Summary: Mr X complained the Council is chasing him for a balance owed for his late father’s care home fees. Mr X says his late father’s care home owes him a balance of a similar amount because of duplicated fees. The Council failed to ensure suitable correspondence was sent to Mr X about who to pay care home fees to following it taking over funding for his father’s care. The Council agreed to reclaim any balance owed from the care home as the credit owed to Mr X’s father’s estate by the care home exceeds the balance owed by Mr X’s father to the Council. The Council also agreed to refund any payments Mr X made in 2025 to the Council as part of the repayment arrangement.

The complaint

1. Mr X complained the Council is chasing him for a balance owed for his late father’s care home fees. Mr X says Maesbrook Care Home owes him an overpayment of a similar amount in care fees because the fees were duplicated.

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The Ombudsman’s role and powers

2. 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)
3. 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.
4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. Service failure can happen when an organisation fails to provide a service as it should have done because of circumstances outside its control. We do not need to show any blame, intent, flawed policy or process, or bad faith by an organisation to say service failure (fault) has occurred. (Local Government Act 1974, sections 26(1), as amended)
5. 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)
6. 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 and have not investigated

7. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
8. The Ombudsman cannot investigate a complaint which is about events known to Mr X for more than 12 months without good reason.
9. Mr X has known about the balance owed to him by Maesbrook Care Home and the balance his father’s estate owes to the Council since 2018. Mr X has never disputed the validity of the balance owed to the Council. Mr X’s concerns have been about seeking repayment of the credit by Maesbrook Care Home before settling the balance with the Council.
10. As such, I cannot investigate the validity of the charges or how the Council managed the funding of Mr X’s father’s care. These matters are beyond 12 months from when Mr X brought his complaint to the Ombudsman and there is no good reason to investigate such matters now.
11. However, I can investigate the dispute over the refund from Maesbrook Care Home and balance owed to the Council. This is because the fault and injustice caused is ongoing and Mr X has repeatedly been in contact with both Maesbrook Care Home and the Council about his concerns.
12. It is of note that I can only specifically investigate any duplicated balance owed to the Council for when it funded Mr X’s father’s care home fees in 2018. I cannot investigate any other potential overpayments to Maesbrook Care Home when Mr X’s father first moved into Maesbrook Care Home. This would also be out of jurisdiction to investigate because of the passage of time.

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How I considered this complaint

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

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What I found

Charging for permanent residential care

15. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. It enables a council to decide whether to charge a person when it is arranging to meet their care and support needs, or a carer’s support needs. 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.
16. Persons who have over £23,250 of eligible capital will be expected to pay for the full cost of their care home fees. We refer to them as self-funders. However, once their capital has reduced to less than £23,250, they only have to pay an assessed contribution towards their fees. The Council will assess any such contribution through a financial assessment and pay any remaining fees itself.
17. When a council becomes responsible for paying a person’s care home fees, they are also responsible for the management of funding these fees.
18. The Ombudsman will investigate a complaint where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions.

What happened

19. Mr X’s father was living at Maesbrook Care Home before 2018 as a self-funder.
20. The Council started to pay towards Mr X’s father care home fees from April 2018 until Mr X’s father passed away later in 2018.
21. On 3 September 2018, Maesbrook Care Home contacted Mr X to confirm it owed Mr X £3,652.55 for overpayments of Mr X’s father’s care home fees. Maesbrook Care Home did not pay this money
22. The Council told Mr X that his father owed it over £5,000 for overpayments to Maesbrook Care Home. Mr X contacted Maesbrook Care Home on 8 August 2019 to chase the refund of the £3,652.55 so he could settle the balance with the Council. Mr X said he believed this credit had accrued because of double-payments by his father and the Council and overpayments by his father when he first moved into Maesbrook Care Home.
23. The Council chased Mr X for payment of the balance owed in September 2022 and again in January 2023. In the January 2023 contact, the Council confirmed that following an account review the balance owed to it was £3,582.63.
24. Mr X told the Council he was waiting on a refund from Maesbrook Care Home and chased Maesbrook Care Home in February 2023 and March 2023.
25. In January 2024, the Council contacted Maesbrook Care Home to enquire about the refund it owed to Mr X and asked why it had not repaid Mr X.
26. The Council chased Mr X for payment of the £3,582.63 in August 2024.
27. On 10 September 2024, Mr X made a formal complaint to Maesbrook Care Home about the failure to refund the £3,652.55. Mr X told the Council about this complaint. Maesbrook Care Home failed to respond to Mr X’s complaint.
28. In January 2025, the Council asked Mr X for an update on his complaint. The Council said Mr X was responsible, as the executor of his father’s estate, for settling the balance owed to the Council before distributing the estate. The Council said Mr X failed to do this. The Council said it hoped Mr X was successful in recovering funds from Maesbrook Care Home but meanwhile requested settlement of the balance owed to the Council. Mr X agreed to pay the Council £100 each month towards the balance owed.

Analysis

29. When the Council started to fund Mr X’s father’s care home placement at Maesbrook Care Home in 2018, the Council became responsible for managing payments to the care home. The contract for funding the care home was no longer between Mr X’s father and Maesbrook Care Home but, rather between the Council and Maesbrook Care Home.
30. Any contribution Mr X’s father would need to pay towards the cost of their care should have been paid to the Council directly at this point. However, Mr X’s father did not pay for the full contributions needed to the Council resulting in a debt owed of £3,582.63. This was the responsibility of Mr X, as the executor of the estate to settle.
31. However, the Council was responsible for ensuring it was providing accurate funding to Maesbrook Care Home and for communicating with Mr X that it had taken over funding meaning payments needed to be made to it. The Council correctly paid the fees to the Maesbrook Care Home and this funding was accurate. However, the Council failed to suitably communicate with Mr X that he should make payments to the Council rather than Maesbrook Care Home.
32. The Council also became responsible for the actions of the care provider, Maesbrook Care Home, when it began to fund the placement. Maesbrook Care Home became an agent of the Council through the agreement to provide care in a funded placement.
33. Because Maesbrook Care Home became an agent of the Council, the Council was responsible for ensuring Maesbrook Care Home did not take extra payment from Mr X’s father for the cost of care. This means the Council was also responsible for refunding the relevant amounts owed to Mr X for any payments incorrectly made to Maesbrook Care Home instead of itself from April 2018 until Mr X’s father passed away.
34. In the circumstances of this complaint, the evidence shows that Maesbrook Care Home confirmed it owed Mr X £3,652.55 for overpayments by his father. Meanwhile, the Council is owed £3,582.63. The Council can reclaim the full amount owed by Mr X’s father through the money Maesbrook Care Home owes to Mr X without involving Mr X.
35. The Council has shown it tried to contact Maesbrook Care Home in January 2024 but failed to follow up on this contact. The Council made no other contact with Maesbrook Care Home except this. The Council failed to recognise its responsibility to follow up on this matter suitably. However, this is mitigated because Mr X has never raised a formal complaint with the Council and, instead, told the Council he was managing this directly with Maesbrook Care Home. The Council’s actions amount to a service failure.
36. The Council should reclaim the money owed by Mr X’s father from the amount owed to Mr X from Maesbrook Care Home. This should settle any balance owed by Mr X’s father to the Council. If the refund from Maesbrook Care Home does not settle the balance owed by the Council, the Council can still seek payment of this from Mr X as the executor of his father’s estate.
37. The Council should refund Mr X any payments he has made to the Council since January 2025. Given the evidenced amounts owed by Maesbrook Care Home and to the Council, these payments since January 2025 would be overpayment for the amount owed to the Council.
38. Mr X would need to seek recovery of any remaining credit balance, of £69.92, directly from Maesbrook Care Home. Mr X has advised that some overpayments to Maesbrook Care Home were made before the Council became involved in funding Mr X’s father’s care. As such, any remaining credit balance owed to Mr X’s father’s estate would be a private matter between Maesbrook Care Home and Mr X.
39. The Council has also agreed to contact Maesbrook Care Home to ensure they improve their billing processes and cease charging individuals when the Council takes over funding for their placements.

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Action

40. Within one month of the Ombudsman’s final decision the Council should:
• Refund Mr X any payments he has made towards the balance owed to the Council for his father’s care home fees since January 2025.
• Confirm in writing to Mr X it will be settling the balance owed of £3,582.63 by Mr X’s father’s estate for his care home fees by reclaiming this from Maesbrook Care Home from the credit balance owed to Mr X’s father’s estate.
• Contact Maesbrook Care Home to ensure they improve their billing processes and cease charging individuals when the Council takes over funding for their placements.
41. Within three months of the Ombudsman’s final decision the Council should:
• Write to Mr X to confirm it has settled the balance owed to it by Mr X’s father through Maesbrook Care Home when it has completed this. If the Council has not completed this within three months, provide an update as to its progress.
42. The Council should provide us with evidence it has complied with the above actions.

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Decision

43. 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