Summary: We will not investigate this complaint about fees for care services. Part of it is about events the complainant was aware of more than 12 months before he complained to us. For the more recent events, there is insufficient evidence the actions of the Care Provider caused Mr and Mrs Y the injustice claimed.

The complaint

1. Mr X complained the Care Provider overcharged his parents (Mr and Mrs Y) for nursing care. He says it then also charged them a carer release fee when the carer came to work for Mr and Mrs Y directly. Mr X estimates Mr and Mrs Y have been overcharged around £60,000. He wants the Care Provider to refund the difference between nursing and care fees for a nine-month period when Mr and Mrs Y were receiving nursing unnecessarily. He also wants the Care Provider to waive the carer release fee of £7,500.

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The Ombudsman’s role and powers

2. 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)
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. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
4. The Ombudsman investigates 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 may decide not to continue with an investigation if we decide any fault has not caused injustice to the person who complained. (Local Government Act 1974, section 24A(6))

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How I considered this complaint

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

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My assessment

7. Mr and Mrs Y had a live-in carer arranged by the Care Provider. They received a period of nursing, however their needs then decreased. Mr X identified in 2021
   Mr and Mrs Y should be receiving care, rather than nursing. He asked the Care Provider to make this change in August 2021, thus reducing their fees.
8. Mr X now complains to us that the Care Provider should have identified nine months earlier that Mr and Mrs Y no longer required nursing, and he wants the difference in fees to be refunded. We usually expect people to bring complaints to us within 12 months of them becoming aware of the matter. Mr X could have complained to us about this issue sooner, however he only escalated this issue to us when he had another matter he wished to complain about. There is not a good reason for the delay, and so we will not now investigate this part of his complaint.
9. Mr X’s complaint is also about the Care Provider’s more recent decision to charge a release fee of £7,500, as the family have now employed the carer directly.
10. Mr X has offered to pay the Care Provider £2,500 as a compromise to settle the matter, because he says this is the fee another provider charges and he believes it is a more reasonable amount. The Care Provider has not accepted this. Mr X says the fee should be waived and highlights the family have paid a significant amount to the Care Provider over the time they have used its services.
11. Mr and Mrs Y’s other attorney, Mr X’s sister, signed terms and conditions on Mr and Mrs Y’s behalf in 2021, agreeing they would pay £7,500 in such circumstances. The terms and conditions do not include any exceptions based on care fees already paid to the company. Nor is the earlier, separable issue about nursing care a reason to waive the carer release fee. It is not for the Ombudsman to decide what is a reasonable carer release fee, and there is no evidence the Care Provider’s actions caused the injustice claimed.

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Final decision

12. We will not investigate Mr X’s complaint because part of it is late, and there is insufficient evidence in more recent events that the Care Provider’s actions caused the injustice claimed.

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Investigator's decision on behalf of the Ombudsman