Summary: Ms Y complained about how the Council dealt with her mother’s, Mrs X, care charges and about her complaints with the standard of care provided to Mrs X. There were some faults by the Council which caused injustice to Mrs X and Ms Y. The Council will take action to remedy the injustice caused.

The complaint

1. Ms Y complained on behalf of Mrs X that the Council:
1. provided inaccurate and inconsistent bills for Mrs X’s contribution to her care charges which caused Mrs X to be in arrears
2. failed to take sufficient action to address the poor care and support Mrs X had received from the Care Provider.
2. Ms Y said the matter has caused avoidable distress and frustration for her and Mrs X.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), 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. Where a person affected by alleged fault and injustice does not have mental capacity to complain, we consider the law about late complaints does not apply. This means we will usually investigate complaints where a representative has taken more than 12 months to complaint to us.
6. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended). The Council commissioned the Care Provider to deliver Mrs X’s care and support under powers and duties in the Care Act 2014. We can investigate the Care Provider. The Council retains responsibility for any fault we find.
7. When considering complaints, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
8. 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(1), as amended)
9. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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What I have and have not investigated

10. I have investigated matters from November 2023 to March 2025. This is because Mrs X lacks capacity to complain and this period is from when Ms Y became aware of the billing issues with Mrs X’s care fees to when the Council issued its final response to Ms Y’s complaint.

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How I considered this complaint

11. I considered evidence provided by Ms Y and the Council as well as relevant law, policy and guidance.
12. Ms Y and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Law and guidance

13. The Care Act 2014, the Care and Support Statutory Guidance 2014 and the Care Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support, and its powers to charge.
14. Councils must carry out a financial assessment to make a decision about care charges. This will assess the person’s capital and income. The upper capital limit is currently set at £23,250 and the lower at £14,250. A person with assets above the upper capital limit are required to pay for their own care. Even if the capital is below the threshold of £23,250, people may have to pay a contribution from their income towards their care.

Care Act Assessments

15. The Care Act 2014 states councils must assess any adult that appears to have needs for care and support. An adult’s needs arise from or are related to physical or mental impairment or illness; the adult cannot achieve two or more specified outcomes because of those needs, and there is likely to be a significant impact on the adult’s wellbeing.
16. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs.
17. Once a council has determined a person is eligible, it must set out the person’s needs and how the council will meet those needs in a Care and Support Plan. The council must meet those identified eligible needs. This includes securing a suitable placement which meets the person’s identified needs as agreed in the person’s Care and Support Plan.
18. Plans must be kept under review and councils are expected to review the support plan at least every 12 months.
19. Independent Living Placement – enables adults with disabilities or support needs to live independently in their own homes, supported by tailored care services rather than traditional care homes. The placement includes extra care housing which are self-contained homes with 24/7 on-site staff support.
20. Care Providers must do all that is reasonably practicable to mitigate risks. Incidents that affect the health, safety and welfare of people using it services must be reported internally and to relevant external authorities.
21. Safeguarding – Councils must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)
22. Mental Capacity - A person aged 16 or over must be presumed to have capacity to make a decision unless it is established, they lack capacity. Where someone’s capacity is in doubt, councils must assess the person’s ability to make a decision. Councils must follow the law set out in the Mental Capacity Act 2005 to decide if individuals can make choices about their care and may need to carry out an assessment of capacity if there is doubt.
23. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Capacity is decision specific, can vary over time and an assessment may become outdated.
24. Lasting Power of Attorney – is a legal document, which allows people to choose one person (or several) to make decisions about their health and welfare and/or finances and property, for when they become unable to do so for themselves. The ‘attorney’ is the person chosen to make a decision, which has to be in the person’s best interests, on their behalf.

Background

25. Mrs X has dementia and she lacks the mental capacity to make decisions about her health and finances.
26. Ms Y holds a lasting power of attorney for her mother, Mrs X, in relation to financial/property and health/welfare matters.
27. In 2019, the Council commissioned an independent living placement (extra care housing) for Mrs X, with access to 24/7 care provided by a Care Provider (CP).
28. Mrs X was assessed to make weekly contribution towards her care after the Council completed her financial assessments (FA).
29. In February 2021, Mrs X started receiving the higher rate of pension credit. This meant that her weekly care contribution would go up. However, Ms Y did not inform the Council about Mrs X’s additional income.
30. In January 2023, the Council completed a review of Mrs X’s care act assessment. A managed care package of 17 hours 30 minutes per week was agreed for Mrs X. This included the CP administering Mrs X’s medication, to support her with meals, drinks, personal care and domestic duties.

Key events

31. In November 2023, the Council became aware Mrs X had been receiving the higher rate of pension credit since February 2021. The Council reassessed and backdated Mrs X’s care fees contribution to February 2021. Mrs X’s care fees arrears amounted to a total of £10,928.97 and her weekly reassessed contribution was £153.85. The Council issued Mrs X with an invoice of £10,928.97.
32. Ms Y questioned Mrs X’s large bill and the increase in her care fees contribution which went from £284 per month to £615.80 per month. Ms Y said Mrs X had minimal income with no assets, so her reassessed contribution was not sustainable.
33. The Council informed Ms Y that Mrs X’s reassessed weekly contribution of £153.85 was correct. It explained the reassessed amount was because of an increase of benefits Mrs X received in February 2021 which she failed to disclose to the Council.
34. In March 2024, the Council completed an annual FA for Mrs X, and her care fees contribution was assessed to be £168.50 per week from April.
35. The Council continued to issue Ms Y with invoices for Mrs X’s care fees.
36. In August 2024, November 2024 and March 2025, safeguarding concerns were raised by the CP and the ambulance service about the CP’s failure to administer Mrs X with her medication. Ms Y was informed.
37. The safeguarding enquiry outcome found that:

• Mrs X’s medication ran out but was subsequently re-stocked and given to her.
• the CP said the medication error was an oversight by its staff and it confirmed relevant staff had been instructed to keep updated records of Mrs X’s medication administration on its system for all staff to access.
• after all the referrals were made, medical attention was sought and confirmed there was no immediate health and well-being risk to Mrs X as a result. Medical professionals advised the CP to continue administering Mrs X with her medication as normal with no requirement for time-specific adjustments.

38. The CP said it would complete a full investigation of relevant staff in relation to the repeated medication error and that it would share the investigation outcome with CQC. Mrs X’s safeguarding case was closed.

Ms Y’s complaints

39. Ms Y complained about the Council’s repeated failure to issue Mrs X with accurate and consistent bills for her care. Ms Y asked the Council to split Mrs X’s care fees into two separate accounts, one account for her ongoing care fee contribution and another account for her arrears. Ms Y also complained about the standard of care the CP provided to Mrs X and she questioned why she should pay for the inadequate care Mrs X received.
40. The Council replied to Ms Y. It reiterated that Mrs X’s weekly contribution as of April 2024 was £168.50. The Council checked its records and confirmed Ms Y had LPA for Mrs X and confirmed Ms Y had made partial payment towards Mrs X’s care fees. But the Council confirmed the remaining balance was £15,536.42 as of August 2024 which included the £10,928.97 invoice it issued in November 2023 (the backdated arrears after it reassessed Mrs X based on higher rate pension credit). The Council sent Ms Y the outcomes of all the FAs it had completed for Mrs X and the breakdown of Mrs X’s £15,536.42 outstanding bill.
41. The Council said if Ms Y was unable to make the full payment, it advised her to make a payment arrangement for the arrears which would enable her to pay Mrs X’s ongoing contributions and an amount on top, towards the arrears.
42. By March 2025, Mrs X’s care fees arrears was a total of £18,565.60.
43. In its responses to Ms Y’s complaint, the Council said:

• it had issued Mrs X with FA paperwork which she signed and agreed to provide the Council with any changes to her circumstances which would affect her FA. This was why it reassessed and backdated her care fees which amounted to £10,928.97 (February 2021 to November 2023).
• but it noted its historic records showed Ms Y held an LPA for Mrs X and so it should have asked Ms Y to have co-signed the FA document due to Mrs X’s lack of capacity. The Council said it would therefore waive the £10,928,97 arrears to acknowledge its error.
• the reason for the difference in Mrs X’s bills was because bills were done either in a four or five weekly period to ensure she was billed for 52 weeks in a year. The Council said it was also because Mrs X got charged for the actual care calls she received. It maintained Mrs X’s bills were correctly calculated, but it said it would re-send Ms Y with clear information about its billing process and with copies of Mrs X’s FA outcomes.
• said it was unable to split or create two separate accounts for Mrs X’s care fees contribution. The Council advised Ms Y to continue to pay towards the invoices it had issued for Mrs X’s outstanding care fees.
• it acknowledged there had been safeguarding referrals about the care and support provided to Mrs X by the CP. The Council said it had addressed the concerns, and the CP had agreed to retrain its staff.
• it would allocate a social worker to Mrs X to review her care and support plan. The Council said it would then organize a professionals’ meeting with Mrs X, Ms Y, the social worker, and the CP to draw up an action plan to meet Mrs X’s care support needs going forward.

The Council’s response to our enquiries

44. In response to our enquiries, the Council:
1. confirmed it waived the £10,928.97 arrears in March 2025 (£18,565.60 less £10,928.97 = £7,637.63). The Council deducted Mrs X’s backdated arrears from when she received the higher pension credit rate (February 2021 to November 2023) from her overall care fees debt (£18,565.60) as of March 2025.
2. said Mrs X’s current care fees contribution was £173.80 per week as of April 2025 but it said Ms Y had only been paying £280.00 per month towards the care fees. The Council said this means Mrs X’s arrears would keep increasing every month due to Ms Y not paying the ongoing charges in full.
3. confirmed Mrs X’s outstanding care fees was a total of £8,929.38 as of November 2025.
4. said Ms Y was unwilling to enter a payment agreement for Mrs X’s outstanding care fees and she said she would be seeking legal advice. The Council said it would continue to address the matter with Ms Y, but if an agreement cannot be made, it would refer the matter to the debt management team and could be escalated to its legal department.
5. did not provide evidence it reviewed Mrs X’s care and support plan between November 2023 and March 2025.
6. said it had allocated a social worker to Mrs X but said the agreed professionals’ meeting was held on 17 October 2025 due to the social worker being absent from work. The social worker’s notes stated Ms Y’s concerns about Mrs X’s care were addressed and it was agreed that Ms Y would directly email the CP’s manager with evidence of any future issues. Regular meetings to be held between Ms Y and the CP were also agreed.
7. said the CP does not currently administer Mrs X’s medication and confirmed she self-medicates with the use of a monitored dosage system. The Council said no issues have been raised but it would ask the social worker as part of the care and support plan review to decide if Mrs X has the mental capacity to make informed decisions about her self-medication arrangement.

Analysis

Charging

45. The Council already accepted it failed to have asked Ms Y to co-sign the FA paperwork (in her capacity as Mrs X’s LPA) which clearly stated she had to disclose any changes in Mrs X’s finances to it for the purposes of assessing her care fees contribution. This was fault and caused injustice to Ms Y (the shock of receiving an unanticipated large bill) when the backdated bill of £10,928.97 was issued for Mrs X’s care in November 2023.
46. However, I find the injustice caused was adequately remedied when the Council waived the £10,928.97 arrears in March 2025 (£18,565.60 less £10,928.97 = £7,637.63).
47. I note Ms Y requested that the Council should split/create two separate accounts for Mrs X’s care fees. One account for the remaining arrears of £7,637.63 and the second account for Mrs X’s ongoing care fees. The Council informed Ms Y it was unable to separate Mrs X’s care fees account for the care she had been receiving. The Council advised Ms Y to continue to pay towards the invoices it had issued for Mrs X’s outstanding care fees and if she was unable to make the full payment, it said she could make a payment arrangement for the arrears which would enable her to pay Mrs X’s ongoing contributions and an amount on top towards the arrears. These are decisions the Council is entitled to make and they are not faults.
48. While I acknowledge Ms Y’s concerns about the standard of care the CP provided to Mrs X, I find Mrs X’s outstanding bill remains payable and I have no grounds to direct the Council to write off the care fees. This is because it is within the Council’s right to charge Mrs X her assessed weekly contribution towards her care fees and to charge her for the care services provided to Mrs X as she got the benefit of the care service for that period.

Mrs X’s care & support / Safeguarding concerns

49. Service users’ care and support plans must be kept under review and councils are expected to review the support plan at least every 12 months. This means the Council should have reviewed Mrs X’s care and support plan by January 2024 and January 2025. The Council did not review Mrs X’s care and support plan between November 2023 to March 2025 (within the timeframe of this investigation). This was fault and caused an injustice to Mrs X. It also caused uncertainty to Ms Y in not knowing whether the Council properly put appropriate support in place to meet Mrs X’s care needs.
50. There were safeguarding referrals made about medication errors in Mrs X’s case between August 2024 and March 2025 and it was found that the CP failed to administer Mrs X’s medication to her during these periods. These were faults.
51. The purpose of the safeguarding enquiry is to establish what happened, take steps to protect the service user and anyone else at risk and to improve procedures to prevent recurrence.
52. While I note safeguarding enquiries were conducted in Mrs X’s case, and an action plan was agreed for each referral to address and minimise the risk of recurrence, however on balance, I am not satisfied the safeguarding actions agreed were robust. This is because the same medication error occurred repeatedly to Mrs X three times within a period of one year. This was fault. Although I note medical professionals confirmed there was no immediate health risk caused to Mrs X, I find it caused ongoing distress, worry and uncertainty to Ms Y.
53. There is also no evidence to show the Care Provider completed a full investigation of the repeated medication error in Mrs X’s case which it agreed to do following its safeguarding enquiry. This was fault and it caused Ms Y uncertainty in not knowing whether the Council properly considered the safeguarding concerns raised in relation to Mrs X.
54. I note the Council in its response to our enquiries stated the CP no longer administers Mrs X’s medication and confirmed she self-medicates with the use of a monitored dosage system. There was no evidence provided to show when and how the self-medication decision was reached given Mrs X has dementia, lacks capacity and her last care and support plan stated the CP was responsible for administering her with medication. While I note decisions about the administration of medication is usually made by an LPA with health/welfare matters, in this case it is Ms Y and it would not be the Council’s decision. However, I am uncertain how the decision for Mrs X to self-medicate was reached in her best interest and that there is no potential risk to Mrs X as a result. This will be addressed in the ‘action’ section below.

Action

55. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although we found fault with the service of the care provider, we have made recommendations to the Council.
56. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following within one month of the final decision:

• apologise in writing to Ms Y and make her a symbolic payment of £250 to acknowledge the injustice caused by the Council’s failings as identified above. The apology should be in accordance with our guidance, Making an effective apology
• liaise with Ms Y and offer her an affordable repayment plan to allow her to pay Mrs X’s outstanding care fees by instalments
• review Mrs X’s care and support plan to ensure her care needs are up to date. This should include a thorough review of Mrs X’s self-medication arrangements and her mental capacity. This should be completed in the best interest of Mrs X and Ms Y should be involved in the process as she holds the lasting power of attorney
• provide the Ombudsman with evidence of the full safeguarding investigation the Care Provider agreed to complete following the safeguarding enquiry into the repeated medication error in Mrs X’s case. Also provide evidence to show the Council shared the safeguarding investigation outcome with the Care Quality Commission.

57. The Council should provide us with evidence it has complied with the above actions.

Decision

58. I find some faults by the Council causing injustice to Mrs X and Ms Y. The Council will take action to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman