Summary: Mrs X complained about the Council’s delay in sending information about her father’s contribution to his care fees. She also complained about the Council’s delay in completing a new care assessment for her father after she raised concerns about the care he was receiving. We find the Council was at fault for its delays in completing the financial assessment and for its failure to send the financial assessment to Mrs X’s email address. It was also at fault for its delay in assigning a social worker to complete a new care assessment. These faults have caused Mrs X distress and upset. The Council has agreed to apologise to Mrs X, make a payment to her, agree a payment plan for the outstanding care fees and a implement a service improvement.

The complaint

1. Mrs X complained about the Council’s delay in sending information about her father’s (Mr Y) contribution to his care fees. She also complained about the Council’s delay in completing a care assessment for Mr Y after she raised concerns about the care he was receiving.
2. Mrs X says the Council’s actions have caused severe distress, upset and financial worry. She wants the Council to waive the outstanding care fees.

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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 may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
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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How I considered this complaint

6. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
7. Mrs X and the Council now have an opportunity to comment on my draft decision. I will consider their comments before making a final decision.

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What I found

Assessment

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.

Charging

9. 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.
10. 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.
11. 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.
12. If a person chooses to go into a home that costs more than the personal budget, and the council can show that it can meet the person’s needs in a less expensive home within the personal budget, it can still arrange a place at the home if:

• the person can find someone else (a ‘third party’) to pay the top-up; or
• the resident has entered a deferred payment scheme with the council and is willing to pay the top-up fee themself.

13. In such circumstances, the council needs to ensure the person paying the top-up enters a written agreement with the council and can meet the extra costs for the likely duration of the agreement.

What happened

14. This chronology provides an overview of key events in this case and does not detail everything that happened.
15. Mr Y has Alzheimer’s disease and dementia. He does not have mental capacity to make decisions about his care and support needs. Mrs X has two Lasting Power of Attorney’s (LPA) to deal with Mr Y’s property and financial affairs and his health and welfare.
16. The Council started assessing Mr Y’s care and support needs in April 2023. Mr Y’s son said the family had received an offer from a care home for respite. The Council’s case notes states Mr Y’s son said the family would pay for Mr Y’s care for four weeks.
17. Mr Y became a resident at the care for respite care only the following day.
18. The Council completed its assessment in May. It decided Mr Y had eligible care and support needs and that a residential placement would meet those needs. The Council noted on its files the personal budget for the care home was £622 per week.
19. The Council’s case notes state it sent a letter to Mr Y’s son and said he needed to complete a financial assessment. The case notes also state Mr Y’s son said the family were still funding Mr Y’s placement at the care home.
20. The Council spoke with Mrs X in late May. Mrs X said she wanted Mr Y to stay at the care home, and she would pay the difference in the amount approved by the Council.
21. Mrs X chased the Council for an update on the financial assessment in early June. The Council said it needed to put the care home on its system and then approve funding.
22. Mrs X completed the financial assessment form and provided the Council with details of Mr Y’s finances in late June.
23. Mrs X completed the Council’s notification of financial assessment form in July. This said she understood the Council would carry out a financial assessment to decide what Mr Y’s care contributions would be.
24. Mrs X also completed the Council’s third-party funding agreement form in July. She confirmed she would pay the weekly top up fees of £378.
25. Mrs X lives and works abroad. She spoke to the Council in early September. She said she was leaving the country and therefore she wanted it to send all communication to her email address.
26. The care home contacted the Council in December. It said Mrs X had been raising issues about Mr Y’s care. The Council agreed to assign a social worker to complete a review of Mr Y’s care and support package.
27. The Council sent the outcome of the financial assessment to the postal address it had on file for Mrs X in January 2024. This said Mr Y would have to pay the full weekly contribution of £622 per week towards his care fees.
28. The Council assigned a social worker to the case in January. The social worker spoke to Mrs X. Mrs X said she had some concerns about whether staff were meeting Mr Y’s needs. However, she said overall Mr Y was happy, and the family did not want to unsettle him. She said she would monitor the situation until May. If the care did not improve, she would discuss an alternative placement.
29. Mrs X emailed the social worker in early April. She said she was concerned the care home was increasing Mr Y’s top up fees by £100 per week at short notice. Mrs X received the social worker’s automatic out of office email. This said the social worker would return to the office the following week.
30. The Council sent a letter to the postal address it had on file for Mrs X in late April. This said Mr Y’s care fees were increasing to £678 per week. It said it would issue invoices every four weeks.
31. The Council received repeated safeguarding reports about the care Mr Y was receiving at the care home from May onwards.
32. Mrs X called the Council in mid-June. She said the care home had put up care fees at short notice. She said she wanted the Council’s help in facilitating a move to a different placement.
33. Mrs X chased the Council several times for an urgent call back. She said she was not happy with the care Mr Y was receiving.
34. The Council emailed Mrs X on 12 July and said it would pass the case to the assessment team for an urgent review.
35. Mrs X emailed the Council on 21 July and said she had been waiting for two months for it assign a social worker. She said it was unacceptable.
36. The Council emailed Mrs X in mid-August and asked whether she was self-funding Mr Y’s placement. Mrs X responded and confirmed she was paying top up fees, and the Council was funding the rest of the placement.
37. Mrs X emailed the Council at the end of August. She said the matter was still unresolved. She also said she had found a new cheaper care home for Mr Y, but she could not move him until the Council had completed the review.
38. The Council sent Mrs X an up-to-date statement of account for Mr Y’s care fees in early September. This showed outstanding care fees. Mrs X replied and asked what it was for as the Council was partly funding Mr Y’s care.
39. The Council sent Mrs X an email in mid-September with the outcome of Mr Y’s financial assessment from January.
40. Mrs X complained to the Council in October. She said it delayed telling her about Mr Y’s contribution to his care fees. She said if it had told her sooner, she would have made different financial and care decisions. She also said the Council delayed completing the new care assessment after she asked to move Mr Y.
41. The Council issued a stage one response to the complaint at the end of October. It said it sent the financial assessment to the postal address it had on file. It apologised for any delays in responding to her contacts. Finally, it said Mr Y was responsible for the full cost of his care.
42. Mr Y moved to a new care home in early November.
43. Mrs X asked the Council to review its response to her complaint.
44. The Council sent Mrs X a letter in early December. It said the outstanding balance for unpaid care fees was £45,036.
45. The Council assigned a social worker to complete the review of Mr Y’s care and support package on 12 December.
46. The Council issued its final response to the complaint the following week. It reiterated that it sent Mr Y’s financial assessment to the address on file. It apologised for the delay in completing the financial assessment. However, it told Mrs X the process would be slow. It also said there was a delay between 17 June and 2 July in the social work team making contact. It apologised for this.

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Analysis

47. Mrs X sent the Council Mr Y’s financial details in late June 2023. She signed the Council’s notification of financial assessment form in July 2023. The Council then took six months to complete its financial assessment. The law and guidance do not specify a timescale for completing a financial assessment. However, we would expect councils to complete assessments within a reasonable timescale. Six months is not reasonable and is fault.
48. Mrs X told the Council in September 2023 to send all information by email. The Council sent the financial assessment (January 2024) and the increase in fees letter (April 2024) to the postal address it had on file. The Council failed to follow Mrs X’s instructions when it knows she lives and works abroad. This is fault.
49. Mrs X contacted the social worker in April 2024 and asked to discuss the increase in top up fees. The social worker did not contact Mrs X when they returned to the office. This is fault.
50. From June 2024, Mrs X repeatedly asked the Council to complete a review of Mr Y’s care and support needs. She thought she had to go through this process because she assumed the Council was contributing to Mr Y’s care fees. The Council did not assign a social worker to complete a review until December 2024. This was after Mr Y had moved to a new care home. This delay is fault.
51. The Council also missed opportunities to resolve the issue with the financial assessment and the outstanding care fees. It failed to send regular invoices asking for payment. It also did not send a statement of account showing the outstanding care fees until September 2024. This is despite the fact it completed the financial assessment eight months earlier and had not received payment.
52. The Council’s faults have caused Mrs X a significant injustice. She had the shock of receiving a large invoice for unpaid fees from the Council. This caused her distress and upset. She was put to time and inconvenience repeatedly contacting the Council to review Mr Y’s care package. She lost the opportunity to consider alternative care options for Mr Y much sooner. The Council needs to remedy this injustice.
53. Mrs X says she would have made different financial and care decisions but for the Council’s fault. She wants the Council to waive the outstanding care fees.
54. Mrs X had some information about the financial assessment process and charging in June/July 2023. She knew the Council was assessing Mr Y’s finances to decide what his care contributions would be. She also knew the service was chargeable from the date the service started. The Council also provided her with links to its website which provides detailed information about charging. Mrs X did not chase the Council for the outcome of the financial assessment. It would have been reasonable for her to have done so especially when she had not heard anything from the Council. The absence of a completed assessment does not mean an individual does not have to pay for their care. While I appreciate Mrs X had concerns about the quality of the care Mr Y received, he still received care over an extended period. Therefore, I cannot recommend for the Council to waive the outstanding care fees.

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Action

55. By 5 December 2025 the Council has agreed to:

• Apologise to Mrs X for the injustice caused by fault in this statement.
• Pay Mrs X £400 to reflect her shock, upset and distress caused from how it handled Mr Y’s financial assessment.
• Pay Mrs X a further £200 to reflect her frustration and the time and inconvenience caused by its delay in responding to her contacts and assigning a social worker to review Mr Y’s care package.
• Arrange a sensible payment plan with Mrs X for the outstanding care fees.
• Issue written reminders to relevant staff to ensure they complete financial assessments within a reasonable timescale and without undue delay. Staff should also ensure they send the financial assessment to the individual/their representative via their preferred method of communication.

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

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Decision

57. I have completed my investigation. I find fault causing an injustice for which I have recommended a remedy.

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Investigator's decision on behalf of the Ombudsman