Summary: Miss X complained the Council failed to provide information about the amount payable for her father’s care fees and delayed completing a financial assessment and in requesting payments. We have found the Council at fault in the delay in providing the outcome of a financial assessment and failures in communication. This meant Miss X received a large, backdated bill for care fees which caused her distress. The Council agreed to apologise, agree an affordable repayment plan and make a symbolic payment to Miss X.

The complaint

1. The complainant, Miss X, complains the Council failed to provide information about the amount payable for her father’s care fees and delayed completing a financial assessment and in requesting payments. Miss X also complains about her father’s personal allowance.
2. Miss X says because of the Council’s fault, her father received a large and unexpected invoice and has been placed in debt.

Back to top

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. 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. (section 26A or 34C, Local Government Act 1974)
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)

Back to top

How I considered this complaint

7. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
8. Miss X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

Back to top

What I found

Background

9. 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.
10. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
11. 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.
12. The Personal Expenses Allowance (PEA) is the weekly amount that people receiving local authority-arranged care and support in a care home are assumed to need as a minimum for their persona expenses. The PEA is specified in regulations made under Section 14(7) of the Care Act 2014. For the next financial year (2024 to 2025), the PEA will increase in line with inflation from its current level of £28.25 per week to £30.15 per week.

What happened

13. The following is a summary of key events. It does not include everything that happened.
14. The Council received a hospital referral for Miss X’s father, Mr Z, on 17 August 2023. The Council met with Mr Z on the hospital ward. It is recorded that Mr Z lived alone and was having regular falls and could not manage his activities of daily living and personal care. It was recorded that Mr Z had capacity to make decisions about his care needs and discharge location. It was further recorded that Mr Z was informed of the Council’s financial policy towards charging and contribution for his care needs and during the discussion reported not having any stocks and shares but savings of about £4,000. Mr Z sought discharge to residential care.
15. The Council emailed Miss X a copy of its ‘Residential and Nursing Care Services Financial Declaration Form’ on 22 August 2023. This included notes about charging which set out that the form had been provided to assess the person’s contribution towards the costs of care received in residential/nursing care. The amount a person would be asked to contribute would depend on their financial circumstances. It says the Financial Assessment team would send a letter confirming how much a person would have to pay towards the cost of their care and it would include a breakdown of the charges they would have to pay.
16. The Council received the completed ‘Residential and Nursing Care Services Financial Declaration Form’ from Miss X on 5 September 2023. This was completed by Miss X and signed on 28 August 2023. The form set out that Miss X dealt with Mr Z’s financial affairs and provided her address. The question on the form about whether Mr Z wanted all correspondence sent to Miss X was not completed. It was recorded that Miss X acted as Mr Z’s Attorney with a note saying she only assisted Mr Z with withdrawing money out of the account if required for shopping or he needed cash. Mr Z signed the declaration on 29 August 2023. This set out that Mr Z lived in sheltered housing and enclosed various financial information. All the enclosed financial statements used Mr Z’s address.
17. Mr Z had a temporary placement at a residential care home (Home A) between 5 September 2023 to 23 November 2023. Mr Z moved to a different temporary placement on 13 December 2023 (Home B). Both these placements were charged at a flat respite rate of £130.50 per week.
18. The Council completed a review of Mr Z’s placement on 3 January 2024. Both Mr Z and Miss X were present at the review. It is recorded that Mr Z had capacity to make decisions about his social care needs. Mr Z confirmed he was happy to stay at Home B long term and Miss X confirmed she was happy with the care provided.
19. The above placement at Home B became permanent from 10 January 2024.
20. There was a delay in updating the Council’s system with the above placement dates until July 2024.
21. The Council completed a provisional Financial Assessment on 13 June 2024. This noted Mr Z was not a self-funder and would be required to contribute towards his residential care. However, this assessment was not completed as the system had not been updated with the placement information above.
22. The Council has provided a copy of Mr Z’s assessment dated 14 June 2024 and Care and Support Plan dated 19 June 2024. The Council cannot provide a record of when this information was provided to Mr Z and/or Miss X. The Care and Support Plan refers to financial advice about Mr Z’s contribution and payment being discussed with Miss X on 3 January 2024. This relates to the 3 January 2024 placement review detailed above which does not record a discussion about charging. I would remind the Council of the need to ensure it maintains an adequate record.
23. The Council completed a Financial Assessment for both 2023/24 and 2024/25 on 17 July 2024. The assessments were sent to Mr Z but to the wrong address. They were re-sent by email to Miss X on 1 November 2024.
24. The Council raised the invoices for Mr Z’s care on 20 September 2024. The invoices raised for Mr Z’s care were initially sent to Home A although Mr Z had moved to Home B. The address was not updated to Miss X’s address until 1 November 2024.
25. The Council telephoned Miss X on 17 October 2024 about Mr Z’s residential care fees. The Council confirmed there were three outstanding invoices on Mr Z’s account totalling £22,505.39. Miss X explained she had sent in the completed financial declaration form in September 2023 but had not received the outcome of the assessment. Mr Z had now received a large, backdated invoice dated 20 September 2024 for £19,536.63 but did not have enough funds to clear the outstanding balance. Miss X agreed for a direct debit to be set up for future invoices and the Council confirmed once this was in place it would be in touch to discuss and agree a reasonable instalment plan to clear the outstanding fees. The Council would update the address for invoices to be sent to Miss X’s address.
26. The Council emailed Miss X the same day to confirm the outstanding balance and that Mr Z’s current contribution was £611.69 per week which equated to four weekly invoices of £2,446.76. The Council attached the three outstanding invoices as follows:

• Invoice 20351853 dated 15/01/24 for £522.00 for period 05/09/23 to 02/10/23
• Invoice 100029983 dated 20/09/24 for £2,446.76 for period 26/08/24 to 22/09/24
• Invoice 100029431 dated 20/09/24 for £19,536.63 for period from 10/01/24 to 25/08/24

27. The Council confirmed it could set up an instalment plan to clear the balance over a period of time and sought financial information so it could propose a reasonable instalment plan. The Council also confirmed it was updating the invoice address to Miss X’s address and had sought a direct debit for all future invoices.
28. Miss X sent a follow up email to the Council on 22 October 2024. Miss X asked why she had not received any correspondence after completing the financial declaration form on 22 August 2023 and noting this was some 14 months ago. Miss X asked why the Council had allowed the unpaid invoices to accrue for so long without contact and had been wrongly sending these to Home A despite Mr Z moving to a new placement on 13 September 2023. Miss X also queried the initial respite placement and why this had been chargeable and noted Mr Z had been paying his sheltered accommodation fees until 31 January 2024. Miss X sought an affordable repayment scheme for Mr Z.
29. The Council sent a holding reply to Miss X on 31 October 2024. The Council provided a substantive response on 1 November 2024. The Council set out the following:

• although Mr Z’s permanent placement started from 10/01/2024, the information was not entered onto its systems until July 2024 which delayed his financial assessment and the issuing of invoices
• an apology for the above delay and for any inconvenience this had caused
• respite care was a chargeable service with residents required to pay a ‘non means tested flat rate’ towards the cost their care - Mr Z had been charged the flat rate of £130.50 per week for his respite care from 05/09/2023 to 02/10/2023
• due to a change in its invoicing system in April 2024, the previous address for Mr Z (Home A) was transferred onto the new system which resulted in invoices being issued to Home A
• confirmation that system to be updated for future invoices to be sent to Miss X’s address
• Noted whilst Mr Z was placed at Home B on a permanent basis from 10/01/2024 he continued to pay for his previous sheltered accommodation until the 31/01/2024 and sought information to see if his sheltered accommodation charges for the period from 10/01/2024 to 31/01/2024 could be included in his financial assessment.
• As Mr Z’s capital was below the lower capital threshold of £14,250, his contribution towards the cost of his care was based solely on his income
• Noted several expenses incurred by Mr Z which Miss X wanted the Council to include in his financial assessment and documentation/receipts for these so they could be reviewed.

30. Miss X provided the requested financial information on 4 November 2024. Miss X also confirmed she had paid £4,893.52 to cover the payments for September and October and set up a standing order to be made on 22 January 2024 for £2,446.76 every 4 weeks until the Council set up the direct debit which had not yet been completed by the Council. Miss X had also contacted Mr Z’s sheltered accommodation provider for the relevant invoices and would send these on once received.
31. Miss X complained to the Council on 11 November 2024. The Council placed a hold on any debt recovery action until the complaint was investigated. The Council acknowledged Miss X’s complaint on 13 November and confirmed it would provide a response within 25 days.
32. The Council acknowledged recent payments on 14 November 2024 which left the outstanding balance at £15,165.11. The Council explained Miss X would need to discuss and agree a reasonable instalment plan if she was not able to make further lump sum payments to clear the balance. The Council also sent a direct debit acknowledgement letter.
33. There followed an exchange of correspondence with Miss X during November 2024 about the full breakdown of which payments had been allocated to which invoice. The Council confirmed on 3 December 2024 that it had reallocated the payments in accordance with Miss X’s instructions and the direct debit would start from January 2025.
34. The Council provided a response dated 20 December 2024 at Stage 1 of its complaint procedure to Miss X on 23 December 2024. The Council apologised for the delay in providing a response. The Council explained that the introduction of a new finance system in April 2024 led to disruption to its billing and other issues. The Council had sent a letter to affected residents about this in October 2024 but accepted this letter was wrongly sent to Mr Z’s old address. The Council confirmed it had received the completed Financial Assessment Form from Miss X on 5 September 2023. Mr Z’s permanent placement started from 10 January 2024 but this information was not entered on to the system until July 2024. This delayed the completion of Mr Z’s financial assessment and the issuing of invoices. The Council apologised for this delay and any inconvenience caused. The Council also accepted that previous correspondence had not been sent to the correct address which had added to the frustration and lack of clarity around Mr Z’s arrangements. The Council confirmed it had not been able to confirm if it received any returned invoices from Home A which would have triggered action. The Council noted it needed a statement of account from Mr Z’s sheltered housing provider to consider including these payments in his financial assessment. The Council noted Miss X had provided evidence relating to life assurance which would not be considered an allowable expense. The Council confirmed a suitable and affordable payment plan would be agreed in the New Year.
35. Miss X escalated her complaint and provided evidence of the sheltered accommodation rent and service charges Mr Z had paid on 9 January 2025.
36. The Council wrote to Miss X at Stage 2 of its complaint procedure on 14 February 2025. This confirmed it would credit the rent and funeral payment.
37. The Council completed the 2025/26 Financial Assessment on 22 March 2025. This was for £626.18 per week. The Council has subsequently issued invoices every four weeks which have all been paid by direct debit.
38. The Council has confirmed it allowed PEA for Mr Z from the start of his care:

Standard PEA for 2023/2024 - £28.25 per week – PEA allowed for Mr Z - £34.75

Standard PEA for 2024/2025 – £30.15 per week – PEA allowed for Mr Z - £37.10

Standard PEA for 2025/2026 - £30.65 per week – PEA allowed for Mr Z - £37.70

39. The Council wrote to Mr Z care of Miss X’s address on 4 April 2025 with the outcome of its annual review of his contribution towards the cost of his care. This confirmed Mr Z’s weekly assessed contribution was £626.18. This allowed a PEA of £37.70.
40. The Council wrote to Mr Z care of Miss X’s address on 28 November 2025 with a full statement of account. This showed an outstanding balance of £17,962.19.

My analysis

41. The Council provided information about charging to Mr Z and Miss X in the form of its ‘Residential and Nursing Care Services Financial Declaration Form’ in August 2023. This document confirmed the information provided would be used to assess the person’s contribution towards the costs of care received in residential/nursing care. It also stated the Financial Assessment team would send a letter confirming how much Mr Z would have to pay towards the cost of his care and this would include a breakdown of the charges he would have to pay.
42. I am satisfied Miss X and Mr Z were made aware there was the possibility Mr Z would need to make some contribution to the cost of his care.
43. However, there was a significant delay between Miss X providing the required financial information to the Council in September 2023 and the outcome of its assessment in July 2024. This delay was fault. The situation was made worse by the further fault by the Council in sending the outcome to the wrong address. This meant Miss X did not receive the outcome until 1 November 2024.
44. Miss X also did not receive the invoices subsequently raised by the Council as they were being sent to the wrong address. This is further fault. This meant Miss X was not made aware of the outstanding care fees being accrued until the telephone call in October 2024. This caused shock to Miss X when she received her father’s accrued care fees.
45. It is concerning that the Council did not take proactive steps to establish the reason Mr Z was not making any payments towards the care fees until these accrued over a significant period.
46. We do not normally consider it to be appropriate to recommend a council ‘waive’ or reimburse payments for care that has been received. This is because, the person received the care and should be assumed to have expected to make some contribution, unless there is compelling evidence of entirely misleading advice. I do not consider that to be the case here. However, I am satisfied Miss X suffered avoidable distress requiring a remedy.
47. I have not found fault in the way the Council considered Mr Z’s PEA.

Back to top

Action

48. The Council will take the following action within one month of the date of my final decision:
1. apologise to Miss X for the significant delay and poor communication identified in my statement above;
2. liaise with Miss X and offer an affordable payment plan option to clear Mr Z’s outstanding care fees by instalment if this has not already been agreed;
3. make a symbolic payment of £500 to Miss X to acknowledge her distress; and
4. review its procedure to ensure contact with service users, their families and/or representatives is made in a timely manner to notify them about accruing care fees.
49. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
50. The Council should provide us with evidence it has complied with the above actions.

Back to top

Decision

51. I find fault causing injustice. The Council has agreed actions to remedy injustice.

Back to top

Investigator's decision on behalf of the Ombudsman