Summary: We will not investigate this complaint about changes to a person’s adult social care personal budget. The Council has correctly made its decisions based on an assessment of needs. There is no reason to expect the Council to backdate changes to a time before they were requested. There is not enough evidence of fault to justify an Ombudsman investigation.

The complaint

1. Ms B says the Council should refund top-up fees paid for adult social care between November and April.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service but must use public money carefully. We do not start or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

3. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)

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How I considered this complaint

4. I considered information provided by the complainant.
5. I considered the Ombudsman’s Assessment Code.

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My assessment

6. When the Council is aware of someone in its area who may need adult social care and support it must assess and meet any eligible care and support needs. The Council must also assess what, if anything, the person can pay toward their support. If the person chooses a more expensive care setting, then a third party must pay a top-up above the person’s personal budget (the amount the Council will pay minus any client contribution).
7. Mr C’s needs are met by a residential care home acting on behalf of the Council. Mr C moved into the care home in November, with a third party paying a top-up.
8. The Council received a request for a reassessment of Mr C’s needs and completed the reassessment in April. Mr C’s needs had increased and so the Council increased his personal budget to pay for his increased care. This reduced the third-party top-up and Ms B thinks the Council should apply this from November.
9. The Council explains it made its decisions in November and April following assessments of Mr C’s needs, in accordance with the Care Act 2014. It can only make decisions based on those assessments. It has applied the change in budget to the date the reassessment was requested, it cannot apply it before that as there is no evidence to support that is required.
10. There is not enough evidence of fault. The Council cannot know when Mr C’s needs changed and became eligible for the change in budget before the reassessment was requested. If Ms B disputes the November assessment and personal budget given then, she should have challenged that at the time.

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Final decision

11. We will not investigate Ms B’s complaint because there is not enough evidence of fault. The Council has followed the correct process to reassess Mr C’s needs when requested, and to base its decisions on that reassessment of need. There is no reason to suggest the Council should backdate the increase in budget to before the assessment.

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Investigator's decision on behalf of the Ombudsman