The Ombudsman's final decision
Summary: We will not investigate this complaint about charges for residential care. This is because the complaint does not meet the tests in our Assessment Code on how we decide which complaints to investigate. There is not enough evidence of fault by the Council.
The complaint
The complainant, Mrs X, complained on behalf of her now deceased mother (Ms Y). Mrs X complained the Council charged her mother for residential care from January 2021. Ms Y’s care before this was paid for by funding available due to the COVID-19 pandemic. Part of Mrs X’s care has since been paid for by NHS-Funded Nursing Care (FNC). Mrs X says her mother only ended up in residential care because of two accidents in respite care in February 2020. This respite care was arranged by the Council.
The Ombudsman’s role and powers
The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or may decide not to continue with an investigation if we decide: there is not enough evidence of fault to justify investigating, or there is another body better placed to consider this complaint.
(Local Government Act 1974, section 24A(6)) We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
How I considered this complaint
I considered information provided by the complainant and the Council.
I considered the Ombudsman’s Assessment Code.
My assessment
We will not start an investigation into Mrs X’s complaint.
The Council has explained a financial assessment showed Ms Y had savings and assets of a level which meant she was liable to pay for any care not covered by FNC. There is not enough evidence of fault in how the Council decided this.
Also, we expect people to complain to us within 12 months of them becoming aware of a problem. Any concerns about the respite care Ms Y received are therefore late. I see no reason why Mrs X could not have complained to us sooner. Even if we investigated this point, we could never establish a causal link between what happened to Ms Y in respite care and her long-term stay in residential care.
If Mrs X thinks her mother should have received a higher level of funding from the NHS in the form of Continuing Healthcare (CHC) then this is something she needs to take up with the local Clinical Commissioning Group. If Mrs X was unhappy with the eventual response she could complain to the Parliamentary and Health Service Ombudsman.
Final decision
We will not investigate Mrs X’s complaint because there is not enough evidence of fault by the Council.
Investigator's decision on behalf of the Ombudsman