Summary: Mrs X complained the Council overcharged Mr Y for care he received which caused her a financial loss and distress. We do not find fault with how the Council carried out its financial assessments or charged for Mr Y’s care.

The complaint

1. Mrs X complains about how the Council assessed Mr Y’s contribution towards his care and provided information about this since 2016. Mrs X says Mr Y has been overcharged since that time and she has had to make up payments herself which has caused her a financial loss and distress.

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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. We consider whether there was fault in the way an organisation made its decision. 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)
4. 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)
5. 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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What I have and have not investigated

6. We cannot investigate complaints about events that took place more than 12 months before the complaint was brought to us. We can only exercise discretion to look back further if there are good reasons to do so.
7. Mrs X first brought her complaint to the Ombudsman in January 2024, meaning a complaint about anything that happened before January 2023 has been raised late.
8. Mrs X has said the Council has been overcharging Mr Y since 2016, but she has not provided any good reasons why she could not have brought a complaint about this to us any sooner.
9. As I have seen no good reason to exercise discretion to look back further than January 2023, I have started my investigation from that point. I have considered how the Council assessed Mr Y’s contributions to his care costs since January 2023 and how these costs have been communicated to him and Mrs X. I have also considered how the Council responded to Mrs X’s challenges to the accuracy of its calculations since January 2023.
10. Any mention below of events that took place prior to January 2023 are for reference only.

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How I considered this complaint

11. I considered all the information Mrs X provided about her complaint. I also considered information received from the Council.
12. 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

Relevant law and policy

13. The Care Act 2014 (the act) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 (the regulations) provide details of councils’ duties towards their residents with eligible social care needs and rules for charging for the services provided.
14. Where a council arranges care and support to meet a person’s eligible need, the council is entitled to charge that person for costs, except where the regulations require it to arrange care and support free of charge.
15. When exercising their social care functions councils must follow the Care and Support Statutory Guidance (the Statutory Guidance) issued by the Department of Health and Social Care, which is based on the act, unless they have very good reasons not to. They should also follow the regulations.
16. The Council’s charging policy for adult social care services explains it uses financial assessments to determine a person’s ability to pay and whether they will be required to pay all of, part of, or none of the cost of their care and support. It explains if a person declines a financial assessment, it will be assumed they can meet the full cost of their care and support from the date of the service.
17. The Council’s policy explains people have the right to ask the Council to review their assessed charges if they consider they cannot afford to pay.

What happened

18. I have summarised below some key events surrounding Mrs X’s complaint. While I have considered everything submitted, this is not intended to be a detailed account of what took place.
19. Mr Y received care and support from the Council for a number of years and had been living in a supported living facility. In March 2022, the Council wrote to Mrs X to explain it had reassessed Mr Y’s contribution to his care as £64.82 per week. The Council provided its calculations to explain how this figure was reached and invited Mrs X to get in touch if she felt the calculations were wrong. The Council’s records do not show Mrs X challenged its calculations at that time.
20. In January 2023, Mr Y was admitted to hospital. Mr Y was not charged anything for the period of time he spent in hospital.
21. While Mr Y was in hospital, Mrs X contacted the Council to explain he would not be returning to his previous supported living facility. The Council consulted with Mrs X and found another supported living facility for Mr Y.
22. Ahead of Mr Y being discharged from hospital, the Council and the new assisted living facility carried out a care and needs assessment for him. This resulted in a care package being agreed for Mr Y at a cost of £2,336.90 per week, starting from when he moved to the new assisted living facility in April 2023.
23. The Council wrote to Mrs X in Marc h hkjasfdnsadfglkhasdfahewrhabjh 2023 to explain it had completed a financial assessment for Mr Y and his contribution towards his care was set at £74.89 per week. The Council provided its calculations to explain how this figure was reached and invited Mrs X to get in touch if she felt the calculations were wrong. The Council’s records do not show Mrs X challenged its calculations at that time.
24. In July 2023, Mrs X contacted the Council to ask for an explanation as to the charges Mr Y was incurring. The Council responded to explain how it assesses contributions people would need to make towards the cost of social care services. The Council again invited Mrs X to complete a new financial assessment if she felt Mr Y’s contributions had been incorrectly calculated, but its records do not show Mrs X did this.
25. Mrs X told the Council she had been making payments for Mr Y’s care personally since around 2016 and asked it to refund these to her. Mrs X asked the Council to provide statements of payments going back to this time so she could dispute these.
26. The Council provided Mrs X with the statements she had asked for and explained there were no overpayments showing on Mr Y’s account to make a refund from. The Council asked Mrs X to provide it with bank statements and financial evidence across the period she was disputing so it could reassess these. The Council’s records do not show these were received at that point.
27. Mrs X complained to the Council in October 2023. Mrs X said the Council’s financial assessment for Mr Y was inaccurate. Mrs X explained she had been making Mr Y’s contributions personally and believed the Council should refund these.
28. The Council responded to Mrs X’s complaint in November 2023. It explained it had invited Mrs X to complete a new financial assessment several times but she had not done this. The Council explained that in the absence of updated information, it had based its calculations on the information it held for Mr Y. The Council explained it was willing to meet with Mrs X to discuss the financial assessments, but it would need to review any evidence Mrs X could provide before it could make any decisions. The Council explained it had provided letters every April since 2016 setting out what Mr Y’s assessed contributions were, with a calculation breakdown included. The Council explained these letters invited contact if any element of the calculation was incorrect, but it had never received any challenges to these.
29. Unhappy with the Council’s response to her complaint, Mrs X brought her complaint to the Ombudsman.
30. Since the complaint has been with our service, Mrs X has provided the Council with the information it needed to review Mr Y’s assessed charges. The Council has now written to Mrs X with revised figures for Mr Y’s contributions going back to 2017 and a breakdown of its calculations, inviting Mrs X to get in touch if she felt the calculations were wrong.
31. The Council’s new calculations have set Mr Y’s monthly contribution as £62.34 per week from April 2022, and nothing from April 2023. The Council has applied the refunded overpayments to an existing debt from underpayments since 2017.

Analysis

32. The Council is entitled to charge for care Mr Y received but would need to properly assess his finances and inform Mrs X of the outcome of the assessments.
33. The Council sent Mrs X a letter setting out Mr Y’s assessed contributions in March 2022. I could not find the Council at fault for making charges in line with this letter until he was admitted to hospital in January 2023.
34. The Council has confirmed Mr Y did not incur any charges for his care from the time he was admitted to hospital up until he was discharged to a new assisted living facility. I do not find fault with how the Council charged for Mr Y’s care during this period.
35. Prior to Mr Y’s discharge from hospital, the Council carried out a new financial assessment and wrote to Mrs X with the outcome of this. The calculation was based on the information the Council held about Mr Y at the time and, provisionally, I do not find fault with how it assessed the level of Mr Y’s contributions. As Mrs X did not challenge the content of the letter or the accuracy of the Council’s calculations, it was entitled to make charges to Mr Y, as set out in the letter. Provisionally, I do not find the Council at fault here.
36. Once Mrs X provided the Council with the information it needed to review the calculations set out in the letter of March 2023, it revised Mr Y’s contributions to zero. This means he was not charged for his care at all during the period I have investigated. So even if I were to find fault with how the Council had calculated the contributions due once Mr Y was discharged from hospital, I find there is no longer an injustice to remedy.
37. Based on the information I have seen so far, when Mrs X challenged the level of Mr Y’s contributions, the Council engaged with her and asked her for the information it needed to reconsider its calculations. I do not find the Council at fault here. While there was a period of several months between Mrs X’s initial request and the Council providing its revised figures, the Council could not carry out a reassessment until it had received the requested information from Mrs X. I do not find the Council at fault for delays here.
38. If Mrs X feels the Council’s recalculations are incorrect, she is free to provide it with evidence to support this and raise a new complaint if necessary.

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Final decision

39. I find no fault with the process the Council followed when charging Mr Y for the care he received from January 2023 and I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman