This fact sheet applies to events occurring before 1 April 2015 (the date when the first stage of the Care Act 2014 came into force) - see our other fact sheet if events occurred after 1 April 2015.
This fact sheet is aimed mainly at people who are having problems with their own, or a relative’s, residential care and may be thinking about complaining to the Ombudsman.
I am unhappy about the way the council has assessed my care needs and organised residential care for me. Can the Ombudsman help me?
Sometimes, yes. The Ombudsman cannot question the merits of decisions, or professional judgements, where they have been reached properly. But we can consider how the council has reached those decisions and whether it has implemented them properly.
People are free to arrange their own residential care privately with a care provider who should be registered with the regulator - the Care Quality Commission (CQC). This is called self-funded or self-arranged care.
The law says the council must arrange residential accommodation for those aged 18 or over who because of age, illness, disability or any other circumstances, are in need of care and attention not otherwise available to them.
The council must protect people’s property where no-one else can do this. The council should place a person at his/her preferred choice of accommodation providing, among other things, the accommodation is suitable and the cost does not require the council to pay more than it would expect to pay.
The council must place a person in preferred accommodation if a third party will agree to pay the difference, often referred to as a ‘top-up’.
A person can express a preference for 24-hour care at home but a council does not have to provide this if it considers residential care would be more appropriate to meet the assessed needs.
Councils must charge for residential care they provide. When a resident stays no more than eight weeks in accommodation - whether for respite or for a trial placement - councils have the discretion to limit what they charge.
The council must do a financial assessment and tell the person how much it will charge them. This may be the whole sum if the person has a high income or large assets. Otherwise the charge takes account of a person's income and savings. It also takes account of the value of their home (unless it is occupied by: the person's partner; a relative or family member who is 60 or over; their child (if under 18); or a relative or family member who is incapacitated).
A person must not do anything to deliberately deprive themselves of capital. If they do the council will assess them as having 'notional' capital.
How do I complain?
You should normally complain to the council first. We will not normally consider a social services complaint until the council has had the opportunity to consider and resolve it locally.
When you complain about social services, the council should give you information about what will happen to your complaint and how long this will take.
The council should agree with you a plan for how it will deal with your complaint, including a timescale. You can complain to us is if you’re not happy with the outcome once the council has completed its consideration of your complaint. You should normally make your complaint to us within 12 months of realising the council has done something wrong.
If you consider my complaint what will the Ombudsman look for?
We consider whether there has been fault in the way the council has dealt with a person’s assessment for and admission to residential care. If there is we will then consider what impact this has had on the person, and sometimes on the person’s family. Some faults we might find are that the council:
- delayed unreasonably in carrying out an assessment on whether the person needed residential care
- delayed unreasonably in providing residential care
- arranged residential care that did not meet the person's assessed needs
- failed to give the person full information about choices of accommodation
- failed to tell the person of the financial charges before entering residential care, or
- wrongly assessed the person’s financial contribution.
What happens if the Ombudsman finds the council was at fault?
If there are errors in the assessments, we may ask the council to reassess the person and ensure it puts the correct services in place.
For errors in financial assessments we may ask the council to refund the person it has overcharged.
If the council has caused substantial harm or distress we may recommend a financial remedy for those affected.
We may also ask the council to amend procedures for the benefit of other service users.
Examples of some complaints we have considered
Other sources of information
The Care Quality Commission, www.cqc.org.uk or call 03000 61 61 61
See Civil Legal Advice (CLA) at www.gov.uk/civil-legal-advice or call 0345 345 4 345 to check if you can get legal aid
Our fact sheets give some general information about the most common type of complaints we receive but they cannot cover every situation. If you are not sure whether we can look into your complaint, please contact us.