Summary: Mrs X complained about the Council’s delays and errors in calculating Mrs Y’s contribution towards her care home charges and in sending an invoice. We find the Council’s significant delays and the errors in the financial assessments are fault. These faults have caused Mrs X an injustice.

The complaint

1. The complainant, Mrs X complained about the Council’s delays and errors in calculating Mrs Y’s contribution towards her care home charges and in sending an invoice. This caused Mrs X unnecessary distress and concern about the accuracy of the calculations.

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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 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

4. As part of the investigation, I have:
• considered the complaint and the documents provided by Mrs X;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with Mrs X; and
• 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

Charging for permanent residential care

5. 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.
6. 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.
7. 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 here

8. Mrs X’s mother, Mrs Y had been a resident at Care Home 1 since February 2021 and was funding her own care. In April 2022 Mrs X contacted the Council to request a financial assessment as Mrs Y’s funds had reduced and she was now close to the upper capital limit.
9. The Council’s social care team completed a needs assessment in early May 2022 and referred Mrs Y to the brokerage team for a financial assessment. Pending the financial assessment the Council asked Mrs Y to pay a provisional weekly charge of £156.95 towards the cost of her care from 12 May 2022. Mrs Y initially paid this sum directly to Care Home 1.
10. The Council contacted Mrs X in late September 2022 to request details of Mrs Y’s finances to complete the financial assessment.
11. On 9 December 2022 the Council wrote to Mrs X advising that based on the financial assessment Mrs Y’s capital would fall below the upper threshold on 13 December 2022. Until that point Mrs Y was responsible for the full cost of her care. The Council calculated that from 13 December 2022 to 9 January 2023 Mrs Y’s weekly contribution would be £353.49. The contribution would then reduce to £261.09 per week.
12. Mrs X did not receive any invoices for Mrs Y’s assessed contribution. She continued to pay the provisional weekly charge. This charge increased to £172.80 in April 2023.
13. The Council wrote to Mrs X in October 2023 to confirm Mrs Y’s contribution towards the cost of her care. This letter set out a breakdown of Mrs Y’s care charges since 12 May 2022. It said she was responsible for the full cost of her care until 12 December 2022. Her contribution was then £322.94 from 13 December 2022 until 9 January 2023, £261.09 from 10 January 2023 to 8 April 2023, and the £280.46 from 9 April 2023 onwards.
14. As the contributions were more than the provisional charges Mrs Y had paid, the Council sent Mrs Y an invoice for £24,230.86 for the period 12 May 2022 to 7 October 2023.
15. Mrs X disputed this invoice as Mrs Y’s finances would drop to around £10,000 if she paid this bill. The Council reassessed Mrs Y’s finances and wrote to Mrs X on 9 November 2023 confirming it now calculated Mrs Y’s capital would have fallen below the upper threshold on 27 September 2022.
16. It then wrote to Mrs X again on 24 November 2023 with a revised financial assessment and an invoice for £18,308.84. It confirmed it had cancelled the earlier invoice for £24,230.86.
17. As Mrs X continued to dispute the level of charges the Council reviewed its assessment again. It wrote to Mrs X on 4 January 2024 confirming is calculations now showed Mrs Y’s capital fell below the upper threshold on 16 August 2022. It again revised Mrs Y’s weekly contributions and sent a new invoice for £15,135.14. It confirmed it had cancelled the earlier invoice for £18,308.84.
18. Mrs X was still not confident the revised invoice was correct and was unwilling to pay it. The Council assured Mrs X the calculations had been checked and were correct, and that the sum was payable.
19. Mrs X made a formal complaint in February 2024. She was concerned that if she had paid the initial invoice, Mrs Y would have paid almost £10,000 more than she needed to. In addition, paying the latest invoice would reduce Mrs Y’s savings to £21,511.20. Mrs X said she had no confidence in the calculations and asked the Council to look again at the charges and provide her with proof they were correct.
20. In its response the Council confirmed it had completed the diminishing capital calculation using incorrect dates for the first two invoices. It also confirmed the latest calculation had not used correct information for the capital held and the start date.
21. The Council upheld Mrs X’s complaint and apologised for the errors. It offered to pay Mrs X £100 for the time and trouble she had been put to. The Council said it would ask a manager to ensure Mrs X received a correct assessment.
22. The Council reviewed its assessment and wrote to Mrs X on 11 April 2024 confirming it had used incorrect balances for two bank accounts. It also noted that a funeral plan and an annuity had not been correctly included in calculations. The Council completed a revised financial assessment which showed Mrs Y’s capital fell below the upper threshold on 24 July 2022.
23. The Council subsequently identified two typographical errors in its letter which it explained to Mrs X.
24. It then provided a detailed breakdown of Mrs Y’s charges on 15 April 2024 and sent a revised invoice for £14,573.68 for the period 12 May 2022 to 7 October 2023.
25. In late April Mrs X reiterated her concerns about the number of mistakes the Council had made in calculating Mrs Y’s contribution. She note that each time she received a new invoice the Council assured her the amount was correct. Mrs X had no confidence in the Council as even the most recent correspondence was incorrect. Mrs X offered to pay £10,000 to settle Mrs Y’s outstanding charges. She noted this would then take Mrs Y’s bank balance to £23,000.
26. The Council’s response confirmed it was confident the latest financial assessment was correct. It accepted there were a couple of minor typing errors in its letter but these had been explained to Mrs X. It was satisfied the charge schedules that accompanied the letter were all correct and that the figures used to generate the charge schedules were also correct.
27. The Council offered to explain the calculations to Mrs X in more detail either over the phone or in person. It also confirmed the latest invoice remained payable.
28. Mrs X paid £10,000 towards the invoice in June 2024. She advised the Council she did not feel comfortable paying any more of Mrs Y’s money. Mrs X noted that if she paid the remainder Mrs Y’s bank balance would reduce to just over £22,000. The Council confirmed this balance would be similar to what the Council would expect if the remaining balance was paid.
29. As Mrs X remains dissatisfied she has asked the Ombudsman to investigate her concerns. She says this has caused her a great deal of stress and given the number of errors is not confident the latest calculations are correct. Mrs X is concerned that other people have been affected by the similar errors.
30. To prevent the recurrence of these problems the Council says it has held individual conversations with the officer involved and has updated its guidance for staff on diminishing capital.
31. In response to the draft decision the Council says there were backlogs with financial assessments at the time of Mrs X’s complaint caused by the demand for assessment. Since then the Council has employed additional resources to reduce this backlog and there is no longer a wait for months for the financial assessments. It says the service has also reviewed its processes to see where they can be streamlined. This has include the launch of telephone and online options.

Analysis

32. It is clear from the documentation and the Council accepts there were errors in its assessments of Mrs Y’s finances.
33. Although Mrs X was aware Mrs Y would need to make a contribution towards her care costs, she did not know the amount. The Council has provided a copy of an unsigned agreement which explains the Council will make an interim weekly charge until it has completed a financial assessment. There is no explanation of how this interim amount is calculated or that it could be substantially less than the assessed contribution.
34. Although there is no statutory timescale for councils to complete financial assessments, we expect them to be completed in a timely manner. In this case the Council took seven months to complete Mrs Y’s financial assessment. The Council has not offered any explanation for the delay in completing the assessment. But delays of this nature are clearly concerning and amount to fault.
35. The Council wrote to Mrs X with the outcome of the financial assessment which put her on notice that the assessed contribution would be higher than the interim charge. However it did not then send Mrs X an invoice for Mrs Y’s contributions until October 2023, some ten months later. This is a further significant delay and meant Mrs Y was faced with a very large bill. The delay in providing invoices for Mrs Y’s care charges was fault.
36. In addition to these delays, the errors in the calculation of Mrs Y’s contributions is also fault. The Council repeatedly miscalculated Mrs Y’s capital and the date on which it would fall below the upper threshold. This in turn meant Mrs Y’s contributions towards the cost of her care were also wrong and Mrs X received three incorrect invoices for significant sums. It is disappointing that when Mrs X disputed the invoices the Council assured her the calculations had been checked and were correct.
37. It is unclear what level of supervision or management oversight the Council had over the financial assessments. It appears that it was only following Mrs X’s formal complaint that the assessment was reviewed by a manager. This review identified further errors and further reduced the amount Mrs Y owed for her care. It is unfortunate that the letter setting out the latest calculations contained two typing errors. However the calculations themselves do not contain these errors and the Council is satisfied they are correct.
38. Having identified fault I must consider whether this has caused Mrs X or Mrs Y an injustice. Mrs X manages Mrs Y’s finances so it is unlikely Mrs Y was aware of the issues with the financial assessments. And as the invoices have been corrected she has not paid more than she should have for her care. I do not therefore consider the faults identified have caused Mrs Y a significant injustice.
39. However Mrs X has experienced distress, frustration, and uncertainty as a result of the Council’s delay and errors. She has also been put to unnecessary time and trouble in trying to resolve this matter.
40. The Council offered to pay Mrs X £100 in recognition of her time and trouble. I do not consider this to be sufficient in this instance. I consider a symbolic payment of £500 would be appropriate.
41. The Council says it has provided training to the officer involved and updated its guidance on diminishing capital calculations. In addition it has taken action to reduce the backlog of financial assessments. This is to be welcomed and I do not consider it necessary to make recommendations for any further service. improvements

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Agreed action

42. The Council has agreed to:
• apologise to Mrs X for the faults identified and the distress, frustration, and uncertainty these caused her. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• make a symbolic payment of £500 to Mrs X to recognise the distress, frustration, and uncertainty she has experienced and the time and trouble she has been put to as a result of the Council’s delays and errors.

The Council should take this action within one month of the final decision on this complaint and provide us with evidence it has complied with the above actions.

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Final decision

43. The Council's significant delays and the errors in the financial assessments are fault. These faults have caused Mrs X an injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman