Summary: Mr X complained the Council has charged Mrs Y for more care hours than she received each week. He also complained that the care provider did not provide the agreed level of support. We found the errors and lack of clarity in the way the Council billed Mrs Y is fault. As was the failure to ensure Mrs Y consistently received the agreed level of care. These faults have caused Mrs Y and Mr X an injustice. Mrs Y did not receive the care she needed and had paid for. The Council will apologise and make payments to Mrs Y and Mr X. It will also review Mrs X’s care charges and its monitoring arrangements.

The complaint

1. Mr X complained the Council has charged Mrs Y for more care hours than she received each week. He also complained that the care provider did not provide the agreed level of support. Mr X said they arrived late and left early, and on some occasions did not attend for the scheduled visit at all or only one carer would attend. This meant Mrs Y did not receive the care she needed and had paid for.

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The Ombudsman’s role and powers

2. 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)
3. 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(1), as amended)
4. 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

5. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
6. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

7. Mrs Y lives in her own home and requires support with all aspects of daily life. She had care package of four calls each day with two carers for a total of 31.5 hours a week. Mrs Y funds her own care.
8. At a care review in February 2024 Mr X says Mrs Y’s family requested a reduction in the number of carers for the lunch and tea visits. This reduced Mrs Y’s care package to 24.5 hours a week. Mr X say this was agreed and the care provider implemented the changes from 13 February 2024.
9. However this change was not recorded in Mrs Y’s care and support plan. The support plan notes Mr X had contacted the care provider to raise concerns that only one carer was attending and was not staying for the full scheduled visit. The assessor noted Mr X did not want to reduce Mrs Y’s current package of care until an Occupational Therapist (OT) had assessed whether Mrs Y required two carers. The review officer recommended Mrs Y continue to receive four double handed care calls until an OT has assessed her needs. The officer recorded that this package as 31.5 hours per week at £20.50 an hour, giving a total weekly cost of £645.75.
10. In April 2024 Mrs X questioned whether the care provider had informed the Council of the changes to Mrs Y's care as the invoices did not reflect the reduced hours. She also asked the care provider to confirm Mrs Y’s care was reduced over the Christmas period so that this could be reflected in the invoices. The care provider confirmed it had made the necessary changes and had not charged for the cancelled visits.
11. Mr X then contacted the Council in May 2024 requesting revised invoices. The Council sent an invoice on 14 May 2024 adjusting the charge for the week 12 to 18 February 2024 from £408.56 to £317.77 based on 24.5 hours care. It charged for all further weeks based on 31.5 hours care per week.
12. The Council made further adjustments in an invoice of 13 June 2024, correcting the hours of care Mrs Y received at Christmas and reducing Mrs Y’s care to 24.5 hours from 19 February to 28 April 2024. Charges after this date continued at £408.56 for 31.5 hours a week.
13. An invoice dated 11 July 2024 then increased the rate to £661.50 for 31.5 hours care each week. In the following months the Council sent further invoices adjusting previous charges for Mrs X’s care to 24.5 hours a week but billing further periods at 31.5 hours a week.
14. In September 2024 Mrs X contacted the Council to raise concerns the Council had invoiced Mrs Y for care she had not received. It had also invoiced her for 31.5 hours care instead of 24.5 for the last three months. Mr X then made a formal complaint in October 2024.
15. The Council arranged a meeting with Mr X and Mrs Y to discuss their concerns on 4 November 2024. The care provider also attended this meeting. The records of this meeting note Mrs Y felt carers rushed her and she wanted them to treat her with respect. Mr X also told the meeting that when he visited Mrs Y he found her surroundings untidy and had installed a camera which would allow him to see how long the carers stayed.
16. The care providers noted the concerns and confirmed they would address them with the carers in order to provide a better service to Mrs Y.
17. The Council then responded to Mr X’s complaint on 15 November 2024. It confirmed it had addressed the discrepancies in Mrs Y’s care hours, which were now 24.5 hours per week, not 31.5 hours per week. The Council also noted Mrs Y did not want to change care providers and that the care providers had addressed Mrs Y’s concerns. It apologised for any distress and frustration caused.
18. Mr X was not satisfied with the Council’s response and asked for his complaint to be reviewed. He noted the most recent bill of 14 November 2024 was for 31.5 hours of care each week rather than 24.5 hours. In addition, he said the carers were still arriving late and leaving early and not providing the agreed support.
19. The Council responded on 8 January 2025 and said the care provider had been invoicing incorrect hours. It had identified that the commissioning team had not received a revised care plan to reflect the reduced hours which was why the care provider was still invoicing for 31.5 hours. The Council apologised that the necessary action was not taken when it first responded to Mr X’s complaint. It would remind officers to ensure care plans are updated and to ensure they identify these errors promptly.
20. The Council said the error meant its invoicing system had been issuing invoices for 31.5 hours, officers would then manually amend them each month so that Mrs Y was not overpaying for the care she received.
21. It also noted the care provider’s call logs showed there were weeks in March and April 2024 when Mrs Y received less than the four calls a day she should have. The call logs showed that on some days she received only one call which suggests she had long periods without a care call. The Council said the care provider had investigated this and had addressed the family’s complaints.
22. The Council apologised for the lack of quality care Mrs Y had received and offered to pay £700 compensation. Given there had been further problems with Mrs Y’s care since the meeting in November 2024, the Council suggested the family consider an alternative care provider.
23. Mrs Y changed to a new care provider in February 2025.
24. In March 2025 Mr X asked the Ombudsman to consider his concerns about the incorrect invoices and overcharging Mrs Y. He said this caused Mrs Y unnecessary stress and frustration and had taken up a great deal of his time to try and resolve.
25. In response to my enquiries the Council says there are a number of reasons for the differences in the invoices. It says the hourly rates increased in June 2024. Although Mrs Y was on the SPOT rate of £18.50 per hours, she was charged at the contract rate of £21 per hour.
26. Due to the configuration of its invoicing system the hourly rates had to be changed manually each month after the invoice had been generated and sent to Mrs Y. This would understandably cause confusion as Mrs Y would not see the changes until the following month’s invoice. Changes in the hours of Mrs Y’s care also needed to be changed manually.
27. The Council says that in overall terms it has now levied the correct charges for the period in question. Mrs Y has paid £27,224.15 for the period February 2024 to April 2025. Based on the information provided by the care provider the Council has reimbursed £907.47 for calls not made up to February 2025.
28. The care provider has also provided details of its own investigation into a complaint about Mrs Y’s carers arriving late in October 2024. This identified a pattern of double up carers logging in separately on arrival and at intervals of several minutes apart on occasions. This showed the need for service improvements for carers attending double up visits and the need for increased spot checks to corroborate logging in and out records.
29. Mrs Y’s care records also show many occasions when Mrs Y did not receive the agreed four visits a day or calls from two carers in the morning and evening.

Analysis

30. The way the Council billed Mrs Y was inaccurate and confusing. Mrs Y’s charges for the same period changed several times over a number of invoices.
31. As an example, in August 2024 Mrs Y received an invoice for the period 1 July to 4 August 2024 for 31.5 hours a week at £661.50 per week. This equates to an hourly rate of £21. In September 2024 Mrs Y received an invoice which adjusted the charges for 1 July to 4 August 2024 to 24.5 hours a week at a cost of £514.50. This again equates to an hourly rate of £21. The Council then made further adjustments for the charges for 1 July to 4 August 2024 in and invoice dated 12 December 2024. This charged Mrs Y £453.25 for 24.5 hours a week at an hourly rate of £18.50.
32. It should not have taken four months and three invoices to correctly charge Mrs Y for her care. The errors and lack of clarity in the way the Council billed Mrs Y is fault.
33. This fault will have caused Mrs Y and Mr X distress and frustration.
34. Although the Council is satisfied Mrs Y have now been charged the correct amount for her care between February 2024 and April 2025 I am not persuade this is the case. In February 2025 the Council sent Mrs Y an invoice for the period 6 January to 2 February 2025 charging an hourly rate of £21. A further invoice in March 2025 charged Mrs Y £21 per hour for the period 3 to 16 February 2025, when there was a change in care provider.
35. I have not received any evidence these charges have been adjusted to reflect the correct hourly rate of £18.50 per hour.
36. In addition, I am not persuaded the Council has properly considered the extent to which care calls were missed.
37. The Council has provided copies of Mrs Y’s care records. These detail the care provided by each carer on each visit. On the basis Mrs Y should have received four visits, two of which involved two carers, there should be six entries for each day. Only four days during the period 16 February to 4 December 2024 record six entries. For 19 days during this period there are no entries recorded and on a further 74 days only one entry is recorded. Many other days record only two or three entries.
38. This suggests that either a substantial number of Mrs Y’s care calls were missed or the care provider’s record keeping is extremely poor. It could be a combination of the two.
39. The Council offered to pay Mrs Y £700 compensation which it says was calculated on the basis Mrs Y missed a week’s worth of care at a rate of £20.50 per hour for 31.65 hour. This sum was then rounded up to include the time and trouble in pursuing this matter.
40. It is unclear how the Council determined Mrs Y missed just one week’s care, and it is disappointing it has applied the incorrect number of hours per week and the wrong hourly rate.
41. The Council also says it has reimbursed £907.47 for calls not made up to February 2025. But it has not provided an explanation for how it has arrived at this figure.
42. Based on the information currently available I am not satisfied the Council has adequately demonstrated Mrs Y has been correctly charged for the care she received.
43. The Council’s failure to ensure Mrs Y consistently received the agreed level of care is fault. This fault means Mrs Y has experienced a significant number of days over a sustained period when she has not received the care she requires. This is a significant injustice. In addition to reimbursing the charges for care not provided, I also consider the Council should make a symbolic payment to recognise the difficulties Mrs Y experienced when care calls were not made and she did not receive assistance with personal care or in preparing meals and drinks.

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Action

44. The Council has agreed to:
• apologise to Mrs Y and Mr X for the frustration and uncertainty, and the difficulties caused by the faults identified. 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.
• pay Mrs Y £750 to recognise the distress and difficulties she experienced when care calls were missed;
• pay Mr X £200 to recognise the frustration and uncertainty caused by the repeated failure to issue accurate invoices for Mrs Y’s care;
• review Mrs Y’s care charges to ensure she has been charged at the correct rate for the agreed number of hours between February 2024 and February 2025. Should this review identify any discrepancies the Council should provide a full explanation and reimburse Mrs Y any overpayments.
• review all relevant information to confirm the extent of any missed care calls between February 2024 and February 2025. The Council should then reimburse Mrs Y the cost of any care she has paid for but not received.
• If the Council calculates it should reimburse Mrs Y more than £1000 in respect of overpayments for care charges, it should include interest on the reimbursement.
• review its monitoring arrangements regarding services commissioned by other providers on its behalf.
45. The Council should take this action within one month of the final decision on Mrs Y’s complaint and provide us with evidence it has complied with the above actions.

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Decision

46. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman