Summary: Miss X complains the Council refused to carry out a financial assessment for her mother, Mrs Y. The Council was at fault for its lack of communication. The Council was not at fault for refusing to carry out a financial assessment. Because of the lack of communication, Miss X suffered uncertainty. The Council has apologised to Miss X which is a suitable remedy.

The complaint

1. Miss X complains about the Council’s refusal to carry out a financial assessment for her mother, Mrs Y. She says the Council has relied on out of date and incorrect information but says her mother’s financial circumstances have changed.
2. Miss X says the Council’s actions have caused distress to her mother. She would like the Council to carry out a financial assessment and refund any care fees paid if it is decided her request for an assessment was properly made.

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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 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)
4. We may investigate complaints from the person affected by the complaint issues, or from someone they authorise in writing to act for them. If the person affected cannot give their authority, we may investigate a complaint from a person we consider to be a suitable representative. (Local Government Act 1974, section 26A or 34C)
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 investigated

6. I have investigated matters in this case from December 2023, when Miss X requested a financial assessment, to June 2024, when the Council sent its complaint response to Miss X.

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How I considered this complaint

7. I read Miss X’s complaint and spoke to her about it on the phone.
8. I considered information provided by Miss X and the Council.
9. Miss X and the Council have had an opportunity to comment on my draft decision. I have considered any comments before making a final decision.

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What I found

10. The purpose of a financial assessment is to determine whether a person or carer is able to fully fund their own care and support and, if not, how much they should contribute towards the cost.
11. A standard financial assessment involves the assessor gathering comprehensive information about every element of capital and income before making a determination about the amount someone can afford to pay towards the cost of care and support services.

Capital limits

12. The care and support statutory guidance says the upper capital limit to be eligible for council funding is set at £23,250. A person with assets above the upper capital limit will have to self-fund their care. Below this level, a person can seek means-tested support from the Council. This means the Council will undertake a financial assessment of the person’s assets and will make a charge based on what the person can afford to pay.

What happened

13. This is a summary of events, outlining key facts and it does not cover everything that has occurred in this case.
14. Mrs Y lives in supported living accommodation and receives a care package of four care visits daily which she self-funds. She has two children, Miss X and Mr Z, who manage her finances with different responsibilities. Mr Z pays for Mrs Y’s care.
15. In December 2023, Miss X asked the Council to carry out a financial assessment. She told it Mrs Y’s funds were running out and her care needs had increased.
16. In early February 2024, the Council completed a care needs assessment and increased Mrs Y’s support. Around this time, the Council also spoke to Mr Z about Mrs Y’s funds. He told the Council he was still managing Mrs Y’s funds and was happy to pay for her care services as a self-funder. The Council told Miss X to complete an online financial assessment form and requested a copy of Mrs Y’s late husband’s will to assist its enquiries into whether Mrs Y’s funds had run out. The Council told Miss X unless she could send it proof Mrs Y’s funds had run out, she would have to continue self-funding the care, but it would look into matters to see if Mrs Y could still be financially assessed. The Council later spoke to Mr Z again who confirmed there had been no change in Mrs Y’s finances and he would continue to make the payments for her care as a self-funder.
17. In late February 2024, Miss X completed and sent a financial assessment form on behalf of Mrs Y to the Council.
18. In late April 2024, Miss X chased the Council for a response about the financial assessment form she had sent to it.
19. In early May 2024, Miss X raised a complaint with the Council. She told it the Council still had not completed a financial assessment despite her chasing it up.
20. In early June 2024, the Council sent its complaint response to Miss X. It told her as Mrs Y’s finances and care payments were managed by Mr Z, the Council did not need to be involved in commissioning her care services as she remains a self-funder. It also told Miss X although it could not complete a financial assessment, it acknowledges there was a lapse in its communication. It apologised for not providing her with regular updates.

Analysis

21. Miss X requested the Council carry out a financial assessment as she claimed Mrs Y’s funds were running out. I asked the Council to explain how it concluded Mrs Y’s funds were above the upper capital limit and her financial circumstances had not changed without carrying out a financial assessment. In response to my enquiries, the Council told me it is of the view Mrs Y has funds above the upper capital limit to pay for her care. It said Mrs Y’s late husband’s will confirms Mrs Y had inherited a property from him, and she had the funds to pay for her care from the sale of the property. The Council also told me Mr Z confirmed on several occasions he was paying for Mrs Y’s care, and she remained a self-funder.
22. In response to my draft decision, Miss X told me Mrs Y had not inherited and sold a property from her late husband, rather his will states she is a tenant of the property for the remainder of her lifetime. I have considered this, but regardless of whether Mrs Y has inherited and sold a property, Mr Z still confirmed with the Council he was paying for the care, there had been no change to Mrs Y’s finances, and she remained a self-funder. If Mrs Y has not inherited and sold a property as Miss X has said, she or Mr Z should provide evidence of this to the Council for it to consider.
23. The Council was not at fault for not completing a financial assessment for Mrs Y. Based on the information the Council had, it was not wrong for the Council to assume Mrs Y’s funds had not run out, or not carrying out a financial assessment at Miss X’s request. It did not have any evidence to show Mrs Y’s funds had run out, even after indicating to Miss X it would require evidence of this in February 2024. And it also spoke to Mr Z in February 2024, who advised there had been no change in Mrs Y’s finances. If Miss X or Mr Z have evidence to show otherwise, they may approach the Council to request another financial assessment.
24. However, the Council was at fault for its lack of communication, which it has acknowledged in its complaint response. It should have clearly told Miss X it could not carry out a financial assessment without evidence Mrs Y’s funds had run out. I have not seen any evidence it did this. This was fault. This caused uncertainty to Miss X and meant she continued to chase the Council for updates about her request for it to carry out a financial assessment. The Council has accepted it was at fault for its lack of communication, and it has apologised to Miss X for not providing her with updates. This is an appropriate remedy.
25. While I appreciate Miss X comments Mrs Y has suffered distress, it is not likely any distress to Mrs Y has been caused as a direct result of the Council’s actions. This is because I have not found the Council was at fault for deciding not to carry out a financial assessment.

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Final decision

26. I have completed my investigation and uphold Miss X’s complaint. There was fault by the Council which caused injustice to Miss X. The action the Council has already taken is suitable to remedy the injustice caused to Miss X.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman