Summary: Mrs X complained the Council failed to properly respond to a complaint about Mrs Y being overcharged for care. We found there was fault in the monitoring and oversight of the care charges and there was a significant delay in responding to the complaint. However, we found the Council remedied the complaint appropriately.

The complaint

1. Mrs X complained in 2022, raising concerns about charges being invoiced by a care provider (Care Provider A). The care was commissioned by the Council. She says the charges were well in excess of what was expected and complaints she made to the care provider and the Council in 2022 went unanswered.
2. Mrs X complained that in November 2023, out of the blue, the Council sent a response to the complaint apologising for the delay and including a bill for care received over a year earlier. She considered the way the Council dealt with the matter was poor and it was inappropriate and upsetting for Mrs Y to receive a bill for care a year after it was received.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), 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)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

6. I spoke to Mrs X and considered the information she provided and the complaint she made. I asked the Council for information and considered its response to the complaint.
7. Mrs X and the Council now have an opportunity to comment on my draft decision. I will consider their comments before making a final decision.

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What I found

8. What follows sets out key facts for the purposes of explaining our decision on this complaint. It is not intended to be a full chronology of all events in relation to the complaints raised.

Background

9. Mrs X holds a Lasting Power of Attorney (LPA) appointing her to act as Attorney for Mrs Y. Mrs X brought this complaint on Mrs Y’s behalf.
10. Since March 2022 Mrs Y has received care from Care Provider A. The care was commissioned by the Council. Because Mrs Y has savings over £23,250, she is responsible for paying the full cost of her care fees.

What Happened

11. As at March 2022 Mrs Y received 12 hours 40 minutes of care. This was reduced to 9 hours 10 minutes in mid-April.
12. In April 2022 Mrs X raised an issue with the level of care being delivered by Care Provider A and about the charges being applied. At a meeting in May Mrs X, a social worker and Care Provider A agreed the hours of care required and agreed the call times for their visits.
13. In June there was a slight increase in care hours to 9 hours 40 minutes.
14. Mrs X told us the bills being received from Care Provider A were too high. She stated on some occasions the bill was twice what it should have been for providing the care set out in Mrs Y’s care plan. Mrs X says she tried to raise the issue of charges directly with the provider in Summer 2022. Her husband also went to Care Provider A’s offices but the issue was not resolved.
15. In Autumn of 2022, Care Quality Commission (CQC) inspected Care Provider A.
16. In October 2022 Mrs X made a complaint to the Council. In the complaint Mrs X stated there was overcharging. She stated that Care Provider A was charging for more time than its carers were actually spending with Mrs Y. She also complained that a Council policy allowed care providers to charge up to 7 hours per week over and above the commissioned care hours for up to six weeks (7 hour flex). She considered this allowed care providers flexibility to vary their charges too easily.
17. In Mid-October the Council asked Care Provider A for information. This was provided on 3 November 2022.
18. The Council held an initial meeting with Mrs X and family members on 6 December 2022.
19. In December CQC published a report about its inspection of Care Provider A. It rated the service as Inadequate. Amongst other things, CQC’s report referred to reports from service users and relatives about lateness, shortness of calls and missed care calls. CQC stated they found from the provider’s records that short, late and missed calls had occurred.
20. The Council says Mrs X was away until early January, which delayed a full review of the situation for around 4 weeks. In January 2023 the Council arranged for Mrs Y to receive care from a different provider.
21. However, there was then a ten-month delay before the Council responded to Mrs X’s complaint in Mid-November 2023. In its response, the Council agreed there had been overcharging. Mrs X’s complaint was that Care Provider A charged for more time than the carers stayed with Mrs Y. The Council stated Care Provider A had charged correctly for the service that was delivered. However, it had also been charging for care which was over and above that which had been commissioned for Mrs Y and set out in her care plan. This was not agreed.
22. The Council stated in October 2022, Care Provider A revised its invoices to date, to reflect only the care that the Council commissioned. This resulted in a credit of £605.47 being applied to Mrs Y’s account for the period March 2022 to October 2022. This was credited to the account in December 2022 invoice.
23. The Council stated Care Provider A agreed, in future it would only invoice the Council for the commissioned care hours and no ‘additional care’.
24. In January 2023, the Council noticed that Care Provider A had not done as it said; it was continuing to routinely bill Mrs Y for care over and above that which the Council had commissioned. When the Council contacted Care Provider A about this, it got no response. However, the Council corrected the bills to record only the commissioned care hours. This resulted in a further credit to Mrs Y’s account of £383.15 in the April 2023 invoice.
25. The Council’s response to Mrs X commented on its “7-Hour Flex” Policy. It stated the aim was to enable care providers and their relatives to react to changes in a service user’s needs without the need for additional paperwork. It stated, in all cases, there needed to be agreement between the Service User/their Representative and the care provider. The Council stated it had reviewed its monitoring of call times to better oversee the actions of care providers.
26. In response to us, the Council provided further explanation of the actions it was now taking to report on and monitor situations where care providers are providing more care than it commissioned. This would enable them to follow up as appropriate. It noted that Care Providers could only provide additional care for short periods. Care Providers then needed to inform the council if a long-term change to someone’s care package was required, so this could be considered.

Was there fault by the Council

27. There was fault by the Council. The Council commissioned care from Care Provider A for Mrs Y. However, Care Provider A invoiced the Council for care in excess of that which the Council commissioned and this had not been agreed with Mrs Y’s family. While I understand the Council has a policy allowing a short‑term flexibility for meeting a service user’s change in needs, there is no evidence that Mrs Y’s needs had changed, short or long-term. The overcharging by Care Provider A also occurred over a period of seven months between March and October 2022 when the Council first raised it with them. This is far in excess of the short-term period the Council’s policy allows for.
28. Overall, I found there was insufficient oversight and monitoring of the policy. I note the Council has since improved the information available and the monitoring of care providers who are charging more for care than originally agreed.
29. In Mrs X’s case the Council explained that it had rectified the impact to Mrs Y. It had done this by reviewing the charges made and ensuring refunds of overpaid were credited to Mrs X’s account in December 2022 and April 2023. Mrs Y now has a new care provider.
30. There was also fault in the way the Council responded to the complaint. There was initial delay in acting on information the Council gained from Care Provider A (between November and December 2022). There was then a significant delay in responding to the complaint in 2023. The delays in complaint handling also represent fault by the Council.
31. In response to Mrs X’s complaint, the Council credited an amount of £200 to Mrs Y’s account to reflect the time and trouble caused by the delay in responding to the complaint. Arguably, the impact of the delays in handling the complaint affected Mrs X rather than Mrs Y. Nevertheless, the Council made a payment to the family overall to recognise the impact.
32. I found the actions the Council took in response to the complaint were appropriate. It gained a refund for Mrs Y, it improved its monitoring of charges for commissioned care and made a payment to reflect the impact of the delay in complaint handling.

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Final decision

33. There was fault by the Council. We found the council had remedied the complaint appropriately.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman