Summary: We will not investigate this complaint about how the Care Provider treated Funded Nursing Care in relation to care charges. This is because further investigation is unlikely to find evidence of fault in the Care Providers actions.

The complaint

1. Mr X complains on behalf of his mother, Mrs Y, that the Care Provider did not reduce her weekly care fees after she became eligible for NHS Funded Nursing Care (FNC) in August 2025.
2. He says the fees already covered nursing care and argues the Care Provider should deduct the FNC. He believes Mrs Y has been overcharged. He also raises concerns about a delay in completing the FNC assessment.

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The Ombudsman’s role and powers

3. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
4. The law says we cannot normally investigate a complaint when someone could take the matter to court. However, we may decide to investigate if we consider it would be unreasonable to expect the person to go to court. (Local Government Act 1974, section 26(6)(c), as amended)
5. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused a significant injustice or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(3 and 4) as amended)
6. 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
• any fault has not caused injustice to the person who complained, or

there is no worthwhile outcome achievable by our investigation. (Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

7. I considered information provided by the complainant and the Care Provider.
8. I considered the Ombudsman’s Assessment Code.

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My assessment

9. Mrs Y has privately funded her care home placement since April 2025.
10. The NHS awarded her Funded Nursing Care (FNC) in August 2025 and pays this directly to the Care Provider to support the cost of nursing care delivered by registered nurses.
11. Mr X says the Care Provider should reduce Mrs Y’s weekly fees because the overall charge already includes nursing care. The Care Provider does not agree to this reduction. It says the contract clearly states FNC is paid in addition to the weekly fee, and my review of the contract supports this position. We will not investigate this part of Mr X’s complaint because further investigation is unlikely to find evidence of fault in the Care Providers actions.
12. Whilst the Ombudsman can interpret contracts based on their ordinary meaning and consider how a reasonable member of the public would understand them. If Mr X disputes whether the contract has been breached, it would be reasonable to expect him to take this matter to a court
13. The Care Provider acknowledged it made a clerical error by selecting the “nursing care” box instead of the “residential care” box on Mrs Y’s admission form, however, this does not change the wording about how it treats FNC payments in the contract.
14. Mr X also raised concerns about a delay in the FNC assessment, which the Care Provider accepted. We will not investigate this issue because the delay did not cause a significant injustice as the amount Mrs Y pays is the same.

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Final decision

15. We will not investigate Mr X’s complaint; because further investigation is unlikely to find evidence of fault in the Care Providers actions.

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Investigator's decision on behalf of the Ombudsman