Summary: Mrs Z, on behalf of Mrs X, complained the Council delaying completing a care needs assessment, delayed completing a financial assessment and failed to effectively communicate. The Council accepts fault and has proposed a remedy which includes correctly applying a disregard and making a symbolic payment for the frustration and distress caused. This is a suitable remedy and so we will discontinue the investigation.

The complaint

1. Mrs Z, on behalf of her mother in law Mrs X, complained the Council delayed completing a care needs assessment, delayed completing a financial assessment and failed to effectively communicate.
2. Mrs Z said the lack of support and contact by the Council caused distress

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The Ombudsman’s role and powers

3. 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

4. As part of the investigation, 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;
• discussed the issues with the complainant;
• sent my draft decision to both the Council and the complainant and taken account of their comments in reaching my final decision.

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What I found

Assessment

5. 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.
6. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Charging for permanent residential care

7. 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.
8. 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.

Key facts

9. This section sets out the key events in this case and is not intended to be a detailed chronology.
10. Mrs X moved into a residential care home in 2023 as her husband was terminally ill and could no longer provide care for her. This was initially a temporary placement and Mrs X self-funded her care. However, the family anticipated Mrs X would need permanent residential care and so contacted the Council seeking a care needs assessment. Mr X died on 12 October.
11. Mrs X was admitted to hospital for a period of time in November 2023. On leaving hospital Mrs X moved into another residential care home on 27 November.
12. The family contacted the Council in January 2024 for financial assistance as Mrs X’s funds had depleted. The Council accepts it delayed allocating a social worker to complete the care needs assessment which was needed to determine whether Mrs X met the eligibility criteria for care. It did complete a financial assessment on 12 February and determined Mrs X would be a full charge payer due to the level of capital.
13. Mr Z made a complaint to the Council on 9 April as there had been no further contact from the Adult Social Care Team and it had still not completed a care needs assessment. The Council completed the assessment on 30 April and determined that Mrs X’s needs could be met at home with a package of care. The family disagreed with the outcome and so the Council agreed to carry out another assessment. The second assessment was completed on 12 June and determined Mrs X was eligible for residential care.
14. Mrs X’s property is in the process of being sold. However, she paid the full cost of her care until July 2024 and so was using all her available savings. The family says that it was worrying about how they would continue to pay the care home charges and did not want Mrs X to move as she was happy and settled at the home. There were discussions between the family and the Council and a deferred payment agreement was discussed. The Council says that it emailed a deferred payment application form but this has never been returned. Mrs X says this application has never been received.
15. The Council wrote to Mr Z on 30 September saying that from 31 July 2024 it was paying the full cost of the care home charges. This is a temporary financial agreement and Mrs X will be recharged the full cost when the funds from the sale of her house are available.
16. In response to my enquiries on this complaint, the Council said that it had reviewed the issues and the documents in respect of this matter. It said it was evident there had been a lack of clear and consistent communication causing the family frustration and distress. It said it had missed several opportunities to remedy the failings in this case.
17. The Council’s review has also identified that it failed to apply a 12-week property disregard. At the time Mrs X became a permanent resident the value of her property should have been disregarded for 12 weeks. The Council noted that for part of this 12-week period Mrs X’s capital was over the threshold but that that the disregard applied for a part of the 12-week period.
18. It has now proposed a remedy for this complaint. This includes applying the partial disregard and making a symbolic payment to Mr and Mrs Z to acknowledge the distress, frustration and inconvenience caused. The Council has also apologised.

Analysis

19. The Council accepts fault in this case. It delayed completing the care needs assessment and did not effectively communicate with the family regarding the financial situation. It has also reviewed the 12-week disregard and will now apply this appropriately and notify the family. The Council has also offered to make a symbolic payment of £350 to both Mr and Mrs Z in recognition of the injustice experienced as a result of the fault. There is an open-ended temporary funding agreement which means the Council is paying the care home fees and it will recover them from Mrs Z at an appropriate time in the future.
20. I welcome the Council’s response and its acknowledgement of fault in this case. I consider it has provided a suitable remedy and so I will not make any further recommendations. The Council has also confirmed it will be issuing a briefing to all teams so lessons can be learned from this case and so no service recommendation is required.

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Decision

21. I will now discontinue my investigation and uphold the complaint. The Council has agreed action which resolves the outstanding issues and so no further action by the Ombudsman is needed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman