Summary: Ms X complained the Council failed to reimburse her with care costs it agreed to pay following the outcome of a previous complaint to us. Ms X also complained the Council has wrongly calculated a contribution towards her care costs she considered unaffordable for her. We have found no evidence of fault in the way the Council has dealt with the matter. So we have completed our investigation.

The complaint

1. Ms X complains the Council has failed to reimburse her with care costs it agreed to pay following the outcome of a previous complaint to us. Ms X also complains the Council says she needs to pay £75 per week towards the cost of her ongoing care package. Ms X says the Council’s actions have added to her distress and caused her financial problems as she cannot afford to pay the assessed care costs.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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)

Back to top

How I considered this complaint

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

Back to top

What I found

Legal guidance on charging (non-residential)

6. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
7. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
8. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)
9. Councils can take disability-related benefit (DRE) into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included. What counts as DRE should not be limited to what is necessary for care and support. For example, above average heating costs should be considered.

What happened in this case

10. The following is a summary of key events relevant to my consideration of the complaint.
11. Ms X complained to us previously (24 003 469) about the domiciliary care provided to her at home by the Council based on a Care Act assessment. Ms X said it did not meet her needs. Unfortunately, the care package broke down in April 2023, and she had no Council funded care until July 2024.
12. The Council carried out a new Care Act assessment on Ms X and agreed a new care plan and personal budget. This meant Ms X could employ two personal assistants (PA) to help her with her care.
13. An outcome Ms X was seeking was for the Council to reimburse her for the care she had to fund herself during the time the care package broke down. During the investigation the Council told us it had agreed to reimburse the care costs Ms X incurred during the unfunded period. Ms X provided evidence of her expenditure to the Council starting from 22 April 2023 which it agreed to consider and process.
14. We upheld Ms X’s complaint, and the Council agreed to take several actions to remedy the complaint including reimbursing Ms X for her care costs as agreed. The Council later provided us with evidence it had completed the agreed actions including reimbursing Ms X’s care costs.
15. Ms X has now complained to us about the amount of care costs the Council has reimbursed her. Ms X submitted a claim of £3587 to the Council for her care costs but it only reimbursed £963.25 based on the hours she would have employed a PA. Ms X says she has had to employ her cleaner to carry out some jobs her PA would have done. And she had to order delivery meals which would have been made by a PA if she had one in place.
16. Ms X also expressed concern that she had not received all the direct payments agreed to. This was due to the Council saying it had started the payments on 19 June 2024, but her new care and support plan did not start until 10 July 2024. And she was not sent a copy of the plan until 29 July 2024.
17. The Council confirmed the service agreement and care plan started on 19 June 2024 and ended on 3 November 2024. It was authorised on 9 July 2024 but backdated to 19 June 2024 being the date Ms X met with the Social Care Assessor. The Council says it sent the reimbursed costs and compensation agreed in the previous complaint directly to Ms X as it was not part of the service agreement. It confirms that while the service agreement was backdated to 19 June 2024 it was reasonable to issue the support plan a few weeks later to Ms X as it could take up to six weeks to arrange a direct payment.
18. The Council documents show that it advised Ms X that once it sets up a direct debit it may back date payments depending on the date of the first payment. So, the Council will have made back dated payments to Ms X in her direct debits to 19 June 2024.
19. The Council confirmed it considered the evidence Ms X provided of her costs including bank details and invoices during April 2023 to July 2024. It calculated the payment to Ms X based on her eligible care needs during that time which were 14 hours a week. It also looked at the costs up to 19 June 2024 when the Council commissioned a direct payment to cover Ms X’s care costs. The Council confirmed it had not included Ms X’s claims for takeaway meals and delivery costs as the Council would not normally pay for food and delivery.
20. The Council has provided a copy of the financial assessment form used to calculate Ms X’s contribution towards her care costs. It shows it considered Ms X’s weekly income. It discounted Ms X’s PIP mobility payments and considered her housing related expenditure including energy and water costs. The Council also considered Ms X’s DRE allowing an amount for each of the payments. The Council disregarded the MIG of £183.25 it was required to leave Ms X each week by law. This left Ms X with a weekly charge of £75.13 to pay.
21. The Council confirmed Ms X was previously assessed in 2023 as not needing to contribute towards her care costs based on her income. But Ms X’s weekly assessable income increased by £156.80 a week in 2024 which has resulted in the contribution payment towards her care costs following the financial assessment in 2024.

My assessment

22. The Council advised in response to Ms X’s previous complaint it intended to reimburse her care costs. When considering the amount to refund Ms X it explained the Care Act assessment found Ms X was eligible for 14 hours PA support a week. The amount of care costs it has refunded is £963.25 being the total cost of PA support Ms X privately arranged before the Council commissioned PA support on 19 June 2024. Ms X provided copies of her invoices to the Council and her bank account statements so the amounts could be verified.
23. Therefore, the Council has refunded what it considers are her care costs being the cost of the private PA support she employed, so it is reasonable for it to repay that amount. The Council has clearly explained the reasons for the amount it has refunded. It has explained it does not pay for food and delivery costs so would not refund those expenses. While Ms X wishes the Council to refund more of her costs it is not reasonable for the Council to repay all the submitted care costs if they would not be included in her eligible care needs. There is therefore no evidence of fault in the Council’s decision to refund Ms X care costs of £963.25.
24. The Council has provided documents showing how it calculated Ms X’s weekly income. It has taken account of her expenditure, allowable expenses and the minimum income guarantee. But Ms X now has a charge due to the increase in her assessable weekly income. The Council has clearly explained how it has reached the charge when carrying out the financial assessment. There is therefore no evidence of fault in the way the Council has calculated Ms X’s weekly charge towards her care costs as it has followed the statutory guidance.

Back to top

Decision

25. I find no fault by the Council.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman