Summary: Mrs B complains about invoices relating to adult social care support. Mrs B says the Council sent her an invoice late in 2023 and that there were multiple and repeated errors in the invoices from 2024. We have found fault in relation to the late invoice but there were no errors in the later invoices. The Council has agreed to apologise and to carry out a service improvement.

The complaint

1. Mrs B complains on behalf of her mother, Mrs C. She says the Council sent an invoice late in 2023 and that there were a ‘magnitude of errors’ in the invoices from 2024 which meant that Mrs C was charged an additional £5,000.

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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. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. 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

5. I have discussed the complaint with Mrs B. I have considered the evidence she and the Council have sent and relevant law, policy and guidance. Mrs B and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.
6. The complaint about the late invoice relates to an event that took place in 2023, when Mrs B received the invoice. I have exercised discretion in Mrs B’s favour to investigate this complaint even through it related to an event that happened more than 12 months ago. I did so because the Council had investigated the complaint as part of Mrs B’s other complaints which she started in 2024 and which related to invoices from 2023 onwards.

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What I found

Law, guidance and policies

Care Act 2014

7. The Care Act 2014, the Care and Support Statutory Guidance 2014 and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.
8. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs and a personal budget which sets out the costs to meet the needs.

Financial assessment

9. Councils must carry out a financial assessment if they decide to charge for the care and support. This will assess the person’s capital and income.
10. The Care Act and the CASS Guidance do not specify a timescale when the financial assessment should be completed. The Ombudsman considers it is good practice for the financial assessment to be completed around the same time as the care plan so that people know what their contribution from their income will be towards the cost of the care and can make informed decisions about which care package to choose.

Capital

11. The upper capital limit is currently set at £23,250. Generally speaking, people with capital over £23,250 will need to self-fund their care and will not be eligible for local authority funded care. When a person receives care at home (non-residential care), their main and only home will not be included in the calculation of capital.

Income – residential accommodation (care/nursing home)

12. If a person is living in residential accommodation, the local authority must leave the person with a minimum amount of income. This is known as the Personal Expenses Allowance (PEA) and the amount is set out in regulations and updates sent via a local authority circular. Anything above this may be taken into account in determining charges.

Temporary stay at a care home

13. Where a person is a temporary resident there is a degree of discretion or modified charging rules to take account of this.
14. A temporary resident is someone whose stay in a care home is unlikely to exceed 52 weeks or, in exceptional circumstances, is unlikely to substantially exceed 52 weeks. Because a temporary resident is expected to return home their main or only home is usually disregarded in the assessment of whether and what they can afford to pay. In addition, for example, certain housing-related costs are also disregarded in the financial assessment.
15. Income and earnings should be treated in the same way as for permanent residents. However, any additional amounts the person may need so they can maintain their home during their temporary stay so that it is in a fit condition for them to return to must be disregarded. 

Council’s charging policies

16. The Council’s charging policy for residential care says:
• A full financial assessment will be carried out for respite/temporary services. Ther may be additional sums allowed as part of the financial assessment for ongoing home expenses.
17. The Council’s charging policy for non-residential care says:
• A reassessment of charges will be carried out annually to re-calculate contributions. Additionally, a financial reassessment will be carried out whenever there is a change in circumstances.
• Service users who have a change in their financial circumstances must inform the Financial Services Team and a reassessment will be undertaken.

What happened

18. Mrs C is an older woman who has needs for care and support. In 2020 Mrs C had a fall and fractured her hip. Following her discharge from hospital, she moved back into her property with a package of care funded by the Council.
19. Mrs C’s physical and mental health deteriorated in the following months and the Council re-assessed Mrs C in February 2021 and it was agreed that Mrs C would move into a care home on a temporary basis. A re-assessment would take place to decide the permanent plan for Mrs C.
20. Mrs C moved into the care home on 20 February 2021. Mrs C’s family was informed that the care package was chargeable and a financial assessment would be carried out. The social worker re-assessed Mrs C on 31 March 2021 and different options such as extra care housing were being considered. The social worker sent the leaflets about the charging to Mrs C in March 2021.
21. The Council carried out a financial assessment of Mrs C on 8 September 2021 and changed her status from temporary to permanent. The Council informed Mrs B of the charges. Mrs B informed the Council that Mrs C’s property was transferred to her about 4 or 5 years ago. The Council informed Mrs B that it did not include the property as capital in temporary accommodation but may look at the details of the transfer if Mrs C was permanently in the care home.
22. Mrs B told the Council that the family had decided that Mrs C would come home to live at Mrs B’s address. Mrs B was in the process of selling Mrs C’s property and an extension (‘granny flat’) would be built to Mrs B’s home where Mrs C could live. Mrs C would continue to live at the care home until the extension was completed.
23. The Council’s financial assessment showed the following:
• 20 February 2021. The weekly contribution was £181.64. The Council assessed Mrs C as a temporary resident and deducted running costs for Mrs C’s property as expenditure.
• 12 April 2021. The weekly contribution was increased to £185 as there were slight changes in income and expenditure.
• 27 September 2022. The weekly contribution was increased to £221 as the Council assessed Mrs C as a permanent resident. The Council did not deduct running costs for Mrs C’s property as expenditure.
24. The Council re-assessed Mrs C’s needs and agreed that Mrs C should remain as a permanent resident at the Home until the extension was built.
25. The Council sent an invoice of £2,960 to Mrs B on 4 October 2021 and Mrs B paid the invoice. After that date the Council started sending monthly invoices to Mrs B.
26. On 16 February 2023, the Council wrote to Mrs B and said:
• It had noticed an error in its charging as it had undercharged Mrs C £709.73.
• These charges related to the time from 20 February to 30 May 2021.
• The Council apologised for not informing Mrs B earlier but said it was working through a substantial caseload caused by the COVID-19 pandemic and a new case management system which caused delays in the invoicing process.
27. The Council said its next invoice would be for £1,471.17 and this would include the charges from 20 February to 30 May 2021.
28. Mrs B contacted the Council as she questioned why it had taken so long for the Council to inform her of the charges. The Council explained the reasons and Mrs B said she understood. Mrs B said she did not want the extra charge to be deducted by direct debit. The Council agreed to suspend the direct debit for one payment as Mrs B said she would make the payment using a different payment method.
29. The Council re-assessed Mrs C’s needs for care and support in July 2023 as the construction of the extension had been completed. The plan was for Mrs C to move out of the care home and into the extension. The Council proposed a care plan of four visits by a care worker a day.
30. Mrs C moved out of the care home in August 2023.
31. Mrs B started to raise questions about the invoices in October 2024 as she was concerned that Mrs C was being charged twice for the same time-period. She noted that the Council was charging Mrs C for backdated payments which Mrs C had already paid. Mrs C was worried that Mrs C was paying twice for the same care.

Mrs B’s complaint – March 2025

32. Mrs B complained to the Council in March 2025 and said:
• In relation to Mrs C’s stay at the care home, Mrs B said the social worker told her there had been an error and because Mrs C stayed in the care home a lot longer than expected (because of delays in building the extension), her stay at the care home had been considered as permanent. Mrs B said she received a request for a large back payment in 2023 because of this and she paid this.
• When Mrs C moved out of the care home, the Council re-assessed her finances and told her what the contribution would be. However, she then received a letter from the Council in April 2024 to say that its original financial assessment was incorrect and Mrs B had to pay additional moneys to compensate for the mistake.
• Mrs B had paid all the invoices but said Mrs C had been charged an extra £5,176 because of the Council’s ‘magnitude of errors’.

Council’s response – April 2025

33. I have summarised the Council’s response to Mrs B and the Ombudsman. In relation to the additional charges for the care home stay, the Council said:
• The additional invoice dated February 2023 of £1,471.17 related to the normal monthly charge for January 2023 (£190.36 x 4 = £761.44) and the contribution from 20 February to 30 May 2021 - £709.73.
• The Council said there had been an error in the calculation of the contribution from 20 February to 30 May 2021. This should have been £2,618.38, not £709.73. The Council provided the correct calculation.
• However, the Council agreed to write off £1,908.65, so Mrs C only had to pay £709.73. She also still had to pay the monthly charge for January 2023 (£761.44). So the total of £1,471.17 remained payable.
• The Council explained the reason for the delay in sending the invoice. The Council started its new finance case management system on 30 May 2021 so its initial invoice to Mrs C was from 30 May 2021 onwards. Any charges before that date were added to a spreadsheet to be calculated and added manually. The COVID-19 pandemic and the implementation of the new system led to large backlogs which took a long time to clear. This was the reason why the Council did not charge Mrs C for the time from February to May 2021 until February 2023.
• The Council confirmed that the charge did not relate to the change in Mrs C’s status from temporary to permanent. Mrs C was charged as a temporary resident from January to September 2021 and as a permanent resident from September 2021 until August 2023.
34. In relation to the contribution once Mrs C left the care home, the Council said:
• The Council reviewed Mrs C’s financial assessment on 22 April 2024. The Department for Works and Pensions (DWP) informed the Council that Mrs C had been awarded Pension Credit on 26 February 2024 and this had been backdated to 28 August 2023.
• So the Council re-assessed Mrs C’s finances and, as her income had increased, this led to an increase in the contribution. The Council backdated the increase to 9 October 2023, 6 weeks after the date of the Pension Credit award, in line with the Council’s policy.
• Mrs C then contacted the Council on 29 May 2024 and said Mrs C’s Pension Credit was only £10.97 per week so the Council’s financial assessment was wrong. The Council contacted the DWP again and the DWP told the Council that Mrs C’s Pension Credit was reduced on 12 May 2024 because Mrs B had started to claim Carer’s Allowance. The DWP had backdated this reduction in Pension Credit to 19 February 2024.
• Therefore the Council had to re-assess Mrs C’s finances again taking into account the new figures provided by the DWP so Mrs C’s contribution reduced from £130.60 to £69.77 backdated to 19 February 2024. The review resulted in a credit which the Council applied to Mrs C’s charges from April to May 2024.

Analysis

35. I note that Mrs C moved into the care home in February 2021 but the financial assessment did not take place until September 2021 so there was fault in that respect. I accept that the move was temporary, but Mrs C should still have had a financial assessment so she could make an informed decision.
36. There was then further fault as the Council did not send the invoices from February to May 2021 until February 2023. The Council has explained why the delay in sending invoices happened, and I accept that some delay can be attributed to the COVI-19 pandemic but the fact remains there was fault.
37. I find no fault in relation to the later changes in the invoices in 2024. It is true that the Council re-assessed Mrs C in April 2024 and increased the contribution and then re-assessed her again in May 2024 and decreased the contribution.
38. But that is normal practice. The Council had a duty to carry out a financial assessment of Mrs C as her financial circumstances had changed. The assessments were correct, based on the information the Council had received at the time, but Mrs C’s financial circumstances changed twice so therefore two re-assessments were required. That is not evidence of fault, but simply evidence of Mrs C’s changing circumstances.

Injustice and remedy

39. I have considered whether Mrs C or Mrs B suffered any injustice as a result of the fault I have identified and, if so, what the remedy should be. The aim of the Ombudsman’s remedy is to put the complainant in the position they would have been if the fault had not happened.
40. The fault I have identified is a delay in the financial assessment and a delay in the invoice. I note that there is no direct financial injustice as a result of the fault. If the Council had done everything right, it would have carried out the financial assessment sooner and it would have sent the invoices sooner. But Mrs C would still have had to pay for the care that she received.
41. There are circumstances, sometimes, where complainants would have made a different choice in care planning if they had known what the charges would be, but that is not the case for Mrs C. The plan was always for Mrs C to go into the care home, initially on a temporary basis and then to remain there until the extension was built.
42. Councils should always aim to send invoices as soon as they can and on a regular basis so I accept that receiving the 2021 invoice in 2023 may have caused some distress which is the main injustice.
43. However, I also note that the Council has, in effect, waived charges of £1,908.65 for care that was received in 2021 so I do not propose any additional financial remedy for the fault I have identified. The Ombudsman does not normally recommend that a Council waives charges for care that has been received. In the end, Mrs C was only charged £709.73 for her stay from February to May 2021 and that is sufficient financial remedy.
44. I will add a recommendation that the Council should remind staff of the importance of completing financial assessments and invoices in a timely manner.

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Action

45. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise to Mrs B in writing for the fault I have identified.
• Ensure all relevant staff understand the Council’s duty to carry out financial assessments and send out invoices in a timely manner. It will provide training or guidance as needed.
46. The Council should provide us with evidence it has complied with the above actions.

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Decision

47. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman