Summary: Mr C complained about the actions of his daughter’s care support provider, which was commissioned by the Council. We found that Ms C received incorrect invoices and her care support workers failed to pick up some issues with the way Ms D managed her money. However, there was no fault in the way the Council tried to support Ms D with engaging in more meaningful activities. The Council had already adjusted the invoices and has agreed to apologise for any distress Mr C and Ms D experienced.

The complaint

1. The complainant, whom I shall call Mr C, complains on behalf of his daughter, whom I shall call Ms D. Mr C complains that:
• His daughter’s care agency failed to take appropriate action when his daughter became ill.
• The care agency failed to provide invoices that were correct.
• The Council failed to ensure the care agency took the correct actions to solve the invoicing problem.
• His daughter did not receive the care support she should have received between February 2019 and February 2020.

Back to top

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, section 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)

Back to top

How I considered this complaint

5. I considered the information I received from Mr C and the Council. I shared a copy of my draft decision statement wit Mr C and the Council and considered any comments I received, before I made my final decision.

Back to top

What I found

Background

6. Ms D lives in her own home in the community. The Council says she has learning difficulties and is independent with many daily living skills, including shopping, cooking, accessing the community, using public transport etc. She has previously had some paid and voluntary jobs and has been applying for further jobs independently. Mr C contacted adult social care in 2010, as he was concerned his daughter risked becoming socially isolated. He also said he believed she needed support with managing finances as she had previously got into considerable debt and was susceptible to cold calling.
7. At the time of this complaint, Ms D was receiving support from two care agency teams: the supported living / home support team (tasked primarily with helping her with her finances) and the Project team (to support access to meaningful activities in the community).
8. It was also recognised that Ms D may sometimes need direction and prompts with accessing health appointments. However, she had in the past made and attended the GP independently. It was not always possible for agency workers to attend every appointment with her, especially at short notice.

The care agency’s response to Ms D’s Bell’s Palsy

9. Ms D’s care support plan says: if there is a decline in health / or other concerning issue, staff needs to alert health professionals and the Council.
10. Mr C says that Bell’s Palsy is a medical condition that results in temporary weakness or lack of movement affecting one side of the face. He says that, when his daughter started to show sign of this illness, the care agency failed to take timely or appropriate action.
11. The Council says the agency discovered that Ms D was unwell and took her to the Pharmacy. She subsequently visited the GP. The GP was not her regular GP and misdiagnosed her thinking she had an infection.
12. However, Mr C says that: When his daughter did not improve after one week, the care agency should have taken his daughter back to the GP.
13. A document from the care provider, which it says included “Extract of notes taken from support visits during that time”, says on 26 September 2018: Support worker (Project Team) noticed Ms D’s face/eye drooping, eye running, complaining about her right ear. The support worker took her to the Pharmacy who recommended to go to the GP. Ms D went to the GP independently later that day. The care agency says Ms D regularly went to GP appointments independently and was able to do so. The GP diagnosed eczema and an ear infection and gave antibiotics and a gel for her eyes. Ms D provided feedback to the support worker over the phone later that same day.
14. The medical records from the GP say (26 September):
• Telephone encounter. Painful R eye, especially in sunlight and red painful ear. Advised to attend Urgent Care Centre today.
• Seen by nurse clinician:
1. Ear: Right ear pain and swelling for a few days. Review if not starting to settle within 2/3-7 or worsening.
2. Eye: Sticky discharge from right eye 3-4/7 ago. Advised eye casualty if worsening symptoms within a week (review in surgery); sooner if symptoms worsening 111/A&E.
15. According to the care provider’s document: Ms D told her support worker on 28 September that she could not swallow the antibiotic tablets as they were too big. As such, the support worker supported Ms D to buy a pill crusher from the Pharmacy.
16. The medical records state that:
• Ms D called the surgery after one week (5 October 2018) and had a telephone consultation. Ms D said the medication for her ear was making her sick and she wanted drops instead. Ms D said her eye drops had not helped, as her eyelids were still sore and itchy. Suggested to switch to shampoo in hot water to clean any crust. Ms D said she had not taken the tablets because it upset her stomach.
• Ms D called the Surgery again on 8 October. It said: eye not better. Red and sore. Starting to go to left eye now. Eye problem viral advised.
17. According to the care provider’s document, Ms D told her support worker on 12 October that her eye was slightly improving, and her ear had fully recovered. The support worker advised Ms D to go back to the GP if her eye did not improve.
18. In addition to support once a week from her (Project Team) support worker, Ms D also received support twice a week at home from the home support team. However, there are no records to show this team noticed, recorded or reported anything with regards to Ms D’s changing condition, during the two weeks before 20 October 2018.
19. Mr C says he visited his daughter on 20 October 2018. He says: it was clear there was still something seriously wrong with his daughter: she could hardly speak, could only drink through a straw and her face was dropped. The care agency should have recognised these clear signs and have contacted the GP again (before his visit). He says he cannot understand how the Project Team support worker spent five hours with his daughter on 19 October (the day before) whilst doing nothing to address what must have been an obvious problem with her face. He says he took her to the Pharmacy who advised that his daughter should see a Doctor first thing on Monday morning. The GP confirmed Bell’s Palsy on 22 October 2018.
20. The medical records state that on 22 October 2018:
• Tel consultation: sore eyelids under / around eyes; one side of face is dropped a bit; feels she needs to be seen today.
• She was seen later that day: Problem: Bell’s facial palsy. Ear and eye pain right side. Now facial droop. Ms D didn’t notice it straight away. Probably has been there. However, she didn’t notice until someone told her.

Analysis:

21. As of 8 October 2018, Ms D was in contact and consultation directly with the GP about (any changes in) her symptoms. The GP treated Ms D’s ear as an ear infection and changed her antibiotics. There was a delay in Ms D starting her antibiotics treatment, but this was not due to the care provider. Her project team support worker monitored the situation and acted / advised when and where needed.
22. Ms D’s community support worker was with Ms D on 19 October 2018. Mr C visited the following day and said he was concerned about his daughter’s presentation, including her facial drop, and ensured she visited a Pharmacy and subsequently a GP. However:
• The project team support worker did not provide an update in her records of her 19 October visit, as to Ms D’s (ear and eye) condition. This is fault.
• She did not raise a concern about Ms D’s presentation that day. It was the facial drop, which Mr C noticed, that resulted in the GP visit and the diagnosis of Bell’s Palsy. On the balance of probabilities, I found this should have been sufficiently noticeable, and therefore concerning, on 19 October for the support worker to take action. This is fault.
23. Ms D was also supported twice a week at home by the home support team. However, there are no records to show this team noticed, recorded or reported anything with regards to Ms D’s changing condition, during the two weeks before 20 October 2018. This is fault. Although this may not have been their specific remit, one would have expected these support workers to have a role in observing / reporting any concerns in (changes in) her overall health.
24. As such, on the balance of probabilities, the care provider should have spotted, one or a few days before Mr C did, that in addition to Ms D’s ear and eye infection, there were unusual things about Ms D’s presentation that should have been escalated. However, this did not result in a significant injustice to Ms D as there is no evidence the delay impacted her situation.

The incorrect invoices and the alleged failure by the Council to solve this:

25. Mr C says the care agency has failed to provide invoices that are correct. He said that each invoice he received over the last 18 months proved incorrect. He told the Council, which failed to ensure the care agency took the appropriate steps to rectify this problem and issue correct invoices. His most recent invoice from October 2020 was also wrong again. He say his daughter has been charged for care she did not receive. If he had not checked this thoroughly, it would not have been spotted and his daughter would have been overcharged.
26. The Council has told Mr C that, in light of the many payment claims it receives from care providers, it has a system where it only scrutinises individual claims from care agencies when the amount claimed is more than the amount contracted.
27. The Council told Mr C in its October 2019 complaint response, that it did not identify specific incidents or examples where the agency claimed hours that were not delivered. However, a review of invoices sent by Mr C identified some administration errors and it made an appropriate credit adjustment as a result.
28. The Council furthermore said in December 2019 that it would review his daughter’s invoices and amend or correct discrepancies identified.
29. According to the information the Council provided to me in the form of a spreadsheet, Ms D was overcharged on 11 occasions, between January 2019 to September 2020, which resulted in 18.5 hours subsequently ‘being removed’ and a credit note. However, according to Mr C, there was a total of 33 hours adjusted between May 2019 and June 2020.
30. The Council says that:
• Its spreadsheet indicates that out of 28 invoices there were 6 instances where the charge was amended due to a change in the care hours recorded. Other adjustments were made due to process timing issues.
• The adjustments partially happened when Ms D would cancel her support, which would often be at short notice.
• It has not received any other concerns in relation to the care provider’s invoices for any other client which would necessitate an audit being required.
• It recognises that regular meetings between commissioners and the payments team are needed to ensure any issues are flagged and discussed. These are now in place moving forward to ensure consistent communication and clear link to the quality and review team to audit documentation as and when needed. A review of the current quality assurance framework and process is set to take place where the Council will review how it monitors and audits any records.
31. The care agency says: it has been evidenced that it has made some unintentional errors. It is sorry these human errors occurred and as a result it has changed its processes.
32. Mr C says that one of the reasons for the discrepancy was that care workers were not accurately recording the hours they provided support.
33. The Council told me that:
• It conducts annual reviews with Providers and will review how it can randomly select and audit client files against their care plans. There will also be monthly meetings with the payments team to discuss invoices and purchase orders to ensure any issues are picked up early.
• Its commissioning department carries out annual contract reviews with Providers. Going forward, the Council will review how the Council will select and audit client Purchase orders, versus invoices and their care as specified in their care plans, as part of these reviews. The commissioning department will also meet monthly with the payments team to discuss invoices and purchase orders to ensure any issues are picked up early. This means that social workers will also have a direct route to commissioners to raise specific concerns following reviews or concerns raised by carers.

Analysis

34. The Council already acknowledged that some mistakes happened, apologised for these and reimbursed any money. It carried out an audit and did not identify any concerns that warranted a further / wider audit of the way in which the care provider calculates its invoices. Furthermore, the Council has also been working on a program to enhance the way it monitors invoices in general.
35. As such, I have nothing further to add with regards to this aspect of the complaint, then to acknowledge there was fault which has been remedied.

Mr C’s complaint about his daughter’s care (meaningful social activities)

36. Mr C says his daughter did not receive the care support she should have received between February 2019 and February 2020. His daughter has been receiving 5 hours a week to access the community. He says this should have been used to help her find a job, help her lose weight and socialise with people. Instead, the support worker only walked her around town and went shopping with her, even though she could do that herself.
37. Ms D’s 2017 support plan says that:
• She would like to have a permanent job and she goes regularly to the job centre.
• The support that she has previously had with shopping and food preparation has been cut as she is managing this independently.
• She needs support to help her establish social networks and maintain a community presence. Without such support, she would risk social isolation and her emotional wellbeing would be affected. To have on-going social outlets where it is possible for Ms D to make friends, develop confidence etc. To continue to look at activities with Ms D that benefit her and increase her community presence.
38. Ms D’s April 2019 assessment and support plan say that:
• The previous support plan was to partly provide hours to support her in the community with regards to interactions. However, Ms D has stated the usually used the hours to go shopping with her support worker and walk around the shops, which is something that Ms D can do alone. Ms D said: "All we do is walk round the shops for hours and it's boring".
• Therefore, a more appropriate support plan will be created to meet her current needs.
1. Outcome: To provide meaningful activities to reduce social isolation.
2. To support Ms D with finding employment or voluntary work and attending the Jobcentre once a fortnight.
3. To attend a slimming activity world once a week for two hours.
• Ms D was asked to record how she spends her time with her support worker which she could, with her consent, show to Mr C to reassure him the five hours are used constructively.
39. The above was further confirmed at a meeting at the end of May 2019 between the social worker, Ms D and the care provider.
40. Following the review, the Council’s brokerage team made various suggestions to Ms D about clubs she could join. However, Ms D was not interested in those.
41. The social worker carried out another review in November 2019. The record starts that:
• Ms D was very positive about the support from her Project team support worker. She outlined her day and said she attended the slimming activity and went for lunch and shopping afterwards.
• She was going to a job club and was about to start a computer course there. She was attending a place to do craft projects and relief work on Saturday.
• She was not very keen on the options proposed by the Council’s Brokerage Team.
42. The social worker also met with the care provider, who said that:
• They have tried to encourage Ms D to go for swimming, the gym and first aid classes, all with limited success.
• They are more than willing to support Ms D with anything she wants to do.
43. After the review, the Council provided further ideas to Ms D to consider. Furthermore, it asked Ms D to think about any different activities she would like to try, and the support worker would take her to the Leisure Centre to look at additional possible activities.
44. The social worker provided an update to Mr C and they discussed how he, and she as the social worker, may be frustrated that Ms D seemed to narrow rather than broaden her world. However, these were her decisions and all we could do is try and suggest new activities to her.
45. The care review in January 2020 showed that Ms D was still spending the time with her support worker in a similar way as she did in April 2019. Ms D’s social worker stressed again that Ms D did not need support with shopping, and the package of support was an opportunity for her to build her skills and try new experience. It was suggested that Ms D should write down any activities she would like to try.
46. It also became apparent that Ms D did not want to keep a record of activities for her father to monitor, and she did not like regular care reviews.
47. Mr C said the objective was to widen social circle. It said desperately needs to find friends and social outlets for people of a similar nature. Instead, her social circle decreased, and she only has one friend whom she sees occasionally. Other than this, the support worker appears to be her only social outlet. He believes his daughter has now become institutionalised and afraid to function on her own.
48. The care provider decided that:
• Ms D’s support worker would plan opportunities/activities with Ms D that she would like to engage in and support her to make any necessary bookings.
• Support staff would record all activities, what has worked and what has not and how Ms D feels about the activities.
49. Ms D found a voluntary position in February 2020.
50. The Council says that:
• It has become apparent that the activities the Council and Mr C wanted Ms D to do, were not always activities she wanted to do. As such, the Council has tried to encourage a positive and proactive approach that achieves a balance with regards to her established activities and new opportunities.
• The Council also gave information to her about activities and workshops that she could attend that were already available in the community.
• The Council has encouraged Ms D and care provider to develop a positive and proactive approach with regards to activities she could do.

Analysis:

51. Ms D’s 2019 April care review found that her hours were mostly used to walk around the town centre and go shopping, which was something Ms D could do independently.
52. The Council has persistently stressed the importance to try and ensure Ms D’s community support is used to identify and do meaningful activities with Ms D that could benefit her, establish social networks, and provide opportunities where she could make friends and develop confidence, to avoid social isolation. It should also be used to support her going to a health activity (once a week for two hours) and find work/volunteering opportunities.
53. Ms D continued to attend the weekly health activity and looked for job / volunteering opportunities.
54. Furthermore, the Council provided a list of suggestions to Ms D to consider. However, so far she has rejected almost all of these.
55. The Council summarised the situation well, when it spoke to Mr C and said Ms D was simply not interested in doing the activities that would be more beneficial for her, but which are the things Mr C and the social worker would like he to do. However, these were her decisions to make, and all the Council could do is to suggest and encourage her to do new activities.
56. So, while it is clear the objective set out in the care plan was not fully achieved during this time, I did not find this was due to fault by the Council.

Mr C’s complaint about his daughter’s care (finance management)

57. Mr C says his daughter did not receive the support she needed with managing her finances, between February 2019 and February 2020. He says:
• His daughter was vulnerable because she had a tendency to incur high phone charges (when she used 4G instead of her wifi).
• She would also sign up for things without realising the consequences.
58. Mr C says that, as such, the care agency was supposed to check her mail and bank statements to ensure it could spot this and/or any other unrecognised transactions and ask her about these. However, he says it failed to do this and as such, failed to notice (for instance) that she:
• Had two home insurances and two phoneline rental agreements.
• Had been making 62 additional transfers to her personal account on top of her agreed weekly allowance, totalling £2,115.
• Had an unusually high one-off phone bill of £158.
59. Ms D’s 2017 support plan says that:
• She needs support with evaluating risks, especially related to finances.
• Ms D has substantial difficulties with managing important elements of finances. Without support she is unable to budget, deal with benefits or manage a bank account effectively. This has led to debt on occasions and could jeopardise her tenancy. This limited comprehension of finances means without weekly support Ms D would not be able to pay bills, manage her benefits and bank account or budget according to her income. She would also be at risk of financial abuse or exploitation. Ms D needs support and guidance around not buying things from cold callers.
60. Ms D’s 2019 April assessment and support plan say that:
• Mr C usually visits his daughter every 2-3 weeks to ensure that all is well.
• Ms D's father is a joint signatory on her bank account so he can oversee this and reduce the risk of financial abuse. He is willing and able to continue as the financial representative for the direct payment, and also oversee his daughter’s bank accounts to safeguard them from mismanagement.
• Ms D would receive two visits a week to support her with correspondence and managing her finances.
61. The care provider’s support plan (Outcome Finance) was for Ms D to show all correspondence to support workers, so they could provide practical support to:
• Budget and meet all financial commitments.
• Maintain her tenancy.
• Stay out of debt.
62. However, a care review in November 2019 found that:
• Ms D would not always let the support worker read her bank statement and letters.
• As such, the social worked explained to Ms D she should ensure she would give the support worker access to her correspondence and bank statements, because otherwise they would not be able to effectively fulfil their role.
• The social worker suggested to Mr C that, if he felt he could no longer support his daughter with her finances, they could look into having an appointee instead, who would be appointed by the Court of Protection to manage all of Ms D’s finances on her behalf.
63. The care provider says this had been an ongoing issue and had been discussed at previous reviews. Ms D would tell staff she didn’t have her bank statement or that she didn’t want support to check it. She was selective with what she showed staff. She would only occasionally show staff her statements, which is when any issues were discovered, or when Mr C checked her statements during his visits and subsequently informed staff. For instance, Ms D allowed the support worker on 8 April 2019 to check her latest bank statement. The worker identified that a company had been taking money for phone/broadband even though she had left them in July 2018. This was resolved.
64. The Council says that:
• Ms D’s support plan from 4/19 outlines the need for commissioned support “with budgeting, finances, correspondence,” with the help that Mr C agreed he could offer. “Mr C is willing and able to continue as the financial representative for the direct payment and also oversee his daughter’s bank accounts to safeguard them from mismanagement“.
• Her subsequent support plan in February 2020 specified further that the care provider should: “check her bank statements, support her to maintain her tenancy, support her to report any necessary repairs, support her to maintain a safe environment, support her to manage necessary correspondence, and be mindful that Ms D can be susceptible to cold calling and to advise and support her to manage her money wisely and not take out unnecessary contracts”.
• The support Ms D received was to a large degree successful. Ms D’s tenancy was not put at risk, she did not incur debt (which historically she has done), she had insurance policies, she paid her bills, she was able to pay for her weekly shop. This success was achieved by partnership work - her father’s overall oversight of her bank account and his ability to alert the care provider to any problematic issues arising.
• In the longer term it has been recognised that to manage finance in the absence of her father’s input from the Court of Protection acting as deputies/appointees may be required – these conversations have already been had with them both.

Analysis

65. Mr C regularly visited his daughter and remained involved with overseeing his daughter’s finances during 2019. As such, he was able to pick up and raise several irregularities (see paragraph 58).
66. It is difficult to determine to what extent the support worker(s) should have (already) identified these before Mr C did. It was the role of the care provider to check bank statements and correspondence and spot these. However, it is also noted that Ms D often failed to share relevant documents with the support workers. However, on the balance of probabilities, I would have expected the care provider to have picked up on:
• At least some of the 62 additional transfers Ms D had made to her personal account.
• Had two home insurances and two phoneline rental agreements.
67. It did not do this, which is fault. However, this did not result in an injustice to Ms D during the time period I investigated.

Agreed action

68. 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 the care provider, I have made recommendations to the Council.
69. I recommended that, within four weeks of my decision, the Council should apologise to Ms D and Mr C for the faults identified above, and any distress these have caused them.
70. The Council has told me it has accepted my recommendation.

Back to top

Final decision

71. For reasons explained above, I decided to uphold Mr C’s complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

Back to top

Investigator's decision on behalf of the Ombudsman