Summary: Mrs X complained about the home care service provided by the Care Provider. The Care Provider was at fault for not providing written information about its service levels and issuing inaccurate invoices. This caused Mrs X uncertainty because she did not know what service levels to expect and whether she was paying the correct amount for her care. The Care Provider should make Mrs X a financial payment and carry out an audit of the care she received and the amount she paid for it over the previous 12 months. It should also review its processes to ensure clear service level information is available to its service users and it issues invoices which accurately record the amount of care received.

The complaint

1. Mrs X receives care at home. She complained that the Care Provider:
• consistently varied the time of arrival of her lunchtime call, with carers often arriving late;
• changed without her consent the conditions by which she could cancel a visit and not be charged for it;
• charged her for visits which she was forced to cancel last minute when carers did not arrive at the agreed time;
• failed to provide her with a breakdown of her visits to enable her to check the invoices were accurate;
• failed to provide her with a copy of her contract and terms and conditions when she requested it; and
• does not have a clear and easily accessible complaints procedure.

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The Ombudsman’s role and powers

2. The Ombudsman investigates complaints about adult social care providers and decides 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)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

5. I spoke to Mrs X’s son, Mr S, and considered the information he provided.
6. I spoke to and made enquiries of the Care Provider and considered its response. This included copies of Mrs X’s care records for 2018, her contract, the Care Provider’s complaints policy, the service user guide, Mrs X’s care plan and copies of correspondence between the Care Provider and Mrs X and Mr S.
7. I have written to Mr S and the Care Provider with my draft decision and considered their comments before I made my final decision.

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What I found

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
9. Regulation 9 says care providers must enable and support the person to understand the care or treatment choices available to them, make decisions about their care and provide them with the information they would reasonably need for this.
10. Regulation 17 says records relating to the care and treatment of each person using the service must be kept and be fit for purpose. Fit for purpose means they must be complete, accurate and up to date.

Background

11. Mrs X lives alone with a package of care which she arranged and funds herself. Since November 2017, she has received care at home from the Care Provider.
12. Mrs X has a care plan drawn up by the Care Provider. This details the type of support she needs. It states Mrs X:
• has no dietary needs; and
• she can take her medications herself but needs prompting by her carers. She has no time specific medications which she needs to take.
13. Mrs X signed a contract with the Care Provider when it began providing care in November 2017. This stated Mrs X would receive four 30 minute visits a day by two carers in the morning, at lunch, at teatime and in the evening. The times of these visits were not recorded in the contract.
14. Mrs X signed another contract in October 2018. This reduced the number of visits to three 30 minute visits a day. Other details remained the same as the previous contract.
15. On 3 December 2018, Mrs X complained to the Care Provider. She said that although she had mainly been happy with the care she had received, her lunchtime visit had become very variable and was frequently late by more than 30 minutes, and sometimes by 75 minutes. Mrs X said this caused her stress, worry and depression because she was diabetic and needed regular mealtimes. Mrs X stated the times of her visits were 9am, 12:15pm and 9pm.
16. Mrs X said that when the carers were late, her friend would prepare her meals. Mrs X would then phone the Care Provider and cancel the visit. However, Mrs X said that when she phoned to cancel her visit on 30 November, the Care Provider told her that she would be charged as the cancellation was made within 15 minutes of the call time. Mrs X said she had phoned at 12:35pm and so this was 20 minutes after her call time of 12:15pm.
17. Mrs X recorded in her complaint letter the outcomes she wanted. These included:
• confirmation in writing of her call times and confirmation the Care Provider would not change them without informing her in writing;
• an assurance these would be met within a 15 minute margin of the agreed time with no more than two visits a month outside the 15 minute margin;
• if the carers were going to be outside the 15 minute margin, they would contact Mrs X who could then cancel the visit with no charge;
• if the Care Provider was outside the 15 minute margin more than twice in a one month period, from that point onwards, it would not charge for any of the visits made on any day when a visit was late;
• details of all visits since she began receiving care where the Care Provider had made changes to visit times, been early or late or cancelled visits.
18. The Care Provider responded on 8 January 2018. It stated it had requested a meeting with Mrs X to discuss her complaint, but she had declined this. The Care Provider’s letter said:
• Mrs X’s visits were scheduled for 9am, 12:30pm and 9pm. The Care Provider apologised if Mrs X had been informed her lunchtime call was at 12:15pm;
• it could not guarantee it could meet the timescale of 15 minutes either side of the arranged call time. The Care Provider would give an assurance of 45 minutes either side with a call after 30 minutes if carers were running late to notify Mrs X of the new call time;
• Mrs X could cancel the call if carers were running one hour late from the scheduled time; and
• it could not provide the historical data Mrs X requested but could provide a weekly rota going forwards.
19. Mrs X remained unhappy and complained again to the Care Provider on 21 January. She said it had failed to respond to some of the points, namely:
• the Care Provider should confirm in writing when set call times were changed;
• if carers arrived outside the 15 minute margin more than twice in one calendar month, Mrs X would not be charged for any of the calls made that day;
• it had failed to provide the historical data she required;
• a 45 minute leeway to scheduled times was unacceptable; and
• recent verbal conversations with the Care Provider indicated Mrs X could cancel calls after 30 minutes without being charged.
20. Mrs X also made reference to the Care Provider’s letter of 8 January. She said this stated her morning call was at 9:30am. But the letter actually stated the morning call was scheduled at 9am.
21. The Care Provider replied on 27 February. Its letter said:
• it would not accept Mrs X’s requirement that she was not charged for any calls on the days carers were running over 15 minutes early or late;
• it could not provide historical data of when carers had been late over the previous 12 months;
• the scheduled times were 9:30am, 12:30pm and 9pm; and
• it had not told her verbally she could cancel calls without charge if carers were going to be more than 30 minutes late.
22. The Care Provider said if Mrs X remained unhappy with the conditions of her care visits and they could not come to any agreement, it would have no alternative than to serve 28 days notice to terminate the contract. The letter said “This is not what the company wants… but [we] cannot adhere to what you are asking for”.
23. Mrs X remained unhappy and complained, through her son, to the Ombudsman.

Ombudsman investigation

24. As part of my investigation, I contacted the Care Provider. It informed me that when it first assessed Mrs X it went through its service user guide with her which specified details of the times of her visits, the acceptable margins when carers were running late, when the Care Provider would inform clients if carers were running late and how and when clients could cancel visits without charge.
25. The Care Provider sent me this document. It contained none of the details specified in paragraph 23.
26. The Care Provider stated it used a system of recording whereby the carer logs in and out by phone when they arrive and leave the client’s property. As a result it has accurate records of when visits took place and their duration.
27. The Care Provider compared the times of visits on its December 2018 invoice with the actual times of visits Mrs X had recorded. It agreed with Mrs X’s records and confirmed the times recorded on the invoices were incorrect.

My findings

Details of Mrs X’s care

28. The process we expect in relation to the setting up of home care visits is as follows. Care providers should:
• document the duration of visits and the time they should occur. This information would usually be recorded in the personal care plan and/or the contract;
• provide written details of the margin of time clients can expect around the expected visit time;
• provide details of the system they have in place to let clients know if carers are going to be significantly late and when clients can cancel visits with no charge.
29. These expectations are in line with the Health and Social Care Act regulated activities.
30. There is no evidence the Care Provider gave Mrs X written details of any of the above information before she complained in December 2018. This led to a lack of clarity about the service Mrs X could reasonably expect. This is not in line with the Regulations and is fault.
31. As a result, Mrs X experienced injustice because this led to confusion and uncertainty over what levels of service she could expect from the Care Provider. In addition, it caused Mrs X unnecessary time and trouble because she then had to complain to the Care Provider in order to receive information she should already have had.

Records of visits

32. Mrs X has kept her own records of when carers arrived, and she has sent me this information for 1 – 27 December 2018. I have also looked at the Care Provider’s care records for the same time period.
33. Based on Mrs X’s records for 1 – 27 December 2018, carers arrived within 15 minutes of the set times on 69% of occasions. On four occasions they were more than 45 minutes late. The Care Provider’s records show carers arrived within 15 minutes on 88% of occasions and were late twice.
34. When providing a daily service, it is to be expected that there will be problems such as delays due to traffic or emergencies, which means carers may arrive late. Based on the records kept by Mrs X for December 2018, the delays she experienced were not unreasonable. So there was no fault in the care provided to Mrs X.
35. However, without written details of service levels, Mrs X could not know what she could reasonably expect. This is not in line with the Regulations and is fault.

Invoices submitted to Mrs X

36. We expect care providers to issue accurate invoices. If these include the times of visits, as opposed to just the duration, the times should be accurate.
37. The invoices submitted by the Care Provider do not accurately record when Mrs X’s visits took place. Instead, they record when the visits should have taken place. This is not in line with the Regulations and is fault.
38. Mrs X is left with uncertainty about whether the Care Provider charged her correctly in the months when she did not keep her own records. This is why she has asked the Care Provider to carry out an audit of previous months. Under these particular circumstances, Mrs X’s request is reasonable.

Request to see a copy of her contract

39. Mrs X complains she asked for a copy of her contract but the Care Provider did not provide this. I can see no record of Mrs X requesting this. Therefore, I will not investigate this further.

Complaints procedures

40. The Care Provider’s customer service guide contains information about how to complain. It also informs clients they can complain to the Ombudsman if they remain unhappy after the Care Provider has made its final response. These are satisfactory steps taken by the Care Provider. There is no fault.

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Agreed actions

41. Within one month of the date of the final decision, the Care Provider has agreed to:
• apologise to Mrs X for the unnecessary confusion and uncertainty she experienced when it failed to provide her with details of the service she could expect and sent her inaccurate invoices; and
• pay her £100 to acknowledge the time and trouble taken to pursue this complaint.
42. Within three months of the date of the final decision, the Care Provider has agreed to:
• carry out an audit of the last 12 months to determine whether Mrs X received the amount of care she was invoiced for. The Care Provider should reimburse Mrs X for any care she paid for but did not receive;
• review its invoices to ensure that they accurately record the amount of care received by the client; and
• review its procedures to ensure all service users have written information about visit times and durations, margins around arrival times, how and when users will be informed if carers are running late and when service users can cancel a visit at no cost.
43. The Care Provider should provide the Ombudsman with evidence it has carried out these recommendations.

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Final decision

44. There was fault leading to injustice. The Care Provider has agreed to my recommendations. Therefore, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman