Summary: Mr X complains about overcharging his late father-in-law, Mr Y, by the Council’s care provider Comfort Call Tameside. The Council accepts Mr Y was overcharged. It has remedied the injustice by repaying money to his estate and paying financial redress to Mr X for the distress caused and the time and trouble it has put him to. It needs to identify anyone else who has been affected and repay any overpayments.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains about overcharging by the Council’s care provider Comfort Call Tameside.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, sections 30(1B) and 34H(i), as amended)
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
5. We may investigate matters coming to our attention during an investigation, if we consider that a member of the public who has not complained may have suffered an injustice as a result. (Local Government Act 1974, section 26D and 34E, as amended)

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How I considered this complaint

6. I have:
• considered the complaint and the documents provided by Mr X;
• discussed the complaint with Mr X;
• considered the comments and documents the Council has provided; and
• shared a draft of this statement with Mr X and the Council, and invited comments for me to consider before making my final decision.

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What I found

What happened

7. Mr X’s father-in-law, Mr Y, lived in extra care housing where the Council arranged for Comfort Call Tameside to provide his care.
8. Mr X first complained to the Council about problems with Mr Y’s care in 2019.
9. When the Council wrote to Mr X in August 2020, it said:
• there had been problems with Mr Y’s care and it had apologised for this in December 2019;
• there had been a lack of management of the contract with Comfort Call Tameside when it had seconded a member of staff to another service, but had now resolved this;
• it would have been good practice to report to Mr X after reviewing record keeping and documentation;
• it had not made timely progress with the organisational safeguarding module of its case management system;
• there had been a delay in resolving Mr Y’s overpayment and a general lack of understanding of the reconciliation process;
• it should not have told Comfort Call Tameside not to provide Mr Y’s logbooks to his family;
• it apologised and agreed to refund £2,035.37 to Mr Y’s estate for the period 25 February 2019 to 21 April 2020.
10. The Council identified these actions:
• amend the terms of its contract with Comfort Call Tameside to ensure it shared information about care provided and this formed the basis of charges, rather than planned care;
• officers to make records of contact with people;
• prioritise developing the Organisational Safeguarding Module of its case management system;
• remind officers how to reconcile personal budget charges and review the personal budget policy to make sure the process was clear;
• a full reconciliation of payments made to Comfort Call Tameside against the service actually provided, and reconcile this against the charges made to its clients to identify other residents overcharged for their care and support.
11. The Council wrote to Mr X on 24 November responding to further concerns he had raised. It said:
• it could not explain why the care hours had been underprovided but referred to a letter Comfort Call Tameside sent to Ms X addressing the issue;
• it had made organisational improvements and addressed individual performance through internal processes;
• its safeguarding module was fully operational and a training programme supported its roll out;
• it had a plan in place to transition the current model for providing extra care housing to a new model, which would be in place by autumn 2021;
• it had carried out a reconciliation of care delivered against care assessed for all people living in Mr Y’s extra care housing scheme;
• it was confident the problems Mr Y experienced were specific to the contract with Comfort Call Tameside.
12. On 30 November the Council told Mr X it had done a full reconciliation of the cost of the care provided for Mr Y and needed to refund a further £922.77.
13. Mr X asked the Council to confirm the period covered by the latest refund.
14. The Council e-mailed Mr X on 14 December. It said:
• it had reconciled Comfort Call Tameside’s charges from 26 February 2016 to 21 April 2020;
• Mr Y had paid £23,735.90 for care delivered costing £20,561.79;
• taking account of £2,252.04 already refunded, it needed to refund a further £922.07.
15. Mr X questioned the Council calculations, saying it had based them on planned hours, rather than the hours delivered. He noted that for the original period (25 February 2019 to 21 April 2020) the care hours had been underdelivered every week and there was no evidence to suggest this would not have been the case since Mr Y’s tenancy started.
16. In April 2021, following further correspondence with Mr X, the Council agreed to:
• refund a further £3,463.77 to Mr Y’s estate, based on a 27% under provision of planned services;
• pay Mr X £750 (having originally offered £500) to reflect the time and trouble he had been put to in pursing the complaint and the distress caused.
17. Mr X accepts this is a satisfactory financial remedy for the concerns he has raised about Mr Y’s care and support.
18. The Council accepts others living in Mr Y’s extra care housing are likely to have been affected by the problems with Comfort Call Tameside. It agreed to take action to address this and said it had completed the work last November. It said it was satisfied the problems did not extend beyond Comfort Call Tameside.
19. I asked the Council to:
• provide evidence it has completed a full reconciliation of payments made to Comfort Call Tameside against the service actually provided, and reconciled this against the charges made to its clients to identify other residents overcharged for their care and support; and
• explain how it satisfied itself this issue was specific to the contract with Comfort Call Tameside for the care provided to the residents of the extra care housing where Mr Y lived.
20. The Council says it:
• has investigated all the service receipts for those living in the extra care housing where Mr Y lived who also have a service from Comfort Call Tameside, to identify anyone who could have been affected;
• has written to let them know it is carrying out a reconciliation process, which may result in a refund;
• is progressing this work, which has identified up to 13 people who may have been overcharged.
21. The Council says it has also:
• “put in place a provider portal where a care provider has to submit the actual hours they deliver to a service recipient and not the number of hours the social care practitioner has assessed and has written on a care plan. This is required to be submitted on a weekly basis in order for the provider to be paid on the submission of actual hours enabling delivered service to be paid. Adult Care and confident this will stop any future situations arising of charges to be made against hours not delivered to the service recipient”.

Is there evidence of fault by the Council which caused injustice?

22. There is no dispute over the fact that Comfort Call Tameside failed to deliver all Mr Y’s care resulting in him being overcharged for his care. That was fault for which the Council is accountable (see paragraph 4 above). The Council was also at fault for failing to pick up on this. Mr X accepts the Council has remedied the injustice arising from these faults by refunding £6,637.88 to Mr Y’s estate and paying him £750. The only outstanding issue is the extent to which other people have been affected.
23. In November the Council told Mr X it had reconciled care delivered against care assessed for those living in Mr Y’s extra care housing. But that was not the case, as it has not yet refunded any overpayments, and is fault by the Council. The Council needs to set a deadline for doing this.
24. Rather than explain how it satisfied itself the problems Mr Y experienced were specific to Comfort Call Tameside and those living in his extra care housing, the Council said it had made changes to its systems to prevent similar problems from happening again. While that was welcomed, it left open the possibility that people receiving support from other care providers and/or living elsewhere may also have been overcharged. However, in response to a draft of this statement, the Council has confirmed that it has no other contracts where payments are made without electronic confirmation of the care actually delivered.

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Agreed action

25. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of Comfort Call Tameside as well as the Council, I have just made recommendations to the Council.
26. The Council has agreed within the next six months to:
• refund anyone who has been overcharged by Comfort Call Tameside at Mr Y’s extra care housing; and
• increase audit processes and random sample the electronic information supplied by care providers on the care delivered.
27. Under the terms of our Memorandum of Understanding and information sharing protocol with the Care Quality Commission, I will send it a copy of this statement.

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Final decision

28. I have completed my investigation, as the Council has agreed to take action to remedy the injustice caused to other people affected by its faults.

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Investigator's decision on behalf of the Ombudsman