Summary: We will not investigate this complaint about the Council’s refusal to refund Mrs Z’s estate the overpayments she made to her care home. This is because the Council has agreed to resolve the complaint early by providing a proportionate remedy for the injustice caused.

The complaint

1. Mr X complains about the Council’s refusal to refund Mrs Z’s estate the overpayments she made to her care home. He says Mrs Z only made these payments due to the delay in the Council finalising responsibility for funding her residential placement.

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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)

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How I considered this complaint

3. I considered information provided by the complainant and the Council.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. Mr X is the executor of Mrs Z’s estate. Mrs Z received care in a residential care home and was initially a self-funder as she had capital over threshold of £23,250.
6. At the end of June 2023, Mr X contacted the Council to ask for financial assessment as Mrs Z’s funds were approaching the capital threshold. At the end of July 2023, Mr X told the Council Mrs Z’s capital was now below the threshold. The Council advised Mr X the Council would decide what date it was responsible for funding and any payments made to the care provider after this date would be reimbursed by the care provider. The Council referred Mrs Z to its finance team.
7. The Council determined it was responsible for funding Mrs Z’s placement from 21 August onwards. However, the Council only finalised the funding for the placement in November 2023. Mrs Z continued to pay the care provider up to 5 November 2023.
8. If we were to investigate, it is likely we would find fault causing Mrs Z an injustice. This is because there was delay in the Council agreeing it was responsible for funding Mrs Z’s residential placement. Mr X asked the Council for assistance at the end of June 2023, but the Council only finalised funding for the placement in November 2023. I am satisfied this delay caused Mrs X quantifiable financial loss as she continued to pay the care home during the period the funding arrangement was not finalised. Mrs Z would not have done this if not for the delay.
9. The total amount Mrs Z paid to the care home directly between 21 August and 5 November 2023 was £15,133.80. The care home has refunded Mrs Z’s estate £7016.74. This leaves a balance of £8117.06 that is still outstanding.
10. It is acknowledged the Council’s position is that the care home needs to issue the refund to Mrs Z’s estate. However, I am satisfied the Council is responsible for the actions of the care home from 21 August 2023 onwards as this is the date it agreed it was responsible for funding the placement. Therefore, our view is that it is the Council’s responsibility to refund Mrs Z’s estate. The Council can liaise with the care home directly to recoup the money.
11. We therefore asked the Council to consider remedying the injustice caused by the delay by issuing a refund of £8117.06 to reimburse Mrs Z’s estate for the overpayments she made to the care home.

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Agreed action

12. To its credit, the Council agreed to resolve the complaint and will complete the above within four weeks of the final decision.

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Final decision

13. We have upheld this 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