Summary: We find the Care Provider at fault for invoicing Mr B for his mother’s care without first making checks about her circumstances. However, the Care Provider later recognised its error and apologised to Mr B. It then went on to say it would no longer ask him to pay the invoice. We did not consider we could achieve a better outcome for Mr B. This was because we could only have conducted a limited investigation, given the passage of time since Mr B’s mother was in the Care Provider’s care.

The complaint

1. Mr B complained about the care his late mother, Mrs C, received when she lived at the Meadway Court care home operated by Borough Care Ltd between 2021 and 2022. There were two parts to Mr B’s complaint:

• first, that while Mrs C lived at the care home, there were several incidents suggesting poor quality of care;
• second, that in February 2024, the Care Provider sent Mr B an invoice for care charges, just a few days after Mrs C died.

2. Mr B said both the incidents of poor care and the invoice caused him avoidable distress.

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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 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)
4. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if it is unlikely we could add to any previous investigation by the care provider or that further investigation will lead to a different outcome. (Local Government Act 1974, sections 34B(8) and (9))
5. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)

6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

7. Before issuing this decision statement I considered Mr B’s complaint to the Ombudsman and supporting information provided. This included correspondence he exchanged with the Care Provider about the matters covered by the complaint.
8. I then made enquiries of the Care Provider and the local social services authority and obtained further background information.
9. I then gave Mr B and the Care Provider a draft version of this decision statement and invited them to comment or provide any further evidence considered relevant to the complaint. I considered any responses they provided before finalising the decision statement.

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What I found

Key facts and investigation

10. During 2021 Mrs C entered the care home, her care funded by an NHS commissioning care group (CCG).
11. In May 2022 the CCG contacted the Care Provider to say that since October 2021, it had funded Mrs C’s care in error. It stopped the funding and recovered the money it had paid for Mrs C’s care after October 2021.
12. Mrs C did not have capacity to manage her financial affairs. Nobody had legal powers to do so on her behalf (for example, with a Power of Attorney or a court appointed Deputy). The Care Provider said it decided to write to Mr B enclosing an invoice for the outstanding care charges, in excess of £25,000. It says it wrote to him several times in 2022 but he did not respond to contact.
13. There were several incidents involving Mrs C while she was at the care home. These led to the local social services authority carrying out investigations under its safeguarding powers (Councils carry out safeguarding investigations if concerned a person with care and support needs, unable to protect themselves, may be at risk of abuse or neglect). In his complaint Mr B said that Mrs C suffered several assaults, including one where the police investigated. Mr B provided details of the injuries Mrs C suffered.
14. In addition, in his complaint Mr B expressed concern he often saw Mrs C in the care home wearing clothes that were not her own.
15. In August 2022 Mrs C was admitted to hospital. She did not later return to the care home, spending time in hospital and another care home before she died in February 2024.
16. Within a few days of Mrs C’s death, Mr B received another invoice from the Care Provider for unpaid care charges. It said it sent this as part of an exercise to chase unpaid, historic debt. Following receipt of the invoice Mr B complained.
17. The care home replied. It apologised that Mr B sometimes found Mrs C was not in her own clothes and could not account for this as there was no record the care home looked into this at the time. It said that following a safeguarding referral to the local authority it had dismissed a member of staff for injuries Mrs C received, which it said resulted from poor support with her personal care. It apologised for this. It also said Mrs C had received injuries because of conflict with other residents. And that she had other injuries where care home staff believed she fell, although there were no witnesses.
18. The care home said that it accepted the invoice sent to Mr B caused him distress. But that it had to seek “payment in line with the contractual agreement that was in place at the time”.
19. However, in response to a contact from this office, the Care Provider said there was no contract in place for Mrs C’s care once NHS funding stopped. That while it had sent a contract to Mr B, he never returned it. And that as a result it would now seek repayment of Mrs C’s care charges from either her local authority or the NHS.
20. The Care Provider wrote to Mr B saying he “would receive no further requests to pay” the invoice it sent him for Mrs C’s care charges. It apologised for not coming to this view sooner and for any distress caused.

My findings

21. I decided to discontinue my investigation into this complaint, because I did not consider I could add to any further investigation undertaken by the Care Provider, nor the outcome it provided to Mr B. Below, I set out my reasons for coming to this view.
22. First, I considered any further investigation into this complaint limited by the passage of time. I explained above the law which usually prevents us investigating late complaints. This applies to the complainant, or person affected by the alleged fault. In this case, that was Mrs C. I did not consider Mrs C had capacity to complain in her own right. So, I could not say the law on late complaints directly prevented me investigating her quality of care.
23. But we will apply the same principles when considering complaints made by representatives of those without capacity. Mr B first complained to us in April 2024, which was twenty months after Mrs C left the care home. He had only complained to the Care Provider two months previously, in February 2024.
24. I am satisfied Mr B had some knowledge of the incidents referred to in his complaint of February 2024 at the time they occurred. I accepted he did not have the full picture. I also noted the incidents he described (which the Care Provider confirmed) were serious. So, I understood why Mr B had the motive to learn more about what happened and what investigations into those incidents took place. But I considered this was not a good reason for me to use my discretion to investigate the complaint. This was because of the how long Mr B had to pursue a complaint sooner and gain that understanding.
25. Mr B asked me also to consider the stress he experienced after August 2022, with Mrs C spending time in hospital and another care home setting. I accepted this would be stressful for him. But I lacked evidence to say this was so great that it prevented Mr B putting his concerns to the Care Provider sooner. So this too was not a good reason for me to use my discretion to investigate this part of Mr B’s complaint.
26. In which case, the only part of Mr B’s complaint I could investigate further was that about the invoice sent to him in February 2024. The Care Provider should not have sent him this. On the CCG withdrawing funding for Mrs C’s care in 2022, the Care Provider should have enquired to find out who had authority to deal with her finances. If no-one had authority, then the responsibility to fund Mrs C’s care would fall to her local social services authority where she was ordinarily resident before entering care. This could have funded her care until her finances became known and someone had the legal authority to deal with those (something in the last resort the local authority could do itself). Any funds it spent while finding out these matters would also be potentially recoverable from Mrs C, depending on her circumstances.
27. It was therefore fault for the Care Provider to approach Mr B for the funds reclaimed by the CCG. And further fault that it let matters drift for over twelve months before contacting him again in 2024 about this matter. The Care Provider’s actions here caused avoidable distress to Mr B.
28. However, during my investigation the Care Provider recognised it was wrong to seek recovery of the funds from Mr B. Further, it apologised to him for sending the invoice and the distress this caused. It also offered its assurance it would no longer pursue him for the outstanding amount.
29. I considered these actions remedied any injustice caused to Mr B from the Care Provider’s faults. I could not achieve any better outcome for Mr B given the limitations on what I could investigate, set out above.
30. One final point I noted was that in its reply to Mr B, the Care Provider had failed to tell him how he could escalate his complaint. It is one of the fundamental standards of care (regulated by the CQC) that care providers have effective complaint procedures. This includes ensuring that complainants know where to go next if unhappy with a reply to a complaint. So, they should know if there is another stage in the procedure and how to access this. The Care Provider should also tell them they can complain to this office. The Care Provider’s failure to do that here was also a fault. Although no injustice resulted, because Mr B came to us to ask us to investigate his complaint.
31. The Care Provider has accepted the findings above. It says it has noted my concern on its complaint handling and has now changed its procedure to ensure it signposts complainants. It has also changed its procedure for chasing historic debts, to ensure there is no drift and delay as happened here. I am grateful for its assurances on these points.

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Final decision

32. For the reasons set out above I discontinued this investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman