Summary: Mrs X complained about the care and support Mr Y received. We find the care provider at fault for billing Mr Y for support hours he did not receive and for delays in responding to Mrs X. The care provider has agreed to apologise, refund the overcharged care hours, and make a symbolic payment to recognise the frustration caused.

The complaint

1. Mrs X complains about the care and support Mr Y has received from a care provider.
2. Specifically, Mrs X’s concerns include:

• Incorrect recording of what Mr Y said during sessions;
• Holding an emergency conference without inviting Mr Y;
• Involving external agencies, and sharing personal data, without consent;
• Incorrect recording of hours and regular overcharging;
• Poor management of introducing new support workers;
• Failure to follow Mr Y’s support plan or make progress towards his objectives;
• Poor complaint-handling; and
• The sudden cancelation of service without notice when she complained.

3. Mrs X says this has caused significant distress to Mr Y, herself and their family.

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The Ombudsman’s role and powers

4. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. When investigating complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. Sometimes it is not possible to make a finding, even on the balance of probabilities.
6. We normally expect someone to refer the matter to the Information Commissioner (ICO) if they have a complaint about data protection. (Local Government Act 1974, section 24A(6), as amended)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).
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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What I have and have not investigated

9. I have investigated Mrs X’s complaint as set out in paragraphs 1-3 above between September 2023 and September 2024.
10. However, I have not investigated Mrs X’s complaint that external agencies were involved, and personal data was shared without consent. This is because the ICO is the expert body dealing with complaints about data and Mrs X can pursue this issue with the ICO.

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How I considered this complaint

11. I considered evidence provided by Mrs X and the care provider as well as relevant law, policy and guidance.
12. Mrs X and the care provider had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and policy

13. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
14. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

What happened

15. I have summarised below some key events leading to Mrs X’s complaint. While I have considered everything submitted, this is not intended to be a detailed account of what took place.
16. Mr Y has a diagnosis of autism and anxiety and lives at home with Mrs X. Mr Y’s care and support plan said Mrs X meets most of Mr Y’s support needs, but provided for six hours of support weekly from a support worker to help him access the local community. The plan said the role of the support worker is to build Mr Y’s confidence and encourage life skills alongside independence so he could become comfortable accessing the community.
17. From September 2023, the care provider met Mr Y’s support needs through a support worker for three hours twice a week. The care provider has provided notes that were made after each session and these suggest the support workers allowed Mr Y freedom to choose the activities in the local community and have independence with managing his money, choosing his food and encouraged independence on public transport.
18. Sessions continued with no issue until one was missed due to staff illness in March 2024. That same month the carer provider came under new management.
19. Mrs X emailed the care provider in April 2024 to explain Mr Y had been incorrectly invoiced for full support hours in March 2024 and asked for this to be changed to account for the missed session. The care provider agreed to look into this and explained it would soon be changing support workers around within their service. Mrs X asked that Mr Y be allocated a support worker of a similar age so they could develop a friendship style experience.
20. The care provider initially agreed that Mr Y would retain his current support worker other than when they were unavailable, however by the end of April they told Mrs X they would be allocating a new support worker to Mr Y.
21. Mr Y’s last session with his usual support worker took place at the beginning of May 2024. Mr Y’s new support worker was in attendance for the first ten minutes of this session to introduce herself.
22. Mrs X contacted the care provider to explain she was under the impression the original support worker would continue to support Mr Y. Mrs X also said the new support worker was significantly older than Mr Y and she felt the ten-minute introduction had been disruptive to the session. The care provider responded to apologise and explain they had misunderstood the situation, and Mr Y’s usual support worker was actually reducing their hours which is why they could not continue to support Mr Y.
23. One of Mr Y’s sessions was missed without notice at the beginning of May 2024. Mrs X contacted the care provider about this and Mr Y received the right care hours from that point onwards. In the notes after the support sessions, the support workers recorded concerns around some of the conversations they had with Mr Y.
24. Mrs X also contacted the care provider again to chase a resolution to the incorrect invoice for March 2024.
25. At the end of May 2024, the care provider emailed Mrs X to explain some concerns had been raised around comments Mr Y had made in support sessions and asked her to attend an online meeting to discuss this and support moving forward. Mr Y was not invited to that meeting.
26. The meeting took place in June 2024 and was attended by the care provider manager, autism professionals and Mrs X. Mr Y was also present with Mrs X, however the support worker who had raised concerns was not available despite being scheduled to attend. The manager used this meeting to discuss concerns that had been raised by Mr Y’s support workers.
27. Mrs X requested a second face-to-face meeting with Mr Y in attendance to discuss these concerns further. The face-to-face meeting took place in early June 2024. Notes from this meeting show the care provider put forward its concerns and allowed Mrs X and Mr Y to respond to them. The notes show Mrs X disputed much of what the support workers had recorded from their sessions with Mr Y. The care provider explained it felt it was meeting the support needs set out in Mr Y’s plan but felt it may have gone as far as it could in terms of helping him to prepare for future independence. Due to its concerns, and the disagreements about what took place in the support meetings, the care provider said it felt the support hours provided to Mr Y should now be on a 2:1 basis.
28. In June 2024, Mr X had a three-hour session, supported by two support workers and attended by Mrs X. Mr Y was invoiced for six hours of support worker time, and Mrs X has said the support session did not work towards Mr Y’s needs or objectives.
29. Mrs X emailed the care provider to ask for another face-to-face meeting to try and resolve the issues that had been raised, but she does not appear to have received a response to this request. Mrs X also explained Mr Y would not need support the following week as they were due to be on holiday.
30. The week following Mr Y’s return from holiday he did not receive any support sessions due to a scheduling error.
31. In June 2024, the care provider reviewed the support it had been providing Mr Y against the outcomes named in his support plan. The care provider’s records show it found it had worked towards supporting Mr Y to a level of independence, but it was no longer able to work towards the targets in his support plan and he would benefit from a personal assistant service rather than support workers going forward.
32. Mrs X emailed the care provider again in June 2024 to explain it still had not resolved the issues with the March 2024 invoice, but Mr Y had now received an invoice for May 2024 which also contained charges for a session that did not take place.
33. That month Mrs X also called the care provider to raise a complaint as she was unhappy the billing issue had not been resolved, and she had concerns about the support provided to Mr Y.
34. The following day, the care provider emailed Mrs X to explain it was giving notice on the support it provided for Mr Y and his last day of support would be later that week. The care provider said Mr Y had not received any support from it for several weeks and it did not feel it was able to meet his needs at present.
35. In July 2024, Mrs X attended the care provider’s office to raise her complaint formally. Mrs X said issues had started to occur following a change in management at the care provider and communication had become an issue since that time. Mrs X said she was unhappy with the change of support workers and questioned the training they had received. Mrs X also disputed what support workers had recorded in their notes and said the 2:1 session had not been to an acceptable standard. Mrs X reiterated that the care provider was yet to rectify the issue with the invoices.
36. The care provider responded to Mrs X’s complaint in August 2024.The care provider explained all support workers received the relevant training as well as access to Mr Y’s previous notes and support plan. The care provider said they were confident any notes made were accurate. The care provider acknowledged there had been multiple changes since the new manager started which had created challenges and this must have been frustrating. The care provider apologised for overcharging Mr Y and said it had requested refunds. The care provider explained it does not usually provide the type of support Mr Y’s support plan called for and that it did not feel it could meet his needs going forward.
37. Mrs X asked the care provider to review her complaint as she did not feel her points had been adequately addressed. Mrs X said she was concerned about how new support workers were introduced and said she had been told they were not properly trained. Mrs X said she was unhappy with how the care provider had dealt with concerns the support workers raised and said it was simply accepting their word over Mr Y’s. Mrs X said she felt the support Mr Y had received was inadequate and poor after new management took over and she felt he had been let down. Mrs X also repeated that the care provider needed to resolve the issue with the invoices.
38. The care provider responded to Mrs X’s complaint in September 2024. The care provider repeated that all staff are adequately trained and had a duty to report concerns where they felt it necessary to do so. The care provider said it was sorry Mr Y was charged for hours he did not receive and agreed it would refund this, as well as the cost of the 2:1 session that Mrs X had said was not of a good enough standard. The care provider apologised for instances where it had not responded to Mrs X’s emails.

Analysis

39. Mr Y’s support plan set out a requirement for six hours of support worker sessions per week. From the start point of my investigation in September 2023, the care provider provided this through two weekly sessions of three hours each. I do not find fault with the steps taken to meet the support provision in Mr Y’s care and support plan.
40. This level of support was ongoing without issue until March 2024, at which point sessions began to be missed intermittently. The care provider has said there were various reasons for this, such as staff illness and staff capacity issues, however Mr Y was still billed for full sessions up until the care provider’s involvement in his care and support needs came to an end in June 2024. Charging Mr Y for sessions that were not delivered is fault, and meant he paid for sessions he did not receive, which is injustice. However, in its response to Mrs X’s complaint, the care provider agreed to refund the sessions Mr X had paid for which he did not receive as well as the 2:1 session that it agreed was not of the expected standard. Once this refund has been made, I find this resolves the injustice.
41. However, the evidence I have seen shows Mrs X had to do considerable chasing to for the refunds. She made the care provider aware of the issue as soon as it arose in April 2024 but had to chase multiple times, up until the end point of my investigation to try and obtain information about the refund. This is poor practice and amounts to fault. This caused considerable frustration and uncertainty for Mrs X, which is further injustice.
42. I have looked through the notes the support workers took detailing the sessions they had with Mr Y. These appear to be comprehensive throughout the timeline I have investigated and set out what actions were taken to meet the objectives in Mr Y’s care and support plan. I do not find fault here.
43. Mrs X has questioned the content and accuracy of the notes. The care provider has said these were all made directly after the sessions and were a true account of the support workers’ experiences. I have seen no reason to question what was recorded. Even on the balance of probabilities, there is not enough evidence for me to find fault with how the notes were recorded or the accuracy of what they contained.
44. Mrs X has also raised concerns with the way new support workers were introduced and their training comparatively to previous support workers. It is not my role to question the level of training a support worker has received. The care provider has said all its support workers receive adequate training before they start, and I cannot find it at fault here. I appreciate there is likely to be some disruption when support workers are changed, but it is for the care provider to judge how best to manage this, and I have seen no reason to find it at fault here.
45. I understand Mrs X’s frustration a meeting was organised to discuss support worker concerns without Mr Y being invited. However, Mr Y was present at the online meeting with Mrs X to hear what was being discussed and he was present and gave his views at the in-person meeting in the following days. This being the case, I find any injustice to Mr Y here is minimal.
46. Mrs X has said she believes the care provider withdrew services from Mr Y as a direct result of her raising a complaint. I appreciate the timing of this is unfortunate, however I have seen no evidence to find the care provider at fault. The available notes show the care provider felt it was no longer able to meet Mr Y’s ongoing objectives, and it has given its reasoning for this. It also suggested this in the meeting prior to Mrs X raising a formal complaint. I understand why this is frustrating for Mrs X and Mr Y, but the care provider was entitled to withdraw its services where it felt it necessary to do so and I do not find it at fault.
47. Generally, throughout the timeline I have investigated, the communication between Mrs X and the care provider was at an acceptable standard. Communication was often led by Mrs X, but she generally received prompt responses. However, there was a period in June 2024 where she sent several messages to the care provider and received no response. The care provider has explained this was down to capacity issues, but failure to respond still amounts to fault and caused uncertainty to Mrs X at what was already clearly a frustrating time for her, which is injustice.

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Action

48. To remedy the injustice set out above, the Council should carry out the following actions within one month:
• Provide a written apology to Mrs X and Mr Y for incorrectly billing for full support hours when these were not received, for not resolving this promptly, and for the failure to respond to all Mrs X’s emails. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Ensure Mr Y has received the refunds for the support hours he did not receive and for the 2:1 support session the care provider has agreed was not at an acceptable standard and provide Mrs X with how and when these refunds were made.
• Make a token payment of £100 to Mrs X to recognise the frustration and uncertainty she was caused by having to chase to have the invoices corrected, and the lack of responses to her emails.
49. The care provider should provide us with evidence it has complied with the above actions.

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Decision

50. I find fault causing injustice. The Council has agreed actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman