Summary: Mrs X complained about how the Council handled her husband Mr X’s care costs. We find the Council at fault for not appropriately checking figures and information when calculating how much Mr X should have contributed to his care costs, and for inadequate complaint handling. This caused Mrs X distress in the form of uncertainty, frustration and time and trouble. The Council agreed to apologise, make a symbolic payment and complete a new calculation to remedy the injustice.

The complaint

1. Mrs X complains about how the Council handled her husband Mr X’s care costs after he moved into a residential care home. In particular she complains the Council:
1. Refused to fund any of his care despite the costs depleting his capital to nearly nothing.
2. Sent her invoices in error after Mr X died.
3. Had poor complaint handling when it failed to acknowledge it had refused to fund her husband’s care when it should have.
2. Mrs X said the Council’s failings caused significant anxiety and distress during a particularly upsetting time, the loss of the lower capital limit of £14,250 from her husband’s estate, and ongoing anxiety.
3. She would like the Council to repay the £14,250 lower capital limit that she said he wrongly had to use to fund his care.

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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 may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
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)

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What I have and have not investigated

8. I have investigated from August 2024 when the Council assessed Mr X’s care needs and wrote a care and support plan, until August 2025 when the Council sent its final complaint response.

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How I considered this complaint

9. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
10. Mrs 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

Law and Guidance

Assessment

11. 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.

Care and Support Plans

12. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

Charging for permanent residential care

13. 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.
14. 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.
15. 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. 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.

NHS Continuing Healthcare Assessments

16. NHS Continuing Healthcare (NHS CHC) is a package of ongoing care arranged and funded solely by the NHS. It applies where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.
17. Complaints about NHS CHC are dealt with by the Parliamentary and Health Service Ombudsman.

What happened

18. This is a summary of key events. It is not a detailed chronology of everything that happened. I have included more information where necessary in the analysis section.
19. On 20 August 2024 the Council completed a care act assessment with Mr X. At that time Mr X was in permanent residential care. He was paying all his care costs because his capital was above the upper capital limit.
20. The Council wrote a care and support plan for Mr X. It recorded he had eligible care needs that should be met in the care home. It also recorded he needed 1:1 care whilst in the care home.
21. The Council started the financial assessment process. It also asked the care home to apply for NHS CHC.
22. On 9 September Mrs X gave the Council Mr X’s financial information to allow it to do the financial assessment. She provided information about Mr X’s savings, income, care costs and other outgoings.
23. On 2 October the NHS wrote to Mrs X. It said Mr X was eligible for NHS CHC. It said the NHS would arrange his care and monitor the arrangement. The Council said it did not receive this information at the time.
24. On 15 October the Council did a rate of depletion calculation. This was part of its financial assessment. It did this to calculate when Mr X’s capital would fall below the capital limits. It calculated his capital would fall below the upper capital limit on 18 October. Therefore, the Council decided it was responsible for paying some of Mr X’s care costs from 19 October.
25. On 17 October the Council wrote to Mrs X. It said it had calculated Mr X’s assets would fall below the upper capital limit on 19 October. It explained he was eligible for Council funding from that date. It explained the amount he would have to continue to contribute to his care costs.
26. On 9 December the Council wrote to Mrs X. It had recalculated the amount Mr X had to contribute to his care costs.
27. Mr X died on 14 December.
28. On 17 January 2025 the Council sent Mrs X an invoice for Mr X’s care cost contributions. The invoice covered the period 19 October 2024 until 5 January 2025.
29. Mrs X complained to the Council on 21 January that it was wrong to charge her. She said the Council had not paid for any of Mr X’s care. This was because Mr X had paid for his care until NHS CHC started. She went on to complain that the invoice was for care until 5 January despite Mr X having died on 14 December.
30. On 14 February the Council sent Mrs X a revised invoice for Mr X’s care cost contributions. The Council had deducted the period after Mr X had died. It maintained Mrs X owed it money for care Mr X had after 19 October.
31. Later in February Mrs X contacted the Council several times to complain about the invoices.
32. She sent the Council a copy of the NHS CHC letter on 20 February. She asked it to confirm she did not owe it any money.
33. On 25 February the Council responded to Mrs X’s complaint. It asked her to send it any evidence Mr X had NHS CHC funding.
34. On 13 March Council records show it realised Mr X was NHS CHC funded. It concluded Mrs X did not owe it any money.
35. On 2 April the Council sent a further response to Mrs X about her complaint. It acknowledged it should not have sent the invoices, that no charges were outstanding, and apologised for the distress.
36. On 16 April Mrs X raised a new complaint. She complained Mr X’s care costs had reduced his assets to nearly nothing by the time NHS CHC started on 2 October 2024. She said the Council should have paid for all of Mr X’s care costs from the point his capital had dropped below the lower capital limit, but it had failed to do so.
37. On 28 May the Council responded to Mrs X’s complaint. It referred to its letter of 17 October 2024 regarding its rate of depletion calculation. It explained Mr X’s capital had not been projected to fall below the upper capital limit until 19 October. It said Mr X’s care costs were being met by NHS CHC funding before that date. It explained this meant Mr X was not entitled to any funding from the Council.
38. On 31 July Mrs X contacted the Council. She thought it had not used the correct figures in its rate of depletion calculation. She explained it had failed to take account of the costs of Mr X’s 1:1 care.
39. On 29 August the Council responded to Mrs X’s complaint again. It said it had made an error and apologised. It said it had revised the calculation to take account of the cost of the 1:1 care. Its revised calculation showed Mr X’s capital would have dropped below the upper limit from 6 October 2024. It said Mr X’s care costs were being met by CHC funding from 27 September 2024 which was before that date. It explained this meant Mr X was not entitled to any funding from the Council.
40. Mrs X complained to us. She said the Council had still used incorrect figures in its revised depletion calculation.

Analysis

41. I address each part of Mrs X’s complaint in turn below.

Refusal to fund any of his care despite the costs depleting his capital to nearly nothing.

42. The Council’s decisions not to pay any of Mr X’s care costs followed its two depletion calculations. The first in October 2024. The second in August 2025.
43. The Council acknowledged its first depletion calculation was incorrect and apologised. This was because it had incorrectly used a lower care cost figure than it should have. This meant it incorrectly calculated Mr X’s capital was depleting more slowly than it actually was. I have considered the information the Council had before the first calculation. I find the Council failed to take adequate steps to check its figures were correct when it did its first calculation. This was fault.
44. Mrs X first highlighted the calculation was incorrect in April 2025. The Council took more than four months to check its financial assessment by doing a second depletion calculation. I find the Council did not act on the information provided in a timely manner. This was fault.
45. I have considered whether the Council took adequate steps to check the accuracy of the figures and information it used for its second depletion calculation. This informed its decision Mr X was not entitled to any funding from the Council.
46. The calculation and decision required the following accurate information about Mr X and his care:

• His net capital on a given date, as a starting point.
• His weekly income.
• His weekly care costs and other outgoings.
• The date his NHS CHC funding started.

47. The evidence shows the Council used a bank statement balance to calculate what Mr X’s capital would have been on a given date, as a starting point.
48. Mrs X said, in a conversation with me, that bank statement did not reflect his net capital on that date. This was because he had incurred 1:1 care costs before the date of the bank statement for which the care home had not invoiced. Therefore, significant care costs were not reflected in the balance figure on that bank statement.
49. Based on this information I find, on the balance of probabilities, the Council did not take adequate steps to check what Mr X’s capital starting point was. This was fault.
50. The evidence indicates the Council used Mrs X’s financial assessment form to calculate Mr X’s weekly care costs. She included information that Mr X had 12 hours of care per day, and listed the cost per hour.
51. Mrs X said, in a conversation with me, that information did not reflect his care costs. This was because the care home told her it had made an error and Mr X actually needed, and received, 24 hours of 1:1 care per day.
52. I have considered this with reference to the Council’s care and support plan for Mr X, dated 20 August 2024. It records the Council’s assessment of Mr X’s needs for 1:1 care and includes the following information:
53. “In the care assessment which was conducted by the Care Home he is required to have 1:1 care in order to ensure that he is safe at all time.” It goes on to record the risks to his own and others’ safety if there were an absence of 1:1 care during the day and night.
54. I note the care and support plan had sections for the Council to record the total hours of care per week Mr X needed. The sections were blank. I find the information in the care and support plan, taken as a whole, shows the Council assessed Mr X as needing 1:1 care for 24 hours a day.
55. Based on the evidence I have seen I find, on the balance of probabilities, the Council did not take adequate steps to check what Mr X’s care costs were. This was fault.
56. The evidence indicates the Council used the letter from the NHS dated 2 October 2024 to decide his CHC funding started on 27 September 2024. The letter says following an assessment completed on 27 September, Mr X had been assessed as having continuing healthcare needs. I find the letter does not say the NHS CHC definitely started on 27 September.
57. Mrs X said, in a conversation with me, the CHC funding started on 2 October, not 27 September. She thought this was correct because the care home had invoiced her for care costs up until the 1 October.
58. Based on the evidence I have seen I find, on the balance of probabilities, the Council did not take adequate steps to check the date Mr X’s CHC funding started. This was fault.
59. The faults in the Council’s approach to checking the figures and information it used in its depletion calculations caused Mrs X significant injustice in the form of distress, uncertainty and frustration. I recommend the Council apologise and make a symbolic payment to remedy the injustice.
60. I also recommend the Council complete a further depletion calculation and financial assessment. It should check the accuracy of the figures and information when doing so. This should include taking adequate steps to:

• Obtain relevant information to verify what Mr X’s net capital would have been at the starting point of its calculations.
• Decide what Mr X's care costs were with reference to his care and support plan and the cost of the weekly number of 1:1 hours it assessed him as needing.
• Clarify when the CHC funding started.
• Consider any information Mrs X may wish to provide about the figures used in its calculation, and gather any other information it considers necessary.

61. If the Council calculates Mr X’s capital did deplete below the capital limits before the CHC funding started, it should calculate and reimburse any funding it should have provided.

Sent Mrs X invoices in error after her husband died.

62. The Council acknowledged it incorrectly sent invoices to Mrs X on 17 January and 14 February 2025. It apologised.
63. In its complaint responses of 25 February and 2 April the Council said it sent the invoices in error because it did not receive the CHC funding letter.
64. Based on the evidence I have seen I find, on the balance of probabilities, the Council did not receive the CHC funding letter until Mrs X sent it a copy on 20 February. For this reason I do not find the Council at fault for sending the invoices.

Complaint handling.

65. The Council’s complaint handling policy says it aims to respond to complaints in 20 working days.
66. I have considered the Council’s handling of Mrs X’s complaints about the incorrect invoices.
67. Mrs X complained on 21 January 2025 and sent it the CHC funding letter on 20 February 2025.
68. The Council did not inform Mrs X she did not owe it money until 11 April. This was 36 working days after Mrs X sent it the CHC funding letter. This was significantly longer than its target timescale. For this reason I find the Council at fault for its complaint handling. It caused Mrs X injustice in the form of time and trouble.
69. I have considered the Council’s handling of Mrs X’s complaints about its depletion calculations and decisions not to fund any of Mr X’s care costs. She first formally raised this part of her complaint on 16 April.
70. The Council provided its stage one response on 28 May. This was 27 working days later. The Council referred to its depletion calculation completed in October 2024. It reiterated this meant Mr X’s capital was above the upper limit at the time the CHC funding was approved.
71. Mrs X explained to the Council why she disagreed with its calculation in an email on 31 July.
72. The Council provided a further response on 29 August. This was 21 days later. It acknowledged its original depletion calculation was incorrect. It described a new depletion calculation. It said the new calculation still meant Mr X’s capital was above the upper limit at the time the CHC funding was approved. This meant it still disagreed with Mrs X’s complaint.
73. I find the Council should have communicated with Mrs X more effectively during the complaint process. This would have helped it understand why she said Mr X’s capital had reduced below the lower limit by the time the CHC funding started. It would have also helped it check the figures in its depletion calculations. I find the Council at fault for not adequately communicating with Mrs X about her complaint. It caused Mrs X injustice in the form of time and trouble.

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Action

74. Within four weeks of the date of my final decision the Council agreed to:
1. Apologise to Mrs X for the distress and uncertainty from the faults in its depletion calculations, and time and trouble from the faults in its complaint handling. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
2. Make a symbolic payment of £200 to Mrs X to acknowledge the uncertainty and frustration caused by the faults in its depletion calculations and financial assessments.
3. Complete a new depletion calculation of Mr X’s capital that includes the points explained in paragraph 60 above.
4. Reimburse Mr X’s estate with any care costs the Council should have funded if the new depletion calculation shows his care costs caused his capital to fall below the capital limits before the CHC funding started.
75. The Council should provide us with evidence it has complied with the above actions.

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Decision

76. I find fault causing injustice in the way the Council decided whether to fund any of Mr X’s care costs and for its complaint handing for the reasons explained in the analysis section. I uphold Mrs X’s complaint. The Council has agreed actions to remedy the injustice.

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Investigator's decision on behalf of the Ombudsman