Summary: Mr X complained that a care provider was not fair and transparent when it increased charges each year. The terms and conditions in the contract provided by the Care Provider were not transparent which caused injustice as the annual increases were not clear. Mr X’s mother did not pay above the standard annual increase so there was no financial injustice. The Care Provider has amended the terms and conditions to remedy the injustice.

The complaint

1. The complainant, Mr X, complains for his mother, Mrs M. Mr X says a Care Provider was not fair and transparent with how it completed assessments of residents care when assessing the rise in charges each year. He says that they are uncertain whether Mrs M has been paying more than the standard rate for her care.

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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)

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How I considered this complaint

5. I considered evidence provided by Mr X and the Care Provider as well as relevant law, policy and guidance.
6. Mr X and the Care Provider had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

7. The Competition and Markets Authority (CMA) has produced written advice on consumer law to help care homes comply with their legal obligations (UK care home providers for older people - advice on consumer law December 2021). The guidance states care providers must ensure:
• their terms set out all the rights and obligations between the resident and/or their representatives. Their terms must be simple, clear and easy to understand;
• their terms are transparent so residents and/or their representatives can foresee and understand in advance, how they might be affected;
• they give sufficient notice of any change. A notice of changes of less than 28 days is likely to be unfair; and
• provide prospective residents and their representatives with information they need such as an indication of fee rates.
8. In relation to changes to a resident's fees during their stay, the guidance states it would not object to more frequent changes in a resident's fees where:
• the resident requests and receives an enhanced service or a better room; or
• the resident's care needs change. However, the resident should also receive a reduction in fees where their care needs reduce. There must be a significant and demonstrable change in the resident's care needs to justify an increase in price for this reason; where you assess charges by reference to care 'bands', these should be limited and clearly defined according to significant steps in increasing care needs.
9. To ensure compliance with the law, the guidance also states care providers should be able to evidence and justify a decision to increase fees due to a change in care needs (for example through the use of recognised accredited dependency tools) and any increase must be reasonable and proportionate to the resident's needs. Where the care provider anticipates or assess that a resident's needs have changed, it should engage in meaningful and transparent consultation with them and their representatives and give them advance written notice (e.g. 28 days) before implementing a change in fees (including the reasons) so they can challenge the decision or avoid the increase if they wish.
10. The Care Quality Commission (CQC) is the statutory regulator of care services. The Health and Social Care Act 2008 (regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The CQC has issued guidance on how to meet the fundamental standards.
11. Regulation 19 says care providers must give timely and accurate information about the cost of their care and treatment to people who use services. 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.

Key facts

12. Mrs M moved into a nursing care home in February 2023. She self funded the cost of the fees.
13. The contract said that fees were £1550 per week with a Funded Nursing Care contribution of £209 per week, totalling £1759. The contract said chargeable items would be invoiced monthly, which included things such as an additional 1-1, hairdressing, newspapers and dry cleaning. The boxes were all ticked, to indicate they were applicable. Mrs M’s signature is on the document, witnessed by her son. The document says ‘I confirm I have received a copy of the booklet which forms part of this agreement and agree to the terms and conditions in it’.
14. The booklet says ‘we shall be entitled to review and increase the long stay fees at anytime, but only once in any 12 month period. We shall also be entitled to increase the long stay fees (having given one months notice) in any of the following circumstances:
• To reflect a change in relevant laws, codes of practice, registration and regulatory requirements and.
• if, following a review of the resident’s care needs we reasonable believe that residents assessed care needs have changed from the date of admission or from the date of admission or from the date of the previous annual fee review.
15. In response to my enquiries, the care provider said that Mrs M was assessed on becoming a resident as having no additional needs and was charged the ‘standard fees’. Mrs M’s fees were not increased in April 2023, at this point the standard fee for a new resident was £1800 per week.
16. Mrs M’s son (Mr X) was notified on 23 February 2024 that the annual fee increase from 1 April 2024 would be from £1550 to 1700 per week. The care provider said that this increased reflected a standard increase of 6.35% and an adjustment to reflect Mrs M’s growing care needs. As a gesture of goodwill, the care provider reduced the fee by £18 per week and agreed to postpone the increase until 1 August 2024 (saving £2300). This resulted in an effective increase of 5.7%.
17. On 27 February 2025 the care home sent a letter to Mr X telling him of the annual fee increase from 1 April 2025. The care home said this increase was the standard increase of 8% only, increasing the fees to £1816 per week.
18. There is a letter from the care home to Mr X on 26 July 2024 in response to his question on the annual percentage increase in fees since the care provider had been operating which says ‘our conversations about fees are based on each resident’s individual needs and are as such confidential’. I can see how this statement could seem less transparent on how fees are calculated, as there is no set fee published on the care provider’s website or detail of how an individual’s needs are assessed when calculating the initial fee.
19. In response to my enquiries the Care provider has said that for both 2024 and 2025 Mrs M’s fees were no higher than the standard 8% increase. So, Mrs M has not been caused any financial injustice. However, the care provider has accepted that its terms and conditions are not as transparent as they should be. The care provider has redrafted the terms and conditions to be ‘more transparent to allow consumers greater visibility of how cost increases are passed on to residents’. The care provider has evidenced that they undertook a proper assessment to determine individual need and individual cost and that for most residents an individual increase is not applied. I consider the re-drafted terms are sufficient to remedy the complaint.

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Decision

20. I have completed my investigation and uphold Mr X’s complaint. The organisation has already carried out the actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman