Summary: Mr B complained the Council delayed financially assessing his mother, who I will refer to as Mrs C; gave him inaccurate financial information; and referred to mental capacity assessments as a formality. There was fault by the Council. It delayed allocating Mrs C’s case for a care assessment to be carried out. Because of the fault, there was a short delay in Mrs C receiving funding from the Council after her finances fell below the upper capital limit. This caused distress and worry to Mr B. The Council has agreed to apologise to Mr B. It has also agreed to send us evidence of a review it has carried out of its case allocation processes, and evidence of training it has provided to staff about the Mental Capacity Act.

The complaint

1. Mr B complains the Council:
• delayed financially assessing his mother, who I will refer to as Mrs C, meaning she reached the upper capital limit before the process had been completed;
• gave him inaccurate financial information before it had assessed Mrs C; and
• referred to mental capacity assessments as a formality.
2. Mr B says the process has caused stress to him, and he has spent a lot of time organising correspondence for his complaint.
3. Mr B would like the Council to apologise to him and provide training to its staff.

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The Ombudsman’s role and powers

4. 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)
5. 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. (Local Government Act 1974, section 26A or 34C)
6. 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(1), as amended)

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What I have investigated

7. I have investigated matters in this case from July 2024, when the financial assessment process began, to February 2025, when the Council sent its final complaint response to Mr B.

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How I considered this complaint

8. I read Mr B’s complaint and spoke to him about it on the telephone.
9. I considered evidence provided by Mr B and the Council as well as relevant law, policy and guidance.
10. Mr B and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Financial assessments

11. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
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.

Care assessments

13. 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.
14. 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.

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What happened

15. This is a summary of events outlining key facts, and it does not cover everything that has happened in this case.
16. In late July 2024, the Council received Mr B’s request for it to carry out a financial assessment for Mrs C, as her finances were reducing and nearing the upper capital limit. The Council contacted Mr B to ask for further details and to give him information about the process. Mr B sent the Council the requested information, and the Council asked the relevant team to carry out Mrs C’s financial assessment.
17. In early August 2024, the Council sent Mr B an online financial assessment form to complete, which he immediately did. A few days later, the Council completed the financial assessment and sent Mr B the outcome, which included its capital threshold calculations and what Mrs C’s weekly contributions to her care fees would be. The Council calculated Mrs C’s finances would fall below the upper capital limit by late December 2024.
18. In early September 2024, Mr B told the Council he had received a letter from Mrs C’s care home advising its care fees would be increasing from mid-October 2024. In mid-October 2024, the Council told Mr B it had recalculated that Mrs C’s finances would fall below the upper capital limit by early December 2024.
19. In early November 2024, the Council allocated Mrs C’s case to a social worker. The social worker’s aim was to carry out a care assessment to decide the best way to meet Mrs C needs due to her finances approaching the upper capital limit. The Council asked Mr B when he would be available so the assessment could be carried out. The Council says it also told Mr B for transparency Mrs C’s care home had not accepted the Council’s guide rate and their fees were approximately double the Council’s guide rate (the rate based on the needs of the service user, and the type and level of care they require). It says it advised Mr B of what the difference between its guide rate and Mrs C’s care home’s rate would roughly be should the Council assess her to have enhanced nursing needs, and what the top-up fee would approximately be if the Council was able to meet need at its guide rate in another placement.
20. In late November 2024, the Council completed the care assessment and sent a copy of the draft assessment to Mr B. He received the finalised care assessment in early December 2024. He also says the Council told him a mental capacity assessment would be completed as a formality. In mid-December 2024, Council funding started for Mrs C’s care, and it was backdated to early December 2024, when Mrs C’s finances fell below the upper capital limit.
21. Mr B complained to the Council a few days later. He told it:
• There were delays by the Council which meant Mrs C’s finances fell below the upper capital limit before it had completed the process.
• The Council had referenced top-up costs in a conversation in mid-November 2024, before any assessment had been carried out.
22. In late January 2025, the Council sent its complaint response to Mr B. It acknowledged there was a delay in assigning a worker to Mrs C’s case to carry out a care assessment. It also told Mr B it had reviewed its allocations process for capital threshold referrals. Mr B was unhappy with its complaint response and requested it to be escalated. The Council sent its final complaint response to Mr B in early February 2025.

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Analysis

23. The Council received Mr B’s financial assessment request in late July 2024. The Council completed and communicated the outcome of the assessment to Mr B in early August 2024. So, I cannot say there were delays by the Council in completing the financial assessment.
24. However, there was a delay in the allocation of Mrs C’s case for a care assessment to be carried out, which the Council has acknowledged. The Council allocated the case to a worker in early November 2024, and the assessment was completed in a timely manner, in late November 2024, before Mrs C’s finances fell below the upper capital limit. But it appears there was a delay in the Council’s funding starting, following its delay in allocating a worker to carry out Mrs C’s care assessment. The funding began in mid-December 2024, a week after Mrs C’s finances fell below the upper capital limit. This delay was fault, and it caused distress and worry to Mr B about finances being in place for Mrs C’s care costs. I have made recommendations below to reflect this.
25. When the Council spoke to Mr B in November 2024, it says it told him should Mrs C be assessed to have enhanced nursing needs, the difference between the Council’s guide rate and Mrs C’s care home rate would mean a top-up of approximately £1,100 would be required if the Council were able to meet need at a guide rate in another placement. It was later confirmed that the amount the care home was requesting meant a top-up of just under £1,100 would be required. So, I cannot say the Council gave Mr B inaccurate financial information. Rather, it gave him this information in attempt to be transparent about potential costs. The Council was not at fault for doing so.
26. In communication with Mr B, the Council referred to mental capacity assessments as a formality. In response to my enquiries, the Council acknowledged this should have been worded differently. It also said it apologises if this wording caused offence to Mr B and provided assurance that it has already put in place ongoing training in relation to the Mental Capacity Act. The Council said the training will ensure clarity and consistency in how these matters are communicated to service users.
27. We have published guidance to explain how we calculate remedies for people who have suffered injustice because of fault by a council. Our primary aim is to put people back in the position they would have been in if the fault by the council had not occurred.

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Action

28. To remedy the outstanding injustice caused to Mr B by the fault I have identified, within four weeks of my final decision, the Council will apologise to Mr B for the distress and worry caused by the fault I have identified. This apology should be in accordance with our guidance Making an effective apology.
29. Within three months of my final decision, the Council will also:
• Send me evidence of the review it says it carried out of its allocation processes for cases where a capital threshold referral has been made, to ensure prevention of further delays.
• Send me evidence of the training it says it has put in place in relation to the Mental Capacity Act.
30. The Council should provide us with evidence it has complied with the above actions.

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Decision

31. I uphold Mr B’s complaint and find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman