Summary: Mr X complained about how the Council handled his mother’s, Ms Y, residential placements’ care fees and its poor communication with him. There were some faults with how the Council dealt with Ms Y’s residential care fees, its poor communication with Mr X and delays with its complaint handling. This caused injustice to Mr X and Ms Y. The Council will take action to remedy the injustice caused.

The complaint

1. Mr X complained about how the Council handled his mother’s (Ms Y) residential placements’ care fees. In particular, Mr X complained about the Council’s:
1. delays and poor communication around charging for Ms Y’s residential care placements at:

• Care Home 1 between 26 June 2024 to 31 October 2024
• Care Home 2 from 1 November 2024
• charging Ms Y a backdated contribution for her care fees which Mr X alleged the Council had agreed to fund and had paid for. This backdated contribution covered the period from 26 June 2024 to 31 October 2024 when Ms Y was a long-term resident at Care Home 1.

2. Mr X said the matter caused him avoidable confusion, distress, and the time and trouble chasing the Council for updates and resolution.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. 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 consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. 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, sections 24A(1)(A), and 25 (7) 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. I have investigated matters from June 2024 to March 2025. This covers the period from when Ms Y became a long-term resident at Care Home 1 to when Mr X made a complaint to the Ombudsman.

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How I considered this complaint

8. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
9. 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

Law and guidance

10. 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.
11. 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 is 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.
12. Once a council completes the financial assessment, it must give a written record of the assessment to the person. It should explain how the assessment has been carried out, what the charge will be, how often it will be made and if there is any fluctuation in charges, the reason. Councils should ensure that this is provided in a manner that the person can easily understand, in line with its duties on providing information and advice.
13. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care.
14. A self-funder is a person who pays the full cost of their adult social care because the person has savings and assets over the government’s upper capital limit of £23,250 or choose not to share their financial information.
15. Third-party top up fees apply where a resident chooses a care home with fees exceeding the amount the council is willing to pay, and a relative, friend or other party (not the resident) agrees to cover the difference in the care fees. The top-up payment must always be optional and never the result of commissioning failures leading to a lack of choice.
16. 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.
17. A council must make safeguarding 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)

The Council’s Charging Policy

18. Where the Council has determined that the care and support provided will be subject to a charge, it will carry out a financial assessment of the person to see what they can afford to pay and, once complete, a breakdown letter will be provided.
19. The Council’s financial assessments team will complete financial assessments in a timely manner and will support a person to maximise their income with any benefits that they may be entitled to.
20. The financial assessment will apply from the date that the care and support commenced. If the financial assessment is completed after the start date, the charge will be back dated. The charge will not be more than the cost that the Council incurs in meeting a person’s assessed needs.

The Council’s complaint procedure

21. The Council has a two-stage complaint procedure, and it aims to respond within 20 working days at both stage 1 and stage 2.

Background

22. Due to safeguarding concerns, Ms Y moved to a residential care home (Care Home 1) as a respite resident. Ms Y was a self-funder for the respite period.
23. Ms Y has dementia and Mr X has a lasting power of attorney for Ms Y’s property and finance.

Key events

Care Home 1

24. On 12 June 2024, the Council completed an assessment for Ms Y. It found Ms Y was eligible for care and support needs because of her health condition and the ongoing safeguarding concerns. The Council agreed that Ms Y should remain in Care Home 1 but as a long-term resident.
25. Ms Y’s social worker (SW) discussed financial assessment, top up fees and deferred payments with Mr X as it related to Ms Y’s care cost. The SW advised Mr X the Council’s commissioned rate for a residential care home for Ms Y was £678 per week. The SW agreed to submit a funding request for Ms Y’s long-term placement at Care Home 1. The SW told Mr X that if the full cost of Care Home 1 was more than the Council’s rate, he would need to pay third-party top up fees.
26. Mr X signed a financial assessment (FA) form. The signed form stated:

• Mr X received information leaflets about ‘paying for care - choice of home and top-up payments.’
• Mr X indicated he understood that any support arranged by the Council was chargeable from the date the services would start and that the amount Ms Y would pay would be based on her individual financial circumstances.
• the Council would contact Mr X to complete Ms Y’s FA either by telephone or post.
• information gathered during FA would be used to calculate the client contribution towards the cost of care and support in a residential home.

27. The total care cost of Ms Y’s placement at Care Home 1 was £940 per week. This was made up of the Council’s rate of £678 per week and £262 per week third-party top up fees. The SW requested funding (£678) for Ms Y’s placement at Care Home 1.
28. On 26 June, the Council commissioned and approved a weekly £678 funding for Ms Y’s long-term placement at Care Home 1.
29. In August and September, Mr X told the Council Ms Y was running out of funds and he chased the Council for updates on when it would complete Ms Y’s FA.
30. In September, the SW apologised to Mr X for the delay. The SW informed Mr X that as part of the safeguarding process, the Council had agreed to fund Ms Y’s long-term placement at Care Home 1 which concluded the safeguarding referral. The SW confirmed the funding would be backdated to the date of the Council’s approval (26 June) and the Council would arrange the backdated payments to Care Home 1.
31. The SW also advised and provided Mr X with three alternative residential care homes with a charge of £678 per week respectively (the Council’s weekly commissioned rate). The SW told Mr X that if Ms Y chose any of the three identified homes, third-party top up fees would not be required. One of the identified homes with no third-party top up fees was Care Home 2.
32. Ms Y said she would like to remain at Care Home 1 where she had already settled into.
33. The Council sent a third-party top up letter to Mr X. The letter stated that because Ms Y had chosen to remain at Care Home 1 which charged more than the Council’s £678 weekly rate, Mr X would be required to make third-party top up payments. The Council said it would inform Mr X how much Ms Y’s assessed contribution towards her care cost would be after it completed an FA.
34. Mr X did not sign the third-party top up payment form because he said he and other family members could not afford the payments. Mr X said he was not Ms Y’s next of kin and that the Council never discussed that he would be making the top-up contribution towards Ms Y’s care fees. The SW apologised if the third-party contribution arrangement had not been clearly explained to Mr X and had assumed he had read the information in the ‘paying for care - choice of home and top-up payments’ leaflet which was provided to Mr X in June. The SW said the leaflet would be resent to Mr X and advised he could still choose an alternative care home with no third-party top up fees.
35. The SW informed Mr X that her involvement with Ms Y’s case had ended but that she had requested the Council to allocate a new SW to Ms Y’s case.
36. In October, Mr X chased the Council for an update about the SW reallocation. Mr X informed the Council that due to Ms Y’s limited funds, she had agreed to move to one of the alternative care homes with no third-party top up fees which had been identified by the Council (Care Home 2). Mr X said he had given the required notice period to Care Home 1, so Ms Y could move to Care Home 2 in November.
37. Ms Y left Care Home 1 on 31 October.
38. In early November, Mr X chased the Council for updates about Ms Y’s funding and care fees payment.
39. On 22 November, the Council paid Care Home 1 the agreed funding for Ms Y’s long-term placement. This was a total of £12,379.72 which covered the period from 26 June 2024 to 31 October 2024.
40. In January 2025, the Council informed Mr X that it was in the process of completing an FA for Ms Y in relation to Care Home 1. Mr X questioned why the Council needed to complete an FA for Ms Y several months after she had left Care Home 1 and after the Council had fully funded her care fees for her placement at the care home.
41. On 27 January, the Council completed an FA for Ms Y and her weekly assessed contribution towards her care costs was £678. This covered the period she was a long-term resident (26 June 2024 to 31 October 2024). The Council informed Mr X of the FA outcome.
42. The Council said although it had fully funded Ms Y’s long-term placement, it said Ms Y’s financial information showed her capital and assets were over £23,250. The Council said Ms Y would therefore be charged the full cost of her care and it said a further review of charges would be completed when her capital falls below the £23,250 threshold. The Council said Ms Y would be sent a backdated invoice for the full cost of her care from 26 June 2024 to 31 October 2024.
43. In late February, the Council sent Mr X an invoice of £12,397.72 for Ms Y’s care cost at Care Home 1 from 26 June 2024 to 31 October 2024.
44. The Council said Mr X paid the £12,397.72 invoice for Ms Y’s care cost in March.

Care Home 2

45. On 1 November 2024, Ms Y moved to Care Home 2.
46. Mr X said the care home asked Ms Y to self-fund her fees until the Council’s funding agreement was set-up. Ms Y started paying for her care fees directly to the care home from 1 November.
47. The Council did not complete an FA for Ms Y to determine her assessed contribution towards her care cost at Care Home 2.
48. In January 2025, Mr X asked the Council for an update with funding for Ms Y’s placement at Care Home 2. The Council said it would let Mr X know once it approved the agreement for Ms Y’s placement from 1 November.
49. Mr X said Ms Y had been a self-funder and she had been paying for her care cost at Care Home 2 since she moved to the residential care home.

Mr X’s Complaints

50. On 24 October 2024, Mr X made a formal complaint to the Council. Mr X said the Council had agreed to fully fund Ms Y’s long-term placement at Care Home 1 as part of a safeguarding process, but it had failed to pay the care home from 26 June 2024. Mr X also complained about the Council’s poor communication with him and its failure to reallocate another SW to Ms Y to manage her funding and move to Care Home 2. Mr X said the Council’s failings had caused delays with paying the agreed Council’s funding to Care Home 1, that Ms Y’s move to Care Home 2 was unmanaged which led to the home asking Ms Y to self-fund her fees until the Council’s funding agreement was set-up.
51. The Council issued its stage 1 and stage 2 to Mr X’s complaint on 13 January 2025 and 20 February 2025 respectively. In its responses, the Council:

• accepted it approved to backdate the funding from 26 June 2024, but the Council did not finalize the funding and made payment to Care Home 1 until November 2024. The Council explained the delays with setting up Ms Y’s funding were due to staff shortage and it apologised for any upset caused.
• apologised it failed to reallocate another SW to Ms Y’s case after the previous SW’s involvement ended.
• accepted it failed to record and respond to all Mr X’s correspondence. The Council apologised for its poor communication with Mr X and said it reminded staff of the importance of acknowledging, responding and properly dealing with service users’ queries.
• accepted it failed to properly manage Ms Y’s move to Care Home 2 in November but confirmed it had asked for an urgent budget to be backdated to when she moved to the placement (1 November).

52. Mr X remained dissatisfied with the Council’s responses, and he made a complaint to the Ombudsman.
53. In response to our enquiries, the Council:
1. confirmed it had paid the weekly funded £678 to Care Home 1 from 26 June to 31 October 2024 but that the payment was subject to the completion of Ms Y’s FA and any required third-party top up fees.
2. the delay with completing Ms Y’s FA for Care Home 1 was due to changes in SW
3. confirmed it had not completed Ms Y’s FA for Care Home 2 and it had not issued any invoice to Ms Y since she moved there on 1 November 2024.

Analysis

Care Home 1

54. In June 2024 and before Ms Y became a long-term resident at Care Home 1, the Council discussed the FA process with Mr X. He also indicated on the FA form that he understood that any support arranged by the Council would be chargeable from the date the care service started and that the amount Ms Y would pay would be based on her individual financial circumstances. I find the Council made Mr X aware of the potential financial implication in relation to Ms Y’s residential care fees. This was not fault.
55. It took the Council approximately three months to inform Mr X about its funding decision (June 2024 to September 2024). This was fault. There was further fault by the Council for its delays with paying Ms Y’s care fees to Care Home 1. The Council made a backdated payment of £12,379.72 to the care home on 22 November 2024 to cover Ms Y’s long-term placement for the period from 26 June 2024 to 31 October 2024. This was a delay of approximately five months, and it was fault. These faults caused worry and uncertainty to Ms Y and Mr X. It also caused avoidable time and trouble to Mr X chasing the Council for updates about the agreed funding and payment to Care Home 1.
56. The crux of Mr X’s complaint was how the Council subsequently sent Ms Y an invoice of £12,379.72 in January 2025 for her care fees which covered the same period the Council agreed to fund and had fully paid to the care home in November 2024.
57. I find the Council took too long to complete an FA for Ms Y. Although the law and guidance do not specify a timescale for completing an FA, councils are expected to complete FAs in a timely manner. In this case, Ms Y became a long-term resident at Care Home 1 in June 2024, but the Council did not complete Ms Y’s FA until January 2025. This meant it took the Council approximately seven months to complete Ms Y’s FA. This was a significant delay, and not in line with the Council’s charging policy. This was fault.
58. We expect the personal budget/care charges to be set out promptly when councils agree to commission care for service users. I find that had the Council completed Ms Y’s FA in a timely manner, Mr X would have been informed promptly when Ms Y became a long-term resident that she was still over the upper threshold for the Council funding. The Council’s delay with completing Ms Y’s FA was fault and caused Mr X distress, worry and a huge shock of a massive £12,379.72 invoice.
59. I acknowledge Mr X’s point that the Council agreed it would fund Ms Y’s long-term placement care fees from 26 June 2024 to 31 October 2024. However, where a resident has more than £23,250 in savings and assets, the resident has to pay the full cost of the care. This was what happened when the Council found out that Ms Y’s assets were more than the £23,250 upper capital limit after it completed her FA in January 2025. As said earlier, while I find fault by the Council for its delays with Ms Y’s FA and the resultant delayed invoice, I however find no fault by the Council for sending Ms Y the £12,379.72 invoice to recover her care fees for her long-term placement at Care Home 1. This was because Ms Y was assessed as a full cost payer. This was not fault.
60. I appreciate Mr X was distressed by the receipt of a large bill some months after the Council had paid the fees and after Ms Y had left the placement. I find Ms Y’s bill was still payable regardless of whether the Council had previously paid the fees in November 2024. And I have no grounds to direct the Council to write off/refund Ms Y the £12,379.72 care fees. This is because it is within the Council’s right to charge for the care services provided to the service user and Ms Y got the benefit of the care service for that period.

Care Home 2

61. The Council already accepted its delays with reallocating another SW to Ms Y’s case and as a result her move to Care Home 2 was not properly managed. This was fault and it caused distress, worry, frustration and uncertainty to Ms Y and Mr X.
62. The Council has not completed an FA for Ms Y to assess her contribution towards her care cost since she moved to Care Home 2 in November 2024. This is a delay of approximately four months from November 2024 to March 2025 when Mr X complained to the Ombudsman. This was fault and it caused further distress and worry to Ms Y and Mr X about the security of the placement.
63. Care Home 2 asked Ms Y to be a self-funder until when the Council agrees and make payments towards Ms Y’s care fees. Care providers should not demand care fees payment from residents and/or their families in the absence of a council arranged placement. This was fault. As the Care Home 2 acted on behalf of the Council, I find the Council was ultimately responsible and was at fault.
64. The Council’s delay/failure to complete Ms Y’s FA and its failure to arrange payment to Care Home 2 also caused financial strain to Ms Y as she had been paying her full care fees since 1 November when she moved to the care home.

Poor Communication and Complaint Handling

65. The Council also accepted it poorly communicated with Mr X. These were faults and caused distress, frustration and uncertainty to Mr X.
66. I find the Council was at fault with its delay in issuing its stage 1 response to Mr X’s complaint. Mr X made his complaint on 24 October 2024 which meant the Council should have issued its stage 1 response on 21 November. There was an approximately 7 weeks delay and it was fault which caused distress to Mr X.

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Action

67. When a council commissions or arranges for another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the actions of the care provider and make the following recommendations to the Council.
68. 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 Mr X to acknowledge the injustice caused to them by the Council’s failings as identified above. The apology should be in accordance with our guidance, Making an effective apology
• make Mr X a symbolic payment of £300 in recognition of the distress, worry, uncertainty, frustration and time and trouble caused to him by the Council’s failings as identified above
• complete and backdate a financial assessment for Ms Y to assess her client contribution towards her care costs for her placement at Care Home 2 which started on 1 November 2024. Based on the outcome of Ms Y’s financial assessment, the Council should also calculate and work out any refund due to Ms Y (if applicable) from 1 November when she started paying Care Home 2 as a self-funder
• remind the Council’s commissioned residential care homes not to demand payments from residents and/or their families in the absence of the Council arranged placement and care fees payment

69. Within two months of the final decision:

• train staff about the importance of adhering to the Council’s complaint procedure timescales.

70. Within four months of the final decision:

• review the Council’s systems and practice to ensure it completes financial assessments and ensure it allocates social workers to service users in a timely manner.

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

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Decision

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

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman