Summary: The care provider was at fault because its contract and terms and conditions did not explain how it would treat funded nursing care payments. The care provider has agreed to apologise to Mr X to acknowledge the confusion and uncertainty this caused and amend its contract and terms and conditions

The complaint

1. Mr X complained the care provider failed to deduct the funded nursing care payments awarded to his mother Mrs X from the weekly fee it is charging for her care home fees. He has therefore taken it from the payments he has made and the care provider is now threatening legal action which is causing Mr X distress.

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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. 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)
4. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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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. I gave Mr X and the care provider an opportunity to comment on my draft decision. I considered the comments I received before making a final decision.

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What I found

The relevant law and guidance

Funded nursing care (FNC)

7. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the cost of nursing care delivered by registered nurses. This is because residents should not be required to pay for the proportion of their care already covered by the NHS. It does not cover the cost of non-nursing care or accommodation.

Competition and Markets Authority Guidance (CMA)

8. The CMA has issued guidance ‘UK care home providers for older people- guidance on consumer law’.
9. Paragraph 4.64 of the guidance sets out that: “Your terms, together with the upfront information you provide to residents about your fees, should clearly explain what FNC is, the resident’s potential entitlement to it, and how you treat FNC payments when the eligible resident is self-funded. In particular, you should clearly set out:
1. The relationship, if any, between FNC payments and a self-funded resident’s own contribution to their overall residential fees (i.e. very clearly defining the services that are paid for by the FNC payments and those paid for by the resident).
2. “What will happen to a resident’s own contribution to their fees if there is a change in the amount of the FNC payment (i.e. where it increases, decreases or ceases).”

Care Quality Commission fundamental standards

10. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
11. Regulation 9 set out that people using a service must have care and treatment that is personalised specifically for them. This includes that people using the service must be given relevant information in the most suitable way for them which includes information that describes the costs/fees/tariffs associated with care and treatment
12. Regulation 19 of the Care Quality Commission (Registration) Regulations 2009 sets out that 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, treatment and support.

What happened

13. The following is a summary of the main events relevant to this complaint.
14. Mr X’s mother Mrs X moved into the care home in June 2024, following a respite stay there. Mr X has lasting power of attorney for Mrs X (which gives him the legal power to act on her behalf on finance matters).
15. In June 2024 Mr X signed the contract (agreement to the terms and conditions) with the care home for a permanent stay. It provided him with a copy of its terms and conditions booklet. Under “type of care” the contract had four tick boxes: nursing, dementia, residential and disabled. In this case dementia and residential (and not ‘nursing’) were ticked. Under liability of funding (based on a weekly fee) it stated gross: £1700, service user £1700.
16. The care home also gave Mr X a copy of the terms and conditions of residency booklet. At 2.7.1 this stated that ”the agreement to terms and conditions attached to the booklet specifies if nursing care will be provided to the service user”. At 3.3.1 this stated that ”the service user shall pay [the care provider] the weekly charge in the sum specified in the agreement to terms and conditions attached to this booklet in respect of accommodation, care and other services referred to in this agreement, one calendar month in advance”.
17. In late June the care home applied for funded nursing care. Mrs X was assessed and this was approved with effect from mid July 2024 at a rate of £235.88 a week.
18. In December 2024 Mr X deducted from the amount he had paid the care home, an amount equal to the funded nursing care payments. Mr X says he told the accounts team why he had done this. In mid February the care provider wrote to Mr X asking him to settle the balance owed on Mrs X’s account which was nearly £14000.
19. Mr X responded that the statement was incorrect as it did not include the payments the care home received for funded nursing care. The care provider responded that the weekly charge inclusive of funded nursing care was £1935.88. It said the NHS covered the funded nursing care resulting in a net charge to him for £1700 and sent him a copy of the invoice it sent to the NHS. Mr X queried the increase in the weekly fee given the contract showed a weekly fee of £1700. The care provider explained what the residential care fee covered and the additional care covered by the nursing care payment which included medication management, liaison with health professionals, clinical risk meetings and any nursing tasks to be completed by a trained nurse.
20. In August 2025 the care provider’s solicitor wrote to Mr X requesting that the balance be settled. Mr X disputed this and then following a further solicitor’s letter Mr X submitted a formal complaint to the care provider requesting that the funded nursing care payments be deducted from the care home fees.
21. The care provider responded to Mr X’s complaint in September 2025. It said Mr X had signed a residential care contract for £1700 a week. The care home received £235.88 per week funded nursing care. It said it had explained in August 2024 that these payments did not affect the residential fee but were an additional payment and it had sent a further email confirming this in December 2024.
22. Mr X remained unhappy and complained to us.

Findings

23. The care provider’s contract and terms and conditions booklet make no reference to funded nursing care and how this will be treated in relation to a resident’s care home fees. This lack of transparency is fault and is not in line with the Competitions and Markets Authority guidance or the CQC regulations. This caused Mr X confusion and uncertainty.
24. Mr X signed a contract for residential care. The terms and conditions and the contract make no reference to what happens if funded nursing care is later agreed. Given Mrs X went on to receive funded nursing care the care provider should have reissued the contract to reflect this and to ensure it clearly set out how the funded nursing care payments were treated in the weekly care charges. The failure to do so was fault.
25. Mr X signed a contract for Mrs X to receive residential and dementia care at the weekly charge of £1700 a week which is the rate for this type of care at the care home. Mr X understood and agreed to Mrs X’s placement on that basis so there is no fault in the care provider charging Mrs X £1700 a week. Mrs X also receives nursing care which is covered by the funded nursing care payments. The care home is not at fault for charging Mr X in this way but the failure to clearly explain how the charges were calculated and how funded nursing care contributions were treated caused Mr X uncertainty and confusion.
26. If Mr X believes the care home has acted in breach of contract in not reducing the weekly care fees it is open to him to seek legal advice.

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Agreed Action

27. Within one month of the final decision the care provider has agreed to:
1. apologise to Mr X to acknowledge the uncertainty and confusion caused by its failure to be transparent about how funded nursing care payments would be treated and for not amending the contract to reflect Mrs X was receiving nursing care. 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.
2. provide a covering letter with its contract and terms and conditions leaflet setting out to residents how the care provider treats funded nursing care payments, with a view to updating the terms and conditions leaflet over the next six months to ensure this includes clear information on funded nursing contributions.
28. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

29. I find fault causing injustice which the care provider has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman