Summary: We do not find fault with how the Council assessed and considered placement and funding for Mr X’s residence at a care home.

The complaint

1. Ms Z complained the Council tried to move Mr X from his care home against medical advice when they approached the Council for funding of his care home placement after his funds fell below the upper threshold of a self-funder. Ms Z says that such a move would have caused foreseeable harm to Mr X given his condition.
2. Ms Z says while the Council has ultimately agreed to fund Mr X’s placement, their actions during their consideration caused her and Mr X significant distress, uncertainty, time and trouble. Ms Z also advised she incurred financial losses caused by the Council’s actions.

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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 recommend 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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How I considered this complaint

6. I considered evidence provided by Ms Z and the Council as well as relevant law, policy and guidance.
7. Ms Z 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

Rules and regulations

8. The Care Act states that where a council assesses a person’s needs and agrees to provide care, it should set a personal budget in a care and support plan. A personal budget is a statement which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute.
9. Councils can charge people towards the cost of a care home placement. They complete a financial assessment, applying charging rules in regulations and guidance to determine how much a person pays. People who have over £23,250 (including property) pay the full cost. However, once their capital has reduced to under £23,250, they pay an assessed contribution towards their fees.
10. 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.
11. 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.

12. 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.
13. 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

14. In May 2025, Ms Z contacted the Council to request a financial assessment of Mr X as she planned to move Mr X into a care home as a self-funder later this month. The Council provided information to Ms Z about when it would be involved in funding a person’s care and sent an information booklet to Ms Z.
15. In September 2025, Ms Z contacted the Council again to advise Mr X’s savings were approaching the upper threshold and Mr X needed a financial assessment. The following day, the Council contacted Ms Z and arranged a care assessment for the start of October 2025.
16. At the assessment, the Council assessor confirmed:
• Mr X met the eligibility criteria for Dementia Residential Care.
• Mr X had 24 hours care needs.
• Ms Z’s wish for Mr X to remain at his current care home placement.
• Mr X’s current care home does not accept the Local Authority rates.
• Ms Z cannot afford the weekly top-up fees needed to bridge the Local Authority rates and the care home’s rates.
• They recommended Mr X remains at his current care home placement if possible as a move would likely impact on Mr X’s health and functioning.
• They would need to wait on feedback from the care home, if they are willing to accept the Local Authority rates, and the financial assessment to determine if Mr X could remain at the current care home.
17. The Council liaised with Mr X’s care home about the rates. The care home confirmed it would not accept the Local Authority rates but offered a reduced rate to Ms Z. The Council noted it needed to consider if it could meet this proposed rate.
18. The Council also liaised with Ms Z who raised concerns about having to move Mr Z and the impact this would have on both Mr X and herself. Ms Z told the Council she considered Mr X was entitled to remain at the current care home because a move would be detrimental to his health.
19. Later in October 2025, Ms Z sent the relevant financial assessment information to the Council. The following day, the Council confirmed with Ms Z it would need to complete the financial assessment of Mr X before advising whether it could meet the reduced rate offered by the care home. Ms Z submitted a formal letter to the Council on the same day for Mr X to remain at the care home outlining their position.
20. The Council completed a financial assessment of Mr X near the end of October 2025 and confirmed his capital would drop below the upper threshold from early November 2025 and recommended funding from this date. The Council wrote to Ms Z confirming the outcome of the financial assessment detailing Mr X’s assessed client contribution and their personal budget from the Council.
21. At the end of October 2025, the Council discussed Ms Z’s complaint with her before submitting a formal response. The Council said:
• It was in agreement that Mr X met the eligibility criteria for 24-hour care in a residential dementia placement.
• Mr X’s care home does not accept the Local Authority rate and would therefore expect a top-up fee.
• It had been unable to make any decision about Mr X’s funding before it completed the financial assessment.
• It has only recently completed the financial assessment so has not had opportunity yet to discuss placement options with Ms Z for Mr X.
• Once Mr X’s funding date arrives, his placement would be funded through the client contribution, the Council’s contribution and any third-party top up as required.
• Since Ms Z has told the Council she cannot afford the third-party top-up it can support her to find a suitable care home placement that could meet Mr X’s needs that does accept the Local Authority rate.
• It understood Mr X’s individual circumstances and needs but it cannot agree to fully fund Mr X’s placement as this was originally a private arrangement between Ms Z and the care home.
22. The Council made a request to its brokerage department to consider other options for Mr X but also to query if Mr X’s care home would consider the Local Authority rate.
23. At the start of November 2025, Ms Z contacted the Council to request consideration of their complaint at stage two. Ms Z said the medical evidence details that moving Mr X from the care home would cause a rapid deterioration. Ms Z said the Council must therefore keep Mr X at the care home to prevent foreseeable harm as outlined under the Care Act.
24. In November 2025, Mr X’s care home reiterated the cost it was willing to offer for Mr X but would not accept the Local Authority rates. The Council discussed this matter with Ms Z further and discussed the various other care home options available for Mr X. Ms Z reiterated her concerns about the impact any move would have on Mr X. Ms Z initially agreed with the Council to explore other care homes for Mr X before retracting this agreement the following day. The Council responded to advise without agreement to consider other care homes it would need to assume Ms Z intended for Mr X to remain as a self-funder at his present care home. The Council also told Ms Z it did not have an up-to-date clinical view as to whether a move would be detrimental to Mr X’s wellbeing and it would be helpful if Mr X’s GP could complete a review. Ms X said she would arrange a review by a Neurologist.
25. Ms Z got an up-to-date review by the Neurologist and submitted this to the Council. The Council agreed, based on medical evidence, that a change of accommodation would be detrimental to Mr X’s wellbeing and agreed to a long-term placement at the rates offered by the care home. The Council backdated the agreement to Mr X’s funding start date.
26. Near the end of November 2025, the Council issued a stage two complaint response to Ms Z. The Council said following input from the Neurologist the Council has agreed to approve the rate offered by the care home under exceptional circumstances. The Council said it based this decision on the full range of information and evidence provided.

Analysis

27. The Care Act 2014 outlines a general duty for a council to meet a person’s assessed care needs. For Mr X, the Council assessed that he needed 24-hour dementia care in October 2025. The Council also confirmed the current care home Mr X resided at was able to meet his needs. The Council completed a suitable care assessment which identified Mr X’s needs and preference to remain at the current placement. The Council also outlined the relevant factors, such as the care home not accepting local authority rates, it needed to consider before committing to a decision. The Council has made a decision it was entitled to make and I do not find fault with the Council’s care assessment.
28. The Council has a responsibility to consider appropriate options to meet a person’s care needs. And, fundamentally, the Council must present a genuine choice of accommodation to a person, including providing at least one option that does not include the need for a top-up fee. Since the care home did not accept the Local Authority rates, the standard practice would have been for Mr X to need to pay a top-up fee to cover any additional rates or to move to a new care home. While Ms Z and Mr X were clear they wanted Mr X to remain in his current placement, the Council still needed to consider the whole range of options available to Mr X. The Council also needed to complete a financial assessment to inform its decision making.
29. The Council outlined the top-up fees Mr X would need to pay, explored other care home options and repeatedly liaised with Mr X’s care home about the fees it was charging. The Council completed the financial assessment before the date it needed to contribute towards Mr X’s care home fees which allowed suitable opportunity for the Council to consider the full options. The Council made a decision in line with the relevant legislation and guidance. I do not find fault with the Council considering the relevant factors applicable to Mr X’s situation and completion of the financial assessment in October 2025.
30. The Council told Ms Z, in November 2025, that it lacked up-to-date clinical evidence that Mr X should not be moved care homes and recommended a review by Mr X’s GP. Ms Z chose to get evidence from Mr X’s pre-existing Neurologist at a cost rather than Mr X’s GP. The Council could have accepted medical evidence from an NHS GP, free of charge, and recommended such evidence should come from a GP. I do not consider the Council’s request for medical evidence caused a direct causal loss to Ms Z in such circumstances.
31. Once Ms Z provided this up-to-date medical evidence, the Council agreed for Mr X to remain at the care home and for it to cover the costs of Mr X’s care home fees. The Council met its statutory duty to meet Mr X’s individual eligible care needs and prevented potential psychological harm to Mr X through moving care homes.
32. The Council made this decision within eight days of receiving the relevant medical evidence. The Council ensured its funding was backdated to the start of the funding date, preventing any financial loss for Mr X or Ms Z, and Mr X had continued residency at the care home throughout. The Council also issued both complaint responses within the timescales it promised Ms Z.
33. Overall, there is no fault in how the Council considered this matter. While Ms Z has undoubtedly experienced uncertainty and distress during this time period, I do not consider this was caused by any fault of the Council.

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Decision

34. I have completed my investigation as there was no fault by the Council.

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Investigator's decision on behalf of the Ombudsman