Summary: Mr X complains on behalf of Mrs Y that the Council has overcharged for her care. The Council is at fault because it did not review Mrs Y’s care needs or address Mr X’s concerns about excessive care provision early enough. Mrs Y was charged for unnecessary care provision. The Council should apologise, recalculate care charges, provide guidance to staff and review the Care Provider’s action plan to identify other learning.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains on behalf of Mrs Y that the Council has overcharged for her care.
2. Mr X says Mrs Y has suffered financial loss.

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The Ombudsman’s role and powers

3. 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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. When considering complaints, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
5. 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)

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How I considered this complaint

6. I spoke to Mr X about the complaint and considered documents he provided. I made enquiries of the Council and considered its response and the supporting documents it provided.
7. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

What happened?

8. This is a brief chronology of key events. It does not contain everything I reviewed during my investigation.
9. Mrs Y was admitted to hospital and then discharged in September 2022.
10. A care needs assessment was completed which identified a package of care for Mrs Y. This was discussed as being chargeable with Mr X.
11. The next day the package of care commenced, comprising 28 hours per week..
12. Mr X raised concerns about the quality and level of care required with the care provider in September 2022
13. Mr X first raised concerns with the Council in November 2022.
14. The Council completed a telephone review and substantially reduced the amount of care being delivered to 14 hours per week.
15. Mrs Y’s care package was reduced again in January 2023 to 8 and three quarter hours per week.
16. In July 2023 Mrs Y’s care package was further reduced to 7 hours per week.

Analysis

17. Mr X’s complaint concerns the time period 6 September to 25 December 2022.
18. I have seen the initial care assessment in September 2022 which shows the care package arranged aligned with the assessment. The initial package of care was correctly implemented. This is not fault by the Council.
19. The care assessment was not authorised until 12 November 2022 when a resource request was made, which was backdated to early September when the care started to be delivered.
20. The Council says that:
• The contents of its complaint response to Mr X fell below the standard it expects and it should have given more detailed information on the areas reviewed as part of the enquiry and how reductions were calculated.
• When it investigated Mr X’s complaint, “the care provider informed [it] that they have no record of being contacted by the service user or family members and was unaware of concerns raised until it was brought to their attention by the Contracts Officer in December 2023.”
• In response to the Ombudsman’s enquiries, the care provider shared information to the contrary, stating in a report that Mr X had expressed concerns relating to punctuality of carers and the duration of calls.
• The care provider said it had taken action to address concerns, and that it would have looked at the effectiveness of the action taken, given that Mr X had raised a formal complaint to the Council regarding the same matters.
21. The report by the Care Provider in response to my enquiries says:
• A care coordinator was allocated to oversee Mrs Y’s care and support. The named care coordinator left the organisation earlier this year following which Mrs Y was allocated a new one.
• Mrs Y had a care and risk management plan formulated following an initial assessment prior to commencement of care and copies of which were given both to Mr X. These have been reviewed periodically.
• Logs showed variations between the planned and actual hours worked from 1 November 2022. Visits were not always conducted during the allocated time; carers would attend up to two hours before their booked time and in some cases, there was no note on the management system explaining the reason for the variances.
• Its service provider has been experiencing syncing issues between the two systems currently being used for care management and call monitoring.
• Mr X has previously expressed concerns about the punctuality of the carers who support his mum and how long they spent on the visits.
• These concerns were reportedly addressed by the then care coordinator overseeing Mrs Y’s care (they have since left the organisation). He replaced the carers, increased telephone monitoring calls and spot checks. This appears to have resolved the issue and the only other concern was the amount of money that the council is charging Mrs Y for her care. This prompted Mr X to propose a reduction in the call hours and changing from double handed to single calls. A risk assessment review was done, and the care package was revised.
• Notes concerning Mrs Y’s contact and correspondence were not necessarily updated by the former care coordinator.
• Significant quality issues were identified while preparing the report.
22. The care package says it should have been reviewed monthly. No review was undertaken until mid November 2022. The Care Provider has been unable to show when Mr X first raised concerns with it. This is fault by the Council.
23. On the balance or probabilities, the care package would have been reviewed significantly earlier. Mrs Y was charged for more care than she should have been.

Action taken by the Council and Care Provider

24. The Council has made numerous downward reductions to charges following investigation. Most recently it has adjusted charges for Mrs Y by rounding them down to 7 hours per week from 26 December 2022 to 24 December 2023.
25. The Council says it has requested further information regarding the dates that the concerns were raised, and action taken. It will also seek to understand why this information was not shared with it at the time of its enquires into the complaint.
26. The Council also apologised for the delay experienced by Mr X in dealing with his complaint. It says it has improved systems by allowing complaints to be assigned to individual officers which will improve on enquiry and response times.
27. The Council says it has, “set up 2 weekly meetings to review new complaints in the system for Adult Social Care, this ensures that complaints are assigned to the correct team for investigation and response, reducing the risk of excessive response durations. A new process between the Financial Assessments & Collections Team and the Contracts Team has also been put into place that gives clarity for officers dealing with complaints relating to invoice queries, it also aims to speed up the process between our teams.”
28. The Care Provider says it will develop an action plan to address the quality issues it has identified and share this with relevant persons.

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Agreed action

29. To remedy the outstanding injustice caused by the fault I have identified, the Council should take the following action within 4 weeks of my final decision:
• Apologise for the fault found in this decision. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Recalculate Mrs Y’s care charges between 7 September 2022 and 25 December 2022 on the basis of care being provided at a level of 7 hours per week, that being the level the Council has reduced charges to for subsequent periods.
• Provide guidance to staff to ensure reviews of assessments are carried out at the appropriate time intervals specified in them.
• Review the Care Provider’s action plan and this complaint to identify any other learning and share this with staff.
30. The Council should provide us with evidence it has complied with the above actions.

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Final decision

31. I have found fault by the Council, which caused injustice to Mr X and Mrs Y. I have now completed my investigation.

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Investigator's decision on behalf of the Ombudsman