on personal items such as clothes and other items that are not part of their care. This is known as the personal expenses allowance (PEA).
7. The Personal Expense Allowance is specified in regulations made under section 14(7) of the Care Act 2014 and applies to all people whose care and support in a care home is arranged by a local authority under section 18 or 19 of the Act. 6. It is intended to allow residents to have money for personal use.

What happened

8. Mr X’s father, Mr Y, privately funded his residential care placement from 2014 until his funds fell below the financial threshold for assistance with funding.
9. Mr X contacted the Council on 28 November 2018 to inform it Mr Y’s funds were below the threshold, and to ask for assistance with funding. Mr Y continued to pay his care fees until the Council completed its assessment.
10. The Council completed the assessment on 3 May 2019. A financial assessment concluded Mr Y had to contribute his income towards his care, leaving him with £24.90 per week personal allowance.
11. Mr X believed the Council should refund the total amount of care fees, which were in excess of £10,000, paid during the months Mr Y was waiting for the Council to complete the assessment. The Council said it would only backdate the amount of eligible funding to the date Mr X requested the assessment. It would not refund the total amount of care fees Mr Y paid.
12. Mr X believed the Council had not properly considered Mr Y’s needs in the assessment, or his monthly expenditure. Mr X submitted two separate appeals to the Council asking it to re-consider expenses for sky TV and payments for health insurance. Mr X cancelled the health insurance but asked how Mr Y would meet the costs of dental and optical care. The Council said Mr Y’s personal allowance should cover the costs of NHS optical and dental care. Mr X also said Mr Y did not have enough money to buy for birthday and Christmas gifts for his family, which he had always done..
13. The Council responded to each appeal separately explaining its reasons both appeals had been unsuccessful. It said, “…there has never been a greater choice of free-to-air television channels and radio stations. It would not be appropriate to increase the level of state assistance by allowing this cost in the financial assessment”. In its letter of 16 June 2019, the Council explained “The Care Act 2014 gives clear guidance on what expenses can be considered during a financial assessment”. It went onto give a detailed explanation of the personal expenses allowance set out in the Act.
14. Mr X remained dissatisfied.

Analysis

15. It is not the Ombudsman’s role to decide what a person should pay towards their care, that is the Council’s role. The Ombudsman cannot question the merits of decisions made unless there is evidence of procedural fault which calls that decision into question.
16. I find no evidence of fault in the process. The Council followed the correct procedure in completing the financial assessment of Mr Y. It also gave due consideration to two appeals Mr X submitted and used its professional judgement to decide not to increase Mr Y’s personal allowance to allow for personal expenditure. As there is no evidence of fault in the way it came to this decision, I cannot comment on the merits of the decision reached, no matter how strongly Mr X may disagree with it.
17. There is no fault in the Council’s refusal to reimburse Mr Y care fees he paid before he contacted the Council to ask for financial assistance.
18. I am satisfied the Council has explained its position and why it has refused Mr X’s request.

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Final decision

19. The Council followed the correct guidance in arriving at its decision. As such, the final decision the Council has made is merits (see paragraph 2).
20. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman