Summary: Mr X complained care worker’s visits to his mother, Mrs Y, were shorter than they should have been. We find the visits were frequently short and there were occasions Mrs Y did not receive appropriate care. This caused Mrs Y distress and Mr X distress and uncertainty. Agincare UK Limited will pay Mr X £200 in recognition of his injustice. Agincare UK Limited has reduced Mrs Y’s outstanding invoice by £1000, which remedies her injustice.

The complaint

1. Mr X complained care worker’s visits to his mother, Mrs Y, were often significantly shorter than they should have been. Mr X said this meant Mrs Y did not receive the care she should have had and paid for. Mr X also complained Agincare UK Limited (the Care Provider) issued a poor complaint response and did not communicate with him well. He said this caused him undue stress.

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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 injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
3. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
5. 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)
6. 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

7. I have considered:
• all the information Mr X provided and discussed the complaint with him;
• the Care Provider’s comments about the complaint and the supporting documents it provided; and
• the relevant law and guidance and the Ombudsman's guidance on remedies.
8. Mr X and the Care Provider now have an opportunity to comment on my draft decision. I will consider their comments before making a final decision.

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What I found

Relevant law and guidance

9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulations) set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
10. Regulation 9 says care and treatment of residents must be appropriate, meet their needs and reflects their preferences.
11. Regulation 10 says people using care services should be treated with dignity and respect.
12. Regulation 17 says care providers should keep an accurate and complete record of the care they give to a person.

What happened

13. This section sets out the key events in this case and is not intended to be a detailed chronology.
14. Mrs Y has health conditions which affect her capacity to make decisions. Mr X manages Mrs Y’s finances and acted as her representative in relation to the Care Provider.
15. In mid-2021 the Care Provider began supporting Mrs Y at home. She had a care package of three visits a day most days of the week. For most of the period she was supported by the Care Provider, Mrs Y had one hour of support in the morning, half an hour at lunchtime and half an hour in the evening. On one day of the week, she had a long visit of several hours to go food shopping with a care worker.
16. The Care Provider produced a care plan which set out the care Mrs Y needed. The plan said Mrs Y needed help:
• taking medication and applying creams;
• changing her incontinence pad;
• drinking enough water;
• getting washed and dressed;
• keeping her home neat; and
• preparing meals.
17. The plan noted carers should sit and chat with Mrs Y if they had extra time during her one-hour morning visit and once weekly shopping trip.
18. In March 2022 Mr X became aware the care workers had not been visiting for the full length of each care visit when he installed a safety camera at Mrs Y’s home. He contacted the Care Provider about the short visits and shared logs of care workers’ arrival and departure from Mrs Y’s home.
19. The Care Provider accepted some of the visits had been too short. Records show that on 21 June 2022, the Care Provider applied a reduction of £287.28 to Mrs Y’s account to reflect the short visits during April and May 2022. The Care Provider emailed Mr X the same day to make him aware of the reduction. Mr X felt the reduction did not accurately reflect the times his camera showed the care workers had spent with Mrs Y.
20. In July 2022, Mr X wrote to the Care Provider with details of what he felt Mrs Y should have paid for March to May 2022. The Care Provider did not respond until late September 2022. It offered Mr X a £500 “goodwill gesture” which Mr X declined because it did not accurately reflect the time care workers spent with Mrs Y.
21. The Care Provider subsequently cancelled the contract, so Mr X sought a new care provider to support Mrs Y from September 2022.
22. Mr X requested a formal complaint response in early October 2022 and at the end of the month, the Care Provider responded to say:
• it had checked its records from June to September 2022 and could see some of Mrs Y’s care visits were short. It said there were times care workers stayed late as well. It said it had adjusted Mrs Y’s invoice to reflect the care visit timings; and
• it was satisfied that although some visits were short, the records showed Mrs Y received the care she needed.
23. Mr X said he did not agree care workers had met Mrs Y’s needs and that any extra time should have been spent engaging with Mrs Y or helping her do light exercise. He did not pay the outstanding amount Mrs Y owed; £9805.88.
24. On 31 May 2023, the Care Provider reduced £1000 from the total amount Mrs Y owed. It wrote to Mr X and told him of the reduction. The Care Provider said this was more than the £500 it had offered as goodwill previously and confirmed Mrs Y now owed £8805.88. It said it would not discuss Mrs Y’s account further.
25. In total, the Care Provider reduced the amount Mrs Y owed for her care by £1287.28.
26. Mr X said £1000 reduction was not reflective of the care Mrs Y had paid for and not received. Mr X told me if the Care Provider had accurately reduced Mrs Y’s account based on when care workers were at her home, the reduction would be greater, in the region of £1800. He does not accept the £1000 reduction on that basis.

