Summary: Ms X complained about the Council’s actions in deciding her husband had to move to a different care home. We have found fault in its decision-making process, which caused Ms X and Mr Y uncertainty and frustration. The Council has agreed to apologise to Ms X and Mr Y and make a symbolic payment.

The complaint

1. Ms X complained that Buckinghamshire Council (the Council) in respect of her husband, Mr Y:
• failed to properly consider all of Mr Y’s assessed needs in deciding he had to move to a different care home in July 2025;
• failed to carry out a personal risk assessment before deciding Home H could meet his needs in October 2025;
• reneged, without reason, on a re-negotiated financial agreement with Home F in October 2025;
• stopped paying for any of the fees for Home F in October 2025 forcing Ms X to arrange the move to Home H independently;
• failed to ensure Home H carried out a pre-admission assessment before Mr Y moved there;
• delayed in deciding Mr Y could move back to Home F when the placement at Home H broke down; and
• failed to consider Ms X’s complaint at both stages of the Adult Social Care complaints procedure.
2. Ms X said these events caused significant distress to both Mr Y and Ms X, exacerbated by the fact he returned to Home F in April 2026.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. 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)
4. 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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How I considered this complaint

5. I considered evidence provided by Ms X and the Council as well as relevant law, policy and guidance.
6. Ms X 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 have and have not investigated

7. I have investigated the period from March 2025 when Ms X first notified the Council that Mr Y’s money was due to run out to October 2025 when she complained to us.

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What I found

Choice of care homes

8. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it arranges a care home place for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings.
9. The council must ensure:

• the person has a genuine choice of accommodation;
• at least one accommodation option is available and affordable within the person’s personal budget; and,
• there is more than one of those options.

10. However, a person must also be able to choose alternative options, including a more expensive setting, where a third party or, in certain circumstances, the resident is willing and able to pay the additional cost. This is called a ‘top-up’. But a top-up payment must always be optional and never the result of commissioning failures leading to a lack of choice.

Top-up payment

11. If no suitable accommodation is available at the amount identified in the personal budget, the council must arrange care in a more expensive setting and adjust the budget to ensure it meets the person’s needs. In such circumstances, the council must not ask anyone to pay a ‘top-up’ fee. A top-up fee is the difference between the personal budget and the cost of a home.

What happened

12. Mr Y has a degenerative health condition and was living in a care home (Home F). He was paying for the care himself, but his funds were due to drop below the savings threshold in 2025. Ms X, his wife, visits him daily and has power of attorney for his care and finances. This means she can make decisions on his behalf about these matters if Mr Y lacks the capacity to do so. Previously he had been in a larger home, but he became very distressed and his condition deteriorated. He had improved since moving to Home F.
13. In March 2025 Ms X submitted a financial assessment form to the Council. It calculated that his money would drop below the savings threshold in July 2025. The Council noted the weekly cost of Home F was significantly above its weekly rate and so would, in the first instance see if Mr Y’s care needs could be met in another home. Ms X could make a top-up payment if they wished Mr Y to stay in Home F. At this point the top-up payment would be over £600 per week. Ms X said she could not afford this amount.
14. The Council carried out an assessment of Mr Y’s care needs in early July 2025. It noted Ms X said she did not want Mr Y to move but would consider an alternative home if it was a small environment that understood Mr Y’s care needs. The professional analysis by the social worker noted that the previous care home had affected him adversely and he became very distressed and deteriorated after a short time. When he moved to the current smaller care home (Home F) he acknowledged that he had been anxious due to the size, noise and number of people and now felt more comfortable and his appetite has returned. The analysis also said any placement needed to be local so Ms X could visit every day. Ms X also said he needed an en-suite bathroom for his continence needs. The care and support plan only said Mr Y required 24-hour specialist nursing care in the local area so Ms X could visit him.

Alternative offers

15. The Council found places at two alternative homes which said they could meet Mr Y’s needs. One was out of the area, and both were specialist dementia units. Ms X rejected the first offer as Mr Y did not have dementia, and she would not be able to visit him so regularly. The Council offered an alternative option (Home G) which was nearer. But Ms X felt it was too big and would not be able to meet Mr Y’s needs. She provided a letter from Mr Y’s GP supporting him staying at Home F. The Council said if Mr Y stayed at Home F Ms X would have to pay the top-up fee of over £600 per week.
16. Ms X appealed against the Council’s plan to send Mr Y to Home G. She said his situation was unique and he should stay at Home F where he was settled. The Council agreed to continue funding Mr Y’s place at Home F in the meantime. Home G confirmed it was able to meet Mr Y’s needs and had attempted to arrange an introductory visit, but Ms X had declined. More recently she had visited but had not contacted the home since. It was still prepared to accept the placement.

Formal complaint

17. In early August 2025 Ms X made a formal complaint to the Council. She said Mr Y was settled and thriving in Home F. She said the care needs assessment identified that Mr Y needed:

1. A small environment but with plenty of space to walk about and with plenty of light (a previous larger environment caused a significant deterioration in physical, mental and emotional wellbeing).

2. His own private bathroom (due to medical needs).

3. A local placement (to enable daily family time and support).

4. Not a specialist dementia unit (no formal diagnosis of dementia and able to make own decisions and converse intelligently).

18. She said the Council had offered places in two specialist dementia units or a top-up payment she could not afford for him to stay at Home F. She said the Council had not properly considered Mr Y’s needs or that a previous stay in a large environment had caused a significant deterioration in his health.
19. On 5 August Ms X noted that Mr Y’s care and support plan did not mention the need for a small environment. The Council approved four more weeks of funding at the end of August. But it notified Ms X that the funding would stop after the end of September 2025 and she would have to pay the top-up fee or Mr Y would have to move to another home.
20. The Council responded to Ms X’s complaint on 12 September. It said it had not been able to arrange an informal discussion with a manager at step one of its procedure, so it was responding at stage 2. It said it acknowledged Mr Y’s needs and Ms X’s concerns about the move but as she was unable to afford the top-up payment the Council had proposed alternatives. Although Home G was a specialist dementia service it would provide the same level of care as Mr Y was currently receiving and as his condition was degenerative, he was likely to require a more specialist level of care in the future. It said that all the rooms in Home G were en-suite and it was divided into four units each with 15 residents sharing a lounge and dining area. It said there was ample space within a unit to meet Mr Y’s needs.
21. Ms X replied disagreeing with the Council’s description of the home, saying the four units were not separate but four corridors connected to one central space. It was similar to the previous environment which had been detrimental to Mr Y’s health and wellbeing. She said there was no quiet space, and the TV was always on in the shared areas. She asked the Council to carry out a risk assessment regarding the proposed move and whether the need for a small environment had been included on the care and support plan.
22. By this point the place at Home G was no longer available. The Council agreed to a final extension of funding until October to source another placement but said to Ms X this was the final extension,
23. The Council responded to Ms X again on 6 October. It said that it recognised people had preferences for different care homes and the top-up payment system allowed for this. But if families were unable to afford the top-up, then the Council expected them to accept its offer. The Council said it had looked at the evidence in relation to people moving between care homes and found that a well-planned move could moderate any adverse risks
24. The Council sourced another place at Home H. The home assessed Mr Y on 9 October (through the care needs assessment and care and support plan) and confirmed they could offer him a place from 13 October. The Council offered the place to Ms X. Ms X did not consider it was suitable and continued to challenge the Council’s approach.
25. Ms X complained to us.
26. On 21 October, Home F agreed to reduce its weekly fee by £100 but the top-up fee was still unaffordable to Ms X. The Council tried to persuade Home F to reduce the fee further which would have brought it in line with Home H but it said it could not do that.
27. On 24 October the Council declined to waive the top-up fee at Home F. The scope of my investigation ends here but I have included the later events for context in terms of my findings.

Home H - November 2025

28. Mr Y moved to Home H on 4 November. Almost immediately he was regularly wandering into other residents’ rooms during the night, causing distress to other residents. He was confused and not aware of his actions. He also fell several times during this time requiring hospital treatment. By 16 December Home H said they could not meet his needs as he required 1:1 supervision.
29. The Council reviewed his care needs in the new setting on 11 December and agreed some actions to address the night wandering and medical condition which appeared to be the cause. But there was no improvement in Mr Y’s behaviour and Home H served notice to quit. The Council began looking for an alternative placement. After considering other alternatives, Mr Y moved back to Home H in April 2026.

Council’s response to my enquiries

30. In responding to my enquiries, the Council said Ms X and Mr Y had a preference for a small homely setting, an ensuite room, proximity to Ms X and a non-dementia environment. While important, it did not consider these were needs which had to be met by a new placement and neither did it consider Home F was the only place that could meet Mr Y’s needs.
31. It also acknowledged that it had not carried out a personal risk assessment in relation to the move as it relied on the existing assessments, care and support plans and professional information. It anticipated the new provider would carry out its own admissions assessment and risk-management planning.

Findings

Care needs

32. As Ms X could not afford the large top-up fee for Mr Y to remain at Home F, it was reasonable for the Council to consider whether other options were available, at a lower cost which could meet Mr Y’s needs, to ensure it was spending public money efficiently. However, the care needs assessment referred to the need for the accommodation to be small and went into detail about the adverse impact on him of living in a larger care home for only a short period of time. Although these aspects appear to be more than preferences as they affect his condition and wellbeing, Mr Y’s care and support plan did not include reference to size of the accommodation, mentioning only 24-hour specialist nursing care, local to Ms X.
33. Given that there was evidence of the problems in a large busy environment which led to a deterioration in Mr Y’s condition and ultimately a new placement, I consider this issue was more than a preference and should have been included in the care and support plan which was sent to potential new providers. The failure to do so was fault.
34. Although Ms X referred to the size and layout of the accommodation on numerous occasions there is no evidence the Council discussed this issue with Ms X to explore what the problem had been in the previous unsuitable placement or what should be avoided in any alternative setting. The failure to explore this key issue further was fault.

Risk assessment

35. The Council said to Ms X it did not carry out an assessment of the risks of moving Mr Y to a new setting because it had considered the general evidence that people could be moved to a new setting without any problems. I do not consider this was an adequate response to Ms X as she had identified a likely risk based on Mr Y’s previous experience supported by the care needs assessment.
36. The Council should have considered this point further and taken steps to mitigate any potential risk to Mr Y. It was not a speculative risk: he had been caused distress and his condition deteriorated after only a short time living in a large environment. This factor alone merited at least some consideration, rather than being dismissed as a preference.
37. I also do not consider it was adequate to rely on the Home F carrying out an admissions assessment as it was too late by then to consider the main risk to Mr Y of a large environment.

Financial negotiations

38. I have not found evidence the Council reneged on any agreement with Home F. It tried to negotiate a lower fee with Home F to bring down the top-up payment but this was ultimately not successful.

Stopping care fees for Home F

39. The Council extended payment of the care charges for Home F on three occasions for a period of approximately four months. It gave Ms X notice of the situation many times during this period, so I do not find fault with the manner in which it ceased payment in early November 2024.

Delay in finding a new placement

40. These events are outside the scope of my investigation, so I have not considered them here.

Failure to consider complaint at two stages

41. Beyond an informal chat with a relevant manager, the Council’s Adult Social Care complaint procedure only has one stage. I do not find fault with the Council’s actions here. I also note it did respond to Ms X a second time in October 2025.

Injustice

42. I have not concluded that Mr Y should have been allowed to stay at Home F without Ms X having to pay a top-up fee as that is not my role. But I consider the failure to properly consider all of Mr Y's identified care needs or carry out a risk assessment regarding the potential move has caused Ms X and Mr Y uncertainty as to whether the move could have been avoided.
43. I understand Mr Y’s particular nighttime behaviour had not occurred previously so could not have been predicted. But as a large busy environment had previously caused him significant distress, I consider the potential for distress should have been taken into account in the Council’s decision-making. My view is strengthened by the speed at which problems occurred at Home H and the fact that Mr Y moved back to Home F in 2026.

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Action

44. In recognition of the injustice caused to Ms X and Mr Y I recommended the Council within one month of the date of my final decision:
• apologises to them and makes a symbolic payment of £500.
45. The Council has agreed to my recommendation and should provide us with evidence it has complied with the above actions.

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Decision

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

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Investigator's decision on behalf of the Ombudsman