Summary: Mrs X complains the Council delayed assessing Mrs Y’s financial contribution for care. The Council was at fault as its communication was poor and there was significant delay in progressing the matter. The Council has agreed our recommended remedy for the frustration and time and trouble caused to Mrs X.

The complaint

1. Mrs X complains the Council failed to respond promptly when her mother Mrs Y’s savings fell below the upper capital threshold. She says the Council delayed completing the financial assessment and other assessments and this led to arrears and stress and uncertainty.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I have discussed the complaint with Mrs X and considered the information she provided. I have made enquiries of the Council and considered the documents it provided. Mrs 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

Legislation and guidance

Charging for permanent residential care

5. 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.
6. 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.
7. 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

8. Mrs Y who had dementia, was living in a residential care home. As she had capital above the upper threshold, she was paying for her care herself.
9. In October 2023 Mrs X contacted the Council and advised Mrs Y was self funding. She requested the Council assess Mrs Y and said she preferred not to use the online assessment system.
10. In January 2024 Mrs X contacted the Council again and stated that Mrs Y would soon have less than the upper capital threshold of £23,250. She completed an online financial assessment calculation.
11. Mrs X did not hear from the Council, and she contacted it several times over the next 3 weeks. At the end of January Mrs X called the Council and said her mother’s capital would run out in 10 weeks. The Council noted the matter was urgent and said it was waiting to allocate it to a social worker.
12. In early February Mrs X told the Council Mrs Y’s care home fees were increasing. The Council noted this. Later in February the Council said it had marked the case as a priority. However, it had not yet allocated it to a social worker.
13. Mrs X chased the Council twice in March and advised that Mrs Y’s savings were now below the lower threshold of £14,250, and she would soon be unable to pay the fees. A customer service officer said they would advise a manager. The Council noted Mrs X had chased several times and the social work team had not opened notifications. Mrs X says she asked for a call back, but no one called.
14. Mrs X emailed the Council and complained it was ignoring her. She asked the Council to urgently provide the financial support Mrs Y was entitled to.
15. On 21 March 2024 the Council allocated the case to a qualified social worker via a contractor.
16. On 25 March the social worker visited to assess Mrs Y’s care needs. She noted that she referred the case to the financial assessment team. She also recommended to the Council’s adult social care Panel that the Council funded Mrs Y’s care at her current care home. She said it would be disruptive to move Mrs Y, taking account of her age and that she was settled in the home, and could put her wellbeing at risk.
17. The social worker asked the care home if it would accept the rate the Council paid. It replied that it would not accept the Council’s rate, but would accept £1200 per week. The social worker referred Mrs Y’s case to the Council’s financial assessment team.
18. Mrs X called the Council to ask for an update on 12 April 2024 and an officer noted she had called.
19. On 22 April Mrs X complained to the Council that it said Mrs Y’s case was a priority and had assessed her needs four weeks earlier. But it had not yet completed a financial assessment. The Council acknowledged this but did not respond.
20. On 30 April Mrs X called the Council’s financial assessment team. It said it had no record of the Council sending a financial assessment form for Mrs X.
21. On 2 May the social worker called Mrs X and said the Council’s Panel had not agreed to pay the care home’s reduced rate. The Panel asked the social worker to explore other care homes that would accept the Council’s rates. Mrs X said the Council should not expect Mrs Y to move to another home given her age and health.
22. The social worker asked the financial assessment team to prioritise Mrs Y’s assessment. However, it replied that it could not complete a financial assessment because there was no live care package on the Council’s system.
23. On 8 May Mrs X chased a response to her complaint of 22 April. The Council’s advanced social work practitioner called Mrs X in response to her complaint. She explained the social worker had not provided other options in her report and would need to set out the reasons why Mrs Y could not move. The Panel could then consider the recommendations.
24. On 15 May Mrs X complained at stage one of the Council’s complaint procedure because she had still not heard from the Council. She said Mrs Y’s funds dropped below the minimum threshold in February.
25. The same day the Panel refused the social worker’s recommendation to fund Mrs Y’s current care home. It asked for more information about alternative options, potential top up payments, and to negotiate a fee reduction. It said the risks to Mrs Y of moving should be set out. The financial assessment team would also need to consider whether the value of Mrs Y’s property could be disregarded.
26. Following a telephone conversation with the advanced practitioner Mrs X emailed the Council to say she was frustrated about being left in the dark while Mrs Y’s funds depleted. She had already sent information to the Council about the reasons Mrs Y’s home should be disregarded. She advised the Council that Mrs Y’s health had deteriorated and it would be inhumane to move her.
27. On 23 May Mrs X called the Council. The advanced practitioner advised the Panel were due to consider the revised recommendation. She said the Panel may agree to fund Mrs Y’s care home for two months to allow time to find an alternative home. She asked Mrs X why she had left it so late to raise Mrs Y’s situation with the panel. Mrs X said she had raised the issue of Mrs Y’s funds reducing in January 2024, but the Council had delayed unacceptably.
28. On 7 June the Council replied to Mrs X’s complaint. It upheld the complaint because Mrs X had contacted the Council in mid January, but it had taken until 21 March 2024 for it to allocate the case to a social worker. There was delay in the Council’s assessment which impacted Mrs Y’s funds further. The Council said it had discussed the delays with its contractor to prevent delays for others. The Council confirmed the Panel had agreed to fund Mrs Y’s placement in her current care home from 3 May to 17 June 2024, to allow time to find an alternative home. The Council noted the current care home would not continue to be suitable for Mrs Y because her needs had changed. The Council would therefore reassess her needs.
29. Mrs X replied that the complaint was not resolved. While it had agreed to fund Mrs Y until 17 June, and it had assessed her needs, it had not provided a care plan. Any change in Mrs Y’s environment would have a detrimental effect on her wellbeing.
30. In late June Mrs X discussed lack of progress with the advanced practitioner. The social worker had not reassessed Mrs Y and the Council had not carried out a financial assessment. The agreed funding had already run out. Mrs X asked the Council to continue funding Mrs Y until an alternative home had been found. She also told the Council that the agreed payments had not been made, and this had caused embarrassment.
31. Mrs X complained to the Ombudsman.
32. In early July the Council sent financial assessment forms to Mrs Y’s former home. The Council said that Mrs Y would need to pay a financial contribution once the assessment was completed. The Council asked if Mrs Y was selling her former home.
33. Mrs X replied that the family had waited many months to complete a financial assessment. She said the family had considered selling Mrs Y’s property, but this was not possible as her son who was over 60 was living there.
34. On 8 July Mrs X complained further that the case was still not resolved. The Council had not paid the fees as agreed. The Council had said it would continue to pay from 17 June, but it had not paid. It was now six months since her request, but it was still not finalised.
35. The Council later advised Mrs X that it would pay the arrears for May and June it had agreed in mid July.
36. In mid July Mrs X returned the financial assessment forms. Mrs X complained to her MP at the end of July that Mrs Y could no longer make any payments but the Council had not resolved the matter. The Council promised payments in June but had still not paid.
37. In August the Council’s Panel considered the social worker’s request for continued funding from 17 June. The Council noted the social worker had not progressed matters as the care home had advised Mrs Y may be selling her home. The Council confirmed it would continue to fund Mrs Y’s current care home until 4 September on 15 August.
38. The Council advised Mrs X of it its financial assessment on 14 August. It agreed that it would disregard Mrs Y’s property. Her weekly contribution from May 2024 was £297 per week.
39. Mrs X replied that it had taken too long to complete its financial assessment, and Mrs Y now had growing arrears. She accepted Mrs Y would need to move. She visited alternative homes.
40. In late August Mrs X wrote to the Council setting out her calculation of overpaid care fees due to the Council’s delays and assessment. She said that Mrs Y’s capital fell below the upper threshold in early February. But because of the Council’s delays she had to pay the fees in full when the Council should have contributed.
41. In early September the Council agreed to extend funding for Mrs Y’s current home until 4 October. Mrs X identified a suitable care home, but it did not have an available room until October.
42. In September the Council responded to Mrs X’s complaint of 8 July. It noted she complained
• the Council failed to follow its own processes and procedures
• there was no joined up communication internally
• notifications to the social work team were not opened
• financial assessment requests were ignored.
43. The Council said its stage one response had accepted there were delays by its social work contractor in allocating the case. It had taken follow up action. It noted Mrs X complained that the Council failed to keep its promises to prioritise the case and make payments. It said that it had made progress as it had completed the financial assessment and answered Mrs X’s queries. It had made considerable efforts to find Mrs Y a new home. But it accepted that promises were not delivered in a timely way. Some delays were outside its control.
44. The Council noted Mrs X complained the Council used jargon and delayed responding. The Council considered that recent communications were clear and timely. It agreed it should provide up to date information about financial assessments to applicants. It planned to provide this in December 2024. It upheld Mrs X’s complaint that it had not taken action in line with its core values to be collaborative and supportive. The Council apologised for this and said it was implementing service improvements to provide a more responsive service from the first request to delivering care and support.
45. Later in September Mrs Y’s health deteriorated, and she passed away before she was able to move.
46. Mrs X advised the Ombudsman that following her mother’s death she continued to query the Council’s calculations and the date that it assessed Mrs Y’s capital fell below the upper threshold.
47. In November the Council agreed that Mrs Y’s savings had reduced below the upper threshold in February. It also agreed as a gesture of goodwill to ignore capital above the lower threshold. This reduced the assessed contribution slightly. The Council made payments to the care home in December. The care home has now reimbursed Mrs Y’s estate the credit on the account.

Analysis

48. The Council accepts that there were faults in its handling of this matter. This includes
• Significant delay allocating the case to a social worker.
• Delays in progressing the assessments
• Poor communication at early stages.
49. I consider there was also poor handling regarding repeated requests to the Council’s Panel as insufficient information was provided. In addition, the Council did not properly consider the date Mrs Y’s capital reduced until very late in the process.
50. The Council has made appropriate service improvements in order to prevent these faults affecting others in the future.

The Council has provided a suitable remedy for the injustice caused by delays in the financial calculation. However, I consider the Council has not provided a suitable remedy for the injustice to Mrs X which was caused by the Council’s faults. She was caused frustration, uncertainty and time and trouble. I have recommended a remedy.

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Agreed action

51. Within one month of my decision, the Council agreed to
• Pay Mrs X £250 as a symbolic payment to recognise the injustice of uncertainty, distress and time and trouble.
52. The Council should provide us with evidence it has complied with the above actions.

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Final decision

53. There was fault by the Council causing injustice. It has agreed to remedy this and so I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman