Summary: Mr X complains the Council failed to provide clear information about charges for his late father’s care, did not properly investigate instances of overcharging and its response to his complaint was significantly delayed. We found there was fault in the information provided. We also found the investigation was not sufficient. We found the complaint response was late and insufficiently detailed. We recommended an apology, a further payment and actions to address the charging concerns Mr X raised.

The complaint

1. Mr X complains that the Council:
1. Provided conflicting and insufficient guidance about the care charges to expect when his father was discharged from hospital.
2. Failed to provide clear information about charges for care his father received at home.
3. Failed to properly manage the care provider and resolve matters when he complained they were incorrectly logging the times of care visits and that the care provider was exceeding and charging for more care than set out in his father’s care plan.
4. Took too long to respond to his complaints and its responses did not address the key issue of overcharging.
5. Failed to implement a care plan that recognised his father’s need for end of life palliative care.
2. Mr X complains the lack of action by the Council led to huge uncertainty about how much his mother needed to set aside for care fees. It led to his father being charged incorrectly for the care he was receiving and the matter caused significant anxiety and upset at a difficult time for the family.

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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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What I have and have not investigated

6. We are not investigating part a) of Mr X’s complaint. This is because Mr X refers to advice and information he was given by a member of NHS staff, rather than information provided to him by the Council. Complaints about the actions of the NHS are not within our jurisdiction. We will not investigate complaint e) as this was not part of the complaint Mr X made to the Council.

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How I considered this complaint

7. I spoke to Mr X and considered the information he provided. I asked the Council for information and considered its response to the complaint.
8. Mr X and the Council 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

Care Plans

9. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has and it must include a personal budget, which is the amount of money the council calculated it will cost to arrange the necessary care and support for that person.
10. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Charging for social care services: the power to charge

11. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17)
12. The Council should provide the person with a written record of its charging decision, explaining how the financial assessment has been carried out, what the charge is, and how often it will be made. That information should be provided in a manner the person can easily understand.

Process for seeking change to care plans

13. In the event that a council commissioned care provider is unable to meet a service user’s documented care needs, or they cannot do this in the time allotted, the correct process would be for them to raise this with the Council to seek a review of the care plan or agreement to a change it.

Short-Term Intervention Team (STIT)

14. This is a Council team providing short-term reablement care for people to regain independence who may need help following a fall, an illness or after a stay in hospital. The care provided is free for six weeks.

What Happened

15. 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.
16. Mr X’s father (Mr Y) received care at home for a number of years. Mr Y was a full cost payer.
17. In May 2023 Mr Y was admitted to hospital. When he was discharged, Mr X says he was told by an Occupational Therapist (OT) that his father would receive six weeks free care by the Short Term Intervention Team (STIT).
18. A discharge form completed by an Occupational Therapist (OT) referred Mr Y to the STIT. Elsewhere, the form noted that Mr Y had previously had carers twice per day but he required an increase in care and help with personal care.
19. A social worker called Mrs Y a few days after the referral. The social worker discussed Mr Y’s discharge and noted Mrs Y had expected her husband to be discharged with care from the NHS or the local authority. The social worker stated because Mr Y had an existing, open package of care, he would not be eligible for this. The notes of the call indicate the social worker discussed there would be a cost increase for the additional care calls Mr Y needed.
20. In a further conversation on 2 June Mrs Y asked for the care to include showers for Mr Y in the morning care call and asked if 30 mins would be sufficient for this. The social worker advised her that the care provider would assess this and the duration of care visits could always be amended if necessary. During the call the social worker told Mrs Y the likely amount of the cost increase would be £98 per week and Mrs Y asked for this to be put in writing.
21. Mr Y was discharged on 13 June and a letter was sent to Mrs Y. The letter confirmed Mr Y had been assessed as requiring an increase to four care calls per day by his existing care provider. It stated there would an increase in cost, but it did not say what this would be.
22. On 26 June Mr X queried his father’s care. He explained what the OT had said about Mr Y receiving six weeks of free care by the STIT. Mr X noted the letter they received did not say what the cost would be. A care manager advised him of the cost per week. Mr X also asked if invoices would reflect actual vs planned time providing care. The social worker stated this would have to be requested from the accounts department. The care manager confirmed that any issues about charging for care not received should be raised with them.
23. Mr X also explained that, on his mum’s behalf, he asked the care provider to reduce the care calls to three times per day to get the balance of care right for them. The decrease to three calls started on 26 June.
24. On 19 July the care provider contacted the Council stating that the morning care call needed to be for 45 minutes rather than 30. The Council’s records indicate that an officer tried to speak to Mr X about this on 19 July but did not reach him. A note on the Council’s records stated a care review would be carried out that week.
25. The care provider reiterated the request on 24 July and explained, sometimes it took an hour to do what was needed, but the average time required was 45 minutes.
26. A review of Mr Y’s care package was conducted on 25 July 2023. It includes reference to the care provider’s request for a longer morning call to fit in all that was needed. The review states that the Council had agreed this and told Mr X the call could always be reduced again if Mr Y’s mobility improved.
27. However, on 1 August Mr X explained he was not in agreement to the increase. He explained the family had been recording the times that carers came and went and the information provided by the care provider did not match what they had recorded. He suggested they monitor this further for two weeks. In further discussions the Council and Mr X considered the carers may be ‘logging in’ while in their car and not yet at the property.
28. Mr X took this up with the care company directly. The manager gave Mr X access to the software application (app) they used to record the location of carers when they logged into care calls (through GPS tracking information). They also agreed to go back and review where carers had been when they had logged in to Mr Y’s care calls and provide records. Mr X told us no records were provided. The care provider confirmed to Mr X that they were working to a 45-minute morning visit now, despite this not being agreed/updated in the care plan.
29. In late August Mr X provided the Council with examples from the care provider’s software app confirming carers had sometimes logged in to his father’s property six minutes before arriving and they had remained logged in for hours after they had left. Mr X noted their leaving time was later corrected, but it was not then recorded accurately.
30. During August and September, there was evidence Mr Y’s health was deteriorating and he was struggling to mobilise. So, equipment and changes to the his care were being discussed.
31. On 7 September, Mr X contacted the Council to question the increase in care charges and to request copy invoices. Later in September Mr X challenged the length of the visits being recorded by the care provider. He explained Mrs Y was recording the time the carers were arriving and leaving and it did not match the entries on the care provider’s systems. He said, on average, the care provider’s staff were actually spending 33 minutes at the property, but seeking to claim 45 minutes.
32. As at 19 September, officers could not gain agreement between Mr X and the Care Provider about the appropriate amount of time needed for the morning call, so they escalated to a manager.
33. On 20 September the Council’s care notes record a conversation between an officer and a hospice nurse who was visiting Mr Y. The nurse stated she believed Mr Y would need to be cared for in bed only. The nurse was in contact with Mr X about this. On 20 September Mr Y was re-admitted to hospital. I understand Mr Y sadly died a few days later.

Mr X’s complaint

34. In October 2023 Mr X complained to the Council about the charges for care and the failure of the Council to address his queries and provide information. He noted that invoices were sent two months in arrears so the issues were not picked up immediately. Mr X stated he was disputing the accuracy of the times logged by the carers based on daily monitoring of the carers arrival and departure times that his mother had been carrying out and comparison of this with the care provider’s data on their software app.
35. Mr X stated he had complained to the care provider that, at the time the carer’s arrival had been logged, there was no carer inside or outside of his parent’s property.
36. Mr X also complained that, when raising these issues he had been given conflicting information from different council staff. He was told initially by a care plan co-ordinator that the care provider had to charge for the contracted time only, and to charge beyond this would require a revised care plan. However, the Council’s accounts team told him this was not correct and the invoices followed a different charging structure. The accounts team stated the minimum call charge was 15 minutes at £5.25. They stated, if a call exceeded the agreed call time, a further 15 minutes would be charged for (whether or not the full 15 minutes was used). Mr X sought clarity about the charges that should be applied.
37. There was a significant delay in the Council’s response. This was sent in July 2024. In its response the Council stated the care logs showed, overall:

• the care provider made allowances for issues with Mr Y’s mobility, which resulted in longer care visits on occasions from the planned morning call length of 30 minutes. The Council stated, when planning care, the allocated time for each care call was estimated by a social worker. Sometimes for unforeseen reasons, care workers may have to work beyond the allocated time. In those situations, the care worker would record the additional time taken to make sure the service user was safe.
• the Council agreed with figures provided by Mr X about the length of calls, which it said, matched the care provider’s records.
• the care provider uses an electronic GPS system which automatically confirms the care worker’s location when they check into a care call. It would provide an alert of the carer had not checked in within a certain time-frame.

38. The Council noted Mr X questioned what had been communicated about payment terms by the Care Co-ordinator because this had not been reflected in his invoices. The Council repeated that the care provider, on occasions, had to over run the allocated time for a call to ensure service users were safe and their needs were met, but it did not comment on what the agreement for charging for such over-runs was.
39. In respect of the inconsistent information Mr X had been provided with, the Council apologised for the difficult time Mr X had endured, and offered £385 which it said was ‘as a result of the investigated’. Although it acknowledged Mr X had been given inconsistent information the Council did not clarify the correct way that care calls should be charged.
40. Mr X was unhappy with the Council’s response. He noted it focused on situations when carers had to spend longer than planned with a service user to meet needs. He said this was not the main issue he was raising. The central point of the complaint was that carers were logging themselves as present at his parents’ property when they were not. Mr X reiterated his complaint and sought an escalation. He noted the care company told him that times logged should be when a carer enters and leaves the property.
41. Mr X set out what the Council’s finance department had stated (that there was a minimum additional charge for 15 minutes of care whether or not this was fully used). So, short ‘overruns’ on a regular basis would mean quite a significant increase in costs.
42. Mr X explained he had kept records of the visits for three weeks and compared these against the care home’s charges. He stated 43% of the visits were incorrectly charged because of incorrect times being logged and charges for an additional 15 minutes of care as a result.
43. Mr X sought a refund of overcharges for the whole period based on his findings. He also wanted the Council to be clearer about how self-funding services users’ bills were worked out and for better information to be provided upfront about the expected costs.
44. The Council’s final response to the complaint apologised for the delay in responding to the complaint and agreed to increase the amount of compensation offered from £385 to £585 as a result. In a separate email the Council made further comments on the charges. It set out a slightly different explanation of the cost of care calls. This included some allowance for overrunning calls. For example, it stated a call between 0 - 17 minutes was charged as a 15 minute call, a call between 18-22 minutes would be counted as a 20 minute call, and so on. It agreed Mr X could raise a complaint with the Ombudsman if he remained unhappy.

Was there fault by the Council

Information about care charges

45. When being discharged from hospital Mr Y needed more care at home than he had previously received. I found the Council did confirm to Mrs Y prior to discharge that there would be an increase in care costs as a result. The Council told Mrs Y verbally what the increase in cost was likely to be. However, they did not include it in the follow up letter sent to Mrs Y. I found on balance this was fault, but it did not cause any significant injustice in itself because the information had been provided.

Need for greater time to meet needs

46. Towards the end of July, the care provider reported to the Council that they could not meet Mr Y’s needs in the allotted 30 minutes morning care call. They sought an increase to 45 minutes. This was the correct process for the care provider to follow in that situation. It allowed a review of Mr Y’s care plan. The Council documented that it had agreed the increase. However, this was a decision reached without Mr X and Mrs Y’s agreement. While the decision was no doubt made with Mr Y’s best interests in mind, confirming the care provider could change the care plan without the family’s agreement was fault.

Issues with call logging times

47. At around the same time that the care provider sought more time to meet Mr Y’s needs in the morning, Mr X had raised his concerns that carers were not logging their start and end times correctly, so they were spending less time actually at the property than they were charging for. As a result, he questioned whether there was a need for longer morning calls, when he believed the carers were not always providing care for the full 30 minutes they were currently paying for.
48. When Mr X raised the issue with the care provider, it was not quickly resolved. While the care provider gave access to Mr X to their GPS app, they did not provide other information they had agreed to. This meant, during August Mr X and Mrs Y felt they need to keep their own records of the carers arrival and departure times, from which Mr X later highlighted discrepancies. Had the issue of log-in times been addressed by the care provider more fully, this may have been avoided.
49. The Council’s response to Mr X’s complaint was significantly delayed. The response was also repetitive. It did not properly address what Mr X had said or set out clearly how the Council had reached its view. The Council also conflated the issue of incorrect call logging and the need for longer calls to meet needs. I found the delay and quality of the response represented fault.
50. On the issue of whether care calls were being accurately logged, the Council gave us more information. It told us that the care provider’s software highlighted if carers logged in as present at a property when they were more than 200m away from it. It found the no evidence that this had happened. As a result, it found only small discrepancies in recorded log in/out times.
51. While I note the carers may have been in the vicinity (within 200m) of Mr and Mrs Y’s property at the time they logged into care calls, Mr X and Mrs Y are clear that there were occasions when they were logged in but not there. In the event this was happening, the timed period of the call would start before the carers started the visit. Even small amounts of incorrect logging could affect charging and in Mr Y’s case it led to confusion about how much time was needed to meet needs properly in the mornings.
52. The Council’s contract with the care provider states that care visits must only be logged from the service users property. It states this must only be done with the service user’s landline or by scanning a physical chip. Following the practice set out in the contract would have ensured that care visit times started only when carers were present. So, while it seems the Council had looked at data from the care provider when it responded to the complaint, I have found that the Council did not adequately address why there instances of carers seemingly logging care visits when they were not present at Mr and Mrs Y’s property and the impact of this. I found this was fault.
53. In response to Mr X, the Council had already agreed to pay Mr X £585, mainly to recognise issues with its complaint handling.
54. In response to our enquiries the Council acknowledged that, because it had not gained full agreement to lengthening the morning care calls, any additional time that the care provider logged over and above that which was contracted should be refunded. It established for the period 24 July to 17 September this was £453.25. This is not the full period that Mr Y received care for. He was discharged from hospital in mid-June. Based on Mr X’s assessment and taken from the care provider’s actual charges from 13 June to 20 September, the additional costs levied appear to amount to £565. Therefore, I have recommended this is the additional amount that the Council deducts from the outstanding bill in addition to the £585 already agreed.
55. I have also recommended the Council reviews the way the care provider logs in at properties to bring this in line with the requirements of its contract.

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Action

56. Within four weeks of our final decision:
57. The Council should send a written apology to Mr X for not having properly investigated the points he raised in his complaint and for the significant delay in responding. The apology should adhere to our guidance on making effective apologies. This can be found on our website, within our Guidance on Remedy here.
58. To recognise that some care calls are likely to have been affected by incorrect logging of the carers’ arrival and departure times and the morning call time was increased without the family’s full agreement, the Council should deduct an amount of £565 from the final bill.
59. To recognise the time and trouble Mr X and Ms Y were put to in pursuing the complaint and the delays in its response, the Council should also deduct the already agreed £585 from the outstanding bill.
60. The Council should review further with the care provider why carers are, at times, logging into care visits prior to their arrival at a given property. They should review the requirements of the contract and consider implementing the requirement to log into properties using the service users telephone or a chip kept at the property. It should write to us to explain the action it will take to address this.
61. The Council should provide us with evidence it has complied with the above actions.

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Final decision

62. There was fault by the Council.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman