Summary: Mr X complained Pro Target Care Ltd failed to return the correct sum due in respect of care charges his mother had paid in advance for the period 21 November to 6 December 2022, which were subsequently funded by Continuing Healthcare. We uphold Mr X’s complaint. The Care Provider’s failure to provide clear information about Mrs Y’s care fees and the errors in calculating the amount to be refunded have caused Mr X and Mrs Y’s estate an injustice.

The complaint

1. The complainant, whom I shall refer to as Mr X complained the Care Provider failed to return the correct sum due in respect of care charges his mother had paid in advance for the period 21 November to 6 December 2022, which were subsequently funded by Continuing Healthcare.

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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. 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)
3. 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

4. As part of the investigation, I have:
• considered the complaint and the documents provided by Mr X;
• made enquiries of the Care Provider and considered the comments and documents the Care Provider provided;
• discussed the issues with Mr X; and
• Mr X and the organisation 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

5. Mr X’s mother, Mrs Y received home care from the Care Provider between May 2021 and her death on 6 December 2022. She paid in advance for her care at a rate of £135 per day.
6. In November 2022 Continuing Healthcare (CHC) agreed to fund Mrs Y’s care. As Mrs Y had already paid her care fees for November and December 2022, Mr X asked for a refund. He noted the Care Provider had invoiced for 31 days in November 2022 at a total of £4185. And for 10 days in December 2022 at a total of £1,350.
7. CHC confirmed they funded Mrs Y’s care from 21 November to 6 December 2022, inclusive. Following Mrs Y’s death, Mr X asked the Care Provider to refund the fees Mrs Y had paid for the period 21 November and 6 December 2022. Mr X asserted Mrs Y’s estate was owed at least 14 days fees totalling £1890 for this period plus a further £405 in respect of errors in the Care Provider’s invoices.
8. The Care Provider said it had requested CHC fund 24-hour care at £200 per day from 22 November to 6 December 2022. It explained this was for the cost of Mrs Y’s care only and did not fund the additional £35 per day to cover additional costs such as insurance and agency fees.
9. The Care provider also noted that Mrs Y had paid £2430 for care from 22 November to 10 December 2022. It calculated the amount due to be refunded for 22 November to 30 November 2022 was £800. This was 8 days at £135 per day minus the £35 daily charge. In addition, a refund for 1 December to 10 December 2022 was due in the sum of £1000. That was 10 days at £135 per day, again less the £35 daily charge.
10. From this £1800 the Care Provider then deducted £500 as the carer had stayed on at the family’s request until 11 December 2022, leaving a refund of £1300. As the Care Provider had incorrectly invoiced for 31 days in September, 32 days in October and 31 days in November 2022 it also agreed to refund a further £405 for the three additional days which had been incorrectly charged. This was a total refund of £1,705
11. The Care Provider had already repaid £1400 to Mrs X’s estate and arranged to repay the outstanding £305.
12. Mr X disputes the Care Provider’s calculations. He calculated Mrs Y was owed £2,160, for 16 days’ charges between 21 November and 6 December 2022 at £135 a day. Plus £405 for the three additional days Mrs Y was overcharged. As the Care Provider had already reimbursed £1705 to Mrs Y’s estate, he requested the balance of £860 be paid immediately.
13. Mr X acknowledged the family had asked the carer to stay on following Mrs Y’s death but noted they had already paid for this and that it was outside the period for which they were requesting a refund.
14. As the Care Provider maintained its calculations were correct, Mr X has asked the Ombudsman to investigate his concerns. He asserts The Care Provider has overcharged Mrs Y and should refund the outstanding £860 to her estate.
15. The Care Provider has provided a copy of its terms of business agreement with Mrs Y. This says the fees for care and associated services will be agreed with the customer or their authorised representative before services commence. And will be confirmed by the terms of conditions signed by the authorised representative of the company. There is no record in the terms and conditions of what the agreed fees are.
16. The Care Provider has not provided records of any discussions with Mrs Y or her family regarding any fees that would continue to be payable after CHC began funding Mrs Y’s care. There is no record the Care Provider told Mrs Y or her family of the ongoing £35 daily charge.
17. In response to the draft decision the Care Provider has confirmed it received 15 and a half days CHC funding. It says it received only half a day’s payment for 6 December 2022 when Mrs Y died.
18. The Care Provider also notes that Mr X initially asked for a refund of £2,295. That is 14 days at £135, (totalling £1890) plus £405 in respect of the three days overpayment. It states that it has already refunded £1805 which would leave a balance of £490. The Care Provider would be prepared to pay Mrs Y’s estate £490.

Analysis

19. CHC confirmed they funded Mrs Y’s care from 21 November 2022 to 6 December 2022, inclusive. That is a period of 16 days, and it is this period Mr X has asked the Care Provider to refund.
20. The documentation provided shows there are a number of errors in the way the Care Provider has calculated the amount to be refunded to Mrs Y’s estate.
21. In calculating the refund the Care Provider refers to two period:
• 22 November to 30 November 2022, which it says is 8 days; and
• 1 December to 10 December 2022, which it says is 10 days.
22. The first period is in fact 9 days and begins a day after the CHC funding commenced on 21 November 2022, so should be a period of 10 days. And the second period continues for longer than Mr X is seeking to recover as he accepts the family asked the carer to stay on, and that this period would not be covered by CHC.
23. In addition, although the Care Provider calculated the second period as 1 December to 10 December 2022, it then deducted fees for the carer until 11 December 2022.
24. The Care Provider has also deducted a daily charge of £35 for administrative costs like insurance and agency fees which it says are not covered by CHC funding. This is a significant charge at almost 25% of the daily fee. I would therefore expect to see a clear reference to this charge and what it covers in Mrs Y’s agreement with the Care Provider.
25. The only reference in the terms of business to a possible daily charge states:

“The Company reserves the right to charge the Customer, at the agreed rate as set out in the Agreement, for additional hours worked by a Care Worker beyond that which has been documented in the Agreement. The company will charge a daily price to cover the finding, holding, and training fees for each worker included in the invoice monthly.”

26. The Care Provider has confirmed this charge only relates to costs incurred in unforeseen circumstances. It is an entirely different charge to the £35 daily charge deducted from Mrs Y’s refund.
27. The terms of business are also silent on what happens when a resident is eligible for and receives CHC funding. We expect care providers to be clear about their charges both at the outset and whenever there are any changes.
28. There is no evidence the Care Provider explained to Mrs Y or her family how the CHC funding would affect what she paid for her care or that she would remain responsible for this significant administration fee.
29. In addition the invoices only detail a unit rate of £135, and do not provide a breakdown of this charge.
30. In the circumstances there is no clear basis for the Care Provider to retain a daily administrative charge of £35 once Mrs Y received CHC funding.
31. The failure to provide clear information about Mrs Y’s care fees and the errors in calculating the amount to be refunded have caused Mr X and Mrs Y’s estate an injustice. Mrs Y has overpaid for her care, and Mr X has been put to unnecessary time and trouble in trying to resolve this matter.
32. Mrs X paid £2160 for her care for the period 21 November 2022 to 6 December 2022. As the Care Provider subsequently received CHC funding for 15 and a half days of this period I consider the Care Provider should have refunded £2,092.50 (15.5 days at £135 per day) to Mrs Y’s estate. This is in addition to the £405 for three days over charging.
33. The Care Provider says it has already refunded £1,805 to Mrs X’s estate, but the documentation available suggests it has only refunded £1,705. This leaves a balance of £792.50 to be returned to Mrs Y’s estate.
34. Mrs X had also paid for care for the period 7 to 10 December 2022, as her family asked the carer to stay on for this period it is right that the Care Provider retain these fees.

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Recommended action

35. I recommend the Care Provider:
• Apologise to Mr X and pay him £150 in recognition of the unnecessary time and trouble he has been put to by the Care Providers errors in calculating the refund due to Mrs Y’s estate and the lack of clarity regarding its fees.

We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Care Provider should consider this guidance in making the apology I have recommended in my findings.

• Refund Mrs Y’s estate the outstanding £792.50 in respect of fees paid for the period 21 November 2022 to 6 December 2022;
• Review its terms of business and agreements with residents to ensure information regarding its charges are clear and transparent;
• Provide reminders/ training for staff to ensure they are aware of the need to fully explain and record any changes in residents’ charges, including any ongoing liabilities where residents become eligible for CHC funding.
2. The Care Provider should take this action within one month of the final decision on this complaint and provide us with evidence it has complied with the above actions.

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Final decision

37. I have ended my investigation and uphold Mr X’s complaint. I have made recommendations to remedy injustice the organisation has not yet agreed to carry out.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman