Summary: Mr X complains on behalf of Mrs Y that the Council has not dealt with adult social care properly because it has not calculated charges for Mrs Y correctly, causing financial loss. The Council did not calculate charges correctly. Mrs Y’s estate suffered financial loss. The Council should apologise and recalculate Mrs Y’s care costs.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains on behalf of Mrs Y that the Council failed to deal with adult social care properly when it did not calculate fees correctly because:
• Mrs Y historically paid fees with assets that should have been disregarded; and
• It failed to refund care costs from November 2023 to December 2023.
2. Mr X says Mrs Y suffered financial loss.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide there is not enough evidence of fault to justify investigating. (Local Government Act 1974, section 24A(6), as amended, section 34(B))
5. 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/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
6. 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(i), as amended)

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What I have and have not investigated

7. I have investigated that part of Mr X’s complaint about how the Council has dealt with a refund for care costs for Mrs Y between November to December 2023. I have exercised discretion to investigate back to November 2023 because Mr X’s complaint was wrongly sent to another Council causing delay.
8. I have not investigated any reference to disregarding of assets because there is not enough evidence of fault by the Council to justify investigating.

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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

What happened?

11. This is a brief chronology of key events. It does not contain everything I reviewed during my investigation.
12. Mrs Y had been in residential care since 2014. She paid for her care herself by selling assets. Mr X’s brother was managing Mrs Y’s financial affairs.
13. Mr X’s brother passed away, and Mr X took on the responsibility of managing Mrs Y’s financial affairs. He found that Mrs Y had not needed to sell assets to pay for her care because they could have been disregarded.
14. Mr X asked the Council to pay for Mrs Y’s care in November 2023. The Council declined to fund Mrs Y’s care because it said another Council was responsible for this.
15. Mrs Y passed away in February 2024.
16. Mr X complained to the Council that it should have funded Mrs Y’s care. The Council has now accepted that it should have funded Mrs Y’s care. The Council has refunded part of Mrs Y’s care costs from December 2023 to February 2024.

Analysis

17. Mr X submitted an online request for financial reassessment in November 2023.
18. The Council says it allowed 28 days for an assessment period and entered a residential contract from December 2023 with Mrs Y’s care provider.
19. The Council completed the re-assessment within 28 days. This itself is not fault by the Council.
20. After it later accepted that it should have funded Mrs Y’s care costs, the Council completed a financial assessment in February 2026.
21. On the basis of that calculation, the Council has since refunded care costs to the Care Provider between December 2023 and February 2024. The Care Provider has passed on these refunded costs to Mr X.
22. The Council has not considered whether it should backdate its refund of costs to November 2023. It has only done so from the date it actually made the assessment.
23. The Council accepts that there is a reasonable basis on the particular facts of Mrs Y's case for funding to be backdated to the date of referral.
24. The Council should have considered whether it should backdate the refund for care costs to the date Mr X asked for a re-assessment, November 2023. There is a 1 month period where Mrs Y paid her own full care costs and shouldn’t have had to do this. This is fault by the Council. Mrs Y’s estate suffered financial loss.

The Ombudsman’s Guidance on Remedies

25. If there is clear evidence of a quantifiable financial loss arising from the fault, we will normally recommend a financial remedy that repays that loss to the deceased person’s estate. For example where the deceased person paid care home fees which should have been paid by the organisation.

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Action

26. To remedy the outstanding injustice caused by the fault I have identified, the Council should take the following action within 4 weeks of my final decision:
• Apologise to Mr X for the fault found. 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 I have recommended in my findings.
• Recalculate Mrs Y’s care costs for the period 21 November to 20 December 2023 based on its February 2026 financial assessment calculation and refund Mrs Y’s estate accordingly.
27. The Council should provide us with evidence it has complied with the above actions.

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Decision

28. I find fault causing fault. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman