Date of decision: 14 November 2025
Summary
A care provider failed for months to give an individual and her representative clear, written information about self-funding care home fees, then demanded a very large backdated payment.
The care home also failed to keep its own internal care plan up to date and did not handle the representative’s complaint promptly, causing distress, frustration and financial uncertainty for both the individual and her relative.
What happened
In September 2023, the NHS placed an older woman, Mrs Y, in a care home run by Avery Healthcare, part of Redwood Tower UK Opco 2 Limited, with her placement funded by NHS Continuing Healthcare (CHC).
The ICB withdrew this funding in February 2024, at which point Mrs Y became responsible for funding her own care in the Avery Healthcare home.
From February 2024 onwards, Mrs Y privately funded her care but Avery Healthcare did not promptly issue either a written contract or regular invoices to her representative, Mrs X, even though Mrs Y was now self‑funding.
In October 2024, Avery Healthcare sent Mrs X a single invoice totalling nearly £60,000, calculated at £1,695 per week from the point Mrs Y began funding her own care.
Mrs X queried this immediately, saying the NHS had told her fees would be around £1,400 per week, and asked for an explanation of the care “scales” and why the cost of care appeared so high. Avery Healthcare replied that the weekly cost comprised £1,265 for accommodation and £430 for care, but Mrs X did not accept that Mrs Y required the level of care for which Avery Healthcare had been billing.
In November 2024, after Mrs X’s challenge, Avery Healthcare sent Mrs X the written contract for accommodation and care, backdated to February 2024, even though Mrs X had not ever signed them. Avery Healthcare also amended the invoices: it refunded the £1,695 per week charges, instead invoicing Mrs X £1,460 per week and billing the NHS for the additional nursing element funded via NHS‑Funded Nursing Care (FNC).
In December 2024, Mrs X made a formal complaint to Avery Healthcare. She complained about the delay in receiving contracts and invoices, disputed the amount of care for which Mrs Y was charged, and raised concerns that the provider’s care plan still included a medication which the doctor had stopped in September 2024.
About three weeks later, Avery Healthcare issued its complaint response, confirming it had updated the care plan and stating that Mrs Y had not actually received the discontinued medication after the doctor stopped prescribing it. The provider apologised for failing to send contracts and invoices promptly and set out its view of the care Mrs Y had received.
Mrs X replied the next day, saying the response did not properly address her questions and asking Avery Healthcare to escalate her concerns through its complaints process. She remained dissatisfied with the provider’s handling of fees, records and her complaint and therefore brought the matter to the Ombudsman, asking that Avery Healthcare give clear information and compensate Mrs Y.
In response to the Ombudsman’s enquiries, Avery Healthcare accepted that its actions had fallen below required standards. It suggested the NHS should have informed Mrs X that Mrs Y would have to fund her own care from February 2024, and also said Mrs X knew she would be expected to pay, but nonetheless accepted fault in how it had handled information on fees, the contract and the complaint.
What was found
The Ombudsman found Avery Healthcare at fault for likely failing to meet regulatory standards under Regulation 19 of the Care Quality Commission Regulations 2009 to provide a written statement of terms, conditions and fees to the service user when she became responsible for paying for her care, and to do so before or at the start of self‑funded services. The contract was only sent in November 2024, nine months after Mrs Y began funding her care.
The Ombudsman examined sample care records over ten days across three months and found that, on nine of those days, Avery Healthcare had recorded more than the two hours of care per day it was charging for, so there was no evidence that the home had charged for care not needed or provided. The Ombudsman therefore did not uphold the element of the complaint alleging over‑charging for unprovided care.
The Ombudsman found Avery Healthcare in potential breach of Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because it did not handle Mrs X’s complaint without delay or in line with its own complaint policy, which caused avoidable frustration. The Ombudsman also found a potential breach of Regulation 17 because the care provider failed to keep an accurate, up‑to‑date care plan when Mrs Y’s medication changed in September 2024, even though the medication was not actually administered after it was stopped, causing further distress to Mrs X and undermining confidence in record‑keeping.
To remedy the injustice to Mrs X and Mrs Y, Avery Healthcare agreed to apologise for the distress and frustration caused by late contracts and invoices, the large backdated bill, the failure to update the care plan and the poor complaint handling, and to pay Mrs X £500 to recognise the distress, frustration and uncertainty caused. Avery Healthcare also agreed to remind relevant staff about effective complaint handling and timely responses to complaints, and to remind them of the requirement to keep accurate records in line with CQC fundamental standards.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
The NHS National Framework does in fact say that when status changes, unilateral withdrawal from funding should not take place until new funding agreements have been clarified and sorted out. Para 210 says this:
“Therefore, if there is a change in eligibility, it is essential that alternative funding arrangements are agreed and put into effect before any withdrawal of existing funding, in order to ensure continuity of care. Any proposed change should be put in writing to the individual by the organisation that is proposing to make such a change.”
Community care law materials on care planning and charging emphasise that where a person moves from NHS to privately funded care in the same placement, authorities should consider whether a Care Act assessment, clear written explanation of potential charges, and support with financial decision‑making or deputyship are needed to avoid unfair backdated demands. Even though the woman had significant means, incapacity could have triggered a local authority duty nevertheless.
From a community care perspective, the remedy of £500 and staff reminders, while important, may understate the systemic learning required on charging, capacity and care planning at the health‑self-funding-social care boundary.
Public law principles, and case‑law‑informed training on sufficiency and charging, suggest that organisations should review their standard letters, pre‑admission information and discharge pathways to ensure people moving off CHC are proactively told about potential self‑funding responsibilities, available Care Act assessments, and routes to challenge affordability or seek legal authority for managing money.
Community care law would therefore treat this decision as a prompt for joint NHS–local authority protocols on explaining funding transitions, avoiding large backdated liabilities, and embedding lawful charging and complaint handling in everyday practice.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Redwood Tower UK Opco 2 Limited (24 020 403) report. If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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