Summary: The Council was at fault for poor communication and delays in the financial assessment process leading to a large debt and putting Mr Y’s care home placement at risk. The Council has agreed to apologise and make a payment to Mr Y’s representative, Mr X to acknowledge the frustration, inconvenience and time and trouble this caused, and backdate its funding of Mr Y’s care home fees.

The complaint

1. Mr X complained the Council refused to backdate funding for his relative Mr Y’s residential care fees to the date when he was eligible for funding. He says the Council has not properly considered the difficulties he had in obtaining financial information. He says Mr Y is under threat of eviction from the care home and the situation is causing stress and worry. Mr X wants the Council to fund the placement from an earlier date.

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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. 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

4. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
5. I gave Mr X and the Council an opportunity to comment on a draft of my decision. I considered any comments before making a final decision.

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What I found

The relevant law and guidance

Assessment of needs

6. 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.
7. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. This 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. 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 care

8. The Care Act 2014 (section 14 and 17) provides a legal framework for charging for care and support. 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.
9. 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.
10. 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 but will still contribute most of their income.

What happened

11. Mr Y lived abroad. He returned to the UK and moved in with Mr X on a temporary basis. Mr X contacted the Council to request an assessment of Mr Y’s needs.
12. The Council assessed Mr Y in May 2023. It noted his memory was poor and he could not manage stairs. He did not have a UK bank account and another relative managed his finances. At that time Mr Y had over the upper capital limit and so he was responsible for paying the full cost of any care he received.
13. In August 2023 Mr Y moved into a care home. Mr X told the Council that Mr Y had enough funds to pay for his care but in six to seven weeks would be under the upper capital limit. An undated assessment noted Mr Y required a financial assessment and that the Council would assist with paying for his care if he had below the capital limit. The Council wrote to Mr X in August 2023 to confirm Mr Y was responsible for paying the full cost of his care.
14. Mr X had difficulty obtaining financial information for Mr Y due to him not having a UK bank account. Records indicate Mr X called the Council in September 2023 to request support with funding. The Council says it sent Mr X financial assessment forms which were not returned. I have seen no evidence of this.
15. In early 2024 the social worker explored the option of extra care housing but two schemes declined Mr Y due to his dementia. Mr X asked that Mr Y remain in the care home. The Council completed a care act assessment in March 2024 which confirmed Mr Y’s needs were met at the care home and which stated that Mr Y needed an urgent financial assessment as his finances had depleted below the capital limit.
16. In May 2024 Mr X told the social worker he had yet to hear from the finance team. A finance officer spoke with Mr X in late June and following this sent him a financial assessment form for completion. Mr X returned it in July 2024. Evidence he provided showed Mr Y dropped below the upper capital limit on 6 November 2023.
17. In late July 2024 the Council wrote to the care provider with an agreement to fund Mr Y’s placement from 18 April 2024. The social worker noted in the case notes that Mr X did not tell the Council the capital had depleted until March 2024. The note said the suggested date of 18 April 2024 was based on when the Council agreed funding.
18. Mr X contacted the Council in September, November and December 2024 querying the funding start date. Mr X said he had alerted the finance team when Mr Y’s finances had depleted.
19. In February 2025 the Council completed a care act review which noted Mr Y’s capital depleted on 6 November 2023 and funding started on 18 April 2024. It said a review of finances was required.
20. In February 2025 Mr X contacted the Council as the care home intended to serve notice due to the arrears. He then complained about the Council’s decision and that he had not received an explanation of the decision not to backdate the funding.
21. The Council told Mr X that it would only fund from the date it was told Mr Y’s capital had depleted which was April 2024. It said there were a number of attempts to complete a financial assessment but it was not returned until April 2024 so the Council was not liable for the funding.
22. In July 2025 the Council responded to Mr X’s complaint. It apologised that it had not responded to his request for an explanation of when the care home funding would be backdated to. It said it had now responded and explained the Council’s decision to backdate funding to 18 April 2024. It said it could not fund any period before it was formally notified of the capital depletion. It said it made several attempts to complete a financial assessment but information was not returned to it until April 2024.
23. Mr X complained to us in September 2025.
24. In response to our enquiries the Council said it had carried out a review of Mr Y’s case and accepted Mr X contacted the Council in September 2023 regarding Mr Y’s financial circumstances and the potential for capital depletion from that time.
25. It acknowledged it could not sufficiently demonstrate that appropriate and timely follow up actions were taken at that stage to progress the financial assessment.
26. It said it accepted the Council was liable for fees paid during the period 6 November 2023 to 3 April 2024. It wished to remedy this by paying the provider as a matter of urgency.
27. In addition, it acknowledged this had caused Mr X frustration and inconvenience and it offered to pay Mr X £250 to acknowledge the time and trouble he was put to in pursuing this matter.

Findings

28. The Council failed to communicate effectively with Mr X and to conduct a financial assessment in a timely manner. This was fault. Although Mr Y remains in the care home this caused Mr X significant uncertainty and frustration and placed Mr Y’s care home placement at risk.
29. The Council, in its correspondence with us has accepted it was at fault and has offered to pay the care provider. This is an appropriate remedy for the injustice caused. However, the Council has suggested paying the care provider for the period 6 November 2023 to 3 April 2024 when the records show it started paying the care provider on 18 April 2024. The period the debt relates to is therefore from 6 November 2023 to 17 April 2024.
30. The Council’s offer to pay Mr X £250 is welcomed. This is an appropriate payment to acknowledge the impact the faults had on him, in line with our guidance on remedies. In addition, I have recommended the Council apologises to Mr X.

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Agreed Action

31. Within one month of the final decision the Council has agreed to:
• Pay the care provider the amount it owes for Mr Y’s care fees from 6 November 2023 to 3 April 2024.
• Clearly set out to Mr X what contribution it has calculated that Mr Y is required to pay towards his care home fees for the same period.
• Apologise to Mr X and pay him £250 to acknowledge the frustration, inconvenience and time and trouble he was put to. 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.
32. The Council should provide us with evidence it has complied with the above actions.

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Decision

33. The Council was at fault causing injustice which it has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman