Summary: The care provider followed the agreed protocol in terms of returning Ms X’s cash. It refunded a significant portion of her fees. However, although it offered her some accommodation when her room was not available, that was not the same standard as she had contracted for and it should recognise that by refunding the remainder of her fee.

The complaint

1. Ms X (as I shall call the complainant) says the care provider (Treatment Direct Ltd) misled her to believe the infestation of cimex lectularius (bedbugs) had been eradicated but she found several during her stay; she complains the care provider failed to make other suitable provision for her and refused to return all her money when she left, or to refund her the whole fee for her stay.

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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 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)
3. If an adult social care provider’s actions have caused 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 information provided by Ms X and by the care provider. Both parties had the opportunity to comment on an earlier draft of this statement, and I considered their comments before I reached a final decision.
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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What I found

Relevant law and guidance

6. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
7. Regulation 9 says that care and treatment must be appropriate, meet people’s needs and reflect their preferences.
8. Regulation 10 says that people must be treated with dignity and respect, ensuring their privacy including when they are asleep.
9. Regulation 15 says that premises must be clean and properly maintained.
10. Regulation 19 says that service users who pay for their own care must be given clear information about the expected costs.
11. The Treatment Direct centre caters for people who are affected by addictions to potentially dangerous substances. It has in place a protocol to protect its clients that involves withholding some of their funds above what is required to safely travel home in the event of an unplanned discharge with a plan to post the remaining funds on to their nominated address. This is agreed as part of the admission process and is designed to minimise the chance and risk of relapse.
12. Clause 9 of the care providers’ contract with Ms X says, “Subject to clause 8.4 [a clause relating to force majeure which does not apply here] you will have no right to cancel a Treatment Order. If you attempt to cancel a Treatment Order or if you or the Client (where appropriate) discharge yourself (themself) from the Treatment Centre then no refund will be due to you and you will remain liable to pay the Fee to us in accordance with these terms”.

What happened

13. Ms X stayed at the treatment centre during November 2021. The care provider says another service user had unfortunately brought bedbugs into the home at that time and so strenuous measures were taken, including commissioning professional pest control services, to eradicate the infestation. The care provider says as a result Ms X did not see or experience any problems with bedbugs then.
14. Ms X says when she arranged a further period of treatment in January 2022, she telephoned the manager to ask specifically about the bedbugs as she has a phobia. She says the manager assured her the problem had been resolved and there had been no further incidents since the start of 2022.
15. The manager says,” I was very clear in stating to [Ms X] that, since the last full treatment of the entire centre which was done on 30/12/21, we had not seen or had any reports of any further activity. She asked me to assure her that there would be no further issues with Bed Bugs and I was extremely clear in stating that I could not make any guarantees but that we had not seen or had any reports now for more than 10 days which was positive.” He says on the basis of that information Ms X decided to proceed with another stay.
16. Ms X signed the agreement to the care provider’s protocol about retaining service users’ funds on 12 January. The care provider says this is always signed at the beginning of treatment as part of the admissions process.
17. Ms X says when she moved into the centre on 12 January, she sat on her bed to go through the admission process. She says after the member of staff left her room she found a bedbug on the bed: she gave it to a staff member who placed it in a plastic glove and informed the manager. Ms X says she then found two more bugs in her room (which she flushed down the toilet). A staff member told her to repack her clothes, put her suitcase on the table and keep items off the floor.
18. The care provider says, ‘Staff…. were given the first bed bug, and did not see the reported two more as these were flushed down the toilet. At the time at which the first bedbug was found staff took swift action to deal with the event. At every point at which Ms X reported a bed bug, action was taken to deal with the event, and appropriate action was taken’.
19. Ms X says shortly after this her heart rate became elevated. She acknowledges this was partly through alcohol withdrawal but was also caused by a panic attack due to her phobia about bedbugs. After a consultation with a doctor the centre was advised to call an ambulance and Ms X was admitted to hospital. She says she did not sleep at all that night.
20. Ms X says when she returned to the centre next day, she found all rooms were being fumigated and she was unable to return to her own room until the afternoon, when she fell asleep. She says when she was woken at 6pm by nurses checking her heart rate, she found another large bedbug. She says her panic was witnessed by staff. The care provider’s notes describe her as “emotional, shaking and angry”. She asked for another room, but none was available.
21. Ms X says staff told her she could sleep in the family room, but she says the couches in there were too small for her. The staff then said she could sleep in the communal/tv room, but the manager said that was only possible when all other residents had gone to bed. He says the intention was to discuss accommodation with Ms X the following morning, including exploring the option of offering her an alternative room. The care provider says this shows options were offered for one night to enable suitable accommodation to be arranged for the following night.
22. Ms X asked if she could stay in a hotel instead but was refused. The care provider’s records note, “(Ms X) was still adamant she wanted to leave and demanded we give her her medication, money and credit card, i explained that it was her decision to leave but there was protocol we had to follow to ensure she was discharged safely…. (Ms X) booked a room at the Holiday Inn and a taxi was rung to take her there, I explained that protocol was that we give her enough money to get to her destination, I gave her £60 to cover the cost of the room and her taxi fare, and that the other £40 would be forwarded on to her”.
23. Ms X complained formally to the treatment centre on 17 January. On the same day the care provider responded to her apologising for the bedbug problems: “We have taken robust action to alleviate the problem and we had thought that it was resolved.  Unfortunately we had a re-occurrence at the time of your admission.  In light of this we will make a refund of £3750 in full and final settlement.”
24. Ms X was dissatisfied with the response and complained to the Ombudsman. She said the care provider charged her £750 even though she did not stay one night at the treatment centre.
25. The care provider says as soon as it was highlighted that bed bugs had been sighted in the centre a treatment was arranged by a professional pest control company the next day. It says there were a further 9 professional treatments at the centre to ensure the matter was eradicated: “there were a number of occasions where we saw close to 2 weeks without a single report of any further activity at which time we would immediately carry out appropriate treatment. Bed Bugs are extremely difficult to eradicate in a residential setting such as ours and we feel that we went to great efforts at considerable expense to ensure that we were doing everything possible to deal with the matter.”
26. The care provider says £750 of the treatment fee was withheld to cover the costs incurred by the company to facilitate Ms X’s admission and the bed holding costs.
27. The care provider says it offered the best available solution for alternative accommodation to Ms X on the night when she returned from hospital, but she declined. It says it took robust action to eradicate the bedbug infestation.

The care provider says the costs which Ms X incurred did not relate only to accommodation. It says costs are incurred once a client arrives and starts to engage with the service and staff.

Analysis

28. The care provider took all measures to eradicate the bed bug infestation which had been apparent on Ms X’s first visit. It could assure her it had done so but did not guarantee there were no bedbugs in the centre.
29. However, the presence of bedbugs in her own room significantly affected Ms X who has a phobia, to the extent that she was admitted to hospital with an elevated heartrate.
30. On Ms X’s return she discovered there were still bedbugs in her room despite the fumigation. Her accommodation was therefore not available to her and no other suitable private accommodation could be provided. That was fault on the part of the care provider which caused injustice to Ms X.
31. The care provider followed the agreed protocol in withholding some cash. It refunded a portion of her fees (despite its terms and conditions) but in my view should refund the remainder of the fees in recognition of the fact that no suitable accommodation was used by or available to Ms X.

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Recommended action

32. Within one month of my final decision the care provider should refund the remaining £750 to Ms X.

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Final decision

33. I find that some actions of the care provider caused injustice to Ms X which the completion of the recommendation above will remedy.

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Investigator's decision on behalf of the Ombudsman