Summary: Mr P complained Altogether Care LLP failed to keep records as set out in the Client Agreement and incorrectly charged for the care it provided his father. We found fault in the Care Provider’s record keeping and invoices to Mr P. It agreed to make payment and apologise for its errors to Mr P which cause him some distress. It also agreed to reconcile its Client Agreements with its current practice for logging care visits. It has already addressed our record keeping concerns and refunded its incorrect charges.

The complaint

1. The complainant, whom I shall refer to as Mr P, complained on behalf of himself and his late father (Mr X). He said Altogether Care LLP (the Care Provider) failed to keep records as set out in the Client Agreement and incorrectly charged for the care it provided Mr X.
2. As a result, Mr P said he experienced distress. He also said he had time and trouble to get the Care Provider to address his concerns and provide the information he asked for.

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The Ombudsman’s role and powers

3. 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 an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
4. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
6. If we are satisfied with a council’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)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

8. As part of my investigation, I have:
• Considered Mr P’s complaint and the Care Provider’s responses;
• discussed the complaint with Mr P;
• considered the information Mr P and the Care Provider sent me; and
• considered the relevant law and guidance.
9. Mr P and the Care Provider had an opportunity to comment on a draft version of this decision. I have considered the comments I received before making my decision.

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What I found

Relevant Law and guidance

10. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
11. Regulation 9 says care providers must enable and support the person to understand the care or treatment choices available to them. This includes make providing them with the information they reasonably need to make their decisions.
12. Regulation 17 says records relating to the care and treatment of each person using the service must be kept and be fit for purpose. Fit for purpose means they must be complete, accurate and up to date.

What happened

13. Mr X had health conditions and struggled to manage his own care. His son, Mr P, had power of attorney to manage Mr X’s health and financial matters.
14. In autumn 2020 Mr P arranged for a care provider (the Care Provider) to provide care for his father (Mr X) in his home. Mr X paid for the care.
15. The Client Agreement set out care should be provided three times a day for 30 minutes. The care included personal care, administration of medication, food preparation and light domestic duties. The Agreement also said Mr X should sign the care worker’s time sheet after each visit to confirm the number of hours worked.
16. The Care Provider provided care to Mr X over a four-month period, until he died in late 2020.
17. A month later, Mr P asked the Care Provider for its records of the care it provided Mr X. He said this was because he was concerned some of its charges were incorrect.
18. The Care Provider took two months to provide Mr P with its care logs and care notes, which its care workers completed following its care visits to Mr X. It told Mr P the delay was because it had moved the location of its paper files.

Mr P’s complaint

19. Mr P told the Care Provider he had reviewed its care notes and logs of Mr X’s care and found issues with its charges. He said:
• it had failed to sign time sheets after each visit as set out in the Client Agreement, instead it wrongly relied on electronic entries completed by its care workers;
• it had charged Mr X for care when he was in hospital and no care was provided; and
• its invoices did not match the dates and times set out in Mr X’s care notes. This included several charges for care visits which were not recorded in the care notes. The invoices also showed milage charges for more visits than it carried out.
20. The Care Provider told Mr P it had found it had incorrectly charged Mr X during his two short hospital stays. It apologised to Mr P for its errors and said it would refund the incorrect charges. It also said to improve its record keeping it had spoken with its staff, updated its policies for record keeping and it had a new paperless electronic system.
21. Mr P acknowledged the Care Provider’s apology and proposed refund. However, he was still not satisfied with its response. He said it had:
• failed to properly explain what information it had used to produce the invoices, and the process it had explained, was not what was set out in the Client Agreement;
• not addressed his concerns about incorrect milage charges;
• failed to keep proper records as it used an electronic system to log care visits, but these were only confirmed by its care workers and not Mr X; and
• had failed to record all its visits in Mr X’s care notes. He said it should not charge for those visits because it could not evidence they took place, or what support it gave to Mr X.
22. In response the Care Provider apologised for incorrect charges. However, it was satisfied the rest of its charges were correct. It provided Mr P with a list of its charges and visits to Mr X. It said the information came from its previous system, which was updated electronically by care workers when they visited Mr X. This was the system it used to generate invoices. It also explained the absence of some care notes were not in itself as reason to presume fraud and such notes were not used to generate invoices.
23. Mr P said he did not accept the Care Provider’s refund and continued to raise his concerns to it. It told him it would respond to his concerns again, but it did not respond any further. So, Mr P asked the Ombudsman to consider his concerns.

Analysis

Record keeping

24. The fundamental standards require the Care Provider’s records for Mr X’s care to be fit for purpose. This means they must be complete, accurate and up to date.
25. The Care Provider accepted its care workers had failed to record all its care visits in Mr X’s care notes, which were stored in his home. This was fault. It has taken steps to ensure its policies are up to date and its staff are aware of their responsibilities for accurate record keeping.
26. In addition, the Client Agreement says Mr X should sign the care worker’s time sheet after each visit to confirm the number of hours worked. This did not happen as the Care Provider was using an electronic system to record its care visits, without any input from Mr X. This system was also used to create the invoices for Mr X’s care.
27. While it is normal practice for care providers to use an electronic system to record the start and end time of care visits, this was not what Mr X had agreed to. The Care Provider was therefore also at fault for not following the process set out in its agreement with Mr X.

Care charges

28. The Care Provider accepted it had incorrectly charged Mr X for some care, including short hospital stays. This was fault. It apologised and offered Mr P to refund the incorrect charges. I am satisfied this was enough to remedy the injustice caused on this matter.
29. Also, Mr P believes the Care Provider should not be allowed to charge Mr X for any of its care visits which are not evidenced in his care notes. However, the Care Provider said its care visits for Mr X did take place as evidenced in its electronic logs of the visit.
30. On balance, I am satisfied the Care provider attended the agreed care visits for Mr X. This includes the visits which were not recorded in Mr X’s care notes. This was because:
• its electronic logs show each of its visits to Mr X; and
• I am conscious some care records were incomplete over three days. If Mr X had not received any support from the Care provider, I would have expected concerns to be raised at that stage. However, I accept it is not known what support Mr X received.
31. Mr P also asked the Care Provider for clarification of its milage charges in its invoices, as some invoices referred to more charges than actual visits to Mr X. This is fault as I have seen no logical reasons for this discrepancy.

Complaint’s handling

32. Mr P was also dissatisfied with how the Care Provider handled his concern, and the time it took to provide the information he asked for.
33. I have not found fault in the Care providers complaints handling. I acknowledge the Care Provider caused delays in providing some information he asked for. However, the delay was short, and it apologised to Mr P told him why its response was delayed.
34. Also, after the Care Provider gave Mr P its final response, he continued to raise his concerns. It told him it would respond further to his concerns but failed to provide a response. I understand this was because Mr P had then brought his concerns to the attention of the Ombudsman. I would therefore not expect the Care provider to continue to respond to concerns after its final response, nor after a complainant has brought the matter to our attention. I have therefore not found the Care Provider at fault on this matter.

Injustice

35. The Care Provider agreed to refund Mr P for its incorrect charges when Mr X was in hospital. I also found fault in the milage charges in its invoices. It should therefore also refund Mr P for the incorrect milage charges.
36. I found fault with the Care Provider’s records keeping and failure to follow its own agreement with Mr X. I am satisfied this caused Mr P some distress due to the uncertainty about what support Mr X had received, and the time and trouble he had to get the Care Provider to correct its errors.
37. However, I found the Care provider did provide care for the agreed visits to Mr X. It was therefore entitled to charge for the care set out in its invoices.

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Agreed action

38. To remedy the injustice the Care provider caused to Mr X, the Care provider should, within one month of the final decision:

• Apologise in writing and pay Mr P £150 to acknowledge the distress he experienced as a result of the uncertainty and time and trouble its faults caused him.

39. Within three months of the final decision the Care provider should also:

• Reconcile its client agreements with its current practice for recording care visits with its service users.

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Final decision

40. There was fault which caused an injustice to Mr P. The Care Provider has agreed with my recommendations. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman