Summary: Mrs X complains the Council was at fault in the way it arranged for her mother to move into a care home, carried out a financial assessment and provided information about care home fees. We have found no evidence of fault in the way the Council considered these matters so have completed our investigation.

The complaint

1. I have called the complainant Mrs X. She complains the Council was at fault in the way it arranged for her mother, ‘Mrs Y’ to move into a care home in August 2020. Mrs X says;
• A junior social worker dealt with Mrs Y’s case and the Council did not provide the family with any information about care home fees.
• The Council did not carry out a financial assessment on Mrs Y. This led to Mrs X receiving an unexpectedly large bill for Mrs Y’s care home fees causing distress.
• The care provider of the care home failed to provide her with any information about its fees and delayed sending her a contract for Mrs Y’s placement.

What I have investigated

2. I have investigated Mrs X’s complaints about the way the Council arranged the care home placement and failed to provide financial information about the care home fees. I have not investigated Mrs X’s complaints about the care provider as this the subject of a separate investigation by us. However, I have referred to the actions by the care provider within the decision statement for information.

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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 cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. 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)

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How I considered this complaint

5. I have read the papers submitted by Mrs X and spoken to her about the complaint. I considered the Council’s comments about the complaint and the supporting documents it provided.
6. Mrs 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

Charging for permanent residential care

7. The charging rules for residential care are set out in the “Care and Support (Charging and Assessment of Resources) Regulations 2014”, and the “Care and Support Statutory Guidance 2014”. When the Council arranges a care home placement, it has to follow these rules when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
8. The rules state that people who have over the upper capital limit (£23,250) are expected to pay for the full cost of their residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.
9. The Council must assess the means of people who have less than the upper capital limit, to decide how much they can contribute towards the cost of the care home fees.

Covid–19 funding

10. In March 2020 the Government agreed to provide funding to the NHS to support enhanced hospital discharge arrangements. The funding included providing free out of hospital care and support to people discharged from hospital or who would otherwise be admitted into it for a limited time. This removed barriers to discharge and transfer between health and social care and enabled people to get out of hospital quicker and back to their homes, community settings or care settings.

Key events leading to the complaint

11. Mrs Y lived in sheltered housing accommodation and received a care package at the property. Mrs Y self-funded the care package due to her capital being over £23,250. Mrs Y was admitted to hospital in July 2020. When Mrs Y was well enough to be discharged from hospital there were concerns about her ability to live independently even with a care package. This was because she was assessed as needing 24-hour care.
12. The Council allocated Mrs Y’s case to social worker B. Social worker B recommended Mrs Y move to residential care and contacted the family to discuss planning for Mrs Y’s hospital discharge. It was agreed Mrs Y needed a short-term placement until the Council could carry out a full assessment of her long-term needs.
13. The Council’s case records for Mrs Y show social worker B told the family the Council agreed to a short-term placement and sent the family a list of care homes to choose from. Social worker B told the family Mrs Y would be initially funded by the government’s covid funding, reviewed after six weeks, and made them ‘aware of the cost implications’.
14. Mrs X told social worker B they had chosen a care home for Mrs Y. Social worker B contacted the care home to see if they had a vacancy. The care home carried out a telephone assessment and arranged for Mrs Y to be admitted that day. Social worker B told the family of the discharge plans.
15. Social worker B contacted the care home a few days later for an update on Mrs Y. The social worker’s case notes show the family were aware that covid funding would end on 29 September 2020 and Mrs Y would be back to self-funding her care.
16. The Council agreed to a long-term placement for Mrs Y and reallocated Mrs Y’s case to social worker D as social worker B left the Council. Social worker D contacted Mrs X to advise that covid funding was due to end so she had requested a financial assessment on Mrs Y. A finance officer contacted Mrs X’s brother, Mr Z for information on Mrs Y as he held power of attorney for Mrs Y for property and financial affairs and health and welfare. Mr Z considered Mrs Y would be self-funding as she had capital over £23,250 but asked the Council to carry out a financial assessment.
17. Social worker D contacted the care home for an update on Mrs Y on 28 September 2020. The social worker carried out a well-being assessment and support plan for a long-term placement for Mrs Y when covid funding ended on 29 September 2020.
18. The financial assessment found Mrs Y had capital over £23,250 so would be self-funding and needed to pay the full cost of her care. The Council did not share the assessment with Mrs Y’s family as it was an internal document. But the Council’s records show an officer telephoned Mr Z twice, to tell him of the assessment outcome and that he was responsible for paying the care home direct. The Council also wrote a letter to Mr Z dated 8 September 2020. The letter confirmed it would not make any financial contribution towards Mrs Y’s fees from 29 September 2020 as she was classed as self-funding. This meant Mrs Y, or her representative would be responsible for paying the care home direct. The Council said it would tell the care provider. The Council issued the letter on 29 September 2020.
19. The Council sent a letter dated 8 September 2020 to the care provider on 29 September 2020. The letter advised the Council would not be making a financial contribution towards Mrs Y’s fees from 29 September as she was classed as self-funding. The Council suggested the care provider send the accounts for Mrs Y’s stay direct to her or a representative to pay.
20. The care provider emailed the Council in November 2020 about Mrs Y’s funding as it had stopped on 28 September 2020. The care provider asked the Council to confirm if there was any further funding or it need to invoice privately. The Council sent the care provider a copy of its letter dated 8 September 2020 advising Mrs Y was self-funding from 29 September 2020. The care provider adjusted Mrs Y’s account and sent Mrs X invoices in December 2020 for £13,000. Mr Z contacted social worker D to challenge the care home fees as it had taken time to notify them. Mr Z complained social worker B quoted the cost as £540 per week but the care home charged them £970 a week.
21. Social worker D explained the rate would not be £540 a week but he may have been quoted the council rate of about £600 a week if Mrs Y was not self-funding her care. The social worker said there were no records of being quoted an amount. The social worker said the self-funding rates were different and not something they get involved in as every care home charges a different rate. Social worker D arranged for a meeting with the family and care home in January 2021.
22. The care home explained to the social worker a lack of administration staff meant they could not act on the Council’s September 2020 letter until November 2020. This caused a delay in sending out the invoices.
23. The meeting in January 2021 discussed:
• The family’s allegation they were quoted £500 to £560 a week for the care home fees. But they had been charged £970 a week .
• The care home being unaware Mrs Y was self-funding or the Council completed a financial assessment with Mr Z in September 2020.
• Mr Z considered he should have been sent the self-funding rates for the care home with the Council’s letter.
• The care home had not sent any information about the placement or a contract.
24. Mrs X complained to the Council in January 2021. Mrs X said social worker B did not involve senior staff in Mrs Y’s case, was allowed to transfer Mrs Y to a care home and did not provide full or accurate information about the care home costs. Mrs X said it led to the family receiving a large, unexpected bill.
25. The family moved Mrs Y to a different care home on 1 February 2021. Mrs Y sadly died in March 2021.

The Council’s response to Mrs X’s complaints

26. The Council confirmed social worker B was a student on placement with the Council. It said social worker B was regularly supervised by a senior officer and discussed Mrs Y’s case to receive guidance and support. The Council confirmed a manager must authorise all care placements, so the social worker discussed with a manager and ensured this happened in Mrs Y’s case. The manager agreed to authorise funding (under covid funding) until the Council could carry out a full assessment of Mrs Y’s long-term needs. The covid funding scheme ended in September 2020 so Mrs Y needed a financial assessment in line with the Care Act
27. The Council told Mrs X the case notes showed social worker B did advise them Mrs Y’s placement would be initially funded under the covid funding scheme. It considers social worker B did not give the family information on specific care costs at the care home. Mrs X says social worker B sent them an email with approximate costs. The Council says it does not have a copy of the email and asked Mrs X to provide a copy, but this has not been sent to the Council.
28. The Council confirmed a finance officer spoke to Mr Z about Mrs Y’s funding and advised Mrs Y would be self-funding her placement due to her capital. The Council sent Mr Z written confirmation of this, and it told the care home to contact the family direct.
29. The Council apologised if they were not told of the self-funding rate of £970.00 for the care home and it resulted in a large bill. But it had told the family it would not be funding the placement from 29 September 2020 and assumed the family and care home would liaise over the care costs.
30. The Council says once a service user is deemed to be self-funding the allocated social worker would not normally get involved with the cost of the placement and advise the service user or family that a financial assessment would be done to establish the funding arrangements. If the service user was self-funding it would be a discussion between them and/or their representative with the home. This is because the private cost of the care would be different to the council rate and the social worker would not necessarily know the exact amount.
31. But as learning from the case it has reminded social care staff that if a service user or their family ask for the cost of care in a care home, they advise that a financial assessment will be carried out. The staff should recommend they liaise directly with the care home if they believe the service user has capital over £23,250.

My assessment

32. The Council acknowledges that social worker B was a student on placement. However, the records show the social worker kept the family informed of the discharge planning for Mrs Y to a care home. The evidence shows the social worker was supervised by a senior officer and sought proper authorisation for Mrs Y’s short-term placement at the care home. I do not consider there is fault by the Council in the way its social workers managed Mrs Y’s case.
33. The records show the family were told about the initial covid funding for Mrs Y’s placement and she would be self-funding when the scheme ended in September 2020. I have not seen any evidence in the information provided to support the family’s allegation they were told a weekly cost for the care home. Social worker B confirms any discussions about costs were in general terms and not specific. This is in line with the Council’s practice of not normally being involved with the cost of a self-funder’s placement as it can differ between care homes. Mrs X alleges she received an email from social worker B about the specific costs but has not provided a copy of the email.
34. Even if there were such an email from the social worker, I would expect the family to clarify directly with the care home what the charges were once Mrs Y became self-funding on 29 September 2020. This is especially as they would be responsible for paying her fees. The records show Mrs Y had previously been self-funding a care package at her home and that the family were aware that Mrs Y would be self-funding her care placement due to her capital.
35. I note the Council did not issue the 8 September 2020 letter to Mrs X or the care home until 28 September 2020. While it is unfortunate the Council delayed sending out the letters, I do not consider it caused any injustice to Mrs X. This is because she and the family were aware of the outcome of the financial assessment on 8 September 2020 and that Mrs Y would be self-funding her care from 29 September 2020. The delay is only minimal, so I do not consider it justifies a finding of fault against the Council.
36. The delay in the family being sent an invoice for Mrs Y’s fees from 29 September 2020 onwards is unfortunate, but I cannot say it is due to any fault by the Council.
37. The Council documents clearly show it carried out a financial assessment on Mrs Y and informed Mrs X and Mr Z of the outcome. The Council wrote to Mr Z as Mrs Y’s attorney to confirm it would not be contributing towards her fees as she was self-funding her care. Again, I would expect Mrs Y’s family to clarify with the care home what her charges would be at that point. There is no fault in the way the Council carried out a financial assessment and notified Mrs Y’s family of the outcome.

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Final decision

38. I am completing my investigation. I have found no evidence of fault by the Council in the way it arranged for Mrs Y to move into a care home, carried out a financial assessment and provided information about care home fees.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman