Summary: Mr Y complains about a care provider’s decision to increase fees for the care it delivers to his wife, Mrs Y. He also complains about the withdrawal of visiting sheets and the provision of care from male staff and those who he considers as lacking in experience. There is no fault in the provider’s actions which cause a significant injustice to Mr and Mrs Y.

The complaint

1. Mr Y complains the provider ‘Serenta Home Care Limited’ substantially increased his wife’s care fees without justification. Mr Y also complains about changes to the services his wife now receives. In particular, that:
1. Mrs Y sometimes receives visits from unexperienced carers; and
2. The care provider has withdrawn ‘visiting sheets’ which gave a schedule of visits for the week ahead.
2. Mr Y says the above actions have caused injustice because he is paying more money despite there being a reduction in some of the services previously provided.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. 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

5. During my investigation I discussed the complaint with Mr Y and considered any information he provided.
6. I made enquiries of the care provider and considered its response. I also consulted the Care Quality Commission (CQC) ‘Fundamental Standards of Care’.
7. Mr Y and the care provider 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

Increased fees

8. Mrs Y has received self-funded home care from the provider since May 2018. Her package of care consists of three double-handed visits per day. Mrs Y also receives two visits every night from another provider. The nightly visits are not part of this complaint.
9. In November 2021 Mr Y received written notice from the provider that it intended to increase fees with effect from 3 January 2022. Mr Y wrote to the provider to express his dissatisfaction and to raise a complaint.
10. We asked the care provider to clarify the reasons for the increase, and to confirm whether it applied solely to Mrs Y or to all users of its services. In summary, the provider said:
• It did not take the decision lightly. Other care providers raised their rates and they had to follow suit.
• The primary reason for the increase is inflated costs and staff turnover, both of which have increased significantly since the COVID-19 pandemic.
• Brexit and the COVID-19 pandemic have affected the workforce with many carers leaving the industry for higher-paid roles. Consequently, the number of available care staff has significantly decreased.
• The provider took the difficult decision to reduce client hours in line with the reduced number of carers. As a result, it had to spread costs amongst fewer hours of care which considerably raised the provider’s costs.
• The provider has reduced its margins and combined senior manager roles to make further savings.
11. When considering complaints about increased care fees, the LGSCO needs to be satisfied the service user received clear and relevant information; both in the original contract terms and when the provider communicated the decision to increase. This is because the Care Quality Commission (Registration) Regulations 2009, regulation 19, states that providers must “…give timely and accurate information about the cost of their care and treatment to people who use services”. To do so, “... providers must make written information available about any fees, contracts and terms and conditions, where people are paying either in full or in part for the cost of their care, treatment and support”
12. The contract signed by Mrs Y in April 2018 states at section 4.5 that the care provider will:

“Provide service users with at least two weeks prior written notice of any changes to the charges”.

13. Based on the evidence I have seen; the provider exceeded this contractual requirement because it gave Mr Y seven weeks’ written notice. Although I appreciate that Mr Y is disappointed with the decision, and disagrees with some of the provider’s rationale, the provider was entitled to increase their fees and there is no fault in the way it did so.

Provision of care from male staff

14. Mr Y complains the provider has not complied with Mrs Y’s original request to receive visits only from female carers. He says this request was made following some distressing experiences Mrs Y has had in the past with care provided by males in healthcare settings.
15. In response to our enquiries the provider supplied a copy of a risk assessment completed for Mrs Y in January 2020. It is evident that Mr Y was part of the assessment because his name and date is entered on the document, which says:

“[Mr Y] would prefer female carers for [Mrs Y] but has had discussions with management about males and females working together – as long as the female carries out the personal care”

16. The provider explained that, upon creation of a new client care plan, it asks service users to specify whether they have a gender preference for carers. The provider says it will meet the requests wherever possible.
17. In late 2019 the provider recruited additional staff in anticipation of disruption caused by the COVID-19 pandemic. Some of the new staff members were male.
18. I appreciate Mrs Y originally indicated a preference for female-only care due to past experiences. The provider met this request for as long as possible until its workforce changed following the recruitment of additional male staff. The risk assessment completed in 2020 shows the provider explained to Mr Y that there may be times when one male attends a double-handed call, but the personal care element will always be completed by the female colleague. The visiting sheets provided by Mr Y show that on times when a male carer is allocated, they are accompanied by a female colleague. In my view, this is an appropriate solution which Mr Y agreed to at the time and there is no evidence of fault from this arrangement which has caused injustice to Mrs Y.

Provision of care from inexperienced staff

19. Mr Y complained that Mrs Y’s care is sometimes provided by young and inexperienced staff. When he commissioned the service, Mr Y says he understood that Mrs Y would only receive care from suitably experienced staff.
20. In response to our enquiries the provider explained that all new staff undergo the same induction, training and shadowing process irrespective of their age or previous experience. New staff complete moving and handling training and undergo continual observation before being signed off as ‘competent’ by their trainer. The shadowing and mentoring process also means that new staff will accompany experienced staff members to oversee their work.
21. The provider is duty bound not to discriminate based on age, or any other characteristics, when it recruits new staff. I appreciate Mr Y prefers for Mrs Y to only receive care from staff who have worked in the role for some years, however it is not feasible for the provider to always fulfil this preference.

Withdrawal of visiting sheets

22. Until recently Mr Y received weekly visiting sheets which contained the names of staff members who would be attending the planned calls. Mr Y says these sheets were useful as they helped him to plan the week ahead, especially with regards to Mrs Y’s frequent medical appointments.
23. Mr Y says the withdrawal of the visiting sheets is an example of the reduction in the service provided despite the significant increase in rates.
24. Mrs Y’s contract says the provider will:

“Prepare and deliver a weekly/monthly timesheet showing the services delivered and the undertaken [sic] in providing these. Include travel time on the timesheet (where relevant) together with any other miscellaneous expenses that may have been incurred on your behalf”

25. In response to our enquiries the provider explained that the timing and duration of calls is decided by the clients; these calls are pre-booked and do not change unless the client makes a request. The provider says the visiting sheets confirmed the names of staff members who were scheduled to attend the calls.
26. Due to the impact of the COVID-19 pandemic on the workforce, particularly with sickness absence rates and staff turnover, the provider temporarily stopped producing visiting sheets. This is because the production of sheets became unmanageable due to the level of amendments needed when staff became absent at short notice.
27. The provider has confirmed that visiting sheets were recently re-introduced when staff levels stabilised.
28. I understand that Mr Y found it useful to know which staff would be attending to care for Mrs Y. However, in my view, the key information which Mr Y requires is the timing of the calls. Based on the evidence seen, the provision of this information has not changed. Although the temporary withdrawal of the sheets was not in line with Mrs Y’s contract, in my view the resulting injustice is not significant.

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Final decision

29. I have completed my investigation with a finding of no fault in the substantive complaint. Although the provider temporarily withdrew visiting sheets, this did not cause a significant injustice to Mrs Y.

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Investigator's decision on behalf of the Ombudsman