Summary: The complaint is the Council gave incorrect advice to Mr B which led to him agreeing to move his mother between nursing homes, on the understanding nothing would change in her care and support. But instead the Council carried out an assessment and Mr B’s mother was liable for her care costs. The Council then delayed responding to his complaint and said it had sent a response when it had not. The Ombudsman’s decision is there is no documentary evidence of the Council’s involvement in the move or in giving the family any advice. There was some delay in its carrying out an assessment and responding to Mr B’s complaint. But these did not cause a significant enough injustice to warrant a further remedy.

The complaint

1. The complainant (Mr B) complains that the Council is asking for payment for his late mother’s (Mrs C) adult social care charges. Specifically he complains the Council:
• did not follow any acceptable practice. Mr B says it was the Council who liaised with them about the 2023 move to a new nursing home. And, at the time of the move, it did not notify them of the financial implications. He and his sister remember being told the move would have no financial consequences whatsoever. This was incorrect, as it triggered a Continuing Healthcare assessment;
• failed to respond to their complaint within the statutory timelines and then gave wrong information about how to appeal;
• falsified information about its complaint response. This relates to the date when the Council says it first sent its complaint response, which Mr B disputes.
2. Mr B says the injustice to the family was the stress during a period of grieving and the financial impact. As an outcome they want the fees cancelled, and for the Council to acknowledge the fault.

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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 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)
4. 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)
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(1), as amended)

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What I have and have not investigated

6. Mr B complains about matters going back to July 2023, when Mrs C moved between nursing homes. This is over 12 months before his March 2025 complaint to the Ombudsman. But the significance of the move did not become fully apparent until August 2024 – partly because the family were appealing the outcome of an NHS assessment. So although the events are outside our normal time period, I have considered them, insofar as they relate to alleged actions by the Council.
7. But I have not considered the outcome of the CHC assessment. This is because the NHS was responsible for that assessment, so a complaint about it is for the Parliamentary and Health Service Ombudsman.

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How I considered this complaint

8. I considered evidence provided by Mr B, his sister (Ms D) as well as relevant law, policy and guidance.
9. Mr B 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

Legal and administrative background

NHS Continuing Healthcare and Funded Nursing Care

10. NHS Continuing Healthcare (CHC) is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. CHC funding can be provided in any setting and can be used to pay for a person’s residential nursing home fees in some circumstances.
11. For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC checklist. If the completed CHC checklist indicates the person may be eligible for CHC, the next step is a full multidisciplinary assessment, co-ordinated by a nurse.
12. If someone does not qualify for CHC, they may qualify for funding of the part of their care that is provided by a registered nurse. This is called Funded Nursing Care (FNC).
13. If, after a full multidisciplinary assessment, a person disagrees with a decision that they are not eligible for CHC or FNC, they can ask the NHS to review its decision. If they disagree with the outcome of the review, they can appeal to an Independent Review Panel organised by NHS England. The third stage is to refer the case to the Parliamentary and Health Service Ombudsman.

Charging for permanent residential care

14. The Care Act 2014 (sections 14 and 17) provides a legal framework for charging for care and support, for people not eligible for NHS funded care. 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.
15. 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

16. The information below is a summary of relevant events, and does not include everything that happened during this period.

Background

17. In the early 2020s Mrs C was discharged from hospital to a nursing home (Home 1). At the end of 2022 a Council social worker completed an assessment of Mrs C’s needs. This assessment found Mrs C’s needs were being met at Home 1 and it was in her best interests for her to remain there. As the NHS was meeting Mrs C’s needs, the Council found there was no reason for its ongoing involvement.
18. A mental capacity assessment concluded Mrs C lacked the capacity to make her own decisions. Ms D and Mr B were making decisions for her.

Mrs C moves

19. In July 2023 Mrs C moved from Home 1 to a different nursing home (Home 2). Ms D says they were told this was because Home 1 was being re-purposed after the Covid 19 pandemic. Ms D says: “we specifically asked at the point of relocation 'will this impact anything at all, including her financial situation' and we were told clearly in that discussion ‘no’”. Mr B and Ms D say their understanding was they had this conversation with an officer of the Council.
20. I asked the Council about this. It advised it had no record of any involvement in the move, or communication with the NHS, or Mrs C’s family, before the move. Its understanding was the NHS moved Mrs C to Home 2 in order to assess her needs. It says its first communication was an August email from the NHS to advise it was planning a CHC assessment.
21. The NHS co-ordinated the CHC assessment. Its decision was Mrs C did not qualify for CHC, but did qualify for FNC for the nursing related part of her care.

The Council’s involvement

22. Mrs C’s CHC ended at the end of October. The Council’s complaint response acknowledged it should have completed its assessment of Mrs C’s needs by this date. But it was delayed as it did not have an available care coordinator.
23. The Council carried out its Care Act Assessment in December 2023. The record of this assessment notes Ms D said the family was happy for Mrs C to remain in Home 2, as it was in her best interests.
24. The Council’s finance team sent Ms D a form for a financial assessment in February 2024 and again at the end of March. Mr B responded to the latter contact to ask to pause the financial assessment, as the family were appealing the CHC decision.
25. The Council’s finance team kept in touch with Mr B and Ms D, culminating in Mr B agreeing to an assessment at the end of August 2024. Mr B arranged for the Council to visit to carry out an assessment in September, which he needed to cancel. The Council rearranged the visit for November.
26. Mr B and Ms D complained in November. The Council says it provided a response in December, which Mr B did not receive. (The Council has sent the Ombudsman a dated email from then). The complaint response did not uphold the main parts of the complaint but did find a delay in its completion of its care assessment.
27. Mrs C passed away in December 2024.
28. Mr B chased a complaint response in January 2025. The Council says that, due to a ‘technical issue’ Mr B’s email was ‘missed’, meaning it did not re-send its complaint response, as intended. In March the Council sent the complaint response again and this time Mr B did receive it. The Council apologised it had not sent it earlier.
29. In March Mr B complained to the Ombudsman.
30. The outcome of the Council’s financial assessment was that Mrs C was responsible for her full care costs, as she owned her own property.

Analysis

The move to Home 2

31. The part of the move to Home 2 I have investigated is the complaint that it was officers of the Council who gave Mr B and Ms D wrong advice before the move. I recognise that Mr B and Ms D had first-hand experience of dealing with Mrs C’s move from Home 1 to Home 2. And I do not dispute that it was their understanding that it was an officer of the Council who gave them this advice.
32. But the Council says it has no record of its involvement until after Mrs C had moved. I can now only judge matters by the available evidence. And in the absence of any documentary evidence confirming the person Mr B or Ms D spoke to was an officer of the Council, on the balance of probabilities, I find it likely the person they spoke to was not a Council officer. So I cannot uphold this part of their complaint.

The Council’s assessments

33. The Council was correct that it needed to carry out assessments of Mrs C’s care and support needs and a financial assessment of her ability to pay. I find no fault with the decisions to assess, or the outcomes of the assessments.
34. The Council has accepted there was a delay in completing its assessment of Mrs C’s care and support needs. That was fault. But there is not enough injustice flowing from that delay to warrant further investigation.
35. The Council then took around two months before it sent Ms B forms to complete a financial assessment. That was too long and was fault. But, again, there is limited injustice from this delay, as Mr B and Ms D asked to pause the assessment pending the outcome of an appeal against the CHC decision.

The complaint response

36. There was a delay in Mr B receiving the Council’s complaint response. The reasons for the initial delay are disputed, although the Council has accepted fault in the reasons why in January Mr B did not receive its resent response. I uphold this part of the complaint, insofar as the Council delayed providing its complaint response, at the least between January and March 2025.
37. But I cannot say, on the balance of probabilities, that the Council ‘falsified information’ about the chronology of its responses.
38. I do not consider that I need to investigate this further. This is because the Council has investigated Mr B’s complaint and made a decision it was entitled to make. When evidence of administrative fault causing injustice is found, the Ombudsman’s role is to seek redress by putting the complainant back into the position they would have been in if the administrative fault had not occurred. In these circumstances, where the Council has now provided Mr B with a response to his complaint, no useful purpose would be achieved by pursuing this aspect of the complaint further, as I see in March the Council apologised for not earlier sending the response.

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Decision

39. I find fault. But there is not enough injustice to warrant further investigation.

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Investigator's decision on behalf of the Ombudsman