Summary: Mr C complained about the way the Council carried out a financial assessment for his (late) mother’s residential care. Mr C said this resulted in distress to him. We found there was fault, for which the Council has agreed to apologise.

The complaint

1. The complainant, whom I shall call Mr C, complained that:
• The Council failed to calculate the correct date on which his mother’s capital reduced to below £23,250.
• He calculated that this date should be earlier, but the Council failed to explain to him why it concluded his calculations were incorrect.
• There was an unreasonable delay (four moths) until the Council started to actually pay the care home.
• The Council failed to include his mother and him (as her carer) in discussions / considerations as to whether his mother should move to another cheaper home and, if so, what home this should be.

Back to top

The Ombudsman’s role and powers

2. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

Back to top

How I considered this complaint

4. I considered the information I received from Mr C and the Council. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received, before I made my final decision.

Back to top

What I found

Relevant background and legislation

5. The Care Act Guidance states that where a council charges for care and support it arranges, it must follow the Care and Support (Charging and Assessment of Resources) regulations and have regard to the guidance.
6. The regulations and guidance say that, if a person has capital below the upper capital limit of £23,250, the Council’s financial assessment will determine how much the person (and therefore the Council) will have to contribute towards the cost of the care. If the person has more than £23,250 in capital, they need to pay for the full cost of their care.
7. It also says the person should have a genuine choice of which care home they want to live in. As such, the personal budget the Council allocates to meet the person’s needs, should be enough to ensure there is at least one care home option available and affordable within the person’s personal budget.
8. If a person wants to choose a care home that is more expensive than the personal budget, the person (or their family) will need to pay a top up fee to cover the difference.

What happened

9. Mr C’s mother, whom I shall call Ms X, was living in a care home. At the beginning, she had more than £23,250 in capital so was paying for the full cost of her care. Mr C told the Council in March 2020, that he believed his mother’s capital would soon reduce to £23,250. He told the Council the following month, that he believed this would happen by the end of June or early July 2020. In response, the Council told him to call again in June when his mother would hit the threshold.
10. Mr C told the Council again on 1 June 2020 that he believed his mother’s capital would reduce to the threshold by the end of July 2020. Mr C subsequently chased the Council for an update on 24 June and 20 July 2020.
11. The Council says it started Ms X’s financial assessment mid-July 2020, when it sent a financial questionnaire to Mr C. Mr C completed and returned this mid-August. A Financial Assessment Officer picked this up on 4 September 2020, completed the financial assessment the same day and determined Mr C’s mother would hit the threshold on 18 September 2020.
12. A record from 4 September 2020 states that Ms X did not have any specific needs that would require her to remain at this particular care home.
13. The Council wrote to Mr C on 4 September 2020 to inform him about the outcome of the assessment and the date when his mother’s capital would reach the threshold. It said this would take effect as and when funding assistance from the Council had been approved.
14. Mr C says that, even though the Council said in its letter that it would start to pay for his mother’s care from 18 September 2020, and that his mother would only have to pay her assessed charge from that date, it failed to put in place what was needed to ensure this happened from that date. He says it took a long time before the Council actually started to pay the home.
15. Mr C chased the Council for an update on 14 September 2020. In response, his mother’s social worker explained to him that:
• His mother’s personal budget was £650 a week. However, the cost of the care home she was living was £765 a week. This meant that, if Mr C wanted his mother to stay in the home, the family would need to pay a top up of £115 a week.
• Alternatively, his mother would have to move to another cheaper home. There were two care homes who expressed an interest in providing a permanent placement to Ms X: one at £650 and one at £675 a week.
• Mr C said he would appeal any plan to move his mother to another home.
16. Mr C says the Council told him the home was too expensive and it would look for a cheaper home. He says the Council did not consult him or his mother in this process, which was very unsettling.
17. In response, the Council said the social worker explained the situation to Mr C and provided him with the names of two care homes that had expressed an interest in meeting his mother’s needs.
18. On 1 October 2020, the social worker spoke to the manager of Ms X’s home. The manager explained that Ms X’s condition had significantly deteriorated since her last needs assessment and that moving her to another home would now be extremely detrimental for her.
19. On 17 October 2020, the Council considered Ms X’s case at panel and decided she should remain at the home and there would therefore no longer be a need for a top up. The social worker told Mr C the same day and said he should continue to pay the weekly assessed charge.
20. Mr C did also not agree with the date the Council had identified as the date when his mother’s capital would reach £23,250. He believed this date should be earlier. As such, Mr C provided the Council with a copy of a spreadsheet he prepared, which showed how he had calculated the start date.
21. Mr C says that, while the Council eventually explained to him how it had calculated its start date of 18 September 2020, it never explained to him why the Council concluded that his calculation was incorrect. He says this issue was a key aspect of his complaint, and the Council should therefore have looked into that, and responded to it.
22. In response, the Council acknowledged to me that it failed to explain this to him, for which it would like to apologise. It has now, in response to my enquiries, provided its explanation to Mr C.
23. The Council confirmed to Mr C on 21 October 2020 that funding had been approved from 18 September 2020 for his mother’s stay at the home. However, Mr C complained there was a delay by the Council in actually starting to pay the care home. He said that, as a result he had to:
• Chase the Council, and
• Continue to pay the full cost of his mother’s care until February 2021, which meant his mother’s savings further reduced. He also had to spend time and trouble chasing the care home for a refund after January 2021.
24. In response, the Council said that:
• There was a delay in starting the payments because there had been an issue about whether Ms X should stay at the care home, which was more expensive than her personal budget. Once the Council was in a position to decide she could stay, the Finance Team immediately authorised payments on 23 October 2020.
• The Council backdated the payments to 18 September 2020 and paid this to the care home on 11 November 2020. It started making regular payments to the home from November 2020 onwards.
• It wrote to Mr C on 17 November 2020, to confirm what amount his mother would need to contribute towards the cost of her care home fees. It also attached a copy of the financial assessment to show how it had calculated this.
• It therefore does not know why Mr C continued to pay the care home until January 2021, when the care home was receiving payments from the Council for the placement from 11 November 2020.
25. I have seen a copy of the letter of 17 November 2020, but Mr C told me he did not receive it. He said he had a close relationship with the care home, and he asked several times each month if they had started receiving payments from the Council. He said that if he had received any confirmation from either the Council or the care home that the Council was now making payments, he would obviously have adjusted his payments at this stage.
26. Mr C continued to receive invoices from the care home for the full amount until 1 February 2021, even though I have seen evidence the Council started to pay the care home from November 2020 onwards.

Analysis

27. Mr C approached the Council in a timely manner (March 2020) to ensure there would be enough time for the Council to carry out a financial assessment to calculate when his mother’s capital would reduce to below £23,250 and what her contribution would be from then onwards. He chased the Council several times and said he believed she would reach the threshold in July 2020. However, the Council postponed the start of the financial assessment process until mid-July 2020. It is good practice for councils to start the financial assessment sufficiently in advance to give it time to deal with any eventualities etc. The Council completed the financial assessment on 4 September 2020, which concluded that Mr C’s mother would hit the £23,250 threshold on 18 September 2020.
28. I did not find fault that the Council did not immediately start to pay the care home, as it was first looking to resolve the issue whether Ms X would need to move to another cheaper care home.
29. The Council did explain to Mr C why such a move to a cheaper home would be needed if Ms X’s family could not pay a top up fee. It also suggested two possible care homes for Ms X to move to. However, when the Council was told by the home that Ms X’s condition had deteriorated, it concluded that a move to another home was no longer advisable, and Ms X would not have to pay a top up fee. Although this must have been distressing for Mr C, there was no fault in the way in which the Council dealt with this.
30. The Council has acknowledged it failed to explain to Mr F why his calculation of the start date was incorrect, for which it is sorry.
31. I am unable to determine why Mr C did not receive the Council’s letter in November 2020. However, the care home started to receive the payments from the Council in November 2020. Nevertheless, the care home continued to send Mr C invoices for the full amount from November 2020 onwards. This is fault.
32. Furthermore, I noted the Council, in its complaint response of 9 October 2020, said that: “A contract will be drawn up between Staffordshire County Council and the care home by the Brokerage Team. The care home will invoice Ms X for her contribution and Staffordshire County Council will pay the rest. This is fault. The Care Act Guidance says that the contract between the care home and the Council should be for the entire amount, with the client paying their assessed contribution to the Council. Only when and after the client agrees, can the Council put a different arrangement in place (such as the client paying their contribution to the care home directly). I have not seen evidence this was explained to Mr C and that he agreed to such an alternative arrangement. This is fault.
33. The Council has told me it has already started work to address this.

Back to top

Agreed action

34. I recommended that, within four weeks of my decision, the Council should:
• Provide an apology to Mr C for any distress caused by the faults mentioned in paragraph 30 and 31 and pay him £100.
• Remind its staff of the importance to ensure it starts the financial assessment process early enough, to leave sufficient time to complete the process before the client reaches the £23,250 threshold.
• Ensure that, from now on, any new contracts for care homes are set up in line with the Care Act requirements as set out above in paragraph 32.
35. The Council had told me it has accepted my recommendations.

Back to top

Final decision

36. For reasons explained above, I found there was some fault with the actions of the Council.
37. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

Back to top

Investigator's decision on behalf of the Ombudsman