Summary: We will not investigate Ms X’s complaint about the Council’s refusal to refund her relative, Ms Y, for care fees paid directly to her care provider after the date the Council agreed to fund Ms Y’s care. There is insufficient evidence of fault to warrant an investigation.

The complaint

1. Ms X complains the Council has refused to refund her relative, Ms Y, for care fees she paid to her care provider after her funds fell below the upper capital limit. She says this has caused distress and financial loss. She wants the Council to refund Ms Y the money she is owed.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide there is not enough evidence of fault to justify investigating.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

3. I considered information provided by the complainant and the Council.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the adult social care 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.
6. Ms X’s relative, Ms Y, lives in residential care. In 2023, Ms Y was funding her own care and paying the fees directly to the care provider. When Ms Y’s funds were nearing the upper capital limit, Ms X approached the Council to ask it to fund Ms Y’s care.
7. Ms Y continued to pay care fees to the care provider whilst the Council completed a financial assessment. The financial assessment concluded the Council would fund Ms Y’s care from July 2023. It paid the care provider directly for Ms Y’s care from July 2023 to October 2023, when Ms Y moved to a different care provider.
8. Ms X asked the Council to refund Ms Y the fees she had paid directly for her care from July to October 2023. The Council said it had paid the care provider for her care during that time. It said it would be for the care provider to decide whether Ms Y was owed a refund of any fees she had paid to it directly.
9. We will not investigate this complaint. The Council completed its financial assessment and began to pay for Ms Y’s care from the date her funds reduced to below the upper capital limit. It would be for the care provider to decide whether Ms Y was owed any refund of care fees she paid to it directly after this date. There is insufficient evidence of fault in the Council’s actions to warrant an investigation.

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Final decision

10. We will not investigate Ms X’s complaint because there is insufficient evidence of fault to warrant an investigation.

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Investigator's decision on behalf of the Ombudsman