Summary: Mrs Y complains a care home wrongly charged her for her family member’s respite stay. She says this caused her financial strain and avoidable and unnecessary distress. The Ombudsman finds the Council at fault which caused injustice. The Council has agreed to make a payment to Mrs Y.

The complaint

1. Mrs Y complains a care home wrongly charged her for her family member’s respite stay. She also complains the care home communicated with her poorly.
2. Mrs Y says this has caused her financial strain and avoidable and unnecessary distress and frustration.

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The Ombudsman’s role and powers

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)
4. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, sections 24A(1)(A), and 25 (7) as amended)

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What I have and have not investigated

6. Mrs Y says her complaint is with Priors Hall care home. However, as I have stated above, as Priors Hall care home was commissioned by the Council to provide its service to Mrs X, the complaint is with the Council.

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How I considered this complaint

7. I considered the information and documents provided by Mrs X and the Council. Mrs X and the Council had an opportunity to comment on a draft of this decision. I considered all comments received before making this final decision.
8. I also considered the relevant statutory guidance as set out below.
9. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

What should have happened

10. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.

What happened

11. In January 2024, Mrs Y called Priors Hall care home to ask about costs for respite care. The care home gave her the contact details to apply for council funding. Mrs Y contacted the Council to discuss a period of respite care for Mrs X.
12. In March, the Council called Mrs Y to discuss her referral for respite care for Mrs X. It explained the referral process. It told her the Council used a specific group of care homes. Mrs Y told the Council she had arranged respite care at another care home.
13. The Council approved to fund the respite at Mrs Y’s chosen care home. It agreed to pay £742 weekly and the family to pay £58 weekly top up.
14. In late March, Mrs X was admitted to the care home for three weeks. On the same day, the care home told Mrs Y to pay £2616. It told her it would refund her once the Council provided payment. The care home contacted the Council for details of funding. The Council agreed to call the care home back.
15. In early April, the Council contacted the care home. It informed the care home it would fund £742 weekly, and Mrs X’s family would pay £58 weekly top up.
16. In late April, the care home refunded Mrs Y £1684.
17. Mrs Y made numerous attempts to contact the care home finance officer and manager. The care home did not return her calls.
18. In early May, the care home contacted the Council for confirmation of the agreed funding. The Council confirmed it funded £742 weekly, and Mrs X’s family were liable for the £58 weekly top up fee.
19. Mrs Y made several more attempts to contact the care home. The care home did not return her calls. She attended the care home in person. She was told the manager and finance officer were not available. Mrs Y made a formal complaint.
20. In late July, the care home responded to her stage two complaint. It told Mrs Y any further refund would be to the Council, and not to her.
21. To date, Mrs Y has not received her full refund.

Analysis

22. The Council commissioned the three week respite stay for Mrs X at Priors Hall care home. The total cost of the stay at the council rate was £2400. The Council was to pay a total of £2226 and Mrs Y was to pay a total top up fee of £174.
23. The care home charged Mrs Y the private rate of £2616 for Mrs X’s three week stay. The care home received confirmation the Council would fund the stay three working days after Mrs X’s admission. At this point, the care home should have refunded Mrs Y. It took the care home one month to provide Mrs Y with a partial refund of £1684. It told her any further refund would be to the original fee payer, which it said was the Council. This is fault which caused Mrs Y unnecessary and avoidable distress and uncertainty and ongoing financial strain.
24. Mrs Y made considerable efforts to contact the care home to resolve her complaint. After the stage one response, the care home delayed actioning her request to escalate it to stage two. Mrs Y also contacted the Council in her effort to resolve the complaint. The care home apologised for its delay in responding to her complaint. I consider the apology does not remedy the unnecessary and avoidable time and effort Mrs Y spent attempting to resolve her complaint.

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Agreed action

25. When a council commissions or arranges for another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the actions of Priors Hall care home and make the following recommendations to the Council.
26. Within four weeks of my final decision, the Council has agreed to:
1. make a payment of £752 to Mrs Y to refund the money owed to her by Priors Hall care home. This amount takes into account the total amount of top up fees Mrs Y is liable to pay.
2. make a payment of £500 to Mrs Y for the unnecessary and avoidable distress and uncertainty caused by taking the original payment and the delay in providing her a full refund. In arriving at this figure, I considered our published guidance on remedies. I considered the level of stress, frustration and uncertainty it caused Mrs Y. I consider this amount is proportionate and appropriate to the level of injustice caused.
3. make a payment of £200 to Mrs Y in recognition of the time and trouble she took to resolve her complaint. In arriving at this figure, I considered the efforts Mrs X has made to resolve the situation, which is still ongoing. I consider this amount is proportionate and appropriate to the level of injustice caused.
27. The Council should provide us with evidence it has complied with the above actions.

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Final decision

28. I have completed my investigation. I find the Council at fault and this caused injustice. The Council has agreed to make a payment to Mrs Y.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman