Summary: Mr X complained about care charges imposed by the Care Provider causing financial loss and distress. We find no fault by the Care Provider.

The complaint

1. Mr X complains about care charges imposed by the Care Provider for his mother’s care, causing financial loss and distress.

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The Ombudsman’s role and powers

2. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
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 an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. We can consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
6. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:
• there is not enough evidence of fault to justify investigating, or

• the action has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify our involvement, or
• we cannot achieve the outcome someone wants (Local Government Act 1974, sections 34B(8) and (9))

7. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)

8. 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(i), as amended)

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How I considered this complaint

9. I reviewed documents provided by Mr X and the Care Provider.
10. I gave Mr X and the Care Provider an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Contract

11. The Care Provider’s contract for services included the following terms.
• It will supervise its carers to ensure a satisfactory standard of work. It asks the customer allows its assessor to attend the care location to enable this.
• If a carer needs to exceed the agreed duration of the visit, it will charge the extra time at the normal rate.
• It reserves the right to charge interest at 7% above the base rate on any sums outstanding 28 days after issue of an invoice.
• It will give 7 days’ notice of its intention to charge such interest.
• It reserves the right to give one week’s notice to terminate the contract if the health and safety of those providing care is compromised. Or, if there is an ongoing disparity with regards to meeting the expectations of the customer.

What happened

12. Mr X’s mother, Mrs Y, received care at home.
13. On 4 February 2022 the Care Provider increased the package of care to meet increased needs. This included a 75 minute morning call with two carers and transfers using a hoist.
14. Mr X says the Occupational Therapist had suggested a 60 minute call would be sufficient, reducing to 45 minutes when the carers became used to the new care plan. However, he says agreed to 75 minutes if the Care Provider reviewed this once the carers were familiar with the plan.
15. On 8 February Mr X raised concerns that some carers needed step by step instructions from their colleagues on how to use the hoist and others raised queries that would have been answered by them reading the care plan.
16. The Care Provider replied the same day. They confirmed all carers completed mandatory Moving and Handling Training every year. However, carers had varied levels of experience and confidence in using equipment. They matched experienced carers with less experienced and less confident carers so they could remind of processes and ensure safe handling. They would remind carers to review the care plan and to tidy up as needed. The Care Provider addressed the remaining points, in the main by agreeing to add notes to the care plan to ensure carers were aware what to do.
17. Mr X replied with final comments but did not further escalate his concerns.
18. Mr X says he asked the Care Provider to reduce the morning call time, because more experienced carers could complete the care in 45 minutes. He says he requested this during conversations with the Care Provider on 10 and 17 February 2022. However, the Care Provider denies this.
19. In March the Care Provider issued an invoice for February.
20. On 3 March Mr X disputed the invoice as he considered the carers should have completed calls in 45 minutes. He provided detailed notes on each care visit, including start and end times, and observations where he thought carers wasted time or spent it training.
21. Mr X and the Care Provider met on 4 March to discuss his concerns. The Care Provider has provided a copy of notes made at the time. These report:
• Mr X was unhappy with the length of the 75 minute morning call. The Care Provider agreed to reduce this to 60 minutes provided Mr X paid additional costs if the call ran over time.
• Mr X was concerned the Care Provider has not reviewed the carers adequately. In reply they said they had overseen visits and attended on occasion. Further, other professionals had not raised concerns about staff moving and handling practices.
22. The Care Provider gave Mr X 7 days’ notice to end the contract during this visit.
23. The Care Provider responded in writing on 25 March. For each call that over ran 75 minutes the Care Provider either explained why the time was justified or why it was not. Where the Care Provider accepted the overrun was not justified they agreed to discount the additional time spent. The Care Provider explained if a scheduled visit ran under time it still charged for the time scheduled. And if a visit ran over it was charged additionally at the rate for that visit. The Care Provider offered a £66.20 refund and an additional £83.80 in acknowledgement of Mr X’s time and effort in raising his concerns and because it could not reach his expectation of the level of support to be provided for Mrs Y.
24. Mr X raised a complaint on 28 March. In summary he said:
• They should not charge Mrs Y for the excess time it took to complete care when it could be given more efficiently and effectively by experienced carers; used to the equipment and used to working effectively and efficiently together.
• He noticed some carers who finished ahead of time looking for things to do to fill the call time.
• The Care Provider gave 7 days’ notice and reduced the morning call to 60 minutes. When he requested 45 minutes the Care Provider said they would not compromise Mrs Y’s safety by agreeing to this and would need to terminate without notice in that instance. He felt he had no choice but to agree to 60 minutes.
• The notice was for the minimum time allowed under the contract causing maximum distress.
• They miss-sold the service.
• The quality of care reduced from February as carers were working out what to do with the equipment rather than engaging with Mrs Y.
• The manager reminded carers to read the care plan and tidy away but they still did not.
• The contract required access for the Care Provider to assess their care staff but no assessments took place.
• He disputed the invoice because it included charges that would not have occurred if the carers were experienced.
• He requested a reduction in the invoice and compensation for the distress in having to complain.
25. On 4 April Mr X added he disputed the final invoice. He said the Care Provider could have reduced the call length sooner and some calls still took less than 60 minutes.
26. The Care Provider replied on 28 April. In summary it said:
• While competency levels may vary from carer to carer, it had reviewed them all to make sure they were sufficiently skilled to carry out the tasks.
• It allocated carers to a service user for the time as per the evaluation made in the care assessment. It paid carers according to the booked time and charged service users for that specified time. If carers finished within time they should check if the service user required anything else and if it is otherwise ok for them to leave.
• It supported the conclusion to discontinue services as he was dissatisfied with its level of performance.
• It considered no further refund or compensation was due.
27. Mr X remained unhappy and said it had overlooked some points. He suggested he would approach the Ombudsman as per the complaints process if unresolved.
28. The Care Provider referred Mr X to the Ombudsman.
29. Mr X then complained to the Ombudsman. He emphasised the issue was not that staff were untrained but that they were not very experienced in using the equipment or used to working in pairs.
30. The Care Provider then sent Mr X an invoice for interest on the amount owed. This charged a rate of £1.12 per day on the March bill and £0.38 per day on the final bill.
31. Mr X disputed he should have to pay interest when the sum was in dispute. However, the Care Provider maintained it could charge interest in line with its contract terms.
32. Mr X highlighted to the Ombudsman the contract required 7 days’ notice before charging interest and he did not receive any notice.
33. In response to enquiries the Care Provider said:
• Mr X did not request a reduction in call length until 3 March and on 4 March he requested a reduction to 45 minutes. Due to the calls previously running over it felt reducing the calls by 30 minutes was cutting them too short so agreed to reduce calls to 60 minutes for one week.
• During this week it noted calls ran at about 45 minutes, however, it also noted carers were no longer being talked to by Mr X, which previously took up time.
• It would be normal practice to carry out a six week review of the care package ie on 30 March, but by this time the care package had ended.
• The relationship between Mr X and its carers had broken down. For the safety and well-being of Mrs Y and its carers, it gave notice on 4 March as it accepted it would probably not be able to provide the support for Mrs Y at the level Mr X wanted.
• They received no complaints from Mrs Y about her care.
34. In comments on a draft decision Mr X said, in summary:
• The Ombudsman did not take into account he agreed the service under duress, with no alternative and only on the understanding the visit duration would reduce over time and there would be a review.
• An independent person could verify the visit duration was excessive.
• The Ombudsman has not investigated the lack of experience of the carers and it was this that resulted in them taking more time to complete calls.
• An Occupational Therapist could verify his requests for a review in February and the threat of termination without notice in March.
• He had complained about carers washing his mother in bed rather than on a commode in line with her care plan. This caused his mother pain and distress. It also took more time, increasing the overall cost.
• The Ombudsman overlooked the Care Provider’s duty to demonstrate supervision of its carers.

Findings

35. It was up to the Care Provider to consider how it could meet Mrs Y’s needs and how much time it needed to do so. The Care Provider decided a 75 minute morning call was necessary and Mr X agreed to this. I find no fault.
36. I am aware Mr X felt under pressure to agree the Care Provider’s terms given his mother urgently needed care, and aware he expected the Care Provider to review the call length. However, it remains Mr X made an informed decision to agree to the service offered. And, while it may have been difficult, it was open to him to reject the service offered if he wished.
37. I appreciate Mr X was unhappy with the time taken by less experienced carers to complete calls and the time spent on supervision or guidance. However, it remained open to Mr X to change provider if he wished. While I appreciate Mr X may have found it difficult to source a different provider, it remained he was free to do so.
38. The Care Provider has a duty to ensure its staff are properly trained. However, staff build up experience over time. The Care Provider does not have an obligation to ensure its staff have a certain level of experience.
39. Mr X says he asked the Care Provider to review the care package and call length on 10 and 17 February but the Care Provider denies this. I will not investigate this further because any fault did not cause significant injustice. I say this because the contract ended in early March in any event and because it would not be possible to say what the outcome of any earlier review would have been.
40. On 4 March the Care Provider agreed to reduce the call length to 60 minutes on the proviso it would apply charges if the call over ran. I cannot say with any certainty the same decision would have been reached at an earlier date.
41. I have not seen any evidence to support Mr X’s assertion the Care Provider warned it would terminate without notice rather than agree to a 45 minute call. However it is up to both parties to agree to any change in the contract and the Care Provider would be entitled to refuse this change. There is not enough evidence of fault to justify investigating this further.
42. The Care Provider gave 7 days’ notice in line with the contract. I appreciate this was difficult for Mr X however I do not find fault.
43. The Care Provider responded to Mr X’s challenge to its invoice within 30 days and responded to complaints in good time. I find no undue delay and no fault.
44. The contract allowed the Care Provider to charge interest on debts owed. Therefore, I find no fault. It was open to Mr X to pay the invoices and still dispute the charges if he wished to avoid incurring interest charges.
45. The Care Provider should have given 7 days’ notice of its intention to charge interest in line with its contract. However, Mr X did not wish to make payment while the sum was in dispute in any event. I will not investigate this further as any fault did not cause significant injustice.
46. Mr X raised concerns with the quality of care provided to Mrs Y however the injustice complained of is not significant enough to justify our involvement and there is no ongoing injustice. I therefore consider it is not proportionate to investigate this part of his complaint further.
47. Mr X also raised concerns the Care Provider had not assessed its carers. However, the Care Provider was under no specific obligation to assess its carers during the period and there is nothing to suggest any fault caused significant injustice. I therefore consider it is not proportionate to investigate this part of the complaint further. To address Mr X’s comments, while the Care Provider must provide appropriate supervision to its staff, this does not include any requirement to assess them at any specified interval.

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Final decision

48. I have completed my investigation. This is because I find no fault in how the Care Provider charged Mrs Y.

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Investigator's decision on behalf of the Ombudsman