Summary: Mrs X complained about errors in how the Council managed her mother’s, Mrs Y’s and father’s, Mr Y’s, care home fees and of poor communication. There was no fault in how it managed Mrs Y’s care fees. There was fault in how it managed Mr Y’s fees. There was delay and error in the financial assessment. It then agreed to pay for Mr Y’s care and backdate payments to September 2021 but did not start doing so for three months. The errors caused Mrs X uncertainty, distress and financial loss. The Council has agreed to pay Mrs X £400 in recognition of the distress and uncertainty caused and support her to ensure she is refunded all monies owed to her by the care home.

The complaint

1. Mrs X complained about errors in how the Council managed her mother’s, Mrs Y’s and father’s, Mr Y’s, care home fees.
2. In relation to Mrs Y, she says the Council has not provided her with a copy of the financial assessment showing how it calculated her assessed contribution to be £157 per week. She is unsure if the calculation is correct.
3. In relation to Mr Y, she says in its complaint response dated 28 April 2022, the Council agreed to pay Mr Y’s care home fees from 27 September 2021. However, the Council had not started paying the fees or refunded her the fees she has already paid to the care home since September 2021.
4. She says the ongoing situation is causing significant distress and financial loss. She wants the Council to review Mrs Y’s financial assessment to ensure calculations are correct and provide her with a copy, pay for Mr Y’s care from the date it agreed and refund her all monies she is owed.

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The Ombudsman’s role and powers

5. 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)
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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How I considered this complaint

7. I read Mrs X’s complaint and spoke with her about it on the phone.
8. I made enquiries of the Council and considered information it sent me.
9. Mrs X and the Council had the opportunity to comment on the draft decision. I considered comments received before reaching a final decision.

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What I found

Charging for care

10. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
11. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
12. 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.
13. A person may continue to receive some benefits when they move into a care home, but some will stop. If a person receives the care component of Disability Living Allowance, this will stop after they have lived in the care home for four weeks.

What happened

14. In 2021, Mr and Mrs Y moved into a residential care home, arranged by the Council. Mr and Mrs Y’s daughter, Mrs X has power of attorney for her parents’ financial affairs. As part of this role, she manages payments towards their care.

Complaint relating to Mrs Y

15. The Council arranged Mrs Y’s placement and agreed to fund Mrs Y’s care from 8 March 2021.
16. The Council completed a financial assessment in December 2021 to calculate Mrs Y’s assessed contribution. It wrote to Mrs X two weeks later with the outcome of the assessment. I have seen evidence that it sent Mrs X this letter. The letter set out its calculations of Mrs Y’s assessed financial contribution from 8 March 2021 onwards, based on her capital and income. The calculations included Disability Living Allowance care component as part of Mrs Y’s income for the first four weeks, but then disregarded this from its calculations after that.
17. Mrs X has told us she has never received a copy of the financial assessment and is unsure if Mrs Y’s assessed contribution is correct. She says she is unsure if the Council are still including Disability Living Allowance care component as part of Mrs Y’s income, even though Mrs Y is no longer receiving this benefit.

Analysis

18. Mrs Y’s financial assessment took into account the Disability Living Allowance care component for the first four weeks, and then disregarded it from its calculations after that. This is what we would expect. There is no fault in how the Council calculated Mrs Y’s assessed contribution.
19. The Council has provided evidence it sent Mrs X a copy of the assessment in December 2021. Although Mrs X says she did not receive this, the evidence shows the Council did send it to her. The Council is not at fault.

Complaint relating to Mr Y

20. In September 2021, Mrs X contacted the Council to request a financial re-assessment for her father Mr Y, as his savings had fallen below the upper capital limit.
21. In January 2021, the Council wrote to Mrs X but the letter was unclear about how much Mr Y needed to contribute to the cost of his care.
22. Mrs X complained to the Council in February 2022. She said the Council had delayed completing the financial re-assessment and she was still paying fees directly to the care home, causing her financial loss.
23. The Council responded to her complaint in April 2022. It apologised to her for the delay completing the re-assessment and for the lack of clarity about how much Mr Y was required to contribute. It said the Council had reviewed its assessment and accepted it had made an error, for which it apologised. It agreed to fund Mr Y’s placement from 27 September 2021.
24. Mrs X brought the complaint to us in May 2022. She said despite the Council agreeing to fund Mr Y’s care from September 2021, it had not started doing so. She said she was still paying the care fees as she did not want a disruption to Mr Y’s placement. She said the matter was causing her financial loss and considerable distress.
25. The Council completed a further financial assessment in July 2022 and wrote to Mrs X with the outcome. This letter confirmed how much it calculated Mr Y’s weekly assessed contribution to be, starting from 27 September 2021.
26. In its response to my enquiries, the Council said it had resolved the matter in July 2022 and the Council was now paying the care home directly for Mr Y’s care. It said it had backdated its first payment to 27 September 2021 and would be contacting the care home to confirm how much it needed to refund Mrs X.
27. Mrs X told us she had not yet received the refund from the care home.

Analysis

28. In its complaint response, the Council accepted it had delayed completing Mr Y’s financial assessment, there were errors within the assessment and its communication with Mrs X had been unclear. I agree with these findings and this was fault. These faults caused Mrs X frustration and distress.
29. In its complaint response in April 2022, the Council agreed to fund Mr Y’s care backdated to September 2021, but did not arrange this, nor did it clarify what Mr Y’s assessed contribution was. The Council delayed a further three months until July before it started to pay for Mr Y’s care and wrote to Mrs X clarifying Mr Y’s assessed contribution. This was fault.
30. This additional delay caused Mrs X further frustration and distress. It also caused Mrs X financial loss as, in the absence of the Council funding, she continued to pay care fees directly to the care home, as she was concerned that not doing so would risk Mr Y’s placement. She was then caused further inconvenience and time and trouble bringing the complaint to us.
31. Mrs X said she had still not received a refund of the care fees she paid to the care home between September 2021 and July 2022. But for the identified faults, the Council would have started paying for Mr Y’s care earlier and Mrs X would not be in this position.
32. The Council has apologised to Mrs X for the impact of the faults but this is insufficient to remedy the injustice caused. I have recommended a suitable remedy below.

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Agreed action

33. Within one month of the final decision, the Council will:
• Pay Mrs X £400 as acknowledgement of the frustration and distress caused by the delay completing Mr Y’s financial assessment, the poor communication and further delay in starting to pay for Mr Y’s care between April and July 2022.
• If not already done so, it should confirm with the care home how much it needs to refund Mrs X for fees paid on Mr Y’s behalf since 27 September 2021. It should support Mrs X as needed until Mrs X confirms the care home has refunded her all the fees she is owed.

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Final decision

34. I have completed my investigation. I have found fault and the Council has agreed action to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman