Summary: We will not investigate this complaint about the Council’s assessment of Mrs Y’s needs for care and support, and its decision it would not commission the nursing home she had previously paid privately for. There is insufficient evidence of fault by the Council.

The complaint

1. Miss X complained the Council did not properly assess her mother’s (Mrs Y’s) needs when Mrs Y asked it to begin contributing towards the cost of her care. Miss X told us the Council:
• did not properly consider Mrs Y’s physical and mental wellbeing;
• assessed Mrs Y based only on a 20-minute telephone call; and
• made its decision based solely on finances.
2. Miss X said Mrs Y had been made to move to an unsuitable alternative nursing home, with significantly reduced access to physiotherapy. She said Mrs Y would suffer physically and mentally, and the family have experienced significant distress.
3. Miss X wanted the Council to refund care fees paid at the previous care home including top up fees, apologise, pay a symbolic financial remedy, and communicate with Mrs Y and Miss X to provide Mrs Y adapted social housing.

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The Ombudsman’s role and powers

4. 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 provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide there is not enough evidence of fault to justify investigating. (Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

5. I considered information provided by the complainant and the Council.
6. I considered the Ombudsman’s Assessment Code.

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My assessment

7. Mrs Y privately commissioned a nursing home after an amputation, at a cost of £2,110 weekly. The nursing home offered the benefit of regular physiotherapy sessions and a fully-equipped gym. Mrs Y made significant progress during her time at the nursing home.
8. When Mrs Y’s finances began to run low, she asked the Council to assess her with a view to commissioning her care. The Council assessed Mrs Y and decided her eligible needs could be met at a lower cost. It agreed therefore to commission care in an alternative nursing home.
9. Miss X complained to us on Mrs Y’s behalf, as they did not believe the Council had properly considered the benefits to Mrs Y of the nursing home she had so far been resident in and believed its decision she would need to move was wrong.
10. I have accessed a copy of Mrs Y’s assessment. The Council set out Mrs Y’s needs clearly and in sufficient detail. It explained Mrs Y’s preference would be to remain in the current nursing home due to the significant benefits it offered, and the impact this had on her independence and mental health.
11. There is insufficient evidence to support Miss X’s concern the Council relied only on a 20-minute telephone call with Mrs Y. The level of detail contained in the assessment indicates it also accessed information about Mrs Y’s needs from other sources, to come to an informed view.
12. The Council’s guide rate for commissioning nursing home placements is £904 weekly. This is significantly lower than the cost of the home Mrs Y privately commissioned. While councils cannot make decisions purely based on cost, it is a relevant consideration as the Council has a duty to spend public funds responsibly.
13. The Council acknowledged in its complaint response that the officer who had completed Mrs Y’s assessment had made a comment to Mrs Y about her current placement being too expensive. The Council said it had reminded the officer there needed to be a balance during discussions with people receiving care between cost and care needs.
14. Despite this, there is insufficient evidence the Council’s decision was one made purely based on cost. Where a person’s needs can be met in a lower-cost placement, councils are entitled to decide they would not agree to commission a more expensive option.
15. The nursing home Mrs Y moved to is one that specialises in physical disabilities and can support people of Mrs Y’s age. It has received a CQC rating of good and is on the Council’s list of approved placements. The nursing home does not have the additional benefits Mrs Y was able to access in her previous placement. However, there is insufficient evidence the Council was at fault for deciding the nursing home could meet Mrs Y’s needs, with NHS community physiotherapy being accessed.

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Final decision

16. We will not investigate Miss X’s complaint because there is insufficient evidence of fault by the Council.

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Investigator's decision on behalf of the Ombudsman