Summary: Mr X complained the Council refused to pay the weekly fee for his mother’s care which it had previously agreed to with the Care Home so his mother (Mrs Y) is at risk of losing her placement. Mr X also complained that the Council failed to consider how Mrs Y’s wellbeing would be affected when it decided to move her to a new Care Home. The Council did not formally agree to a weekly figure with the Care Home so it was not at fault for this. The Council also considered Mrs Y’s wellbeing when deciding to move her to a new Home in line with the relevant guidance and without fault.

The complaint

1. Mr X complained of the Council’s handling of the Care Home placement for his mother (Mrs Y). He says the Council has refused to pay the Care Home fee amount it had previously agreed to with the Home so Mrs Y is at risk of losing her placement.
2. Mr X also complained that the Council failed to consider how Mrs Y’s health and wellbeing would be affected when it decided to move Mrs Y to a new Care Home.
3. This has caused distress, frustration and uncertainty.

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The Ombudsman’s role and powers

4. 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)
5. 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

6. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
7. Mr X 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

Relevant law and guidance

8. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it arranges a care home place for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings.
9. The council must ensure:

• the person has a genuine choice of accommodation;
• at least one accommodation option is available and affordable within the person’s personal budget; and,
• there is more than one of those options.

10. However, a person must also be able to choose alternative options, including a more expensive setting, where a third party or, in certain circumstances, the resident is willing and able to pay the additional cost. This is called a ‘top-up’. But a top-up payment must always be optional and never the result of commissioning failures leading to a lack of choice.
11. The council must make clear in writing the consequences should there be a break down in the arrangement to meet the cost of the ‘top-up’. This should include that the person may be moved to an alternative accommodation where this would be suitable to meet their needs and affordable within the personal budget or local mental health after-care limit. As with any change of circumstance, a local authority must undertake a new assessment before considering this course of action, including consideration of a requirement for an assessment of health needs, and have regard to the person’s wellbeing (Care and Support Statutory Guidance 2014).

What happened

12. This section sets out the key events in this case and is not intended to be a detailed chronology.
13. Mrs Y has a diagnosis of Alzheimer’s and Dementia and moved into a residential Care Home in early 2020. Mrs Y paid for the full cost of the care as her capital was above the financial limit at which the Council will contribute towards care fees. In June 2024, Mr X contacted the Council as Mrs Y’s funds had almost reduced to the financial limit and therefore she would be eligible for Council funding.
14. The Council carried out a care needs assessment the same month and determined Mrs Y did have a need for residential care. In conjunction with this, the Council carried out a financial assessment. Mrs Y’s finances were projected to fall below the financial limit in September 2024 at which point she would be eligible for Council funding.
15. Mr X has provided records which show in September 2024 the Council emailed the Care Home asking whether it would be agreeable for Mrs Y to stay there under Council funding for a proposed weekly rate of £1400.
16. In October 2024, the Council told Mr X the Care Home fees were £1400 weekly which is £200 above the Council’s placement rate. It advised Mr X could pay a top up fee to meet the care costs. Alternatively, the Council had identified a different Care Home where the fees were in line with the Council’s rate. The records show Mr X responded to this saying he felt it would be detrimental to Mrs Y’s health and well-being to move her. Mr X asked the Council if it had carried out a risk assessment regarding moving her. The Council responded to his email but did not address this question.
17. The same month Mr X made a complaint to the Council. Mr X said he was not able to pay the £200 weekly top up fees. He said it would be detrimental to Mrs Y’s health and wellbeing to move her to a new Home and asked the Council to reconsider its decision.
18. A few days later the Council issued a complaint response saying it wishes to support Mrs Y to live at the Care Home and has noted Mr X’s concerns that a move may be detrimental to her well-being. It advised its brokerage team were in the process of negotiating fees with the Care Home. However, if an agreement could not be reached Mrs Y would need to move to an alternative suitable Care Home. The Council said it did contact another Care Home to undertake a pre-admission assessment. However, when the Care Home got in contact with Mrs Y’s family they refused the assessment and advised that Mrs Y would not be moving. Mr X said they refused the assessment as the Council did not notify them beforehand this would be happening.
19. The Care Home emailed Mr X in January 2025 saying it had agreed a weekly fee with the Council of £1400 for Mrs Y’s care but it has not received any payments since the end of October 2024.
20. There is a call record from late January 2025 between Mr X and the Council. Mr X informed the Council there had been an agreement made between the brokerage team and the Care Home for payment of £1400 weekly for Mrs Y’s placement. The Council advised Mr X there has been no formal agreement with the Care Home and there is no contract for the costs. It reiterated it could only cover costs of £1200 per week.
21. Mr X remained dissatisfied with the Council’s handling of the matter and complained to us.

The Council’s response to our enquiries

22. The Council has provided the most recent care act assessment dated March 2025. The care act assessment showed a deterioration to Mrs Y’s health over the past few months as she had some falls and is now a wheelchair user. The assessment said what support Mrs Y required to support her care needs. For example, she had an increased need for two carers to support her with daily tasks. The assessment also said a transition care plan will be in place to handover to the new placement to help reduce the impact of moving Mrs Y to a new care setting.
23. The care act assessment said Mrs Y does not want to move homes. It also said both her family and the Care Home have concerns about the effects this will have on her health and wellbeing particularly her mental health. The Council has provided a case note which shows it has considered the impact to Mrs Y’s emotional wellbeing if moved to an alternative residential Care Home. The Council noted that whilst Mrs Y has a history of distress and emotional withdrawal when faced with significant change, she has always adjusted to the transitions. The Council also noted the move to a new Care Home can be supported to minimise this period of disruption through a transfer plan and a GP referral for increased anxiety during this time.
24. The Council said it will provide the care act assessment to any potential new Care Home prior to an agreement of Mrs Y being placed so the Home can consider if it can meet her care needs. The Care Home will also undertake its own initial assessment.

My findings

Care home fees

25. Mr X complained the Council initially agreed with the Care Home for Mrs Y to stay in the Home for a weekly fee of £1400 but then went back on this. There is an email which shows in September 2024 the Council emailed the Care Home asking whether it would be agreeable for Mrs Y to stay there under Council funding for a proposed weekly rate of £1400. The Care Home passed the contents of this email onto Mr X. However, this figure was part of negotiation talks and ultimately never approved and authorised by the Council. The Council has made it clear to Mr X since October 2024 the average charge for a residential care home place in the area is £1200 per week so this is the rate the Council will fund. There is no evidence the Council made a formal agreement or contract with the Care Home to pay the £1400 rate and therefore, it was not at fault.

Consideration of Mrs Y’s health and wellbeing

26. The Ombudsman is not an appeal body. This means we do not take a second look at a decision to decide if it was wrong. Instead, we look at the processes a council followed to make its decision. If we consider it followed those processes correctly, we cannot question whether the decision was right or wrong, regardless of whether someone disagrees with the decision the Council made.
27. As Mr X cannot meet the ‘top up’ payment of £200, the Council intends to move Mrs Y to an alternative Care Home which is in line with the average weekly charge for the area. The Care and Support Statutory Guidance says, a Council must undertake a new assessment before considering this course of action, including consideration of a requirement for an assessment of health needs, and have regard to the person’s wellbeing (Care and Support Statutory Guidance 2014). The Council undertook a new assessment which captured Mrs Y’s current care needs and how these needs are met. The assessment also documented her families’ views and concerns about moving her. Their concerns are primarily regarding Mrs Y’s emotional well-being should she move. The Council has provided a case note which shows it had considered Mrs Y’s emotional well-being and how it will support her during the move. The Council has demonstrated it has considered Mrs Y’s well-being in line with the statutory guidance and determined Mrs Y can be moved with the correct support in place. There is no evidence of fault in the way the Council reached its decision so I cannot question it.

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Decision

28. I find no fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman