Summary: It was not fault for the Council to request details of Mrs X’s previous expenditure before it decided her eligibility for financial assistance with care home costs. The Council gave timely information about respite charges based on the information provided by Mrs X’s family.

The complaint

1. Mr A (the complainant) says the Council gave him false information about likely care charges for his mother Mrs X then said Mrs X had given away money to avoid care charges. He says this has caused financial hardship and embarrassment.

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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 Mr A and the Council as well as relevant law, policy and guidance.
5. Mr A 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

Relevant law and guidance

6. 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.
7. 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. Charges are means tested based on a person’s financial resources; including any income or capital they have. This means that when the council arranges care and support it will undertake a financial assessment, that asks people what income or capital they have. The term ‘capital’ includes things such as savings and investments, and can include the value of assets such as second homes and in the case of a permanent care home resident the house they previously lived in (although in some cases this may be disregarded).
8. 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.
9. Regulations say a council can treat someone as ‘possessing capital’ if they find that person has ‘deprived themselves’ of it, ‘for the purpose of decreasing the amount they may be liable to pay towards the cost of meeting their needs for care and support’ (Care and Support (Charging and Assessment of Resources) Regulations 2014, Regulation 22).
10. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

What happened

11. Mrs X went into hospital in September 2024. The Council’s records show that she was then referred to a Discharge to Assess (D2A) placement so that her care needs could be determined away from the hospital. The D2A placement was free of charge. It was extended for a further period as Mrs X was still making progress with therapy.
12. On 19 November the therapy service discharged Mrs X as she was not making any more progress and the care home had indicated her residency was permanent. The Council says the social worker challenged the issue of permanent residency but discussed the possibility of respite care with Mr A and his brother. The records show Mr A spoke to the social worker on 6 December about the costs of respite care. The social worker indicated the respite care charge would be £184 a week based on the figures Mr A gave him then but said a more detailed financial assessment would be undertaken if her placement became permanent.
13. The Council’s records show the needs assessment of Mrs X in December determined that she required a 24-hour placement due to her high risk of falls, and that there would be unmet need if she returned home with a care package. Mr A asked the social worker again about costs. The social worker noted, “informed him again that her contribution depends on her capital. …based on that information [given by Mr A], her respite charges will 184.39 per week during the respite period, this may be different once she become permanent and this will be determined after a financial assessment and she will need to enter a deferred payment scheme and reimburse the LA contribution once the property is sold during the period she was on permanent care.” There was some disagreement documented between Mr A and the social worker about Mrs X’s perceived wish to return home.
14. Once the placement became permanent the social worker referred the matter to the finance office for a detailed assessment. The finance officer noted that Mrs X had received non-residential services since 2020. She noted some discrepancies on the bank statements already submitted. She emailed Mr A at the end of January asking for more information to enable her to complete the assessment. She requested bank statements back to 2019. She also queried some gifts made by Mrs X and said she needed to see evidence of a gifting pattern.
15. In February Mr A responded to the finance officer. He said he couldn’t comment on his mother’s spending as she had a gambling addiction. He said the family would just fund the placement themselves by selling his mother’s property.
16. The finance officer responded. She said, “ I understand that instead of providing the requested evidence you will be self-funding her placement at (the care home). We will write to (the care home) to notify them of this and they will issue invoices going forwards.” She also confirmed that if the family approached the Council for funding again at a later date, the same bank statements and evidence would be requested again. The Council says from this point forward Mrs X was deemed to be a self-funder.
17. The finance officer also referred the matter to the Safeguarding team because of her concerns around the large amounts of money being moved from Mrs X’s account.

The complaint

18. At the end of February Mr A complained to the finance officer because the family had now been charged full cost charges for the period of time Mrs X had been in respite care. He said at no time had they been advised the respite charges were also dependent on a financial assessment.
19. The finance officer replied that he could still have a financial assessment undertaken if he submitted the requested evidence.
20. Mr A submitted a number of bank statements. The finance officer wrote to him again in March and explained there was still other evidence she required from another of Mrs X’s accounts, as well as questions that required an answer around her spending and gifting pattern
21. Mr A took Mrs X out of the care home so that alternative arrangements could be made for her care at home. He wrote to the finance officer and explained that he had now made a corporate complaint.
22. The Council responded to Mr A’s complaint. It said Mrs X had been discharged initially on a ‘Discharge 2 Assess’ basis which was free of charge and was extended as Mrs X showed some signs of progress. That placement was altered to a respite status when she no longer progressed. It pointed out that the social worker had explained the likely charges based on the information given by Mr A at the time but had indicated a financial assessment would be required if the placement was made permanent. This aspect of the complaint was not upheld and Mr A was informed he should continue to pay the care home at its private contract rate.
23. The Council also responded to Mr A’s complaint about the social worker’s interaction with Mrs X. He said that he did not believe the social worker had any empathy with Mrs X. The Council responded that on the evidence available the social worker had listened to Mrs X’s wishes and supported her to discuss them when her voiced wished were different from those of her family. The complaint was not upheld.
24. Mr A remained dissatisfied and complained again. An independent investigator investigated his concerns on behalf of the Council and wrote to him. They said the Council had been clear about the care charges and explained that the final amount depended on the financial assessment. They said, “I cannot resolve a complaint which at its centre is the issue of costs, when they remain undetermined because the Financial Assessment has not been completed. The Council is willing to complete the Assessment, upon receipt of the required further information”. The complaint was not upheld.
25. Mr A complained to us. He said the family had been misled over the cost of care and would have removed Mrs X from the care home much sooner had they known the true cost of the care. He complained that the Council had initiated a safeguarding enquiry. He said the Council’s actions had caused considerable financial distress.
26. The Council says it cannot trace the provisional financial assessment which should have been sent to Mrs X’s son. It says, “The Social worker has advised that he posted information about payments for care home fees to (Mrs X)’s address as requested by her son. Unfortunately, he did not record on the system when he actioned this request, He has however, noted that (her son) completed an online Financial Assessment using the QR code that was contained in the information posted.”
27. Mr A has sent a copy of an email from the care provider about the fees. It says, “We were advised by the local authority that as the family declined taking part in the financial assessment, they deem (Mrs X) and/or her representatives liable for the fees on a private basis. We have confirmation of this from the Local Authority which is the basis on which we raised the invoice. We were advised of this in February, in writing, and this was communicated to you immediately by us.” Mr A says he disputes that the respite fees should have been charged at a different rate from those agreed in November.

Analysis

28. There is sufficient documentary evidence to show that the Council explained to Mrs X’s family that the charges would be calculated based on a financial assessment, and that the figures suggested were based on information given by Mr A. There is no evidence the Council misled the family about likely charges.
29. The finance officer was entitled to make further enquiries to enable her to complete a robust and defensible financial assessment. It was Mr A’s choice to withdraw from the process.
30. It was not fault for the finance officer to refer her concerns about the unusual spending pattern in Mrs X’s bank accounts to the safeguarding team.

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Decision

31. I have completed this investigation on the basis that there is no evidence of fault in the Council’s actions.

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Investigator's decision on behalf of the Ombudsman