Summary: There was fault by the Care provider. The Care provider gave the wrong information to a resident and then did not deduct Funded Nursing Contributions from fees which it said it would. Refunding the amount of the Funded Nursing Contribution’s remedies the injustice.

The complaint

1. The complainant, who I shall call Mrs X, complains on behalf of her father, Mr D. Mrs X says the care home has not deducted Funded Nursing Care (FNC) payments from the fees paid for her fathers care. Mrs X would like this money refunded.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
3. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))

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How I considered this complaint

4. I read the papers put in by Mrs X.
5. I considered the Care provider’s comments about the complaint.
6. Mrs X and the organisation 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

7. 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.
8. In response to Mrs X’s official complaint, the Care provider accepted that it was at fault by giving the wrong information. The Care provider proposed to refund half of the FNC amount (£6,000) up until the date when the correct information was given. Mrs X complained to the Ombudsman as she felt that all the fees should be refunded, not half.
9. In response to my enquires, the Care provider has agreed to refund all the amount of the FNC’s from 22 March 2023 until 31 March 2024. Refunding the extra £6,000 remedies the injustice to Mr D.

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Agreed action

10. Within one month of the date of the decision on this complaint, the care provider should:
• Pay Mr D £12,000.
11. The Care provider should provide us with evidence it has complied with the above actions.

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Final decision

12. I have completed my investigation and uphold Mrs X’s complaint. I have made recommendations to remedy the injustice caused and the organisation has agreed to carry them out.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman