Summary: There was no fault in the Council’s assessment and handling of Ms X’s late mother’s care charges.

The complaint

1. Ms X complained on behalf of her late mother Mrs Z. Ms X complained the Council:
1. incorrectly charged for Mrs Z’s care and without their prior agreement.
2. told her that they would not need to pay for the care when it assessed Mrs Z’s needs after she was discharged from hospital in 2024.
3. ignored her comments that the care charges were not affordable and their requests for cancelling Mrs Z’s care. Ms X said the Council later acknowledged their request for cancellation but did not action it, as it considered Mrs Z required the care.
4. failed to respond to her correspondence regarding the care charges in a timely and efficient manner.
2. Ms X said as a result they were caused distress and frustration.

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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 consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. 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.
6. 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

7. I spoke to Ms X about the complaint.
8. I considered evidence provided by the Council as well as relevant law, policy and guidance.
9. Ms X and the Council had an opportunity to comment on the draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

Needs assessment and care planning

10. 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 for care

11. A council can 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) Where a council decides to charge for care, they must carry out a financial assessment to determine what a person can afford to pay (called the ‘client contribution’).
12. Most adult social care is chargeable, apart from reablement care (short term care following illness, injury or hospital stay) or Discharge to Assess/D2A care (short term care to allow time for councils to carry out a needs assessment and determine longer term care needs). These are free for up to six weeks.
13. If a person has capital over the upper capital limit of £23,250, a council may charge them the full cost of their care. When someone’s capital is below the upper limit, they are entitled to seek means-tested support from the council which requires a financial assessment of the person’s assets. (Care and Support Statutory Guidance Paragraphs 8.11 and 12)
14. Councils recognise that a person will need to pay for daily living costs such as food and utilities and must have enough money to meet those costs. The regulations set out that after charging a person must be left with at least the minimum income guarantee from their income. The level of the minimum income guarantee is set by the Government. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.
15. Councils can take disability-related benefit into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting.
16. Councils must be transparent so people know what they will be charged for their care. There should be enough information available so they can understand any charge. (Care and Support Statutory Guidance, paragraphs 8.2 and 8.3)
17. Councils must regularly reassess a person’s ability to meet the cost of any charges to take account of any changes to their resources. This is likely to be on an annual basis but may vary according to individual circumstances. However, this should take place if there is a change in circumstance or at the request of the person.

The Council’s charging policy

18. The Council publishes its charging policy on its website which sets out details about its financial assessment process. It states that:

• If the person does not complete the financial assessment within 28 days and has not contacted the Council regarding any delays, the Council would assume that they are over the £23,250 threshold and it will charge them for the full cost of their care. The Council will consider that the person does not require any financial contribution until the assessment is completed.
• On completion of the financial assessment, the person receives a letter from the Council confirming their contribution towards the cost of their care, known as their “care charge”. The cost of a person’s care is based on the rates the Council is charged by providers and a person’s care charge will not be more than the price charged by a provider.
• If the financial assessment finds that a person has no available income, they will not be charged for their assessed care and support services.

What happened

19. This section sets out the key events in this case and is not intended to be a detailed chronology.
20. Ms X’s mother Mrs Z had dementia and other health conditions.
21. In early 2024, Mrs Z received free discharge to assess care following her discharge from hospital, funded by the NHS. Due to changes in Mrs Z’s health conditions and wellbeing, she was referred to the Council’s adult social care department for a care needs assessment to assess any ongoing long-term care and support needs. Prior to Mrs Z’s hospital admission, she had no package of care and was supported by Ms X.
22. In March 2024 the Council social worker visited Mrs Z to complete a care needs assessment. Records of this assessment showed that:

• There were no concerns about Mrs Z’s capacity to make decisions related to her wellbeing.
• The social worker discussed the Council’s financial threshold and the financial assessment process; Mrs Z said she would need Ms X’s support with this.
• Ms X previously supported Mrs Z full time as an informal carer before her hospital admission but it was recorded that she was no longer able to do so due to the “demands of Mrs Z’s behaviours”.
• They recommended a package of care and advised that a financial assessment would be sent out to Mrs Z for Ms X to support her with.

23. In early April 2024 the Council records showed that it sent the financial assessment forms to Mrs Z. The Council also sourced a provider and Mrs Z’s care package with this provider began.
24. As the Council had not received a completed financial assessment form it invoiced Mrs Z for the full cost of her care package. In May 2024 Ms X said, after failing to make contact with the Council, she emailed its debt team to say that they had received an invoice from the Council requesting payment for Mrs Z’s care. Ms X said that she was told that the care would be free. She also added that the Council was going to send the financial assessment form in March, but she had not seen this likely because Mrs Z usually discarded post she received. She asked the Council to send the financial assessment form directly to her. The Council sent the form to Ms X.
25. In mid-June 2024 the Council social worker visited Mrs Z and Ms X to review Mrs Z’s package of care. The notes of this visit showed that:

• Ms X confirmed that Mrs Z required ongoing formal care. It was noted that she said Mrs Z’s package of care was a relief and had reduced her responsibilities allowing her to continue with her informal support for Mrs Z when needed. Ms X was happy with the care provider and it was noted that no changes were required at the time.
• The social worker told Mrs Z and Ms X that ongoing long-term care may not be free and that if Mrs Z had savings below the threshold then a financial assessment would need to be completed to determine Mrs Z’s contribution towards her care package. Ms X said that they were in contact with the finance team who were completing Mrs Z’s financial assessment.
• Ms X provided informal support to Mrs Z with her finances.

26. In mid-June 2024 the Council received a completed statement of financial circumstances (SFC) form from Ms X.
27. In late June 2024 the Council wrote to Mrs Z to say that it had completed the financial assessment and assessed her contribution towards her care as £198.65 per week, in line with its charging policy and the information Ms X had provided. A copy of this letter showed a summary of its calculations based on the figures Ms X had provided in the SFC form.
28. In late June 2024 Ms X contacted Mrs Z’s social worker and said that they had received an invoice for care changes – she said that the Council’s financial assessment was not correct. Mrs Z had less than £10,000 in her bank so she could not afford to pay the requested amount. She asked to speak someone from the finance team. Mrs Z’s social worker passed this message to the finance team asking for someone to contact Ms X to discuss the financial assessment.
29. In late July 2024 the Council wrote to Mrs Z (following a reassessment) and said that Mrs Z’s contribution towards her care was £142 per week. A copy of this letter showed a summary of the Council’s calculations.
30. In late July 2024 the records noted that Mrs Z contacted the Council to say that she wanted to cancel her current package of care. She felt she was able to independently complete tasks and due to finances.
31. The Council social worker contacted Mrs Z to further discuss her wish to cancel her care package. Mrs Z said she could not afford to pay the carers and that “they were not doing anything or attending.” The social worker sought Mrs Z’s permission to speak to Ms X to discuss this which she agreed to.
32. The Council social worker contacted Ms X the next day. Ms X said that Mrs Z had dementia and could not remember if carers had visited. Ms X explained that the concern was not with the care but the cost of that care; Mrs Z did not have enough money to cover her outgoing expenses and contribute towards the cost of her care. Ms X also raised concerns about the impact of Mrs Z’s dementia on household tasks and personal care. She added that she had made many attempts to get clarification on the care charge invoices but there had been no resolution thus far. She requested that all correspondence from the Council regarding Mrs Z was sent to her as Mrs Z would throw away the post.
33. In late July 2024 the Council’s finance team contacted its adult social care team to provide clarification on the invoices. Records of this contact showed that:

• It assessed Mrs Z’s finances in June 2024 which resulted in a client contribution of £198.65 per week, backdated to April 2024. It then completed a re-assessment in July 2024, backdated to April 2024, which resulted in a client contribution of £142 per week – it said the adjustments would show on the next invoice.
• Financial assessments were based on Mrs Z’s income, savings and expenses unless these were above the threshold; having savings below the threshold did not mean that there would be no charge.

34. The Council emailed the above information to Ms X on the same day. In the email, the Council:

• Clarified the cost of Mrs Z’s care and her contribution towards that cost.
• Reiterated that the client contribution was calculated using Mrs Z’s income and that it was not solely based on her savings.
• Explained that the only way to decrease the costs would be to significantly reduce Mrs Z’s package of care, however it was important to assess the impact this would have on both Mrs Z and Ms X because Ms X had said that she had reached the limits of her capacity to support Mrs Z.
• Advised that it could undertake a tailored assessment if Mrs Z had any disability related expenses.
• Advised Ms X to contact the finance team to explore options for a payment arrangement and that she considered setting up a direct debit to manage future invoices. It also told Ms X that all further invoices would be sent to her.

35. In early October 2024 Ms X contacted the Council to say she did not agree with the client contribution it had asked Mrs Z to make. The Council records showed that its finance team spoke with Ms X who was unhappy with client contribution amount. It told her it had been completed based on the information she had provided the Council. The finance team noted that it had asked Ms X if Mrs Z had any disability related expenses to which Ms X advised that she had already completed all the related forms and that she did not have anything to add.
36. In November and December 2024 Ms X contacted the Council’s debt team about the care charges. The Council noted Ms X said Mrs Z did not have the funds to pay for her care, and she said they did not ask for carers. Ms X said she did not understand why Mrs Z needed to pay when she was under the threshold. She added that no payments would be made and if that “meant carers would be stopped, so be it.” The debt team forwarded Ms X’s email to the finance team and said that they could see adjustments in charges on Mrs Z’s account in July and August 2024. They queried if a reassessment was needed.
37. In January and February 2025 Ms X contacted the social worker and the debt team and reiterated her concerns about the care invoices. She said they had received a final reminder for payment. Mrs Z was also admitted to hospital; it was noted that Mrs Z’s needs had increased and Ms X was concerned about Mrs Z’s ability to manage at home with the previous package of care. The Council completed a mental capacity assessment which concluded that Mrs Z lacked insight into her care needs and was unable to make informed decisions about her care and discharge. It was agreed that Mrs Z would be discharged to a care home and Ms X was told that a new financial assessment form would be sent to her.
38. In early March 2025 Ms X complained to the Council. She complained that:

• She was told that Mrs Z did not need to pay towards her care as she was below the threshold. She did not understand why Mrs Z was being charged.
• Mrs Z was not able to pay the client contribution and clear the outstanding debt of approximately £6000.
• The Council’s communication was poor – it kept telling her that someone would call her but no one did.

39. In early March 2025 the Council contacted Ms X to discuss her complaint following which it sent her an email. A copy of this email showed that the Council:

• Contacted its finance team to share the additional expenses Ms X had disclosed on the call.
• The finance team confirmed that many outgoings were not counted against the means testing and reiterated that Mrs Z’s client contribution was £142 per week.
• Said it had requested another reassessment

40. Ms X replied to the Council’s email and continued to disagree with the assessment. She added that she spoke to someone in the finance team in September 2024 that she did not agree with any payments being made and “if that was the case, then to stop the carers.”
41. The Council replied to Ms X and said that it acknowledged that she did not agree with the current assessed contribution therefore it had requested an additional assessment taking into account the expenses Ms X had highlighted recently. It said that if the debt remained after the new financial assessment, then it was happy to look into the possibility of payment plans.
42. The next day the Council’s finance team contacted adult social care following the reassessment. It said Mrs Z’s new client contribution would be £145.63 per week and that it could do a tailored assessment which would include costs such as taxis to hospital appointments, extra washing etc but it would need bank statements to show these expenses.
43. In late March 2025 the Council issued a complaint response. In this response the Council:

• Noted that Ms X had spoken to an officer about her complaint earlier that month.
• Explained that the package of care Mrs Z received after being discharged from hospital in early 2024 was initially arranged and funded by the NHS (therefore, free) – such packages were a short term and temporary intervention to allow a needs assessment to take place once the person’s needs were more established and stable. This package of care was adjusted many times before Mrs Z was referred to adult social care as it was noted she likely needed long term services due to not being able to independently manage tasks at home.
• Explained that it had allocated a social worker, carried out a needs assessment and recommended a package of care that was agreed by both Mrs Z and Ms X. It was also noted that Ms X was consulted and communicated with throughout the process and that this care package offered her “peace of mind” as she had been Mrs Z’s sole carer.

44. Regarding the financial assessment, the Council said:

• It sent the financial assessment paperwork to Mrs Z in March 2024 but this was not returned to the Council. Therefore, as per the Council’s process, Mrs Z was treated as a “full cost” service user and was billed accordingly. It added that the initial paperwork it sent was likely lost so another was sent out in May and the bills were held until the completed form was returned.
• Notes of a care review in June 2024 showed that Mrs Z and Ms X were happy with the care Mrs Z was receiving and for it continue. Records also showed that finances were discussed, and it was explained that the care might not be free and charges would depend on the outcome of the financial assessment.
• It assessed the SFC form Ms X sent in late June 2024 and sent a letter to Mrs Z confirming her assessed client contribution. It reassessed Mrs Z’s contribution in late July 2024 to £142 per week and advised that the debt would be recalculated to reflect the updated amount. Ms X was informed via email the same day.
• It acknowledged that Ms X put in significant effort and time to explain their situation to social care workers and the finance team between end of June to mid-July 2024. It accepted that this was frustrating for Ms X and it apologised that the situation had remained unresolved at the time.
• It noted that Ms X continued to have contact with individuals from the finance team, social work frontline support and the debt team between October and December 2024. It noted that Ms X made it clear that Mrs Z’s savings were not enough to cover the assessed client contribution.
• It explained that Mrs Z had less than the capital threshold limit of £23,250 and therefore her savings were not taken into account in determining the client contribution. However Mrs Z’s income was considered and when outgoings and disregards were applied, £142 per week remained which was her contribution towards her care costs. It said the calculations were included in the letters sent by finance.
• It reiterated that the figures used to calculate Mrs Z’s contribution were collated through submitted documents and a completed SFC. No figures used were estimated. The cost of care the Council charged Mrs Z for was in line with its charging policy.
• It confirmed the outstanding care costs and told Ms X it was happy to discuss a payment plan.

45. Ms X was unhappy with the Council’s response and complained to us.

Findings

Financial assessment

46. Records showed that the Council sent the financial assessment/SFC forms to Mrs Z in early April 2024 before her care package began. Because the Council did not receive the completed SFC form, it wrote to Mrs Z with the full cost charge in May 2024 which was in line with its published policy. This was not fault.
47. When Ms X queried the full cost invoice, the Council resent the forms which Ms X returned in June 2024. The Council completed a reassessment soon after and revised the contribution. It wrote to Mrs Z in July 2024 to confirm the new client contribution of £142 per week backdated to April 2024 when Mrs Z’s care package started.
48. The Council’s care charge letter provided a summary of calculation that showed how it worked out Mrs Z’s client contributions, in line with the statutory guidance, using the information Ms X provided. It left her with an amount in line with the minimum income guarantee set by the Government. The Council also emailed Ms X at the end of July 2024 to say that having savings below the threshold did not mean that there would be no charge to pay. There was no fault in how the Council assessed and explained Mrs Z’s care charges.

Communication

49. Ms X said they were told that Mrs Z would not need to contribute towards her care costs. However, the Council records showed that social workers told Mrs Z and Ms X that a financial assessment was needed and that depending on the outcome of this assessment, Mrs Z may need to pay towards her cost of her care. The Council’s communication of this matter was without fault.
50. The Council acknowledged that Ms X spoke to many individuals from different departments between late June to mid-July 2024 regarding the care charges but remained without a resolution; it apologised for this. However, the records showed that the Council repeatedly explained that having savings below the threshold did not mean care would be free.
51. The records showed Ms X was happy with the care but not its cost. Councils are entitled to charge for care and the Council charged in line with the law and statutory guidance. While Ms X told the Council that she did not agree with any payments being made and “if that was the case, then to stop the carers”, there is no evidence she followed this through and/or insisted that the care be stopped.
52. The Council could not have cancelled Mrs Z’s package of care at Ms X’s request because it had a legal duty to ensure Mrs Z’s assessed needs were met. The Council could have only cancelled Mrs Z’s care package if she wanted the Council to and if it was satisfied that she had the capacity to make decisions about her care, and it was satisfied the care would be provided from elsewhere. Mrs Z continued to receive care and Ms X was aware that this was at a charge. The Council was not at fault.

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Decision

53. I found no evidence of fault.

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Investigator's decision on behalf of the Ombudsman