Summary: Ms X complained about the way the care provider dealt with her mother’s care home fees which she said caused financial uncertainty. We have found no fault causing injustice.

The complaint

1. The complainant, whom I shall refer to as Ms X, complains on behalf of her mother about the way the care provider has dealt with her care fees. In particular, Ms X says the care provider has:

• failed to comply with the terms of the contract;
• unreasonably increased the fees several times within a short period with inadequate notice or explanation;
• incorporated a temporary additional amount towards fuel costs into the fees despite saying it would review this; and
• failed to follow properly its own complaints procedure.

2. Ms X says because of the care provider’s fault, she suffers financial uncertainty and her mother is worried about her money.

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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. If they have caused a significant injustice or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(3 and 4) 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 read the papers provided by Ms X and discussed the complaint with her. I have also considered information from the care provider, Nottingham Care Village Limited.
6. I have explained my draft decision to Ms X and the care provider and considered the comments received before reaching my final decision.

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What I found

Background and legislation

7. Regulation 19 of the Care Quality Commission (Registration) Regulations 2009 says care providers must:

• make written information available about any fees, contracts and terms and conditions, where people are paying either in full or in part for the cost of their care.
• notify people of any changes to their terms and conditions, including increases in fees and give them sufficient time to consider whether they wish to continue with the service.

Key events

8. Ms X’s mother self-funds her residential care and Ms X manages her mother’s finances and pays the care home fees for her.
9. Ms X signed an admission agreement on 2 November 2022 shortly after her mother became a permanent resident. At the time, the weekly fees were recorded as being £1,100 plus £20 from the 1 December 2022. Clause 2 of the agreement said the fees would be reviewed on the 1st of January each year and …

“a 6% increase will be levied each year. However, should there be any changes to Government legislation, this figure will be reviewed in the light of these changes... Residents will be given a minimum of four weeks’ notice of any change in the scale of charges (unless a change in fees related to a change in care needs, when one weeks’ notice will be given).”

10. The agreement set out how to make a complaint. The complaint procedure says complaints should be made in the first instance to the Home Manager to provide an opportunity to resolve the issue. It says an initial response will be provided within seven days and a more substantive response within 28 days. If a complainant remained unhappy with the outcome, they could contact the Nominated Individual for the Home. A complainant could then contact the Ombudsman.
11. On 23 February 2023 the Nominated Individual sent an email to Ms X to inform her there would be a 10% increase to fees from 1 April 2023. The email gave several reasons for the increase, including:

• Increased food costs
• Increased utility bill costs
• Increased staff costs

12. Ms X raised concerns about the increased fees and met with the Nominated Individual in early March. Following this meeting Ms X sent an email on 2 March to formally raise her concerns about the fees.
13. Ms X explained her mother had originally been receiving respite care at the home from September 2022 but became a permanent resident in October. Ms X had originally understood the fee would be £1,000 per week. However, when signing the contract Ms X was advised the fee would be £1,100 with an additional £20 per week for electricity and gas. Ms X said she accepted the additional £20 was reasonable under the circumstances everyone was facing at the time but the additional £100 was a surprise. Ms X confirmed she agreed to pay the increased fee from 1 December and did not expect there to be a further increase for one year. Ms X said the additional 10% advised on 23 February 2023 therefore came as a shock and she was concerned about future budgeting if fees were to go up every few months. Ms X noted the annual 6% increase each year but asked what legislation had led to the 10% increase. Ms X received an acknowledgement the same day.
14. Ms X chased a reply on 28 March and asked if the additional £20 towards energy costs was to continue after 1 April.
15. The Nominated Individual provided a response to Ms X by email on 29 March and apologised for the delay. The email explained it had been decided the increased fees would remain in place due to the increased costs in fuel, wages and food costs. This acknowledged the home would normally increase its rates once a year by 6% but it had been an unprecedented time and prices had risen.
16. Ms X raised the issue in discussion with the Nominated Individual who provided a further reply on 25 May. This confirmed that due to the unprecedented rise in costs for utilities, food and staff the home had no choice but to pass on the increases as advised. In particular, the increase to the Minimum Wage was noted and that the home had needed to pay a substantial increase in wages to retain good and competent staff.

My analysis

17. It is not our role to determine whether care home fees are reasonable, what the level of fee increases should be, or whether increases are justified. Care providers are entitled to charge fees and to increase these. This is a commercial decision which takes account of several factors including staff costs, increased energy bills, and planned refurbishments. We cannot decide whether the fee a care home charges is fair or reasonable. My role is to determine if the care provider has followed the relevant law and guidance.
18. When we consider complaints about increased care fees, we must be satisfied the service user (or their representative) received clear and relevant information; both in the original contract terms and when the provider communicated the decision to increase the fees. This is because the Care Quality Commission (Registration) Regulations 2009, regulation 19, states that providers must “…give timely and accurate information about the cost of their care and treatment to people who use services”. To do so, “... providers must make written information available about any fees, contracts and terms and conditions, where people are paying either in full or in part for the cost of their care, treatment and support”.
19. Ms X has raised concerns about changes made to the weekly fees before she signed the contract with the home. However, the signed agreement sets out the weekly fee as £1,100 plus an additional £20 with no detail of when or if the additional £20 fee would be reviewed. By signing the agreement, Ms X said she understood and accepted the terms and conditions. Therefore, I have considered the subsequent increase made to the fees only.
20. The home notified Ms X on 23 February 2023 that there would be a 10% increase to fees from 1 April 2023. The signed agreement makes clear fees would be reviewed each year on 1 January. The only potential issue would be the 10% increase rather than the standard 6% increase set out in the agreement. However, the agreement does allow for that figure to be reviewed in the light of changes to legislation. The care provider highlighted the significant increase to the Minimum Wage that year by the Government which fed into its staffing costs. The home provided more than the four weeks’ notice set out in the agreement.
21. Based on the information provided, I am satisfied there was relevant, clear information given to Ms X about the fee increase in accordance with the contract she signed and accepted and the fee increase has been applied across the board to all residents. In these circumstances, I have found no fault in the decision to increase fees which is one the care provider was entitled to reach.
22. Ms X made her complaint directly to the Nominated Individual and received a reply within the expected timescale of 28 days although an apology was provided for the time taken. I see no fault here. I do note this reply and the subsequent correspondence did not remind Ms X of her right to contact the Ombudsman if she remained unhappy with the outcome. It would be good practice to do so. However, the published complaint procedure sets out this right and Ms X was able to make a complaint to the Ombudsman without any undue delay. Therefore, I do not consider Ms X was caused a particular injustice by any omission here.

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Final decision

23. I have competed my investigation as I have found no evidence of fault causing injustice in the care provider’s actions.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman