Summary: Mr X complained on behalf of him and his late mother about how the Care Provider charged them for home care. The Care Provider was at fault for not clearly explaining the care charges, for sending insufficiently detailed invoices and for failing to readvertise for live-in care. It should apologise to Mr X and pay him £100 to acknowledge the frustration and uncertainty caused. The Care Provider was also at fault for its care planning, but this did not cause them a significant personal injustice.

The complaint

1. Mr X complained on behalf of him and his late mother. He complained the Care Provider:
1. harassed them for payment for care services without providing a breakdown of what the charges were for;
2. would only talk to Mr X about the care package for him; and
3. called the RSPCA about Mr X’s care of his cats and threatened to call others.
2. Mr X says this caused him and his mother avoidable distress and frustration.

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What I have investigated

3. I have investigated point (a) above. The final section of this complaint contains my reasons for not investigating the rest of the complaint.

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The Ombudsman’s role and powers

4. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(4))
5. We provide a free service, but must use public money carefully. We may decide not to start or continue an investigation if we believe it is unlikely we could add to any previous investigation by the care provider. (Local Government Act 1974, sections 34B(8) and (9))
6. 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
7. If we are satisfied with a care provider’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)
8. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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How I considered this complaint

9. I have considered:
• all the information Mr X provided;
• the Care Provider’s comments about the complaint and the supporting documents it provided; and
• the Care Provider’s policies, relevant law and guidance and the Ombudsman's guidance on remedies.
10. I gave Mr X and the Care Provider the opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Relevant law and guidance

Care planning

11. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulations) set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
12. Regulation nine states the care and treatment of a person must be appropriate and meet their needs. To do this, care providers must carry out an assessment of the persons’ needs and design care and treatment to meet those needs. Associated guidance says this should involve production of a care plan.
13. Regulation 17 deals with good governance. It notes care providers must maintain accurate, complete and detailed records in respect of each person using the service

Charging

14. “Caring about Complaints”, the Ombudsman's guidance for care providers, says invoices for care services should be accurate and properly reflect the services provided.

Good administrative practice

15. The Ombudsman's guidance “Principles of good administrative practice”, says we expect organisations we investigate to be open and accountable. This includes keeping proper and appropriate records.

What happened

Background

16. Mr X lived with his mother Mrs X and in late October 2020, Mrs X asked the Care Provider to provide a live-in care package. However, the Care Provider did not have anyone available to provide this. The majority of the care package was for Mr X, but documents created when Mrs X first got in contact with the Care Provider show she also needed support due to her own health needs.
17. In November 2020 Mr X signed an agreement to receive a care package of hourly support and night sits. Mr X spoke to the Care Provider about advertising for a live-in carer. In late November, the Care Provider suggested wording for the advert which stated the support was for Mr X but “we also support his mother”. The Care Provider says it advertised for the position of a live-in carer in November 2020 but was unable to find a suitable candidate. The Care Provider says it therefore agreed an alternative care package for night sits and companionship calls.
18. In early December Mr X emailed the care provider to apologise for the delay in paying the invoice. In the email he stated on the whole, his experience with the Care Provider ‘has been very positive’.
19. In mid-December the Care Provider emailed Mr X as he had enquired about the advertising for a live-in carer. The Care Provider said it had two candidates, but neither were suitable and both were male. It asked, ‘if a male carer would be a consideration for you and your mum’. It said pre-Christmas was a difficult time to recruit. It said, ‘we will really push it in the new year and I have asked a company to put together a new advert’. I have seen no evidence it did this.
20. The Care Provider sent Mr X invoices every two weeks which required payment within a week. The invoices did not include a breakdown of the money owed. Mr X frequently paid the Care Provider late and at times accrued a significant debt. As a result, the Care Provider contacted him repeatedly to ask for prompt payment. Mr X decided to move to a new Care Provider at the end of February and paid the remaining invoices by early March. In total, Mr X paid around £36,000 for care over a 5-month year period.

Complaint

21. Mr X’s representative complained to the Care Provider in late August 2021. He said the Care Provider harassed Mr X and Mrs X for payment but never sent an invoice showing a breakdown of the charges.
22. The Care Provider responded in mid-September. It said Mr X signed a contract which stated the hourly cost of his care during the day and the cost of the carers staying overnight. It said this also included a daily and weekly total. It said the invoices Mr X received described what the invoice was for. It said emails from the Care Provider were polite.
23. Despite not upholding Mr X’s complaint about its invoices and method of chasing payment, the Care Provider said as a result of the complaint it had taken the following actions:
• ‘All invoices are now sent out with a copy of the electronic logging in and out system stating call time, time to and from and the carers name who attended.
• All phone calls are now logged on an electronic system and recorded coming in and out of the office and actions assigned to staff.
• No package of care is started now without an assessment being carried out and a minimum of 24 hours to turn the package around’.

Response to enquiries

24. In response to our enquiries, the Care Provider sent a support plan it produced for Mr X. Mr X said he never saw a copy of the care plan. This stated Mr X ‘is receiving home support at the moment to support him with daily tasks and support with household chores’. It goes on to say the Care Provider ‘are supporting [Mr X] to help him get organised and to feel better about organising himself to do daily tasks and to get in to a routine to help with his mental health and to support him to cook and clean’.
25. The Care Provider said it did not create a care plan for Mrs X because it did not offer her any care.
26. It has provided screen shots which shows visits planned between 4pm and 8pm daily were to assist with household tasks including laundry and to make drinks and for sleeping nights between 8pm and 8am to assist with dinner for Mr X and Mrs X, cleaning and to assist with the cats and to provide drinks.
27. The invoices the Care Provider sent Mr X for his care stated the dates billed for, were for ‘care provision’ and showed the total amount. The amount due varied each billing period. The Care Provider sent us detailed invoices listing the time of visits and the charges made. There were discrepancies between the invoices sent to Mr X and the breakdown which the Care Provider sent to us. Following further enquiries, the Care provider has clarified these and I am satisfied the detailed invoices equate to the amount Mr X was charged and paid for.
28. The Care Provider sent us invoices which show they now include the start and end time for a care visit, the type of care provided, the rate for that type of care and the total amount due for that visit. This will prevent a recurrence of the fault.
29. The Care Provider only keeps emails for three months, so most were not available by the time Mr X complained to it. I have reviewed those available and emails provided by Mr X. They show the Care Provider politely explained to Mr X that he needed to pay the invoices promptly so it could pay the carers.

Findings

Care planning

30. The Regulations state care providers must design care to meet a person’s needs and should do this by producing a care plan. The Care Provider produced a care plan for Mr X, but this made no reference to any need for night time support and did not set out any need for 24 hour care. It showed Mr X just needed some support with light household tasks. It failed to set out what support the Care Provider was actually providing to Mr X which was fault.
31. While the main package of care was for Mr X, the Care Provider was offering to support Mrs X from the beginning and advertised for a live in carer to support both Mr X and Mrs X. So, it should also have created a care plan for her. The Care Provider’s failure to consider producing a care plan for Mrs X was fault. I am satisfied the poor quality of Mr X’s care plan and the lack of a care plan for Mrs X has not caused them a significant personal injustice because it appears the Care Provider appropriately met their needs.
32. Mr and Mrs X wanted live-in care. The Care Provider unsuccessfully advertised in November 2020. The Care Provider told Mr X it would re-advertise in January 2021. I have seen no evidence the Care Provider did so. This was fault. Mr X continued to receive support through sleeping night visits and blocks of day care which are more expensive than live in care. The evidence shows Mr X was aware he was being charged for hourly visits and for night sits and agreed to this and was satisfied with the care provided. Given the first advert was unsuccessful, I cannot say that if the post was readvertised it would have been filled. However, this leaves Mr X with a sense of uncertainty over whether he could have received support at a lesser cost.

Charging

33. Mr and Mrs X originally requested live-in care which the Care Provider was unable to provide. It attempted to provide the equivalent support through blocks of care and night sits which meant Mr X was not billed consistently for the same amount each week/month.
34. The failure to ensure Mr X had sufficient information to be satisfied he was billed correctly was fault. In its complaint response, the Care Provider said Mr X had enough information about his care charges because the invoices stated they were for care, the amount charged, and his contract stated the hourly rates he would pay. However, because the amounts varied each billing period, the information on the invoices was insufficient to allow Mr X to confirm the charges were correct. This was not in line with the Ombudsman's guidance for care providers and was fault. It caused Mr X avoidable frustration and meant he had to go to time and trouble pursuing a complaint to ensure he was being charged correctly. The Care Provider has taken suitable steps to prevent the fault occurring again because it now issues more detailed invoices. However, I do not consider this has remedied the injustice to Mr X.
35. Given the length of time between the events complained about and Mr X’s complaint to the Care Provider, some of the emails between it and Mr X have been deleted in accordance with its retention policy. Mr X has also provided copies of emails between himself and the Care Provider. The emails show the Care Provider sought payment of late invoices, was polite and there was no evidence of harassment. However, the Care Provider did not keep a record or note of any of its phone calls This was fault; the Ombudsman expects care providers to keep proper and accurate records. This includes records of key conversations between staff and people receiving care. The Care Provider’s failure to keep a record of the phone call between it and Mr X meant it was unable to provide a comprehensive response to his complaint. This caused him frustration. The Care Provider now has a system in place to note calls received or made and emails received. This will prevent a recurrence of the fault in future.

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Recommended action

36. Within one month of the date of my final decision, the Care Provider should apologise and, in line with our guidance on remedies, it should pay Mr X £100 to acknowledge the frustration, time and trouble and uncertainty caused to him by the Care Provider’s faults.
37. Within three months of the date of my final decision the Care Provider should remind its staff to produce a care plan when they begin providing someone with care, which should contain sufficient detail so staff understand what support they are to provide.

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Final decision

38. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.

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Parts of the complaint that I did not investigate

39. I did not investigate points (b) and (c) of Mr X’s complaint. This is because the Care Provider properly investigated the issues and did not uphold his complaint. It is unlikely further investigation would result in a different outcome. In addition, it is open to any individual in any capacity to report their concerns to the RSPCA. I would not be able to say it was administrative fault for an individual to contact the RSPCA, if they had concerns. It was then for the RSPCA to decide what, if any, action to take.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman