Summary: We will not investigate Ms B’s complaint about the Council’s failures to provide a proper care needs assessments for her mother, Mrs C, a Continuing Health Care (CHC) funding checklist in 2022 or its failure to communicate effectively and in a timely way with her. This is because we could not add to the Council’s investigation or response even if we investigated. We could not achieve the outcome Ms B wants.

The complaint

1. Ms B complained the Council failed to:

• provide information and advice in line with the Care Act;
• ensure a proper assessment of her mother’s, Mrs C’s, care needs were undertaken on discharge from hospital in 2022;
• provide her with a copy of Mrs C’s assessment and outcomes;
• undertake a Continuing Health Care (CHC) checklist.
• respond to correspondence and complaints within 10 working days and within time constraints outlined its own complaint procedures.

2. Ms B says she has had to liaise with several different agencies and has had to navigate selling Mrs C’s property without support. Ms B says she has suffered stress and anxiety because of the Council’s actions which has exacerbated her own health conditions. Ms B wants the Council to apologise, explain why it failed her and Mrs C, repay care fees Mrs C paid up until the CHC assessment was completed and ensure care fees paid directly to the home are reimbursed.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse effect 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 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)

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How I considered this complaint

4. I considered information provided by the complainant.
5. I considered the Ombudsman’s Assessment Code.

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My assessment

6. The Council responded to Ms B’s complaint in April and undertook a full investigation into her concerns in November 2023. In the initial complaint response, the Council acknowledged and apologised for the delay in responding to her complaint, the poor level of communication she received and for its failure to contact her regarding the Deprivation of Liberty Safeguards (DoLS) assessment. The Council says it undertook a DoLS for Mrs C following a capacity assessment which found she did not have capacity to decide where she should live. The Council said it will ensure DoLS assessors contact families in the future when undertaking an assessment and issue the decision once completed. We are satisfied the Council has remedied the fault and further investigation by us could achieve no more than this.
7. The Council says Mrs C was discharged from hospital to an Enhanced Assessment Bed in May 2022 for a full assessment of her needs. Ms B was present during the assessment and was aware Mrs C had capital above the threshold for Council funding so would be fully funding her own care. The Council says the Assessor was satisfied Mrs C did not have any health needs requiring completion of a CHC checklist, but apologised this was not discussed with Ms B at the time. It confirmed the start of the self-funded placement would begin on 11 July 2022. The Council confirmed there were no concerns with the placement with Ms B and the care provider in August 2022 and closed the case.
8. Ms B contacted the Council in September 2022 enquiring about a CHC assessment. She was advised to contact the care provider and request they complete a checklist.
9. Ms B contacted the Council again in March 2023 asking for a CHC checklist to be completed. The Council reassessed Mrs C’s care needs and completed a CHC checklist. The outcome of the assessment was that Mrs C did not meet the criteria for CHC funding but was eligible for Funded Nursing Care (FNC). The Council advised Ms B the NHS agreed to pay the care provider FNC for Mrs C from October 2022 to 20 August 2023. We could not add to this point even if we investigated.
10. The Council found no evidence Ms B had had to chase up contact. We will not investigate this point. Where the substantive matters do not themselves warrant investigation, the Ombudsman will not normally consider how the Council has responded to a complaint about them. That is the case here.
11. It is not an administrative function of the Council to decide whether a person is eligible for CHC funding, nor can the Council decide not to provide CHC funding. In the absence of evidence from the NHS confirming Mrs C was eligible for CHC funding from 2022, there is no fault with the Council for charging Mrs C for care it provided.
12. Information about the NHS funding can be found on the website below.

https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care

13. Mrs C was awarded retrospective FNC. FNC is the amount the NHS pays for nursing care in a care home. It applies where people are eligible for some NHS nursing care as well as personal social care, but are not eligible for fully funded NHS Continuing Health Care (CHC). The Council has advised Ms B to contact the care provider who will clarify whether FNC is included in the terms and conditions of the contract. We could not add to this.

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Final decision

14. We will not investigate Ms B’s complaint because we could not add to the Council’s investigation or make a different finding of the kind Ms B wants.

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Investigator's decision on behalf of the Ombudsman