Summary: Miss Y complained the Care Provider failed to refund all the fees her mother, Mrs X, overpaid after she transferred from private to council funding in 2023. The Care Provider delayed refunding Mrs X for nearly two years and has not refunded everything Mrs X overpaid. This caused a financial loss to Mrs X and avoidable frustration, time and trouble to Miss Y. The Care Provider agreed to refund the rest of the fees Mrs X paid and to review its process for when people move from private to state funding.

The complaint

1. Miss Y complains, on behalf of her mother, Mrs X, that the Care Provider has failed to refund charges Mrs X overpaid for a period after which her local council became responsible for her care fees in 2023. Although Miss Y asked for a refund at the time, she says the Care Provider:
• took nearly two years to refund any money;
• has not refunded the full amount; and
• has failed to explain how it has calculated the amount it has refunded.
2. As a result, Miss Y says Mrs X is still owed money and Miss Y was caused avoidable inconvenience and frustration. She wants the Care Provider to refund the remaining outstanding charges, apologise and properly recognise the inconvenience it caused.

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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. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. We may investigate a complaint on behalf of someone who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable. (Local Government Act 1974, section 26A(2), as amended)

6. 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

7. I considered evidence provided by Miss Y and the Care Provider as well as relevant law, policy and guidance.
8. Miss Y 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

Refund timescales

9. The Care Provider’s contract with Mrs X does not say how quickly it will refund overpaid fees when someone moves from private to council funding. However, for all other refunds, the contract says the Care Provider will pay refunds within five working days.

What happened

10. Mrs X moved to a care home operated by the Care Provider in 2022. At first, Mrs X’s fees were paid by her local council, but she became responsible for paying her own fees in late September 2022.
11. The local council again became responsible for paying Mrs X’s fees from mid-April 2023. However, the Care Provider continued to invoice Mrs X for some time after the local council also started paying.
12. A few months after the local council started paying Mrs X’s fees, Miss Y contacted the Care Provider about the ongoing invoices and fees that Mrs X had overpaid. She asked the Care Provider to refund those overpaid fees.
13. Over the next year or so, Miss Y continued to chase the Care Provider about the overpaid fees. While the Care Provider responded to Miss Y several times, it did not pay any refund until after Miss Y complained to the Ombudsman in early 2025. Miss Y said that refund was not all the fees Mrs X overpaid, and the Care Provider did not explain how it had calculated the refund.

My findings

14. Mrs X is the person affected by the Care Provider’s actions. I am satisfied Mrs X could not have understood she had reason to complain due to her health conditions and care needs. Therefore, the usual time limit for bringing a complaint about the impact on Mrs X does not apply and I can matters from April 2023.
15. I am also satisfied Miss Y can bring the complaint on behalf of Mrs X, since she has a lasting power of attorney from Mrs X.
16. Mrs X was responsible for her own care home fees for a period of 200 days. Based on the Care Provider’s fees at the time, the total fee for that period was just over £34,350.
17. Based on the evidence from the Care Provider and Miss Y, Mrs X paid a total of just over £43,600 towards her private care fees. Therefore, Mrs X overpaid just under £9,250.
18. However, the Care Provider has only refunded just over £6,700, leaving around £2,500 Mrs X remaining. The Care Provider’s failure to refund all the fees Mrs X overpaid caused her a financial loss, and is therefore fault.
19. There was also a significant delay in the Care Provider paying any refund to Mrs X. The delay caused Mrs X an injustice, since she did not have the benefit of that money for nearly two years, and was therefore also fault.
20. Where an organisation has failed to pay money due to a complainant, we can recommend the organisation also pays interest to recognise the difference in value of that money. Given the delay to both the partial refund and the remaining balance, and the amount of the refunds due, I consider a further interest payment is appropriate. Using the average retail price index for the period, I consider the interest payment should be just over £500.
21. The delays in agreeing and processing the refund, along with poor communication from the Care Provider while she was chasing the refund, also caused Miss Y avoidable frustration, time and trouble. Given the length of the delays I consider an apology along would not be suitable, so the Care Provider should also pay Miss Y £200 to recognise that avoidable frustration.

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Action

22. Within one month of my final decision the Care Provider will:
• refund a further £3,065.76 to Miss X, including an interest payment;
• apologise to Miss Y for the avoidable frustration, time and trouble caused by the delays and poor communication with the refund; and
• pay Miss Y £200 to recognise that avoidable distress.
23. Within three months of my final decision the Care Provider will:
• review how it manages residents’ transfer from private to council funding. It should ensure it stops private invoices and refunds any overpaid fees without delay; and
• review how it records and monitors complaints to ensure that it captures all complaints made and responds to these within the timescales set out in its complaints policy.
24. 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.
25. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

I have completed my investigation and uphold Ms Y’s complaint. I have made recommendations the organisation has agreed to carry out.

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Investigator's decision on behalf of the Ombudsman