Summary: Mrs X complained the Care Provider overcharged her mother from June 2019 until November 2021 for nursing care rather than residential care. We found fault with the Care Provider for failing to transfer Mrs X’s mother to a residential bed sooner. The Care Provider agreed to our recommendation to provide a rebate to Mrs X’s mother for half the difference in costs between a residential and nursing bed from 19 August 2019 to 29 September 2019. The Care Provider also agreed to provide a rebate to Mrs X’s mother for the full difference in costs between a residential and nursing bed from 30 September 2019 to 5 November 2021. And, the Care Provider agreed to apologise to Mrs X and pay her £100 for the frustration and inconvenience caused through its poor handling of Mrs X’s complaint.

The complaint

1. Mrs X complained the Care Provider overcharged her mother from June 2019 until November 2021. Mrs X says the Care Provider has agreed to provide a rebate for the overcharges from September 2019 until November 2021 but not for the period June 2019 to September 2019.
2. Mrs X also complained she experienced distress and frustration when trying to resolve this matter with the Care Provider.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. 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.
5. If we are satisfied with an organisation’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

6. I have considered all the information Mrs X provided. I have also asked the Care Provider questions and requested information, and in turn have considered the Care Provider’s response.
7. Mrs X and the Care Provider provided comments on my draft decision which I considered before making my final decision.

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What I found

Care Provider’s assessment system

8. Bondcare (Halifax) Ltd. use the RFC Dependency System v8.12 to assess residents needs. This system classifies residents in a band from 1 to 6, with 1 being the lowest and 6 being the highest level of need.
9. The RFC Dependency System will provide details of the dependency category of an individual and the number of hours care needed each day for this individual.
10. The RFC Dependency System says that while it can provide an indication of need if cannot identify “whether the person is defined to be in need of nursing care”.
11. The spreadsheet for assessing needs contains a line stating “Nursing care required?”. The guidance for the system says the assessor should put a “1” in this column if the person needs nursing care. The assessor should leave the column blank or put an “R” in this column if the person needs residential care.

Care Provider’s complaints policy

12. Bondcare’s complaints policy says that it must investigate any complaint received and take proportionate action in response to the complaint.
13. Bondcare’s policy says it will acknowledge a complaint within two to three working days of receipt.
14. The policy says it will complete an investigation into a written complaint within 28 days and provide a written response to the complainant. This is Stage 1 of its process.
15. If a person is not happy with the Stage 1 complaint response, they can complain to the body commissioning the service, for example the Council. This is Stage 2 of Bondcare’s process.
16. At Stage 3 a person can take their complaint to the Local Government and Social Care Ombudsman (the Ombudsman).

What happened

17. In December 2018, Mrs X’s mother went into hospital.
18. On 4 April 2019, the Joint Health and Social Care Panel said Mrs X’s mother would need residential care on discharge from hospital. Mrs X, and her mother, chose Summerfield House, the Care Home, for Mrs X’s mother.
19. The Care Home assessed Mrs X’s mother on 17 April 2019 before agreeing a contract for her residence. The Care Home did not have any residential beds available when Mrs X’s mother agreed a contract for residence. Mrs X’s mother agreed a contract with the Council for residential care fees. Mrs X’s mother agreed a separate contract with the Care Home for nursing care fees on the understanding this would be temporary until a residential bed became available.
20. Mrs X’s mother entered the care on to a nursing bed on 18 April 2019.
21. On 28 June 2019, the Council completed a Continuing Healthcare Assessment of Mrs X’s mother. This assessment confirmed Mrs X’s mother was only eligible for residential care and did not need a full Continuing Healthcare Assessment for nursing care.
22. The Care Home contacted Mrs X on 25 September 2019 to advise the Council was only paying for residential care and it needed payment for the nursing care. The Care Home confirmed it agreed that Mrs X’s mother “would be placed in a nursing bed until a residential bed became available”.
23. In March 2020, the Care Home went into lockdown following Government regulations in line with the Covid-19 pandemic outbreak. Mrs X’s mother remained in the Care Home on a nursing bed.
24. Following easing of the lockdown regulations, the Council met with Mrs X and her mother on 23 September 2021 to complete a Continuing Healthcare Assessment of Mrs X’s mother. The Council again confirmed Mrs X’s mother did not need a full Continuing Healthcare Assessment for nursing care but noted that Mrs X’s mother was paying nursing care charges.
25. Mrs X contacted the Care Home on 28 October 2021 to query why it had not moved her mother to a residential bed. The Care Home told Mrs X it did not know it needed to move her mother to a residential bed. The Council also contacted the Care Home who advised the Council it did not believe it could meet Mrs X’s mother’s needs in a residential bed. The Council and Care Home could not reach an agreement about Mrs X’s mother’s needs so the Council asked a Quest Matron to complete an assessment of Mrs X’s mother.
26. The Quest Matron completed an assessment of Mrs X’s mother on 29 October 2021 and decided she did not need nursing care.
27. The Council told the Care Home about the outcome of the assessment. The Care Home completed its own assessment and said Mrs X’s mother did need nursing care. However, the Care Home left section of the assessment titled “Nursing care required” blank.
28. Following further contact between the Council and Care Home it agreed to move Mrs X’s mother on to a residential bed. It completed this on 5 November 2021.
29. Mrs X complained to the Care Home on 1 December 2021 about it keeping her mother on a nursing bed. Mrs X said she believed the Care Home had overcharged her mother because of this.
30. Mrs X chased the Care Home for a response on 16 December 2021. The Care Home said it would respond within 28 days on 23 December 2021.
31. The Care Home investigator met with Mrs X on 27 January 2022 before providing a formal response on 24 February 2022. The Care Home investigator said It is clear Mrs X’s mother currently only needs residential care and this has not changed in the last six months.
32. The Care Home said during the first eight weeks of Mrs X’s mother entering the Care Home she needed additional care. The Care Home said the first residential bed available after this date was 30 September 2019. The Care Home said it was willing to accept this date as the date it should have moved Mrs X’s mother to a residential bed.
33. Mrs X responded to the Care Home on 23 March 2022 to say she believes her mother should have been in residential care from day one. However, Mrs X said her mother had more difficulties during the first eight weeks because of the transition from hospital. Mrs X asked the Care Home to use 13 June 2019 as the date it should have moved her mother to residential as this was eight weeks after she entered the home and fell in line with the Care Home’s information about the first eight weeks.
34. The Care Home responded to advise the first bed available was 30 September 2019 so could not have moved Mrs X’s mother sooner. The Care Home maintained its position to rebate the difference in fees from 30 September 2019.
35. Mrs X entered into discussions with both the Care Home and Council for evidence of when a residential bed became available. The Council said it had records of three residential beds becoming available from 18 April 2018 to 30 September 2019. This was on 17 May 2019, 19 August 2019 and 29 September 2019. The Care Home disputed the information from the Council causing an impasse between the Care Home and Mrs X.

Analysis

Transfer from nursing to residential

36. When Mrs X’s mother entered the Care Home, the Joint Health and Social Care Panel had assessed her as only needing a residential bed. Despite this, Mrs X agreed for her mother to enter the Care Home on a nursing bed because it did not have any nursing beds available. Mrs X agreed to a contract to pay the extra costs for the nursing bed in April 2019. I find no fault with the Care Home putting Mrs X in a nursing bed on 18 April 2019.
37. Mrs X says she had an agreement with the Care Home for her mother to only remain on a nursing bed until a residential bed became available. This is a position confirmed by the Care Home within its email dated 25 September 2019.
38. Given the agreement between Mrs X and the Care Home, I would expect to see the Care Home move Mrs X’s mother to a residential bed as soon as one became available. This would be regardless of any further contact between Mrs X and the Care Home to prompt this. The Care Home failed to move Mrs X’s mother to a residential bed until 5 November 2021; this was fault.
39. The Care Home has said it can rebate any difference in charges between the nursing bed and residential bed fees from 30 September 2019 to 5 November 2021. Mrs X says this should be earlier.
40. The Care Home said it believes Mrs X’s mother should have been on a nursing bed for the first eight weeks. This statement is in contradiction to the assessments of Mrs X’s mother at a similar time. However, Mrs X confirmed to the Care Home on 23 March 2022 that her mother had increased difficulties in the first eight weeks because of her transition from hospital. It is evident there is a meeting of minds between the Care Home and Mrs X that Mrs X’s mother’s needs for the first eight weeks would have been heightened compared to her residential assessment. As such, I do not find fault with the Care Home for deciding the best place for Mrs X’s mother from 18 April 2019 until 13 June 2019 was on a nursing bed.
41. The Care Home said the first bed available on a residential unit after this date was 30 September 2019. Mrs X has disputed this statement because of the information provided by the Council.
42. The Care Home provided the Local Government and Social Care Ombudsman with its records of admissions and terminations across all three of its different floors for residential, nursing and dementia beds.
43. The Council says all three of the beds it identified as becoming available related to residential care beds. However, the Council also said some residents of these beds had changing needs during their time at the Care Home.
44. The resident of the first bed moved to the nursing unit on 17 May 2019 according to the information from the Council. This would have released a bed in the residential unit. The Council’s records say this residential placement only ended on 28 June 2019 despite the move to the nursing bed on 17 May 2019. However, the Care Home’s records show a resident entered the residential unit on 22 May 2019. This means, the bed vacated on 17 May 2019 had already been filled on 22 May 2019 and was, therefore, not available on 28 June 2019 as shown in the Council’s records. As detailed in paragraph 40, Mrs X’s mother needed a nursing bed before 13 June 2019. So Mrs X’s mother could not have taken the bed vacated on 17 May 2019 as this was filled by 22 May 2019.
45. The Council’s records show the second bed in the residential unit ended on 18 August 2019. The Council said the resident moved to a nursing bed on 19 August 2019 so remained in the Care Home but no longer occupied a residential bed. The Care Home’s records do not show any admissions or terminations of residential, nursing or dementia beds around within a week of 18 August 2019.
46. The evidence provided by the Council and the Care Home is contradictory. I cannot decide, even on balance of probabilities, if a bed became available in the Care Home’s residential unit on, or around, 19 August 2019 because of this contradictory evidence from the two organisations.
47. The Council and Care Home have a responsibility to keep accurate records. The contradictory records between each organisation is demonstrative of poor record keeping between the two organisations; this was fault. This poor record keeping has meant I cannot decide if the Care Home should have moved Mrs X’s mother to the residential unit sooner than 30 September 2019. Since the Care Home is partly responsible for this poor record keeping, it should provide a rebate of half the additional charges from 19 August 2019 to 30 September 2019.
48. The Council’s records show the third residential bed became available on 29 September 2019. The Care Home’s records do not show a residential bed becoming available on 29 September 2019 but do show a resident taking a residential bed on 30 September 2019. Logically, these two events marry up and this is the bed the Care Home is saying Mrs X’s mother would have taken. This is also the date the Care Home has offered to provide a rebate of the additional nursing care fees to Mrs X’s mother from. I consider this date is suitable to provide the rebate of the full additional nursing care fees.

Complaint handling

49. While Mrs X was in contact with the Care Home before 1 December 2021, Mrs X’s first written complaint was on 1 December 2021. This is Mrs X’s first formal complaint to the Care Home.
50. The Care Home’s complaints policy says it will acknowledge a complaint within two to three working days. The Council failed to acknowledge Mrs X’s complaint until 23 December 2021; this is outside the Care Home’s complaint process timescales and was fault.
51. The Care Home’s complaints policy says it will provide a Stage 1 complaint response within 28 working days. The Council should have provided a Stage 1 complaint response by 29 December 2021. The Council failed to provide a Stage 1 complaint response until 24 February 2022; this is outside the Care Home’s complaint process timescales and was fault.
52. When the Care Home provided the Stage 2 complaint response it also failed to refer Mrs X to the Council to proceed with a Stage 2 complaint response. While Mrs X approached the Council again following the Stage 1 complaint response the Care Home still failed to signpost in line with its policy; this was fault.
53. Following the Stage 1 complaint response, Mrs X engaged with ongoing discussions with both the Care Home and the Council. While these discussions were extensive, there is no direct fault in how the Care Home managed these contacts.

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Agreed action

54. Within one month of the Ombudsman’s final decision the Care Provider should:
• Provide a rebate of half the difference in charges between what Mrs X’s mother paid on a nursing bed and what she would have paid on a residential bed from 19 August 2019 to 29 September 2019. The Care Provider should initially apply the calculated credit to any outstanding balance owed for Mrs X’s mother’s care charges to the Care Home with this rebate before providing a refund of any resultant credit.
• Provide a rebate of the difference in charges between what Mrs X’s mother paid on a nursing bed and what she would have paid on a residential bed from 30 September 2019 to 5 November 2021. The Care Provider should initially apply the calculated credit to any outstanding balance owed for Mrs X’s mother’s care charges to the Care Home with this rebate before providing a refund of any resultant credit.
• Provide Mrs X with an apology and a payment of £100 to reflect the poor handling of her complaint and the inconvenience and frustration this caused.
55. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

56. There was fault by the Care Home and as the Care Home has agreed to my recommendations, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman