Summary: There is no evidence of fault by the Care Provider in the way it supplied and charged Mrs Y for homecare services.

The complaint

1. Mrs X complains the Care Provider:

1. supplied and charged for unnecessary home care services for her mother, Mrs Y
2. did not remind her of the need for a 28-day notice period before cancelling the care provision.

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What I have investigated

2. I have only investigated point a of the complaint. I explain the reasons for this at the end of this statement.

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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. If they have caused an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
4. We can decide whether to start or discontinue an investigation into a complaint within our jurisdiction. (Local Government Act 1974, sections 24A(6) and 34B(8), as amended)

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How I considered this complaint

5. I have:

• considered the complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and the Care Provider, including the Care Provider’s response to the complaint;
• made enquiries of the Care Provider and considered the responses;
• taken account of relevant legislation.

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What I found

6. The Care Quality Commission (CQC) is the statutory regulator of health and social services in England. It keeps a register of care providers, inspects care services to assess if they meet the fundamental standards of care and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
7. 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 CQC has issued guidance on how to meet the fundamental standards below which care must never fall.

• Regulation 9 – Person-centred care, sets out the action that care providers must take to make sure that each person receives appropriate person-center care and treatment that is based on an assessment of their needs and preferences.
• Regulation 20 – Duty of Candiru, requires care providers and registered managers (known as ‘registered persons’) to act in an open and transparent way with people receiving care or treatment from them

Key Facts

8. Mrs Y is elderly. At the time of the events complained about, she lived at home and received home care services from the Care Provider.
9. In September 2020, Mrs Y’s health began to decline, and she was admitted to hospital. During her stay the Care Provider had contact with the hospital occupational therapy (OT) team to clarify Mrs Y’s care needs. I have had sight of the records confirming the contact. The OT informed the Care provider that Mrs Y needed several aids in place before discharge, including slide sheets to enable carers to turn her in bed. The Care Provider says two carers were required when turning a person using a slide sheet.
10. Prior to Mrs Y’s discharge from hospital, the Care Provider contacted Mrs X to discuss the discharge. I have seen the records of this call. Mrs X said Mrs Y was unable to walk and confirmed the hospital physiotherapist was “looking at putting things in place”.
11. A manager from the Care Provider visited Mrs Y’s home on 7 October 2020 to meet with three carers to discuss the care Mrs Y needed when she returned home. I have seen the notes of this visit. The manager discussed the use of a mobility aid and the slide sheets. All three carers expressed concern about managing Mrs Y single handed. The manager agreed to discuss the carers concerns with the hospital OT. Carers also expressed concern that Mrs Y’s bed had no bed- guards to prevent her falling out of bed.
12. On returning to the office, the manager discussed the carers concerns with senior staff. One of the carers sent an email to the manager formally expressing her concerns, she believed two carers would be needed to manage Mrs Y and the equipment.
13. The manager contacted the OT at the hospital. The OT said she had been able to manage Mrs Y and the mobility aid single-handed but could not comment on the use of the slide sheets. The manager asked if the Care Provider’s assessor could visit the hospital to complete an assessment. The OT said she would ask the principal OT to contact the manager.
14. The principal OT contacted the manager later the same day. He confirmed that two staff members from the Care Provider would be allowed to visit the hospital to complete an assessment of Mrs Y.
15. Staff from the Care Provider visited the hospital and completed an assessment. This concluded two carers would be needed during moving and handling.
16. Mrs Y’s discharge was initially planned for 10 October 2020. The Care Provider had concerns that all the required aids were not in situ. It contacted the hospital and the hospital agreed to cancel the discharge until the Care Provider had spoken with the hospital OT.
17. The Care Provider contacted Mrs X on 12 October 2020 to inform her that Mrs Y would require two carers. Mrs X agreed but asked if the hour and half calls could be shortened to an hour.
18. Mrs Y was discharged from hospital on 12 October 2020. The Care Provider says Mrs Y required three double-handed calls during the day, and because her overnight needs were uncertain an overnight carer was put in place the first night. The records show Mrs X asked if the overnight care could be extended. She also enquired about the cost of a live-in carer.
19. The records show the Care Provider contacted the hospital OT again on 15 October 2020 to provide an update on Mrs Y’s care arrangements and ask, subject to further assessment, if a single-handed carer would be sufficient to manage Mrs Y during moving and handling, The hospital OT said the number of carers was subject to the Care Provider’s assessment. The Care Provider asked the OT to confirm this in an email.
20. A live-in carer was put in place on 15 October 2020. The Care Provider deemed additional carers to be necessary to support the live-in carer when moving and handling, so additional carers attended periodically during the day.
21. Mrs X says the Care Provider initially supplied an agency live-in carer. She says the quality of care provided was poor. She says the Care Provider advised that Mrs Y needed four hours care each day in addition to the care provided by the live-in carer.
22. The allocated live-in-carer went off sick at short notice on 20 October 2020, and the replacement live-in-carer was unavailable, so the Care Provider commissioned an agency carer. The Care Provider has apologised to Mrs X for this.
23. Mrs X says some of the additional care was unnecessary, for example two carers were present for one hour to give Mrs Y her tea. The Care Provider says double- handed care was required for moving and handling, not to just give Mrs Y her tea.
24. The records show Mrs X contacted the Care Provider on 22 October 2020 to ask who would be allocated when the agency live-in-carer left. She also asked how many top-up carers were visiting each day.
25. Over the following days the Care Provider had concerns for Mrs Y’s health and contacted the GP.
26. The Care Provider contacted Mrs X on 28 October 2020 to discuss the top- up care visits. I have seen a record of this conversation. The Care Provider told Mrs X it had asked the GP for a referral to OT so Mrs Y’s needs could be reassessed, and asked Mrs X if the level of care could remain unchanged until the OT assessment was complete. The records show Mrs X agreed to this. The Care Provider agreed to keep Mrs X updated.
27. The Care Provider reduced the double-handed calls to mornings and evenings from 2 November 2020.
28. The OT contacted the Care Provider on 11 November 2020 to ask why a new referral had been made. The Care Provider updated the OT about Mrs Y’s condition. The OT confirmed that double-handed calls should continue for the morning and evening calls.
29. Mrs X contacted the Care Provider on 13 November 2020 to say Mrs Y would be going into residential care over the Xmas period, from 21 December 2020 to 4 January 2021. She asked for the usual morning call on 21 December 2020 and asked if a carer that knew Mrs Y well could meet her at the care home to help settle her in.
30. Mrs X sent an email to the Care Provider on 22 November 2020 to confirm the conversation on 13 November 2020. I have seen a copy of this email. She also asked about paperwork Mrs Y had been asked to sign. She asked that any paperwork be sent to her before it was sent to Mrs Y. Mrs X reminded the Care Provider she had Power of Attorney for Mrs Y.
31. The Care Provider contacted Mrs X on 26 January 2021 to enquire about Mrs Y. Mrs X said it was probable that Mrs Y would remain the care home permanently. She asked if the Care Provider would keep Mrs Y on the ‘backburner’ in case she returned home.
32. Mrs X wrote to the Care Provider on 1 March 2021 to complain about the level and cost of Mrs Y’s care. She complained about the number of carers and said some of the additional top-care had been unnecessary and that that Mrs Y had been overcharged £1843.13. She also complained about the quality of care provided by the agency live-in carer. She offered part payment of an outstanding invoice to settle the complaint.
33. The Care Provider responded to Mrs Y on 3 March 2021 saying it had liaised with health professionals involved in Mrs Y care and taken their advice. It said at no time during its ongoing contact with Mrs X regarding care visits, had she complained. It did not accept Mrs X’s settlement proposal.

Analysis

34. It is not the Ombudsman’s role to decide the level of care Mrs Y needed, that was the role of health professionals and the Care Provider, the Ombudsman’s role is to consider if the Care Provider acted properly, did it take account of all information in deciding the level of care Mrs Y needed, and did it review this as/when Mrs Y care needs changed.
35. In this case I consider the Care Provider acted properly. There is no evidence of fault in the way it made its decisions about Mrs Y’ care needs. It kept detailed records which show it sought advice from health professionals on numerous occasions and that it followed the advice given.
36. The Care Provider reviewed Mrs Y’s care and contacted professionals before it made changes to the care provided. It properly recorded the rationale behind its decision-making.
37. The records show the Care Provider discussed all changes to Mrs Y’s care with Mrs X. There is no evidence to show Mrs X disagreed with the decisions made.
38. The Care Provider had staffing issues and did not have any live-in carers available. This was beyond the Care Provider’s control; it commissioned an agency live-in-carer to provide the care Mrs Y needed. Had it not done so, Mrs Y would have been left without a live-in carer. The Care Provider apologised to Mrs X, and I consider this to be an adequate remedy.

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Final decision

39. There is no evidence of fault by the Care Provider in the way it supplied and charged Mrs Y for care.
40. It is on this basis; the complaint will be closed.

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Parts of the complaint that I did not investigate

41. The Care Provider provided Mrs X a copy of its terms of business,, which she signed in 2018. I do not consider the Care Provider had any responsibility to remind Mrs X of the notice period.

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Investigator's decision on behalf of the Ombudsman