Summary: Mrs D complained about the Council’s actions when her husband Mr D went into a care home in 2023. We have found some fault which caused Mrs D distress and uncertainty. The Council has agreed to apologise and pay her £300 and improve its procedures for the future.

The complaint

1. Mrs D complained that Suffolk County Council (the Council):
• failed to offer adequate support and information to her when her husband, Mr D went into residential care (initially respite care) in February 2023.
• failed to offer prompt support or assistance when Mrs D had concerns about the quality and cost of care at the first care home; and
• delayed in carrying out a financial assessment from June to December 2023 and then took another two months to correctly assess Mr D’s capital.
2. Mrs D has been caused significant distress and inconvenience throughout this period.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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

5. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Mrs D 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

Residential care

6. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it arranges a care home place for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings.
7. The council must ensure:
• the person has a genuine choice of accommodation;
• at least one accommodation option is available and affordable within the person’s personal budget; and,
• there is more than one of those options.
8. However, a person must also be able to choose alternative options, including a more expensive setting, where a third party or, in certain circumstances, the resident is willing and able to pay the additional cost. This is called a ‘top-up’. But a top-up payment must always be optional and never the result of commissioning failures leading to a lack of choice.

Top-up payment

9. If a person chooses to go into a home that costs more than the personal budget, and the council can show that it can meet the person’s needs in a less expensive home within the personal budget, it can still arrange a place at the home if:
• the person can find someone else (a ‘third party’) to pay the top-up; or
• the resident has entered a deferred payment scheme with the council and is willing to pay the top-up fee themself.
10. In such circumstances, the council needs to ensure the person paying the top-up enters a written agreement with the council and can meet the extra costs for the likely duration of the agreement.

Charging for permanent residential care

11. 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.
12. 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.
13. The financial limit, known as the ‘upper capital limit’ (currently £23,250), 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 (currently £14,250) limit they will not need to contribute to the cost of their care and support from their capital.

What happened

14. Mr D has a progressive medical condition. Mrs D was his main carer at their home alongside a package of care from a care agency. In January 2023 the Council assessed his care needs and due to the level of his savings said he was not eligible for any assistance with the cost of the care.
15. In early 2023 Mrs D had a carer breakdown and Mr D went into a care home (Home Z) initially for two weeks’ respite care. This was arranged by a local carers support group and paid for privately by Mr and Mrs D.
16. Mrs D contacted the Council for assistance on 27 February 2023. The Council said it would put Mr D on the list for allocation to a social worker and gave Mrs D some details of other care options and placements. Mr D’s daughter (Mrs E) was also in contact with the Council in respect of Mr D’s care.
17. In March 2023 Mrs D extended Mr D’s stay at Home Z. The carer support group told the Council on 6 March 2023 that Mrs D could no longer care for Mr D. The Council tried to ring Mrs D the following day. Mrs D says she kept trying to ring the Council but never got through or no-one rang her back. She found a place at another care home and reserved a room for Mr D but as she was unable to get through to the Council the room was lost.
18. In mid-March 2023 the Council said Mr D’s case was still awaiting allocation for a care act assessment. Mrs E said Mr D would run out of money soon. Mr D’s stay was extended at Home Z again. The Council spoke to Home Z who confirmed that it had just issued a new contract and the payments were up to date.
19. On 23 March 2023 the Council spoke to Mr D to ascertain his wishes.
20. In April 2023 Mrs D found an alternative home she liked, Home Y. She asked the Council again to do the care act assessment.
21. On 6 April 2023 the Council visited Mr D at Home Z for the assessment. Mr D said he wanted to go home but Mrs D did feel able to care for him. During the meeting the Council recorded that Mr and Mrs D said they agreed to separate and that Mr D said he would rather stay in a care home than go home.
22. Mrs D explained that she did not say they were separating but rather that due to her own health problems she could not look after Mr D at home even with two carers visiting four times a day.
23. Mrs D chased the Council several times in April and May 2023 as she wanted Mr D to move to Home Y. Meanwhile the Council was looking for a home for Mr D to move to on a more permanent basis. Mrs E provided a completed financial assessment form.
24. On 10 May 2023 the Council spoke to Mrs D and said it would not approve Home Y for Mr D until it had considered other cheaper options. Home Y would not accept the BinJ rates and so there would be a significant shortfall in the fees which Mr D or his family would have to pay. Mrs D said she was upset she had made 18 calls before she managed to speak to someone about Mr D’s case. The Council referred to the assessment meeting where Mr and Mrs D had said they were separating. Mrs D said this was not true, she just did not want him to return home but wanted a good care home for him. The Council provided Mrs D and Mrs E with a list of possible care homes to try.
25. The Council telephoned Mrs D on 15 May 2023 to discuss how top-fees would work for Home Y. The Council made it very clear that it would not cover the whole cost and that the top-up fees would not be time-limited but would continue as long as Mr D remained in the home. The Council also discussed with Mrs D other homes with availability. Mrs D said she would look at some of them.
26. The Council requested details of Mr D’s savings and capital for the financial assessment.
27. On 17 May 2023 Mrs D said she had visited one other home which she liked but was concerned it was difficult for her to get to regularly, She also liked another home but was then offered a place for Mr D at Home Y which was their preferred choice.
28. On 22 May 2023 the Council spoke to Mrs D again. She was upset about the care at Home Z and felt she had to move Mr D immediately as the Council was not doing what it should. She said the Council was holding things up by asking for more financial information. The Council explained that as soon as funding was agreed for the home Mrs D had said she liked, Mr D could move there. The financial assessment could be completed after he moved. Later that day Mrs D said she and Mr D agreed he would move to Home Z the following day.
29. On 2 June 2023 confirmed to Mrs D that it would pay £900 a week, Mr D would make a contribution and Mrs D would pay a top-up for at least the next two years.
30. On 8 June 2023 the Council confirmed the funding arrangements.
31. Mrs D had complained to the Council about the delay in providing support since February 2023 and its lack of concern about poor care at Home Z, which led to her decision to move Mr D at short notice. She had now incurred a large bill for four weeks’ notice from Home Z. She also complained about the poor communication for several months when she was in crisis.
32. The Council replied to the complaint in June 2023. It apologised for the lack of communication before Mr D was assessed but said the stay at Home Z was privately arranged and funded so it could not help with the notice period charge. Mrs D escalated her complaint. The Council replied again in September 2023 but confirmed its previous response.
33. The Council completed the financial assessment in December 2023. It concluded that Mr D had more savings than the upper threshold due to some money left to him by a relative and so he would have to pay for his own care entirely. It sent him a bill for over £27,000.
34. The family challenged this decision and after Mrs E provided some information about the money the Council decided Mr D had savings under the threshold and was eligible for financial support. It sent out a revised bill for approximately £5,800 for the period from 8 June 2023 to 5 January 2024.
35. Mrs D complained to us in February 2024. In response to my enquiries the Council said with hindsight its communication could have been enhanced at times.

Analysis

failed to offer adequate support and information to her when, Mr D went into residential care (initially respite care) in February 2023

36. Mrs D first contacted the Council about Mr D on 27 February 2023. It tried to call Mrs D twice on 2 and 7 March 2023, spoke to Mr D on 23 March 2023 and carried out an assessment in person on 6 April 2023, five weeks’ later. I appreciate this was a very stressful time for Mrs D, but I do not consider the Council delayed excessively in carrying out the assessment.
37. The Council also gave Mrs D and Mrs E information about other care home options and explained to Mrs D how the funding would work if they chose a more expensive home.
38. However, I agree with the Council that it could have made more contact with Mrs D during this very stressful period and acted more quickly to provide information about Mr D’s long-term care options.

failed to offer prompt support or assistance when Mrs D had concerns about the quality and cost of care at the first care home

39. The Council was not involved in arranging the care for Home Z and was not responsible for the care given. It did however make contact with the Home during Mr D’s stay including visiting him on several occasions and speaking to him on the telephone. There was no evidence of any safeguarding concerns and I do not consider it should have done more at this point.
40. In terms of the cost of the care I do consider the Council was slow to act when Mrs E told the Council in March and April 2023 that Mr D did not have much money left. I appreciate he had been assessed previously as a self-funder, but his savings appear to have dropped well below the upper threshold by March 2023. The delay has created uncertainty that Mr D may have been eligible for Council funding at an earlier point.

delayed in carrying out a financial assessment from June to December 2023 and then took another two months to correctly assess Mr D’s capital

41. Mrs E returned the completed financial assessment form on 27 April 2023 and then provided evidence of Mr D’s capital and savings at the end of May 2023. The funding for Mr D’s care was confirmed from 8 June 2023. However, the financial assessment was not completed until December 2023 when the Council decided Mr D had notional capital. I consider six months was too long to complete the financial assessment.
42. However, the Council was paying towards Mr D’s care throughout this period, so I do not consider Mr or Mrs D were out of pocket during this period. The injustice was limited to some uncertainty.
43. The review process worked appropriately: once Mrs E provided evidence of why and how the money was used, the Council continued to fund the placement and produced a significantly reduced bill for Mr D’s contribution to his care since June 2023.

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Agreed action

44. In recognition of the injustice to Mrs D from the poor communication and delay in responding to Mr D’s reducing finances, I recommended the Council, within one month of the date of my final decision:
• apologises to Mrs D and pays her £300; and

within three months:

• reviews its care assessment procedures so that when there will be a delay in allocating a case for assessment, the Council provides clear advice and information about the likely waiting period and addresses any immediate concerns about interim care and finances.
2. The Council has agreed to my recommendations and should provide us with evidence it has complied with the above actions.

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Final decision

46. I consider this is a proportionate way of putting right the injustice caused to Mr and Mrs D and I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman