Summary: The care provider acted properly in altering the number of carers when the late Mrs X was no longer able to bear weight on her foot. The care provider set out the pricing structure for care visits: however, the carers’ logs were not always clear about the length of each visit. The care provider will ensure its records are clear so service users can identify the time period for which they are charged; it will also now carry out a review of the disputed charges.

The complaint

1. Ms A (as I shall call the complainant) complains the care provider altered her grandmother’s (Mrs X’s) care plan without agreement, and charged for times when carers were not present. She says as a result, the price of the care package doubled, and her parents and grandmother were upset at the attitude of the care provider and the termination of the contract.

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The Ombudsman’s role and powers

2. 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)
3. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

4. I considered all the information provided by Ms A and the care provider. Both Ms A and the care provider had an opportunity to comment on a previous draft of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

5. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 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.
6. Regulation 12 says care providers must provide care and treatment in a safe way:

‘(a) assessing the risks to the health and safety of service users of receiving the care or treatment;

(b) doing all that is reasonably practicable to mitigate any such risks;

(c) ensuring that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely;

(d) ensuring that the premises used by the service provider are safe to use for their intended purpose and are used in a safe way;

(e) ensuring that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way;

7. Regulation 17 says providers ‘must maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided’.
8. Regulation 19 says:

(1) Where a service user will be responsible for paying the costs of their care or treatment (either in full or partially), the registered person must provide a statement to the service user, or to a person acting on the service user’s behalf—

(a) specifying the terms and conditions in respect of the services to be provided to the service user, including as to the amount and method of

payment of fees; and

(b) including, where applicable, the form of contract for the provision of services by the service provider.

(2) The statement referred to in paragraph (1) must be—

(a) in writing; and

(b) as far as reasonably practicable, provided prior to the commencement of the services to which the statement relates

What happened

9. Mrs X was an elderly lady living with her husband. In February 2021 the care provider agreed a care package with Mrs X and her daughter (Mrs B). The care provider explained at a pre-meeting the care which would be given to meet Mrs X’s needs - at that time a 45-minute morning call and a 30 minute evening call (each with one carer). Mrs X had had a broken right leg, wore a special boot on her foot and transferred with the use of a rotunda to assist her.
10. The care provider says she explained the pricing structure for the calls. She says, “Once we decide what is needed on each call and how long it will take we decide whether it will be a 30, 45 or 60 mins call. Each call is charged at what is decided. (Mrs X) needed a 45 min am call so was charged for 45 mins, our charges state that the carer has 45 mins to do the call, if she has finished a few mins early, and client wants her to leave the call is still charged at 45 mins. The same with a 30 min call at night. We do not and never have charged by the minute.”
11. The contract which the care provider agreed with Mrs X says, “charges are based on a fixed rate charge as per your commissioned time, eg 30 min call will be charged at 30 min, 45 min will be charged at 45 min, 60 min will be charged at 60 min. Anything over commissioned time charges will apply min by min”.
12. The care provider says there were no problems with the delivery of the care package. The care provider has forwarded copies of text messages from the family thanking her for the care they gave to Mrs X: “just wanted to say how wonderful the carers are helping mum on her road to recovery, physio going well mum says she loves all the carers company”.
13. In August 2021 Mrs X had to go back to hospital. It was discovered her foot was still fractured. The care provider says, “she was told she couldn’t put any weight on it so was unable to use the rotunda for transfers she needed a hoist which meant having 2 carers instead of one, as hoists can only be used by 2 carers for safety. I explained this to (Mrs X) and she was happy with the new care package and the price it would reflect being charged for 2 carers.” The care plan was updated on 14 August 2021 and said, “hoist now being used not rotunda”. It also now included a lunchtime call to transfer Mrs X from the bedroom to the lounge for the afternoon.
14. In October Mrs X’s foot was x-rayed again and it was found the fracture was healing and she was able to use the rotunda again for transfers. The care provider says Mrs X had to wear a special boot again to prevent pressure being put on her foot. She says both the consultant and the Occupational Therapist advised Mrs X should not use her foot to move herself up the bed. The care provider says carers had to use a slide sheet to move Mrs X so two carers were needed.
15. The care provider says around this time Mr X and Mrs B started to request the care provider reduced the package so only one carer was used, as Mrs X could use the rotunda again. The care provider says she explained this would be against medical advice and she would not agree to reduce the care package to one carer.

The complaint

16. On 17 October Ms A emailed the care provider. She complained the care provider had not updated the care plan. She complained that the care provider was prepared to use one carer at visits when it suited business needs. She also complained that care staff were not logging their calls properly, so it was not possible to tell how long they had been at the property.
17. Ms A produced a table showing the discrepancies she said had found in the carers’ logs. Her calculations were based on the minutes the carers had attended, not the booked calls: so where a lunchtime visit by two carers was booked for 2 x 30 minutes on the care plan, but the carers’ log showed the carers had been there 20 minutes instead, she calculated the amount to be paid was 40 minutes, not 60 minutes as the contract stipulated.
18. Ms A also noted that on some occasions care staff had not logged out so it was not possible to tell how long they had been at the property, but the care provider had charged for a standard visit.
19. The care provider responded. She said she had agreed with Mrs B, after Mrs X’s hospital visit in August, that two carers were needed for Mrs X’s safety. She added Mrs B had agreed ‘when we didn’t have 2 carers to send at night she agreed to having 2 x carers at teatime and then 1 carer later to check Mrs X’s pad’. She said the care plan had been updated after the medical advice that Mrs X could not put pressure on her foot. She said the morning care call had been reduced recently as Mrs X no longer needed a 45-minute call. She refunded the cost of 2x 45-minute calls. She said if the family did not want to accept the pricing structure as described in the contract then they would cancel the care package.
20. Ms A says the family found another care provider and gave notice. She says the carers started to ignore Mrs X when they attended to give her care, and then finished the contract a day early so Mrs X was left in bed all day.
21. The care provider says the company gave notice on the contract as the situation had become untenable. She says she asked the family if they could end the contract early as so many staff were away from work with Covid 19. She says the family told her their new care provider could not start early so she continued to provide carers until the end of the contract.
22. Ms A says she emailed the care provider asking for a formal complaint response but did not hear further except for an acknowledgement.
23. The care provider says Ms A should have used the company’s complaints process outlined in its ‘statement of purpose’. This details an informal stage, a complaint to the local authority social care department, and finally a complaint to the CQC as registration authority.

Analysis

24. It was not fault on the part of the care provider to adhere to the medical advice in relation to Mrs X’s foot. It had a duty to provide safe treatment.
25. The contract set out the pricing structure for calls so there should have been no misunderstanding about the times for which calls were charged: I cannot see Mrs X suffered any injustice as a result of the way the booked calls were charged.
26. However, there was a lack of clarity in the records of the length of some visits – for example where care staff had not signed out. The care provider did not address that in her reply to Ms A.
27. Finally, I note the care provider complaints process refers to a final stage complaint to the CQC. That is incorrect and should be updated on the care provider’s documents.

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Agreed action

28. Within one month of my final decision the care provider will review the disputed call dates where carers failed to sign out, set out for Ms A a precise record of how charges were applied on those dates and reimburse any overpayments;
29. Within one month of my final decision the care provider will take steps to ensure carers enter records accurately and let me know how this has been done;
30. On receipt of my final decision the care provider will revise their complaints documents to reflect that the Local Government and Social Care Ombudsman, not the CQC, is the body which investigates complaints.

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Final decision

31. I have now completed this investigation. I find there was some fault on the part of the care provider and injustice which the completion of the recommendations at paragraphs 28-30 will remedy.

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Investigator's decision on behalf of the Ombudsman