Summary: Mr X complained the Council has failed to carry out a proper care assessment that captures his medical conditions. He also complained about inaccuracies in the Council’s financial assessment. We find the Council was at fault for its delay in dealing with a review of Mr X’s financial assessment. This has caused Mr X frustration. The Council has agreed to apologise to Mr X and complete a review of his financial assessment.

The complaint

1. Mr X complained the Council has failed to carry out a proper care assessment that captures his medical conditions. He also complained the Council's financial assessment is incorrect and wrongly states he must make a client contribution.
2. Mr X says he is not receiving the appropriate care for his needs because of the Council’s faults. The matter has also caused distress and upset.

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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 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)
4. 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)
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(1), as amended)

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What I have and have not investigated

6. Mr X told me he wanted me to include issues in this investigation about the Council (Council X) he used to live in. I will not be investigating any issues about Council X. We issued a final decision under case 25008438 against Council X and explained why we would not investigate Mr X’s complaint. Therefore, my investigation will focus on the actions of the Leicestershire County Council only.

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How I considered this complaint

7. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
8. Mr 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

Assessment

9. 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

10. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). 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. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

Charging

11. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
12. 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.

Disability Related Expenditure

13. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting.

Direct payments

14. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

NHS Continuing Healthcare Assessments

15. Where it appears a person may be eligible for NHS Continuing Healthcare (NHS CHC), councils must notify the relevant integrated care system (ICS). NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.

What happened

16. This chronology provides an overview of key events in this case and does not detail everything that happened.
17. Mr X has care and support needs. He previously lived in Council X’s area, where he received care and support. He used direct payments to arrange his care and support.
18. Mr X moved to the Council’s area in March 2023. The Council visited Mr X in July 2024 to start a care assessment. It did not complete the assessment sooner as it was unaware Mr X had moved to its area.
19. Mr X explained during the visit he previously received 40 hours per week of care from Council X. He also provided details about his care and support needs. The Council explained the financial assessment process to Mr X during the visit.
20. The Council continued to have further discussions with Mr X about his needs. An occupational therapist also assessed Mr X and recommended equipment for him.
21. The Council completed an initial care assessment in July and recommended 12.25 hours of care per week (60-minute daily morning calls and 45-minute daily tea calls) for Mr X. It commissioned a care agency for this care.
22. The Council updated its assessment in August. It decided in the updated assessment Mr X should receive 16.25 hours of care per week. This consisted of an extra four hours per week for social inclusion and shopping. It said Mr X could use direct payments to organise his care.
23. The Council sent a letter to Mr X in early September about his financial assessment. It explained he would need to pay £57.01 per week towards his care.
24. Mr X signed the direct payments agreement in late September.
25. Mr X called the Council in late November. He said he needed more support as there was not enough time for the carers to support his needs. He asked for more support to access the community. He also said he could not afford his client contribution, and that when he completed the online financial assessment form, it said he had nil contribution. Finally, he said his personal budget was £288 per week, but he was only receiving £260 per week.
26. The Council called Mr X a few days later. It signposted him to its website for the financial assessment. It also said it could refer him to local area co-ordinators to help with community support. The Council’s local area co-ordinators aim to improve the health and wellbeing of individuals and communities. Mr X refused a referral and said the local area team would not understand his needs.
27. Mr X called the Council the following day and said he wanted it to complete a reassessment of his care and support needs. He also said he wanted it to review his financial assessment. He said he wanted to raise the matter as a complaint.
28. The Council reviewed the file. It told Mr X it wanted to speak to his brother (who provides Mr X with care and support) to understand what had changed since it completed its care assessment. Mr X told the Council to speak to his son. The Council spoke to Mr X’s son. Mr X’s son said he could not provide any information about Mr X’s care and support needs.
29. The Council issued a response to Mr X’s complaint in late December. It said it would ask an officer to visit him to complete a reassessment of his needs. It also asked him to complete another online financial assessment.
30. Mr X emailed the Council in January 2025. He said he was still unhappy with how much care he was receiving. He also said the financial assessment estimator consistently said he did not have to pay for his care and support. He said he continued to receive a payment of £811.96, which he believed was incorrect.
31. The Council emailed Mr X in early February and apologised for the delay in assigning an officer to review his care and support needs. It also said it would ask for an officer from its finance team to re-look at his financial contribution.
32. The Council visited Mr X in mid-February to complete a reassessment of his care and support needs. Mr X said he was struggling and vulnerable. The Council offered to refer Mr X to the local area co-ordinator team and to a stroke charity. Mr X declined the referrals.
33. The Council completed its reassessment. It decided Mr X’s allocated care and support hours were meeting his needs. It also noted there had some been some positive changes in Mr X’s condition since its assessment last year.
34. Mr X emailed the Council and asked for another reassessment. He said he had received more care from Council X.
35. Mr X complained to the Council in late March. He said it had failed to complete a lawful and person-centred care assessment. He said its reassessment from February did not reflect his medical needs. He also continued to raise concerns about his care contribution, the shortfall in his direct payments and that the financial assessment did not accurately reflect his DRE.
36. The Council emailed Mr X in late March and provided him with copies of the financial assessment from September 2024. It agreed to complete a review of his financial assessment.
37. The Council responded to Mr X’s complaint in early April. It said it had referred his case to its complex care team. It said an officer had contacted him about the financial assessment.
38. The Council emailed Mr X a few days later. It provided a financial assessment form for him to complete. It explained the online financial assessment form he completed was a residential financial assessment, and the income he disclosed did not include all his Universal Credit. That is why it said he did not have to contribute to his care and support. Mr X completed the correct form and provided financial information.
39. The Council emailed Mr X at the end of April and asked for further information to complete his financial reassessment. Mr X replied two days later and provided the further information.
40. An officer from the Council’s complex care team visited Mr X in May to complete a further reassessment of his care and support needs. She agreed to complete a CHC checklist to see if Mr X could get some health funding.
41. The NHS decided Mr X did not meet the CHC threshold. The officer completed her reassessment and decided Mr X’s care package was accurately meeting his needs.
42. The Council issued a response to Mr X’s complaint about his direct payments in late September. It explained he was receiving £260 per week. This covered 16.25 per hours of support per week at the self-employed personal assistant rate of £16 per hour. Therefore, it was appropriately funding his care and support.

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Analysis

Care assessment

43. Mr X says he is not receiving enough care and support. He says he was receiving more support from Council X.
44. The Council is not bound by the care assessment from Council X. It has a duty to complete its own assessments and make its own decisions about what care and support Mr X requires. That is what it has done.
45. When Mr X raised concerns about the lack of appropriate care and support, it visited him twice to complete reassessments. It listened to his views but decided he was receiving enough support. That was a decision it was entitled to take, despite Mr X’s strong disagreement. Mr X said he wanted more care because he needed someone with him to do things for him. The Council explained it did not commission care for this reason, unless there was an identified unmet essential daily living task. The Council also suggested making referrals to another team and a stroke charity, but Mr X declined this.
46. Mr X says the Council’s assessment from February 2025 is inaccurate and does not reflect his medical needs. He says the Council did not reflect this neurological distress, his full medication list and the side effects, the severity of his bowel/bladder dysfunction and his jaw misalignment and the impact on his posture/balance.
47. The Council has recorded in its assessment Mr X’s own words during the visit and what it observed. I am satisfied the assessment details Mr X’s medical conditions, and the information he provided at the time. It details Mr X’s issues with his balance, his co-ordination, his bowel issues and how he struggles to process information following his stroke.
48. The Council’s assessment states that Mr X needed support with medication. That is his eligible care and support need. There was no requirement for the Council to detail all the medication Mr X takes, nor can I see any evidence Mr X provided this information to the Council during the visit or the side effects of the medication he takes.
49. Finally, Mr X says the Council did not seek medical input when completing his assessments. It is for the Council to decide whether it needs input from other professionals. The Council decided it did not, as there was no uncertainty regarding Mr X’s eligible care and support needs. That was a decision it was entitled to take. I do not find fault.

Financial assessment and direct payments

50. Mr X contests his client contribution of £57.01 per week. He says this is unaffordable, and the Council’s online financial assessment estimator tool showed he did not need to make a contribution.
51. The Council explained to Mr X that he was using the residential financial assessment form and he had not included all his income. This is why the results showed he had nil contribution.
52. The Council agreed to review Mr X’s financial assessment after Mr X raised repeated his concerns about his contribution. Mr X provided further financial information at the end of April 2025. There is no evidence the Council responded to Mr X’s email or pursued the review any further. This is fault, which has caused Mr X frustration.
53. In its response to my enquiries, the Council said it has now written to Mr X to pursue the matter further. While I welcome this, I make formal recommendations to ensure this matter progresses without further delay.
54. Mr X says he should have been receiving £288.73 per week, rather than £811.96 every four weeks for his direct payments. The figure of £288.73 per week was the personal budget when Mr X was receiving care and support from a commissioned care agency (late July to early August 2024). These payments were made directly to the agency. This figure changed to £260 per week when Mr X started receiving direct payments. This is detailed in Mr X’s care and support plans from August 2024 and May 2025. Mr X makes a client contribution of £57.01 per week, and so it is correct he receives £811.96 every four weeks from the Council. I do not find fault.

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Action

55. By 7 July 2026 the Council has agreed to:

• Apologise to Mr X for the frustration caused by the delay in completing a review of his financial assessment.
• Write to Mr X and ask him for the outstanding information it requires to complete a review of his financial assessment. It should then complete the review within two months of receiving the information from Mr X. If there is any change in Mr X’s contribution, it should backdate it to the date when Mr X first asked for a review of his financial assessment.

56. The Council should provide us with evidence it has complied with the above actions.

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Decision

57. There was fault by the Council, which caused Mr X an injustice. The Council has agreed to my recommendations and so I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman