Summary: Mr B complained on behalf of Mr J that Sid Bailey Care Home, operated at the time by Danforth Care Brampton Ltd, wrongly charged him for his care. We found no fault in the charges, but distress was caused by not advising Mr B of an underpayment sooner. The care provider did not properly deal with Mr B’s complaint. It has agreed to apologise for the distress and time and trouble caused.

The complaint

1. Mr B complained on behalf of Mr J that Sid Bailey Care Home, operated at the time by Danforth Care Brampton Ltd, has wrongly charged him for his care. In particular he complains that Danforth Care:
1. Allowed Mr J to sign a resident contract on 29 June 2023 although he did not have the mental capacity to do so.
2. Did not issue any invoices.
3. Gave no notice of a fees increase.
4. Wrongly charged Mr J increased fees from June 2024 to October 2024.
5. Did not issue any notice advising there had been an underpayment.
6. Evicted Mr J in response to a safeguarding concern.
7. Failed to log his complaint of 15 December 2024 and delayed responding.
8. Wrongly shared his email address with third parties in its email of 26 September 2024.
2. Mr B says the matter has caused significant distress and inconvenience. He wants the Care Provider to correct the charges, refund money he believes it owes Mr J and make service improvements.

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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 recommend 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(1), as amended)

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How I considered this complaint

5. Since Mr B was a resident, a different care provider has started to operate Sid Bailey Care Home. I considered evidence provided by Mr B and the care provider as well as relevant law, policy and guidance.
6. Mr B 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

Relevant law and guidance

Fundamental Standards of Care

7. 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. The standards include:
• Person-centred care (Regulation 9): The service user must have care or treatment that is tailored and meets their needs and preferences. Providers must involve a person acting on the service user’s behalf in the planning of their care and treatment.
• Complaints (Regulation 16): The provider must have a system in place to handle and respond to complaints.
• Good governance (Regulation 17): Providers must maintain securely an accurate, complete and contemporaneous record in respect of each service user.
8. Regulation 19 of the Care Quality Commission (Registration) Regulations 2009 says care providers 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. Providers must 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.

Mental capacity

9. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. A key principle is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests.
10. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established they lack capacity.
11. When a person’s capacity is in doubt, their ability to make a decision must be assessed. An assessment of someone’s capacity is specific to the decision to be made at a particular time. The person assessing an individual’s capacity will usually be the person directly concerned with the individual when the decision needs to be made. More complex decisions are likely to need more formal assessments.
12. If there is a conflict about whether a person has capacity to make a decision, and all efforts to resolve this have failed, the Court of Protection might need to decide if a person has capacity to make the decision.

Safeguarding

13. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

NHS Continuing Healthcare

14. NHS Continuing Healthcare (CHC) is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Where it appears a person may be eligible for CHC, councils must notify the relevant integrated care system. A health or social care professional will complete a checklist which may lead to a full assessment called a Decision Support Tool, which contains a recommendation about eligibility at the end.

What happened

15. I have summarised the key events.
16. Mr J has health conditions. His son, Mr B, has lasting power of attorney for finance and health and welfare. In 2023, Mr J had a stroke and was admitted to hospital. Following the stroke, Mr J suffered seizures and required care and support.
17. Mr B contacted Sid Bailey Care Home (“the Home”). The Home’s pre-admission assessment in June 2023 notes Mr J “has capacity” though “needs time to get his words out in the correct order”.
18. Mr J moved into the Home on 22 June. That day Mr B signed a pre-admission financial questionnaire. This said the weekly fees were £950 and that fees over the next 24 months would total £104,000. The Home’s billing agreement says invoices would be sent to Mr B by email and lists his email address. The Home’s schedule of future payments sets out that payments were in advance for fixed 28‑day billing periods starting on 8 July 2023. A standing order was set up.
19. On 29 June, Mr J signed the Home’s contract. This said the weekly fee would increase to £1,050 after 12 months, so from 22 June 2024. Mr B says he did not see this contract.
20. In summer 2024, Mr J’s health had deteriorated and he had a number of hospital admissions. He was diagnosed with dementia in July. The Home contacted the local authority and asked for a CHC checklist to be done. On 5 August, the Home assessed Mr J as having capacity to decide to live in the Home. Mr J had another stroke and seizures and was admitted to hospital. On 4 September, another assessment by the Home said Mr J lacked capacity to decide where he lived. The Home applied to the local authority for DOLS authorisation. The local authority arranged to visit Mr J to do the CHC checklist on 23 September.
21. On 19 September, Mr J had a seizure and went to hospital. The ambulance made a safeguarding referral to the local authority that Mr J’s behaviour was a risk to other residents. The Home told the local authority it could meet Mr J’s needs; there was a discussion about the need for a sensor mattress to alert carers if Mr J had a seizure at night. It was felt this would be helpful as Mr J became aggravated due to frequent monitoring during the night.
22. The local authority social worker visited Mr J to do the CHC checklist; she noted that the Home’s care plan had not been updated since November 2023 and did not refer to his recent seizures. She raised a safeguarding alert about this, the lack of a sensor mattress and the need for further staff training in relation to seizures. During the safeguarding enquiries, on 26 September, the Home told the local authority that it believed Mr J required a nursing placement and that it could no longer meet his needs.
23. The care provider emailed a newsletter to residents’ families, including Mr B, on 26 September. All email addresses were showing which was a possible breach of data protection rules. The care provider alerted the Information Commissioners’ office and recalled the email.
24. The Home gave notice on 1 October. It said it could no longer meet Mr J’s increasing medical and behaviour needs. The local authority therefore closed the safeguarding enquiry. It assessed Mr J’s capacity to decide on his care and support and where he should live on 9 October. The assessment found he did not have capacity and a best interest decision was made that Mr J required a nursing home placement. Mr J moved to a nursing home on 24 October.
25. On 29 October, the Home advised Mr B that there was an outstanding bill. This was because the fees had increased to £4,200 per month (£1,050 per week) since 22 June but the standing order had been for £3,800. On 18 November the Home issued a corrected outstanding balance, having credited Mr J for 24 and 25 October. It said Mr J owed £1,500 up to 23 October.

Mr B’s complaint

26. Mr B emailed the Home on 18 November. He said he had never received an invoice or a contract and the Home had asked Mr J to sign a contract containing the fee increase, without his knowledge as attorney and when Mr J did not have capacity to understand complex issues. The Home sent a payment reminder on 28 November giving Mr B seven days to pay. On 12 December it told Mr B that Mr J’s payments were acceptance of the contract and it would pursue debt recovery action.
27. Mr B emailed the Home on 15 December saying he had posted a complaint letter. The Home replied on 17 December saying it had received Mr B’s “signed and written confirmation” as detailed below:
• Mr B had emailed the Home on 23 June agreeing that Mr J could sign the contract
• Mr B had signed the pre-admission financial questionnaire and in this had confirmed that Mr J had sufficient finances to cover 24 months of fees totalling £104,000. The Home said this comprised 12 months at £950 per week and 12 months at £1,050 per week.
• Invoices had been emailed to Mr B.
28. Mr B came to the Ombudsman but it was too soon for us to investigate as Mr B had not received a response to his complaint. Mr B complained again to the Home on 30 January 2025.
29. The Home replied to the complaint on 29 May. It said it had considered Mr J to have capacity when he signed the contract on 29 June 2023. The response was emailed to Mr B but it went to an incorrect email address. In Autumn 2025, Mr B came back to the Ombudsman as he had not heard from the Home.

My findings

30. Mr B complains the Home allowed Mr J to sign a contract on 29 June 2023 although he did not have the mental capacity to do so. The law says a person must be presumed to have capacity to make a particular decision unless it has been established that they do not. If there is any doubt about capacity, an assessment must be done.
31. I have reviewed the hospital’s discharge notes and the Home’s pre-admission assessment. There is no reference to doubts about Mr J’s capacity and there had been no assessment finding he did not have capacity. I therefore cannot say that Mr J did not have capacity when he signed the contract. It was therefore not fault for the Home to ask him to sign the contract.
32. It follows that there was no fault by the Home in increasing its fees in June 2024, as this increase was set out in the contract. Mr B complains there was no notice advising of the fee increase. However, the contract distinguished between the agreed founders fee of £950 for the first year and the fee of £1,050 for the following year. I am satisfied the increase was part of the original contractual arrangement rather than a subsequent annual increase requiring four-weeks’ notice. I do not find fault.
33. I appreciate that Mr B had an LPA and that care providers must give residents clear information about their fees and contractual terms. However, an LPA does not remove a person's right to make their own decisions while they retain mental capacity. The Home was therefore not required to send a copy of the contract to Mr B. If Mr J wished Mr B to have a copy, he could have shared it with him or asked the Home to correspond directly with him. I therefore do not find fault in the Home not sending the contract to Mr B.
34. The Home did not advise Mr B that there had been an underpayment until 29 October 2024. My view is this was fault. The Home could have alerted Mr B and Mr J to this after the July payment was made as by then it would have been clear that the standing order was insufficient. The delay in advising him caused an unnecessarily large debt to build up, causing distress.
35. Mr B says he received no invoices. The Home says it emailed them to Mr B. I have seen the invoices but I have not seen evidence of the emails. My view is I have insufficient evidence to reach a finding on this point. But even if I found there to be fault, I do not consider this caused any additional injustice to the distress identified above.
36. Mr B complains the Home served notice on Mr J in response to the safeguarding concern. The evidence shows the safeguarding concern was in part about the need for equipment and training relating to Mr J’s seizures. During its discussions with the local authority the Home concluded it could no longer meet Mr J’s needs and he required nursing care. There was then a best interest decision, involving Mr B, that Mr J required nursing care. I do not have evidence that the Home could have continued to care for Mr J if there had been no safeguarding referral. I therefore do not find fault.
37. The Home failed to properly deal with Mr B’s 15 December complaint and delayed responding to his January 2025 complaint. This is fault which caused Mr B time and trouble as he has had to come to the Ombudsman to pursue the complaint.
38. There was an apparent data breach when the care provider emailed the newsletter on 26 September. The care provider took the actions we would expect in alerting the Information Commissioner’s office. I have seen no evidence of any adverse consequences so I do not find this caused Mr B significant injustice.

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Action

39. Within a month of my final decision, the Care Provider has agreed to apologise to Mr B for the delay in advising him of the underpayment and the failure in complaint handling.
40. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

41. There was fault by the Care Provider. The actions it has agreed to take remedy the injustice caused. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman