Summary: We uphold Mrs X’s complaint about the Care Provider’s actions when Mrs Y’s needs changed, requiring a second care worker to attend care calls. The Care Provider failed to update Mrs Y’s assessments and care plans when she came out of hospital. It failed to inform her attorney in writing in advance of a significant increase in the cost of Mrs Y’s care. This was not in line with regulations or guidance. The contract wrongly signposted the attorneys to the Care Quality Commission for complaint handling and the complaint response also did not signpost us. The Care Provider will apologise and make changes to the Care Provider’s contract and complaint procedures.

The complaint

1. Mrs X complained about Executive Carers Ltd (the Care Provider) who provided home care to her relative, Mrs Y until March 2025. Mrs X complained the Care Provider changed the agreed package of care for Mrs Y in around October 2024 without informing Mrs Y’s attorneys and issued a new contract in January 2025 which was only signed by one of the attorneys.
2. Mrs X said this caused avoidable distress and a financial loss.

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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. (Local Government Act 1974, sections 34B and 34C)
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(1), 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 considered evidence provided by Mrs X and the Care Provider as well as relevant law, policy and guidance.
7. Mrs X and the Care Provider 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

Relevant law and guidance

8. A lasting power of attorney (LPA) appointing attorneys jointly and severally means one attorney can make a decision independently of the other(s). It means attorneys do not need to agree on every decision, for example if one is unavailable. Any attorney can sign documents and make decisions on their own.
9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC) issued guidance in March 2015 on meeting the regulations (the Guidance.) The Ombudsman considers the 2014 Regulations and the Guidance when determining complaints about poor standards of care.
10. Regulation 9(3) of the 2014 Regulations says the Care Provider must carry out an assessment of the person’s needs and preferences for care and treatment. This must be done collaboratively with the person or their representative. Guidance explains:
• Providers should give relevant information and support to make sure people understand the choices available to them.
• Assessments should be reviewed regularly, including when people are transferred, readmitted and discharged.
• People using services or their representatives must be given information that describes the costs/fees and tariffs associated with care and treatment.
11. Regulation 12(i) of the 2014 Regulations says a care provider must provide care and treatment in a safe way including by working with health professionals to ensure the health and welfare of residents.
12. People have a right to timely and accurate information about the cost of care. Providers must make written information available about fees, contracts and terms and conditions. This should usually be provided before the service starts. (Care Quality Commission Registration Regulations 2009, Regulation 19 (fees))
13. Care providers are required to operate an effective complaints procedure. (Regulation 16 of the 2014 Regulations). Guidance says appropriate action must be taken without delay to respond to any failures identified and information must be made available which includes how to escalate a complaint to other appropriate bodies if the person is not satisfied with how the provider manages their complaint.
14. Regulation 17 of the 2014 Regulations requires a care provider to keep accurate, complete and contemporaneous records of care and treatment and decisions taken about care and treatment.

What happened

15. Mr A and Mrs B (Mrs Y’s other relatives) hold joint and several LPA for Mrs Y for finances and health and welfare. The Care Provider provided four care calls a day for Mrs Y, with one care worker. Mrs B signed a contract for Mrs Y’s home care in 2022.
16. Mrs Y went into hospital in September 2024. She was discharged back to her home at the end of September 2024 and her care calls with the Care Provider resumed, this time with two care workers each call.
17. I asked the Care Provider to give me copies of its updated or reviewed assessment and care plans for Mrs Y. The Care Provider sent me a copy of an NHS occupational therapy (OT) moving and handling assessment dated October 2024 which said Mrs Y required two care workers for all transfers, using a sit to stand aid. The Care Provider did not share copies of its own updated assessments or care plans for Mrs Y.
18. I also asked the Care Provider to share copies of an agreed written call schedule with Mrs Y’s LPAs following her discharge from hospital in September 2024. It did not provide this.
19. The Care Provider sent me a summary of its contact with the LPAs and third parties:
• The Care Provider liaised with the NHS OT in the middle of October 2024. The OT said one care worker could be trialled using the sit to stand aid, but her professional view was two care staff were necessary because of Mrs Y's anxiety and unpredictability.
• Also in the middle of October, the OT told the Care Provider Mr A had spoken to her and he was angry and upset, demanding a reduction to a single care worker.
• The Care Provider also spoke to Mr A about an invoice and double-handed care since Mrs Y’s discharge. He was unhappy with the cost and said Mrs Y may need to go into residential care.
• The Care Provider also spoke to a council social worker at the end of November. The council had assessed Mrs Y for public funding for her care. Two care workers were considered necessary for all four calls.
• At the start of December, Mrs Y was observed to be struggling using the sit to stand aid, leaning back and letting go. The Care Provider made an urgent referral to the OT.
• In the middle of December, the OT reported the transfers were appropriate and recommended two care workers in the morning and single for the remaining calls.
• At the start of January 2025, Mr A was noted to be unhappy with paying for two care workers. A nurse had raised concerns that care workers could not change Mrs Y’s pads safely with one care worker and the Care Provider’s view was it could not continue to care for Mrs Y safely with one person only.
• A social worker from the council discussed Mrs Y’s case with the Care Provider and noted Mr A had cancelled Mrs Y’s care raising safety risks. The social worker planned to refer Mrs Y’s case to the Public Guardian due to the LPAs not acting in Mrs Y’s best interests. The social worker was going to request council funding.
20. Mrs B signed another contract for Mrs Y’s care in January 2025. This set out the increased rates for care for 30, 45 and 60 minutes per care worker. It said a care package could be reduced with two weeks’ notice. The contract said that if a complaint was not resolved satisfactorily by the Care Provider, it should be referred to the Care Quality Commission.
21. The Care Provider issued invoices once a fortnight. They clearly set out the length of each call, said what time and day it was and give a breakdown of the minutes spent and the cost. From 27 September 2024, the invoices set out the attendance of two care workers each visit with two entries. The fee per care worker, per visit is included.
22. Mrs Y’s care with the Care Provider ended in March 2025.
23. Mrs X and the Care Provider exchanged emails between March and May 2025 about the matters that led to her complaining. The Care Provider said professionals concluded Mrs Y was unable to weight bear and so two care workers were needed to reduce risks to Mrs Y and to care staff. Mrs B was made aware of this. Mrs X asked to access the Care Provider’s on-line care recording system for Mrs Y and was told this was not possible as she was no longer a client. The Care Provider also told Mrs X that it required both LPA’s to give permission for her to receive information about Mrs Y. But the LPAs could sign a contract individually as the document was joint and several.
24. The Care Provider’s response to the complaint in May 2025 said:
• The decision to increase to two care workers was a multi-agency one involving external professionals
• It consulted with Mr A as LPA
• The agreed visit schedule was:
1. Morning: 45 minutes
2. Lunch: 30 minutes
3. Tea: 30 minutes
4. Bed: 30 minutes.
• Invoices were issued to one attorney every two weeks
• The rate applies per care worker.
• The contracts were signed by one legal representative. This was acceptable because the attorneys were appointed jointly and severally.
• The Care Provider sought permission from both LPAs about dealing with her (Mrs X) as she was not an LPA.
25. The Care Provider’s complaint response did not signpost Mrs X to the LGSCO.
26. The Care Provider told me Mrs Y’s care plan was ‘amended outside to inform the care workers of double handed calls’. However, it has not provided any written evidence to support this claim.

Findings

27. There was fault by the Care Provider. It did not carry out its own re-assessment or review of Mrs Y in September 2024, or issue updated care plans to reflect her change in mobility needs. The Care Provider says it amended the care plans, however the documents it has supplied for this investigation have not been amended to reflect the change in Mrs Y’s needs. This was not in line with Regulations 9(3) or 17. Written notification of the increase in cost should also have been given to at least one of the LPA’s in September 2024, which was not in line with Regulation 19 of the 2009 Regulations.
28. The above faults caused avoidable frustration and confusion when the LPA started receiving increased invoices. The Care Provider’s records indicate it made one of the LPA’s (Mr A) aware of the reason for the increase in October 2024. He could have given notice, or asked for different provision, but he did not. So the injustice is limited to avoidable confusion, anger and frustration upon receiving the first large invoice.
29. The Care Provider liaised regularly with the OT and with social workers to ensure the assessment for two care workers remained appropriate. This was good practice and in line with Regulation 12(i).
30. Complaint handling was not in line with our expectations or Regulation 16 of the 2014 Regulations which was a further fault because:
• The contract wrongly says people should complain to the Care Quality Commission once they have used the Care Provider’s own complaint procedure. This is wrong. CQC do not deal with individual complaints.
• The complaint response did not signpost us. This is not in line with our expectations and was fault which may have caused some confusion to the LPA signing the contract, although not to Mrs X who complained to us anyway.
31. It was not fault for the Care Provider to have contracted with one of the LPA’s only in January 2025 because the power was held jointly and severally which allows one of the attorneys to act alone.

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Agreed Action

32. Within one month the Care provider will:
1. Apologise. 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. Amend its contract to include contact details for the LGSCO.
3. Have a standard complaint response template which includes details of how to contact the LGSCO at the end. (See Adult social care complaints – frequently asked questions - Local Government and Social Care Ombudsman for sample wording)
4. Remind relevant staff to complete reassessments/reviews and update care plans when a client transfers from hospital with a change in needs.
33. The Care Provider should provide us with evidence it has complied with the above actions.
34. I have not recommended a reduction in the invoices, because Mrs Y received the care charged for; the attorneys did not give notice at the time the invoices increased and so payment is due.

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Decision

35. I find fault causing injustice. The Care Provider has agreed action for the Care Provider to remedy the injustice.

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Investigator's decision on behalf of the Ombudsman