Summary: Mr B says the Council charged Mr C for care he did not receive and failed to get evidence from the care provider to support its charges. The care provider charged for periods when Mr C did not receive care and does not have the electronic records it should have to support its charging. The Council has acted appropriately by refunding the period when Mr C did not receive care. The Council will liaise with the care provider to arrange for spot checks on service user’s files to ensure carers are electronically logging care visits.

The complaint

1. The complainant’s representative, whom I shall refer to as Mr B, complained on behalf of Mr C who received a package of care from a care provider commissioned by the Council. Mr B complained the Council:
• charged Mr C for the care he did not receive when he was in hospital and after he died; and
• failed to get evidence from the care provider to support its charges for care.

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The Ombudsman’s role and powers

2. The Ombudsman investigates complaints of injustice caused by maladministration and service failure. I have used the word fault to refer to these. The Ombudsman cannot question whether a Council’s decision is right or wrong simply because the complainant disagrees with it. He must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3))
3. 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)

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How I considered this complaint

4. As part of the investigation, I have:
• considered the complaint and Mr B's comments;
• made enquiries of the Council and considered the comments and documents the Council provided.
5. Mr B and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
6. 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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What I found

What should have happened

7. The Government has issued guidance: ‘Fairer Charging Policies for Home Care and other nonresidential Social Services’. This says deciding whether to charge for non-residential social services continues to be a matter for a councils’ discretion.

What happened

8. Mr C was due to receive a package of care at home from the beginning of October. However, Mr C went into hospital on 3 October 2019 and did not come out until 22 October 2019. Mr C then went back into hospital on 2 November 2019 and sadly died on 5 November 2019.
9. Mr B raised concerns with the Council about charges for Mr C’s care in December 2019 as the family had been charged for care during weeks commencing 7 and 14 October and 4 November when Mr C was in hospital. The Council contacted the care provider who advised a charge had been made for up to 7 October 2019 due to the late cancellation of care. The care provider told the Council the package had been increased from 24 October. The care provider told the Council from that point Mr C received care from two carers each day.
10. The Council contacted the care provider in January 2020 to ask for copies of timesheets because the family were disputing the care provided. The Council issued a revised invoice on 27 January 2020. Mr B queried that invoice on 10 February and asked for evidence to support the charges made. Mr B also pointed out Mr C had been in hospital from 2 November. The Council agreed to contact the care provider to obtain more information. The Council asked the care provider for supporting evidence for the charges. The Council told Mr B it was waiting for that information on 12 February.
11. The Council issued a new invoice for care on 18 February, removing the charges for the period from 2 November. Mr B asked the Council for clarification about the hours billed for during weeks commencing 21 and 28 October. The care provider confirmed the hours provided on 20 February, although it did not provide any evidence.
12. Mr B put in a complaint in June 2020. The Council responded to that in November 2020. The Council explained call durations included 10 minutes travel time. The Council confirmed it had not seen the care logs but assumed all tasks had been undertaken as Mr B was not raising concerns about the quality of care provided.
13. The Council contacted the care provider again in March 2021 after Mr B complained to the Ombudsman. The care provider gave the Council a copy of records showing what it says was care provided to Mr C between 23 October 2019 and 2 November 2019.

Analysis

14. Mr B says the Council wrongly charged Mr C for care he did not receive when he was in hospital and after he died. The Council accepts it initially charged Mr C for care not provided when he was in hospital and in the lead up to his death in November 2019. The evidence I have seen satisfies me the Council issued an invoice for those periods of care based on the information provided by the care provider. I appreciate Mr B expected the Council to ask the care provider to submit evidence to support the charges made. However, at the point at which the Council issued the first invoice, which included periods for which Mr C did not receive care, I have seen no evidence to suggest the Council knew of any periods for which care had not been provided. I therefore do not criticise the Council for issuing the first invoice which included periods when Mr C had not received care. It is not fault for the Council at that point to have relied on the information submitted by the care provider, in the absence of any challenge.
15. I am satisfied though when Mr B raised concerns about the charges made the Council acted appropriately by asking the care provider to submit further information. I am satisfied the Council then acted appropriately by issuing revised invoices following receipt of information from the care provider. Those invoices removed the charges for the periods of care Mr C had not received. As I am satisfied the Council acted appropriately here I have no grounds to criticise it.
16. Mr B remains concerned about the other periods charged when Mr C received care from the care provider. Mr B understandably lacks confidence in the care provider’s records given it charged for care Mr C did not receive. That has undermined his confidence in the charge for the other weeks where Mr C received care. I am satisfied the Council sought information from the care provider to support its charging. It is clear though the care provider does not have a copy of the written care records completed by the carers. While the care provider should have a separate electronic record of the care provided it does not hold that in this case. That is fault and means the Council cannot obtain evidence to verify the length of time carers visited Mr C on the weeks for which he has been charged. As the Council commissioned the care it is responsible for any failure to keep proper records, which is fault. I recommended the Council work with the care provider to arrange for spot checks on service user’s files to ensure carers are electronically logging visits. The Council has agreed to that.
17. In this case the evidence I have seen satisfies me Mr B is not querying that care was provided to Mr C during the weeks that have been charged now that the weeks where he was in hospital have been removed from the overall charge. Rather, Mr B is querying the amount of time carers spent with Mr C on each occasion. As the Council has pointed out the charge is for the care provided rather than the length of calls. Mr C was assessed as having to pay a maximum of £208.51 towards his care on a weekly basis but that does not reflect the full cost of provision based on the hourly rate. So, I am satisfied Mr C was not charged for each half hour or hour but was instead charged for the care provided during each visit. In those circumstances I am satisfied although the care provider’s records are inadequate it is unlikely Mr C has been overcharged for the care provided, now the Council has refunded those periods when he was in hospital. I therefore do not consider any further remedy, other than the spot checks referred to in the previous paragraph, necessary for this case.

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Agreed action

18. The Council will liaise with the care provider to arrange for spot checks over a three month period to ensure carers are electronically recording care visits for service users.

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Final decision

19. I have completed my investigation and uphold the complaint.

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Investigator's decision on behalf of the Ombudsman