Summary: The Council delayed assessing Mrs Y’s contribution to her care charges which resulted in a large debt accruing. It sent an inaccurate letter stating she was to pay the full cost due to her level of savings which caused her distress. It also delayed responding to her daughter, Ms X’s, complaint which caused frustration. The Council has agreed to apologise, make payments and offer a repayment plan to acknowledge the impact of its fault. It will also review its procedures to ensure it follows up financial assessments and that letters accurately reflect the situation.

The complaint

1. Ms X complained on behalf of her mother Mrs Y that the Council delayed sending Mrs Y information about care charges which led to a large debt accruing. It also billed Mrs Y for the full cost of care without warning which caused her distress and delayed responding to Ms X’s complaint which caused her frustration.

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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. 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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How I considered this complaint

4. I considered evidence provided by Ms X and the Council as well as relevant law, policy, guidance and our guidance on remedies published on our website.
5. I gave Ms X and the Council the opportunity to comment on a draft of my decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

6. A council has a duty to arrange care and support for those with eligible needs, and a power to meet both eligible and non-eligible needs in places other than care homes. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
7. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. If a person has more than the upper capital limit (£23,250) the council must meet their eligible care needs if requested but they will be expected to pay the full cost of their care and will not receive financial assistance from the council.
8. The Care Act 2014 does not specify a timeframe in which councils should complete a financial assessment. Our view is that it should be completed within an appropriate and reasonable timeframe, in line with the requirements set out in the Care and Support Statutory Guidance (paragraph 6.29). This allows people to know how much they may need to contribute to the costs of their care at the relevant time, so they can make an informed choice about what they want.
9. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee (MIG). This is set by national government and reviewed each year. A council can allow people to keep more than the MIG. (Care Act 2014)
10. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included.

The Council’s complaints’ procedure

11. The Council operates a two stage complaints procedure. At the first stage it aims to resolve the complaint within 10 working days. If it will take longer it says it will let the complainant know.
12. At the final stage a senior manager will investigate and respond within 30 days.

What happened

13. Mrs Y has dementia. Following a hospital stay, Mrs X was discharged home with a package of care consisting of two care visits a day, in the morning and evening, initially funded by the NHS for six weeks. The Council took over the care package in February 2024.
14. Mrs Y’s daughter, Ms X, said she contacted the Council in March 2024 to query when Mrs Y would be charged for her care. The Council said the social worker sent Ms X a financial assessment referral form but the date this was sent was not noted in its records. Ms X returned the completed form to the Council by email in late March 2024. On the form she ticked that Mrs Y agreed to a financial assessment and that she did not have savings over £23,250. Ms X asked the Council to call her to check she had completed it correctly. On the form she gave Mr Y’s details as Mrs Y’s financial representative.
15. In early July 2024, the Council’s records show it requested that a letter, financial assessment form and an information leaflet explaining how care charges are calculated be posted to Mrs Y. The cover letter stated ‘please return all documents within 14 days. If you are unable to return within 14 days please contact us otherwise we may assume you are willing to pay the full cost of your care services’. Ms X says they did not receive this letter.
16. The Council did not receive a completed form and wrote to Mrs Y in mid-August 2024. The letter stated ‘we have financially assessed your community care contributions in accordance with the Council’s charging policy and the Care Act 2014’. It said ‘you are charged the full cost of your community care services due to your total assets exceeding £23,250’. It also sent Mrs Y an invoice for the full cost of her care from February 2024. Ms X contacted the Council by email. She said she had not received a response to her email of March 2024 and that Mrs Y did not have over £23,250.
17. A Council officer telephoned Ms X. The notes record the officer explained the situation regarding the financial assessment and full cost outcome and that Ms X would need to provide some financial information. The officer sent Ms X a form which she signed and returned to enable her to act as Mrs Y’s financial representative. The officer also emailed Ms X and said they would contact the financial assessment officer and ask them to send the relevant documents to Ms X once they received the authorisation form. Ms X returned the authorisation form the following day. I have seen no evidence the Council sent Ms X the financial assessment form and supporting information.
18. Ms X emailed the Council to complain in early October 2024. She said she had returned the authorisation form and had not received anything further whilst Mrs Y had received three final invoices. Around the same time she sent the Council some of Mrs Y’s financial information stating, ‘sending you this as you take too long to do anything..’. A Council officer replied that they required some further information and a completed financial assessment form. Ms X responded that she had not seen a letter or form and needed to be supplied everything from scratch. The officer sent Ms X a blank form, a cover letter and information about disability related expenditure by return.
19. The Council responded to Ms X’s complaint in mid-October 2024 and said the service had been in direct contact and had enclosed a financial assessment form in their correspondence, so it had closed the complaint. Ms X responded that her complaint had not been answered and asked to go to the next stage. The Council reopened Ms X’s complaint at stage one of its complaints’ procedure.
20. Ms X returned the completed financial assessment form to the Council in mid-October 2024. She included a recent bank statement and explained she was awaiting the further bank statements requested. In early November 2024 the Council officer chased Ms X for the bank statements which she sent that day.
21. The Council officer responded the same day with the outcome of the financial assessment. The officer also attached a form for any disability related expenditure (DRE). They also notified the Council’s income collection team of the changes who backdated the calculations to accurately calculate Mrs Y’s care charges from February 2024.
22. The Council responded to Ms X’s complaint in early December 2024. It summarised the events and apologised for the delays. It said the financial assessment team had reviewed Mrs Y’s charges and invoices. It sent Ms X the booklet which explained how the charges were calculated.
23. Ms X remained unhappy. She said the Council had not followed its complaints policy and her complaint was not managed in the Council’s timeframes. The Council’s delays had placed her mother in debt and the Council had failed to ensure the family understood the financial commitment required. She requested compensation for the distress caused. The Council responded in mid-December 2024 and suggested meeting with Ms X to try and resolve her concerns. Ms X responded the next day that she preferred a response in writing.
24. The Council responded in late January 2025. It said it accepted there was a delay in processing the financial assessment referral form and in the process but said the financial assessment did progress and the charges adjusted accordingly.
25. In late January 2025 Ms X remained unhappy and replied to the Council. She said there was no communication from the Council between February 2024 when care began and August 2024. Ms X said the Council had offered a repayment plan but required payment over three months unless Mrs Y completed an income and expenditure form which she considered unfair and intrusive. Ms X requested a detailed explanation of the delays and an explanation of how the Council would prevent such incidents in future. Ms X then complained to us.

Findings

26. Mrs Y started receiving Council commissioned care in February 2024. I do not know exactly what was discussed with Mrs Y or other family members at that time about charging. However, it appears Ms X was aware there would be charges for Mrs Y’s care.
27. The Council records do not show when it sent Ms X the financial assessment referral form. This failure to keep accurate records is fault. Ms X completed and returned this form on 31 March 2024. The Council delayed processing this form and it was not allocated to an officer to complete a financial assessment until July 2024. This delay between March and July 2024 was fault.
28. The Council’s records show an officer requested that the financial assessment form, cover letter, a leaflet on charging be sent to Mrs Y. I am satisfied on balance that this was sent to Mrs Y however she did not receive it. There was no attempt to check Mrs Y had received the letter or to follow up the request. Given Ms X had completed a form to request a financial assessment the Council’s failure to follow this up was fault.
29. When the Council did not receive a response it sent a letter saying it had assessed her finances and stating that ‘you are charged the full cost of your community care services due to your total assets exceeding £23250’. This was inaccurate and was fault. Ms X had already sent a financial assessment referral form declaring Mrs Y did not have over £23,250. The Council had decided Mrs Y was a full cost payer as she had not returned the financial assessment form not because of her finances. This letter caused Ms X and Mrs Y significant distress and frustration.
30. Ms X contacted the Council following receipt of this letter and immediately completed and returned a form of authority. Although the officer stated on receipt of this, they would ask the financial assessment officer to send the relevant documents this did not happen. The Council then sent Mrs Y three final invoices and so Ms X complained and sent it some initial financial information in early October 2024. This further delay by the Council was fault. It added to Ms X’s frustration and the accumulation of Mrs Y’s debt.
31. When the officer sent Ms X the form and cover letter in early October 2024, they failed to send her the leaflet explaining how the Council charged for its services. She did not receive this until early December 2024, in response to her complaint. This added to the delay in Ms X understanding how the Council charged for its services.
32. Mrs Y received the care for which the Council is entitled to charge and so she is required to pay a contribution towards the cost of this. The Council has now correctly calculated Mrs Y’s care charges back to February 2024 but the delay has meant Mrs Y is faced with a large backdated bill of 10 months of care charges. The Council has offered a three month repayment plan or longer if Mrs Y returns an income and expenditure form. I do not consider this is reasonable in the circumstances given the Council’s delays.
33. The Council failed to properly respond to Ms X’s complaint at stage one of its complaints’ procedure. The response referred to an officer being in touch but did not address any of her concerns. This was fault. The Council reopened the complaint and responded further but this was now significantly outside of its timescales. This caused Ms X additional frustration.

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Agreed Action

34. Within one month of the final decision the Council has agreed to:
1. Apologise to Ms X and pay her £100 to acknowledge the frustration caused by the delays in carrying out the financial assessment and in the complaints’ procedure.
2. Apologise to Mrs Y and pay her £200 to acknowledge the frustration and distress caused by the delays in the financial assessment process which led to a large bill accumulating, the failure to contact her when the financial assessment was not returned and the inaccuracy of the full charging letter.
3. Offer Mrs Y a 12-month repayment plan for the accumulated care fee contributions owed from March 2024.
35. Within two months of the final decision, the Council has agreed to review its procedures to ensure:
1. Where a financial assessment form is not returned within 14 days a reminder is issued or a telephone call made.
2. Full cost letters accurately reflect the situation where a financial assessment form has not been returned. I.e. that the Council has assumed an individual does not wish to disclose their financial situation and is willing to pay the full cost of their care.
36. The Council should provide us with evidence it has complied with the above actions.

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Decision

37. I find fault causing injustice which the Council has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman