CQC Complaint Justified ? ? ?

[Slippydiff]

Apologies for the long post in advance

My mother went into a care home in July 2016. The costs vary between £4,000 to £4,400 per month.
In October last year my mother had a fall and spent 5 days in hospital as a result (she'll be 90 in October of this year), she came out of hospital and being a resilient individual, bounced back within a month. She had another fall in May of this year and spent 14 days in hospital, once again she bounced back fairly smartly (albeit every fall takes it's toll on her general health and mobility).

When my mother moved into the care home, we were required to fill out a direct debit mandate, but by December no funds had been debited from her account and we were subsequently presented with an invoice for over £20k .... ! !

When questioned why they'd not drawn on the DD mandate, they said they'd tried to but the sort code was wrong. Questioned as to why they'd not been in contact sooner to notify us, no answer was given.

In January the monthly invoice had risen to £5k, so I contacted the accounts office at the home to ask for a breakdown of the charges. I was told the invoices were generated at head office (some 100 miles away) and thus a breakdown wasn't available .....
I felt this wasn't a good enough response, so again requested a breakdown of the invoice on 3 further occasions. On the fourth occasion I was told a breakdown would be available the following day. I duly made the 30 mile round trip to collect said breakdown, only to be told the member of staff who'd promised it, had gone on holiday for 10 days .....

I duly contacted head office and was immediately sent a copy of the invoice (not a clear and transparent breakdown of their charges as requested).

Having owned several businesses over the years, I'm pretty good at crunching numbers, but I couldn't make head nor tail of the care homes billing processes (items/care rates billed then credited etc etc)
I therefore took all the invoices to my accountant to enable them to check the figures were correct.

They emailed me a day later to say all the charges added up, and I duly paid the larger monthly bill.

Fast forward to July and out of the blue I receive an invoice for over £9k !!
I ring head office who tell me I need to talk to the accountants manager at the care home. Sensing I was being sent on a wild goose chase, I once again took all the relevant paperwork to my accountant. He crunched the numbers and produced a spreadsheet that showed the home was trying to bill 303 days of increased care charges as a result of my mother's fall last November.

Suitably incensed I went to see the care home manager with my sister to establish why the charges had been levied initially, AND why they were now trying to charge them out some 9 months later .....

An explanation by the care home manager revealed several members of staff had been negligent in their actions (failing to put the care rate increase through last November) and a taciturn admission that the billing from head office was flawed and causing numerous issues for the home.

As a sop we were offered a fixed price care package for our mother (which could save between £400-600 per month, and is not normally offered to existing variable rate residents) and a 50% discount on the £5400 of additional charges for increased care levels.

Initially this sounded a reasonable offer, but we declined it prior to discussing it at length. Having done so, my sister and I felt that the increased care level was not "tangible" and thus whilst there had been some increased care levels required, it certainly wasn't 303 days, but also no credits had been given for the two hospital stays at the increased care charges levied (these totalled £1500)
Thus the offer of a credit of £2700 against £5400 was not justified and should have been closer to £4200.

I met with the care home's manager and her senior today and requested the credit be increased to £4200. This was met with a flat refusal, as in their words they were doing us a massive favour offering us the option to go on to a fixed rate care package AND they considered their offer of a 50% reduction in the increased care costs, very good.

This is not a situation I envisaged we'd be in when we placed my mother in what is an expensive care home. Both my sister and I feel very aggrieved, but also feel we're being press ganged into a decision that neither of us feel comfortable with.

Is this a matter the CQC would be willing to investigate ? Or do they only deal with actual care of residents rather than billing issues ?

Many thanks in advance.

[Dolf Stoppard]

CQC primarily deal with complaints about the quality of care. For other matters you need to go through the care home's own process. If you remain unhappy the Local Government Ombudsman can investigate.

[CTO]

^^

This.

Billing issues wouldn't fall under the regulated activities regulations the organisation is registered to provide. If you wanted to really push it, you could say you have concerns about their internal governance systems (reg 17), it would likely be noted for a future inspection and you would be advised to use the providers existing complaints system and then PHSO.

Organisations don't tend to like matters being referred to the PHSO, it is usually referenced within the responsive domain of a CQC report, it wouldn't however be an automatic breach of regs or result in a rating of "requires improvement" (in that domain).

HTH.

Edit: link to the regs below, if you're interested.

http://www.legislation.gov.uk/ukdsi/2014/978011111...

Edited by CTO on Tuesday 26th September 20:54

[Slippydiff]

Thank you both. I'll need to discuss this with my sister and see whether we think an escalation of the complaint useful, or whether perhaps a letter to the care home's CEO would be a more pertinent.