The Ombudsman's final decision:
Summary: Mrs C complained about the care home’s fee and the way in which the family was informed about it by the care home. We found fault because the care home had charged an incorrect (higher) rate. The care provider has agreed to apologise for this and correct the corresponding invoices.
- The complainant, whom I shall call Mrs C, complained to us on behalf of her mother, whom I shall call Mrs X. Mrs C complained the care home failed to call a member of Mrs X’s family before the day she went into the home, to inform the family what would happen and (more importantly) what the fee could/would be.
- Furthermore, the care home first told the family that the fee would £1,140 but the actual fee ended up as £1,255. Mrs C said the care home also failed to provide a breakdown to show how the care home fee had been arrived at.
- Mrs C also complains the Care Home fees are too high. They are about £400 higher than the average care home fee for residents living in the care provider’s other care homes
The Ombudsman’s role and powers
- We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
- If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
- If we are satisfied with a care provider’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 34H(i), as amended)
How I considered this complaint
- I considered the information I received from Mrs C and the care provider. I shared a copy of my draft decision statement with Mrs C and the care provider and considered any comments I received, before I made my final decision.
What I found
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC) issued guidance in March 2015 on meeting the regulations (the Guidance.) The Ombudsman considers the 2014 Regulations and the Guidance when determining complaints about poor standards of care.
- Regulation 19 “Fees” says that: “Where a service user will be responsible for paying the costs of their care or treatment (either in full or partially), the registered person must provide a statement to the service user, or to a person acting on the service user's behalf:
- specifying the terms and conditions in respect of the services to be provided to the service user, including as to the amount and method of payment of fees; and
- including, where applicable, the form of contract for the provision of services by the service provider”.
- in writing; and
- as far as reasonably practicable, provided prior to the commencement of the services to which the statement relates.
- Mrs C said her mother needed to go into a care home. Winters Park Care Home came and assessed her mother’s needs, and she moved into the home two days later. Mrs C said:
- The family did not know what the care home fee would/could be before her mother arrived at the home.
- The manager asked them on arrival to complete forms and said the fee would be £1,140. However, the contract said £1,255.
- The Council’s Care Home Select Team contacted the care home to ask for a placement for Mrs X. The team subsequently told the home manager that Mrs X and her family were aware of the cost of care and agreed to the admission. As such, the home manager believed that all information about the placement and fees had been communicated to Mrs X and her family by the Care Home Select Team.
- The Home undertook a pre-admission assessment and within 24 hours Mrs X was admitted to the Home as a “residential” client, not a “dementia residential” client.
- The Home will usually contact and engage with the nominated relative in advance of the admission, regardless of who the initial enquiry was from. This allows the home to have a conversation and ensure that everyone is aware of what the agreed fee amount is.
- Mrs X’s daughter received a welcome letter on the day of admission, along with a copy of the residency agreement. The agreement needs to be signed before or on the day of admission. The home usually sends this out before the day of admission. However, due to the short timeframe, this was not possible.
- When the initial enquiry came into the Home, it was for Mrs X to be admitted as a respite placement, which costs £1,255 per week. However, just before the admission, Mrs X’s family decided the placement should be permanent, which is £1,140 per week. Due to the short notice of the placement and change of category of placement, there was a miscommunication, which regrettably resulted in the amount on the contract being different to the correct amount that was communicated to Mrs C by the Home Manager. We have revised the outstanding debt to reflect this and the amount outstanding has reduced to £5,606.22.
- We expect providers to provide clear written information about charges in advance, at least on the day a service-user moves in, but it should be in advance so service-users and/or their family can make informed decisions about whether to move there and incur those charges.
- There is a responsibility on the care provider to ensure the service-users and/or their family have this information in a timely manner, no matter whether they were referred to by a council or not. The care provider has acknowledged they agree with this. It said it usually provides all relevant information in advance. However, this was not possible on this occasion due to the very short time between the assessment and Mrs X moving in. As such, they still provided the information on the day of arrival.
- In response to my enquiries, the care provider has identified that it has been charging Mrs X the incorrect amount for her stay. It has charged her £1,440 a week instead of £1,255. It has now corrected the outstanding balance accordingly.
- It is up to the provider to decide what fees they want to charge in one of their care homes and whether this should be more or less than they may charge in another home. In the end these are commercial decisions. It is subsequently up to a potential client to decide if they are willing to pay the required fee. There is no requirement for care providers to provide a detailed breakdown of the fee, as part of the admission process, to show how the final fee was arrived at.
- I recommended that, within four weeks of the date of my decision, the care provider should apologise for charging Mrs X the incorrect fee.
- The care provider has told me it has accepted my recommendation.
- For reasons explained above, I found fault by the care provider.
- I am satisfied with the actions the care provider will carry out to remedy this and have therefore decided to complete my investigation and close the case
- Under the terms of our Memorandum of Understanding with the Care Quality Commission (CQC), I have shared a copy of my final decision statement with the CQC.
Investigator's decision on behalf of the Ombudsman