Summary: Mr X complains the Council delayed from May 2021 calculating and paying its care charge contribution for his mother’s care in a home. We consider there is fault by the Council. It has agreed our recommendations for a remedy and a service improvement.

The complaint

1. The complainant whom I shall refer to as Mr X, complains on behalf of his mother Mrs X that the Council failed to:
• calculate its contribution to Mrs X’s care home fees from March 2022 when Mrs X’s savings fell below the upper capital limit of £23250.
• send a financial assessment stating the contribution Mrs X needed to pay.
• respond fully to the complaint that Mr X made, and despite upholding the complaint twice, it did not take the appropriate action to resolve the matter.
2. As a result Mr X says the Council owes Mrs X’s estate over £10,000 and he was put to inconvenience and time and trouble in pursuing the complaint.

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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 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)
4. 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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How I considered this complaint

5. I have discussed the complaint with Mr X and considered the complaint and the documents he provided. Mr X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Charging for permanent residential care

6. 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.
7. 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.
8. 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.

What happened

9. Mrs X moved into a residential care home in 2021. She had capital over the upper capital limit of £23250, and so she was self funding.
10. In March 2022 Mr X contacted the London Borough of Brent because Mrs X had lived in that borough. He said that her capital had reduced, and he asked it to assess Mrs X’s contribution. The Council advised in May 2022 that the care home was in Ealing Council’s area and so Mrs X must apply to that authority.
11. Mr X contacted the Council in May 2022 and completed a new referral form. He chased the Council at the end of June because he had not heard anything. The council then provided a financial assessment form which Mr X completed in July 2022. He provided evidence of Mrs X’s capital and income.
12. In September 2022 the Council said it would pay Mrs X’s care home fees in full from September 2022 pending completion of the financial assessment. Mr X asked about backdating the Council’s contribution to March 2022. However, he did not receive a response, and could not get through to the financial assessment team. He sent emails to it without response, and his calls were not returned.
13. Mr X says he chased the Council several times between September and December 2022. In February 2023 he made a formal complaint. He explained that he had been asking the Council to provide assistance from May 2022, but it had not properly confirmed the payments Mrs X must pay from September 2022 and it had not responded about backdating its assessment to March 2022.
14. The Council replied in March 2023. It apologised that Mr X had been unable to get through to the financial assessment team and that there had been a delay. The Council said that it would expedite the matter that day, and it would write to him to confirm the charge from September 2022.
15. However, Mr X did not hear from the Council. In May 2023 he complained further that he had not received a response. In addition the Council had not referred in its response to backdating its assessment to March 2022. He said it was now a year since he had first contacted the Council.
16. The Council wrote to Mr X in May 2023 and advised him of the contributions that Mrs X must pay for her care from September 2022. Mr X responded that the Council had still not considered its contribution from March 2022. He had calculated that the Council owed his mother £10,000.
17. Mrs X sadly passed away in mid 2023.
18. The Council replied to Mr X’s complaint in June 2023. It stated the complaint was about its failure to send an invoice to Mrs X. The Council upheld the complaint and apologised regarding its delay. It said it would send an invoice and gave details of the weekly contributions payable from September 2022.
19. Mr X replied that the Council’s response was only partially correct. He said the Council also needed to backdate its contributions to March 2022. He said he had made numerous attempts by email several telephone calls, but the Council had not addressed the issue of backdating contributions to when Mrs X’s savings fell below the threshold. As he was the executor of Mrs X’s will, he needed to deal with her estate and consider any outstanding charges or refunds due.
20. In July 2023 Mr X complained to the Ombudsman. He said the Council had sent an invoice for Mrs X’s care contributions, which he would pay. However, he considered that the Council owed Mrs X care contributions for the period March 2022 to September 2022. In his view the Council owed Mrs X’s estate £10,000.
21. In its response to my draft decision the Council said it could not contribute to the care charges from March 2022 to May 2022 because it did not receive a Care Act Assessment referral until May 2022. It also was aware that Brent Council had received Mr X’s request in March 2022, and had initially agreed to contribute towards the fees. However, Ealing Council has now agreed to assess its contribution towards the fees from March 2022.

Analysis

22. There was considerable delay by the Council in carrying out a financial assessment of Mrs X’s circumstances. It is not clear why the Council delayed from May 2022 when Mr X first contacted it. This delay is fault.
23. While the Council has made contributions to Mrs X’s residential care from September 2022, it has not responded fully or properly to Mr X’s complaints. It upheld the complaints and stated it would take action. But there was further delay in sending details regarding Mrs X’s contribution and invoices. The Council did not address the issue of backdating its contributions. The Council’s delay and failure to respond fully is fault. This has caused Mr X inconvenience and time and trouble. I have recommended a personal remedy.
24. The Council’s financial assessment team appears to have failed to respond to Mr X’s contact with it. This is fault. Mr X had to repeatedly contact it to progress matters. I have recommended a service improvement remedy.

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Agreed action

25. Within one month of my decision the Council has agreed to:
• Assess its contribution to Mrs X’s residential care charge from March 2022 to September 2022 and send a written notification to Mr X. If there is a refund due to Mrs X’s estate the Council should make payment.
• Apologise to Mr X for its delay in considering his backdate requests and for its failure to properly responds to his complaint
• Pay Mr X £250 for the inconvenience caused by its delays and for his time and trouble in pursuing the complaint.
• Provide an action plan showing how the Council will improve the financial assessment team’s communication with service users and their representatives.
26. The Council should provide us with evidence it has complied with the above actions.

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Final decision

27. I have found fault causing injustice. The Council has agreed a remedy. I have completed my investigation and closed the complaint.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman