Summary: Mrs X complained the Council has incorrectly charged for her father, Mr Y’s, care home fees. Mrs X says this has caused her distress and she has taken time and trouble to complain. There was fault in the way the Council evidenced the amount owed and communicated this with Mrs X. This fault caused distress and uncertainty to Mrs X. The Council has agreed to apologise, pay Mrs X £150 and remind its staff of the importance of providing clear information in its communication with service users.

The complaint

1. Mrs X complained the Council has incorrectly charged for her father, Mr Y’s, care home fees. Mrs X says this has caused her distress and she has taken time and trouble to complain.

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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 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

4. I read Mrs X’s complaint and spoke to her about it on the phone.
5. I considered information provided by Mrs X and the Council.
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

Background information

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
8. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
9. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
10. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
11. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person can get council support to meet their eligible needs. People who have over the upper capital limit must 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.

What happened

12. This is a summary of events, outlining key facts and does not cover everything that has occurred in this case.
13. Mr Y lived in a care home and the Council completed a financial assessment in September 2021. The Assessment confirmed a weekly charge of £205.85. Invoices were sent to Mrs X for payment. Mrs X had a direct debit set up to ensure invoices were paid promptly.
14. Mr Y’s wife moved into the care home in November 2021. The Council completed a joint financial assessment and confirmed a charge of £228.27 per week.
15. The Council wrote to Mrs X in February 2022 and confirmed the weekly payment of £228.27, backdated to the start of November 2021. The Council continued to charge Mrs X £205.85 per week.
16. The Council completed another financial assessment and wrote to Mrs X again on the same day in February 2022. This assessment included a property not previously included as Mr Y’s wife had been living there. This property being included on the assessment meant he would pay the full cost of his care, £850 per week. This cost would be backdated to the start of November 2021.
17. Mrs X complained at the end of February. She stated the Council should not include the property as there was a trust on it. Mrs X stated she had spoken to the Council in November and December 2021 and had chased a response in early February 2022, before the updated financial assessment had been completed.
18. The Council completed a new financial assessment after Mrs X complained. It removed the property from the financial assessment and the Council confirmed the charge was £228.27 per week.
19. At the end of March 2022, Mrs X received an invoice for £9,350. It stated this was the full cost of Mr Y’s care from the end of January 2022.
20. The Council wrote to Mrs X again and confirmed the cost would be £228.27 per week, payable from the end of January.
21. The Council completed another financial assessment in May 2022 and confirmed a charge of £234.99 per week.
22. The Council did not increase the charge on the invoice sent in May, but it increased the charge in the June invoice.
23. The Council issued three credit notes to Mrs X, totalling £9,350. It issued another invoice for £2,510.97 which was for the correct weekly charge from the end of January.
24. In July 2022, Mrs X emailed the Council and stated she received a chasing letter about the £9,350 bill despite being assured when the invoice was sent, this was incorrect, and it would be credited. Mrs X explained she paid the £2510.97 but was being chased for payment for £564.57. She stated she did not have an invoice for this amount. Mrs X requested the correct invoice and stated she would make payment when she had this.
25. The Council issued another invoice for £564.57. This invoice does not have any dates of care on it. It stated the invoice was “for the balance of financially assessed charges”.
26. Mrs X wrote to the Council again stating she had received the invoice the Council had created but there were no dates of care or an explanation what the invoice was for.
27. The Council responded and apologised for the invoice received in error. The Council explained it had raised a manual invoice to ensure its system was correct.
28. At the end of July 2022, Mrs X submitted another complaint. She stated the Council had still not resolved her original complaint from six months before.
29. The Council wrote to Mrs X at the start of August 2022. The Council provided Mrs X with a breakdown of the charges and payments.
30. The Council responded to Mrs X’s complaint in the middle of August 2022. The response explained it had completed multiple financial assessments which made the invoices difficult to follow. It stated it provided the invoice for £564.57 at Mrs X’s request. It provided a breakdown of the costs. The Council apologised for any distress and inconvenience it had caused.
31. Mrs X requested the Council reviewed her complaint again and the Council responded at the end of August. It stated the invoice in question was raised at Mrs X’s request. It explained about payment runs being done every four weeks and this affected the timing of invoices and credit notes.
32. Mrs X was not satisfied with the Council’s response and has asked the Ombudsman to investigate. Mrs X would like the Council to provide a detailed invoice, explaining what the payments were for.
33. In response to my enquiries the Council stated it had to obtain advice from its legal department which created a delay in changing the payments. It also explained it had to raise invoices and credit notes the way it did because that is the way its system worked.

My findings

34. The Council has provided a lot of invoices and credit notes about this matter. The documents provided are confusing. However, after lengthy consideration the invoices correctly detail the assessed charges. Multiple invoices and a lack of clarity is fault and has caused uncertainty and distress for Mrs X.
35. While the invoice amounts are correct, the information provided on the invoices and credit notes is not enough. To invoice Mrs X and only put “for the balance of financially assessed charges”, is not sufficient information for Mrs X to understand the invoice or have appropriate information for her records. This is fault and has caused Mrs X an uncertainty, distress and time and trouble pursuing clarity.
36. The Council acknowledged delay in updating the payments due to having to consult with its legal department and due to the payments only happening every four weeks. It has apologised for this in the complaint response. I am satisfied with the Councils explanation of its actions.

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Agreed action

37. To remedy the outstanding injustice caused to Mrs X by the fault I have identified, the Council has agreed to take the following action within 4 weeks of my final decision:
• Apologise to Mrs X for the distress caused because of its fault.
• Pay Mrs X £150 for the time and trouble, distress and uncertainty caused because of the identified fault.
• Issue guidance to staff, reminding them of the importance of providing clear information in communication with service users.
38. The Council should provide evidence of the actions taken to satisfy the recommendations.

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Final decision

39. I have completed my investigation. I have found fault by the Council, which caused injustice to Mrs X.

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Investigator's decision on behalf of the Ombudsman