Summary: Mr X complained that the care provider failed to respond to his requests to settle his late father’s account. The care provider has now resolved the payments. I find the care provider took too long to respond to Mr X’s reasonable requests. It should apologise to him, offer a sum which recognises the time, trouble and frustration he was caused by its delay, review its complaint processes and its adherence to the guidance on fee notification.

The complaint

1. Mr X says the care provider agreed it had applied an unjustified increase to his late father’s account without prior notification but then delayed for many months in calculating the refund. He says this caused additional distress as the matter remained unresolved when his father died.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
3. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
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)
5. We have the same powers as the High Court in respect of the production of documents (Local Government Act 1974, section 34G (as amended)
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

7. I considered evidence provided by Mr X and the care provider as well as relevant law, policy and guidance.
8. Mr X and the care provider had an opportunity to comment on this draft decision and I considered their comments before making a final decision.

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What I found

Relevant law and guidance

9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
10. Regulation 19 says

“(1) 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—

(a) 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

(b) including, where applicable, the form of contract for the provision of services by the service provider.

(2) The statement referred to in paragraph (1) must be—

(a) in writing; and

(b) as far as reasonably practicable, provided prior to the commencement of the services to which the statement relates”.

11. Regulation 16 says, “Any complaint received must be investigated and necessary and proportionate action must be taken in response to any failure identified by the complaint or investigation.” The CQC guidance adds, “Information must be available to a complainant about how to take action if they are not satisfied with how the provider manages and/or responds to their complaint. Information should include the internal procedures that the provider must follow and should explain when complaints should/will be escalated to other appropriate bodies.”
12. The Competition and Markets Authority provides guidance for care providers on consumer law. It says (para 4.41),” Fee increase terms need to be treated with great care, in particular so that they do not allow you to increase your fees arbitrarily. To ensure compliance with consumer law, your fee variation terms must set out clearly the circumstances in which the resident’s fees may change and the method of calculating the change.”
13. The CMA also says, in respect of complaints handling, “You should set out clear and reasonable timescales within which residents can expect to hear back about their complaint, at each stage of the procedure”.

What happened

14. Mr X’s father (Mr A) first entered the care home as an NHS funded resident in 2021. From May 2022 until July 2023, when he was awarded NHS continuing healthcare (CHC) funding which paid 100% of his fees, he was self-funding.
15. Mr X says in April 2023 the care provider applied a 30% increase to his father’s fees without justification or prior notice. He says he complained orally at the time. In June 2023 he emailed the care home manager and said, “This is now the third month in a row that I have raised with you the fact that you have raised fees without consultation or notification. I have received no reply on each occasion”. Mr X says the care provider does not have a formal complaints process, only a policy which says that complaints can be made orally or in writing/by email.
16. In July, as he had not received any response, Mr X emailed again and said he had now stopped the payments to Mr A’s account as Mr A was fully funded by the NHS. He said if he did not receive a proper complaint response he would take the matter further.
17. In August the finance manager emailed Mr X and apologised for the delay and the issuing of automated invoices for Mr A. He said he would calculate the final settlement for Mr X and undertook to speak to him on 21 August. He did not do so. On 24 August Mr X emailed again. On 29 August a finance officer from the care provider emailed Mr A and said “Firstly let me apologise with regards to the delay on sending the fee increase letter to you. As requested, I have attached the fee increase letter that was sent to everyone back in January this year.”
18. In September Mr X emailed the finance manager and said there was a “fundamental disconnect” in the care provider’s accounting, and the delay and demands for money were causing the family considerable distress at a time when Mr A was on end-of-life care.
19. Mr A died in October. Mr X contacted the finance manager again and said it was now even more urgent to resolve the finances so that the estate could be resolved.
20. Mr X met the Operations Director in December. He emailed him subsequently to confirm their conversation: that “You mentioned that you were keen to resolve the outstanding issues regarding closing out dad’s account following his death in October. You confirmed you could not support the proposed increase without evidence of any communication to myself to substantiate. You raised via email on Friday with (the finance director) to get a final settlement account drawn up to close out and pay the sums outstanding to dad’s account.” The finance manager emailed him the same day asking for his bank account details to repay the relevant sum.
21. On 3 January 2024 Mr X emailed the finance director with the relevant details. In February he asked what progress had been made as there had been no payment to the account and no breakdown of figures as requested. An accounts officer spoke to him and then emailed him to say he would let both the finance manager and the Operations Director know and ask them about progress in a few days’ time. On 20 March Mr X emailed again as he had not received any responses.
22. Mr X complained to the Ombudsman. He said he was still awaiting a resolution on an agreed refund despite further phone calls and emails. He added, “Park Homes has consistently failed to respond to my complaint and this matter is preventing resolution of probate for my father's estate”.
23. The care provider met Mr X in a Teams meeting on 14 November and agreed to resolve the payments. The finance manager wrote to Mr X the following day: “In regard to the finance part of the discussions, I can confirm that we will arrange the refund of your fathers account, totalling £3628.93. Please can you confirm the bank details where this refund needs to be sent to. This refund will be with you next week”. Mr X supplied the requested details and said he looked forward to the written response to his complaint.
24. The Operations Director responded to Mr X on 26 November. He apologised for the significant delay and said it should not have happened: “you deserved a better service and I’m sorry we let you down”. He said the refund was being processed. Mr X replied asking for the refund to be processed immediately.
25. Despite the care provider’s assurances, the refund was not paid until 30 January 2025.
26. The care provider told us “(Mr X) did not raise a formal complaint at any time; his concerns were stated in emails and on a Teams meeting on 14/11/2024”.

The complaint

27. Initially we considered the complaint was premature as there was no formal complaints evidence. We spoke to the care provider who said that its officers were trying to arrange a meeting with Mr X, but Mr X said this was not the case. The records show the care provider only contacted M X to arrange a meeting in October, after we became involved.
28. On 1 November we asked the care provider for information about the matter. The care provider did not send us a substantive response until 28 February 2025, after we had explained our legal powers to require it to attend our offices with the necessary documents.
29. In response to our draft decision the care provider said Mr A “was notified of the fee increase in a fee letter which was posted out to him, this was not without notification and was done in accordance with the contract”. The care provider says in its view it has already apologised and compensated Mr A by agreeing with him to apply a lower fee increase than on other accounts.
30. The care provider sent us a copy of the letter from January 2023 but did not also send us the email from August 2023 which showed the letter had not been sent to Mr A in January. Mr A says, “this mail was acknowledged to be late and also incorrect as they had used standard fees in this letter which resulted in a 35.4% increase”.

Analysis

31. The care provider was wrong to try and impose a 30% increase in fees without justification or prior notification. That was contrary to the CMA guidance as well as a potential breach of the regulations.
32. The care provider does not have a proper complaints procedure. That is also a potential breach of the regulations. It was disingenuous of the care provider to say Mr X had not submitted a formal complaint when its policy is only to say that complaints can be made orally or in writing or email.
33. In any event the care provider quite clearly failed to respond with any diligence to Mr X’s concerns about the way it had imposed an increase in fees without prior notice, and without justification, and continued to issue invoices even after Mr A was fully funded by the NHS. Despite Mr X’s indication that he needed to settle the account after his father died in October 2023, the care provider continued to delay without reason. Essentially it took the care provider 16 months from the first written complaint in June 2023 to reach an agreement with Mr X, and over 18 months to refund the payment. That is extraordinary delay, and the care provider acknowledged Mr X had deserved a better service.
34. The care provider replicated that attitude in its response to us. Despite numerous reminders of our powers, it ignored our requests for information until threatened with a witness summons, compounding the injustice to Mr X of the long delay already experienced.

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Action

35. Within one month of my final decision the care provider should apologise to Mr X for its poor handling of his complaint and the way in which it notified him of a fee increase.
36. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
37. Within one month of my final decision the care provider should pay Mr X £300 to recognise the frustration caused by its poor response to his complaints; it should offer an additional £500 in recognition of the added stress and inconvenience caused by its delay in refunding the fees.
38. Within three months of my final decision, the care provider should:

(a) review its complaint handling and establish a proper complaint process which should be made freely available to residents and relatives/interested parties; LGSCO provides guidance on complaints processes for adult social care providers on its website at Resources for care providers - Local Government and Social Care Ombudsman

2. review the way in which this complaint arose and ensure its processes for increasing fees now align with the regulations and the CMA guidance;

39. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

40. I have completed this investigation on the grounds that there was fault by the care provider which caused injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman