Summary: Mrs D complained about the way in which the Care Provider dealt with issues relating to the care of her mother in one of its care homes and the associated fees. The Care Provider has agreed to refund £1942, make a written apology and improve its procedures for the future.

The complaint

1. Mrs D complains on behalf of her mother, Mrs B that Brancaster Care Homes Ltd (the Care Provider):
• failed to provide a contract detailing the terms and conditions of Mrs B’s stay at Home D or provide information about when fees would be charged and how much they would be;
• gave Mrs B 28 days to find alternative accommodation without good reason;
• increased the fees by an excessive amount from 24 February 2020 and obtained a signature from Mrs B agreeing to the fees without ensuring she understood what she was signing or that she had the capacity to make that decision and without consulting any of her daughters;
• failed to provide evidence of the increased care Mrs B received;
• failed to provide evidence to support its view that Mrs B was difficult to manage;
• failed to provide evidence of some of the alleged complaints made by/against Mrs B; and
• failed to refund £1942.92 to Mrs B after she left Home D on 26 March 2020.

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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. (Local Government Act 1974, sections 34B and 34C)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
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)

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How I considered this complaint

5. I have considered the complaint and the documents provided by the complainant, made enquiries of the care provider and considered the comments and documents from the care provider.

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What I found

6. Mrs B was discharged from hospital to Home D in October 2019. Prior to her hospital admission Mrs B was living at home with a care package. She is elderly with health problems. Sometimes she gets confused and is unable to read documents with normal-sized print.
7. Mrs D did not know the terms on which Mrs B was staying at the home and says the Care Provider did not provide a contract. She said her sister asked the Care Provider about a contract and was told that Mrs B did not need one as she was ‘on trial’ and that a review would take place after six weeks.
8. Mrs D says the Care Provider carried out a review after nine weeks, on 16 December 2019.
9. At the beginning of December 2019, Mrs B made an allegation against a member of staff. In response to the allegation the Care Provider:
• temporarily suspended the member of staff;
• informed the police who interviewed Mrs B (she then withdrew the allegation against the member of staff and said it was an intruder); and
• alerted the safeguarding team.
10. The safeguarding team said that Mrs B should have 2:1 support at all times for a period of three months. The Care Provider set up 2:1 support but said it couldn’t sustain that level of care at night and Mrs B would need to find alternative accommodation. It gave her written notice on 6 February 2020 saying she needed to leave by 24 February 2020.
11. Mrs B made a second allegation against a member of staff on 31 January 2020. She said they had pushed her onto the bed and said she was a troublemaker.
12. Mrs D complained against the notice on 8 February 2020. The Care Provider responded on 22 February 2020 and said that Mrs B could stay at Home D until she found an alternative placement. It agreed it should have provided a contract but there were mitigating circumstances given the speed she was discharged from hospital.
13. On 21 February 2020 the Care Provider showed a letter to Mrs B requiring her to sign a new temporary contract increasing the fees from £800 to £1855 per week to cover the cost of the 2:1 support. Mrs B signed the contract without any of her family present. Mrs D alleges that the Care Provider did not inform her of the increase in fees before she signed and said it was just so she could stay at Home D for a little bit longer. The Care Provider sent one of Mrs B’s daughters a copy of the contract after Mrs B had signed it.
14. Mrs D complained to the Care Provider about the imposition of the contract and questioned whether Mrs B had the capacity to properly understand what she was signing. Mrs D also pointed out that she and her sisters had lasting power of attorney for decisions about finance and they should have been contacted. She said Mrs B was not going to pay the increase and they looked for an alternative placement. She also requested details of any extra agency staff employed to look after Mrs B and statements from the member of staff accused of pushing Mrs B on to the bed. The Care Provider said it would not provide any further information. In March 2020 the safeguarding team said Mrs B no longer needed 2:1 care.
15. On 16 March 2020 the Care Provider wrote to Mrs D saying it would arrange for another contract to be signed by Mrs B in the presence of one other family member and it would reduce the fee to £1150 per week, because Mrs B was demanding but it had not had to employ any agency staff.
16. On 25 March 2020 Mrs D replied saying she had found a new placement for Mrs B and she would be moving on 26 March 2020. She did not agree to pay any increase and requested a refund of the fees already paid, amounting to £1942.
17. Mrs D chased up the Care Provider on 10 May 2020.
18. Mrs D had complained to the Ombudsman in March 2020 but due to the pandemic we did not start our investigation until September 2020.
19. On receipt of our enquiries the Care Provider has offered to meet with Mrs D and arrange for the refund to be made as soon as possible. Mrs D says she would be satisfied if the refund is made but would also like an apology and some commitment to learn lessons for the future.

Analysis

20. Even if Mrs B was only staying at Home D on a temporary basis the Care Provider should have provided clear information at the start regarding the terms and conditions of her stay, including the fees.
21. It should also have carried out a review of Mrs B’s needs after six weeks to assess how she was getting on and whether any changes needed to be made.
22. As part of the discussion, the Care Provider should have raised with Mrs B‘s family its difficulties in providing 2:1 support and discussed the available options rather than simply issuing a notice for Mrs B to leave. This caused distress to Mrs B and the family at an already difficult time.
23. It should also have discussed the proposed increase in fees with the family and properly assessed Mrs B’s capacity to understand the document before getting her to sign it. The failure to do so has raised valid concerns about the whole process, exacerbating the distress caused to Mrs B and her family.
24. I accept the Care Provider attempted to put matters right by offering a new contract to Mrs B and her family with reduced fees. But the fees were still very high and it was too late to repair the concerns Mrs D had about the way in which the Care Provider had acted.

Agreed action

25. The Care Provider has offered to meet with Mrs D and the family and refund £1942. I welcomed this offer but also asked the Care Provider, within one month of my final decision, to:
• offer a written apology to Mrs B and her family;
• ensure written information, about fees and other terms and conditions, is given to residents and their families before the stay begins; and
• ensure staff are aware of the requirements of the Mental Capacity Act 2005 when asking residents to make decisions about their care or finances.
26. The Care Provider has agreed to my recommendations.

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Final decision

27. I consider this is a proportionate way of putting right the injustice caused to Mrs B and Mrs D and I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman