Summary: Ms X complained the Council did not explain the fees and charges for her father’s (Mr F’s) care when he moved into supported accommodation. She said the Council did not charge him properly or communicated with him or Ms X for the last three years and has now issued a large invoice for his care.

The complaint

1. Ms X complained the Council did not explain the fees and charges for her father’s (Mr F’s) care when he moved into residential care. She also said it had not charged him properly or communicated with him or Ms X for the last three years, the Council had since issued a large invoice. Ms X says this caused emotional distress to her and Mr F and financial distress to Mr F. Ms X wanted the Council to apologise and waive some or all the fees.

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The Ombudsman’s role and powers

2. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. 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(1), as amended)

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What I have and have not investigated

5. As explained in paragraph three above, we cannot investigate late complaints unless we decide there are good reasons. Ms X complained to the Ombudsman in March 2025 about issues starting in 2021. Ms X only became aware of the issues in September 2024 when the Council sent her the invoice. I have therefore exercised discretion to investigate beyond 12 months.

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How I considered this complaint

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

What I found

Assessment, planning and reviews

8. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
9. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
10. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
11. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Charging for permanent residential care

12. 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.
13. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person must pay towards the cost of their residential care.
14. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person can get council support to meet their eligible needs. People who have over the upper capital limit must pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, 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.

What happened

15. I have summarised below the key events; this is not intended to be a detailed account.

Assessment of care and finances

16. Mr F considered moving into supported accommodation (an independent flat within a building where care is provided) in early 2021. Mr F and Ms X visited the accommodation in February.
17. The Council completed a financial assessment in March 2021. This showed Mr F had savings over the upper capital limit threshold.
18. The Council sent a letter to Mr F in March which explained the costs for the supported living accommodation. The letter said there was a weekly housing charge, the amount depended on if Mr F was eligible for housing benefit. The letter also said as Mr X had over £23,250 in capital, his maximum weekly contribution towards his care would be £439. The letter summarised the charges and said, ‘In total, [Mr F] will be required to pay the overnight and emergency charge and care charges up to a weekly maximum of £439 or whichever is less, plus housing costs.’
19. At this time, Mr F decided he did not want to move to supported accommodation.
20. In October, Mr F decided he wanted to move to supported accommodation. The Council completed a care act assessment.
21. In November, the finance team said as Mr F had savings over the threshold he would pay the full care fees. This was extra to the housing charge. The Council explained this in a letter to Mr F and in an email to Ms X.
22. At the beginning of December, a social worker spoke to Ms X and confirmed Mr F was full fee paying.

Mr F moved into supported accommodation – December 2021

23. In the first week of December, Mr F moved into the supported accommodation.
24. A note on the file in the first week of January says ‘pass … over to annual review now as everything is settled.’

Review of care and finances – September 2024

25. Ms X told me her and her father received a phone call “out of the blue”, in September 2024 from someone asking to arrange a meeting about Mr F’s care and charges. Ms X told me the call was on a Saturday and she and her father thought this was a scam. Ms X told me she had previously asked all correspondence went through her; the Council was not to contact Mr F directly.
26. Ms X agreed to meet with the caller the following week and asked a member of staff from the supported accommodation to be present.
27. The meeting went ahead. The caller was an agency social worker who completed a care act assessment for Mr F. The report said Mr F ‘has not had an assessment of his care since moving to live in [supported accommodation]. It said Mr F ‘is a self-funder as his savings are above the threshold.’ The social worker said Mr F should be paying for his care.
28. Following the social workers advice, Ms X contacted the Council’s finance department to discuss the invoice.
29. At the beginning of November, the Council issued an invoice of around £28,000 for the period December 2021 to November 2024.
30. The following week, Ms X contacted the Council and queried the invoice. She said she did not understand how the figure had been calculated as the invoice was not itemised. The Council put the invoice on hold while it investigated the query.
31. The Council sent Ms X a spreadsheet which broke down the charges weekly. This set out the hours of care provided and the hourly charges a week. It also included the overnight charges each week. Ms X told me she spent time checking the figures to ensure the total amount charged on the invoice was correct. Ms X confirmed the total on the invoice was correct, but as the Council had not itemised the invoice, it did not reflect the services Mr F received. She said while the invoice was correct, it was misleading.

The complaint

32. Ms X complained to the Council in the middle of November 2024. She said she was shocked to receive the large invoice, backdated to December 2021 and asked if the Council could waive or reduce it. The family had not received any care invoices for the three years Mr F lived in supported accommodation. Ms X said she and her father had been open and honest about Mr F’s finances and this had happened through no fault of their own. She said as Mr F received Guaranteed Pension Credit, he received housing and council tax benefit, even though he had savings over the threshold. Ms X told me the Pensions Credit Service advised this meant Mr F may not have to pay for care. The family assumed as they had not received any correspondence from the Council, Mr F was not being charged for his care.
33. The Council responded in early December. It set out a chronology of the communication it had with Mr F and Ms X which it said showed they were aware the charges were due. It accepted it was the social worker’s responsibility to add Mr F’s care provisions on to his record when he moved into supported accommodation but did not uphold the complaint. The Council said Ms X was aware her father was to pay the full fees and ‘would expect you to have queried this in a timely manner’. Instead, it was raised at the review in September 2024 which resulted in three years of unpaid care charges.
34. In conversation with Ms X, she said she felt the Council’s complaint response was blaming her for the backlog of charges that were due. I asked the Council about this in my enquiries, it apologised and said ‘this was not the intention… but rather to provide a chronology of events which confirmed she was aware charges would be incurred.’ It went on to say the Council ‘accepts [Mr F] was not invoiced for his Extra Care placement in a timely manner…’, but ‘this does not negate the charges.’
35. In response to my enquiries, the Council said the care act assessment did not say, not to contact Mr F. It said there was a note on Mr F’s record to say to contact Ms X to arrange visits.

Analysis

Care act assessment

36. The statutory guidance says an individual receiving care should know, before care and support planning begins, what amount (if any) they will pay. In this case, the Council told Mr F and Ms X that because Mr F had savings other the threshold, he would pay for his care. The Council set this out in writing, explaining the different fees and charges, both in March 2021 when Mr F originally considered moving into supported accommodation, and again in November 2021, just before he moved into supported accommodation. The Council is not at fault.

Financial assessment

37. The Council completed a financial assessment in March 2021 when Mr F first asked about supported accommodation. The Council wrote to Mr F, told him the result of the assessment and explained the fees for supported accommodation in line with the guidance. It is not at fault.
38. Ms X said she thought the Council should have done a new financial assessment in October 2021 when Mr F decided to go into supported accommodation. In response to my enquiries, the Council said as it had completed a financial assessment on Mr F in March 2021, it did not need to do a new one in October 2021. It explained the finance team confirmed with Ms X that her father still had savings above the threshold and would need to pay his own care fees. The Council carried out checks and confirmed its decision in writing. The Council is not at fault.

Reviews of Mr F’s care

39. The statutory guidance recommends councils conduct a light touch review, six to eight weeks after a council introduces a new care plan. There is no record the Council did this after Mr F moved into supported accommodation. This is fault.
40. The Council should review the care plan every year. The Council completed the first assessment in October 2021. I would expect the Council to complete an annual review by October 2022. There are no records of the Council reviewing the plan after Mr F moved into supported accommodation until September 2024. This is a delay of around two years, this is fault.
41. Had the Council completed a light touch review or an annual review, it would have noticed it failed to invoice Mr F and could have addressed this sooner. The amount would have been smaller, limiting the financial injustice to Mr F. This is discussed further in paragraph 45 below.

Communication, record keeping and invoicing

42. Ms X complained the Council cold called her and her father on a Saturday, “out of the blue”. The Council told me the caller was an agency social worker, recruited to help with the back log of assessments. As they were agency staff, they worked outside business hours which included weekends. I do not find the Council at fault for calling on a Saturday. While unexpected, this was part of the Council’s plan to complete outstanding work.
43. In response to my enquiries, the Council said Mr F’s care act assessment did not say contact should be through Ms X. However, it also said there was a note on his file detailing ‘special requirements for communication/correspondence’ which said to ‘…contact Ms X to arrange visits etc.’. The Council was unsure when this was added but suspected it was pre-2021. The Council should have considered this detail and not telephoned Mr F directly. It is at fault for doing so, which caused Mr F distress.
44. The Council should have sent invoices to the family from when Mr F moved into supported accommodation in December 2021. The Council sent the first invoice in November 2024. This was roughly three years after Mr F moved into supported accommodation. This is significant delay, this is fault. The delay means Mr F now has a large invoice due, causing financial distress.
45. The Council sent an invoice to Ms X. The Council had not itemised the invoice. Ms X did not understand where the total figure had come from, what it was for and whether it was an accurate record of the care her father received. Considering the invoice was for a large amount, I would expect the Council to have provided a breakdown of the costs or explain the calculations. Its failure to do so is fault. The Council provided Ms X with a spreadsheet and further information which showed a breakdown of the fees. Ms X studied the information and is satisfied the total figure is an accurate reflection of the care her father received. The Council provided the information, there is no injustice.

Council’s complaint response

46. The Council’s complaint response does not uphold Ms X’s complaint. It refers to the correspondence which sets out the charges, before Mr F moved into supported accommodation and says the family were aware these were due, and the invoice must still be paid. In conversation with Ms X, she said she felt the Council tried to blame her for not paying for the care for three years, despite not having received any invoices. In response to my enquiries, the Council said it was not the intention to “blame” Ms X, but to provide a chronology to explain what happened and to show Ms X was aware the charges were due.
47. In its complaint response, the Council did not accept responsibility or apologise for failing to invoice Mr F for three years or communicate with the family during this time. The Council’s response was poor, causing further distress to Ms X.

Summary of fault causing injustice

48. The Council is at fault for failing to complete two annual reviews of Mr F’s care plan, failing to invoice Mr F, poor communication and poor record keeping. The Council also produced a poor complaint response.
49. This has caused Ms X and Mr F emotional distress and has caused Mr F financial distress as he received a large invoice for his care which he cannot afford to pay immediately. Ms X is also concerned how Mr F will pay recent care costs, once he has paid the invoice.

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Action

50. Within four weeks of my final decision, the Council should:
• Apologise to Mr F and Ms X and pay them £500 each for the distress caused by failing to invoice Mr F for his care for three years, poor communication and poor record keeping, which was made worse by a poor complaint response.
• Conduct a new financial assessment. This should calculate if/when Mr F crossed the financial threshold had he paid regular invoices for his care. The Council should adjust the invoices accordingly.
• Contact Ms X to discuss a plan to repay the outstanding invoice over a period up to three years (the same time the Council took to invoice Mr F). Allow Ms X four weeks to respond before producing a payment plan.
• Review how it monitors cases and create an action plan to alert staff when a review of an individual’s care plan is required (both at six to eight weeks after a new plan, and annually).
• Remind staff to update the appropriate systems to ensure invoices are raised in a timely manner, and to check this has been effective.
• Remind staff of the importance of good record keeping and communication.
51. The Council should provide us with evidence it has complied with the above actions.

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Decision

52. I find fault causing injustice. I have suggested actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman