Summary: The care provider was at fault as it did not refund care home fees paid by the late Mr Y during a period when he received continuing health care funding. The care provider should refund the fees Mr Y paid but as the care provider has ceased trading and is going through the insolvency process we cannot achieve this remedy.

The complaint

1. Mrs X complains the care provider has failed to refund care home fees paid for a period when her late father, Mr Y, received continuing health care funding between February and March 2018.

Back to top

The Ombudsman’s role and powers

2. 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. (Local Government Act 1974, sections 34B and 34C) If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))

Back to top

How I considered this complaint

3. I have considered the information supplied by Mrs X and information available on-line about the care provider.
4. Mrs X and the care provider were sent a copy of a draft of this decision for their comments.
5. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

Back to top

What I found

6. The Care Quality Commission (CQC) is responsible for monitoring, inspecting and regulating services to make sure they meet fundamental standards of quality and safety.
7. “NHS continuing healthcare (NHS CHC) is a package of care arranged and funded solely by the health service in England for a person aged 18 or over to meet physical or mental health needs that have arisen because of disability, accident, or illness.” (NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012).
8. The NHS can provide continuing healthcare at home or in a care/nursing home. The NHS is responsible for meeting the full cost of care in a care home for residents whose primary need for being in care is health-based.
9. Mrs X’s late father, Mr Y, lived at Radcliffe Gardens Nursing Home. He qualified for NHS CHC at the end of February 2018 until he died in March 2018. The NHS says it paid the care home Mr Y’s CHC funding during this period. Mrs X says the care provider also debited the money from Mr Y’s bank account for the same time period and so has been paid twice. It has not refunded this money. This is fault. The care provider owes Mr Y’s estate the care home fees he was charged when CHC funding was in place.
10. We would have recommended the care provider refund these overpaid fees. However, we have received no response to our correspondence with the care provider at its registered address. The care provider is no longer registered with the CQC, is no longer trading and is in the process of insolvency. There are no active directors listed for the company. Because of this we cannot achieve a remedy for Mrs X’s complaint.

Back to top

Final decision

11. I uphold the complaint. There was fault leading to injustice but I cannot achieve a remedy for the injustice as the care provider has ceased trading and is being dissolved.

Back to top

Investigator's decision on behalf of the Ombudsman