Summary: There was fault by the Council, because a social worker gave the complainant’s family incorrect advice about the charging process for adult social care. We are satisfied, though, this misinformation did not alter what the complainant had to pay for her care, and the Council’s apology remedies the remaining injustice. We have therefore completed our investigation.

The complaint

1. I will refer to the complainant as Mrs H. Mrs H is represented in her complaint by her relative, Mrs T.
2. Mrs T complains the Council provided misleading information about the charging arrangements for a care home placement for Mrs H. As a result, she says Mrs H now faces a significant bill for her placement, which would have been avoided had the family received accurate advice.

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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. 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 s34H(1), as amended)

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How I considered this complaint

4. I considered evidence provided by Mrs T and the Council as well as relevant law, policy and guidance.
5. I also shared a draft copy of this decision with each party for their comments.

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What I found

6. Mrs H was living at home with her partner, who provided her with some care. In December 2024, she had a stay in hospital, during which the Council agreed to arrange a package of care visits, to support her once she returned home. A social worker visited Mrs H in the hospital and completed a care needs assessment as part of this. The assessment noted there were no concerns about Mrs H’s mental capacity, and that a financial assessment had been requested for her.
7. In January the Council contacted Mrs H to arrange a financial assessment. On the day of the assessment, Mrs H’s partner fell ill, and so she cancelled the appointment. Mrs H’s partner was then admitted to hospital.
8. The following day the Council contacted Mrs H to check on her welfare. Mrs H said she could not cope at home without her partner’s support, and so the Council arranged an emergency care home placement for her, which started later that day.
9. After being diagnosed with a terminal illness, Mrs H’s partner returned home for palliative care. Due to the amount of equipment and care he needed, Mrs H was unable to live in the property with him, and remained in the care home. In March, Mrs H’s partner passed away.
10. In April, Mrs H moved to a care home in a different council area.
11. In May, the Council completed a financial assessment of Mrs H. It determined her assets were above maximum threshold for council funding, which meant she was responsible for paying the full cost of her care.
12. In July Mrs T submitted a stage 1 complaint to the Council. She said she had received several invoices from the Council to cover the care Mrs H had received between December and April, and that the invoices were confusing and appeared contradictory. She said that, either way, Mrs H’s assets were “below the £23,000 care cap”, which meant she could not pay them.
13. Mrs T said the Council had allocated a new social worker to carry out a needs assessment of Mrs H in February, but that she did not complete the assessment until early April. She said that, following the assessment, she was told Mrs H would be charged for her final few days at the original care home.
14. Upon receiving an invoice for Mrs H’s care, Mrs T said she contacted the social worker, who told her Mrs H should not pay for the care she received before the needs assessment was completed. The social worker contacted the Council’s debt management team to advise them of this. Mrs T said she had nothing more from the Council about this, until it began to send her new invoices at the end of June.
15. Mrs T explained she had spoken to a social worker at a different council, who had told her it was not normal practice to charge someone for care, until the charging process had been discussed with them or their representatives. She said, had this happened, the family would have made different arrangements for Mrs H’s partner’s care, to enable her to return home.
16. The Council responded in August. It explained that adult social care service users should receive a financial assessment, to determine whether they should contribute to their care costs, and that charges are payable from the date the care starts.
17. The Council said it had assessed Mrs H’s needs during her hospital stay in December 2024, and that, during the visit, the social worker had explained the charging and financial assessment process to her and her partner, neither of whom raised any objection. It noted it had previously completed a financial assessment for Mrs H in September 2023, the outcome of which was that she was eligible to pay the full cost of her care.
18. The Council acknowledged the second social worker had told Mrs T that Mrs H only needed to pay for her care after the completion of the needs assessment in April. But it explained this was incorrect, and apologised for the social worker’s error. The Council confirmed Mrs H’s stay in the care home was chargeable from January 2025.
19. The Council said it understood Mrs T had not been party to the previous discussion about charging with Mrs H and her partner, and said it would now arrange a new financial assessment, and would put the outstanding invoice on hold until this was complete. The Council also provided a breakdown of the invoice, to make clear what it was charging for.
20. In October Mrs T referred her complaint to the Ombudsman. She said it was unfair the Council had refused to cancel the invoice, given its confirmation the social worker had misinformed them, and said the family would have made different arrangements had it understood properly, meaning Mrs H would not have received chargeable care. She also said Mrs H and her partner had had limited capacity, and would not have understood the charging arrangements in December 2024, when the Council said the first social worker had explained it to them.

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Legislative background

21. The Care Act 2014 (section 14 and 17) provides a legal framework for charging or 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.
22. When a 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.
23. 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.

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Analysis

24. Mrs T says neither Mrs H nor her late partner had the capacity to properly understand the charging process in December 2024, at the point the Council says a social worker explained it to them.
25. But I have reviewed the needs assessment form the social worker completed at that time, and it records explicitly there were no concerns about Mrs H’s capacity. I note Mrs T has, herself, separately confirmed Mrs H had mental capacity. I cannot say the Council should have treated Mrs H as not having capacity to understand the charging process.
26. However, apart from the record that a financial assessment had been requested, there is nothing in the needs assessment form to show the social worker had this conversation with Mrs H at the time. I asked the Council to give me a copy of any evidence it had to support this assertion; but, while it has provided additional detail to show the course of events leading to Mrs H being charged for care, its response does not address this question.
27. I am not satisfied, therefore, the Council can now defensibly assert it explained the charging process to Mrs H in December 2024, and that she accepted this without objection. There does not appear to be any evidence to support this.
28. Equally though, I am unconvinced the family could practically have avoided Mrs H’s care charges, as Mrs T says.
29. First, although it is not disputed the second social worker gave misleading information about the charging arrangements, this was evidently sometime after her placement had already started. The Council did not appoint the social worker to Mrs H’s case until late February, and so this was the earliest possible date she could have misinformed the family. By that point, Mrs H had already been in the care home for nearly two months. So I cannot accept that the social worker’s misinformation led the family to agree a placement they otherwise would not.
30. Second, Mrs T says the family would have made different arrangements for Mrs H’s partner’s care, to enable Mrs H to return to her property, and thus avoid having to pay for the care home. But I cannot overlook that Mrs H did not return home even after her partner died, and instead moved to a new care home. This strongly suggests that, even if there had been no question about the family’s understanding of the charging arrangements, Mrs H would still have incurred the same or similar charges.
31. Third, the Council has also highlighted the previous financial assessment it completed in September 2023, which had already established Mrs H was a full-cost payer. Although, as I understand it, this assessment was completed for slightly different reasons, I agree it suggests Mrs H would already have been aware that she had to pay for any care she received.
32. I also note Mrs T has explained she was estranged from Mrs H at that time, and indeed remained so until she entered the care home in January 2025, meaning she could not have been involved in any conversation the Council had had with Mrs H about charging arrangements up that point.
33. Therefore, while there was clear fault by the Council, in that the second social worker gave incorrect advice about the charging process, on balance I am not persuaded this fault can reasonably be said to have caused the injustice claimed by Mrs T. The evidence shows that, either way, Mrs H would have incurred the care charges.
34. I accept the discovery of the social worker’s misinformation caused some distress to Mrs T, which is a form of injustice in its own right. Given the fault made no material difference to the situation though, I consider the apology the Council gave in its complaint response to be adequate to remedy this, and so I make no further recommendation.

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Decision

35. I find fault causing injustice, but which the Council has already remedied.

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Investigator's decision on behalf of the Ombudsman