Summary: Mrs F complained that her mother, Ms G, received inadequate respite care, did not receive a contract and has not been adequately refunded for the fees paid for a four week stay. Mrs F says this caused Ms G distress, financial hardship and has put her to the time and trouble of making a complaint. We find the Care Provider did not obtain a signed contract on admission but its actions did not cause a significant injustice to Ms G.

The complaint

1. Mrs F complains that her mother, Ms G, has not been adequately refunded after leaving a four week respite stay in a care home after only one night. Mrs F says the standard of care her mother received was unsatisfactory and that she did not receive a contract from the Care Provider.
2. The Care Provider has refunded half of the fee Ms G paid for her stay, however, Mrs F says the experience has left her mother distressed and in financial hardship. Mrs F would like the Care Provider to provide a full refund.
3. Mrs F represents her mother Ms G in making the complaint.

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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 an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
5. 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)
6. We normally name care homes and other providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
7. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

8. In considering this complaint I have:

• spoken to Mrs F and read the information accompanying her complaint;
• put enquiries to the Care Provider and reviewed its responses;
• researched the relevant law and guidance; and
• shared with Mrs F and the Care Provider a copy of the draft decision giving them an opportunity to comment on the facts and view taken. I have considered the comments I have received.

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What I found

Relevant law and guidance

9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC) issued guidance in March 2015 on meeting the regulations (the Guidance). We consider the 2014 Regulations and the Guidance when determining complaints about services in care homes.
10. Regulation 19 of the 2014 Regulations requires a Care Provider to issue a statement with the terms and conditions of service including the fee and method of payment. This should where applicable include a written contract. The statement and contract should generally be issued before the service starts, wherever possible. The Guidance says:

• providers must give people written information about the terms and conditions of care, including the expected costs, before their care begins;
• providers must make sure that they give a copy of any contract detailing the service to be provided to the person using the service and/or the person lawfully acting on their behalf;

• providers must tell people about any changes, including to the fee and give them enough time to consider whether they want to continue with the service; and
• people must be given a written copy of the terms and conditions that they must agree to before their care, treatment or support begins.

What Happened

11. After receiving Mrs F’s enquiry about respite care for her mother, Ms G, the Care Provider says it posted a copy of the contract to Mrs F in late November 2020. It says it emailed an invoice on the same day. It says that during a telephone conversation it told Mrs F to submit the signed contract when she dropped Ms G off to start her respite care.
12. In December 2020, Ms G entered Halstead Hall Care Home as a self-funded residential client for four weeks of respite care following an operation.
13. The Care Provider says its admissions officer was busy at the time of Ms G’s admission to the care home and later discovered that Mrs F had not left the signed contract.
14. The contract set out the terms and conditions on which the Care Provider would accept Ms G. Mrs F disputes she received a contract. The Care Provider issued an invoice for a four week stay which Mrs F paid in full before Ms G entered the care home.
15. Mrs F says she visited the following day after being made aware Ms G was anxious and was unhappy with her stay. She says Ms G raised concerns about the care and provision at the home and says her mother told her that she:

• received inadequate food and drink throughout her stay;
• was not provided with a stool for washing when she requested this;
• was told the heating could not be turned up even though she complained she was cold; and
• made several call bell requests throughout the night for members of staff to attend her room which went unanswered.

16. The Care Provider says it received a call from Mrs F in the morning after Ms G’s admission. It says that Mrs F did not raise any concerns with them during the call and said the reason her mother wanted to leave early was because she was not settling well, was recovering better than expected, missed her own bed and the room was too small.
17. The Care Provider says a larger room had now become free and it had verbally offered this to Mrs F over the telephone. It says this offer was refused.
18. Mrs F says she attended the care home to collect her mother and they left shortly after lunchtime. Mrs F says that Ms G was only a resident for eighteen hours.
19. The Care Provider says that Mrs F did not make it aware of any issues Ms G says she experienced and did not give it time to address them.
20. Mrs F complained to the Care Provider in December 2020.
21. The Care Provider responded to Mrs F’s complaint and said:

• it was sorry Ms G did not enjoy her stay;
• significant preparatory work went into the stay and the care home would usually only accept respite stays of two weeks, however this had increased to four weeks due to the pandemic;
• a contract was sent out before admissions and that it would not allow admission without a signed contract;
• the contract could be cancelled before admission but not once a resident was in the home;
• concerns were not raised until the issue of a refund was requested;
• it had offered Ms G a larger room during her stay but she had refused;
• the food and drinks served was freshly prepared and hot;
• no stool was requested;
• there were no issues with the temperature or controls in Ms G’s room; and
• there were no issues with the call bell system.

22. In recognition of Mrs F’s dissatisfaction, the Care Provider refunded Mrs F half of the fee. The Care Provider said under its terms and conditions it did not have to refund any fee but that it had done this as a gesture of goodwill.
23. Mrs F asked the Care Provider to reconsider its offer. While she recognised it could retain some of the fee, she felt the refund did not adequately reflect Ms G’s experience and short stay of eighteen hours.
24. The Care Provider refused an additional refund explaining it had completed significant preparatory work before Ms G’s arrival. It said it recognised that Mrs F had said she had not received a contract, however it repeated it had sent one out. The Care Provider said its usual practice would have been not to admit Ms G to the care home without a signed contract.
25. Mrs F says in her complaint she did not receive a copy of the contract from the Care Provider and never signed one either before or after Ms G’s admission to the care home.
26. As part of my enquiries the Care Provider sent a copy of the unsigned contract. This says in paragraph 5, “when you leave the home, for whatever reason, our charges are payable in full for one calendar month from the date you give us written notice. If you are staying in the home on a respite basis, your fees must be paid in full for your stay before it commences… A weeks’ notice is required of residents staying with us on a respite basis.”
27. Mrs F complained to the Ombudsman in January 2021.

Analysis

Contract

28. Mrs F says she did not receive or sign a copy of the contract. Therefore, Mrs F says she did not know the full terms and conditions on which Ms G had entered the care home. The Care Provider says it sent out a contract for signature but did not receive a signed copy. Mrs F also paid the full amount of the cost of Ms G’s stay before she was admitted into the care home.
29. The Care Provider could not give me a copy of the signed contract and accepts it did not obtain a signed copy on Ms G’s admission to the care home. The Guidance is clear that best practice expects the Care Provider should have obtained a copy of a signed contract before Ms G was admitted to the care home. The Care Provider has also acknowledged it would not usually accept a resident without a signed contact. In this case it did.
30. The contractual terms and conditions meant that the fees Mrs F had paid before Ms G was admitted to the care home were non-refundable regardless of the length of her stay. In this case, the Care Provider did consider Mrs F’s complaint and refunded her half of the fee as a goodwill gesture. I find that the absence of a signed contract did not cause a significant injustice to Ms G as she was still admitted to the care home for respite care, received its services and was refunded half of the fee paid for the stay. This was more than she would have received had the strict terms of the contract been followed.

Care provided during Ms G’s stay at the Home

31. Mrs F says that Ms G received inadequate care and provision during her short stay at the care home. The Care Provider has supplied me with a copy of Ms G’s care plan, statements from staff involved in Ms G’s care and an audit of the call bell system. The information I have suggests the Care Provider gave overnight care and checked on Ms G numerous times throughout the night. It provided a detailed audit of the duration of time it took to respond to bell calls and that it offered assistance. The staff statements detailed the food and provision offered. The Care Provider gave a temperature reading for the room. It said it had no record of a request for a stool. I find the care provided to Ms G as set out in the records did not cause an injustice, even though the care did not meet her expectations.

Final decision

32. I have completed my investigation by finding the Care Provider has not caused an injustice to Ms G, even though it admitted her to the care home without a signed contract.

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Investigator's decision on behalf of the Ombudsman