Care records

27. I have reviewed a sample of Mrs Y’s care records and Mr X’s record of when care workers arrived and left her property. The records largely correspond, showing that on over two thirds of the visits from March to September 2022, care workers stayed at Mrs Y’s home for less time than allocated. On average, care workers left Mrs Y’s shortest care visits (30 minutes) around ten minutes early, but sometimes left significantly earlier than that. In early May 2022, a care worker spent twelve minutes of a 30 minute call visit with Mrs Y. Similarly, in early August 2022, a care worker stayed just eleven minutes with Mrs Y. The morning visits were frequently around 40-45 minutes long instead of one hour and on average, the weekly shopping trips were 40 minutes too short.
28. The records also show care workers stayed longer than planned for on one fifth of the visits from March to September 2022. On average, they stayed around five minutes longer.
29. The care records indicate care workers completed tasks broadly in line with Mrs Y’s care plan. However, some issues were evident. In one record a care worker noted care workers had not changed Mrs Y into night clothes the previous evening. A further record said a pharmacist had decided Mrs Y should take the medication she normally had at lunchtime in the evening instead. The care worker noted evening care workers had not given Mrs Y the medication for a few days. There is no evidence Mrs Y refused to accept care and support on the occasions set out in this paragraph.
30. In addition, in one record a care worker noted the previous day’s care workers had not changed Mrs Y’s incontinence pad at all. Records from the day before state ‘pad check’ in the morning and ‘changed pad’ in the evening.

Findings

Short care visits

31. It is evident many of Mrs Y’s care visits were shorter than they should have been. Mrs Y has a significant need for care in all aspects of her day-to-day life. While the daily records I have seen suggest the care workers largely completed tasks in line with Mrs Y’s care plan, it is difficult to see how, on the short visits, care workers could have accomplished all of the tasks set out in paragraph sixteen while ensuring Mrs Y was treated with dignity and care. This is particularly the case for the eleven and twelve minute visits. This was not in line with Regulation 10 and was fault.
32. The issues set out in paragraphs 29 and 30, including that Mrs Y was left to sleep in her day clothes and did not have her pad changed at all one day, show that there were occasions when Mrs Y did not receive appropriate care. This was not in line with Regulation 9 and was fault.
33. It is particularly concerning that one care worker noted workers had not changed Mrs Y’s incontinence pad the day before, despite recording that they had done so. This was not in line with Regulation 17, that care providers should keep a complete and accurate record of care given, and was further fault.
34. When care workers complete all of their care tasks early during a visit, the Ombudsman expects to see evidence they made efforts to talk with the person receiving care or did other tasks to help them. That is rarely evident in the daily care records I have seen, which was fault.
35. Lastly, Mrs Y’s long visits to go food shopping were often much shorter than planned for. If care workers found they did not need all the allocated time, the Care Provider should have promptly discussed reducing the care package with Mr X. This was further fault.

Injustice

36. A short care visit does not automatically cause an individual an injustice. For that reason, the Ombudsman does not normally recommend care providers reduce a person’s care fees to reflect each minute a care visit is short by.
37. Following contact from Mr X, the Care Provider applied a reduction of £287.28 for the months April to May 2022. The Care Provider later reduced Mrs Y’s account by a further £1000 and made a final request for Mr X to pay the remaining amount. Mr X does not accept the £1000 reduction which he says is insufficient because it does not reflect the times care workers were actually at Mrs Y’s home across the period the Care Provider supported her. That is Mr X’s decision. If Mr X feels the Care Provider failed to meet its contractual obligations to Mrs Y, it is open to him to seek a court remedy.
38. Overall, I am persuaded the faults set out in paragraphs 31, 32 and 34 meant Mrs Y experienced avoidable distress and paid for care she did not receive. The Ombudsman’s Guidance on Remedies sets out we will normally recommend a symbolic remedy payment for distress of up to £500. In this case, the circumstances justify a payment of £1000. The Care Provider has already applied a £1000 reduction to Mrs Y’s account so I have not made a further recommendation.
39. The faults in paragraphs 31 to 35 meant Mr X experienced distress and uncertainty about the quality of care Mrs Y received. I have made a recommendation, below, that the Care Provider pay Mr X £200 to recognise the injustice he experienced. In response to a previous version of this decision, Mr X said he did not want to accept the £200. It is open to Mr X to accept the payment if he now wishes to do so.

Communication and complaint response

40. Mr X and the Care Provider had repeated contact about Mrs Y’s care charges after Mr X became aware of the short visits. It is evident Mr X and the Care Provider disagree on how much Mrs Y’s account should be reduced by and using what method.
41. As part of that correspondence, Mr X contacted the Care Provider in July 2022. It did not respond until late September 2022, which was fault. The fault caused Mr X undue frustration.
42. In addition, in its late October 2022 response to Mr X’s complaint, the Care Provider said it had corrected Mrs Y’s invoice to reflect the times care workers stayed at her home for too long or too short a time between June and September 2022. There is no evidence the Care Provider applied that reduction. It was fault for the Care Provider to issue an inaccurate complaint response. The fault caused Mr X an injustice for which I would normally recommend an apology. However, I do not consider Mr X would welcome an apology from the Care Provider so have not made that recommendation.

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Agreed action

43. In an earlier version of this decision, the Care Provider agreed to apologise to Mr X. It also agreed to share a copy of the decision with its care workers and emphasise that if they complete their caring duties early during a visit, they should explore what other support they could offer the person or spend social time with them. If they regularly find they do not need all the time allocated, they should report that to the Care Provider so it can consider whether to shorten the time allocated. The Care Provider has evidenced it has completed these actions so I have not recommended them again.
44. Within one month of the date of my final decision, the Care Provider will pay Mr X £200 in recognition of the distress and uncertainty he experienced. If Mr X accepts the payment, it should be made to him directly and not applied as credit to Mrs Y’s account.
45. The Care Provider should provide us with evidence it has complied with the above action.

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Final decision

46. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman