Care home accountants for residential and nursing homes.
A care home is a business where the margin lives in three numbers: occupancy, staff cost and fee mix. We run the accounts, payroll, VAT and CQC-ready figures around exactly those numbers, so you always know where the home stands and nothing surfaces late.
LOYALS are specialist care home accountants for residential and nursing homes across the UK. We run occupancy-led management accounts, rota payroll with sleep-in and minimum wage testing on every run, welfare VAT handled correctly, fee billing and credit control across local authority, NHS and private funders, and CQC-ready year-end accounts. Fixed monthly fees from £349 for a single home, quoted in writing within 24 hours of a free 15-minute call.
A care home's finances fail quietly. Then all at once.
Occupancy slips two beds, agency cover creeps up, a funder short-pays, and the year-end accounts arrive months too late to do anything about any of it. These are the four pressures we see in almost every home that comes to us from a generalist firm.
"Two empty beds are eating the entire margin and nobody costed it."
A home's costs are mostly fixed, so occupancy is the profit lever. At typical fee levels, a couple of sustained voids can absorb the whole surplus. Without monthly occupancy-led figures showing occupied beds, average weekly fee achieved and the break-even point, voids get discussed at year end when the money is already gone.
"Agency staff costs have crept from cover to habit."
Staff cost is the biggest line in the home, and agency hours are its most expensive form. When staff cost as a share of fee income drifts up quarter after quarter, the home is working harder for less. We track the ratio and the agency spend monthly, so the drift is visible while it is still a decision rather than a fact.
"I am not certain our sleep-ins pass a minimum wage inspection."
Sleep-in treatment and national minimum wage averaging across the pay reference period is where well-run homes carry silent risk. From April 2026 the wage floor is £12.71 with employer National Insurance at 15%, so the cost of getting it wrong compounds fast. We test every pay run before it goes out, not at year end.
"CQC and the bank both want numbers I do not have to hand."
Financial viability is part of being well-led, and lenders ask the same questions when you refinance or expand. Statutory accounts describing a year that ended months ago do not answer either. Current management accounts, forward cash flow and a clean debtor position do, and we keep them ready rather than assembling them in a panic.
We build your accounts around the four numbers that actually run a care home.
Most accountants give a care home the same pack they give a shop. We report the operating numbers that decide whether the home makes money, every month, while the month can still be influenced.
Occupancy and average weekly fee
Occupied beds against capacity, the average weekly fee actually achieved per resident, and the occupancy level at which the home breaks even. When a void opens, you see what it costs per week to leave it unfilled.
Staff cost ratio and agency spend
Total staff cost as a share of fee income, with agency hours split out and priced. This is the number that quietly decides the margin, and the one we watch hardest as the wage floor and employer National Insurance rise.
Fee mix across funders
Local authority, NHS Continuing Healthcare and private residents pay different rates on different terms. We show the blended position and what a change in mix does to income, so fee negotiations and admissions decisions are made with the numbers in front of you.
Cash and debtor days
Who owes what, how old it is, and which funder is short-paying or clawing back. Fees are billed in the format each funder requires, remittances reconciled line by line against residents and periods, and the outstanding balance chased properly.
One specialist team for the whole picture. Not just year-end.
Most homes come to us for one urgent thing and hand over the rest, because it all connects. Payroll feeds the accounts, billing feeds cash flow, and the monthly figures tell you whether the home is actually working.
Occupancy-led management accounts
Monthly figures built on occupancy, fee rates, staff cost ratio and cash, readable in ten minutes and delivered while the month can still be influenced.
Rota payroll with NMW testing
Weekly or 4-weekly runs with sleep-ins, waking nights and unsocial hours treated correctly, RTI and pensions handled, and minimum wage tested on every run.
Welfare VAT & bookkeeping
Care VAT exemption applied correctly, mixed supplies reviewed rather than assumed, and tidy cloud books in Xero or QuickBooks reconciled every month.
Fee billing & credit control
Local authority, NHS CHC and private fees invoiced in each funder's format, remittances reconciled line by line, short payments spotted and chased.
Year-end & CQC-ready compliance
Annual accounts, Corporation Tax and Companies House filings prepared to a standard lenders and CQC financial viability reviews take seriously.
Acquisitions, TUPE & growth
Due diligence on buying or selling a home, TUPE payroll transfers landed correctly, and our free business mentor programme for every client.
We already run care finances every single week.
Anonymised, because that is what people in regulated care need from an adviser.
Registration-ready numbers, then the ongoing engagement.
A residential care operator came to us needing a registration-ready cashflow forecast: month-by-month income built on realistic occupancy ramp-up rather than optimism, a staffing model that matched the rota the home actually needed, and assumptions a reader could trace and test. The forecast did its job, and they stayed as an ongoing client.
Alongside engagements like that, we run a complete weekly care finance function in the sector: payroll for around fifty care staff with sleep-ins and unsocial hours treated correctly, billing across local authority, NHS and private funders, remittances reconciled line by line, credit control worked every week, and monthly management figures the owner actually reads.
That weekly machinery is exactly what a care home needs, with placement billing and occupancy in place of visit billing. You are not paying us to learn your sector on your time.
Details are generalised and no client is identified. This is anonymised expertise drawn from our care sector practice.
Fixed monthly fees, quoted to your home.
A 20-bed single home and a three-site group billing four funders are very different businesses, so we price to what you actually run. These are the anchor points.
What this typically costs at LOYALS
All fees exclude VAT and are fixed in writing. Every quote is issued within 24 hours, after a free 15-minute scoping call so we price your actual home, not a guess. Switching from another accountant is handled free with any monthly plan.
Care home guides from our chartered accountants
- How much does an accountant cost for a care home?
- Nursing home vs residential home: accountant costs compared
- Occupancy and voids: how they hit your numbers
- Agency staff costs: the number that decides your margin
- Sleep-in shifts and national minimum wage
- Care home VAT: exempt or not?
- What payroll costs for a care home
- CQC registration cashflow forecasts: what you need
- Buying a care home: accounting due diligence
- TUPE transfers on a care home acquisition
- Specialist vs high-street accountant for a care home
- When to switch to a specialist accountant
- Best accountant for a multi-site care group
- What it costs to start a care home
Get your home's real numbers in front of you.
Tell us your bed count, funder mix and team size. We will send a written fixed-fee quote within 24 hours covering exactly what your home needs, including any current offers.
Frequently asked questions.
If your question is not here, message us on WhatsApp or book a free 15-minute call.
Do you specialise in care home accounting?+
How much does an accountant cost for a care home?+
What are occupancy-led management accounts?+
How should sleep-in shifts be treated for minimum wage?+
Is care home income VAT exempt?+
Can you handle billing and chasing for local authority, NHS and private fees?+
Can you help with buying or selling a care home, or a TUPE transfer?+
Care home accountants in London, working with homes UK-wide.
Our office sits at 39-41 North Road, King's Cross, London N7 9DP, five minutes from Caledonian Road tube. Care is delivered everywhere, so most of our care engagements run remotely across the UK through cloud accounting, secure portals, video calls and WhatsApp, which suits busy owners and registered managers perfectly.
Everything is built for distance without losing the personal side: a named account manager who knows your home, same-day replies during opening hours, and a real person on the line Monday to Saturday. For those who prefer to meet, the King's Cross office is open six days a week.
London N7 9DP
10am to 7pm
Run another care service?
- Care Agency Accountants (domiciliary & homecare)
- Children's Home Accountants (Ofsted)
- Care Sector Accountants (overview)
- Clinician Accountants
Related services
Ready for an accountant who already knows care homes?
Book a free 15-minute call. We will quote your engagement in writing within 24 hours, including any current offers. If LOYALS is not the right fit, we will tell you that too.
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