Summary: We will not investigate this complaint about care home charges from 2021 to 2023. This is because the complaint does not meet the tests in our Assessment Code on how we decide which complaints to investigate. This is a late complaint with no good reason why the complainant did not raise it sooner.

The complaint

1. In short, Mr X says the Care Home has failed to satisfactorily explain the care home charges for his late relative, Mr Y, starting from 2021 to early 2024 when Mr Y sadly died. He believes Mr Y was charged more as a self funder than local authority commissioned clients.
2. Mr X would like a breakdown of the care charges including the figures used for inflationary increases. Mr X says he wants a refund of the Funded Nursing Care element in full for year 2023 and inflation upgrade element for year 2022.

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The Ombudsman’s role and powers

3. We provide a free service but must use public money carefully. We do not start an investigation if we decide the tests set out in our Assessment Code are not met. (Local Government Act 1974, section 24A(6), as amended).
4. 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 care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. We investigate 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 do not start or continue an investigation if we decide we cannot achieve the outcome someone wants. (Local Government Act 1974, section 24A(6), as amended, section 34(B))
6. The law says we cannot normally investigate a complaint when someone could take the matter to court. However, we may decide to investigate if we consider it would be unreasonable to expect the person to go to court. (Local Government Act 1974, section 26(6)(c), as amended)

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How I considered this complaint

7. I considered information provided by the complainant. I also considered the Ombudsman’s Assessment Code.

Assessment

8. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the cost of nursing care delivered by registered nurses. If a person does not qualify for NHS Continuing Healthcare, the need for care from a registered nurse must be determined. If the person has such a need and it is determined their overall needs would be most appropriately met in a care home providing nursing care, then this would lead to eligibility for NHS-Funded Nursing Care.
9. I have seen information showing the Care Home responded to Mr X by recounting the steps taken when Mr X raised concerns. It said Mr Y was charged less than comparable clients in some instances. The Care Home also points to Mr X agreeing the previous charges and paying in full. The Care Home is seeking payment of outstanding fees of £2163.63.
10. We will not investigate. Mr X knew about the issues now raised with us from 2021. This is over 12 months ago and so the complaint is late as outlined in paragraph five. I have seen no good reason why Mr X could not have raised his complaint to the Ombudsman within 12 months of becoming aware of the issues he now raises.
11. Further, if the Ombudsman chose to ignore the 12-month rule and did decide to investigate it is unlikely we would achieve the outcome requested. The facts are Mr X chose the Care Home and signed a contract for a certain rate that he paid in full in the main. If Mr X now considers the terms of the contract were unfair this may be better dealt with in court as a contractual matter.
12. Mr X also raises a complaint of about one aspect of specialist nursing care received by Mr Y during his End-of-Life care. This is in connection with the operation of a syringe driver to administer drugs so we cannot investigate. Mr X may wish to approach the Health Service Ombudsman.

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Final decision

13. We will not investigate Mr X’s complaint because it does not meet the tests in the Assessment Code on how we decide which complaints to investigate. Mr X has made his complaint late and there are no good reasons to investigate.

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Investigator's decision on behalf of the Ombudsman