Summary: We have decided not to investigate Ms X’s complaint about Ms Y paying more than she should for her adult social care. The Council has upheld the complaint and has agreed an appropriate remedy for the injustice caused.

The complaint

1. Ms X, who is the executor of her late grandmother, Ms Y’s, estate, complained Council delay led to her grandmother paying £1,361.11 more for her adult social care than she should have done. Ms X also complained about delayed and inaccurate responses to her queries and complaints, which meant she was put to avoidable time and trouble pursuing the Council to resolve the matter.

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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 provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we are satisfied with the actions an organisation has taken or proposes to take. (Local Government Act 1974, section 24A(7), as amended)
3. 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)

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How I considered this complaint

4. I considered information provided by Ms X and the Council.
5. I considered the Ombudsman’s Assessment Code.

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My assessment

What happened

6. In March 2017, Mr Z, who was Ms Y’s son, told the Council Ms Y’s capital would soon fall below the upper capital limit of £23,250. The Council carried out a financial assessment and told Mr X in early April that it would assist with the funding of Ms Y’s care from 26 May 2017. This was calculated on the basis of bank statements to show Ms Y’s capital as at 1 February 2017 and the information the Council had about the level of care home fees at that time. Its letter to the family asked them to let it know if there were any changes to Ms Y’s financial circumstances.
7. On 2 May 2017, Mr Z paid Ms Y’s care fees for the period 1 May to 25 May 2017. This reduced Ms Y’s capital to £21,889, which is below the upper capital limit. He queried this with the Council. The Council told him the upper capital limit was simply the trigger for a financial assessment but did not consider whether the information provided meant the funding date was wrong. Mr Z did not pursue the matter after mid-June 2017.
8. In March 2023, Ms X contacted the Council to say she thought Ms Y’s estate was due a refund. There was a delay in the Council responding, and Ms X was not satisfied with the outcome, so she made a formal complaint in September 2023. Ms X sent several chaser emails and the Council responded at stage 1 of its process in March 2024. In its response, it accepted it had not responded in a timely manner to contacts from Mr Z in late 2016 and early 2017. It said it had reviewed the financial assessment and confirmed the original funding date was correct.
9. Ms X asked the Council to consider the complaint at stage 2. In July 2024, the Council said it had reviewed the case again. It said it was unclear from its records whether Ms Y’s care fees had increased around April 2017 and asked Ms X to send bank statements to show the fees paid around that time, which Ms X did. After considering the bank statements, the Council said the funding date should have been 14 May 2017. It provided appropriate records to show how it had calculated this. The change of funding date meant Ms Y paid the full costs of her care from 14 May to 25 May when she should not have had to do so. However, she would have had to pay a contribution towards those fees. The Council said it would waive £906.11 Ms Y overpaid but fees of £437.89 remained outstanding.

My Assessment

10. We would not usually investigate complaints made more than 12 months after the events complained about or after the complainant had notice of the problem. In this case, Mr Z had raised a query in 2017, which was not fully addressed by the Council, but the family did not pursue the matter at the time as Mr Z became ill and died. It is unclear why Ms X did not raise the matter with the Council until March 2023, but she did pursue it consistently from that point and complained to us in March 2024 after receiving the Council’s stage 1 complaint response. Further, the Council responded to the complaint and has adequate records to address it. Therefore, there are good reasons for us to consider the complaint, despite the delay.
11. The Council accepted some delay in responding to Mr Z in 2016/2017. If we investigated further, it is likely we would find fault with its failure to consider whether the information Mr Z provided in May 2017 meant the funding date may not be correct. Although we accept the Council told the family was told to let it know if Ms Y’s financial circumstances changed, and they had not told it the care home fees had increased, the Council may well have been able to resolve the matter in 2017 if it had been more proactive at that time. It is also likely we would find fault for delays in responding to Ms X both before she made a formal complaint and during the complaints process.
12. The Council had already offered to waive the amount Ms Y overpaid. It has now sent a further apology letter and waived the £437.89 that was outstanding on Ms Y’s account. This additional sum is an appropriate remedy for the time and trouble Ms X was put to pursuing the Council to resolve the matter.

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Final decision

13. We have upheld Ms X’s complaint because the Council has agreed to resolve the complaint early by providing a proportionate remedy for the injustice caused.

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Investigator's decision on behalf of the Ombudsman