Summary: The Council was at fault for delay completing the care act assessment, care and support plan and financial assessment and failing to share these with the family. It also failed to pause invoices when it had agreed to do so. The Council should apologise and make a financial payment to remedy the distress caused.

The complaint

1. Mr X complained the Council wrongly invoiced his mother, Ms M for three weeks of care for his father, Mr F, which the Council originally said would be non-chargeable. This caused distress to the family. Mr X said the Council agreed to pause the invoice until it completed the complaint process but the finance team continued to chase Ms M for payment causing further distress. Mr X would like the Council to apologise and agree Ms M should not pay the care charges.

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The Ombudsman’s role and powers

2. 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)
3. 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.
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. 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

6. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
7. Mr 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

Relevant legislation

Intermediate Care and Reablement

8. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently.
9. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Charging for permanent residential care

10. 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.
11. 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.
12. The financial limit, known as the ‘upper capital limit’, exists for the purposes of 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 but will still contribute most of their income.
13. Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment. Councils have no power to assess couples according to their joint financial resources. A council must treat each person individually. A council must not charge more than the cost it incurs to meet a person’s assessed eligible needs.

What happened

14. I have summarised below the key events; this is not intended to be a detailed account.

Mr F’s stay in hospital and plans for discharge

15. Mr F went into hospital in late September 2024.
16. In early October 2024, the social worker telephoned Ms D (Mr F’s daughter) and discussed the plans for where her father would go when the hospital discharged him. The notes show the social worker explained there were three potential pathways on discharge from hospital:
• Pathway one: discharge home;
• Pathway two: discharge to an interim bed which would be free of charge for 20 days; or
• Pathway three: discharge to a long-term placement. The social worker explained Mr X would need to pay for this care himself if he had savings over the threshold. The Council would need to do a financial assessment to decide if he would need to pay for his care.
17. The social worker’s note from the conversation recorded that Ms D said she did not think her father’s condition would improve and her mother would not cope providing the care he needed. Ms D said she thought her father needed a long-term placement. The social worker said if they were considering pathway three, they would need to know Mr F’s financial circumstances. The social worker said they would send the family a financial assessment form, which they posted the same day.
18. The social worker completed a care act assessment following this conversation. The assessment record said Mr F’s wife ‘…does not feel that she will manage should [Mr F] be discharged home from hospital and would like for him to be discharged to a care home setting. Following assessment the discharge plan for [Mr F] is to move into a long-term placement.’ The Council did not share a written copy of the assessment with the family.
19. The hospital discharged Mr F to a Nursing Home in the middle of October 2024.
20. Mr F died three weeks later.
21. In the middle of November 2024, (after Mr F died), the Council completed a care and support plan. This said the ‘…discharge plan for [Mr F] was to move into a long-term placement.’

The financial assessment

22. In December 2024, the Council’s finance department telephoned Ms M. The Council asked questions about Mr F’s finances. Ms M said Mr F had savings over the financial threshold while he was in the care home.
23. At the beginning of January 2025, the Council completed a financial assessment and decided Mr F was to pay the full costs of his care as he had savings over the financial threshold. The Council wrote to Ms M in February and said the family owed just under £3,000 for Mr F’s care. It sent Ms M an invoice.
24. Mr X telephoned the Council about the invoice. He queried the invoice and explained the family thought the care was not chargeable and asked the Council to put the invoice on hold while this was sorted. Mr X told me the Council continued to send invoices to his mother which caused her distress.

The complaint

25. Mr X complained to the Council in February 2025. He said the Council told his mother and his sister the care would be nonchargeable. They understood this was for at least four weeks while the Council assessed him. He said the Council did not write to the family and tell them it would charge Mr F for his care. Mr X said the Council telephoned Ms M and asked for financial details to complete a financial declaration. Mr X said this caused his mother distress as she did not understand who the call was from or why and was worried this was a scam.
26. The Council responded to Mr X’s complaint in May 2025. It explained the hospital discharged Mr F to the Nursing Home as a chargeable services provision. It was not an interim bed for assessment. This was because the family chose pathway three as they did not think Ms M could cope with his care if he came home.
27. Mr X complained to the Ombudsman in September 2025.

Analysis

28. The Council provided verbal information to Mr F’s family about the different pathways available after he left hospital and the associated charges. The notes show it also explained that if Mr F had over the financial threshold, he would need to fund his own care.
29. The Council should carry out a care act assessment and provide an individual with a care and support plan before it provides the care. The care and support plan should include a personal budget setting out the cost of the care. The Council completed the care act assessment for Mr F in early October and drafted the plan in the middle of November. The Council did not share the plan with the family. This was fault causing uncertainty as the family was not sure what the Council’s plan was for Mr F, which pathway it had chosen and what the cost of the care was.
30. The Council should complete a financial assessment within a reasonable timeframe of the care act assessment. This is so people are aware of the cost and can make an informed choice about what care and support they want. The Council competed the care act assessment for Mr F in October 2024 and the financial assessment in January 2025. It told the family about how much they owed in care fees in February 2025. This was a delay of three to four months. This was fault which caused uncertainty and distress as the family did not know how much Mr F’s care would cost.
31. We aim to put people back in the position they would have been if not for the fault. The Council told the family that if Mr F had savings over the financial threshold, he would need to pay for his own care. Had the Council sent the family a written copy of the care act assessment, care and support plan and the financial assessment before it provided the care, the family would have known which pathway the Council was following and how much they would have to pay for Mr F’s care.
32. On balance, having considered the records of the discussion with the social worker and Mr F’s needs, had the Council acted without fault it is likely the family would have still agreed to Mr F’s stay in the care home, pay for his care, and the outcome would have been the same. However, the Council’s delay in providing this information caused the family uncertainty and the shock of an unexpected, large care bill.
33. The Council is also at fault for continuing to send invoices to the family after agreeing to put this on hold while it considered the complaint. This caused added distress to the family.

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Action

34. Within four weeks of the final decision, the Council agreed to:
1. Apologise to Mr F’s family and pay them £300 for the distress and uncertainty caused by the delay completing the care and support plan and financial assessment and failing to share this with the family.
2. Offer a repayment plan to enable the family to pay the care bill over a reasonable timescale, if it has not already done so.
35. The Council should provide us with evidence it has complied with the above actions.

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Decision

36. On the evidence considered I find fault causing injustice. The Council has agreed to remedy the injustice.

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Investigator's decision on behalf of the Ombudsman