Summary: Mr X complained about the Council’s handling of his father, Mr Y’s, care and support needs. We have found fault because the Council did not explain a delay in completing a reassessment of Mr Y’s needs in 2024. This caused avoidable distress and frustration to Mr X. To remedy the injustice caused by the fault, the Council has agreed to apologise to Mr X.

The complaint

1. Mr X complains about how the Council has handled his father, Mr Y’s, care and support needs. Mr X complains the Council has made the decision to source an alternative care home for Mr Y based on cost, when this is not in his best interests and was against the advice of Mr Y’s social worker. Mr X also complains the Council has not completed new assessments to determine Mr Y’s needs, as it said it would.
2. Mr X says this has caused him and the family avoidable frustration, distress and confusion.

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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. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
5. 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

6. I have considered all the information Mr X provided and discussed this complaint with him. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
7. Mr X and the Council had the opportunity to comment on my draft decision. I have taken any comments received into consideration before reaching my final decision.

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What I found

Assessment

8. Sections 9 and 10 of the Care Act 2014 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. It must also involve the individual and where suitable their carer or any other person they might want involved.

Care Plan

9. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has.

Charging for permanent residential 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 (CSSG).
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.

Top-up payment

13. 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.

14. 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.

Care and support statutory guidance

15. Section 10.27 of the CSSG says that the local authority may take reasonable consideration of its own finances to ensure funding available to it is sufficient to meet the needs of the entire local population. The local authority may reasonably consider how to balance that requirement with the duty to meet the eligible needs of an individual. It states that this does not mean choosing the cheapest option; but the one which delivers the desired outcomes for the best value.
16. Section 10.85 of the CSSG says that due regard should be taken to the use of approval panels in both the timeliness and bureaucracy of the planning and sign-off process. In some cases, panels may be an appropriate governance mechanism to sign off large or unique personal budget allocations and/or plans. Where used, panels should be appropriately skilled and trained.

The Council’s policy

17. The Council’s policy states that after an assessment of need has been completed a personal budget will be established based on the needs of the person and the availability at that time of care or nursing home placements that could meet the assessed need.
18. If a person is settled in their current accommodation the Council will support them to remain there and seek to negotiate care fees to the same level as the personal budget or lower. If the current provider fees cannot be negotiated to the required amount, then the Council will need to consider whether the person should move to alternative accommodation. This is so that there is sufficient funding available to meet the assessed needs of all eligible residents (in the Council’s area).
19. A third party top up will be discussed with the family if the fees being charged are not in line with the personal budget.

What happened

20. I have set out below a summary of the key events. This is not meant to show everything that happened.
21. Mr X is representing his father, Mr Y, in this complaint. Mr Y has a number of age-related health conditions.
22. In February 2023, arranged by Mr X, Mr Y moved from his own property in to a residential care home in the local area, Home A. At the time he moved in, Mr Y was a self-funded resident there as his savings were above the threshold, the upper-capital limit, at which he should pay all of his care costs.
23. At the end of July 2023, Mr X contacted the Council to ask for a care and support assessment for Mr Y under the Care Act 2014. Mr Y’s savings that were being used to pay for care at Home A were at this time getting closer to the threshold at which he would not have to contribute towards his care – the lower capital limit.
24. The Council passed the case to its finance team to complete a financial assessment (FA) for Mr Y. The Council advised Mr X that due to the cost of Mr Y living at Home A, it was likely he would be moved to a different home in the area.
25. The Council completed Mr Y’s FA in mid-August 2023. In mid-September 2023, it visited Mr Y at Home A to complete the care and support assessment the family had requested.
26. Early in October 2023, Mr X contacted the Council to find out what the next steps in the process would be. The Council advised him that alternative placements to Home A would need to be considered for Mr Y before any arrangement at Home A could be made permanent. It informed Mr X of Mr Y’s FA outcome.
27. In mid-October 2023, the Council discussed Mr Y’s case at its quality assurance panel (QAP). Mr Y’s social worker provided a report to the panel that said she believed he should stay at Home A and that she had concerns a move would affect Mr Y’s mental wellbeing. Her report also said there were currently no other beds available to meet his needs.
28. At the panel meeting, the Council decided to backdate its payment of the full cost of Mr Y’s care at Home A to the beginning of August 2023. It also agreed for Mr Y to stay a resident at Home A until a vacancy at another home, Home B, became available, provided Home B said it could meet Mr Y’s needs.
29. Two days later, the Council added Mr Y to Home B’s waiting list.
30. Towards the end of November 2023, a place became free at Home B. The Council wanted to review Mr Y’s case and support a move to Home B. The Council called Mr X to advise of this. Mr X explained he and the family did not wish for Mr Y to be moved from Home A as they were concerned his health would deteriorate.
31. On 4 December 2023, the Council called Mr X in response to an email he had sent. The Council explained Mr Y’s case had been to its QAP and the decision had been made for Mr Y to move to Home B. It said that if the family wanted Mr Y to stay at Home A, this could only be done where the fees would need to be topped up by the family (a third-party top up). The Council said this was because Home A was more expensive than Home B. Mr Y’s family said they would not be able to contribute to top up Mr Y’s fees at Home A above what the Council would have paid for his care at Home B.
32. The next day, the Council visited Mr Y at Home A. The family requested a reassessment of Mr Y’s needs and his case to be re-submitted to the QAP as they believed his care needs had increased since moving into Home A. The Council agreed to meet with the family to discuss matters.
33. The Council met with the family on 6 December 2023. The family explained they did not feel Mr Y’s needs had been accurately presented or fully understood at the QAP, that their views had not been taken into consideration and the decision had been made purely on cost. A new assessment was carried out to understand Mr Y’s current needs.
34. On 8 December 2023, the Council emailed the family to advise a senior social care officer had considered Mr Y’s recent decline and emotional wellbeing, but it would still ask Home B to see if it could meet his needs. The Council sent a formal letter to confirm the above, said the officer had reviewed the QAP decision and that the Council therefore considered it was meeting its responsibilities and duties.
35. Mr X emailed the Council on 10 December 2023. He repeated his unhappiness that Mr Y would be assessed by Home B and wanted Mr Y’s case to be discussed again at the QAP. Mr X was unhappy the review decision had been made by the senior officer alone.
36. At the beginning of February 2024, the Council sent its formal response to a complaint made by Mr X. In this, it outlined what had happened so far in the discussions between it and the family. It also said that as Home A would not reduce its fees to the amount the Council would pay, it had had to consider other placements for Mr Y in line with its policy. It did not uphold Mr X’s complaint.
37. In the same response, the Council also said that as a long time had passed since the QAP and that Mr Y had now been living at Home A for 12 months, it would not be appropriate to go ahead with the decision to move him to Home B without a reassessment of his care and support needs. Instead, it would reassess Mr Y and someone would be in contact within the next 14 days to arrange this. The Council said Mr Y would stay at Home A and would continue to be fully funded by it in the meantime.
38. The Council allocated a social worker to complete the review on Mr Y in mid-June 2024.
39. The reassessment was done at the beginning of August 2024. This decided that since the original assessment Mr Y’s physical and mental capacity had significantly decreased. His physical needs were bordering on requiring care in a nursing home rather than a residential home. The reassessment stated that it would not be in Mr Y’s best interests to move him to another residential home for him to then potentially have to move again to a nursing home in the near future.
40. At the end of August 2024, the Council agreed for Home A to be Mr Y’s permanent placement for the time being and to continue fully funding this.

Analysis

The decision to explore other care providers

41. In response to my enquiries, the Council said its QAP was in place to ensure quality, equity and consistency of decision making in relation to requests for care and support. It said the panel also ensured decisions also took into account the Council’s obligations to achieve value for money. It also said the panel ensured Council procedures and processes had been followed, which included the decision to consider alternative placements.
42. I am satisfied, that in line with Section 10.27 of the CSSG and in the circumstances of this complaint, the Council was entitled to explore other options that it felt would meet Mr Y’s eligible needs and achieve the desired outcomes for Mr Y’s care and for the best value.
43. The assessment of need and where this could be most cost effectively met was a decision for the Council to make. Fees at Home B were around £700 per week and those at Home A around £1500 per week. The Council has a duty to balance the needs of the individual and the cost to the Council so that it can meet the needs of the local population. I find no fault in the Council’s decision to explore other care homes provided they would be able to meet Mr Y’s assessed need.

Quality assurance panel

44. Section 10.85 of the CSSG states that in some cases panels may be used to sign off large or unique personal budget allocations or plans and that panels should be appropriately skilled and trained. I am satisfied that in line with this and in the circumstances of this complaint, the Council was entitled to decide Mr Y’s case at such a panel, given the financial commitment involved in paying for Mr Y’s full care costs.
45. In response to my enquiries, the Council explained that panel members were senior officers with significant social care experience. I find no fault in the Council’s decision to assess Mr Y’s case at its QAP.
46. I am also satisfied the Council followed its own policy in looking at other homes which could meet Mr Y’s assessed need and asking the family if it was able to top up the fees if it wished for Mr Y to stay at Home A. I find no fault in the Council’s actions here.
47. Mr X complained that the panel decided to investigate the possibility of Mr Y moving to Home B despite his social worker voicing concerns about a move affecting his wellbeing. In response to my enquiries, the Council confirmed that any such evidence would be taken into consideration at the QAP but that it also had to balance this with wider issues. I am satisfied, that in the circumstances of this complaint, this is something the Council and its QAP was entitled to do. I find no fault in the actions of the Council here.

Review of the QAP decision

48. Mr X complained the review of the QAP decision was done by a senior officer alone.
49. In response to my enquiries, the Council advised that it was reasonable and appropriate for a senior manager with significant adult social care experience and who was not involved in the original QAP decision, to carry out any review. I am satisfied, that in the circumstances of this complaint, this was appropriate action for the Council to take and find no fault here.

2024 reassessment of Mr Y’s needs

50. Mr X complained the Council had not completed its reassessment of Mr Y’s needs promised in its complaint response sent to him in February 2024.
51. In response to my enquiries, the Council apologised for and explained the delay in reassessing Mr Y’s needs. It said the reassessment was added to a list which was prioritised based on need and safety. As the Council considered Mr Y was safe at Home A, others with a higher level of need were assessed before him.
52. There is no evidence to suggest this information was shared with the family between the time of the complaint response early in February 2024 and when the allocated social worker made contact with the family at the end of June 2024 to begin the reassessment process.
53. The reassessment was completed at the beginning of August 2024.
54. I am satisfied there was no injustice to Mr Y throughout this time as he remained in the home where he was settled and the Council had already committed to paying the full care fees due until a further decision had been made.
55. In the circumstances of this complaint, I am satisfied the Council should have communicated the reasons for the delay to the family. This lack of communication is fault and would have caused Mr X avoidable distress and frustration. However, I consider this injustice was limited as Mr Y remained at Home A during this time, which is where the family had wanted him to stay. I have made a recommendation below to remedy this injustice.

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Agreed action

56. To remedy the injustice caused by the fault I have identified, the Council has agreed to apologise to Mr X for the injustice caused by not explaining there would be a delay in reassessing Mr Y in 2024.
57. The apology should be sent within four weeks of the date of my final decision.
58. The apology written should be in line with the Ombudsman’s guidance on remedies on making an effective apology.
59. The Council should provide us with evidence it has complied with the above actions.

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Final decision

60. I have now completed my investigation. I uphold this complaint with a finding of fault causing an injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman