Summary: Ms A complained about the way the Council dealt with a request for a financial assessment for her father. She complained the Council delayed in providing the assessment and failed to respond to her adequately. The Council is at fault here. We recommend the Council remind staff of the importance of processing assessments in a timely manner.

The complaint

1. Ms A complains about the way the Council have dealt with a request for a financial assessment for her father (Mr X). She complains the Council:

• Failed to complete the assessment until nine months after she asked for it, despite being told he could not afford to fund his care;
• Failed to respond to her calls and messages;
• Chased her to pay a bill knowing she was awaiting a refund from the care home;
• Failed to provide a breakdown of its calculations despite several requests;
• Failed to contact her as promised by the complaints handler at their meeting in June 2023.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)

Law and Policy

4. 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.
5. 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.
6. 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.
7. Section 17 of the 2014 Act says a council must assess the person’s financial resources and any amount the person would be likely to pay towards the cost of meeting the needs for care and support once it has decided on eligibility. The care and support statutory guidance says an assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Local authorities should inform the individual of a timescale over which their assessment will be conducted and keep the person informed throughout the assessment process.
8. The Council’s Residential Care Charging Policy (The Policy) says the Council will carry out a financial assessment to determine what a person can afford to pay. The Council will apply the Government’s upper and lower capital limits to decide what, if anything the person should pay.
9. If a person’s capital fell below £23,250, the Council would contribute to the person's care. If their capital fell below £14,250, the person would not need to pay anything toward their care costs.
10. The Policy says every person who received a financial assessment would be given a written record of the assessment which would explain how the assessment had been carried out, what the charge would be and how often it would be made, and when it would be reviewed. The financial review would generally take place annually but this may vary according to individual circumstances.

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How I considered this complaint

11. I have considered the information provided by Ms A and the Council, and the relevant law and policy.
12. Ms A and the Council have had the opportunity to comment on my draft decision. Their comments were considered in reaching a final decision.

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What I found

What happened

13. Mr X moved into a residential care home in June 2017. He paid for his own care.
14. In August 2022, Ms A contacted the Council to ask for a financial assessment for Mr X as his capital had fallen below the threshold.
15. When this did not happen, Ms A chased the Council in October 2022, explaining her father’s savings were reducing.
16. The Council carried out a care assessment in November 2022.
17. Mr X passed away in March 2023, and Ms A complained to the Council as the financial assessment had still not taken place.
18. The Council carried out a financial assessment in May 2023 and sent an invoice for Mr X’s estate.
19. Ms A complained about the invoice and asked for a breakdown of the Council’s calculations.
20. The Council reassessed the bill and confirmed it was correct in November 2023.

Analysis and Findings

The Council failed to complete the assessment until nine months after Ms A requested it, despite being told he could not afford to fund his care.

21. The Council accepts it did not carry out the financial assessment within a reasonable time.
22. The Council has said it does not prioritise financial assessments for people where their capital is reducing. It says that as Mr X was safe and his needs were being met, his assessment was not carried out as a priority.
23. I found the Council at fault for causing unnecessary delay in completing the financial assessment. This is because I have seen no evidence it properly considered Ms A’s financial assessment request and the urgency of the situation as Mr X’s savings were depleting. It also failed to give Ms A any timescales for how long the process would take.
24. The fact that Mr X passed away while she was worried about how his care would be paid for would only compound her distress.
25. I consider there has been a fault in the Council’s service here and that it has caused Ms A injustice.

The Council failed to respond to Ms A’s calls and messages.

26. I have seen that in her emails of complaint, Ms A referred to being unable to speak to the Council by telephone. However, the evidence shows the Council responded to Ms A’s email communication without unnecessary delay.
27. Although I recognise it must have been frustrating to try to speak with the Council and not reach anyone, the limited evidence provided to me does not amount to fault.

The Council chased Ms A to pay a bill knowing she was awaiting a refund from the care home.

28. I have seen the Council sent a bill following the financial assessment in May 2023. Following this, Ms A complained, and a complaint handler met with her in early June.
29. Ms A says the complaint handler assured her she would not be chased for payment as a reassessment of the invoice was needed. Although I do not have any notes from the meeting, the evidence shows the Council completed the assessment in November 2023.
30. I have seen the Council sent Ms A a bill reminder in July 2023.
31. It is unfair to tell Ms A to pay a bill which was in dispute and the Council had agreed to reassess. It would have been clear sending a reminder in the given circumstances would add to her distress and this could have easily been avoided.
32. This is a fault in the Council’s actions.

The Council failed to provide a breakdown of its calculations despite several requests.

33. I have considered the information the Council provided to Ms A in May 2023 with the invoice to Mr X’s estate. This included:

- a letter which explained the care charges;

- an invoice for August 2022 to March 2023; and

- the Council’s Residential Financial Assessment Summary.

34. I am satisfied the information the Council gave Ms A provided enough information around how it calculated Mr X’s contributions towards his care costs.
35. The evidence shows the Council reviewed Mr X’s contributions following her complaint. However, it found its calculations were correct. I have not found fault in the Council’s calculations.

The Council failed to contact Ms A as promised by the complaints handler at their meeting in June 2023.

36. I can see Ms A met with a complaints handler in June 2023, and complained two weeks later that she had not heard from him as he had promised.
37. I have no evidence the Council were aware of such a promise, nor that this forms part of its complaints process.
38. While I appreciate it would add to Ms A’s distress, in the absence of evidence of an agreement I cannot decide there has been a fault here.

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Agreed action

39. To remedy the injustice the Council caused to Ms A, the Council agreed to, within one month of the final decision:
1. apologise in writing to Ms A, and pay her £500 to acknowledge the distress and uncertainty the Council’s unnecessary delays and reminder caused her;
40. Within three months of the final decision the Council will also:
1.  
2. remind staff of the importance of carrying out financial assessments in a timely manner; and
3. put in place a process to ensure staff are aware of when a financial assessment is due to be completed. This is to ensure it does not rely on individuals, or their representatives, chasing it to carry out overdue assessments.
41. The Council should provide us with evidence it has complied with the above actions.

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Final decision

42. I find the Council at fault for causing unnecessary delays in Mr X’s financial assessment process, which caused Ms A an injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman