Summary: Mrs X complained the Council’s actions resulted in an overcharge to her late mother’s care home fees. We found fault with the Council delaying the Deferred Payment Arrangement application resulting in Mrs X’s mother incurring a higher Valuation fee. The Council agreed to apply a credit to the balance owed for £185 to reflect this extra charge and apologise for its delay in processing the application. We did not find fault with the Council’s actions about the other charges for Mrs X’s mother’s care fees. While we did not find fault, we recommend the Council writes to Mrs X to confirm it will complete a review of its financial assessment for the 12-week disregard if Mrs X has new information.

The complaint

1. Mrs X complained the Council’s actions resulted in an overcharge to her late mother’s care home fees.
2. Mrs X says the Council failed to claim back an overpayment of £2,679.90 to her mother’s Car Home when it changed the conditions on which her mother could return to the Care Home.
3. Mrs X says the Council delayed completing the Deferred Payment Arrangement paperwork resulting in an increased cost of £185.
4. Mrs X says the Council charged for full legal works but completed less than half of the work resulting in an overcharge of £209.29.
5. Mrs X also complained the Council failed to consider her mother’s service charges on her flat when it calculated her client contributions for the 12-week disregard through its financial assessment.

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The Ombudsman’s role and powers

6. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused a significant injustice or that could cause injustice to others in future we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
7. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
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(i), as amended)

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How I considered this complaint

9. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
10. Mrs X and the Council had opportunity to comment on my draft decision before I made a final decision.

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What I found

Rules, regulations and council policy

Charging for permanent residential care

11. 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.
12. Following a needs assessment the Council must offer a financial assessment to decide who will pay for the eligible care needs. Councils can charge for care services. The Council should provide clear information about charges and how it assesses them at the time it finds out care needs. If a person refuses a financial assessment they must self-fund their care.
13. Persons who have over £23,250 of eligible capital will be expected to pay for the full cost of their care home fees. However, once their capital has reduced to less than £23,250, 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.
14. The Council’s information leaflet, Help with paying for Adult Social Care, details that a person should provide information about their income and capital so it can complete a financial assessment. The Council says a person should also provide housing related expenses such as Mortgage/Rent, Council Tax and any Service Charges and information about any Disability Related Expenses. The Council will use this information to calculate a person’s contribution towards their care fees.
15. When carrying out a financial assessment, a council must ignore the value of a care home resident’s property for the first 12 weeks after their stay becomes permanent. This means the council will assist with funding of the placement for the first 12 weeks. Funding in this period is called a “12-week property disregard”. (CSSG paragraph 45(a), Appendix B)
16. While the Council must disregard the value of a person’s property for the first 12-weeks, it will still consider any other savings or income they have when considering the contributions they need to make towards the cost of their residential care.
17. The Council’s Adult Social Care Charging Policy details that if a person is living in a care home and are admitted to hospital, charges will still be payable for the care home. The Council’s policy details that charges will stop being payable once the care home can no longer offer a place at the care home or the care home agrees they cannot meet a person’s needs.

Deferred Payment Agreement

18. A person needing care can enter a “Deferred Payment Agreement” with the Council. This lets a person use the value of their home to help pay care home costs by having the Council pay the care fees on their behalf. The Council does not write the deferred payment off. It is repaid later, usually from the proceeds of the person’s house sale.
19. The Care Act 2014, the Care and Support Statutory Guidance and the Care and Support (Deferred Payment) Regulations 2014 sets out the establishment of a universal deferred payment scheme towards the cost of care homes.
20. The Council’s website and its policy on Deferred Payment Arrangements confirms that it applies a one-off “Set-up fee” which “whether or not the application proceeds to completion”. It also confirms that it charges a “Valuation fee” which is chargeable whenever a valuation is needed or requested. The Council details the specific costs of these fees on its website.
21. The Council’s Deferred Payment Arrangement factsheet says that it usually takes approximately 12 weeks for a Deferred Payment Arrangement to be agreed.

What happened

22. In September 2023, Mrs X’s mother moved into a Care Home as a self-funder.
23. On 19 December 2023, Mrs X made an enquiry for a Deferred Payment Arrangement for her mother’s care in the Care Home. The Council acknowledged the request on the same date and confirmed it had completed a request for a Needs Assessment for Mrs X’s mother. The Council confirmed a Set-up fee of applied to the Deferred Payment Arrangement and provided a document which explained the fees it applied.
24. Mrs X put in the signed formal paperwork for the Deferred Payment Arrangement on 3 January 2024, which the Council received on 10 January 2024. This signed paperwork contained the following statements:
• “I understand that there will be charges in respect of work undertaken to make this agreement and that I have been provided with a copy of the Deferred Payment Agreement Fees & Charges leaflet”.
• “ I understand that if I later choose not to proceed with the deferred payment agreement, I will be required to pay the fees and charges for work already undertaken by the Council in respect of the deferred payment agreement following this instruction.”
25. On 7 April 2024, Mrs X’s mother went into hospital.
26. On 22 April 2024, Mrs X asked the Care Home not to charge for her mother’s room beyond 7 May 2024. Mrs X asked this because they could have handed in notice two weeks earlier if the Care Home had been clear that Mrs X’s mother could not return. Mrs X shared this contact with the Council.
27. The Care Home contacted the Council on 23 April 2024 and confirmed Mrs X would not be returning to the Care Home. The Council stopped all payments from 22 April 2024.
28. The Council wrote to Mrs X on 29 April 2024. The Council said as Mrs X’s mother owns a property giving her savings over the upper threshold, she should have self-funded her full stay at the Care Home. The Council said it had paid Mrs X’s mother’s fees from 1 December 2023 to 23 April 2024 resulting in a balance owed to the Council. The Council said since Mrs X’s mother was moving care homes it need to complete the Deferred Payment Arrangement application to continue providing funding. The Council asked Mrs X to provide information about her mother’s finances.
29. On 9 May 2024, the Council completed a financial assessment of Mrs X’s mother. The Council detailing its calculations of the 12-week disregard client contributions and that Mrs X’s mother would need to pay the full care fees after the 12-week disregard ended.
30. The Council wrote to Mrs X on 13 May 2024 to confirm it would now action her application for a Deferred Payment Arrangement. The Council confirmed from 28 April 2024 a Valuation fee of £450 is applicable.
31. Mrs X contacted the Council on 20 May 2024 to query the client contribution charges for the 12-week disregard. The Council explained why it had applied the client contributions in the 12-week disregard period. Mrs X said she was unhappy about the Care Home charging for the two-week period when her mother was in hospital. Mrs X said the Care Home knew before the fall that Mrs X would not be able to return because of her dementia.
32. On 28 May 2024, the Council wrote to Mrs X to advise it paid the Care Home up to 22 April 2024 to protect Mrs X’s placement at the home. The Council said a 12-day turnaround to assess that Mrs X’s mother could not return to the home was relatively short. The Council also said the Care Home can charge for up to 6-weeks residential fees while a person is in hospital before ending a contract. The Council said it had paid the Care Home in lines with the terms and conditions of contractual care and the charges are valid.
33. The Council also confirmed on 28 May 2024 it had agreed a Deferred Payment Arrangement in principle from 21 May 2024. The Council outlined the contribution Mrs X’s mother would need to make to the cost of her care in line with the Deferred Payment Arrangement. The Council said it had now passed this to its legal department who will make arrangements with Mrs X’s mother’s solicitor for a charge to be attached to the property. The Council reiterated that it applied a fee to set up a Deferred Payment Arrangement.
34. The Council passed the Deferred Payment Arrangement application to its legal team on 11 June 2024.
35. On 21 June 2024, Mrs X contacted the Council to cancel the Deferred Payment Arrangement application. Mrs X said they are about to sell her mother’s property and will use the funds to settle any care fees.
36. Mrs X made a formal complaint to the Council on 27 June 2024. Mrs X said:
• She does not accept the extra Care Home charges for the 12 days while her mother was in hospital.
• The Care Home changed their mind about why her mother could not return to the Care Home. Mrs X said the Care Home originally told them this was because of dementia and later changed this to being because of physical ability following the fall. Mrs X said her mother’s dementia had been a pre-existing condition and the Care Home would have known her mother could not return as soon as she went into hospital.
• She considers the Care Home knew the Council would need to pay for her mother’s room while she was in hospital so delayed assessment of whether her mother could return to ensure it continued to receive payment.
37. On 23 August 2024, the Council provided a complaint response to Mrs X. The Council said:
• It had completed its assessment based on the guidance set out in the Care Act when assessing how much a person should pay towards their care.
• When Mrs X’s mother went into hospital the Care Home had not decided that she would not return meaning her room remained available.
• The Care Home told the Council on 23 April 2024 that it had completed a formal assessment and decided Mrs X’s mother could not return to the Care Home meaning the Council stopped all payments from 22 April 2024.
• It had contacted the Care Home about Mrs X’s concerns it had made its decision earlier than 23 April 2024 that her mother could not return. The Care Home told the Council that while it had said if Mrs X’s mother could not manage the stairs she could not return, it had not completed a formal assessment regarding her mobility until 22 April 2024. The Care Home was in contact with the hospital and it was only following assessments it formally made its decision.
• The Council can terminate placements immediately where a person becomes absent from a Care Home for more than 42 calendar days. The Council said charges are still payable if someone remains in hospital for a short time or if their possessions remain in a room.
• The outstanding balance it had calculated was still valid.
38. Mrs X contacted the Council to query why she had to pay £450 rather than £265 for the Valuation fee for the Deferred Payment Arranged. Mrs X asked if the Council could reduce this to the original fee. The Council responded on 1 October 2024 to advise the £450 was the fee it had to pay to the surveyors for their report so it could not reduce this. The Council said it appreciated there were delays in the overall process.
39. On 28 January 2025, the executor of Mrs X’s mother’s estate contacted the Council to confirm the outstanding balance owed. The executor said they understood part of the balance owed to the Council was in dispute and wanted to ensure they settled the correct balance.
40. The Council responded on 28 February 2025. The Council said:
• It previously investigated the fees from 7 April 2024 to 22 April 2024 and found these to be correct in line with its Adult Social Care Charging policy.
• It does not have a record of Mrs X disputing the Deferred Payment Arrangement fees of £450 and £419.29. The Council said the full set up fee of £419.29 is owed even if the application is not completed. The Council said it confirmed this to Mrs X when she signed the agreement in January 2024.
• It applies the Valuation fee of £450 when it carries out the work. Since the surveyors completed the valuation in May 2024, the fees from 2024 were applicable rather than 2023.
• The full fees are payable to the Council and outlined what this balance owed was.

Analysis

Care Home charges from 7 April 2024 to 22 April 2024

41. When a person enters a care home they agree to the terms and conditions of any contractual agreement over the stay in that care home. The Council took over funding for Mrs X’s mother’s care in December 2023. This meant Mrs X’s mother was subject to the contractual agreement of care with the Care Home and the Council’s charging policy for adult social care.
42. The Council’s policy is clear that a person will continue to be liable for the cost of their care home if they go into hospital. The Council’s policy is also clear that a person’s liability for these costs ends once the care home agrees they cannot meet a person’s needs. The rationale for this stance is that as long a person wishes to keep their room, or is using a room in a care home, a care home cannot provide that room to someone else. As such, the person keeping the room would still need to pay for it.
43. The Care Home contacted the Council on 23 April 2024 and told it on this date it could no longer accept the return of Mrs X’s mother following its assessment. The Council used this contact to end all charges from 22 April 2024. The Council acted in line with its policy and ensured Mrs X’s mother was not charged after the date the Care Home confirmed it could not meet her needs.
44. Mrs X has argued the Care Home knew when her mother entered hospital that she would not be able to return to the Care Home because of her dementia. Mrs X says the physical mobility issues given as a reason by the Care Home was a change in stance from its communication with her.
45. Mrs X’s mother’s dementia was a pre-existing condition she had while living at the Care Home. The Care Home only decided it could not meet Mrs X’s mother’s needs following her hospitalisation. It is rational for the hospitalisation to be the change in circumstances meaning that Mrs X’s mother could not return. There is no evidence the Care Home changed its decision reasoning other than Mrs X advising this was the case in her contacts with the Care Home and the Council. Neither is there evidence of Mrs X contacting the Council before 23 April 2024 to advise her mother would no longer be able to live at the Care Home. The Council has acted on the contacts made with it, the evidence available and followed its policy to charge up to the date Mrs X’s mother continued to save the room. I cannot find fault with the Council.

Deferred Payment Arrangement Set-up fee

46. The Council’s website is clear that it charges a one-off cost for the Deferred Payment Arrangement Set-up fee and that this cost is chargeable whether or not an application proceeds to completion.
47. The Council made Mrs X aware of this before she returned the signed forms and put similar information on the form Mrs X signed, as detailed in paragraph 24.
48. While the Council did not complete the application, following Mrs X cancelling this in June 2024, the Council was entitled to charge this fee as soon as Mrs X signed and return the forms in January 2024. I cannot find the Council at fault for this.

Deferred Payment Arrangement Valuation fee

49. The Council completed the required works to justify application of the Valuation fee. However, Mrs X complained the Council’s delays caused her to incur a higher fee because of an uplift in costs.
50. The Council’s policy says a Valuation fee is chargeable whenever a valuation is needed or requested. The Council considered it needed to complete a valuation following its confirmation on 13 May 2024 that it would action Mrs X’s application. The Council is therefore correct the chargeable fee is the £450 fee in place from 28 April 2024.
51. However, the Council’s policy also says a Deferred Payment Arrangement application should take approximately 12 weeks. Mrs X submitted her application on 3 January 2024 which the Council received on 10 January 2024. This would make the approximate 12-week timescale end on 4 April 2024; before the uplift in cost on 28 April 2024.
52. The Council delayed handling Mrs X’s application and failed to process this until 13 May 2024. This was fault. Once the Council processed the application, it completed the valuation and passed it to its legal department in four weeks.
53. Had the Council not delayed processing Mrs X’s application, and instead met the approximate timescales detailed in its policy, it would likely have completed the full works before 28 April 2024. At the least the Council would have completed the valuation. It is the Council’s fault through its delays that have caused Mrs X to incur the extra £185 in charges for the Valuation fee. The Council should apologise for this delay and provide a credit of £185 to the outstanding balance owed by Mrs X’s mother estate for her care fees.

12-week disregard

54. The Council completed a financial assessment of Mrs X’s mother on 9 May 2024 based on the evidence made available to it by Mrs X. The Council used this financial assessment to detail Mrs X’s mother’s client contributions during the 12-week disregard period. The Council is entitled to allocate client contributions when a person’s income and non-property savings exceed the threshold.
55. Since the Council completed the financial assessment on the information Mrs X provided, there is no evidence it completed the financial assessment incorrectly. However, there is also no evidence the Council considered Mrs X’s mother service charges applicable to her property when it calculated the financial assessment.
56. Within the Council’s letter of 9 May 2024 it detailed to Mrs X that she can appeal the financial assessment and provided information about how to do this. Mrs X did not appeal the financial assessment or provide any new information to the Council.
57. The Council has followed the correct process and there is no reason to find fault. But, the Council should ensure that financial assessments it completes are accurate if new information comes to light. While I do not find fault with the Council, I recommend it writes to Mrs X to invite her to provide any information she has that she did not make available to the Council previously, such as the service charge. The Council can use this to complete a review of her mother’s financial assessment for the 12-week disregard period.

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Action

58. Within one month of the Ombudsman’s final decision the Council should:
• Provide Mrs with an apology for its delays in processing the Deferred Payment Arrangement application and apply a credit of £185 to the outstanding balance owed by Mrs X’s mother estate for her care fees.
• Write to Mrs X to confirm it will complete a review of its financial assessment for her mother’s 12-week disregard if Mrs X has new information that was not previously considered, such as the service charge.
59. The Council should provide us with evidence it has complied with the above actions.

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Decision

60. There was fault leading to injustice. As the Council has agreed to my recommendations, I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman