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Banbury Heights Nursing Home (18 009 786)

Category : Adult care services > Residential care

Decision : Upheld

Decision date : 27 Mar 2019

The Ombudsman's final decision:

Summary: Ms C is unhappy about the way in which the care provider has dealt with an increase in Mr D’s care home fees, as well as his final bill. The Ombudsman has upheld Ms C’s complaint. The care provider has agreed to provide an apology to Ms C, revise its final bill and share the lessons learned with relevant staff.

The complaint

  1. The complainant, whom I shall call Ms C, complained to us on behalf of (the late) Mr D. Ms C complains that the nursing home where Mr D’s stayed:
    • Failed to notify her about an increase in the weekly fees from 1 April 2017 onwards, as required within the contract.
    • Sent her a final invoice in April 2018, without providing a sufficiently detailed breakdown to enable her to understand how the care home had arrived at this figure.
    • Failed to deal with her subsequent concerns and questions properly.

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The Ombudsman’s role and powers

  1. 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 or others. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
  2. If we are satisfied with a care provider’s actions or proposed actions, we can complete our investigation and issue a decision statement.
  3. 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

  1. I considered the information I received from Ms C and the care provider. I also made enquiries with Oxfordshire County Council. I have shared a copy of my draft decision statement with Ms C and the care provider, and have considered any comments I received before I made my final decision.

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What I found

  1. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards, below which care must never fall.
  2. When investigating complaints about standards of care in a care or nursing home, the Ombudsman considers these Regulations and whether the fundamental standards set out in CQC guidance have been met. If they have not, he considers whether any identified faults have resulted in an injustice.
  3. Regulation 19 of the Care Quality Commission (Registration) Regulations 2009 says care providers should provide the resident or their representative with a written statement, ideally before the resident moves in. The statement should:
    • Set out the terms and conditions of service, including the amount and ways to pay the fee;
    • Include a contract.
  4. Guidance by the Care Quality Commission says that: providers must notify people of any changes to their terms and conditions, including increases in fees and give them sufficient time to consider whether they wish to continue with the service

What happened?

  1. Mr D moved into the nursing home in January 2017 for respite care, paid for by the NHS. However, it ceased funding the placement on 5 March 2017, after which Mr D became a private resident. The Service User Contract with the home is dated 6 March 2017. Mr D’s fees were £1,020 per week, which was to be paid four-weekly (£4,080).
  2. Care homes have the right to increase the tariff (fee) in accordance with the cost of living at Nursing Homes. In any such event, the care home must notify the resident. The Care Home’s “Individual Service User Contract” says: Fees may be adjusted in line with the cost of inflation. One month’s notice of any changes will be given.
  3. The care home provided a copy to me of a template of a “Fees Increase Letter”, dated 1 March 2017. The letter says there will be an 8% increase in fees from the beginning of April 2017. Mr D, nor Ms C, received a copy of this letter.
  4. The care provider gave me a copy of a letter dated 4 April 2017, which it says it sent to Ms C in April, along with a copy of Mr D’s invoice. The letter says: Please find attached our April invoice (…) showing the proposed fee increase as notified last month. However, Ms C says the care provider did not send her any invoices between April and August 2017. In addition, Ms C showed me a different copy of the letter dated 4 April 2017 from the care provider, which did not include the above sentence about the fees increase.
  5. Ms C says she only started to receive invoices from September 2017 onwards, when she told the care home of the new address she had just moved to. Ms C says it was only then when she became aware there had been a fee increase from £1,020 to £1,101.60 a week. Ms C immediately contacted the care home to ask why there had been an increase. The care home says it subsequently discussed this during a meeting in September 2017.
  6. Ms C says she approached the Council for financial assistance in December 2017. Mr D’s capital had reduced to below £23,250, which meant he would be eligible for Council support. The Council sent a letter to Ms C on 8 January 2018. It said that, based on the financial information she submitted, it appeared Mr D was eligible for a twelve weeks property disregard. This meant that, if the Council concluded that Mr D would be eligible, it would: pay Mr D’s entire care home fees of £1,101.60 a week (for 12 weeks), while Mr D would only have to pay a Council an assessed contribution of £395 a week. However, the Council said it would only agree to provide this funding after the Council had assessed Mr D’s needs and concluded he needs to be in a care home.
  7. Ms C forwarded the letter immediately to the care home and said she would stop Mr D’s standing order. However, at the time, Mr D had already paid £4,080 for the month of January 2018. From the cover note to the care home, it appears Ms C believed the twelve weeks property disregard was already actively in place, which it was not.
  8. It took until 8 June 2018, before the Council confirmed to the care home that Mr D met the requirements for a twelve-week property disregard from 4 January 2018 onwards. The Council told me it has paid the correct and full amount to the home for the period 4 January 2018 until Mr D passed away on 5 February 2018. However, the care home says there is still an amount from the Council outstanding.
  9. This meant the care home had been paid double for the period after 4 January 2018: Ms C paid £4,080 to the care home (for four weeks), in addition to the Council who paid £1,101.60 a week.
  10. Following Mr D’s death, the care home sent a final bill to Ms C. However, Ms C says she noticed discrepancies, which she challenged the home about. Ms C says the (first) final bill she received on 3 July 2018 was for £4,222.51.
  11. In addition, Ms C wanted the care provider to explain:
    • When and how the care home gave notice, in writing, that the fees would increase from £1,020 per week to £1,106 per week.
    • Why the care home did not notify her, over the course of almost a year, that there was an outstanding balance with regards to the payment of fees.
    • How much the care home had received from the Council and why this was not reflected in the final bill.
  12. The care home has told Ms C that
    • It gave notice to residents in a letter in March 2017. The home’s administration manager also briefed Ms C in a meeting in September 2017. During the meeting, they also spoke about the payment arrears.
    • It has original copies of the monthly invoices it sent out, with the increase weekly amount clearly indicated.
    • The home was not aware the Council would financially support Mr D, until it received a payment from the Council in June 2018. The care home received £5,563.91 from the Council in June 2018. However, the amount was wrong and the home was trying to correct it.
  13. Ms C has since asked:
    • For a copy of the March 2017 notification letter the home referred to. However, the care home has only said it has a “general copy of the fee increase advice letter”. It did not provide a copy of the letter to Ms C.
    • Why the care home believes the amount it received from the Council was incorrect and what it should be. However, the care home has not explained / shown why there has been an alleged shortfall.
  14. The care home’s complaints policy says that if a complaint cannot be satisfactorily resolved within the care home, the complaint / complainant will be referred onto the Care Quality Commission.
  15. The care provider has told me that it is not comfortable settling any (uncovered) debt with Ms C, until the Council has paid any monies due to the care provider.

Assessment

  1. The care provider showed me a template of a fee increase letter, dated 1 March 2017, which it says it sent to its residents. This means the care provider already knew, at the time Mr D signed his contract, that his fees would increase by 8% from April 2017 onwards. There is no recorded evidence to conclude the care home informed Mr D and/or Ms C of this increase at the time Mr D signed the contract. As the significant increase was imminent, I would also have expected the care provider to have mentioned the fees he would have to pay (from four-weeks time onwards) within his contract. Mr D was therefore not sufficiently clear or aware, when he signed the contract, what his care home fees would be. This is fault.
  2. Based on the evidence I have seen; I found the care home failed to send a letter to Ms C in which it informed her of the fee increase. However, the increase was shown on invoices from April 2017 onwards. I am unable to come to a view why Ms C says she did not receive the invoices from the care home until September 2017. I am unable to conclude, on the balance of probabilities, that the care home failed to send these.
  3. The care home first informed Ms C on 4 April 2017, as the increase in the weekly rate is shown in the April 2017 invoice. This means that, according to the contract that talks about a ‘one month notice’, the fee increase for Mr D should only apply from 4 May 2017 onwards.
  4. When the care home sent its (first) final bill to Ms C on 3 July 2018, it knew already that the Council had become responsible for paying Mr D’s fees from 4 January 2018 onwards. It also knew that Mr D had (also) paid the care home for this period. However, it failed to deduct Mr D’s £4,080 from this final bill. This is fault. It has since deducted this, which has contributed to a revised final bill of minus £1,012.69, as of February 2019.
  5. The care providers complaint policy only mentions the Care Quality Commission (CQC). It does not mention the role of the Local Government and Social Care Ombudsman (LGSCO). Once a complaint has been dealt with by a care provider, and the complainant remains unsatisfied, the care provider should refer the complainant to the LGSCO. The CQC cannot get involved in individual complaints about providers, but is happy to receive information about a care home service.

Agreed action

  1. I recommended that, within four weeks of my decision, the care provider should:
    • Provide an apology to Ms C for the faults identified above and the time and trouble she had to spend to resolve it.
    • Recalculate and settle the outstanding balance with Ms C, in line with paragraph 26 and 27.
    • Introduce a system to ensure it periodically informs its residents in writing (for instance at least every six months) when any arrears are building up.
    • Ensure that its complaints policy, information it provides to its residents and its complaint letters refer to the LGSCO.
    • Share the lessons learned from this case with relevant staff in the care home.
  2. The care provider has told me it has accepted my recommendations.

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Final decision

  1. For reasons explained above, I have upheld Ms C’s complaint. I am satisfied with the actions the care provider will carry out to remedy this and have therefore decided to complete my investigation and close the case.
  2. I have shared a copy of this decision with the CQC.

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Investigator's decision on behalf of the Ombudsman

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