Summary: We found the Council at fault for failing to properly explain care home fees to Ms X’s representatives and for its record keeping. These faults caused Ms X’s representatives avoidable distress. The Council has agreed to apologise and make a payment to them to recognise the injustice caused.

The complaint

1. Ms X’s representatives, Ms Y and Mr Z, complained the Council did not properly explain how much Ms X would have to pay when she went into a care home. They said they were confused and distressed when they noticed the Council was taking more money out of Ms X’s account than they expected.

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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 recommend a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
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 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)
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. Ms X has died; Ms Y and Mr Z are suitable representatives for Ms X.
7. I considered evidence provided by Ms Y and the Council as well as relevant law, policy and guidance.
8. Ms X’s representatives 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

Laws and guidance about care and charging for care

9. 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.
10. 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.
11. 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.
12. In calculating the person’s contribution for care in a care home, councils must disregard the value of a person’s main or only home for 12 weeks from when they first enter a care home as a permanent resident. This is called the 12-week property disregard.
13. If someone chooses a care home which is more expensive than a suitable one the council has agreed to pay for, the council can charge a top-up fee to cover the difference in costs. Where someone is subject to a 12-week property disregard, they can pay this top-up fee themselves.

Principles of Good Administrative Practice

14. We publish guidance called Principles of Good Administrative Practice. This guidance sets out the standards we expect to see when we investigate complaints about councils.

What happened

15. In May 2025 Ms X left hospital and became a permanent resident in a care home.
16. Before Ms X moved into a care home, her relatives (Ms Y and Mr Z) discussed the move with her social worker.
17. Ms X died in June 2025.
18. Ms Y then contacted the Council because she noticed the Council was still taking money out of Ms X’s bank account. She asked if this was correct or if the Council had overcharged Ms X. She also asked it to explain an invoice it sent her.
19. The Council responded to say the direct debits and invoice were correct and explained why.
20. Ms Y complained to the Council and said it had not clearly explained Ms X’s care fees at the time she moved into the care home. She said she knew Ms X would need to pay a weekly top-up fee for her care, but she did not know Ms X also had to pay another contribution to her care home fees from the day she went into a care home. She thought this fee did not start until 12 weeks after Ms X moved to the care home, because the Council applied a 12-week property disregard.
21. The Council replied and said its case notes showed Ms X’s social worker discussed care home costs with Ms Y and Mr Z. They told them about the 12-week property disregard, said Ms X would need a new financial assessment and advised Ms Y and Mr Z to seek independent financial advice.
22. The Council said it assumed that Ms Y and Mr Z understood Ms X would pay the contribution to care fees straight away because they knew she needed a new financial assessment. The Council accepted it should not have assumed this and there should have been a clear conversation about care home costs.
23. Ms Y then complained to us. She said the Council had led her to believe that Ms X would initially only be charged a weekly top-up fee for her care. She did not think Ms X would need to make any other contributions to her care until after the 12-week property disregard period.

Analysis

Fault and injustice

24. According to the Care and Support Statutory Guidance, councils should be clear and transparent about care costs, so people know what they will be charged.
25. Ms Y told us that she received some factsheets about care costs, but most of the financial conversations with Ms X's social worker about her move were verbal, and were not followed up in writing.
26. The Council’s case notes showed that Ms X’s social worker did have a conversation with Ms Y and Mr Z about finances, but the case note did not give much detail or show what factsheets they gave to Ms Y and Mr Z. It did not say which care fees they were told would apply as soon as Ms X moved into a care home.
27. Our principles of good administrative practice says keeping proper and appropriate records helps councils to be accountable. Therefore, it was fault by the Council to not clearly record what financial information it gave Ms Y and Mr Z.
28. The Council’s record keeping fault caused Ms Y and Mr Z injustice because we couldn’t confirm what the Council told them, which caused them uncertainty.
29. Due to the lack of evidence showing what information the Council gave to Ms Y and Mr Z, I have considered the available evidence and considered what was more likely to have happened.
30. Having considered the available evidence, I cannot say, even on the balance of probabilities, if it was more likely the Council told Ms Y and Mr Z that Ms X would need to pay towards her care in the first 12 weeks of living in a care home.
31. However, the Council has accepted there was not a clear and direct conversation about this and it made assumptions about what Ms Y and Mr Z knew. It failed to ensure the information about care costs was clear. This was fault.
32. This fault caused injustice to Ms Y and Mr Z, because it caused them uncertainty as they did not understand why they received an invoice for care home fees.
33. This injustice was made worse by the fact Ms Y and Mr Z were dealing with Ms X’s death at the same time as trying to understand the care home fees.

Personal remedy

34. In line with our guidance on remedies, the Council should make a symbolic payment to recognise the distress caused to Ms Y and Mr Z by its poor communication about care home costs. We normally recommend a remedy payment for distress of up to £500.
35. In Ms X’s case, £300 to recognise Ms Y’s and Mr Z’s distress is appropriate. This recognises the unexpected charges covered a relatively short period of time which lessened their distress, but also that Ms Y and Mr Z were dealing with Ms X’s death at the same time, which increased their distress.

Service improvements

36. Where we find fault by an organisation, we can recommend changes to improve how the organisation delivers its services to prevent the same issue happening to others.
37. Since Ms X’s complaint, the Council has updated information about care charges on its website. The Council has agreed to make further changes to ensure this information is shared with people using its service, and how it records the information it gives. These are explained in paragraph 39, below.

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Agreed action

38. Within four weeks of our final decision, the Council will:
1. apologise to Ms Y and Mr Z for the injustice caused to them by the failings identified during this investigation. This apology should be in accordance with our guidance for making an effective apology; and,
2. pay Ms Y and Mr Z a total of £300 to recognise the distress caused to them by the failings identified in this investigation. (Ms X’s estate still owes the Council money for her care home fees and the Ombudsman’s findings do not change any outstanding debt. This remedy is separate to any debt that still exists.)
39. Within three months of our final decision, the Council will review its process for how it gives people information and advice about care costs, and how it records what it tells them. It will identify if there are any changes it could make to its process to ensure it can show it gave people all the information they needed. It will send us a timebound action plan of when it will make changes to its process.
40. The Council should provide us with evidence it has complied with the above actions.

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Decision

41. 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