Summary: The Council was not at fault for how it charged Mr X for the care fees for the care of his late mother, Mrs X. The Council was at fault for the delay in responding to Mr X’s complaint. It was also at fault for not retaining a copy of the contract between Mrs X and the Care Home.

The complaint

1. Mr X complained about charges for a Council commissioned care home where his late mother, Mrs X lived. Mr X says the Council did not tell him about the charges. Mr X says Mrs X had a fall at the Care Home which resulted in readmission to hospital. Mr X says poor care caused Mrs X’s fall and he does not consider Mrs X’s estate should be liable to pay charges when it did not provide safe care.
2. Mr X also complains about the Council’s response to his complaint and the long delays.

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The Ombudsman’s role and powers

3. 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)
4. 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.
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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What I have and have not investigated

6. 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)
7. Some of Mr X’s complaint is late. Mr X said the Council moved Mrs X into the Care Home against his wishes in September 2023 and it had no care plan in place. In October and November 2023, Mrs X was admitted to hospital as a result of injuries sustained in the Care Home. After she left the hospital, she moved elsewhere.
8. Mr X complained to the Council about this in November 2023 but did not complain to us until June 2025. While the Council did not respond to Mr X’s original complaint until August 2025, Mr X did not pursue his complaint about the poor standard of care until he received an invoice in May 2025 for the care Mrs X received in the care home. It was open to Mr X to complain to us earlier about the events that occurred between September and November 2023. There are no good reasons to exercise discretion to investigate this period.

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How I considered this complaint

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

Charging for permanent residential care

11. 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.
12. 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.
13. 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.

The Council’s complaints policy

14. In its complaints policy, it states the Council will have 20 working days to provide a stage two complaint response.

Background

15. Mrs X went into hospital from the community. Following this, Mrs X moved into the Care Home on 12 September 2023.
16. While in the Care Home Mr X says Mrs X sustained a head injury and went back into hospital. Mr X says while she was in the hospital she then contracted a chest infection and coronavirus. Mrs X was in the hospital from 15 October and discharged on 1 November.
17. On 23 October, the Council held a meeting with Mr X and his family about the concerns. The notes record the following:
• Mr X went to visit Mrs X on 14 October and she reported having a fall, but no one could confirm this;
• Mr X’s brother, Mr Y visited on 15 October and Mrs X told him she had fell from her bed which had caused her head to bruise. The Care Home subsequently called the emergency services; and
• Neither Mr X or Mr Y wanted Mrs X returning to the Care Home.
18. On 1 November Mrs X was discharged to another Care Home. On 7 November 2023 Mrs X received an invoice for £3600 for care at the Care Home between 11 September 2023 and 8 October 2023.
19. Mr X complained to the Council in November 2023. In early December the Council responded saying it would investigate the complaint.
20. Mrs X passed away in May 2024.

What happened

21. Mr X heard nothing further from the Council until February 2025 when the Council contacted him to ask whether probate had been granted yet for Mrs X’s estate. Mr X confirmed it had.
22. In May 2025, the Council sent Mr X an invoice for outstanding care fees of £6428.57 and asked when it could expect payment.
23. In June 2025, Mr X raised his complaint again with the Council. He also added the original care fee costs were £3,000 and then later raised to £6428.57 without any explanation.
24. The same month Mr X bought the matter to us. Mr X told us the Council increased the invoice to cover the period where his mother was in hospital.
25. The Council provided a final complaint response in August which said the following:
• It apologised for the delay in responding to the complaint;
• While Mr X did not want Mrs X to go into a care home, the social worker recommended she had an interim placement at the Care Home as it would be unsafe for Mrs X to return home;
• The social worker contacted Mr X about this on 8 September alongside the Council’s charging policy;
• The care home said it could meet Mrs X’s care needs based on the medical information it had at the time;
• The records show Mr X was satisfied for Mrs X to move to the care home once discussed; and
• It was unable to recommend any invoices are cancelled.

The Council’s response to my enquiries

26. In December 2024, the Council said it issued a probate search form to identify the executor of Mrs X’s estate. At the end of January 2025, the Council identified the executors. The Council has provided evidence it made a phone call to Mr X to confirm this. It said it advised of the balance in February and emailed across the balance. At the end of May, chaser letters were sent to both executors advising of the balance.
27. The Council has broke down the £6428.57 balance as follows:
• £3600 charge for the period 11 September and 8 October 2023
• £2828.57 charge for the period between 09 October and 30 October 2023.
28. The Council was asked to provide a copy of the contract between Mrs X and the Care Home. The Council was unable to provide this.
29. The Council has said that historically the contracts used to have a clause in place where the resident would pay a reduced rate for their care when they were admitted to hospital. The Council said this was usually done on a sliding scale after a set number of weeks that the resident was absent from the service. The Council has said it has not issued these types of contracts since 2019.

My findings

30. In early June 2025, Mr X raised his complaint again with the Council. He added that the original care fee costs were increased with no reason. The Council should have responded within 20 working days and by early July at the latest. The Council did not respond until Mid-August which was a delay of six weeks and fault. The caused Mr X distress, frustration and uncertainty.
31. In addition to this, the Council’s complaint response did not address all points of Mr X’s complaint. For example, about the standard of care Mrs X received in the care home. It also failed to provide a breakdown of the care fees even though Mr X raised concerns that the Council had increased these with no explanation. This was fault which caused Mr X uncertainty and was a missed opportunity to resolve the complaint sooner.
32. We would have expected the Council to retain a copy of the contract between the Care Home and Mrs X. This would have meant when Mr X raised a dispute over care fees we could determine whether the Council had calculated the fees correctly regarding charging for hospital stays. The Council had not retained a copy of the contract which was fault. However, the Council stopped issuing contracts where residents paid a reduced rate during hospital admissions in 2019. Mrs X’s contract was issued in 2023. On the balance of probabilities, Mrs X contract would not have included any clause for a stop or reduction in charging the normal care home rate during a hospital admission. Instead, Mrs X would continue to be charged as long as she retained a bed at the care home, as is standard practice. She would also be charged during any notice period.
33. It is understandable Mr X would have been shocked by the increase in cost, particularly as the Council did not explain the reasons for this. However, on a balance of probabilities, the Council has properly applied the fees and was therefore not at fault.

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Action

34. Within one month of the final decision, the Council has agreed to:
1. Apologise to Mr X for failing to respond to the full complaint in its complaint response. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology I have recommended.
2. Provide written guidance to the relevant officers that complaint responses should be issued within the timescales set out in the Council’s complaints policy and address the complaint in full.
35. Within three months of the final decision, the Council has agreed to:
1. Review this case to identify why it has not retained a copy of the contract and create an action plan to prevent this from occurring in the future.
36. The Council should provide us with evidence it has complied with the above actions.

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Decision

37. 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