Summary: Mrs X complained on behalf of her parents, Mr and Mrs Y, that the Care Provider overcharged for care services, and provided a poor standard of care just before the care package ended. We have found fault with the actions of the Care Provider as it did not tell Mrs X about changes to the cost of her parents care package, meaning they were charged more. We also found fault with the actions of the Care Provider after carers were told not to assist Mr X. The Care Provider agreed to apologise, pay back the difference in care charges Mr and Mrs Y paid and carry out a service improvement.

The complaint

1. Mrs X complains on behalf of Mr and Mrs X that Audley Willicombe Limited:
• Overcharged her parents between August 2022 and August 2023 for care services.
• Displayed a poor attitude towards her when trying to resolve the overcharging issues.
• Provided a poor standard of care just before the care package ended in November 2023.
2. Mr X has since passed away.

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The Ombudsman’s role and powers

3. 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 a significant injustice or that could cause injustice to others in future we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) 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. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)

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How I considered this complaint

6. I considered evidence provided by Mrs X and the Care Provider as well as relevant law, policy and guidance. I sent a draft of this decision to Mrs X and the Care Provider and considered comments received in response.
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Law and guidance

8. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions. Part 3A is for complaints about care bought directly from a care provider by the person who needs it or their representative, and includes care funded privately or with direct payments using a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
9. The Care Quality Commission (Registration) Regulations 2009 set out the standards that registered care providers must achieve.
10. Regulation 19 says “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—
1. 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
2. including, where applicable, the form of contract for the provision of services by the service provider.
11. The statement referred to must be—
1. in writing; and
2. as far as reasonably practicable, provided prior to the commencement of the services to which the statement relates.”

What happened

12. In late 2021, Mrs Y started to receive care from the Care Provider. This consisted of three home visits per day by carers. At this time there was only a care plan in place for Mrs Y. Carers attended for 1.5 hours in the morning, 1 hour for lunch and 30 minutes in the evening. Mrs X said Mr Y did not receive care but sometimes carers prepared his meals alongside Mrs Y’s.
13. In August 2022, the Care Provider told Mrs X it had been audited. The audit picked up that some of Mrs Y’s care logs mentioned carers doing things for Mr Y and he needed his own care package.
14. The Care Provider visited Mr and Mrs Y’s home and met with them and other family members, including Mrs X to complete a care plan for Mr Y. Mrs X said the Care Provider told her the care which was in place would remain the same and the cost of care would remain the same. The Care Provider said it did not discuss costs with the family but thought it left a brochure with its prices.
15. Mr Y and Mrs X signed a contract with the Care Provider starting in August 2022 which outlined its terms and conditions for care. The term and conditions did not contain any information about pricing or cost of Mr Y’s care.
16. After August 2022, Mr and Mrs X both had separate care packages. The same number of carers still attended Mr and Mrs Y’s home for three visits per day for the same overall time. The only difference was the morning visit was split to allow one hour of care for Mrs Y and 30 minutes for Mr Y.
17. In April 2023, Mrs X was going through paperwork for Mr and Mrs Y and noticed since August 2022, the direct debit amounts Mr and Mrs Y were paying to the Care Provider had increased. Mrs X said the invoice showed the Care Provider charged Mrs Y for one hour of care in the morning visit and Mr Y for 30 minutes of care. Mrs X said this was £12 per day more than just charging Mrs Y for 1.5 hours of care. Mrs X also said many visits listed on the bills were for a minute or so over the allotted visit time, which resulted in extra charges for Mr and Mrs Y.
18. Mrs X contacted the Care Provider in April 2023 and asked it to refund Mr and Mrs Y for the overcharges since August 2022. In late June 2023, the Care Provider told Mrs X that Mr and Mrs Y needed two separate care packages and the visits were charged per person. The Care Provider apologised for any miscommunication around the costs of care but said its invoices were correct and no refund was due.
19. In July 2023, Mrs X attended a meeting with the Care Provider to discuss her concerns. Mrs X said the Care Provider denied there were issues with the billing and made accusations about Mr Y. Following this meeting the family agreed to remove Mr Y’s care package. Mrs X believed he was not receiving personal care. The Care Provider agreed if Mr Y needed care and support from carers who were visiting Mrs Y, the carers could record this and then charge Mr and Mrs Y.
20. In early November 2023, Mrs X made several reports to the Care Provider. This included carers leaving Mrs Y without access to her chair lift remote, carers refusing to pass Mr Y his teeth and help him with his cardigan.
21. The Care Provider told Mrs X it could not carry out any tasks for Mr Y without reinstating his care plan.
22. On 6 November 2023, the family gave the Care Provider notice to end the care as they had found an alternative provider. Shortly after this Mr Y passed away.

Mrs X’s complaint

23. In early January 2024, Mrs X made a formal complaint to the Care Provider. Mrs X said the Care Provider overcharged her parents between August 2022 and August 2023 as it split the morning visit between Mr and Mrs Y. Mrs X also said carers regularly stayed for a minute over the allotted time and this created extra charges for Mr and Mrs Y. Mrs X also complained about the attitude of staff at the Care Provider after she reported these concerns and the way carers treated Mr Y in the final weeks of his life.
24. The Care Provider responded to Mrs X’s complaint in February 2024. The Care Provider said:
• A manager met with Mrs X to discuss Mr Y’s care package. They did not say costs would remain the same and left a price list with Mrs X.
• After Mrs X told it about the charges in April 2023, it looked into the matter and decided it had correctly charged Mr and Mrs Y for their care packages.
• There were times when carers stayed for longer than their allotted time. Feedback from carers said this was because Mrs Y asked carers to complete a task as they were about to log out of the visit.
• It apologised for the delay responding to Mrs X about the charging issue.
• It told carers not to support Mr Y during Mrs Y’s care calls. This was because Mr Y did not have a care plan and the Care Provider had to make sure it worked towards Care Quality Commission Regulations and staff were insured to help Mr Y. The Care Provider recognised it could have used some common sense and compassion and helped Mr Y by passing him his teeth and helped with his cardigan. The Care Provider apologised for not doing this.
• It could not find any evidence carers left Mrs Y without access to her chair lift remote. The Care Provider said the carer stayed for more time than their allotted visit on this day so was not in a rush to leave. The carer would have passed Mrs Y the remote if she had asked for it and it was not a task in her care plan to ensure she had the remote.
25. In late February 2024, Mrs X asked the Care Provider to consider her complaint at the next stage of its process.
26. The Care Provider sent Mrs X with its final response in March 2024. The Care Provider:
• Apologised for the lack of clarity around billing practices and said it would review its procedures.
• Apologised for the inconvenience caused by the discrepancies with carers overstaying for one minutes after visits. The Care Provider said it would put in place measures to make sure carers stayed to their allotted visit times.
• Apologised for any frustration caused by the attitude from management towards Mrs X when she tried to resolve the overcharging issues.
• Apologised for the incidents with Mr Y from early November 2023. The Care Provider said it would review its procedures and provide staff with extra training where this was necessary.
• Offered Mrs X £600 to cover the overstay of carers.
27. Mrs Y remained dissatisfied and complained to the Ombudsman.

Analysis

Overcharging of care fees

28. In August 2022, both Mr and Mrs Y had their own care plans. The number of hours carers attended their home did not increase, nor did the number of carers who visited. The only difference after August 2022, was the morning visit which lasted 1.5 hours was split between Mr and Mrs Y.
29. Mrs X said the Care Provider told her the costs of care would remain the same. There is no correspondence from this time showing what the Care Provider told Mrs X. Internal correspondence from the Care Provider showed staff said they did not discuss costs with Mrs X when they met in August 2022 and thought they left her with brochure showing prices.
30. On balance I am satisfied the Care Provider did not tell Mr or Mrs Y or Mrs X the price of care from August 2022 and that this would increase. This was fault. The Care Provider did get Mrs X and Mr Y to sign a contract with the terms and conditions, however the fee structure part of this document was blank. This was a good opportunity to communicate the costs of the two care packages to them in writing.
31. As the Care Provider was not assigning further carers or resource to Mr and Mrs Y and the hours carers were supposed to visit remained the same, I am satisfied on balance Mrs X believed the costs would remain the same.
32. Once Mrs X found out her parents were paying more each month for their care costs than they had been before August 2022, she raised this with the Care Provider. Mr Y’s care plan was then cancelled. Had the family known the costs of care would increase after the Care Provider completed a separate care plan for Mr Y, they may have decided to look at other options for Mr and Mrs Y’s care. Not telling the family the new amount of Mr and Mrs Y’s care costs has meant Mr and Mrs Y have paid out more for care than they thought they would.
33. In relation to carers overstaying visit times, the Care Provider has looked into this, apologised and offered Mrs X £600 to recognise the overstays. The Care Provider told us it calculated this figure as it found overstays between August 2022 and August 2023 which amounted to over 13 hours. It used its hourly rate to work out how much this came to and rounded it to the nearest hundred pounds. I am satisfied this is an appropriate remedy for the injustice caused to the family.

Attitude of staff when trying to resolve the overcharging

34. There are no meeting notes from the meeting Mrs X had with the Care Provider staff in July 2023. Mrs X said staff dismissed her concerns, however the Care Provider has said this did not happen. Without further evidence it is difficult to say what happened at the meeting. The Care Provider should have taken notes at the meeting for its own records.
35. The Care Provider did delay investigating Mrs X concerns about overcharging. Mrs X initially reported this to the Care Provider in April 2023. It was not until late June 2023, the Care Provider told her she would not get a refund and there were no issues with the billing.
36. After the Care Provider told Mrs X its position about the charges the family decided to remove Mr Y’s care package. Had the Care Provider investigated Mrs X concerns sooner, the family may have ended Mr Y’s care package earlier.
37. The Care Provider has recognised this and apologised for this delay. I am satisfied an apology is appropriate tor remedy any injustice this caused.

Standard of care

38. The Care Provider has recognised its treatment of Mr Y in early November 2023 should not have happened. Internal communication from the Care Provider showed carers should have used common sense and passed him his teeth and helped with his cardigan.
39. While it is welcomed the Care Provider recognised this, it did not offer any remedy for the distress and upset this caused Mrs Y.
40. In relation to carers leaving Mrs Y without access to her stair lift remote, I do not consider the Care Provider at fault. Making sure Mrs Y had access to the remote was not a task set out for carers to do. There is no evidence Mrs Y asked carers for the remote during their visit.

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Agreed Action

41. Within one month of my final decision the Care Provider should carry out the following:
1. Apologise to Mrs X for not telling her the cost of Mr and Mrs Y’s care from August 2022. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
2. Work out the difference in care costs between August 2022 and August 2023, that Mr and Mrs Y paid. The Care Provider should then pay this amount to Mrs Y.
1. Mrs X says this amounted to £12 per day. The Care Provider should tell us how much this was and provide evidence as to how it calculated this.
3. Pay Mrs Y £150 to acknowledge the avoidable distress and upset she experienced for the way Mr Y was treated in November 2023.
4. Take steps to ensure there are procedures in place so that customers are told how much their care package costs.
42. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

43. I have completed my investigation on the basis the actions of the Care Provider caused injustice. The Care Provider agreed to the above actions to remedy the injustice caused.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman