Summary: Mrs Y complained the Care Provider unfairly charged additional fees when her mother moved to a smaller room in her care home. We found fault with the Care Provider’s administrative practices as it could not provide evidence to justify the increased costs and did not give prior notice to Mrs Y about them. There was further fault with poor complaint handling. The Care Provider has agreed to our recommendations to remedy the injustice caused.

The complaint

1. The complainant, whom I refer to as Mrs Y, complained the Care Provider added an extra charge in fees when her mother, Mrs X, moved to a smaller room in the residential care home she lived in. She said there was no adequate explanation given for this or any prior notice. Mrs Y said this was unfairly done and she felt forced to move Mrs X to another care home. This caused stress, inconvenience, and frustration.

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What I have and have not investigated

2. I have not investigated Mrs Y’s concerns relating to an outstanding insurance claim for Mrs X’s lost items while she was in the care home. If it cannot be resolved directly with the Care Provider, Mrs Y can pursue a claim at court.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
6. 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)
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. I discussed the complaint with Mrs Y, Mrs X’s daughter, and considered her views.
9. I made enquiries with the Care Provider and considered its written responses and information it provided.
10. Mrs Y and the Care Provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Law and administrative background

11. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) issues guidance on how to meet the fundamental standards.
12. Regulation 9 (‘Person-centred care’) states that each service user should receive care personalised to them. Care providers should take into account people’s capacity and ability to consent, and that either they, or a person lawfully acting on their behalf, must be involved in the planning, management and review of their care and treatment.
13. Regulation 16 (‘Receiving and acting on complaints’) states information must be available to a complainant about how to take action if they are not satisfied with how the provider manages and/or responds to their complaint. The care provider should explain when complaints should/will be escalated to other appropriate bodies.
14. Regulation 17 (‘Good governance’) states that care providers must keep accurate, complete, and detailed records for each person using the service.

What happened

15. In October 2019, Mrs X moved into Holmewood Residential Home, managed by Lakeland Care Services (the “Care Provider”). She lacks mental capacity. Mrs Y, her daughter, holds Enduring Power of Attorney for her and manages her financial affairs.
16. At the end of May 2022, after various issues related to a room change, Mrs X moved permanently to a smaller room at the care home.
17. Mrs Y said she was told by the Care Provider there would be an extra charge of £100 per week, on top of the normal rate she had been paying for Mrs X in her previously larger room.
18. Mrs Y questioned this. In an email dated 19 July 2022, the Care Provider responded the room fees varied due to the size and location of room. Dependency assessment tools were also completed to consider the needs and support for a resident, which would affect staffing requirements to meet this. The dependency of each resident would be calculated and where needed, added to the cost of the fee. In this case, the Care Provider said there had been an increase added to reflect the support required to ensure Mrs X’s higher dependency needs were met.
19. Mrs Y disputed Mrs X had any additional support beyond normal care needs. She said she not been provided with evidence of these extra needs. She did not agree to pay the full amounts invoiced and made partial payments.
20. Mrs Y raised additional points to the Care Provider’s response asking about the timing of the increase and why she had not been informed beforehand. The Care Provider repeated the explanation that it was based on the dependency assessments.
21. The Care Provider requested for the overdue payments to be paid. It said if they continued to be unpaid, as per policy, it would give notice to Mrs X to leave.
22. In August 2022, Mrs Y complained to the Ombudsman. Later that month, Mrs Y moved Mrs X to a different care home. She said she felt she had no choice as she would not be forced to pay fees she did not believe were justified.

Care Provider’s response to my enquiries

23. The Care Provider could not provide me with the contract it held with Mrs X. Mrs Y sent me a copy. It states: “During any year, the cost of providing the care required for the resident may be increased in the event of increased provision of service required through any deterioration in the health of the resident. This would only be done following consultation with the care manager, family, and interested parties i.e. doctors, solicitors, next of kin”.
24. It could not provide a copy of any dependency tool that was completed in relation to Mrs X.
25. It provided company behaviour charts completed which recorded incidents of distressed behaviour and high levels of anxiety for Mrs X. This covered February 2022 to August 2022. There were two entries from February and six entries from May; the period before the price increase.
26. The Care Provider could not locate case logs recording additional staffing requirements to support Mrs X’s additional needs. It said information suggested the Deputy Manager’s hours were utilised to provide this additional support to Mrs X.
27. I have seen a copy of the Care Provider’s Complaints Policy. It states complaints can be taken to the Local Government and Social Care Ombudsman if they are not satisfied with the outcome.
28. The Care Provider accepted Mrs Y’s complaint could have been handled with more consideration and kindness. The Care Provider has said it is open to reaching an agreement with Mrs Y to write off the outstanding payments.

Analysis

29. Whilst the Care Provider explained why it had increased the fees, it was unable to locate the majority of supporting evidence it relied upon for this. I note the behaviour charts provided are used to track incidents. However, if it was the Care Provider’s view this justified a need for extra support or staffing, this should have been recorded in a clear assessment. It also could not provide a copy of the contract with Mrs X. The lack of clear records is poor record keeping. The extra charges were not reasonably evidenced as fair, causing avoidable uncertainty for Mrs Y. This is fault and not in line with Regulation 17 of CQC guidance.
30. The Care Provider increased fees because of Mrs X’s needs, without prior consultation involving Mrs Y (who lawfully acts on Mrs X’s behalf), the care manager or health professionals. This goes against the terms of its contract. This caused avoidable uncertainty to Mrs Y as it was not communicated to her appropriately. This is fault and not in line with Regulation 9 of CQC guidance. It should have been transparent and supportive in giving information to Mrs Y about any changes needed to Mrs X’s care, allowing for a fair discussion of any potential increased costs before being implemented.
31. The Care Provider has offered a discussion to reach a resolution with Mrs Y with outstanding payments, which I commend.
32. Mrs Y had further valid questions to the Care Provider’s reply to her complaint, but it did not address these adequately with a fully considered response. It did not give her the opportunity to escalate her complaint internally or signpost her to the Ombudsman if she remained dissatisfied. The poor complaint handling caused Mrs Y additional frustration and her time and trouble in pursuing the complaint. This is fault and not in line with Regulation 16 of CQC guidance.

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Agreed action

33. To remedy the injustice set out above, the Care Provider agreed to carry out the following actions:
34. Within one month of the final decision:
• Apologise to Mrs Y for the way it handled her complaint and pay £150 to acknowledge her time and trouble in pursuing it;
• Liaise directly with Mrs Y to come to an agreement about any unpaid invoices;
• Take note of the Ombudsman’s good practice guide “Caring about complaints” issued in March 2019. This shares lessons from complaints to help adult social care providers improve their services. The Care Provider should ensure this is sent to all staff who are involved in handling complaints; and
• Remind all staff of the importance of keeping and maintaining accurate records for residents. When dependency tools are used and it is assessed changes are needed to care; this needs to be made clear in records and evidenced before any change to fees is considered.
35. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

36. I found the Care Provider’s actions caused Mrs Y injustice and this is fault. The Care Provider has agreed with the recommendations to remedy this, and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman