Summary: Mr H complains the care provider has delayed repaying overpaid care home fees. He is the executor of his uncle’s estate and has been trying to resolve the issue for many months. The Ombudsman’s view is the care provider did delay responding to Mr H. Although this delay was not the reason for the confusion about how much they owe, it was avoidable. It led to unnecessary time and trouble and frustration for Mr H. The care provider has agreed to apologise.

The complaint

1. The complainant, whom I shall refer to as Mr H, complains the care provider has delayed repaying overpaid care home fees. He is the executor of his uncle’s (Mr J) estate and had been trying to resolve the issue for many months. This delayed him finalising his uncle’s estate.

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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. We may investigate complaints from a person affected by the matter in the complaint, or from someone the person has authorised in writing to act for him or her. If the person has died or cannot authorise someone to act, we may investigate a complaint from a personal representative or from someone we consider suitable to represent the person affected. (section 26A or 34C, Local Government Act 1974)

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How I considered this complaint

5. As part of the investigation, I have:
• considered the complaint and the documents provided by Mr H;
• made enquiries of the care provider and considered its response;
• asked the local council for its comments;
• spoken to Mr H;
• sent my draft decision to Mr H and the care provider and invited their comments.

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What I found

Legal and administrative background

6. The charging rules for residential care are set out in the ‘Care and Support (Charging and Assessment of Resources) Regulations 2014’, and the ‘Care and Support Statutory Guidance 2014’. When a council arranges a care home placement, it has to follow these rules when undertaking a financial assessment to decide how much a person has to pay towards the costs of their residential care.
7. The rules state that people who have over the upper capital limit are expected to pay for the full cost of their residential care home fees. However, once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees.
8. The council must assess the means of people who have less than the upper capital limit, to decide how much they can contribute towards the cost of the care home fees.

What happened

9. Mr J moved into a care home run by the care provider in January 2019. To start with, he had too much capital to qualify for help from the local council with funding his care home costs. So he was funding his care costs out of his savings.
10. By 13 March, Mr J’s capital had reduced to below the upper capital limit. This meant he was entitled to partial help from the council with his residential care costs. Mr H says they continued to pay the care home direct, which they later believed had led to an overpayment.
11. At the beginning of April, Mr J received a rent rebate. This took his capital back over the upper capital limit. It meant that Mr J should have been paying fully his residential care costs between 13 March and 6 April (when his capital dropped back below the upper capital limit).
12. Mr H says the council told them that it was easier if they continued to pay it. And it would sort out the issue with the care provider. On 21 May, the council wrote to Mr J’s relative (Mr K), who had responsibility for dealing with Mr J’s finances. This letter advised Mr K the council would be invoicing Mr J for costs between 13 March and 6 April.
13. Mr J died on 24 May.
14. Mr J named Mr H and Mr K as executors of his will. Mr H says they spent months after Mr J died trying to clarify with the care provider what the final balance was on Mr J’s account. In December 2019 the care provider advised Mr H Mr J’s estate was due a refund of over £4000.
15. Mr H tried to clarify some issues with the care provider about the refund. At the end of January 2020 he asked to complain, as the matter was unresolved. In February, a member of staff apologised for the delay in responding.
16. At the beginning of March Mr H contacted the Ombudsman. We asked the care provider if it had responded to Mr H’s complaint. Its response advised it was ready to refund the balance. But it needed information from the local council to confirm its records were correct. It apologised for the time it had taken. We decided to investigate the complaint (rather than first ask the care provider to respond, as we would normally do) because of the delay in the care provider’s response to Mr H.
17. At the end of April the council responded to the care provider. It advised it had paid all it owed it in June 2019. This was for Mr J’s care costs from 5 April.
18. The Ombudsman’s investigation was delayed by the COVID-19 pandemic and a pause in our casework. When we did make enquiries, the care provider response included:
• its view that it owed Mr J’s estate around £142 and was happy to reimburse this if Mr H provided bank details;
• advice its records did not match the information Mr H had provided;
• a statement to show Mr J’s account credits and debits.
19. I asked Mr H about the care provider’s account statement. He advised the payments agreed with their records. But he noted the care provider’s account did not tally with the fact the council had told them that it would be billing Mr J for money it paid the care provider.
20. I asked the council about this. Its response:
• advised it did not make any payment to the care provider for the 13 March to 5 April 2019 period. It had added that charge to Mr J’s account in error, but had corrected it in September 2019;
• advised Mr J’s estate did however owe the council for charges accrued from 6 April to the time of his death.
• sent statements confirming this information.

Analysis

21. The care provider has now provided information that clarifies the final balance on Mr J’s account. Mr H’s understandable confusion appears to be due to advice from the local council, not the care provider.
22. But the care provider’s delay in clarifying with Mr H Mr J’s final balance, and taking a complaint, was fault. And it led to an avoidable delay in Mr H being able to confirm the situation with the outstanding charges. That fault will have caused Mr H unnecessary time and trouble and frustration.

Agreed action

23. I recommended the care provider write a letter of apology to Mr H which acknowledged its delay and the injustice this will have caused him. The care provider has agreed to this suggestion.

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Final decision

24. I uphold the complaint because of the delay and the injustice to Mr H. The care provider has agreed to my recommendations.

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Investigator's decision on behalf of the Ombudsman