Summary: Mr Y complained about how the Care Provider dealt with his late mother’s, Mrs X’s, care fees when she was admitted to hospital and how it handled his complaint. There were some faults by the Care Provider which caused injustice to Mr Y. The Care Provider should take action to remedy the injustice caused.

The complaint

1. Mr Y complained on behalf of his late mother, Mrs X.
2. Mr Y complained about how the Care Provider:
1. refused to stop charging Mrs X for her home care package when she was admitted to hospital
2. wrongfully invoiced Mrs X for the whole period she was in hospital
3. handled his complaint.
3. Mr Y said the matter caused him upset and time and trouble dealing with the Care Provider about the issues while Mrs X was ill in hospital.

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The Ombudsman’s role and powers

4. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
5. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
6. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
7. 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.
8. 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)
9. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

10. I have investigated matters from January 2025 to March 2025. This covers the period from when Mrs X was admitted to hospital to when Mr Y made a complaint to the Ombudsman.

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How I considered this complaint

11. I considered evidence provided by Mr Y and the Care Provider as well as relevant law, policy and guidance.
12. Mr 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

13. The Care Quality Commission (Registration) Regulations 2009: Regulation 19 require providers to give timely and accurate information about the cost of their care and treatment to people who use services. To meet this regulation, providers must make written information available about the 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.
14. A self-funder is a person who arranges and pays for their care privately.

The terms of contract between the Care Provider and Mrs X

15. If cancellation of an assignment was as a result of the service user’s admission to hospital, fees would be chargeable but only in relation to the time the Care Provider was due to provide the service on the day of the service user’s admission to hospital. If the care package was not terminated at that point, the Care Provider would reserve a space for the service user’s return; a 50% suspension charge would be applied.
16. Service users must give the Care Provider at least 21 days’ notice in writing if they no longer require the service.
17. The Care Provider may terminate the contract:

• by giving 14 days’ written notice for any reason; or
• after giving 14 days’ written notice that the service user had failed to pay care fees; or
• after giving 14 days’ written notice that the Care Provider was unable to meet the service user’s needs
• immediately in the event of the service user’s death and their estate would remain responsible for paying any outstanding fees.

18. Service users must pay their care fees within 14 days from the date of the invoice unless otherwise agreed. The Care Provider shall be entitled to cancel the contract or suspend any further services to the service user if they fail to make payments on the due date.

Key events

19. Mrs X had a home care package which was provided to her by the Care Provider (CP). Mrs X was a self-funder.
20. On 8 January 2025, Mrs X was admitted to hospital after a fall.
21. On 13 January, the CP wrote to Mr Y about its contract with Mrs X and it said it would apply a 50% suspension charge to Mrs X’s account while she was in hospital. The CP advised Mr Y to consider the suspension and termination clause in Mrs X’s contract and asked him to inform it about his decision on the matter as soon as possible.
22. The next day, Mr Y replied to the CP. He explained Mrs X would be in a rehabilitation centre for two weeks after which she would be discharged home with a care package funded by the hospital for six weeks. Mr Y said he believed the hospital would contact the CP and ask it to provide Mrs X with the care package when she got discharged. So, Mr Y asked the CP not to charge Mrs X for the duration she was in hospital. Mr Y said he was not sure if that meant suspending Mrs X’s care or not, but that he would go with the CP’s advice on the matter.
23. The CP said it could either suspend or terminate Mrs X’s care package in line with the terms of Mrs X’s contract. The CP said it was happy to suspend Mrs X’s account but at a 50% retention charge. The CP asked Mr Y to confirm his preferred choice by 26 January, so it could make the necessary adjustments to Mrs X’s account.
24. On 25 January, Mr Y responded and referred to the email he sent to the CP on 14 January, where he said he had asked the CP to stop Mrs X’s care package and with no charge until he knew when and whether she would resume her care package. Mr Y said he did not mind whether the CP classified it as either suspension or termination of her contract, but he reiterated he did not want Mrs X to be charged while she was in hospital.
25. On 30 January, Mr Y asked the CP if it had stopped charging Mrs X.
26. The CP wrote to Mr Y and confirmed it had not stopped Mrs X’s charges in line with the contract terms. The CP also said it had spent considerable time, and it had exhausted all avenues of resolution as regard Mr Y’s concerns about Mrs X’s care fees while she remained in hospital. The CP then informed Mr Y that effective from 31 January, it formally terminated Mrs X’s contract. The CP provided Mr Y with details about how he could make a complaint if he was dissatisfied with its decision or that he could contact the Ombudsman.
27. The CP issued Mrs X’s invoice for the period 1 January to 31 January, with the payment due on 7 February.
28. The CP applied a full charge of Mrs X’s care fees on 8 January (the date Mrs X was admitted to hospital), and it then applied 50% suspension charge from 9 January to 29 January.
29. In February, Mr Y and the CP exchanged a number of correspondence which included Mr Y’s concerns and the CP’s responses.
30. Mr Y said despite him asking the CP on several occasions, it failed to stop charging Mrs X for care services since she got admitted to hospital. Mr Y also complained the CP failed to properly deal with his concerns and that it wrongfully terminated Mrs X’s contract without notice or an explanation. Mr Y asked the CP to provide him with a copy of its complaint procedure.
31. The CP responded to Mr Y, and it attached a copy of Mrs X’s contract. The CP said:

• in line with her contract, care charges could only be stopped when the contract was formally terminated regardless of individual requests. So, the CP said Mrs X’s charges ended when it terminated her contract at the end of January.
• it reserved the right to discontinue services under specific circumstances including non-payment and a breakdown in the working relationship.
• its efforts to resolve Mr Y’s concerns proved abortive and due to ongoing dispute about Mrs X’s care charges, the CP said it believed it was in the best interest of all parties to have formally terminated Mrs X’s contract.

32. Mrs X passed away in late February.
33. The CP continued to send reminders to Mr Y to pay Mrs X’s outstanding care fees.
34. Mr Y remained dissatisfied with how the CP dealt with Mrs X’s care fees while she was admitted to hospital, how it wrongfully terminated her contract and its complaint handling process.
35. In response to our enquiries, the CP provided us with its one-stage complaints process. The CP’s complaints process was not published on its website, and it was different from the details it provided Mr Y on 31 January.

Analysis

36. Based on Mrs X’s contract with the CP, there was no fault by the CP for applying a full charge on 8 January 2025 (the day Mrs X was admitted to hospital) and the subsequent 50% charge it applied from 9 January to 13 January. These were charges the CP was entitled to apply to Mrs X’s account for this period. This is because the contract stated the CP would be entitled to reserve a space for Mrs X with a 50% suspension charge during a hospital admission.
37. However, the crux of the matter in this case was how the CP then continued to charge Mrs X from 14 January onwards.
38. After Mrs X was admitted to hospital, Mr Y sent an email to the CP on 14 January where he asked the CP to stop charging Mrs X for her care package for the duration she was in hospital. On balance, I find Mr Y expressed clearly that he wanted to stop the care package.
39. So, in line with the terms of Mrs X’s contract, I find the 21 days’ notice for the termination of Mrs X’s contract started on 14 January and ended on 4 February. Consequently, the CP was entitled to apply charges to Mrs X’s account until 4 February (end of the notice period). The CP continued to apply a 50% charge to Mrs X’s account from 14 January to 29 January. This was not fault. Also, Mr Y was provided with a copy of Mrs X’s contract. This meant Mr Y was aware of the cancellation and termination policy which included the requirement of the 21 days’ notice period if he wanted to cancel the service.
40. I note Mr Y’s point that the CP should have stopped charging Mrs X’s account when he told it to do so on 14 January without him having to use the specific wordings in the contract (suspend or terminate) which the CP continually asked him to choose from. Mr Y and the CP exchanged several correspondence on the matter which I criticise the CP for. As earlier stated, I find Mr Y was clear he wanted the service stopped and the Ombudsman does not expect a service user to use the exact contractual words; so, I find the CP’s behaviour was unfair and not in line with our expectations.
41. Mr Y also complained the CP wrongfully terminated Mrs X’s contract without notice and an explanation. I find there was no need for the CP to have given notice to terminate Mrs X’s contract. This was because Mr Y, the other party, had already given notice when he asked the CP to stop Mrs X’s care package on 14 January. The CP’s actions in giving notice were therefore confusing and unclear.
42. CPs must ensure their complaints procedure are easy to find and use and must deal with complaints fairly. In this case, there was no evidence to show the CP’s complaints procedure was published on its website. And although the CP responded to Mr Y’s concerns via its email, there was no evidence it considered Mr Y’s complaint properly and issued a formal response under its complaints procedure. These were faults and caused Mr Y frustration and uncertainty in not knowing whether his complaint was properly dealt with.
43. In conclusion, I find the CP was not at fault with how it applied charges to Mrs X’s account when she got admitted to hospital from 8 January to 29 January 2025, when the CP stopped charging her. But I find fault with the CP’s complaint handling process.

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Action

44. To remedy the injustice caused by the faults identified, the Care Provider should complete the following within one month of the final decision:

• apologise in writing to Mr Y to acknowledge the injustice caused to him by the Care Provider’s failings as identified above. The apology should be in accordance with our guidance, Making an effective apology
• publish the Care Provider’s complaints procedure on its website to ensure service users and their representatives are clear on how to raise formal complaints via the appropriate route
• by training or otherwise, advise relevant staff of the importance of carrying out effective complaint handling to address its service users’ and/or their representatives’ concerns and complaints.

45. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

46. I find some faults by the Care Provider causing injustice to Mr Y. I have made recommendations to remedy the injustice the organisation has not yet agreed to carry out.

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Investigator's decision on behalf of the Ombudsman