Summary: Miss Y complained the Care Provider wrongly charged her for unnecessary care for Mr X. She says this caused unnecessary distress and financial strain. We find no fault with the Care Provider’s decision making.

The complaint

1. Mrs Y complains the Care Provider wrongly charged her for unnecessary care for Mr X.
2. Mrs Y says this caused avoidable and unnecessary distress to her and financial strain.

Back to top

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 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)
5. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
6. 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)

Back to top

What I have and have not investigated

7. Mrs Y complains about matters which started in late December 2023. She complained to the Ombudsman in February 2025. As I have said above, we cannot investigate late complaints unless there is good reason to do so. In this case, I consider exercising my discretion to investigate for a further six weeks is proportionate to the investigation. Therefore, I have considered matters from late December 2023.

Back to top

How I considered this complaint

8. I considered evidence provided by Mrs X and the Care Provider as well as relevant law, policy and guidance.
9. Mrs X and the Care Provider have had an opportunity to comment on a draft of this decision. I considered all comments received before making a final decision.

Back to top

What I found

What should have happened

10. A person with sufficient means and capacity may arrange and pay for their own residential care placement, without involving the council.
11. The Care Quality Commission (CQC)(registration) Regulations 2009: Regulation 19 requires care providers to provide accurate and timely information about the cost of their services to people who use them.
12. The contract provided to Mr X by the care home stated the following:
• If the resident’s position as supported by the Council or not supported changes, it will discuss with the resident the effect of any changes, and whether this makes any difference to any sums due to be paid by the resident or resident’s representative.
• It reserves the right to increase fees with 28 days’ notice in writing.
13. The Mental Capacity Act 2005 introduced the “Lasting Power of Attorney (LPA)”. An LPA is a legal document, which allows a person (‘the donor’) to choose one or more persons to make decisions for them, when they become unable to do so themselves. The 'attorney' or ‘donee’ is the person chosen to make a decision on the donor’s behalf. Any decision has to be in the donor’s best interests.
14. The Property and Finance LPA gives the attorney(s) the power to make decisions about the person's financial and property matters, such as selling a house or managing a bank account. Unless the donor says otherwise, the attorney may make all decisions about the donor’s property and finance even when the donor still has capacity to make those decisions.
15. NHS Continuing Healthcare (NHS CHC), is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness.

What happened

16. Prior to December 2023, the Council arranged Mr X’s discharge from hospital to a Care Worldwide Care Home, “the Care Provider”. The Council told the Care Provider Mr X required one-to-one care support.
17. Mrs Y held Property and Finance LPA for Mr X. She regularly visited Mr X throughout his residency at the care home.
18. In late December, the Council completed a financial assessment and decided Mr X should fund his care. It terminated its contract with the Care Provider.
19. In February 2024, the Care Provider sent Mrs Y two invoices. The first invoice was for Mr X’s monthly care home fees. The second invoice was for Mr X’s monthly one-to-one care fees. Mrs Y paid the care home fee. She did not pay the one-to-one care fees. The Care Provider sent two separate invoices to Mrs Y each month thereafter.
20. Mrs Y’s solicitor contacted the Care Provider and requested copies of Mr X’s care plans to support their application for NHS CHC funding. Shortly afterwards, Mrs Y and her solicitor attended a meeting with the Care Provider to discuss her plans to apply for NHS CHC funding for Mr X’s one-to-one care fees.
21. In late February, the Care Provider sent Mrs Y a notification letter that the monthly care home fees would increase in mid-March.
22. In mid-March, the Care Provider told Mrs Y’s solicitor the one-to-one care fees had still not been paid and requested payment.
23. In June, the Care Provider told Mrs Y the one-to-one fees had not been paid and requested payment.
24. In July, the Care Provider told Mrs Y that it was ending Mr X’s placement due to the outstanding one-to-one care fees.
25. In late autumn, Mr X died.
26. In December, Mrs Y made a formal complaint to the Care Provider.

Analysis

27. Mr X’s contract says the Care Provider will inform a resident if their fees change because of the Council stops or starts supporting them financially. Mrs Y says the Care Provider did not inform her that the Council had stopped paying for Mr X’s monthly care home fees and one to one care fees in December 2023. It seems there was an omission by the Care Provider to provide Mrs Y with this information. In any case, Mrs Y became aware of the fees when she received the first invoices from the Care Provider shortly after the Council decided Mr X should self-fund his care. I consider any injustice caused to Mrs Y by the Care Provider’s omission to immediately inform her Mr X was now liable for his fees to be limited. I do not consider this omission to be significant enough to make a finding of fault.
28. The Care Provider made its decision to implement one-to-one care support for Mr X based on his care plan and medical assessments provided by the Council upon his admission. I am satisfied Mrs Y was fully aware of the one-to-one care support Mr X was receiving throughout his residency. I am also satisfied Mrs Y had multiple opportunities to raise any concerns she had about this additional care being unnecessary and did not do so. I find no fault with the Care Provider’s decision-making in its decision to continue to provide the one-to-one support.
29. Mrs Y had finance and property LPA for Mr X and was therefore responsible for managing Mr X’s finances. She received the invoices for both the care home fees and one-to-one support fees. At the time, she considered applying for NHS CHC funding for the one-to-one care support fees and did not do so. I find no fault with the Care Provider’s decision-making in its decision to pursue Mrs Y for the outstanding fees.

Back to top

Decision

30. I find no fault.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman