Summary: there was fault by the Care Provider because it did not give Mr X the required one month’s notice of an increase in his mother’s care home fees. It also failed to follow the steps set out in its complaints procedure when it considered his complaint. The Care Provider has agreed to provide a suitable remedy for the injustice this caused.

The complaint

1. Mr X made this complaint on behalf of his mother, Mrs Y, who is a resident in a care home operated by Welford Court Limited.
2. Mrs Y does not have capacity to make the complaint herself. Mrs Y appointed Mr X to be one of her joint attorneys for property and finances. Mr X was in the process of registering the power of attorney when he made this complaint to us. We consider he is a suitable person to make the complaint for Mrs Y.
3. Mr X complained that Welford Court Limited:
1. misled him into signing the care contract in January 2018 because the former manager, Mrs A, told him there would be no significant increases in the fees;
2. did not give him the required notice of a £100 weekly increase in care home fees from February 2023 because it sent the email to an account he no longer used;
3. did not give him details of its complaints procedure when he requested it and failed to investigate and respond properly to his complaint;
4. imposed an excessive increase in fees.

Back to top

The Ombudsman’s role and powers

4. 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)
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)

Back to top

What I have and have not investigated

6. I investigated parts b) and c) of Mr X’s complaint: the alleged failure to give proper notice of the fee increase and the complaint-handling.
7. I decided not to investigate part a) of the complaint. Mr X signed the admission agreement when his mother became a resident in late January 2018. His conversation with the then manager about potential future fee increases took place more than five years ago. That manager has since left and there are no records of any written undertaking about future fee increases. For these reasons, we cannot establish now what the former manager said to Mr X in 2018 and whether she misled him.
8. I did not investigate part d) of the complaint. Mr X complained that the weekly fees increased in February 2023 from £700 to £800. He said this was an arbitrary and excessive increase of 14.3% which outstripped inflation.
9. We do not usually investigate how a care home calculates its operating costs and sets fees for residents. This is a commercial decision which takes account of several factors including staff costs, increased energy bills, planned refurbishments etc. We cannot decide whether the fee a care home charges is fair or reasonable.

Back to top

How I considered this complaint

10. I have spoken to Mr X and the registered manager of Welford Court Limited.
11. I considered the terms and conditions in the agreement Mr X signed when his mother was admitted to the care home. I also read the care home’s complaints procedure.
12. I gave Mr X and the Care Provider an opportunity to comment on my draft decision. I considered their comments before making a final decision.
13. Under our information sharing agreement, we will share this final decision with the Care Quality Commission.

Back to top

What I found

Notification of the increase in fees

14. When we consider complaints about increased care fees, we must be satisfied the service user (or their representative) received clear and relevant information; both in the original contract terms and when the provider communicated the decision to increase the fees. This is because the Care Quality Commission (Registration) Regulations 2009, regulation 19, states that providers must “…give timely and accurate information about the cost of their care and treatment to people who use services”. To do so, “... providers must make written information available about any fees, contracts and terms and conditions, where people are paying either in full or in part for the cost of their care, treatment and support”.
15. Mrs Y self-funds her residential care. Mr X manages her finances and pays the care home fees for her.
16. Mr X signed an admission agreement on 29 January 2018 when Mrs Y became a resident. At the time, the weekly fees were £650. Clause 7 of the agreement said:

“Should there be an increase in fees, the home reserves the right to give one month’s prior notice.”

17. The agreement did not say how often the fees would be reviewed or increased or how the notification would be sent. By signing the agreement, Mr X said he understood and accepted the terms and conditions.
18. The weekly fees increased to £700 in December 2020. There was no further increase until 2023.
19. On 15 January 2023 the registered manager and the Director of the care home sent a letter by email to inform Mr X that the fees would increase from £700 to £800 from 13 February 2023.
20. The letter gave several reasons for the increase, including:
• The cost of making improvements to the building, redecoration and buying new furniture and fittings;
• Extra operating costs due to high inflation and a steep increase in energy bills;
• Increased wage costs to retain and reward staff;
• Additional costs incurred during the COVID-19 pandemic.
21. Mr X says he did not receive this letter because it was sent to an email account he no longer used. He had notified everyone in his contact list when he changed his email address but he did not remember giving the care home his email address when Mrs Y was admitted. He therefore did not separately notify them. Mr X said the care home notified him of the previous increase in 2020 by handing a letter to him when he was visiting Mrs Y.
22. The care home said it sent the letter to the email address it had for Mr X in its contact records. The email was not returned as undelivered so it assumed he had received it. A hard copy of the letter was also left in the the office at the care home. It is not clear from the manager’s response to my enquiries whether a member of staff was expected to hand this letter to Mr X when he visited Mrs Y. Mr X says he was not given a hard copy of the letter during one of his regular visits.
23. On 16 February 2023 the registered manager sent the letter to Mr X’s new email address.

My analysis

24. The admission agreement says the Care Provider must give one month’s notice of any fee increase. It does not say how it will send the notification. It was not fault to send the letter to the email address it had for Mr X in its records. Sending the notice in this way ensured it had a record of when it notified Mr X of the fee increase.
25. Mr X said he did not realise the Care Provider had his old email address in its records so it did not occur to him to notify them when he changed it. However, it was not fault for the Care Provider to rely on and use the email address it had in its records. Presumably Mr X had given the Care Provider his email address at some point after Mrs Y was admitted to the care home.
26. Mr X said the Care Provider had not notified the previous fee increase in 2020 by email. But I cannot say it was fault to use a different method of communication to notify him of the 2023 increase.
27. I have also considered whether Mr X was given the appropriate notice required in the admission agreement. In this case, the letter was sent by email on 15 January 2023 to give notice of a fee increase from 13 February. That is four weeks’ notice. However, the admission agreement requires one month’s notice of any fee increase. It was fault for the Care Provider not to give the notice required by the admission agreement.
28. In response to my enquiries, the registered manager said he was prepared to accept the increase should take effect from 16 March. This is one month after Mr X received the reissued letter on 16 February.
29. If the care home intends to give four weeks’ notice of fee increases in future, it should consider whether to vary the terms in the admission agreement.  

Complaint-handling

30. The registered manager says the complaints policy and procedure is always available in the office and it is displayed by the front door of the care home. He says he suggested to Mr X that he could complain to the Ombudsman. Mr X disputes this and said he found out about our service by searching online.
31. The admission agreement Mr X signed in 2018 says a copy of the complaints procedure was attached to the agreement. Mr X says it was not attached to the agreement he received then.
32. I have read the Care Provider’s complaints procedure. It has six stages and gives a timescale for completing the investigation. I have not reproduced the complaints procedure in full in this statement. The main parts relevant to this investigation are:
• The first step is for a staff member to try to resolve the complaint immediately;
• If that is not possible, the staff member will explain the complaints process and report the complaint to the most senior member of staff on duty;
• A formal acknowledgement of the complaint must be sent by letter or email within three working days to the person who made the complaint – this will include the name of the staff member responsible for the investigation and an invitation to meet to discuss the complaint;
• The acknowledgement should also explain the investigation process and say it will be completed within 28 days (unless the complainant is informed more time is required to complete the investigation);
• Following the investigation, a response letter is sent to the complainant – this will include a clear and concise explanation of the findings and say whether the complaint is upheld, partially upheld or not upheld;
• The letter will also explain the outcome, including any remedial action taken or lessons learned and an apology if the complaint is upheld. It will also inform the complainant of the right to make a complaint to the Ombudsman if they are not satisfied with the outcome.
33. On 16 February 2023 Mr X sent an email to the registered manager to say he was unhappy with the increase and considered it excessive. He asked if he should complain to the Care Quality Commission or whether there was some other course of action.
34. On 17 February the registered manager sent Mr X an email referring to their telephone conversation about the issue. He said he hoped this had resolved Mr X’s concerns.
35. On 22 February Mr X complained to us. We decided it was too early to investigate because his complaint had not completed the care home’s complaints procedure first. We informed Mr X on 27 February.
36. Meanwhile Mr X had sent another email to the registered manager on 24 February. He expressed concern that the home had notified him of the increase by email when previous correspondence was handed to him when he was visiting Mrs Y. He said the increase was more than 14% and exceeded the rate of inflation. He said the registered manager had dismissed his complaint when they spoke on the telephone and simply told him he had to cover the home’s increased expenses. He said the registered manager had not responded to his request for information about how to make a complaint.
37. On 4 March Mr X chased the registered manager for a reply to his 24 February email. He said he had not received a reply and was keen to resolve matters. He asked for a written response so he could complain to us and get an impartial decision if they could not reach agreement.
38. On 5 March the registered manager replied by email. He said he did not understand the grounds for Mr X’s complaint. He said this was the first fee increase in over two years. Staff wages were due to increase by 10% from April 2023. The care home’s insurance had risen, and the cost of gas and electricity had increased by 300% over the past few years. He said Mrs Y’s needs had also increased and more staff time was needed to care for her. He expressed indignation at Mr X’s claim that the increase was excessive and greedy. He said Mr X was paying £50 per week less for Mrs Y’s care than other residents in similar circumstances. He said he was willing to negotiate.
39. On 6 March Mr X suggested he increased the standing order by £50 per week. The registered manager sent a brief response to say that was unacceptable. Mr X resubmitted his complaint to us on the same day.
40. The registered manager says Mr X has not paid the increase due since 13 February 2023. He says there are substantial arrears on the account and these continue to accrue.

My analysis

41. The care provider did not follow the steps set out in its complaints procedure. The registered manager had a telephone conversation with Mr X but I have seen no evidence that he offered to meet him. Mr X did not get an acknowledgement explaining how his complaint would be investigated. There was an exchange of emails between Mr X and the registered manager but no formal final response letter. This means Mr X did not get the required information about the findings and outcome. The final email did not tell Mr X about his right to complain to us. The registered manager did respond within the 28 day timescale.
42. The tone of the registered manager’s emails suggest he was upset by Mr X’s claim that the increase was arbitrary, greedy and excessive. Nevertheless, he should have responded to the complaint formally and followed the steps set out in the care home’s complaints procedure.
43. For these reasons, I find fault in the way the Care Provider considered and responded to Mr X’s complaint. Mr X first contacted us in February 2023 so he already knew about our service. For this reason, the Care Provider’s failure to refer to the Ombudsman in the final email did not delay him bringing the complaint to us.

Back to top

Agreed action

44. Within one month of my final decision, the Care Provider will:
• Send a written apology to Mr X for failing to investigate and respond to his complaint in line with the steps set out in its complaints procedure;
• Revise the outstanding balance on Mrs Y’s account to reflect that the fee increase will be applied from 16 March 2023 and send an amended bill to Mr X.

For future fee increases, the Care Provider should give one month’s notice in writing or, alternatively, consider whether it wishes to vary the terms in the admissions agreement to enable it to give four weeks’ notice instead.

45. The Care Provider should provide us with evidence it has complied with the above actions.

Back to top

Final decision

46. I have completed the investigation and found the Care Provider’s actions caused injustice to Mr X. The Care Provider has accepted my findings and agreed to provide a suitable remedy.

Back to top

Investigator's decision on behalf of the Ombudsman