Summary: Ms X complained about how the Council carried out care, and financial assessments for Mr Y. We find the Council at fault for how it completed Mr Y’s care assessments. We recommend the Council apologise to Mr Y and Ms X and make payments to recognise the distress caused.

The complaint

1. Ms X complains on behalf of Mr Y about care assessments and financial assessments the Council carried out for Mr Y. Specifically, Ms X has said:
• The care assessments were poor and inaccurate;
• There were delays in completing a financial assessment which meant Mr Y was funding the full costs of care himself and the Council failed to properly backdate or explain its calculations;
• The Council continued to send invoices and correspondence to Mr Y despite assuring Ms X it would not.

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What I have and have not investigated

2. I have investigated the quality of the care assessments the Council produced for Mr Y. I have also investigated the delays in completing a financial assessment and how the Council sent its invoices.
3. We cannot investigate complaints that have been brought to us more than 12 months after the complainant ought to have been aware of reason to complain. We are only able to exercise discretion if there are good reasons to do so.
4. Ms X brought her complaint to the Ombudsman in May 2022, meaning anything prior to May 2021 would be considered late.
5. Any reference below to events that took place prior to May 2021 are for reference only.

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The Ombudsman’s role and powers

6. 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)
7. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
8. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
9. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
10. 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

11. I spoke to Ms X about her complaint and considered information she provided. I also considered information received from the Council.
12. Ms X and the Council 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

Care and support needs

13. The Care Act 2014 (the Act) is the legislation that sets out local authorities’ powers and duties in respect of adult social care services.
14. Sections 9 and 10 of the Act require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve.
15. Where councils have determined that a person has any eligible needs, they must meet those needs. The person’s needs and how they will be met must be set out in a care and support plan. The plan should be proportionate to the needs to be met and should reflect the persons wishes, preferences and aspirations.
16. If it is found a person needs residential care, councils have a duty to arrange for this care.

Charging for social care services

17. The law says a council may charge for care and support it has arranged to meet a person’s needs. Where it decides to charge, a council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 (the Regulations) and have regard to the Government guidance (Care and Support Statutory Guidance (CSSG)).

Financial assessments

18. Once a council decides a person has eligible care and support needs, the law says it must carry out a financial assessment to see what contribution the person may have to pay towards the cost of their care.
19. The assessment will take account of the person’s income and assets. People receiving care and support at home need to retain a certain level of income to cover their living costs. The level of this allowance is set by the Government and known as the Minimum Income Guarantee.
20. When the council arranges a care home placement, it must follow the Regulations when undertaking a financial assessment to decide how much a person has to pay towards the cost of their residential care. The council must leave the person with a minimum amount of income.
21. Once the financial assessment is complete, the council must give a written record of that assessment to the person. This should explain how the financial assessment has been carried out, what the charge will be and how often it will be made. The council should ensure this is provided in a manner the person can easily understand.
22. People who have over £23,250 (including property) pay the full cost of care. However, once their capital has reduced to under £23,250, they pay an assessed contribution towards their fees. When carrying out a financial assessment, a council must ignore the value of a care home resident’s property for the first 12 weeks after their stay becomes permanent. This means the council will assist with funding of the placement for the first 12 weeks. Funding in this period is called a “12-week property disregard”.
23. Councils should complete financial assessments as soon as reasonably practicable. The Ombudsman would expect a council to complete a financial assessment within four weeks of a care assessment. A care assessment and financial assessment are part of one process.

Choice of care home and top up fees

24. Where a council is meeting needs by arranging a care home, it must ensure a person has a genuine choice of accommodation. The council should give the person clear and balanced information to make the best choice. It must ensure there is at least one accommodation option available that is affordable and within a person’s personal budget. If no accommodation is available within the personal budget the council must arrange care in a more expensive setting and adjust the budget to ensure that needs are met. In such circumstances, the council must not ask for the payment of a ‘top-up’ fee.
25. A person can choose accommodation that is more expensive than the amount set in the personal budget, if a third party is willing to pay the additional cost - a top up fee. But if a person is placed in more expensive accommodation solely because the council has failed to arrange accommodation at the anticipated cost, then a top-up fee will not be payable.

What happened

26. Mr Y has a diagnosis of Parkinson’s and Dementia and was being cared for at home by Ms X and a home care provider that he paid for himself.
27. On 23 December 2020, Ms X contacted the Council and asked it to carry out a care assessment for non-residential care for Mr Y. She explained his needs had increased and he needed help arranging care.
28. On 26 January 2021 the Council contacted Ms X to discuss a financial assessment for Mr Y. Ms X explained he currently had more than £23,250 available and asked for the financial assessment to be put on hold.
29. On 6 April the Council completed a care assessment for Mr Y. The assessment identified a need for increased support from the home care provider, but Mr Y remained a self-funder at that time.
30. On 23 May, Ms X emailed the Council to ask for information about financial assessments. The Council responded on 7 June to explain she would need to fill out a financial assessment form.
31. The Council sent Mr Y’s completed care assessment to Ms X on 2 July. This was dated 3 May 2021 and said:
• Mr Y had Parkinson’s disease, dementia, arthritis, vertigo and was hard of hearing but chose not to wear hearing aids
• Mr Y was receiving one hour of daily support from Age UK on weekdays with appointments, shopping and meal planning, and one hour of daily support from Homecare including helping him get up for the day
• Mr Y needed help to access and make use of services in the local community and the Council would consider how to provide this once Covid-19 restrictions were eased
• Mr Y needed assistance to maintain and clean his home and currently had a cleaner once a week, as well as support from Homecare
• Mr Y needed support managing his paperwork and finances and this was overseen by Ms X
• Mr Y needed support with shopping and preparing meals and Ms X ordered food for him online that could be heated up in the oven
• Mr Y could get himself dressed and undressed independently but did have some support from Homecare in the mornings
• Mr Y needed support maintaining his personal hygiene but was being prompted to do so by Homecare
• Mr Y was able to independently see to his toilet needs and move around his home
• Ms X was heavily involved in Mr Y’s care, often daily
32. Ms X wrote to the Council on 4 July to complain about inaccuracies in the care assessment:
• It was dated incorrectly, listed an obsolete contact number, and frequently misspelled Mr Y’s surname
• It incorrectly stated Mr Y had arthritis, chose not to wear hearing aids, was able to dress himself independently, and described his dementia as “early onset”
• It referred to Mr Y having multiple children when Ms X is his only child
• It contained outdated information about Age UK’s involvement and how Mr Y received his weekly shopping
• It did not properly reflect Ms X’s level of involvement in Mr Y’s care
• It did not note Mr Y required lifeline medication prompts to remember to take his medication
33. On 6 July the Council acknowledged Ms X’s complaint and said it would correct the mistakes in the care assessment.
34. The Council produced a new care assessment that day. This largely mirrored the previous but was amended to show Mr Y wore hearing aids, his dementia was not “early onset”, he was receiving one hour daily support on weekdays from Age Concern, not Age UK, and he only had one daughter.
35. On 16 July, Ms X returned a completed financial assessment form. The Council wrote to Ms X on 27 July asking for more information about Mr Y’s finances from 2016 onwards. Ms X said she could provide the information and the Council agreed to pick it up when she had it ready.
36. The Council produced another care assessment on 11 August. This mirrored the previous but noted Age Concern was paid to do shopping for Mr Y. It also indicated Mr Y could no longer get dressed and undressed or manage his toilet needs independently, and he needed lifeline medication prompts to remember to take his medication.
37. Ms X contacted the Council again on 20 August to let it know the financial information it had asked for was ready for collection and the Council arranged to pick this up.
38. The Council responded to Ms X’s complaint on 25 August. It apologised for the quality of the initial care assessment and provided the updated assessment.
39. Ms X responded to the Council that day to say there were still inaccuracies and asked how to move forward with an accurate assessment. Ms X explained she believed Mr Y needed a Continuing Healthcare Checklist (CHC) assessment to ensure the Council fully understood his needs. Ms X also told the Council she wanted it to consider a complaint about the fact the financial assessment had taken more than three months by that point.
40. The Council acknowledged Ms X’s complaint on 6 September and said it would aim to respond within 30 working days.
41. The Council produced a further care assessment for Mr Y on 9 September. This mirrored the previous, other than some minor wording changes, but indicated Mr Y now needed a nurse or carer to administer his medication.
42. On 17 September, having completed the financial assessment, the Council wrote to Ms X to explain that, subject to a care assessment being completed, Mr Y was eligible for funding backdated to 5 August 2021. The Council explained Mr Y’s maximum weekly contribution for care and support at home would be £136.69 and provided a breakdown of its calculations.
43. The Council wrote to Ms X on 28 September in response to her complaint about Mr Y’s financial assessment. It apologised for the time taken to complete the financial assessment. The Council explained its usual process is to carry out social care assessments and financial assessments concurrently. As Ms X had asked the Council to deviate from this process, it created a delay.
44. On 30 September the Council wrote to Ms X in response to her complaint about the care assessment. The Council agreed the information Ms X and Mr Y gave was not properly reflected in the assessment and apologised for this. It agreed to re-allocate Mr Y’s case to another member of staff.
45. Ms X wrote to the Council on 15 October. She explained Mr Y was now moving into a residential care home. Ms X asked the Council to clarify how it worked out its financial contribution to Mr Y’s care and what needed to happen for the Council to pay its backdated contribution.
46. Mr Y entered the residential care home on 28 October.
47. On 22 November the Council completed a new care assessment. This acknowledged Mr Y was now in residential care and explained:
• He was not able to access the local community independently, but this was not an applicable need while he was in residential care
• He needed support developing and maintaining personal relationships and would be reliant on others visiting him
• He was unable to maintain a habitable home and the staff at the residential care home would support him by ensuring his space was clean and comfortable
• He could eat and drink independently and the staff at the residential care home would support him by ensuring he had an appropriate diet and maintained his nutrition
• He needed assistance getting dressed and undressed but could choose his own clothing
• He could maintain his personal hygiene when it came to washing his face and hands and shaving himself, but needed support from carers to cut his fingernails
• Mr Y needed support managing his paperwork and finances and this was overseen by Ms X
• He was mainly continent and did not need much support managing his toilet needs
• He was independently mobile, but his Parkinson’s meant he was at risk of falling and he needed assistance using a wheelchair for long distances
48. The assessment noted a CHC had been completed and Mr Y was not eligible for further assessment.
49. On 3 December the Council emailed Ms X to confirm Mr Y was eligible for residential care and entitled to funding via a 12-week property disregard. It explained its residential fee rate for clients with dementia was currently £571.06 and the Council would fund this, less Mr Y’s client contribution. The Council explained that even after this, based on the rates Ms X had agreed with the care home, a top-up would still be needed during the 12-week disregard. This is because the fee rate at the care home was more than the Council’s residential fee rate. At this point the Council provided information about options for paying the top-up and a copy of Mr Y’s care assessment.
50. The following day, Ms X responded to the Council to explain she had concerns with how it had handled Mr Y’s case and asked for clarification on funding arrangements.
51. Ms X wrote to the Council again on 8 December asking it to correct some inaccuracies about Mr Y’s history in his care assessment. The Council agreed to do this and explained the concerns Ms X had raised had been passed to the complaints team.
52. The Council wrote to Ms X on 10 December to explain how it had reviewed Mr Y’s financial assessment, answer her questions from 15 October, and respond to her complaint. The Council explained care assessments and financial assessments could be done independently of one another, but it needs a care assessment before it can confirm if someone is eligible for a financial contribution in a financial assessment. For this reason, it usually tries to carry out the assessments concurrently.
53. The Council acknowledged it had asked for financial information from a long time back but said this was necessary to get a total view of Mr Y’s financial situation while he was receiving care. The Council explained it had provisionally decided Mr Y was eligible for financial assistance backdated to 5 August 2021 and had asked Ms X for more information about the care he had been receiving so it could decide what assistance he was eligible for during the backdated period so it could refund this.
54. On 17 December the Council wrote to Ms X to give more clarity on how it carries out its financial assessments. It explained:
• Once it had completed its financial assessment it would reimburse Mr Y the rate of £571.06 less his contribution. The repayment would be made directly by the residential care home once the Council confirmed its own contributions.
• If Ms X had chosen to have a 12-week property disregard, Mr Y’s contribution would be payable directly to the care provider. Or, if this was backdated the residential care home would reimburse Mr Y for the difference between his assessed contribution and the Council’s agreed contribution.
• Regarding the top-up during the 12-week disregard, Mr Y could pay this himself.
• The role of its brokerage team was to negotiate with care providers for contracts and the costs of these.
55. On 12 January 2022 the Council negotiated rates with Mr Y’s care home for the 12-week property disregard. The Council agreed funding from 28 October 2021 until 19 January 2022 at £600.18 per week.
56. The Council wrote to Mr Y on 14 January to explain it had assessed the total cost of his care from 2 August 2021 until 27 October 2021 as £4,508.66. It had assessed Mr Y’s contribution to be £1,606.08, meaning he was due a refund of £2,902.58. The Council said it would liaise with Ms X to get the refund paid.
57. The Council wrote to Ms X again on 25 January explaining it had now calculated how much Mr Y needed to pay towards his care in the care home. It explained:
• The weekly amount Mr Y should pay from 28 October 2021 to 24 November 2021 was £320.59.
• The weekly amount Mr Y should pay from 25 November 2021 to 19 January 2022 was £201.99.
• From 20 January, when the 12-week property disregard ended, Mr Y would be a self-funder.
• As Mr Y’s assessed contribution is backdated and more than the weekly contribution of £152.20 he should already have paid to the care provider, the Council needed to invoice him for the difference. This was calculated to be £1,071.88.
58. The Council sent an invoice to Mr Y for his contribution to residential care on 8 February.
59. Ms X wrote to the Council on 26 February to complain it should not be sending complex invoices to Mr Y in his care home. She explained these had confused and worried him. Ms X explained Mr Y had already paid for his care and she would not be making further payment until the Council fully explained its calculations. Ms X also asked the Council to ensure all future correspondence was sent to her rather than Mr Y.
60. The Council updated its systems so all future invoices would be sent to Ms X and wrote to her on 14 March to confirm this and apologise for the one that was sent to Mr Y.
61. Ms X wrote to the Council again on 19 March. She explained the residential care home had not received any money from the Council and so Mr Y had paid the fees himself. She also asked the Council to reassess the top-up calculations and explain its previous invoices.
62. On 6 April the Council issued a credit note for £1,347.12 to Ms X to be used against Mr Y's next payment. This was to recognize that Mr Y had overpaid from 28 October 2021 until 14 November 2021.
63. Ms X responded to the Council on 16 April to explain she did not understand the credit note and there had been no explanatory cover letter. She explained Mr Y had not paid anything directly to the Council so she did not understand why the Council was now responsible for providing a credit note.
64. The Council responded to Ms X’s complaint on 9 May. The Council said:
• Financial assistance from a council is means tested and certain capital assets and income, including properties, are included in financial assessments. Where someone is eligible for residential care and they own a property, a period of care is provided before their property is included as an asset for financial assessments. This is the 12-week property disregard and is granted to allow a person time to consider how they will use the assets held in their property to pay for their care going forward.
• While councils complete a financial assessment, people are asked to pay a ‘standard minimum’ contribution to the care home which is £152.20 per week. This amount is adjusted to reflect the actual amount the person is assessed to be able to afford once the financial assessment is completed. If the person’s assessed contribution is more than the standard minimum, the Council invoices for the difference.
• Mr Y moved to the residential care home as a private arrangement before his care assessment was completed so the usual process was not followed. This has created some confusion around money the Council and the care home owe to Mr Y.
• The Council contacted the residential care home who confirmed the weekly cost of Mr Y’s care during the 12-week disregard was £1,350. This was agreed privately without the Council’s involvement. The Council asked the residential care home to refund Mr Y the amount it would be covering, meaning the difference between the standard minimum and the Council’s usual rate of £600.18 per week.
• The residential care home should contact Ms X directly to pay any refund owed to Mr Y. If there are any issues with this, Ms X can contact the Council’s financial assessment team.
• The Council has updated its systems so any future correspondence will go to Ms X instead of Mr Y.
• It had issued an invoice for the wrong amount previously and the credit note was issued to correct this.
65. Ms X then brought her complaint to the Ombudsman.
66. In response to our enquiries the Council has said:
• Mr Y self-funded his care until August 2021, at which point he became entitled to financial assistance from the Council.
• The Council confirmed Mr Y’s needs for residential care retrospectively and applied a 12-week disregard of his property from 28 October 2021 until 19 January 2022.
• It accepts the care assessment from April 2021 was below the standard it expects. It is sorry for this but has worked with Mr Y and Ms X to produce an accurate assessment.
• Ms X provided completed financial assessment forms on 16 July 2021 and the Council received all supporting documentation on 26 August 2021. The outcome of this was provided on 17 September 2021 – 16 working days later.
• Following Mr Y’s move to residential care, Ms X asked the Council to complete another financial assessment on 9 December 2021 and include the 12-week property disregard. The Council gave the outcome of this on 25 January 2022 – three days after receiving all supporting documentation.
• The Council agreed to reimburse Mr Y for £2,902.58. This was in recognition of care he had paid for between becoming eligible for assistance on 2 August 2021 and entering residential care on 28 October 2021.
• As Mr Y’s family agreed his placement in residential care privately, it was not possible for the Council to negotiate a lower rate for care initially. However, the Council required the care provider to refund the difference between the Council’s contribution of £600.18 and Mr Y’s assessed contribution for the 12-week disregard period. The Council followed its usual process in calculating what fees would be owed and invoiced accordingly. When it noticed an error on an invoice, it refunded this.
• The Council has paid fees to the care provider, less Mr Y’s assessed contribution, for the 12-week disregard period and all invoices for this have now been cancelled so there is no refund due from the Council.
67. Ms X told us Mr Y chose the care home. She has said he was aware he would have to pay his own fees while his capital was above the threshold, and he wanted a location close to Ms X’s home. Ms X has explained she currently does not want to move Mr Y or explore alternative options.
68. The Council told us Mr Y’s family chose his care home themselves and appear happy with it so there has been no discussion around alternative or cheaper options.
69. In response to a draft of this decision, Ms X said:
• The information the Council has provided us with is inaccurate and does not give a true reflection of the situation. The Council has omitted and altered some things to give a different view of what has happened.
• The Council asked for an unreasonable amount of information before it carried out a financial assessment for Mr Y which contributed to delays.
• She remains concerned her father is still owed a refund.

Analysis

70. When considering complaints, if there is a conflict of testimony or evidence, we make findings based on the balance of probabilities. This means weighing up the available relevant evidence and basing our findings on what we think was more likely to have happened.

Accuracy and quality of care assessment

71. The care assessment the Council produced for Mr Y in April 2021 contained multiple inaccuracies and was not a true reflection of Mr Y’s situation at that time. This is fault and would have created uncertainty and distress for Ms X and Mr Y, which is injustice.
72. Once the Council was made aware of the inaccuracies it produced further care assessments, but these also contained inaccuracies.
73. The Council did not complete an accurate care assessment until November 2021. This is fault and would have caused further uncertainty and distress for Ms X and Mr Y at a time when they would already have been under pressure due to Mr Y’s changing needs. This is injustice.

Alleged delays in carrying out financial assessment

74. The Council did not follow its usual process and complete a financial assessment for Mr Y concurrently to completing his care assessment. However, it did this to comply with Ms X’s request for a delay as Mr Y was above the threshold to receive financial assistance. I do not find the Council at fault here.
75. The Council then carried out the relevant financial assessments on Ms X’s request and gave its decisions promptly on receiving all the information it needed from her. I do not find the Council at fault here.

Calculation and explanation of fees and invoices

76. Based on the information I have seen, the Council gave full consideration to the information it received from Ms X before calculating its contribution to Mr Y’s fees. I do not find fault with the Council’s decision-making process.
77. Once the Council became aware of the care home placement it explained it would apply a 12-week disregard pending its financial assessment. This is in line with the law and its own policy and I do not find the Council at fault here.
78. The Council limited its contribution towards costs during the 12-week disregard period to its usual rate. While the Council should usually have offered an affordable placement before requiring the family to pay any top up fees, it has reason to believe Mr Y did not want to move in any case. Therefore, the top up would remain payable and an offer of cheaper accommodation would make no difference. The Council explained why Mr Y would pay the difference between its rate and the care home fees. I do not find the Council at fault.
79. The usual process is for residents to pay the Council any contribution and for the Council to pay the care home directly. In this case, Mr Y had already paid the care home in full before the Council became involved. Nonetheless, once it completed its assessment, the Council was entitled to ask Mr Y for his contribution towards costs and it was then for Mr Y to seek a refund as due from the care home. The Council told Ms X the care home would arrange a refund and I do not find it at fault here.
80. Looking at the information the Council has provided, it attempted to set out what it considered when calculating fees. I appreciate the information the Council provided was often complex, but Ms X was free to contact the Council to ask for an explanation as to anything she was unsure of.
81. Ms X has said she thinks the Council should provide individually tailored covering letters to fully explain invoices. While this may help to make things clearer for recipients, it is not something the Council is obliged to do. The Council sends out many invoices on a regular basis and it would not be reasonable to expect each of these to come with an individually tailored explanation. However, anyone with queries about their invoices can contact the Council direct to discuss these. I do not find the Council at fault.
82. I have looked at the invoices Mr Y and Ms X have been sent and these seem to clearly set out what costs are being incurred and the total charge of this. I do not find fault with how the Council sets out its invoices.
83. That said, the Council did send invoices to Mr Y even after Ms X had asked it not to. This is fault and caused Mr Y stress, which is injustice.
84. When the council sent a credit note to remedy its calculation error it should have explained what this was for. That it did not do so is fault. This caused confusion and distress which is injustice.

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Agreed action

85. To remedy the injustice identified above, I recommend the Council:
86. Within one month of my final decision:
• Provide Mr Y and Ms X with a written apology for the faults identified above.
• Pay Mr Y £100 to recognise the distress caused to him.
• Pay Ms X £100 to recognise the distress caused to her.
87. The Council should provide us with evidence it has complied with the above actions.

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Final decision

88. I find fault with the Council for failing to accurately complete a care assessment for Mr Y and for continuing to send him invoices rather than Ms X.
89. The Council accepted the recommendations set out above and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman