Summary: Mrs X complained the Council delayed completing a financial assessment for her father, Mr Y. She also complained the Council provided late and incorrect invoices and did not reassess Mr Y’s care needs when his circumstances changed. We found fault by the Council on all matters. The Council has agreed to apologise to Mrs X and Mr Y and make Mrs X a symbolic payment in recognition of the avoidable time and trouble caused to her. It also agreed to reduce the invoices for Mr Y’s care to reflect that he would likely have made different choices about his care, save for the delay in completing his financial assessment and to reflect the uncertainty about the accuracy of the invoices.

The complaint

1. Mrs X complained on behalf of her father, Mr Y. She complained the Council delayed completing a financial assessment to determine his contribution towards his care costs. She also complained the Council failed to provide clear and correct information about the assessment, delayed replying to her communications, provided late and incorrect invoices for his care and did not reassess Mr Y’s care needs when his circumstances changed.
2. Mrs X stated Mr Y has been charged for backdated care costs without notice causing Mr Y and his family significant distress. She also stated the delay in completing the financial assessment denied them the opportunity to make informed decisions about Mr Y’s care.

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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. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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 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

8. 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)
9. 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. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
10. 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)

Care Plans

11. 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.
12. 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.

Key events

13. This chronology provides an overview of key events. It is not intended to show everything that has happened.
14. Mr Y lives with his wife, Mrs Y, in their home.
15. In summer 2022 the Council assessed Mr Y and found he had care needs around personal care and nutrition. He needed two visits per day from carers to meet his needs. Mrs Y provided the rest of his support. Mr and Mrs Y’s children live too far away to provide this support to Mr Y.
16. In July Mr Y’s family asked the Council for a financial assessment form to complete so the Council could determine if he needed to contribute towards his care costs.
17. In August Mr Y signed an Agreement to Pay form for his care. The form said Mr Y confirmed he understood that he may need to pay a charge for his care and that he had received a booklet explaining how the Council would assess his needs and how it would decide any charges for his care.
18. In October Mr Y’s family received the financial assessment form, having followed up their initial request on multiple occasions.
19. In November Mr Y’s case was assigned to Officer Q. Mrs X liaised with Officer Q to complete the financial assessment. Officer Q gave advice about Mr Y’s savings and allowable expenses but did not explain that his income would also be considered when deciding the financial assessment.
20. In July 2023 the Council decided Mr Y’s financial assessment. It found he would need to pay the full cost of his care from September 2022.
21. Mrs X contacted Officer Q to discuss the Council’s decision. Officer Q requested Mrs X provide updated information about Mr Y’s savings, pension income and expenditure.
22. In September Mrs Y was hospitalised and so was unable to help care for Mr Y. In response the Council arranged two additional visits per day from carers.
23. In October Mrs Y began to receive support from a live-in carer, after being discharged from hospital. The live-in carer also provided support to Mr Y.
24. Case records show no further substantive action was taken regarding Mr Y’s financial assessment until summer 2024 when the Council confirmed he would need to pay the full cost of his care from September 2022 and so, Mr Y owed around £30,000 for his care.
25. Following the Council’s decision Mrs X reduce the care provided to Mr Y by the Council to one visit per day. The remainder of his care was provided by a live-in carer that was supporting Mrs Y as this was a more cost-effective way of meeting both their care needs. I note there were delays in reducing the care provided by the Council.
26. Unhappy with the Council’s decision Mrs X complained to the Council. She complained:
• the financial assessment took too long.
• communication was poor and it was not clear that Mr Y’s income would be taken into consideration.
• the delay in completing the financial assessment deprived Mr Y of the opportunity to make informed decisions about his care and household expenses.

Mrs X also explained that Mr and Mrs Y’s household care costs had increased significantly due to Mrs Y needing a live in carer to meet her needs. She also stated Mr Y does not have the money to pay the backdated contributions the Council has invoiced him for.

27. The Council replied to Mrs X ‘s complaint. It said:
• it acknowledged it took too long to act on the initial request to complete a financial assessment for Mr Y.
• it completed the initial financial assessment for Mr Y in July 2023 which found he should pay the full cost of his care. However it was not until July 2024 that it established that irrespective of the amount of Mr Y’s savings, he would need to pay the full cost of his care due to his income.
• Officer Q should have considered Mr Y’s income when deciding the initial financial assessment.
• it will not forgo the outstanding amount Mr Y owes for his care and has payment options available if he cannot pay the outstanding amount in full.
28. Mrs X escalated her complaint to the second stage of the Council’s complaints process. She complained about the same matters as in her initial complaint but also included concerns that:
• Mr Y’s care needs were not reassessed for two years; and
• recently received invoices for Mr Y’s care dating back to September 2022 are inaccurate and its now too late to effectively scrutinise the invoices.
29. The Council replied said:
• it received unprecedented demand for assessments during the period in question and so delays occurred. The demand also impacted its ability to send out invoices in a timely manner. It apologised for the delays.
• it is reviewing its financial assessment process to establish where changes are needed to improve the timeliness of its financial assessments.
• the invoices provided to Mr Y are based on the agreed package of care, his personal budget and the outcome of his financial assessment.
• it apologised for the delays and inconvenience caused to Mrs X.
• it remained of the view Mr Y’s financial assessment is correct and the invoices he has received are due and payable. It said Mr Y could make payment of the outstanding amount in instalments if he cannot pay in full
30. Mrs X remained unhappy and complained to the Ombudsman.
31. In January 2025 the Council completed a reassessment of Mr Y’s care needs.

Finding

Financial Assessment

32. The Council took from October 2022 to July 2023 to issue an initial decision on Mr Y’s financial assessment. Although there are no statutory timescales for completing financial assessments, the Ombudsman would expect the Council to complete them within in four weeks.
33. The Council took from July 2023 to July 2024 to confirm the outcome of Mr Y’s financial assessment. This is further delay by the Council.
34. While I appreciate the Council was experiencing increased demand during this period, a delay of two years in deciding Mr Y’s financial assessment is fault.
35. The identified delay was in part caused by the Council’s failure to consider Mr Y’s income when completing the initial financial assessment. The Council should consider all the relevant information when deciding a financial assessment. The Council’s failure to do so meant the assessment took longer than it otherwise would have. It also put Mrs X to the additional time and trouble of providing unnecessary information and challenging the Council’s decision. This is injustice.
36. Mrs X says Mr Y would have made different decisions about his care if he had known he would be charged the full amount for his care. Mr Y reduced the care he received from the Council to one visit per day as soon as the Council decided his financial assessment in July 2024. I therefore consider it is more likely than not he would have taken this action in October 2023 when Mrs Y began receiving support from a live-in carer. This is because the live-in carer now provides Mr Y with the rest of the support he needs. While I appreciate that Mr Y benefited from the care provided by the Council during this period, arranging care via the live-in carer would have achieved the same outcomes at a reduced cost. I therefore consider Mr Y has incurred higher costs for his care. This is injustice.
37. Prior to Mrs Y being hospitalised Mr Y received two care visits per day to meet his needs. The care provided in the visits met the needs set out in his care plan. I have seen nothing to suggest that Mr Y’s needs decreased during this period or that it was likely Mrs Y or Mrs X would have been able to provide sufficient care and support to Mr Y to allow him to reduce the amount of paid for support he received. Therefore I do not consider it likely that Mr Y would have been able to reduce the number of care visits he received during this period, even if the Council had decided his financial assessment sooner.

Invoices

38. The Council accepted it did not invoice Mr Y for care received from summer 2022 onwards until it completed his financial assessment. The Council should provide invoices in a timely manner and its failure to do so amounts to fault.
39. The failure to issue timely invoices means Mr Y was unable to ensure the invoices accurately reflected the care he received. I note the Council’s view the invoices reflect the package of care agreed for Mr Y. However it is not possible to ensure the invoices account for missed visits or visits cancelled by Mr Y. This means there is uncertainty about the accuracy of the invoices and that Mr Y may be charged for care he did not receive. This is injustice.

Care Assessment

40. The Council should review care plans every 12 months. I have seen no evidence the Council reviewed Mr Y’s care plan in 2023 or 2024. This is fault.
41. Mr Y’s most recent care plan does not show his care needs have significantly altered. When Mrs Y was unable to continue providing care for Mr Y the Council arranged additional care support for Mr Y. Therefore I do not consider Mr Y has been caused injustice because of the missed care plan reviews.

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Agreed Action

42. Within in one month of my final decision the Council will:

1. Apologise to Mrs X and Mr Y for the identified delays. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.

2. Amend the invoices for Mr Y’s care costs for the period from October 2023 onwards so that he is charged for only one visit per day. The Council should provide Mrs X with revised invoices to reflect the agreed reduction.

3. Reduce the amount of invoices issued to Mr X for care in 2022 and 2023 by 10%. This is to account for the likelihood the invoices do not accurately reflect the care received by Mr Y. The Council should provide Mrs X with revised invoices to reflect the agreed reduction.

4. Pay Mrs X £500 in recognition of the avoidable time and trouble caused to her in pursuing this matter with the Council.

43. Within three months of my final decision the Council will:

1. review its procedures for dealing with financial assessments to ensure assessments are completed within in four weeks.

2. provide information and training to all staff handling financial assessments to ensure the applicant’s income is considered when deciding an assessment

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

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Final Decision

45. I have completed my investigation and fault by the Council. The Council has agreed to remedy the injustice caused by the fault.

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Investigator's decision on behalf of the Ombudsman