Summary: Ms D complained the care provider increased the charges for her mother’s care without following the process set down in the contract. And that the increase was not justified. She said that as a result Ms X was charged too much and was threatened with eviction when they did not pay the increased charge. She also complained about how the care provider dealt with a request for continuing healthcare (CHC) funding and responded to the complaint correspondence. There was fault by the care provider which caused injustice for which it will apologise.

The complaint

1. I refer to the complainant as Ms X. She is represented in bringing the complaint by her daughter Ms D. Ms D complained the care provider increased the charges for her mother’s care without following the process set down in the contract. And that the increase was not justified. She said that as a result Ms X was charged too much and was threatened with eviction when they did not pay the increased charge. She also complained about how the care provider dealt with a request for continuing healthcare (CHC) funding and responded to the complaint correspondence.

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The Ombudsman’s role and powers

2. 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)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))

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How I considered this complaint

4. I considered the complaint and documents provided by Ms D and spoke to her. I asked the care provider to comment on the complaint and provide information. I sent a draft of this statement to Ms D and the care provider and considered their comments.
5. 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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What I found

Summary of what happened

6. Ms X moved into the home in May 2019. There was a contract which referred to how fee increases would be dealt with.
7. There was an annual increase of about 6% in April 2020.
8. At the end of August the care provider wrote to the family saying there was an increase in the fees of just over 25%. The letter said this was because Ms X’s needs had increased.

Analysis

The fee increase

9. The contract says – “Fees are reviewed annually. However, if the service user care needs increase during the year then in consultation with the service user, their representative and the relevant Local Authority we shall review the possibility of an increase the fees. Field House will give two weeks notice of any increase in fees.”
10. There was no consultation with Ms X’s family or with the local authority. I am not sure contact with the local authority would be relevant here as Ms X was responsible for her own care fees. The notification letter does invite the family to view or discuss the care plan with the home to gain a better understanding of the review and justification for the increase. But this does not constitute consultation as it was clear a decision had already been made – for consultation to be meaningful it should be done before a decision. However, over a month’s notice was given of the intended increase which did give the family some time to consider whether they would wish to move Ms X.
11. According to the fee structure from the care provider the increase took Ms X from needing residential care to needing high dependency dementia care. The care provider has provided two care plans. The first is undated but I think runs from the time Ms X moved into the home in May 2019. The second is from just before the fee increase. That does show an increased level of need because of Ms X’s dementia. I am satisfied the care provider did assess Ms X’s needs before deciding she required more support and that meant an increase in the fees charged. I recognise it was a significant increase in the fees but I cannot say there was fault in how the care provider decided on Ms X’s needs.

Continuing healthcare funding

12. When the fee was increased and the family questioned the basis for the increase there was mention that Ms X could be considered to see if she would qualify for CHC funding.
13. The care provider said that staff would ask nurses when they visited to carry out a CHC assessment but they were unable to do so because of staffing pressures due to the pandemic. There are no records of that contact or of informing the family of what had happened or that they could make a direct request for assessment. The failure to keep proper records and to inform the family is fault.

Complaint handling

14. The family queried the fee increase and then complained. After Ms X had moved out of the home Ms D escalated the complaint. The care provider responded and supplied some additional documents. Ms D remained dissatisfied and wrote again. The care provider has said that they did not receive any further email from Ms D. I cannot say there was fault by the care provider on this point.

Conclusion

15. There was fault in the areas I refer to above. However this has not altered the position significantly for Ms X or the rest of the family. I cannot say the decision to increase the fee was in itself flawed. Or that Ms X would have been awarded CHC funding.

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Agreed action

16. The care provider will apologise for the faults found. It should do so within a month of this decision.

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Final decision

17. There was fault which caused injustice.

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Investigator's decision on behalf of the Ombudsman