Summary: Miss X complained the Council has wrongly assessed that she has to pay a significant charge for her care which she cannot afford. She complained the Council is also seeking to recover backdated charges. Miss X says this has led her to cancel the care provider so she is now without any care. In addition Miss X complained the Council failed to ensure care provided by the care provider was adequate or appropriate. We found the errors in the Council’s financial assessment are fault. The failings in the care and support provided by Company Z is also fault. The Council has apologised and made an appropriate offer to remedy the injustice caused.

The complaint

1. Miss X complained the Council has wrongly assessed that she has to pay a significant charges towards the cost of her care which she cannot afford. Miss X says this has led her to cancel the care provider so she is now without any care.
2. Miss X also complained the Council is wrongly seeking to recover backdated charges for her care between 2019 and 2024. Miss X says she was unaware of the contribution until 2024 and would not have accepted the care package if she had known about the contribution.
3. In addition Miss X complained the Council failed to provide a Care Act advocate to assist her with care assessments so she did not receive the right support. And that the Council failed to ensure care provided by the care provider was adequate or appropriate.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. 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.
7. 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)
8. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

9. Miss X complained about failings in her care package and the information and support the Council has provided since 2018, but I have not investigated this full period.
10. As set out above, we expect people to come to us within 12 months of them thinking the Council has done something wrong. As Miss X contacted us in June 2025 we would generally only consider events since June 2024.
11. We have discretion to consider events outside this 12 month timeframe if there are good reasons for doing so. I have exercised discretion to consider events in the few months before June 2024, but do not consider it appropriate to exercise discretion beyond that. It was open to Miss X to raise her concerns about the care provider sooner. I recognise Miss X would need support in raising her concerns, but note that she has had access to support from an independent living support worker for significant periods since 2019. I am also mindful that Miss X has previously made a complaint to the Ombudsman in relation to a different issue, so was aware of and, with support, able to use our service.

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How I considered this complaint

12. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
13. Miss 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

Care and support

14. 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.
15. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. One of the ways a personal budget can be administered is through direct payments. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. 
16. 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)
17. Where a council has decided to charge for care, it must carry out a financial assessment to calculate how much an individual should contribute to the cost of their care. The assessment must comply with the principles in law and guidance, including that charges should not reduce a person’s income below the Minimum Income Guarantee (MIG). This is set by national government and reviewed each year.
18. If a person incurs expenses directly related to any disability he or she has, the Council should take that into account when assessing his or her finances. This is called disability related expenditure (DRE).
19. The Care and Support Statutory Guidance sets out key principles the councils should take into account when making decisions on charging. The principles include that the approach to charging should be clear and transparent, so people know what they will be charged.

What happened here

20. The following is a summary of the key events relevant to our consideration of the complaint. It does not include everything that happened.
21. Miss X has eligible care needs and has received a package of care and support since 2018. This was initially arranged by the NHS and then transferred to the Council in 2019. Miss X had six hours each week to support her with her correspondence, appointments, shopping and social activities.
22. The Council completed a financial assessment in April 2019 and determined Miss X would not have to pay a weekly charge for her care. It says it reviewed this annually, but Miss X disputes this.
23. The Council wrote to Miss X on 25 March 2024 with an annual review of her assessed weekly charge with effect from 8 April 2024. The Council calculated Miss X had to pay £0.00 per week. It asked Miss X to check the Council’s calculation sheet was correct and to inform it immediately if the information was incorrect of her circumstances had changed. Miss X says she did not receive this letter.
24. Miss X complains the care providers, Company Z did not provide her with appropriate care or meet her needs. Miss X says carers sometimes missed visits or did not stay for the full session and were not always able to support her wellbeing activities. The Council discussed the support Miss X received with Miss X, her independent living support worker, and Company Z separately in March 2024. It identified that Company Z and Miss X’s independent living service appeared to be duplicating support.
25. The Council reviewed Miss X’s care needs in May 2024. Miss X’s independent living support worker attended the review meeting with her. The review document notes Miss wanted to be supported to complete domestic tasks around the home which cause her pain and fatigue. And to engage in activities and hobbies in her local area. Miss X did not consider the support provided by Company Z adequately met her needs or recognised the influence of her medical conditions and diagnosis on her ability to carry out tasks.
26. The review also notes Miss X was happy with six hours support but wanted more consistency of carers and the flexibility to change the support days if she had appointments. She wanted to change from a commissioned service to a direct payment or to change the current care provider to one who understood her needs.
27. Miss X asked for more information about direct payments and met with a social worker and a direct payments advisor in early June 2024. The records of this meeting show Miss X again raised concerns about Company Z’s carers arriving at the wrong time, not completing sessions and not being supportive of her needs. Miss X also told the advisor Company Z rarely responded to her emails and communication was poor.
28. The advisor agree to discuss the issues with Company Z and see whether it was possible to change providers while Miss X considered hiring a personal assistant via direct payments
29. The Council subsequently agreed to source a new care provider and end Miss X’s care package with Company Z. The Council’s records say it gave Company Z 28 days’ notice on 21 June 2024 so the care package would end on 19 July 2024.
30. On 24 June 2024 the Council reviewed Miss X’s care charges and assessed she should pay £42.92 per week with effect from 8 April 2024. It said it would send Miss X an invoice for the period 8 April 2024 to 9 June 2024 in the sum of £386.28 and would then send monthly invoices.
31. Miss X challenged this charge which she told the Council she could not afford. Miss X said she was not aware she would have to pay a charge and would have cancelled the care package months ago if she had known. Miss X also disputed the figures used in the financial assessment regarding her savings and DRE. She said she had never been asked to fill in any forms regarding her finances.
32. The Council asserted Miss X had been informed of the care charges and had a financial assessment in 2019. It recommended Miss X contact the financial team to discuss the care fees. The Council also confirmed it had identified a specialist provider who could begin supporting Miss X in September 2024. The Council would arrange interim support to cover the period between July, when Company Z’s supported ended, and September 2024.
33. On 28 June 2024 Miss X told the Council she did not want Company Z to support her anymore. She said she could not afford any care so could not have a new or interim provider.
34. The Council wrote to Miss X on 1 July 2024 explaining it had had to reassess her contribution as it had recorded an incorrect lower amount of universal credit than Miss X was receiving for a significant period. Miss X was not the only person affected in this way. The Council had now updated Miss X’s universal credit to reflect the correct amount she received which had resulted in a care charge of £42.92 per week.
35. However, since that calculation the Council said it had received clarification that Miss X’s child was now 18 and no longer lived with her. The Council had therefore recalculated the weekly charge as a disregard of a dependent child allowance premium of £101.25 was no longer applicable. It said the correct weekly charge now exceeded the cost of Miss X’s care package of £130.08, so Miss X would be charged £130.08 per week backdated to 8 April 2024.
36. The Council provided a calculation sheet showing how it had assessed the charge. It advised Miss X if the expenditures were incorrect she could provide documentation to support this and it would reassess. It also asked for details of Miss X’s gas and electric charges to use in the assessment.
37. In addition the Council confirmed that as a result of the recalculation, the outstanding charges now totalled £1,170.72 for the period 8 April 2024 to 9 June 2024. It said Miss X’s social worker would arrange a meeting to discuss these charges.
38. Miss X contacted an advocacy agency for support. She also asked the Council to immediately end the care package with Company Z. This service ended on 4 July 2024.
39. Miss X and her independent living support worker met with her social worker on 10 July 2024 to discuss the package of care. The social worker agreed to inform the financial team of Miss X’s difficulties in paying the care charges and closed her social care case.
40. The Council subsequently confirmed it would review the charges and asked Miss X to confirm when she first raised concerns to Company Z about the quality of its service. Miss X said the care package had not been what she was told it would be from the outset and that she would need support to go through years of emails and texts. She said the main issue was that she was not told about the care charges at the start.
41. Miss X reiterated that had she been told she would have to pay she would not have agreed to a care package from the start. She said it was not explained during the assessment and she was not offered any help to understand. Miss X asked for the matter to be escalated to a formal complaint.
42. The Council responded to Miss X’s complaint in October 2024. It noted Miss X’s complaints as:
• Company Z did not meet her eligible care and support needs
• She was not informed of the need to pay an assessed weekly care charge
• She had not received annual review letters until this year;
• The care needs assessments do not accurately reflect her care and support needs as they fail to take account of her medical conditions.
43. It noted Miss X’s independent living support worker told the Council in March 2024 that Miss X was not happy with the care and support provided by Company Z. As a result the social worker arranged an unscheduled review, which took place in May 2024.
44. The Council said it investigated Miss X’s concerns and ended the package of care with Company Z. It acknowledged Company Z had failed Miss X and the care and support it provided was not of the standard she was entitled to expect or that the Council requires. The Council apologised for the distress caused.
45. It also noted Company Z had apologised and had said it would learn from the situation and provide staff training and supervision where appropriate.
46. In relation to the care charges, the Council noted Miss X’s package of care had started on 8 October 2018 and that on 2 October 2018 she had signed a request for a financial assessment. An officer then visited Miss X at home in April 2019 to complete the financial assessment. The Council said that over the next three years it sent Miss X annual review letters confirming the assessed weekly care charge.
47. On this basis the Council was satisfied the assessed weekly charge should be paid and that the sum of £1,635. 29 remained due and owing. However it offered to reduce this sum by 50% (£817.65) to reflect the lack of care and support provided by Company Z and the distress caused.
48. Miss X’s advocate wrote to the Council asking to discuss the matter further. Miss X did not feel she was liable for the charges as she was unaware they were payable and was not in a contract to so. The advocate also noted Miss X did not have an advocate during the assessments when she was entitled to one. They said the Council was aware of Miss X’s circumstances and that she had told the Council many times that Company Z were unsuitable, but they were still allocated to her.
49. In its response the Council confirmed the financial assessment was completed in accordance with the Care Act 2014 and statutory guidance. It did not accept that Miss X was not aware of the need to make a payment towards her care and support. The Council considered the financial assessment was accurate and as it had already reduced the debt by 50% was not prepared to reduce it further.
50. The Council also confirmed that people with a commissioned package of care and support are not provided with a copy of the contract as this is a legal document between the Council and the care provider.
51. In relation to the question of a Care Act advocate, the Council noted Miss X’s independent living support worker attended the last care review. It said Miss X did not meet the criteria for a Care Act advocate as the support worker attended and could ensure Miss X was fully involved in and understood the assessment. It said that if Miss X met the criteria in the future the Council would provide an advocate.
52. The Council chased payment of the charges in January 2025, and in late April 2025 told Miss X it had now passed the debt to its legal team for recovery.
53. Miss X has asked the Ombudsman to investigate her concerns. Miss X says she still has care needs but does not have any support as it is unaffordable and she no longer trusts the Council or adult care services.
54. In response to my enquiries the Council has provided copies of Miss X’s care and needs assessments and reviews, support plans, and financial assessments. It acknowledges its records so not contain a specific entry regarding the consideration of advocacy. It says this appears to be a reflection of Miss X’s level of engagement with Adult Social Care. The Council says that during previous assessments Miss X demonstrated a clear ability to understand, retain and weigh information through her active participation and ability to articulate her views. It says that as Miss X did not appear to face ‘substantial difficulty’ in representing her own interests and it did not identify any significant communication barriers, it determined the criteria for a statutory advocacy referral were not met.
55. The Council has also confirmed the outstanding care charges relate to the period 8 April 2024 to 4 July 2024. This is a period of 12 weeks and four days at a rate of £130.08 per week, which gives a total of £1,635.29. It has agreed to waive 50% so the balance is £817.65.

Analysis

56. The Ombudsman does not act as an appeal body. It is not the Ombudsman’s role to decide whether Miss X should pay for her care, or how much she should pay; that is the Council’s job. We can only consider whether the Council completed the financial assessment correctly. We cannot criticise a council where officers have followed the correct procedures and reached a reasoned decision.
57. Although Miss X complained the Council is now seeking to recover charges for her care between 2019 and 2024, the documentation shows this is not the case. The Council has only assessed Miss X needs to pay a weekly charge from April 2024. It is not seeking retrospective payments for earlier years. The Council assessed Miss X’s charge as nil between 2019 and March 2024 and has not changed this.
58. Miss X says she cannot afford the charges and cancelled the care package as soon as she was aware of the cost. This meant there were no further charges but has left Miss X with a bill for the period 8 April to 4 July 2024.
59. The Council completed the annual review in March 2024 using information it already held about Miss X’s finances and circumstances. The Council subsequently identified it had used incorrect figures for Miss X’s benefits and had wrongly allowed a disregard for her child. The errors in assessing Miss X’s care charges are fault. The Council should have been aware the dependent child allowance premium had not been applicable for some time and should have ensured it was using accurate benefit figures.
60. These errors have led to arrears in Miss X’s care charges. Had the errors in the calculation been identified sooner it is likely Miss X would have cancelled the care package sooner and would not have incurred this level of debt.
61. However, I do not consider this automatically means the Council should not recover these care charges.
62. I am mindful that the Council asked Miss X to check the information used in the annual review calculation in March 2024. It also asked her to inform the Council if the information was incorrect or her financial circumstances had changed. There is no record Miss X responded to the annual review or corrected any of the figures used. Miss X would have been aware of the benefits she received and could have corrected the figures at that stage. Miss X would also have been aware that her child had not lived with her for several years.
63. This would have prompted the Council to reassess the care charges and Miss X would have known sooner that there would now be a cost.
64. Miss X also disputes the sums used for her DRE but has not provided any additional information regarding the cost of her specialist diet or any other expenses related to her needs.
65. The Council has offered to reassess the charges but is unable to do so unless and until Miss X provides details of her finances and her current DRE. If Miss X was able to evidence other DRE it is possible this would reduce her charges/ the debt.
66. In the circumstances I would not expect the Council to waive the care charges in full as Miss X requests.
67. Miss X says she has complained about the support Company Z has provided since the package was first set up in 2018. However as set out above, I am only considering events since 2024.
68. When a council commissions another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. In this instance the Council commissioned Company Z to provide Miss X’s care and support. We would therefore treat any failure by Company Z’s to provide appropriate care and support to be fault by the Council. And would expect the Council to take action to address this.
69. When Miss X’s support worker raised concerns about her care package and Company Z’s support in 2024, the Council investigated Miss X’s concerns. It accepted there were failings in the service and agreed to change care providers.
70. The Council has also apologised that Company Z’s care and support was not of the required standard. And has offered to waive half of the charges to recognise the failings in the care and support, and the distress this caused.
71. I consider this to be an appropriate remedy for the injustice caused to Miss X by this fault and do not consider it necessary to make any further recommendations.
72. Miss X complains the Council did not arrange an advocate to support her. The Care Act 2014 says councils must appoint an independent advocate if it considers someone would have difficulty in being fully involved in the assessment of their care needs and decision making; and if there is no appropriate family member, friend or individual who can support them.
73. The Council considers Miss X was able to understand, retain and weigh information during her care needs assessments and did not face any substantial difficulty in representing her own interests. Miss X disputes this, but I note that Miss X was supported by her independent living support worker during the care needs review in May 2024 and in a subsequent meeting to discuss the care charges. And that Miss X engaged an advocate herself to assist her challenging the care costs.
74. In the circumstances I do not consider the Council at fault for not appointing an independent advocate for Miss X during the period I am investigating.

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Decision

75. I find fault causing injustice. The Council has offered to take appropriate actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman