Summary: Mrs B complained APT delayed issuing invoices. APT also delayed in responding to Mrs B’s concerns. We suggest APT take action to acknowledge the time and trouble Mrs B has spent pursuing the matter.

The complaint

1. Mrs B is concerned that APT Care Limited (APT) failed to issue invoices for Mrs D’s care in a timely way. This resulted in Mrs B discovering the account was in arrears of over £40,000 which was very distressing. She would like to ensure this situation does not occur again. Mrs B also spent considerable time and trouble trying to get APT to respond to her concerns.

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The Ombudsman’s role and powers

2. 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)
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. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. Although Mrs B became aware of the issues in 2018, she has been pursuing APT since that time to resolve the matter. It APT’s failure to respond in a reasonable time to Mrs B’s complaints that has caused the delays. I therefore consider there are good reasons to investigate now.

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How I considered this complaint

6. A colleague has discussed the complaint with Mrs B. I have considered information from Mrs B and APT including complaint correspondence and the agreement for Mrs D’s care.
7. Mrs B and APT 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

Relevant law and guidance

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 (the Guidance) on how to meet the fundamental standards below which care must never fall.
9. Regulation 16 sets out the standard on receiving and acting on complaints. The Guidance says care providers must take appropriate action without delay when a complaint is received.
10. The Competition and Markets Authority (CMA) has written a document ‘Care homes: consumer law advice for providers’. This gives information about care homes’ rights and duties in relation to complaints handling and how to treat residents.
11. Paragraph 1.47 sets out the characteristics of a good complaints handling procedure. One of the criteria for such a procedure is that it should have clear and reasonable timescales and a final response should be provided within 28 calendar days.

Key facts

12. Mrs B holds power of attorney for Mrs D. I therefore consider she is a suitable person to make this complaint.
13. In October 2018, Mrs B became aware that APT may not have been invoicing Mrs D for her care. She contacted APT and was told verbally that Bedford Borough Council (the Council) had been paying for Mrs D’s care. APT responded by email the following month acknowledging it had failed to send invoices and the Council had not paid for Mrs D’s care. It confirmed the outstanding amount was over £40,000.
14. Mrs B responded requesting invoices and confirming she did not believe the Council was responsible for funding the care. Mrs B requested an apology.
15. In December 2018, having heard nothing further from APT, Mrs B requested a meeting.
16. In January 2019, APT sent Mrs B invoices for January 2016 through to August 2018. Mrs B continued to request further information from APT. However, her requests went unanswered. Instead, APT sent Mrs D’s elderly brother a demand for the debt.
17. In July 2019, APT responded to Mrs B. It said it would begin to start charging interest at a daily rate if she failed to pay the outstanding amount. Mrs B replied, this time as a formal complaint. She asked for an explanation and apology.
18. In September 2019, Mrs B met with APT. It wrote to her following the meeting, on 12 September 2019. It acknowledged it had failed to send invoices. It explained it had mistakenly thought that the Council had been paying for Mrs D’s care as this was the case for many of its service users. It further explained that it now generated a report to ‘track activity to payment’ for its board so it could identify situations where services had not been paid for. It accepted full responsibility for its error. APT also acknowledged the failure to respond to Mrs B’s concerns. It apologised for its failures.
19. The same month Mrs B received an email from the Council confirming it had completed assessments and reviews for Mrs D but had not paid for her care.
20. In October 2019, Mrs B wrote again, in particular, she requested a copy of the contract for Mrs D’s care. She also asked APT to acknowledge Mrs D did not owe any interest. To date, she does not appear to have received a response.

Analysis

21. Mrs B notified APT about the outstanding invoices in October 2018. It wrote to her in November asking her to pay the amount by the end of the year. However, it provided no invoices until January 2019. I share Mrs B’s view that it was unreasonable for APT to expect payment without showing how it arrived at the figure or providing invoices for the same.
22. However, there is no dispute that the outstanding amount was due. The delay in issuing the invoices and in payment has not affected this fact. I therefore cannot conclude there is fault because of the delay.
23. In relation to the issue of interest. It would appear APT has accepted Mrs B’s reasons why she has not paid any interest owing. However, Mrs B will continue to feel uncertain about whether APT intends to pursue this matter until it confirms its position.
24. APT has now explained why it failed to issue the invoices (as it assumed the Council had paid for the care) and the steps it has taken to avoid the situation happening again. Mrs B has, however, been put to considerable time and trouble in pursuing this matter. I have seen evidence of communications she sent that went unanswered. It would seem APT finally sent her a substantive response. However, that was not until September 2019 when it seems Mrs B’s communications since January that year could have been considered as complaints. This is fault and a potential breach of the fundamental standard on complaints handling.
25. Mrs B has sent a further letter to which APT does not appear to have replied. I accept this is frustrating and inconvenient for Mrs B.

Recommended action

26. Within a month of my decision, APT should take the following steps:
• Pay Mrs B £150 for the time and trouble to which she has been put in pursuing the matter.
• Respond to Mrs B’s further letter.
• Confirm to Mrs B no interest is owing.

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Final decision

27. I have completed my investigation and uphold Mrs B’s complaint. I have recommended action APT take to address the fault I have identified.
28. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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Investigator's decision on behalf of the Ombudsman