Summary: We will not investigate Mrs X’s complaint about how her late parents' Care Provider dealt with issues about outstanding charges. There is not enough evidence of fault in relation to the Care Provider’s handling of outstanding charges for Mrs X’s late father. There is also nothing more we could add to the Care Provider’s investigation and response to Mrs X’s complaint about how the Care Home Manager approached discussions with her about outstanding charges.

The complaint

1. Mrs X complains about the way in which her late parents’ Care Provider dealt with issues around outstanding charges. She says the Care Home Manager’s approach to discussions about this was ill-timed, rude and insensitive. Mrs X also believes the Care Provider should not be chasing her late father’s estate for outstanding charges as the National Health Service (NHS) has confirmed these should be entirely covered by Continuing Healthcare (CHC) funding.

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The Ombudsman’s role and powers

2. 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, or
• we could not add to any previous investigation by the organisation, or
• there is another body better placed to consider this complaint. (Local Government Act 1974, section 24A(6), as amended, section 34(B))

3. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

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How I considered this complaint

4. I considered information provided by the complainant.

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My assessment

5. The Care Provider has explained to Mrs X that CHC funding for her late father was declined following assessment in May 2023. Mrs X has sent us information from the NHS which states CHC funding should have been provided for her late father from 7 April to 8 June 2023. The NHS also invited Mrs X to make a claim for reimbursement for any care charges paid over this period.
6. It is unclear if Mrs X has shared this information with the Care Provider or made a claim for reimbursement from the NHS. There is not enough evidence of fault by the Care Provider in relation to this issue. Because of this, we should not investigate further.
7. The Care Provider has responded to Mrs X’s complaints about how the Care Home Manager approached her to discuss outstanding charges shortly before Mrs X’s mother passed away. The Care Provider accepted the Care Home Manager’s approach to these issues was ill-timed and appeared insensitive. It has apologised to Mrs X for adding to her distress at an already upsetting time. The Care Provider has also confirmed it will learn from Mrs X’s experience.
8. There is nothing more we could achieve by investigating this issue further. The Care Provider has already provided the outcome we would typically expect in these cases.

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Final decision

9. We will not investigate Mrs X’s complaint because there is not enough evidence of fault and we could not add to the Care Provider’s investigation and responses.

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Investigator's decision on behalf of the Ombudsman