Summary: We will not investigate Mrs X complaint that her father’s care home has refused to refund the money her father paid for his care placement despite also receiving money from the Council for the same period. This is because there is insufficient evidence of fault.

The complaint

1. Mrs X complains her father’s care home has refused to refund the money her father paid for his care placement despite also receiving money from the Council for the same period.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide there is not enough evidence of fault to justify investigating. (Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

3. I considered information provided by the complainant and the Care Provider.
4. I considered the Ombudsman’s Assessment Code.

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My assessment

5. Mrs X’s father, Mr Z, received care and support from a care home. He made payments totalling just under £10,500 to the care provider to cover the period April to July 2024.
6. In July 2024, the Council agreed Mr Z was eligible for funding, backdated to April 2024. The Council made a payment to the care provider to cover this period. The Council then invoiced Mr Z for his contribution.
7. Mrs X considers the care provider should refund Mr Z the money he had paid as it has also received money from the Council for the same period.
8. The care provider agreed to refund just over £1600. This was due to Mr Z’s account being in arrears due to underpayments. This was due to a rate increase that applied from January 2023.
9. Mrs X disputes this and says they never agreed to the rate increase and told the care provider her father could not afford the increase. She says as the care provider never chased her father for the underpayments or wrote to them to disagree, this was implied they accepted that Mr Z would continue to pay the old rate.
10. The care provider has provided a copy of the original signed contract. The contract set out that the care provider would review fees on 1 January each year and that the cost of providing care could be increased. The contract detailed that residents would be given a minimum of four weeks notice of any change in the charges.
11. The care provider sent Mrs X a letter in October 2022 detailing the increase in care home fees, to apply from January 2023. I note there does not appear to be any dispute over whether this notice was received as Mrs X position is that the increase in fees does not apply because they had not agreed to the increase.
12. An investigation is not justified as we are not likely to find fault. The care provider’s contract clearly stipulates increases in rates and that these would apply. Further, the care provider has met the terms of its contract by providing the appropriate notice of the rate increase. Therefore, we are not likely to find fault with the care provider for applying the increased rate from January 2023. Subsequently, we are also unlikely to find fault with the amount refunded.
13. If Mrs X disputes the contract or feels the care provider had agreed to a different fee rate by not disputing their refusal to accept the rate increase, then this is a matter that needs to be considered by the courts as it is contractual dispute.

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Final decision

14. We will not investigate Mrs X’s complaint because there is insufficient evidence of fault.

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Investigator's decision on behalf of the Ombudsman