The Ombudsman's final decision:
Summary: Ms X complained the Care Provider failed to provide her a refund for overpaid care charges paid by her mother Mrs Y. There is no fault in the way the Care Provider has calculated the amount owed to Ms X. However, the Care Provider sent Mrs Y an invoice when she was no longer in the care home, provided confusing information to
Ms X and failed to clearly explain how it calculated the refund. The Care Provider has agreed to pay Ms X £250 to recognise the frustration and uncertainty caused to her.
- Ms X complains the Care Provider has not refunded all money due to her after it incorrectly charged her mother for care when she moved out of the Care Home.
The Ombudsman’s role and powers
- 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 34B and 34C)
- 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 council has done. (Local Government Act 1974, sections 26B and 34D, as amended) I have used my powers to consider what has happened since April 2014. Due to a change in ownership of the Care Provider and lack of records I cannot consider what happened before this date.
- If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
- If we are satisfied with a care provider’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)
How I considered this complaint
- As part of the investigation, I have:
- considered the information Ms X provided and discussed the complaint with her;
- made enquiries of the Care Provider and considered the comments it provided;
- made third party enquiries to the organisation that managed the financial administration for this Care Home before the new owners of the Care Provider took over;
- looked at the relevant law and guidance, including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; and
- written to Ms X and the Care Provider with my draft decision and considered their comments.
What I found
- Mrs Y moved into a care home (the Care Home) in late 2012. Her daughter,
Ms X, managed payments for her care. At that time, the Care Provider had different owners and all financial administration was carried out by a separate company (the Financial Administrator).
- The Care Provider’s statement of Mrs Y’s care charges and payments (the Statement) shows Mrs Y’s fees were initially £2,426.24 every four weeks. Between 30 November 2012 and 11 May 2013 this equated to £14,124.18. The statement shows Ms X paid £13,260 which meant Mrs Y had arrears.
- Ms X, the Care Provider and the Financial Administrator cannot explain why
Ms X was not paying the correct amount for Mrs Y’s care. There is no record to show how the Care Provider informed Ms X of care charges, for example a service user contract. Ms X was not aware there was a debt on the account before bringing her complaint to the Ombudsman. I cannot now investigate how these figures were calculated. It was too long ago for me to consider now and there is a lack of records. However, the bank statements provided by Ms X show Mrs Y paid £2,380 every four weeks. Because the payments were not enough to meet the charges, Mrs Y was in arrears and owed money to the Care Provider.
- From April 2014, Mrs Y’s fees changed to £2,571.80. Ms X started paying the correct amount every four weeks and so the arrears did not then grow further. However, Mrs Y was still in debt to the Care Provider because of the arrears that had already built.
- Mrs Y was admitted to hospital on 23 February 2015 and she was assessed as needing nursing care, so she could not return to the Care Home. The Care Provider cancelled her bed on 5 March however Ms X did not cancel the standing order before the next payment on 9 March which covered care fees up to 11 April 2015. She says the Care Provider had told her not to.
- In March, the Care Provider issued another invoice by mistake. Neither the Care Provider nor the Financial Administrator can explain why this happened.
- The Statement shows at the end of March the Care Provider refunded £2,479.95 into Mrs Y’s care charges account because Mrs Y had paid too much when the standing order was not cancelled. This refunded 27 days’ fees for the period
5 March to 31 March.
- Ms X, however, believed that the Care Provider would pay £2,479.95 into Mrs Y’s bank account, rather than her care charges account the Care Provider held. She was therefore concerned there was no record of the payment on Mrs Y’s bank statement. The Care Provider later apologised for the confusion and explained this to Ms X, however she was still confused about why the charge did not show on Mrs Y’s bank statement.
- Mrs Y went into a nursing home in March and then passed away in April.
- The Care Provider wrote to Ms X to say it had calculated Mrs Y had overpaid by £2,008.86. This calculation included adjustments to account for the incorrect invoice the Care Provider issued in March.
- The Care Provider sent Ms X a Statement to help her understand its calculations. Ms X identified many errors she believes the Statement included. I have checked Ms X’s notes and analysed the Statement and I am satisfied there are no errors. Ms X highlighted:
- two versions of the Statement show different balances in places. However, this is due to invoices and payments being shown in different orders. The invoices and payments match and this does not impact the final balance;
- one breakdown the Care Provider sent to her does not show “missed dates of payments”. Through further investigation I clarified Ms X meant that a list of payments the Care Provider sent to her does not show invoices. This breakdown was not intended to include invoices as well as payments, and the payments shown match the information on the Statement;
- dates repeat in places. Despite there being two invoices with the same date on some occasions, the invoices relate to different billing periods; and
- there were more entries on one version of the Statement. However, these showed invoices the Care Provider later adjusted, and the statement shows they did not impact the end balance.
Ms X believes she paid for care after 5 March 2015. The Care Provider paid Ms X £2,008.86 as this is what it calculated she had overpaid.
- Due to a change in owner, the Care Provider could not provide records to help me with my investigation. This means I cannot properly investigate:
- how Ms X was informed of care charges;
- whether the Care Provider’s policy allowed it to keep Mrs Y’s bed open until 5 March 2015; and
- why an invoice was raised incorrectly after Mrs Y’s bed should have been cancelled.
- the information it includes matches Ms X’s account of events when her mother moved out of the Care Home;
- it accounts for the incorrect invoice that the Care Provider raised in March 2015, and the extra payment Ms X sent in March 2015;
- the Care Provider refunded £2,479.95 into Mrs Y’s care fees account as it had charged for the period 5 March 2015 to 31 March 2015;
- charges, payments and final balances are consistent in all versions of the Statement, even though they are shown in different orders; and
- the total fees for the time Mrs Y stayed at the Care Home were £75,724.49, and the total payments £77,733.35. Therefore, there was a £2,008.86 overpayment, which the Care Provider has now refunded.
- Mrs Y paid £2571.80 on 9 February and then again on 9 March.
- Mrs Y therefore paid £5143.60 for care fees for the period 15 February to 11 April 2015.
- Mrs Y should only have paid from 15 February to 4 March 2015 which amounts to £1653.30.
- Mrs Y therefore overpaid £3490.30.
- the account was £1481.44 in debt. This was due to Mrs Y not paying the full amount in the past.
- This meant Mrs Y was due a refund of £3490.30 minus £1481.44. This equates to £2008.86 which is the amount the Care Provider refunded Mrs Y.
- I recommended the Care Provider apologises to Ms X and pays her £250 to recognise the frustration and uncertainty caused by its records.
- The Care Provider has agreed to take the above steps within one month of our final decision and it should provide evidence to the Ombudsman that it has done so.
- I found fault causing injustice, for which I have made recommendations. Subject to further comments by Ms X and the Care Provider, I intend to complete my investigation.
Investigator's decision on behalf of the Ombudsman