Summary: We have not found fault with the way the Council calculated the costs of a residential placement or the advice that the social worker gave at the time. The Council has already upheld the complaint that there was a significant delay in completing the financial assessment and this was fault. This delay caused an injustice to Mr D as it meant that he was not provided with the financial assessment and an accurate forecast of the costs at the time when he was making decisions about where his mother should live. The Council has agreed to review the invoice for the care home fees.

The complaint

1. Mr D complains on behalf of his mother, Mrs E, who has sadly passed away. Mr D says the Council gave him the wrong information about how much Mrs E would have to pay towards her care home fees. He says the invoice the Council sent him was much higher than he was told it would be.

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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 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(i), as amended)

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How I considered this complaint

4. I have discussed the complaint with Mr D. I have considered the information he and the Council have sent, the relevant law, guidance and policies and both sides’ comments on the draft decision.

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What I found

Law, guidance and policies

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 (updated 2017) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties and powers to charge. The Council also has its own policies.

Financial assessment

6. Councils must carry out a financial assessment if they decide to charge for the care and support. This will assess the person’s capital and income.

Capital - threshold for funding

7. The upper capital limit is currently set at £23,250 and the lower limit at £14,250.
8. People who own capital over the upper capital limit are expected to 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.

Contribution from income

9. Regardless of capital, residents may also have to pay a contribution from their income towards the fees.

What happened

10. Mrs E was an elderly woman who had additional needs for care and support.

Assessment – 4 February 2020

11. Mrs E had previously had hospital admissions and could no longer live on her own without any support.
12. The social worker visited Mrs E and Mr D on 4 February 2020 to carry out an assessment of Mrs E’s needs.
13. The note of the visit said Mrs E managed her finances with support from Mr D. They discussed the finances during this assessment. The social worker was informed that Mrs E had savings just below the threshold of £23,250.
14. The social worker’s note of the visit said: ‘Charging policy/financial information also discussed in detail and charging policy provided. [Mrs E and Mr D] are aware that should she need services following the assessment and be eligible for support from adult social care, then she would be financial assessed to determine her financial contribution towards her care. [Mrs E and Mr D] demonstrated their understanding of this information and signed to confirm receipt of financial information/charging policy.’
15. The Council has sent me a copy of this document and it explains that, if a person has capital over £23,250, they have to self-fund their care.
16. The social worker put in a care package of two visits a day to assist Mrs E in personal care and preparing meals.

Hospital admission – 3 March 2020

17. Mrs E suffered several falls during February. On 3 March 2020 the care worker attended Mrs E’s home and found her lying on the floor. Mrs E was taken to hospital where she remained for the following weeks.
18. The hospital said Mrs E was fit for discharge on 21 March 2020.

Move to care home 1 – 29 March 2020

19. Mrs E moved to care home 1 where the social worker had found a ‘transfer to assess bed’ at a care home. This was a temporary move to assess Mrs E further to decide where she would live. The cost was £774 per week and this was paid by COVID-19 funding.
20. The social worker spoke to Mr D on 3 April 2020 and said the plan was for Mrs E to return home with a package of care. Mr D said he had concerns about this as Mrs E had become very confused recently and had forgotten how to do things. The social worker said the care workers had noticed this as well so she would carry out a mental capacity assessment of Mrs E to assess her capacity to make decisions about her care.

Mental capacity assessment – 6 and 7 April 2020

21. The social worker assessed Mrs E’s mental capacity on 6 and 7 April 2020 and concluded that she lacked the capacity to make decisions about her long-term care needs.

Discussion of plans with Mr D

22. The social worker discussed possible care plans for Mrs E with Mr D on 6 April 2020. Mr D said Mrs E had suffered several falls before her recent hospital admission so he did not think she could move back home with a package of care. He was of the view that extra care housing (ECH) with on-site carers was needed for Mrs E to be safe.
23. The social worker spoke to Mr D again on 8 April 2020. The social worker and Mr D agreed Mrs E could not return home with a care package as this would not be safe.
24. Mr D had found an ECH development which was being built. The social worker asked whether Mr D thought Mrs E could return home with a package of care in the meantime, but Mr D said this would not be safe. The social worker said Mrs E would need to move into short term residential care in that case, until she could move into ECH.
25. The social worker advised him of the costs, and said this was on the basis that Mrs E had savings which were under the savings threshold.
26. The social worker spoke to the housing association providing the ECH. She was informed that the construction had been delayed slightly because of the COVID-19 pandemic but the ECH development would be open in approximately 8 weeks. Mrs E would be an ideal candidate and would benefit from the on-site carers and social activities.
27. The social worker sent an email to Mr D on 14 April 2020 and said she had spoken to the Finance Team. The Council would carry out a financial assessment to determine the cost of the placement. She attached a copy of the Council’s finance booklet which set out the funding rules in detail. This booklet explained that, if a person had savings over the threshold of £23,250, they would be charged the full cost of their care.

Discussion – 11 May 2020

28. The social worker spoke to Mr D about the financial assessment. Mr D said Mrs B had around £17,000 in savings. Mr D did not have a Lasting Power of Attorney (LPA) for finances for Mrs E. The social worker advised him that she did not think Mrs E had the capacity to approve an LPA and advised him of applications for deputyship.
29. The note said: ‘Financial discussions taken place, information provided and consent to financial assessment signed in February 2020.’

Assessment and care plan – April and May 2020

30. The assessment of Mrs E’s needs dated 29 April 2020 said Mrs E said she was below the threshold of savings and understood that a financial assessment would have to be carried out.
31. The care plan said Mrs E would be at high risk of hospitalisation if she went home. She needed a short-term residential placement until her preferred ECH placement became available which should be in 8 weeks. The weekly cost was £484.

Chronology from 14 May 2020

32. Mrs E moved to care home 2 on 14 May 2020.
33. The LPA for finance and property was signed by Mrs E and Mr D on 10 June 2020.
34. The Council’s finance team contacted the social worker on 9 September 2020 and asked that a financial agent be found for Mrs E (as she lacked capacity to manage her finances) so that the financial assessment could be carried out.
35. Mrs E moved into ECH on 9 October 2020.
36. The social worker spoke to Mr D on 16 October 2020 and asked whether he was the nominated financial agent for Mrs E. Mr D said that he was but he was in the process of obtaining an LPA for property and finances for Mrs E, but it was still with the solicitor.
37. Mr D said Mrs E’s savings were ‘just over £23,000’, but he needed to buy items for her new apartment. The social worker advised him that, if the items were necessary, this should not affect the financial assessment. Mr D also said he was worried as he was not able to pay any invoices in the meantime. The officer said the Council’s finance team may be able to hold off any invoices until Mr D had access to Mrs E’s bank accounts.
38. A finance officer spoke to Mr D on 19 October 2020 to discuss the financial assessment. Mr D said he was applying for an LPA and the documents should be ready soon. The finance officer agreed to ring him in a month to see if the LPA had been completed.
39. The finance officer spoke to Mr D on 25 November 2020. Mr D said he was still waiting for the LPA, but said Mrs E had savings over the threshold of £23,250. The finance officer informed Mr D that she would have to pay the full cost of her care. Mr D said the social worker had told him that the cost would be around £200 per week as the Council would take account of the fact that Mrs E still paid rent and council tax at her old home. The officer explained to Mr D that, if Mrs E’s capital was over the threshold, she would have to pay the full cost.
40. The LPA was registered with the Office of the Public Guardian on 1 December 2020.
41. Mr D confirmed on 17 December 2020 that Mrs E’s capital was £26,564. The Council sent the financial assessments to Mr D on 21 January 2021. These showed that:
• Mrs E was a full cost payer from 14 May 2020 until 30 July 2020 so she paid £484 a week during that time.
• Mrs E’s capital decreased to £23,250 after 30 July 2020, so her weekly contribution from 31 July 2020 was £216.83.
42. Once Mrs E moved into ECH, her contribution reduced to £0. Mrs E had to pay an invoice of £7,900.

Mr D’s complaint

43. Mr D complained to the Council on 22 March 2021. He said:
• He recalled speaking to the social worker before the move to the care home and the social worker told him the cost would be £170 to £200 per week.
• He had been upfront from the beginning that Mrs E had capital over £23,250 so he expected to pay around £4,500 to £5,000 which was ‘fair enough’.
• He had been given incorrect advice by the original social worker and he did not agree to the invoice of £7,900 as this was much higher than the social worker advised him.
• He would not have agreed to the placement if he had known about the costs and the bill had caused him a lot of distress.
44. The Council responded on 14 December 2021 and said:
• It apologised for the delay in replying to the complaint.
• Mrs E signed the financial declaration on 4 February 2020 and received a copy of the Council’s charging booklet.
• The social worker was informed, during her assessment of Mrs E’s needs on 29 April 2020 that she had around £2,000 in savings.
• The Council emailed the financial charging policies to Mr D on 1 April 2020.
• The social worker advised Mr D on 7 April 2020 of the possible cost of the placement, but explained this was on the assumption that Mrs E had savings below the threshold as the social worker had been told that this was the case.
• On 27 August 2020, the finance team were preparing information for the financial assessment. The team contacted the social work team and asked that a financial agent should be identified as Mrs E did not have the mental capacity to manage her finances.
• The Council called Mr D on 16 October 2020 and Mr D said he was the financial agent but he was in the process of obtaining an LPA for Mrs E.
• The Council outlined the conversations Mr D had with the financial team between 16 October 2020 and 21 January 2021 when the financial assessment was completed.
• The Council admitted that ‘there were significant delays in concluding the financial assessment and also issuing the invoice for the care charges’ and apologised for this.

Further information

45. Mr D said that, although he did not hold an LPA for property and finance for Mrs E in April 2020, he would have been able to view her bank accounts. Mrs E had a current account and a savings account. Mr D said he had been supporting Mrs E in her finances and had set up an online account for her current account and had been to the bank with Mrs E and her sister in January 2020 to view the savings account.
46. He says he agreed to Mrs E moving into the care home on the basis that she would have to pay around £200 a week which was the figure the social worker gave him. He says he would not have agreed if he had known she would have to pay £484 a week.

Analysis

47. I do not find fault in the information the social worker provided to Mr D about the finances. The social worker explained the financial framework on several occasions. She also provided him twice with the leaflet which set out the rules on charging. Mr D was aware of the threshold of £23,250 and knew that, if Mrs E’s capital was above the threshold, she would have to pay the full cost of her care.
48. I think the issue was that nobody, neither the Council nor Mr D, knew in April 2020 that Mrs E had savings over the £23,250 threshold. The social worker was informed that Mrs E had savings under the threshold and she therefore gave an estimate of the costs on that basis.
49. Therefore, I cannot say there was fault in the advice the social worker provided. She gave the advice based on the information she had. She made it clear this was on the assumption that Mrs E did not have capital over the threshold.
50. However, there was a delay in completing the financial assessment and I agree with the Council that this was fault. The Council should have started the financial assessment in April 2020, but did not do so until September 2020.
51. I do appreciate that April 2020 was in the early days of the COVID-19 pandemic and the first lockdown and that councils were adapting to the new restrictions in terms of visits and working from home. I accept that this would have affected services, but I do think there was fault in not initiating any contact about the financial assessment between April 2020 and September 2020, which was a period of six months.
52. I accept that the delay after September 2020 was not the Council’s fault as there was then a further problem which was that Mr D did not hold an LPA for finance and property for Mrs E and could therefore not complete the financial assessment. The LPA was not registered with the Office of the Public Guardian until December 2020.
53. Mr D suffered an injustice as a result of the fault. If the Council had carried out the financial assessment in April 2020, Mr D would have been given more accurate information about the future costs at the time when he was making the decisions. It would also have meant that he would have received regular invoices rather than one large invoice of £7,900.
54. In light of this, I am of the view that a fair remedy is for the Council to review the invoice and to reduce the weekly rate for the costs of the care home fees from £484 to £216.83 for the entire time that Mrs E stayed at the care home as this is the amount that Mrs E would have been charged if her capital had not been over the £23,250. It was also roughly the amount that Mr D said he had been informed that he would have to pay by the social worker.

Agreed action

55. The Council has already apologised for the delay in completing the financial assessment. The Council has agreed to take the following actions within one month of the final decision. It will:
• Review the invoice for the care home fees and reduce the fees from £484 to £216.84 a week for the entire period that Mrs E resided at the care home.
• Send the revised invoice to Mr D.

Final decision

56. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

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Investigator's decision on behalf of the Ombudsman