Summary: The complainant (Mr X) said The Bishops Care Home Limited failed to refund a deposit and overpaid fees due to his late mother’s (Mrs Y) estate. We found the failure to pay back the deposit and fees as well as inadequate complaint-handling was detrimental to Mrs Y’s estate and caused injustice to Mr X. The Bishops Care Home Limited has agreed to apologise, refund the money due with interest and make a symbolic payment to recognise Mr X’s time and trouble. It also agreed to review its refund and complaint-handling processes.

The complaint

1. Mr X says The Bishops Care Home Limited (the Care Provider) failed to refund the deposit and some of the care fees due to his mother’s (Mrs Y) estate after she had died.
2. Mr X says he spent much time contacting the Care Provider. The Care Provider’s misleading responses and lack of any action caused him distress at the difficult time after his mother’s death.

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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)

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How I considered this complaint

7. I spoke with Mr X and considered the information he provided.
8. Mr X 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

Legal and administrative framework

9. Providers must give people information in writing about the terms and conditions of their care, treatment or support, including the expected costs and the requirement to pay for their care, treatment and support. (Care Quality Commission (Registration) Regulations 2009 paragraph 19)

Residency agreement

10. Terms and conditions attached to the residency agreement for self-funded residents state:
• The deposit shall be held safely our client monies account as security against non-payment of fees or damage to property. The deposit will be repaid to you without interest within 28 days of the death of the Resident or of the Resident leaving the Home, subject to the Service Provider’s right to deduct any amounts that are then outstanding and any costs for deep cleaning, reasonable damage and replacement of items that may be needed. (clause 1.3)
• After the death of a Resident, the Service Provider shall, in its best endeavours, return any deposit or other sums due, that have been paid in respect of the Resident, to the Representative or other appropriate person within 28 days of the date up to which the weekly Fees are payable under this clause. (clause 11)

The Council’s complaint policy

11. When a complaint cannot be immediately resolved the Care Home Manager or person in charge will complete the following actions within the timescales from the time the complaint was made:
• Within 12 hours will review the complaint and record it on the system;
• Within three days will send a written response summarising the complaint;
• Within five days will discuss the matter with the person raising the complaint and start proper investigations;
• Within further 16 days will end the investigation and send the complainant a full response.
12. Where any exceptional circumstances mean the investigation cannot be finished within 21 days from its receipt, a letter explaining the reason for the delay will be sent to the complainant with the dates the investigation is expected to end.
13. Where a complaint is not resolved at stage one it may progress to stage two. At stage two the complaint would be considered at a regional level.

What happened

Refund of the deposit and overpaid fees

14. Mrs Y died in the second week of April 2023. At the time of her death she was a self-funded resident in Bishop’s Cleeve Care Home.
15. Mr X’s asked for a refund of a deposit and overpaid fees for Mrs Y’s residential care.
16. In mid-July 2023 the Care Provider’s member of staff told Mr X the person dealing with such matters was away.
17. At the beginning of August the Care Provider sent Mr X a refund authority form and Mrs Y’s account statements, specifying the deposit of £6,400 and the overpaid fees for Mrs Y’s residential care of £2,285.72.
18. Mr X queried the need to provide a Grant of Probate, sought by the Care Provider. He explained he was an executor of his late mother’s will and presented the evidence. The Care Provider confirmed it was acceptable.
19. In September Mr X contacted the Care Provider by phone and by email. At the end of the month the Care Provider told him the process for refunds had changed and he needed to contact a different team. Mr X was told to use a different email address.
20. Mr X did not receive a response to any correspondence sent to the refund team’s email address.

Complaint

21. At the end of September 2023 Mr X complained about the Care Provider’s failure to complete a refund of the overpaid fees and Mrs Y’s deposit. Mr X said it was wrong for the Care Provider to wait for him to complete a repayment form. In line with the terms and conditions of the residency agreement, he said, the refund should have happened within a certain timescale from Mrs Y’s death. Mr X was not happy the Care Provider kept giving him various reasons why it could not make a repayment.
22. In October Mr X contacted the Care Provider by email and by phone asking for a response to his complaint but did not receive any communication back. Mr X came to us at the beginning of November.
23. In mid-January 2024 we asked the Care Provider whether it had completed the complaint process for Mr X. Having received no response we contacted the Care Provider again a month later but did not receive any answer.

Analysis

Refund

24. The terms and conditions attached to Mrs Y’s residency agreement provide for a refund of a deposit and any overpaid fees within 28 days from the date of the resident’s death. Mrs Y died in the second week of April 2023, so the Care Provider should have completed the refund by mid-May. This did not happen, which caused a shortfall in her estate.
25. Mr X based his request for a refund on the account statements provided by the Care Provider. The Care Provider did not query how much it owed to Mrs Y’s estate.
26. The Care Provider’s delay in refunding Mrs Y’s deposit and overpaid fees for her residency care and lack of communication from October 2023 was detrimental to Mrs Y’s estate and caused injustice to Mr X.

Complaint

27. The Care Provider failed to comply with its complaint handling policy. It failed to respond to Mr X’s complaint which caused him injustice, as his concerns remained unaddressed.
28. The Care Provider’s failure to consider Mr X’s complaint meant he had to spend extra time and trouble, trying to get a response from the Care Provider. He was distressed as the Care Provider did not seem to query its duty to refund Mrs Y’s fees but failed to action this and respond to Mr X’s correspondence.

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Agreed action

29. To remedy the injustice caused by the Care Provider’s actions, we recommend the Care Provider complete within four weeks of the final decision the following:
• apologise to Mr X for the injustice caused by its actions. When making an apology the Care Provider will follow our guidance;
• Pay Mr X as an executor of Mrs Y’s will £8,740.25, which consists of £8,685.72 of the main sum owed by the Care Provider and £53.81 of interest from May 2023.
• pay Mr X £100 to recognise extra time and trouble Mr X spent when contacting the Care Provider due to its failure to communicate with Mr X and respond to his complaint.

The Care Provider will send the evidence that this has happened.

30. We also recommend the Care Provider within three months of the final decision complete the following:
1. review its process for the deposit and overpaid fees refunds after their residents’ death to ensure they happen within 28 days;
2. review its complaint handling.

The Care Provider will send the evidence that this has happened.

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Final decision

31. I uphold this complaint. I found the Care Provider’s actions were detrimental to Mrs Y’s estate and caused injustice to Mr X. The Care Provider has accepted my recommendations, so this investigation is at an end.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman