Summary: Ms X complained about the Care Provider’s standards of care for her family member, Mrs Y. I found the Care Provider failed to record and report injuries to Mrs Y and had poor communication with Ms X, which caused distress, risk of harm, and time and trouble. The Care Provider should make a symbolic payment to Ms X, reimburse her for damage caused to a table and change its procedures for quoting case costs to align with the law.

The complaint

1. Ms X complains about the service of OM Care Ltd trading as Caremark (Wokingham and Bracknell), which I shall refer to as the Care Provider, when it provided live-in home care for Mrs Y.
2. Ms X complains the Care Provider:

• provided an inadequate standard of care and damaged Mrs Y’s dining table.
• charged too much given the standard of care, and charged for additional hours Ms X had not authorised.
• failed to reimburse the cost of repair to a dining table, despite saying it would.
• failed to properly apologise and respond to contact from Ms X to try to resolve the matter.

3. Ms X says this caused her and Mrs Y distress and anxiety and the Care Provider’s poor communication has caused her frustration and significant time and trouble.

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The Ombudsman’s role and powers

4. 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)
5. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
6. 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)
7. We normally expect someone to notify the Care Quality Commission about possible breaches of standards. However, we may decide to investigate if we think there are good reasons to do so. (Local Government Act 1974, section 34B(8), 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)
9. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

10. I considered the information Ms X provided and discussed the complaint with her.
11. I considered the Care Provider’s comments and the documents it provided.
12. Ms X and the Care Provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Regulations and guidance

13. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 and 2014 set out the fundamental standards that registered care providers must achieve. The CQC has guidance on how to meet the fundamental standards which includes:

• Regulation 10: Dignity and respect. To make sure people are always treated with dignity and respect when receiving care.
• Regulation 12: Safe care and treatment. To prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm.
• Regulation 19: Fees. To make sure providers give timely and accurate information about the cost of their care and treatment to people who use services.

14. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

What happened

15. Mrs Y is an elderly person with physical health issues and dementia who requires support in several areas. She is cared for by her family member Ms X.
16. Ms X had previously used the Care Provider to provide live-in care for Mrs Y.
17. Ms X had a two week break in September 2023. Ms X contacted the Care Provider which supplied a live-in carer. It quoted Ms X a cost of £1,300 per week for the two weeks, in an email. The exact length of the care was two weeks and one day, but this was not clarified in the email. I have not seen evidence the Care Provider produced a more detailed quote or contract for Ms X.
18. Ms X said when she was away she spoke to Mrs Y on the telephone. Ms X said Mrs Y said things that made her worried about the standard of care she was receiving. Ms X said she did not raise the concerns when she was away because Mrs Y was scared it might make things worse.
19. During the period of care, the Care Provider said it became apparent that the carer needed breaks to be covered. It said it tried to contact Ms X by phone, but was unable to get through. It then decided to contact the relevant council adult social care team, which approved the breaks.
20. The day after she returned from her break, Ms X complained to the Care Provider that the carer:

• refused to sit with Mrs Y to keep her company.
• shouted whilst having an argument on a private phone call which frightened Mrs Y.
• failed to follow the general housekeeping guidelines Ms X had provided and left the house in a dirty and untidy state.
• failed to properly report and record injuries Mrs Y sustained.
• damaged Mrs Y’s dining table by writing on it.

21. The Care Provider sent a person to clean the house. This was completed to Ms X’s satisfaction.
22. On 19 October the Care Provider responded to Ms X’s complaint. It had spoken to the carer who denied some elements of the complaint. The Care Provider accepted:

• The carer had not properly reported and recorded Mrs Y’s injuries.
• The dining table had been damaged.

23. The Care Provider apologised. It said the cost of the repairs to the table would be reimbursed and asked Ms X to send it a quote. It also said the carer would be retrained in reporting and recording injuries before taking another position.
24. The Care Provider said Ms X could complain to the relevant local authority if she was not satisfied with the way it had handled her complaint. It did not tell Ms X she could raise a complaint with us at the Ombudsman.
25. On 27 October 2023 Ms X sent the Care provider a quote for the repair to the table. However, the document is titled as an invoice, not a quote. The repair had not been carried out at that point.
26. On 2 November 2023 the Care Provider sent Ms X an invoice for the care. The total charge was £3,148, comprised of:

• £2,692 for the live-in element. This was the sum of £1,300 per week for two weeks and £92 for the additional day.
• £456 for additional hours of care on nine days to cover the carer’s breaks.

27. Ms X raised concerns about the invoice. She said the Care Provider had quoted only for two weeks at £1,300 per week. Ms X said she should not be charged for the breaks because they had not been included in the quote. She also said she had arranged for someone to visit Mrs Y and the carer could have taken breaks when there was someone else there. She also did not think she should be charged the whole amount given the poor standard of care.
28. On 8 November 2023 the relevant council held a safeguarding meeting about the care Mrs Y had received. People at the meeting included a council social worker that had worked with Mrs Y, a manager from the Care Provider and Ms X.
29. Attendees agreed the injuries to Mrs Y had not been properly recorded and reported, and that failure was a serious concern.
30. The Care Provider and Ms X also discussed the charges for the extra carers that covered the carer’s breaks. Ms X said the Care Provider had not given her any information about the extra charges before its final invoice. The Care Provider said it tried to contact Ms X by telephone during the period of care, when it decided extra cover was needed. It could not get through by telephone so decided to ask the council to agree to the extra care instead. Ms X said the Care Provider should have provided information about the costs of covering breaks before the care started. She also said it should have emailed her during the care instead of using the telephone. Ms X disagreed extra carers were required in the circumstances.
31. The council recorded the safeguarding concerns were substantiated. The Care Provider said it would retrain the carer before considering further placements. It was also advised to provide a formal written apology to Mrs Y as soon as possible.
32. On 23 November the Care Provider emailed Ms X and asked her to pay only for the live-in element of the care. It did not ask her to pay for the additional hours to cover the carer’s breaks, the payment for which was arranged with the council separately. It offered a £100 discount for her concerns, which resulted in £2,592 owing. Ms X thought this was still too high and told the Care Provider she did not want to pay until all matters including the cost of repairing the table had been resolved.
33. Ms X had the dining table repaired at a cost of £620. There is an invoice for the repair dated 15 December 2023. This document is very similar to the invoice sent as a quote dated 27 October 2023. On 1 January 2024 she emailed details of the repair to the Care Provider. A screenshot of an email from this date shows it had two photographs attached, but not an invoice.
34. Ms X contacted the Care Provider several times about payment for the care, and reimbursement for the repair to the table. The Care Provider did not provide clear responses to Ms X.
35. In February 2024, at Ms X’s request, the council social worker that had worked with Mrs Y, contacted the Care Provider to try to help resolve the matter. The Care Provider replied to the social worker and said someone would contact Ms X. I have seen no evidence anyone did contact Ms X.
36. Ms X complained to us in July 2024. When we contacted the Care Provider it told us it was still willing to pay for the damage to the table but had not received a repair invoice from Ms X.

Analysis

The standard of care

37. I have considered the evidence of the care Mrs Y received with reference to the CQC guidance on the fundamental standards the Care Provider must achieve.
38. The relevant council held a safeguarding meeting regarding Ms X’s concerns about the standard of care. It discussed the matters Ms X had previously complained to the Care Provider about. The evidence I have seen indicates the council found the failure to properly report and record the injuries to Mrs Y was the most serious concern. The safeguarding enquiry substantiated the concern. I have seen no evidence that leads me to disagree with the council’s findings.
39. Ms X said the failure to record and report Mrs Y’s injury meant the wounds went untreated for a week because a District Nurse who attended during the period was not made aware of them. This failure is a potential breach of Regulation 12.
40. I note in response to Ms X’s concerns the Care Provider:

• cleaned the house shortly after Ms X complained.
• initially apologised in its letter of 29 October 2023.
• verbally apologised to Ms X and undertook to retrain the carer during the safeguarding meeting on 8 November 2023.
• offered a reduction of £100 for the cost of care.

41. Ms X said the Care Provider did not send a written apology after the safeguarding meeting despite the meeting notes indicating it would. The Care Provider said it did send a written apology regarding the care it provided. It provided an apology letter dated 13 November, and a screenshot of an email to Ms X dated 23 November 2023 with the letter attached. I find the evidence shows it is more likely than not the Care Provider sent an apology, but Ms X did not see it.
42. I find the Care Provider provided care that fell below an acceptable standard when it failed to record and report injuries. This caused Mrs Y distress and risk of harm, and Ms X distress in the form of anxiety and frustration.

Invoices and communication

43. I have considered the part of Ms X’s complaint about the amount she was charged with reference to the CQC guidance that providers must give timely and accurate information about the cost of care.
44. The Care Provider failed to provide timely and accurate information about the cost of the care as it did not include the additional day rate and hours for breaks in its quote. This is a possible breach of Regulation 19.
45. The Care Provider contacted the council to seek agreement about the hours for breaks. However, the care had been arranged by Ms X and the Care Provider should not have charged Ms X for costs that had not been arranged with her.
46. I note the Care Provider has now asked Ms X to only pay for the live-in element of the invoice, not the additional hours, and offered £100 reduction. This resulted in a final charge of £2,592. So I do not consider she has been caused a significant injustice.
47. I have also considered Ms X’s complaint about the failure to reimburse the cost of repairing to the table. The Care Provider initially told Ms X this would be done after she provided it a quote for the cost. It then asked for an invoice for the completed work.
48. Ms X said she sent the invoice dated 15 December 2023 to the Care Provider on 3 January 2024. The Care Provider said it did not receive it, and the screenshot of an email it did receive does not have the email attached. It is unclear when Ms X sent the invoice. However, it is clear she sent a quote, photographs of the repair, and then tried to communicate with the Care Provider in January and February 2024. In my view, the Care Provider’s communication with Ms X at that point was unclear and not timely.
49. I find the Care Provider’s failure to provide timely and accurate information in its communication with Ms X caused her injustice in the form of frustration, and time and trouble spent contacting the Care Provider about the invoice and reimbursement.

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Recommended actions

50. Within four weeks of the date of this decision, the Care Provider will:

• Reimburse the cost of the table repair.
• Pay Ms X a symbolic payment of £100 in recognition of the injustice caused. This is in addition to the £100 reduction already offered in the reduction of fees. It should not be deducted from the outstanding costs.
• On completion of the reimbursement and symbolic payment, raise a final invoice for Ms X for £2,592 for the cost of the care.

51. Within eight weeks of the date of this decision, the Care Provider will:

• Amend its procedure for quoting the costs of care to ensure it aligns with Regulation 19 regarding fees, and provide an explanation of how the amendments achieve that objective.

52. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

53. I have completed my investigation and uphold Ms X’s complaint. Ms X has been caused an injustice by the actions of the Care Provider and I have recommended it take action to remedy that injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman