Summary: Mr X complained, on behalf of his grandmother Mrs Y, that the Care Provider incorrectly charged her for care she did not request or receive. The Care Provider’s actions caused Mrs Y uncertainty, which is an injustice. The Care Provider has agreed to apologise, repay Ms X for care it should have cancelled, and implement service improvements.

The complaint

1. Mr X, on behalf of his grandmother Mrs Y, says the Care Provider invoiced and charged Mrs Y for care she did not request or receive. He says the Care Provider has not provided the invoices or corrected the overcharging. He also complained the Care Provider committed a data breach when it obtained Mrs Y’s statements from her bank without her consent. Mr X says this has resulted in financial loss and caused Mrs Y distress.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
3. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC). 

Back to top

What I have and have not investigated

7. I have not investigated Mr X’s complaint that the Care Provider committed a data breach. This is because the Information Commissioner’s Office, the organisation that deals with data protection, is best placed to deal with this issue.

Back to top

How I considered this complaint

8. I considered evidence provided by Mr X and the Care Provider as well as relevant law, policy and guidance.
9. Mr X and the Care Provider now have an opportunity to comment on my draft decision. I will consider their comments before making a final decision.

Back to top

What I found

Relevant legislation

10. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.
11. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
12. Regulation 19 states that providers should give timely and accurate information about the cost of their care and treatment to people who use their services. To meet this regulation, 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.

What happened

13. In 2023, Mrs Y arranged and self-funded a domiciliary care package with the Care Provider Live Long Live Well Ltd, also known as Heritage Healthcare. The care arrangements were a 30-minute care visit every morning six times per week, in addition to a two-hour companionship call, and one-hour of personal care per week.
14. In mid-November 2024 Mrs Y was admitted to hospital. Mr X asked the Care Provider to cancel Mrs Y’s scheduled care visits while she was in hospital. The Care Provider cancelled six of the eight scheduled visits but invoiced her for the remaining two.
15. The Care Provider said the hospital’s discharge team indicated it would only discharge Mrs Y if she agreed to have four care visits per day, due to the extent of her ill health and the care she subsequently required. The Care Provider then spoke to Mrs Y and discussed a provisional package of care for the first seven days post-discharge. It agreed to four visits per day: 1 hour for breakfast, and 30 minutes each for lunch, dinner, and bedtime. Mrs Y said she was happy to proceed with the arrangement but explained she was not sure what care she would need once she was at home.
16. Mrs Y was discharged from hospital towards the end of November. The Care Provider said it understood that Mrs Y was due to be discharged on the 25 November. However, it had received a call from the hospital on Friday 22 November indicating that Mrs Y might be discharged sooner than this.
17. The Care Provider said it had phoned the hospital to establish what day and time Mrs Y would be discharged so it could put a provisional package of care in place for a “recovery period” for Mrs Y as soon as she was back at home. The hospital advised the Care Provider it was unlikely Mrs Y was going to be discharged from hospital that day.
18. Mrs Y was discharged that evening. The Care Provider said the hospital advised of Mrs Y’s discharge later in the evening, once she was at home. The Care Provider sent an on-call carer to Mrs Y’s home at approximately 9pm, but Mrs Y had already gone to bed and so the carer left without seeing her.
19. The next day, the carers visited Mrs Y three times.
20. Following Mrs Y’s discharge home, the Care Provider said it spoke to her multiple times and asked her if she would like to reduce the level of care she was receiving. It said she advised she wished to keep things as they were until January 2025.
21. At the beginning of December, Mr X emailed the Care Provider and asked to cancel Mrs Y’s care over the Christmas period as he would be with Mrs Y, so the care visits were not necessary. The Care Provider confirmed it would cancel the visits.
22. Mr X emailed the Care Provider and queried why Mrs Y had been charged for two care visits while she had been in hospital. He also asked why Mrs Y had been invoiced for longer care visits than agreed on some occasions following her discharge. He further questioned who had agreed the post-discharge package of care and said neither he nor Mrs Y had been involved in the decision-making.
23. The Care Provider replied to Mr X in mid-December. It explained that, in line with its policy, it had charged Mrs Y for two care visits as it required two weeks’ notice for any cancellations. It said it had managed to cancel the other six visits for Mrs Y, without charge, as it had been able to rearrange staff rotas to accommodate the change. It also explained the extended care visits had been due to Mrs Y needing extra care in the weeks following her hospital discharge. It explained, due to her health, she needed more support at times, and the visits had therefore run over the scheduled time. It said it extended another of the visits as it had taken Mrs Y to a hospital appointment.
24. Mr X emailed the Care Provider in January 2025. He complained the care staff had visited Mrs Y at the end of December, despite his request to cancel the care. He said Mrs Y had also phoned the Care Provider to request the cancellation and had requested that the care restart on 2 January. He was concerned the Care Provider had not checked in with Mrs Y to see if she wished the care arrangement to remain or change, and Mrs Y had been left feeling vulnerable as a result. Further, he complained about the Care Provider’s handling of Mrs Y’s post-discharge care, and he said it had missed a care visit the day after she was discharged.
25. The Care Provider issued its response in January. It said it had responded appropriately following Mrs Y’s hospital discharge and had put together a team of carers to carry out the care visits over the weekend, despite the hospital’s discharge team stating Mrs Y would not be discharged until after the weekend. It also said the hospital had told it, and Mrs Y, that she would only be discharged on the proviso she would receive four daily visits, due to the extent of her ill health. It also said it had missed a visit the day after her discharge as it had not expected her to be sent home that early and therefore did not have staff availability to make the fourth visit.
26. Mrs Y moved to a new care provider in June. Mr X approached the Ombudsman in the same month.

Analysis

Care visit cancellations

27. The Care Provider says it charged Mrs Y for two of the scheduled care visits while she was in hospital. I have reviewed the Care Provider’s policy, which states the Care Provider requires two weeks’ notice to cancel any planned care visits. The Care Provider charged for the two visits in line with its policy. To its credit, the Care Provider also explained it was able to cancel six further care visits during the two-week period Mrs Y because it was able to rearrange staff rotas in time. However, it could not do this for the initial two visits.
28. Mr X also said the Care Provider incorrectly charged Mrs Y for a care visit he had asked to cancel in late December, because he would be visiting Mrs Y and she did not therefore require the care. I have reviewed correspondence between Mr X and the Care Provider and can see he asked at the beginning of December to cancel the visit, therefore giving the required cancellation notice period.
29. However, I have reviewed the corresponding invoice and can see the Care Provider failed to cancel this visit and charged Mrs Y a total of £112 for four visits throughout the day. Mr X gave adequate notice, and a legitimate reason, to cancel. He said Mrs Y also requested the cancellation, though I have no evidence of this call and cannot make a finding on it.
30. I cannot say Mrs Y actively refused the care when the carers arrived, but that is not material, as she had taken steps to cancel in advance. I therefore find the Care Provider’s failure to act on the cancellation request caused Mrs Y a financial injustice, as she was charged £112 for care she did not require. I have recommended a suitable remedy below.

Care package following hospital discharge

31. Following Mrs Y’s discharge from hospital, she received four care visits per day. Mr X queried who was involved in the care planning following her hospital discharge and says Mrs Y was not involved in the care planning. He said the Care Provider did not explain to him and Mrs Y how the care package was agreed.
32. The Care Provider said the hospital’s discharge team would discharge Mrs Y only if she agreed to have four care visits per day, due to her physical health. The Care Provider’s case notes show that it did have a conversation with Mrs Y while she was in hospital about the need for increased care visits, which she agreed with. The Care Provider also said it spoke with Mrs Y throughout her hospital stay and she indicated she was happy to receive the four care visits per day, though she did say she was not sure what level of care she would need once discharged. It told the Ombudsman that senior nursing staff at the hospital were involved in these conversations and all parties agreed to the care package.
33. Further, it also said it spoke to Mrs Y about the level of care she was receiving again in December, and she indicated she wished to keep the visits as they were until January 2025. I am satisfied the level of care arranged for Mrs Y was suitable given the circumstances, and the Care Provider considered Mrs Y’s needs. The Care Provider’s contemporaneous notes show it did discuss this with Mrs Y, and sought her agreement and views, before implementing the care package. Mr X queried why the Care Provider did not discuss the care package with him. The Care Provider’s position is that he had no formal role in her care arrangements and that she had capacity to agree the package herself. On that basis, there was no obligation to involve him, and I find no fault on this point. Further, the Care Provider’s decision to arrange four visits per day, in consultation with Mrs Y, was one of professional judgement. It considered this best for her needs, and it is not the Ombudsman’s role to challenge this, given the decision was made properly.
34. However, the Care Provider has not shown any evidence to suggest it gave Mrs Y this information in writing. As set out above, regulation 19 of the Health and Social Care Act 2008 stipulates providers must provide such information in writing. The Care Provider should have formalised any changes to Mrs Y’s care, particularly where additional costs were incurred, in writing.
35. This is particularly important in the context of vulnerable people. Its failure to do so placed Mrs Y in an unnecessarily vulnerable position. I cannot say whether Mrs Y would have agreed to the extra care had the additional charges been put in writing, though the evidence suggests she did agree to the charges verbally.
36. Mr X asked the Ombudsman to obtain Mrs Y’s hospital discharge records. He said these would show the Care Provider knew when Mrs Y would be discharged, contrary to what it has said. I do not consider it proportionate to obtain these records. I have reviewed the care visit schedule, which shows only one missed visit on the day after Mrs Y’s discharge. Even if the Care Provider had known of the discharge date, any resulting impact would be limited to that single visit. Mrs Y was not charged for this visit, and there is no evidence it caused her any further injustice, so the records would not materially affect either my findings or the remedy.
37. The Care Provider told the Ombudsman it is certain she would have agreed to the care if put to her in writing. However, at the point Ms X was discharged, she was unwell and in circumstances where she could not reasonably be expected to retain or query the details of what had been agreed. Without a written record, she had no means of verifying what had been agreed, the cost of care agreed, or sharing that with people supporting her. This led to uncertainty for Mrs Y. have recommended a suitable remedy to address this injustice below.

Missed care visits

38. As outlined above, the Care Provider arranged to visit Mrs Y four times per day for the period initially following her discharge from hospital. Mr X said the Care Provider failed to visit Mrs Y on the evening of her discharge from hospital, leaving her vulnerable and without suitable care.
39. I have reviewed the Care Provider’s case notes. I can see that it proactively contacted the hospital on the day of Mrs Y’s discharge, which was a Friday, and was advised by the hospital’s discharge team it was very unlikely she would be sent home that day. The Care Provider therefore arranged the package of care for the following Monday, when it was told it was likely she would return home. However, the hospital phoned the Care Provider that evening and advised she had been discharged and was back at home. The Care Provider did not become aware of Mrs Y’s discharge from hospital until after it had happened.
40. The Care Provider arranged for its on-call carer to visit Mrs Y that night, but she was already in bed, so the carer did not see her. To its credit, the Care Provider arranged, at short notice, a same day visit to Mrs Y. It could not have arranged care sooner since it was advised it was very likely Mrs Y would still be in hospital. Mr X said the Care Provider invoiced Mrs Y for this visit, but the invoice does not show any charges applied for that date.
41. Mr X also said on the day following Mrs Y’s hospital discharge, the Care Provider failed to deliver four care visits as required by the care package and only visited her three times. As stated above, the Care Provider was given no opportunity to bring forward the care package start date as Mrs Y was discharged without its involvement. It took reasonable and proactive steps to establish Mrs Y’s likely discharge date and arranged care accordingly. That it was unable to visit Mrs Y four times reflects the practical constraints of mobilising a care package at short notice following an early discharge.
42. Mr X also says Mrs Y was invoiced for four visits; however, the invoice suggests she was only charged for three visits. I find no fault on this element of the complaint.

Extended care visits

43. Mr X said following Mrs Y’s discharge from hospital, some of the care visits ran over their scheduled times, and Mrs Y was subsequently invoiced for the additional costs incurred. In response to my written enquiries, the Care Provider explained that one of the visits ran over because a carer had taken Mrs Y to and accompanied her at a hospital appointment. It explained the remaining visits overran by between 20 and 40 minutes because, following her discharge, Mrs Y required a higher level of care than she had done previously. This occasionally resulted in visits lasting longer than planned, and the level of support she required could vary day to day.
44. The Care Provider has provided contemporaneous notes from the visits and the reasons provided for the overruns seem reasonable given the circumstances. These include, for example, administering medication at Mrs Y’s request after first checking with a pharmacist, in addition to the usual care delivered. The overruns were also infrequent. I do not find any resulting injustice because of the extended care visits. Mrs Y received care she ultimately needed. Had the care visits not run over, Mrs Y would likely have been left without care she required.
45. However, there is no evidence the Care Provider notified Mrs Y formally, or communicated in writing, that there would be any excess costs incurred by any visits that ran over. It told the Ombudsman it informed Mrs Y verbally, though I have not seen supporting evidence of this. We also expect care providers to inform service users in writing.
46. Given the Care Provider has demonstrated the extended care visits were reasonable and necessary in the circumstances, I cannot say Mrs Y would have refused the further care had the Care Provider told her in writing she would incur further charges. However, Mrs Y received invoices for care costs she had no prior written notice of. This caused her uncertainty and denied her the opportunity to query or understand the charges when they arose. This is an injustice regardless of whether the underlying charges were justified. I have recommended a suitable remedy to address this injustice below.

Back to top

Agreed action

47. Within one month of the final decision statement the Care Provider has agreed to:
1. Apologise to Mrs Y for the uncertainty caused by its actions.
2. Refund £112 for the care Mrs Y cancelled on 29 December 2024.
48. Within three months of the final decision the Care Provider has agreed to implement a procedure requiring it to notify service users in writing of any changes to their care plan and any associated changes to care costs before those changes take effect.
49. The Care Provider should provide us with evidence it has complied with the above actions.

Back to top

Final decision

50. The Care Provider’s actions caused Mrs Y an injustice. The Care Provider has agreed to issue an apology, a refund of fees, and service improvements to address this injustice.

Back to top

Investigator's decision on behalf of the Ombudsman