Summary: Ms X complains the Council was at fault in the way it carried out a financial assessment on her mother, Mrs Y while she was in a residential care home causing distress and financial expense. We found fault by the Council as it delayed carrying out a financial assessment on Mrs Y. We have recommended a suitable remedy for the injustice caused in this case and so have completed our investigation.

The complaint

1. Ms X complains there were failings in the way the Council carried out a financial assessment on her mother, Mrs Y, while she was in a residential care home. Ms X says the Council has now asked her to pay some backdated charges causing her distress and financial expense.

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The Ombudsman’s role and powers

2. 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 future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
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. I spoke to Ms X and considered the information she provided with her complaint. I considered information from the Council and the supporting documents it provided along with the relevant law and guidance.
5. 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

6. The Care Act 2014, the Care and Support Statutory Guidance 2014 and the Care Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support, and its powers to charge.
7. Councils must carry out a financial assessment to make a decision about the charges. This will assess the person’s capital and income.
8. Once a council completes the financial assessment, it must give a written record of the assessment to the person or their representative. It should explain how the assessment has been carried out, what the charge will be, how often it will be made and if there is any fluctuation in charges, the reason. Councils should ensure that this is provided in a manner that the person can easily understand, in line with its duties on providing information and advice.

What happened

9. This is a summary of key events and is not intended to detail everything that happened.
10. Mrs Y moved to live in a care home in June 2021 arranged by the Council. The Council wrote to Mrs Y in July 2021 about the need for a financial assessment and possible contribution towards her care costs. It advised it would set up a minimum charge of £152.20 a week for her to pay towards the full cost of the care until the financial assessment.
11. The Council wrote again to Mrs Y in August 2021 advising she may need to pay a charge towards the cost of the care provided. It asked her to complete a financial assessment form to determine the level of charge she may need to pay. Ms X says she did not receive this form. The Council accepts it did not properly follow this up when it did not receive a reply from Mrs Y.
12. In June 2022 Ms X sent a form updating Mrs Y’s financial circumstances due to selling Mrs Y’s property. Ms X advised she held power of attorney for Mrs Y. Sadly, in July 2023 Mrs Y passed away and Ms X notified the Council a week later. Ms X distributed and closed Mrs Y’s estate five months later.
13. The Council contacted Ms X in December 2023 about Mrs Y’s passing and that she had received care and support arranged through the Council. It explained it had not completed a financial assessment for Mrs Y to determine if she needed to make a contribution towards the cost of care and support received. The Council explained its policy was to charge the full amount for the period of care provided if a financial assessment had not been completed. It asked Ms X to complete a financial assessment so it could calculate if the estate needed to contribute towards the cost of care. The Council asked Ms X to provide information back to 2021.
14. Ms X complained to the Council:
• She was upset at the Council’s correspondence to her. And it had sent correspondence about the financial assessment over two years after Mrs Y moved into the home and five months after she notified the Council of Mrs Y’s passing.
• She had been making regular payments since July 2021 as instructed by the Council towards the assessed contribution and assumed she was making the correct payment. Ms X said she replied to all Council correspondence about the matter in 2021 and 2022.
• She had disposed of Mrs Y’s estate five months after she died as she had not heard anything from the Council after notifying of Mrs Y’s passing. So, she would need to pay a delayed charge for additional contributions from her own funds. Ms X said if the Council had told her while Mrs Y was in care home or in the five months after she died, then she could have paid the money from Mrs Y’s bank account and estate.
15. The Council responded to Ms X’s complaints. The Council:
• Apologised for the timing of its contact in December 2023 and having to ask for sensitive information. The Council said it would change its systems to ensure staff do not approach customers at that time of year who have lost family members.
• Accepted a delay in assessing Mrs Y’s contribution after informing her in July 2021 about setting up a minimum charge pending the financial assessment.
• Had sent her a form to complete and return in August 2021 and it did not follow this up after receiving no response.
• Missed a further opportunity to properly assess Mrs Y in June 2022 when Ms X sent a change in financial circumstances form.
• Confirmed it was dealing with an unprecedented backlog of work during 2021 and 2022. This meant it was unable to follow up all the referrals it was receiving until the end of 2023 which was why it had contacted her in December 2023.
• Apologised for the delays and any undue stress or anxiety caused her. The Council explained it had taken action over the last few years to change its systems to prevent the delays and omissions Mrs X experienced.
• It would consider the information Ms X recently provided about Mrs Y’s finances from 2021 and carry out an assessment. The Council considered it likely Mrs Y’s contribution to the cost of her care would be slightly more than it had previously invoiced her for. And any further charge due would be made to Mrs Y’s estate.
16. The Council completed the financial assessment in March 2024 and told Ms X. It explained the assessed weekly charge for Mrs Y since July 2021. The amount increased each year in line with the increase in Mrs Y’s state benefits and allowances leaving a balance of £968.94 to pay. The Council advised Ms X may be able to pay the amount in instalments.
17. In response to my enquiries the Council explained it has carried out an end-to-end review of the financial assessment process and identified where the issues of delay have occurred. It has taken action to make changes including allocating caseloads to the financial assessors and new work steps to make it easier to manage and deal with any delays. This has led to a reduction in cases waiting for assessment and the Council no longer has a backlog. The Council currently receives on average 440 referrals a month and the average time for dealing with cases with all information provided is now six working days.

My Assessment

18. It is important that a council gives sufficient information about paying for care at an early stage to those who may be considering residential care. This is to enable informed decision making. Where a council is not able to complete a prompt financial assessment it should still give appropriate written general information about the likelihood of needing to make a contribution towards care costs. The documents show the Council clearly informed Mrs Y and Ms X about the need for a financial assessment and a possible contribution in July 2021. It also set up a minimum ongoing charge until a financial assessment.
19. It is unfortunate if Ms X did not receive the Council’s letter and form of August 2021 with the financial assessment forms. The Council has acknowledged it failed to follow this up when it did not receive a response from Ms X.
20. While the Council did give information about a possible contribution towards care costs and set up the minimum charge the documents show a lengthy delay in carrying out the financial assessment. The Council has acknowledged the delay and poor service Ms X and Mrs Y received. And it missed the opportunity to carry out the financial assessment in August 2021, and June 2022 when Ms X provided an update about Mrs Y’s finances after selling her property. The delay is fault by the Council.
21. Where we find fault, we consider the injustice caused by a council’s actions. In this case Mrs Y received the care while at the care home. And should be assumed to have expected to make some contribution towards the cost as advised in July 2021. Where the care charges are rightly owed, we would not ask that they are waived. It is unfortunate Ms X disposed of Mrs Y’s estate without waiting for or receiving formal notification from the Council of any possible care charges still owed. And the Council is now seeking payment of the charges from her. However, the Council is entitled to pursue the outstanding debt for the care received, should this be necessary.
22. So, I consider the fault in this case caused inconvenience, frustration, and uncertainty for Ms X. I therefore recommend the Council should apologise and make a symbolic payment of £200 to Ms X to recognise the impact the matter has had on her. This is in line with our guidance on remedies. It should also offer Ms X a suitable payment plan to clear the outstanding fee payment if necessary.
23. The Council confirmed the delay was caused due to an unprecedented demand for financial assessments which created a backlog. We would normally make service improvements recommendations if appropriate to a council to improve the service it offers to its customers. But the Council’s response shows it has been proactive in resolving the issues with its financial assessment service, made changes and removed the backlog. So, I do not consider it is necessary to make any service improvements recommendations to the Council in this case.

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Agreed action

24. Within one month of the date of my final decision the Council will:
• Apologise and make a symbolic payment of £200 to Ms X to recognise the impact the matter has had on her.
• Offer Ms X a suitable payment plan to clear the outstanding fee payment if necessary.
25. The Council should provide us with evidence it has complied with the above actions.

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Final decision

26. I have completed my investigation. There was fault by the Council as it delayed carrying out a financial assessment on Mrs Y. I have recommended a suitable remedy for the injustice caused in this case.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman