Summary: Mrs X complains the Council delayed in completing a financial assessment in respect of her mothers’ contribution towards the cost of her residential care. As a result, Mrs Y continued to pay private fees for longer than necessary. We have found the Council to be at fault. To remedy the injustice caused the Council has agreed to apologise, refund the overpaid fees and make a payment to recognise the distress and time and trouble caused to Mrs X.

The complaint

1. Mrs X complains on behalf of her mother, Mrs Y. Mrs X says her mother is owed over £15,782.99 in residential care fees taken from her account between January and August 2020.
2. Mrs X made the Council aware in January 2020 that her mother’s capital had fallen below the threshold. Mrs X says her mother has been financially disadvantaged. Mrs X has been trying to resolve the issue for over a year and this has caused her significant distress.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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

5. I have spoken to Mrs X and considered the information she provided with her complaint. I made enquiries of the Council and reviewed and considered the information it provided.
6. I sent Mrs X and the Council a copy of my draft decision and invited their comments. I considered all the comments I received before reaching a final decision.

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What I found

Legal and administrative background

7. 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 a 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 cost of their residential care.
8. The rules state that people who have over the upper capital limit (£23,250) are expected to pay for the full cost of their residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.
9. A council must assess the means of people who have less than the upper capital limit to assess how much they can contribute towards the cost of their care home fees.

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What happened

10. Mrs Y was a resident at Beech Lawn Residential Home (the Provider). Initially, Mrs Y’s capital was over the upper capital limit and therefore she was funding the care home fees out of her savings.
11. In January 2020 Mrs X told the Council that Mrs Y’s capital had reduced to below the upper limit. This meant Mrs Y was entitled to partial help from the Council with her residential care costs. At the time, Mrs Y continued to pay the Provider the same amount in private fees, £4002.08 per month.
12. Mrs Y’s case was allocated to a social worker on 15 April 2020 for a financial assessment. The social worker was unable to complete an assessment with Mrs Y due to Covid-19 pandemic and Mrs Y being unwell. The social worker reviewed Mrs Y’s care and support plan and asked the Provider if it would accept a new rate for Mrs Y at £559.00 per week, backdated to 27 January 2020. This figure included both the Council’s and Mrs Y’s contribution. The Provider agreed.
13. On 3 July 2020 the Council completed a financial assessment. It wrote to Mrs Y and the Provider and confirmed a new rate of £531.00 per week from 27 January 2020. Mrs Y’s contribution was assessed at £295.54 per week. The letter stated that from February 2020 Mrs Y would pay £207.89 per week towards the cost of her care home fees.
14. Mrs X cancelled the payment for private fees on 7 July 2020. Since then, Mrs X has attempted to recover a refund of overpaid private fees on behalf of Mrs Y. It is Mrs X’s view that her mother is owed over £15,782.99 from 27 January 2020.
15. The Provider has agreed to refund Mrs Y for overpaid fees from 2 July 2020 totalling £1952.84. Mrs X has not accepted this payment and the matter remains unresolved.

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Analysis

16. The Care Act guidance says Councils should be clear and transparent so people know what they will be charged.
17. When a care and support package has been agreed the social worker should refer the case to the finance team to complete a financial assessment. There is no set time limit in which the Council must complete this assessment. We would expect a council to complete a financial assessment as quickly as possible to avoid people being faced with large and unexpected bills and situations like this where there has been an overpayment.
18. The evidence shows there was a delay by the Council in requesting and completing a financial assessment. The Council was aware that Mrs Y’s finances had dropped below the threshold in January 2020 but did not complete a financial assessment until July 2020. This is fault. I appreciate there would have been a period of delay in completing the assessment, however in this case a delay of six months has led to Mrs Y paying private fees for longer than necessary. Had the Council completed the financial assessment sooner, then Mrs Y would have been prompted to stop paying the private fees sooner.
19. As a result, Mrs Y is due a refund. I consider it appropriate and proportionate for the Council to refund the overpaid fees from 27 January 2020 to 7 July 2020, less the amount the Provider has agreed to pay from 2 July 2020.
20. Furthermore, I consider it appropriate for the Council to apologise to Mrs Y and Mrs X for the faults identified and make a payment of £250 to Mrs X to acknowledge the distress and uncertainty this caused and the time and trouble she went to bringing this complaint to the Ombudsman.

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Agreed action

21. Within one month of my final decision the Council will:
1. apologise to Mrs Y and Mrs X for the faults identified in this statement;
2. liaise with Mrs X to calculate and agree the refund due to Mrs Y for the period 27 January 2020 to 7 July 2020 and issue a refund accordingly;
3. pay Mrs X £250 as an acknowledgement of distress and time and trouble caused to her;
4. remind staff of the importance of completing a financial assessment in a timely manner.

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Final decision

22. I have found fault by the Council causing injustice to Mrs Y and Mrs X. I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman