Summary: Miss X complained about the Council’s financial assessment of her mother, Mrs Y, for her care in a care home. There was no fault in the Council’s calculation of how much Mrs Y should pay towards her care. There was fault in the Council’s invoices, complaint handling, and record keeping. The Council agreed to pay Miss X £400 to acknowledge the frustration and distress this caused.

The complaint

1. Miss X complained on behalf of her family member, Mrs Y. Miss X says the Council:
• failed to inform her about the outcome of Mrs Y’s financial assessment after she moved to a care home in July 2021;
• incorrectly calculated Mrs Y’s contribution for her care in a care home;
• failed to update its system with her correct address which meant she received no invoices between October 2021 and October 2022; and
• delayed in responding to her complaints.
2. Miss X says the matter caused her frustration, uncertainty, and distress about the amount Mrs Y owes for her care.

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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 an injustice, we may suggest 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 the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
6. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
7. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended). I chose to exercise discretion and investigated the complaint beyond 12 months from July 2022 because Miss X did not become aware of the matter until October 2022.
8. 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

9. I spoke to Miss X and considered information she provided.
10. I considered the Council’s response to my enquiries and the relevant laws and guidance.
11. Miss X and the Council had the opportunity to comment on the draft decision. I considered comments before I made a final decision.

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What I found

Relevant law and guidance

Charging for care

12. 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.
13. 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.
14. The rules state that people who have savings over the upper capital limit (currently £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. People with capital below the lower limit (currently £14,250) will only pay a contribution based on their assessed income, not their capital.
15. The “personal expenses allowance” (PEA) is the amount of money a council must ensure a resident provided with care in a care home is left with after any charges are made for their care. In the year 2021-2022 the amount was £24.90 per week. In the year 2022-2023 the amount was £25.65 per week.
16. Where a person lacks capacity, they may still be assessed as being able to contribute towards the cost of their care. Councils should work with a person who has the legal authority to make financial decisions on behalf of a person who lacks capacity. If there is no such person, family members can apply for Lasting Power of Attorney. If there are no family members, the council must approach the Court of Protection.
17. The Mental Capacity Act 2005 introduced the “Lasting Power of Attorney (LPA)”. An LPA is a legal document, which allows a person (‘the donor’) to choose one or more persons to make decisions for them, when they become unable to do so themselves. The 'attorney' is the person chosen to make a decision on the donor’s behalf. Any decision has to be in the donor’s best interests.
18. There are two types of LPA: property and finance, which gives the attorney power to make decisions about the person’s finance and property matters, and health and welfare, which gives the attorney power to make decisions about the person’s health and personal welfare matters.

Council’s charging policy

19. The Council has a charging policy called “Charging for Adult Social Care”. The policy says where there is a disagreement about the assessed contribution, a person can ask for a review. The stage one review will be completed by a new officer. If the complainant continues to disagree, they can ask for an external stage two review.

The Council’s complaints policy

20. The Council has a corporate complaints policy. The policy has a stage one and stage two phase. The policy says complaints at both stages will be responded to within 20 working days.
21. The Council’s complaint policy for adult social care complaints has one stage. The policy says complaints will be acknowledged within three working days and a final response will be sent within ten working days.

Background

22. The below is a summary of key events that took place. It is not a comprehensive overview of everything that happened.
23. Mrs Y has a diagnosis of dementia. Miss X has lasting power of attorney for property and finance. In mid-2021 Mrs Y spent time in a hospital. Following a care needs assessment, she moved to live in a residential care home.
24. At around the same time, Miss X told the Council she had moved house and provided her new address. She asked the Council to send all correspondence relating to Mrs Y to that address.
25. In September 2021 the Council wrote to Miss X and told her how much Mrs Y would likely contribute towards her care. It explained Mrs Y would retain her personal expenses allowance (PEA). However, the letter was sent to Miss X’s old address.
26. In September 2021, the Council completed a financial assessment of Mrs Y. Miss X provided bank details, evidence of assets, and details of Mrs Y’s income.
27. Between October 2021 and March 2022, the Council did not send any invoices to either Miss X or Mrs Y. In March 2022, it sent an invoice for the period to Mrs Y at her care home. It then sent monthly invoices, reminders, and final notices to the care home up until October 2022.
28. In October 2022, the Council sent Miss X a final reminder for payment by email. It told her Mrs Y owed over £12,988.19 for her care contribution. Miss X responded the same day and asked how the debt had accrued, how the contribution was calculated, and why she had only just been told Mrs Y owed a contribution.
29. Miss X then submitted a formal complaint to the Council. She complained the Council failed to provide her with invoices for Mrs Y’s care charges. She asked for details of Mrs Y’s financial assessment showing how the Council calculated the care contribution, and for copies of the invoices and reminders sent. She asked how the Council had decided Mrs Y could afford the amount she was being charged.
30. Several weeks later in November 2022 the Council wrote to Miss X and told her it had received the complaint and passed the details to the relevant departments to respond.
31. In January 2023 Miss X wrote to her MP because she had received no response from the Council.
32. In February 2023, the Council’s adult social care department sent an incomplete stage one response to Miss X. It said it apologised for the delay in responding to her complaint. It told her there was a delay in adding Mrs Y’s care details on to its system, which resulted in a delay in sending the invoices.
33. Miss X wrote to the Council again in late March 2023. She asked the Council about how the financial assessment had been calculated and why there was a late invoice. The Council logged this as a new stage one complaint.
34. In April 2023, the Council contacted Miss X to explain how the care charges were calculated. It said Mrs Y’s care cost was based on her income. Because it assessed her capital as below £14,250 it was not taken into account in the financial assessments for 2021 and 2022. The Council agreed to review the care assessments and asked for updated copies of Mrs Y’s bank accounts.
35. Miss X responded several days later. She acknowledged she had received the financial assessments and invoices from the Council. She thanked the officer for explaining how the charges were calculated and provided the information the Council asked for. Miss X asked further questions about how the calculations were made, including whether Mrs Y’s funeral costs were included and whether Mrs Y’s joint-owned property was included at its full value in the assessments.
36. In May 2023 the Council wrote to Miss X and explained:
• any capital held by Mrs Y below £14,250 was not considered as part of the financial assessment;
• Mrs Y’s funeral plan could be considered in the financial assessment, but if there was no reoccurring charge and the cost was paid out of the capital under £14,250 then it would have no impact on the care contribution cost;
• how it considered Mrs Y’s joint property and calculated its value, but did not explain whether this was a proportion of the ownership;
• it had included money held in various bank accounts by Mrs Y, including overseas accounts. It asked Miss X to provide additional bank statements from 2021 and 2022 to enable it to check the calculations were correct; and
• because none of the invoices for Mrs Y’s care had been paid, her assets had now exceeded the upper limit of £23,250. It explained it would complete a re-assessment of her finances for the financial year starting April 2023 once the historical invoices were paid to ensure the calculation was accurate.
37. Later that month the Council’s finance department wrote to Miss X and provided an additional stage one response for her October 2022 complaint. It acknowledged it had not sent a response alongside the adult social care team in February 2023. It said this was a mistake and apologised. It explained the reason it had not sent invoices earlier was because of an error in its system. It had updated its system with Miss X’s new address, but for an unknown reason the address was updated again to her old address.
38. In mid-June 2023 the Council’s adult social care team sent a stage one complaint response for the complaint Miss X submitted in March 2023. The Council:
• apologised for the delay in responding to the complaint;
• told Miss X it had explained the breakdown of Mrs Y’s care charges to her in May 2023, but Miss X could ask the Council for further clarification. It sent a copy of the explanation with the complaint;
• it had sent a letter in September 2021 explaining the likely charges for Mrs Y’s care;
• the invoices were sent late due to an error in the Council’s processes. The error meant the system did not update with Mrs Y’s care contribution until later, which also delayed the financial assessment; and
• it was improving its processes to ensure there was no repeat of the error.
39. The Council wrote to Miss X in July 2023 and explained again how it had calculated Mrs Y’s care contribution. It provided Miss X with a breakdown of the charges for Mrs Y’s care contribution:
• August 2021 to April 2022 at a rate of £221.63 per week;
• April 2022 to March 2023 at a rate of £228.70 per week.
40. The Council told Miss X if she still disagreed with the calculations the next stage would be to request a review by an external person independent of the Council.
41. Miss X remained dissatisfied with the Council’s response and brought the complaint to us.
42. In response to our enquiries, the Council said:
• after it had completed a care needs assessment of Mrs Y, there was a delay in completing the processes on its systems. This resulted in a delay in completing the financial assessment and resulted in the large bill being sent;
• it completed a re-assessment of Mrs Y’s finances in April 2023 considering the complaint;
• staff involved in the adult social care assessment process have received additional supervision and monitoring to ensure there is no recurrence of the fault;
• it had made changes to its processes and provided evidence of how it now monitors the adult social care process monthly to ensure no delay; and
• it would offer to meet Miss X in person to offer a formal apology and answer any further questions.
43. The Council provided a summary of the invoices sent to Miss X for Mrs Y’s care contribution. For the 213 days Miss X was in the care home between August 2021 and March 2022, it invoiced Mrs Y at a rate of £222.03 per week. For the year April 2022 March 2023, it charged Mrs Y £229.10 per week.

Analysis

Original financial assessment and change of address

44. Councils can charge individuals for care they receive in a care home where it has completed a financial assessment in line with the law and statutory guidance. The Council assessed Mrs Y’s finances in September 2021. However, because of delays in updating its system, it did not send any invoices for Mrs Y’s care between September 2021 and March 2022. This was fault.
45. The Council failed to update its systems correctly when Miss X notified it in July 2021 of her change of address. It could not find the reason her address was updated from her new address, back to her old address. This was poor record keeping and was fault.
46. Because the Council failed to update its records it sent the letter explaining Mrs Y’s likely care charges to the wrong address in September 2021. The Council said it sent invoices for Mrs Y’s care to the care home from March 2022. I do not know why the care home did not pass the invoices to Miss X. However, because the Council did not send copies of the invoices to Miss X, she did not know about the invoices for Mrs Y’s care in the care home until October 2022. This caused Miss X distress and frustration, and led to a large, backdated care bill.
47. Because Miss X provided information for the financial assessment in September 2021, I consider it more likely than not that she was aware Mrs Y would need to pay a contribution towards her care. However, the delay in receiving the information caused her distress and uncertainty about how much Mrs Y would pay.

Updated financial assessment April 2023

48. Miss X asked the Council to review Mrs Y’s financial assessments and explain how it calculated her contribution.
49. The Council’s updated financial assessments for Mrs Y’s care in a care home for the years 2021 and 2022 show Mrs Y had capital below the lower limit of £14,250. Therefore, the Council did not include this in the calculation for Mrs Y’s payments. It appropriately considered Mrs Y’s income from her pensions and her disability related expenditure. It calculated Mrs Y’s contribution for her care would be all her income, minus the disability related expenditure and PEA, which it included correctly. This was not fault.
50. Miss X says the Council incorrectly included the full value of a joint property in its calculations. However, even if the full value of the property was included it did not cause Mrs Y to exceed the lower capital limit of £14,250 during the financial years between August 2021 and March 2023. Therefore, there is no injustice caused and I will not investigate the matter further.
51. The Council did not send us a copy of Mrs Y’s financial assessment for the financial year starting April 2023. However, the Council told Miss X that because it had not received payment for Mrs Y’s care for the previous years, Mrs Y’s capital was over the limit of £23,250 which would affect the assessment. It told Miss X that it would conduct a re-assessment of the April 2023 contribution once it received payment for the previous years. This is an appropriate action.

Invoices for care in a care home

52. The Council sent us a summary of the charges it had made for Mrs Y’s care.
53. For the year starting August 2021, the financial assessment calculated Mrs Y should pay £221.63 per week. However, the invoice summary says it charged Mrs Y £222.03 per week.
54. For the year April 2022 to March 2023 the financial assessment calculated Mrs Y should pay £228.70 per week. However, the invoice summary says it charged Mrs Y £229.10 per week.
55. The above calculations show the invoices are incorrect. This is fault. While there is only 40p per week difference, the discrepancy calls into question the accuracy of the Council’s invoices and caused Miss X uncertainty about the amount Mrs Y owes.

Service improvements

56. The Council provided us with evidence of improvements to its processes to ensure there is no delay between social work assessments being completed and financial assessments being completed. It also said it had completed further training and supervision with staff to improve the process. The Council has explained the changes have resulted in no financial assessments being delayed beyond 30 days following social care assessments. This was an appropriate action to prevent recurrence of the fault.

Complaint response

57. Miss X first complained to the Council in October 2022. The Council’s first stage one response was sent 80 working days later. The response was also only a partial response and did not address all of Miss X’s complaint.
58. The Council sent a further stage one response in May 2023, 146 working days after the original stage one response.
59. Finally, Miss X wrote to the Council in March 2023 and requested further information about the financial assessment and how it was calculated. The Council considered this as a new stage one request and responded 52 working days later in June 2023.
60. All the above was not in line with the Council’s policy and was fault. The Council apologised for the delays in May and June 2023, but this does not go far enough to remedy the frustration and uncertainty the faults caused Miss X.

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Agreed action

61. Within one month of the final decision, the Council agreed to:
• pay Miss X £400; this is made up of £200 for the frustration and uncertainty caused by its delays in responding to her complaints, and £200 for the frustration and uncertainty caused by its poor communication about the charges Mrs Y owed;
• write to Miss X and extend its offer to meet with her to apologise for the errors in its processes and explain how the assessment charges were calculated;
• review the invoices sent to Miss X for Mrs Y’s care to ensure they align with the most recent financial assessments and provide an updated invoice to Miss X; and
• remind staff members who handle complaints that, where a joint complaint response is required from multiple service areas, it should ensure the Council’s response is complete before sending its response.
62. The Council agreed to provide us with evidence it has complied with the above actions.

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Final decision

63. I completed my investigation. I found fault and made recommendations to remedy the injustice caused by the faults.

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Investigator's decision on behalf of the Ombudsman