Summary: Mrs Y complains the Care Provider did not deduct Funded Nursing Care (FNC) contribution payments from her father’s care home fees. During our investigation, we established the Care Provider had not received these payments. We found the Care Provider at fault for ambiguity in its contract about FNC payments and for Mrs Y’s time and trouble to get clarity on the payment situation with this investigation, causing frustration. The Care Provider has agreed to apologise, pay a symbolic payment to Mrs Y and arrange a meeting to make a decision about her father’s care and fees going forward. It has also agreed to review and update its contract about how it treats FNC payments.

The complaint

1. Mrs Y, on behalf of her father (Mr X), complains the care home has failed to deduct his Funded Nursing Care (FNC) payments from the total weekly fees. She says its contract is not clear about how it treats FNC in individual cases and it failed to communicate how it applied it to her father. This has caused her father and the family distress and frustration.

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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) If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
3. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(1), as amended)
4. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

5. I discussed the complaint with Mrs Y and considered her views and information she provided.
6. I made enquiries of the Care Provider and considered its written responses and information it provided, as well as relevant law, policy and guidance.
7. Mrs Y and the Care Provider 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

Law and administrative background

Care Quality Commission (CQC) Fundamental Standards

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The CQC has guidance on this. Regulation 19 refers to care home fees and requires registered care providers to give accurate and clear written statements about costs, contractual conditions, and notice of any fee changes.

Funded Nursing Care (FNC)

9. FNC is when the NHS pays for the nursing care component of nursing home fees. The NHS pays a flat rate directly to the care home to support the cost of this nursing care delivered by registered nurses, and the resident does not receive any money directly.
10. The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care from the Department of Health and Social Care makes clear that contracts between residents and care homes should include transparent and fair terms governing how FNC payments are treated.

What happened – summary of key relevant events

11. In May 2024, Mr X was discharged from hospital to the White House Nursing home (the Home), run by Priory CC130 Limited aka Care Concern Limited (the Care Provider).
12. Mrs Y said she visited the Home and it told her assuming Mr X was not eligible for FNC funding, the total fee would be £1,450 per week and would cover all his assessed care needs. She said staff at the hospital completed an NHS Continuing Health Care checklist.
13. In June 2024, the Integrated Care Board (ICB) wrote to Mr X. It said the assessment identified he required the services of a registered nurse and he qualified for FNC. It was a contribution towards the nursing cost of care paid direct to the Home.
14. In August 2024, Mrs Y made a formal complaint. She said the Home had not reduced the weekly total fees for Mr X after the FNC payments.
15. In September 2024, the Home responded. It apologised for not responding to her emails. It quoted its contract which said FNC payments “will NOT (emphasis in original) be automatically deducted from fees and may be treated as an additional contribution”. Further to this, the contract said, “The Company shall confirm the position with regards to FNC contributions as soon as reasonably practicable”.
16. Mrs X escalated her complaint. She said the contract signed by Mr X had left a box referring to FNC fees blank with no indication from the Home that FNC contributions would not be deducted from the total fee payable if received.
17. In October 2024, the Home responded with its final complaint response. It said at the time Mr X moved in, it assessed him as having residential needs and so his fees were in line with the residential fee rate. It was not aware at the time of admission they had applied for FNC. It was correct the FNC fee box in the contract was left blank. If it assessed him as needing nursing care, the fees would have been higher to reflect his care needs. It also reviewed Mr X’s care. It said he was still considered a residential resident. It said he did not need nursing care and so would not necessarily qualify for FNC. It would contact the FNC funding team to say this and payments may be returned.
18. In April 2025, Mrs Y complained to us. She had email confirmation from the ICB and it said it had been paying the Home Mr X’s FNC since May 2024. Since her complaint to us, Mrs Y provided me with a letter from the ICB dated June 2025. This said following a review, Mr X continued to be eligible for FNC.

The Care Provider’s response to my enquiries

19. In response to my enquiries, the Care Provider confirmed it had not received FNC payments for Mr X. For my investigation, it contacted the ICB in November 2025 and I have seen a copy of this email. The ICB said it assessed Mr X as eligible in May 2024, and funding was available on its system from that date. It also said, “No invoices have been submitted to the ICB by [the Home] for payment”.
20. The Care Provider says it has reviewed Mr X’s care several times since and it has continued to provide the relevant care for his needs. It said because of this investigation, it would meet with Mrs Y and Mr X to discuss the care and fees going forward and consider if any changes need to be made to Mr X’s contract.

Analysis

The contract

21. I cannot make a safe finding on Mrs Y’s understanding of how FNC would be treated by the Home before Mr X moved in. This is because there is no contemporaneous written evidence of what was discussed between Mrs Y and the Home (about FNC payments) at the time. I can consider other documentary evidence available. The contract I have seen says at the time Mr X moved in; he was classed as “residential”, not nursing. It set out the payable fee for Mr X’s care as £1,450 per week, at the residential rate.
22. The contract’s terms do mention FNC and from the outset that these are not automatically deducted but may be treated as an additional contribution. It then says the Home would confirm the position as soon as reasonably practicable. This leaves it open and ambiguous. It should be clearer to say on what grounds it will or will not deduct FNC from fees. In my view, it is vague and not transparent on this part and raises concerns on how or whether it applies it consistently. This is fault with the contract, and caused some frustration for Mrs Y. This is also a potential breach of Regulation 19 (Paragraph 8).

Investigation into Mr X’s FNC payments

23. I cannot see evidence the Home was aware of Mr X being eligible for FNC until Mrs Y clearly informed it in emails before her formal complaint. At that point, the Home then outlined its general position, in response to Mrs Y’s complaint, that it would not deduct FNC payments. It said it had not assessed Mr X as needing nursing care. It said it would contact the ICB about it. It did not.
24. There may be a difference between the ICB and the Home’s views about Mr X’s eligibility and what specific nursing care a resident needs to meet the threshold, but it is not our role to define this or get into the details of how this was assessed by either side.
25. I recognise the Home did not think Mr X would qualify. But that is a decision for the ICB. In my view, the Home should have followed this up with the ICB to clarify the matter at the source, rather than leaving it open for Mrs Y. Mrs Y ended up contacting the ICB herself which confirmed the payments to the Home. It was then because of my involvement that the Home contacted the ICB itself to verify it had not received payments. This confused matters during this investigation, as Mrs Y understandably believed the ICB paid the Home the FNC payments and was keeping them. This is fault by the Home here. If it had proactively acted on this at the time, this could have been established sooner, rather than at this late stage. This has caused injustice to Mrs Y for the avoidable time and trouble of having to go through us to get this clarified.
26. The Home has regularly reviewed Mr X’s care since and he remains on a residential contract. It does not appear it has charged for or provided nursing care. Mrs Y is not disputing the level of care provided and the Home is of the view that it has not needed to increase the level of care resulting in additional nursing charges.
27. On balance, I do not consider there is injustice to Mr X financially. FNC payments are intended to go towards the nursing element of care costs. He has not paid the Home for the higher rate for nursing care, and the Home has not claimed the payments to date.
28. However, the Care Provider has said in light of this, it would now offer to establish a way forward with Mrs Y and Mr X about his care and his fees. I welcome this and think this is appropriate in the circumstances.

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Agreed Action

29. To remedy the injustice set out above, the Care Provider has agreed to carry out the following actions:
30. Within one month of the final decision:
• Apologise in writing to Mrs Y and Mr X (in line with our guidance on making an effective apology) and pay Mrs Y a symbolic payment of £100 for the injustice caused by the faults identified; and
• Invite and arrange a meeting with Mrs Y and Mr X (or another suitable representative) to discuss the arrangements, and for it to make a decision, relating to his care fees, contract, and FNC payments going forward.
31. Within two months of the final decision:
• The Care Provider should review and update its contract for service users to give clearer information regarding the application, collection and treatment of FNC payments.
32. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

33. I find fault causing injustice. The Care Provider agreed to my recommendations. I have competed my investigation.

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Investigator's decision on behalf of the Ombudsman