Summary: Ms W complained her mother’s care home did not deduct NHS funding from the fees she paid. Based on current evidence, we have not found fault with the charges made. However, we consider the care home to be at fault as it has not shown that it provided Ms W with sufficient costs information. We have recommended the care home apologise to Ms W and make a payment in recognition of the injustice caused.

The complaint

1. Ms W complains Eastwick Barn Limited (“the care home”) did not deduct NHS funding for her mother’s nursing care from the fees they charged her. She says she has had to raise her concerns continuously. Ms W believed NHS funding for her mother’s nursing care would mean a reduction in the fees she was paying but did not.

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The Ombudsman’s role and powers

2. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

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. If they have caused a significant injustice or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(3 and 4) as amended)
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
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)
6. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
7. 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

8. I considered evidence provided by Ms W and the care home as well as relevant law, policy and guidance.
9. Ms W and the care home have had an opportunity to comment on my draft decision. I considered any comments received before making this final decision.

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What I found

What happened

10. Ms W’s mother moved into the care home in September 2022. Ms W was advised verbally that the fee was £1400 per week, which she paid.
11. Ms W applied to the NHS for funded nursing care, and this was agreed in January 2023.
12. Ms W spoke to the care home manager as she believed this funding would be deducted from the weekly fee she was paying, so her costs would reduce.
13. The care home sent an internal email to its head office at the end of January 2024, which says Ms W had looked into moving her mother to another home. The note says Ms W had found another home which would charge £1350 per week, with the funded nursing care on top.
14. The email says Ms W would prefer not to have to move her mother and asked if there was anything that could be done to help. I have not seen that any response was provided to Ms W.
15. Ms W did not move her mother as she says her health deteriorated and a move would have been difficult in the circumstances.
16. Ms W’s mother remained at the care home until she passed away in November 2023. Ms W continued to pay the weekly fees of £1400 until this time.

Analysis and findings

17. At the time Ms W’s mother moved into the care home, Ms W had power of attorney for her.
18. In its response to Ms W’s complaint, the care home said it had shared a copy of its contract with her mother when she first moved in.
19. The care home has provided a copy of an unsigned contract which says care fees would be £1400 weekly plus any funding provided by the NHS. However, there is no evidence this contract was shared with Ms W at the outset.
20. As Ms W had power of attorney for her mother and was being billed for the care home fees, the care home should be able to evidence that it provided her with adequate costs information at the outset. The care home’s failure to do so is fault.
21. It is evident that Ms W must have been told the weekly fee she would have to pay, as she paid this from the outset.
22. I accept Ms W applied for funded nursing care in the belief she would receive a deduction, given she enquired about this as soon as it was agreed.
23. On the balance of probabilities, it is fair to say Ms W did not understand the NHS funding would not reduce the fee she had to pay, because the care home did not appropriately explain this to her before she applied.
24. Where we find an organisation at fault, we consider whether it is appropriate to recommend a remedy. Any remedy should, where possible, reflect the injustice caused.
25. If the care home had provided Ms W with sufficient costs information from the outset, her weekly fee would not have been any less than she has paid. The fault is not the cause of the £1400 fee here.
26. However, she could have chosen to take the time and trouble to apply for NHS funding knowing it would not benefit her financially.
27. Ms W would also have been saved the disappointment of finding out that the funding did not mean her payments would decrease, and the distress and frustration of arguing the point with the care home in her mothers last months.
28. On this basis, I recommended the home apologise to Ms W and make a payment in recognition of the injustice caused here.

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Action

29. Within one month of the decision, the care provider will apologise to Ms W and make a payment of £200 in recognition of the injustice caused.
30. The Care Provider should provide us with evidence it has complied with the above actions.
31. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.

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Decision

32. I find the care home is at fault causing injustice. The care home has agreed to provide an apology and a payment in recognition of this.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman