Summary: Mrs X complains the care provider failed to provide her with information about care home fees or a private residency contract when caring for her mother, so she unexpectedly received a large bill for care home fees. There is no evidence the actions of the care provider caused injustice to Mrs X and her mother, so we have completed our investigation.

The complaint

1. I have called the complainant Mrs X. She complains that Akari Care Limited (the care provider) was at fault when it cared for her mother ‘Mrs Y’. Mrs X says;
• The care provider failed to provide her with any information about care home fees resulting in her unexpectedly receiving a large bill causing distress.
• The care provider delayed in sending her a contract for Mrs Y’s placement.
• The local council involved used a junior social worker to deal with Mrs Y’s case, failed to give information on care home fees and to carry out a financial assessment.

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What I have investigated

2. I have investigated Mrs X’s complaints about the lack of information provided and the delay in sending the invoices and contract by the care provider. I have not investigated Mrs X’s complaints about the actions of the local council involved as this is the subject of a separate investigation by us. However, I have referred to actions by the council within the decision statement for information.

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The Ombudsman’s role and powers

3. 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)
4. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we could add to any previous investigation by the care provider, or
• it is unlikely further investigation will lead to a different outcome.

(Local Government Act 1974, sections 34B(8) and (9))

5. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative if they have one, (Local Government Act 1974, section 26A(2), as amended)

6. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the care provider followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.

7. 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 30(1B) and 34H(i), as amended)
8. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

9. I have read the papers submitted by Mrs X and spoken to her about the complaint. I considered the care provider’s comments about the complaint and the supporting documents it provided.
10. Mrs X and the care provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Fundamental Standards of Care

11. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall. Of relevance to this complaint are:
• Regulation 9- ‘Person–centered care’. This regulation says the care provider must give people information about the terms and conditions of their care, treatment, or support, including the expected costs and the requirement to pay for their care, treatment, and support.
• Regulation 17 – ‘Good governance’. This regulation requires providers have systems and procedures in place to meet other regulatory requirements. Providers must also maintain accurate, complete and detailed records for each person using the service.
• Regulation 20 – “Duty of candour”. This says that providers should be open and transparent with people who use their services and other relevant persons acting lawfully on their behalf. The CQC says the regulation promotes openness and honesty at all levels as an integral part of a culture of safety that supports organisational and personal learning. It says care providers should apologise when things go wrong.

Covid–19 funding

12. In March 2020 the Government agreed to provide funding to the NHS to support enhanced hospital discharge arrangements. The funding included providing free out of hospital care and support to people discharged from hospital or who would otherwise be admitted into it for a limited time. This removed barriers to discharge and transfer between health and social care and enabled people to get out of hospital quicker and back to their homes, community settings or care settings.

Key events leading to the complaint

13. Mrs Y lived in sheltered housing accommodation and was admitted to hospital in July 2020. When Mrs Y was well enough to be discharged from hospital there were concerns about her ability to live independently. This was because she was assessed as needing 24-hour care.
14. The local council social worker recommended Mrs Y move to residential care and discussed planning for her hospital discharge with the family. It was agreed Mrs Y needed a short-term placement until the council carried out a full assessment of her long-term needs.
15. The social worker sent the family a list of care homes to choose from. The social worker told the family Mrs Y would be initially funded by the government’s covid funding, reviewed after six weeks, and made them ‘aware of the cost implications’.
16. Mrs X chose a care home for Mrs Y run by the care provider. The social worker contacted the care home to see if they had a vacancy. The care home carried out a telephone assessment and arranged for Mrs Y to be admitted that day.
17. The social worker contacted the care home a few days later for an update on Mrs Y. The social worker’s case notes show the family were aware that covid funding would end on 29 September 2020 and Mrs Y would be self-funding her care.
18. The council agreed to a long-term placement for Mrs Y and arranged a financial assessment on Mrs Y as covid funding was due to end. Mr Z, Mrs X’s brother, held power of attorney for Mrs Y for property and financial affairs and health and welfare. Mr Z considered Mrs Y would be self-funding as she had capital over £23,250 but asked the council to carry out a financial assessment.
19. The financial assessment found Mrs Y had capital over £23,250 so would be self-funding and needed to pay the full cost of her care. A council officer spoke to Mr Z about the outcome of the assessment, and he was responsible for paying Mrs Y’s care home fees direct to the care provider from 29 September 2020. The council confirmed this in a letter to Mr Z dated 8 September 2020. The letter said it would not make any financial contribution towards Mrs Y’s fees from 29 September 2020 as she was classed as self-funding. This meant Mrs Y, or her representative would be responsible for paying the care provider direct. The council said it would tell the care provider. The council issued the letter on 28 September 2020.
20. The council sent a letter dated 8 September 2020 to the care provider on 28 September 2020. The letter advised it would not be making a financial contribution towards Mrs Y’s fees from 29 September 2020 as she was classed as self-funding. The council suggested the care provider send the accounts for Mrs Y’s stay direct to her or a representative to pay.
21. The care provider emailed the council in November 2020 about Mrs Y’s funding as it had stopped on 28 September 2020. The care provider asked the council to confirm if there was any further funding or if it needed to invoice privately. The council sent the care provider a copy of its letter dated 8 September 2020 advising Mrs Y was self-funding from 29 September 2020. The care home adjusted Mrs Y’s account and sent Mrs X invoices in December 2020 for £13,000. Mr Z contacted the council social worker to challenge the care provider fees as it had taken time to notify them.
22. The social worker arranged for a meeting with the family and care provider in January 2021. The care provider explained to the social worker a lack of administration staff meant they could not act on the council’s September 2020 letter saying Mrs Y was self-funding until November 2020. This caused a delay in sending out the invoices.
23. A finance officer at the care provider spoke to Mr Z before the meeting and explained he had been unable to send him a contract due to not being in the office. The finance officer offered to send Mr Z an electronic copy, but Mr Z wanted a paper copy. The financial officer agreed to post a contract to Mr Z on 19 January 2021 when he was back at the office. The care provider says Mr Z agreed to this.
24. The meeting in January 2021 discussed:
• The care home being unaware Mrs Y was self-funding or the council completed a financial assessment with Mr Z in September 2020.
• Mr Z considered he should have been sent the self-funding rates for the care home with the council’s letter.
• The time taken by the care provider to send an invoice, so they received a bill for £13,000 which they had not budgeted for. And care home had not sent any information about the placement or a contract.
25. The care home manager sent Mrs X a copy of the care provider’s resident guide on 12 January 2021. The care provider sent a complaint outcome letter to Mr Z on 14 January 2021.
26. The family moved Mrs Y to a different care home on 1 February 2021. Mrs Y sadly died in March 2021.

The care provider’s response to Mrs X’s complaints

27. The care provider says during the Covid-19 pandemic there was a change to its usual assessment and admission procedures because they were replaced by the government and local council’s interim procedures. This involved using a ‘trusted assessors’ model so any hospital discharges were led by an assigned trusted assessor from the hospital trust. Elderly patients were discharged from hospital as soon as they were medically fit to free up beds under covid funding.
28. The care provider says in normal circumstances when a person assessed as needing residential care, a social worker provides a list of homes. Family and prospective residents can visit the homes, ask questions, and discuss weekly fees and costs. Once it is agreed a resident will move into a care home a financial assessment is carried out to see who would be funding the placement either the local council or the resident.
29. The care provider explained Mrs Y had been admitted to the care home under covid funding and due to the change in the admission procedure, the level of information it usually requests did not happen. There had been no discussions that Mrs Y would be self-funding, so they did not discuss self-funding fees.
30. The care provider says it was unaware of the financial assessment carried out by the council in September 2020. The council sent notification dated 8 September 2020 of self-funding charges from 29 September 2020, but it did not receive it on that date. The care provider says it cannot confirm the date it received the notification. It considers it was due to postal delays and delays by the council sending out information. It was also due to the care home not having an administrator in place at the time because the staff member was shielding from Covid 19. This meant incoming post was not dealt with in the usual prompt manner.
31. When the care home manager found the council notification, it was sent to the care provider’s finance section on 5 November 2020. The finance section sought clarification from the council, adjusted Mrs Y’s account and sent out invoices on 14 December 2020.
32. The care provider has apologised to Mrs X and Mr Z for the delay in sending information about the care home and providing a contract for private residency. The care provider also apologised that they did not receive the invoices in a timely manner.

My assessment

33. I acknowledge that it was a difficult time for many care providers during the Covid-19 pandemic with some admissions to care homes under covid funding. The care provider says in its experience it was often done without the usual exchange of information with residents and relatives. While that may be the case the fundamental standards require a care provider to have systems and procedures in place and keep accurate, complete, and detailed records for each person using the service. So, I would expect the care provider to comply with these requirements when admitting residents.
34. However, the care provider would not have known whether Mrs Y was likely to be self-funding at admission until the council carried out the financial assessment. This was completed on 8 September 2020 and the council told Mrs X and Mr Z of the outcome that day. This was that Mrs Y would be self-funding from 29 September 2020 when the covid funding ended. The council confirmed the outcome in notification letters dated 8 September 2020 issued on 28 September 2020 to Mr Z and the care provider. The council told the care provider to invoice Mrs Y or her representative directly.
35. The care provider says the delay in dealing with Mrs Y’s invoices was largely due to delays by the Council sending out information. I note the Council did not send the 8 September 2020 letter out until two weeks later. This was a small delay, but the notification would have been received by the care provider shortly afterwards. The evidence shows it took the care provider until 5 November 2020 to see the notification and seek clarification on what was clear notification of the situation about Mrs Y’s self-funding status. So, I do not consider the delay in dealing with the invoice can be solely attributed to the council. I consider there was fault by the care provider as it had no working systems in place at the time to deal with incoming post from September to November 2020.
36. The fundamental standards require a care provider to give people information about a care home including expected costs. There is no evidence the care provider gave Mrs Y’s family a resident’s guide for the care home or a contract for private residency until January 2021. I consider the delay in doing so is fault by the care provider as Mrs Y had been in the care home since August 2020 and self-funding since September 2020. The care provider has apologised to Mrs Y’s family for the delays in sending information and a contract.
37. I must consider whether the fault I have identified by the care provider has caused an injustice to Mrs Y or her family. I do not consider the delay in sending the invoices or contract caused a significant injustice to Mrs Y or her family. This is because evidence I have seen shows the family was aware Mrs Y would be self-funding once covid funding ended. The family had been advised of this several times by the council including on completion of the financial assessment. So, I am satisfied Mrs X and Mr Z were aware there would be costs and they were required to pay for Mrs Y’s care. I would have expected the family to liaise and clarify the fees with the care provider once Mrs Y became self-funding on 29 September 2020 especially as they would be responsible for paying her fees. I have no evidence to show Mrs X or Mr Y pursued the issue of fees with the care home until they received the invoices in December 2020. Or about the lack of a contract until Mr Z’s spoke to a finance officer in January 2021.
38. The care provider has investigated Mrs X’s complaints and apologised for the delay in sending out the contract, invoices, and information. So, I do not consider I can add anything to the investigation already carried out by the care provider or achieve a different outcome for Mrs X. The care provider has apologised which is according to the fundamental standards. Because of this I do not consider any further remedy is needed in this case.

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Final decision

39. I find that no injustice has been caused to Mrs X or Mrs Y by the actions of the care provider.

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Investigator's decision on behalf of the Ombudsman