Summary: Mrs X complained that Valley Court Care Home wrongly charged for 1:1 care for Mr X. She complains that although they were told Mr X required 1:1 care, the Care Home did not tell them Mr X would be responsible for the cost of this additional care. We found the Care Home’s failure to clearly set out the arrangements for the 1:1 care in writing before the care commenced was fault. However, we do not consider this fault caused Mrs X or Ms Y an injustice.

The complaint

1. Mrs X complained that Valley Court Care Home wrongly charged for 1:1 care for Mr X. She complains that although they were told Mr X required 1:1 care, the Care Home did not tell them Mr X would be responsible for the cost of this additional care. Mrs X says they have received invoices totalling over £6,000 for this care which has caused the family significant distress. She would like the Care Home to waive these fees.

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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 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)
3. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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. I considered evidence provided by Mrs X and the Care Home as well as relevant law, policy and guidance.
6. Mrs X and the Care Home 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

7. Mr X had a diagnosis of dementia and was a resident at Valley Court Care Home. He was paying privately for his care.
8. In April 2024 the Care Home raised concerns about an increase in the number of falls Mr X had and his challenging behaviour. Mrs X says the Care Home recommended 1:1 care. She says it was explicitly discussed whether the 1:1 care would be provided by existing staff known to Mr X and the Care Home assured them this would be the case. Mrs X says they were not told during the meeting or at any point before the 1:1 care commenced that there would be an additional charge for the 1:1 care. The family understood that this care would be managed internally by existing staff within the scope of Mr X’s existing fees.
9. Mrs X says they subsequently raised concerns about the 1:1 care as this was causing Mr X increased distress. She says that when they asked for the 1:1 care to be discontinued the Care Home asked the family what their “Plan B” was. Mrs X considers this remark unprofessional and that it implied Mr X would be asked to leave the Care Home if the 1:1 care was withdrawn.
10. The 1:1 care ended in July 2024.
11. The Care Home provided monthly invoices for the 1:1 care which it handed directly to Mr X’s daughter, Ms Y who had Power of Attorney for Mr X.
12. Ms Y did not pay these invoices, nor did she question them at the time.
13. The Care Home chased Ms Y for payment of the outstanding invoices in April 2025. Ms Y challenged the invoices on the basis they were not informed the 1:1 care would incur any additional cost and had not signed an agreement for the additional cost. She asked for the invoice to be withdrawn as Mr X had died and his estate settled.
14. The Care Home was satisfied the family was aware of the charges and noted the invoices were given by hand to Ms Y on a monthly basis. It considered the charges were due and valid and said if Ms Y did not pay them it would instruct a debt collection agency to recover the funds.
15. Ms Y disputed that acceptance of an invoice automatically implies acceptance of the charges. She also said she received the invoices in bulk after the 1:1 care had ended.
16. Mrs X asked for a copy of the Care Home’s complaints procedure and a copy of Mr X’s care plan showing where it was recorded that the family had agreed to 1:1 care, the hourly rate for this care and records of the family’s involvement in selecting or approving carers.
17. The Care Home provided copies of its complaints policy, Mr X’s 1:1 care plan and its internal notes. It was satisfied the notes showed that it was made clear to the family at the time that there would be a cost for the 1:1 care. It said the family verbally accepted this. Although there was no formal written contract the Care Home considered the verbal agreement was a binding contract.
18. It referred to a meeting with Mr X’s family to discuss the risk management plan, where it had explained the need for 1:1 care in detail. The Care Home implemented the 1:1 care on the understanding the family had authorised this and considered it necessary for Mr X’s safety and wellbeing. The Care Home said it was not uncommon for urgent care decisions to be made following verbal agreements in high risk situations, particularly where families are actively involved.
19. The Care Home acknowledged Mr X’s Service User Contract does not list 1:1 care but noted it does state additional cost may be incurred for enhanced support based on assessed needs. It said families were not involved in the selection of individual carers, but any concerns raised were taken seriously. The Care Home said that were there were no safe alternatives to 1:1 support, and it had a duty to discuss the implications honestly, even if the discussions were difficult.
20. Mrs X continues to dispute the 1:1 charges and has asked the Ombudsman to investigate her concerns.
21. In response to our enquiries the Care Home has reiterated that staff met with the family to discuss concerns about Mr X and the home’s ability to safely meet his needs. It says the family agreed to fund the 1:1 care as they did not want Mr X to move to a different care home.
22. The Care Home’s records of a meeting with Mrs X and Ms Y on 22 April 2024 state:

“[Ms Y and Mrs X] were informed that we are struggling to manage the behaviour and that while further action is being taken (such as mental health team and GP visit tomorrow,) we need to put other precautions in place. We discussed 1-1 care while funding is being agreed, for family to fund in the interim…1:1 care is agreed 11am to 10pm”

23. The Care Home says it does not and never has funded 1:1 care as this is not financially viable for the home.
24. In addition the Care Home says given Ms Y’s connection to the Care Home staff personally handed the invoices to her. It says Ms Y did not dispute these invoices and was aware this was a private funding arrangement. It says non-payment of the invoices was not immediately escalated due to Ms Y’s connection to the Care Home.
25. The Care Home says it has strengthened its financial and authorisation processes to prevent similar disputes in the future. This includes:
• requiring advance payment for all 1:1 or additional support services;
• ensuring written confirmation of financial responsibility is obtained and retained
• reinforcing escalation procedures for unpaid invoices in a timely manner in line with it contracts regardless of the payee’s connection to the Care Home.
26. Mrs X has also asked the local authority to investigate her concerns about the 1:1 charges. Its response noted the Care Provider had written to the family on 22 April 2024 confirming the 1:1 escort fee would be £16 per hour. The local authority also noted an officer had contacted Ms Y on 24 April 2024 to advise the Care Home had asked it to find an alternative placement for Mr X as the home could no longer meet his needs.
27. It said that during this conversation Ms Y asked for a social care assessment as Mr X’s finances were approaching the threshold for local authority support with his care charges. It said Ms Y told the officer Mr X’s savings would not last long due to the cost of one to one care.
28. The 1:1 care ended before Mr X’s funds fell below the threshold and the local authority assumed responsibility for Mr X’s care costs. The local authority told Ms Y it could not intervene regarding the charges for 1:1 care.

Analysis

29. There is no dispute the Care Home discussed the need for 1:1 care for Mr X with Mrs X and Ms Y, or that Mrs X and Ms Y agreed to this being implemented. However Mrs X and Ms Y’s account of the discussion around how this care would be provided and who would bear the cost differs to that of the Care Home.
30. Mrs X and Ms Y say they specifically asked and were assured the care would be provided by existing staff and would be covered by the current fees. They dispute there was any discussion regarding an additional charge for this care.
31. The Care Home has provided its records of the meeting which state Mr X’s family agreed to fund the 1:1 care in the interim. The notes do not reference any discussion about whether the care would be provided by existing staff or agency. We would expect this arrangement to have been confirmed in writing but the Care Home says it implemented the care based on the verbal agreement alone.
32. The Care Home also issued invoices for this care and appears to have sent Ms Y a letter confirming a rate of £16 per hour for a 1:1 escort. Ms Y does not dispute receiving the invoices but says she did not receive a letter confirming an hourly rate. Ms Y also asserts that the Care Home does not have a set rate for 1:1 care and the charge of £16 an hour relates the cost of escorting a resident to appointments outside the care home.
33. Where there are conflicting accounts we cannot simply accept one person’s word against another. We look at the available relevant evidence and decide on the balance of probabilities what was more likely to have happened.
34. In this instance I consider it more likely than not that the family was aware that Mr X would incur an additional cost of the 1:1 care, even if they were not aware exactly how much this would be.
35. They would certainly have been aware when they received the invoices. If Ms X was not expecting to pay for the care, it is unclear why she did not immediately question the invoices when she received them. The documentation provided suggests Ms Y did not challenge these additional charges until the Care Home chased payment almost a year later.
36. I am also mindful that Ms Y discussed her father’s care with the local authority a couple of days after the meeting in April 2024. The Council was not at this stage involved in the funding of Mr X’s care but noted Ms Y’s concerns thathis savings would not last long due to the cost of the 1:1 care. This suggest Ms Y was aware of the charges from the outset.
37. I recognise Ms Y denies making this comment, but I consider it unlikely the Council’s notes would refer to the increased cost of Mr X’s care if this had not been raised.
38. While it would clearly have been better if the Care Home had clearly set out the arrangements for the 1:1 care in writing before the care commenced, I do not consider the failure to do so caused Mrs X or Ms Y an injustice. I consider, on the balance of probabilities Mrs X and Ms Y were aware Mr X would incur an additional charge for the 1:1 care.

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Decision

I find fault not causing injustice.

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Investigator's decision on behalf of the Ombudsman