The Ombudsman's final decision
Summary: There is no fault by the Council. The Council was waiting for information which meant the financial assessment took longer than it should have. The Council did include a Personal Expenses Allowance in the financial assessment.
The complaint
The complaint, Mrs X, complains for her mother, Mrs Y. Mrs X says there was a delay in completing a financial assessment which led to a large backdated invoice for care home fees which will mean financial hardship.
Mrs X also complains Mrs Y has not been left with a Personal Expenses Allowance during her placement in a residential care home.
The Ombudsman’s role and powers
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) 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)
How I considered this complaint
I read the papers put in by Mrs X and discussed the complaint with her.
I considered the Council’s comments about the complaint and any supporting documents it provided.
Mrs X and the organisation had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
What I found
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.
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.
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.
Key facts Mrs Y paid privately for her stay in a residential care home. Mrs X asked the Council to carry out a financial assessment as she felt her mother’s savings had gone below the upper capital limit.
Mrs X telephoned the Social Worker on 21 November 2022. The notes of the telephone call say ‘Mrs X will email bank statements and proof of tax paid separately as Mrs Y was a director of a company and has to complete a tax return annually in January. So, the amount for the occupational pension on the bank statement is gross’.
A file note of 28 November 2022 says ‘received some bank statements for 2 bank accounts and gross pension amount’. The officer noted Mrs Y received attendance allowance and state pension. The social worker calculated the Council could start financial assistance on 16 December 2022. The file said ‘need to know if service user is eligible for funding – worker needs allocating to look into this and complete a Care and Support assessment’. The officer noted the online declaration for the financial form had not been completed.
The next file note is dated 24 February 2023. This notes the online declaration had not been completed and a copy was sent to Mrs X.
On 7 March 2023 further bank statements were received and funding could start from 7 November 2022 but new documents would need to be completed. Payments started to the care home at the end of March 2023. The officer noted that additional information was needed on Mrs Y’s private pension. The Council completed the assessment on 13 June 2023 with an estimated figure as they had not received the information from Mrs X. The financial contribution Mrs Y was assessed to pay was around £300 per week, which meant there would be a backdated invoice of over £10,000.
My analysis Mrs X says the Council delayed completing the financial assessment which led to the large backdated invoice. Mrs X says she supplied the Council with all the information at the start and disagrees the delay was due to her failure to supply info.
On looking at the Council’s file notes I can see the Council was waiting for Mrs X to complete an online declaration. Then Mrs X sent in further bank statements in March 2023 which changed the start date for financial assistance. The Council was still waiting for pension information in June 2023 but completed the assessment with estimated figures. I do not find fault, there is no evidence that any significant delay was due to the Council.
Mrs X says that she was not aware they would have to contribute financially so the backdated invoice was a surprise. Mrs X says they received a contract. The section for contributions on the contract said ‘nil’ so she thought they would not have to pay. She feels strongly that once the contract was issued it should have had all the information.
I have seen a copy of the contract. Point 7 says ‘the service user will pay to the Council a contribution towards the total cost of services which is based on a financial assessment by the Council and will be notified to the service user separately’. So, while I appreciate Mrs X says she did not understand Mrs Y would need to make a financial contribution this was set out in the contract. The Council has said it is able to consider a repayment plan for the arrears.
Mrs X also complains that her mother has not been left with a Personal Expenses Allowance during her placement in a residential care home. The financial assessment shows the Personal Expense Allowance of £31.55 (£34.75 from 10 April 2023) was included so I can find no fault on this point.
Final decision
I have completed my investigation of this complaint. This complaint is not upheld as I have found no evidence of fault.
Investigator’s decision on behalf of the Ombudsman
Investigator's decision on behalf of the Ombudsman