Summary: The Ombudsman will not investigate Ms B’s complaint about care home fees because an investigation is unlikely to add to the responses Ms B has already received.

The complaint

1. The complainant, who I shall call Ms B, complains on behalf of her mother, Mrs D, that she did not receive physiotherapy and rehabilitation (rehabilitation support), following her discharge from a hospital into a care home. She complains that Mrs D was admitted to a seasonal pressures bed which incurred a weekly charge. Ms B says her sister, Ms K, only agreed to Mrs D’s discharge from hospital and admission to the care home on the basis she would receive rehabilitation support. Ms B says staff from West Sussex County Council (the Council) pressured Ms K to agree to her mother’s discharge as soon as possible.
2. Ms B also complains that on one occasion, the care home did not assist Mrs D with her personal care needs.
3. Ms B says had she known the care home was only a temporary measure and Mrs D would not receive rehabilitation support, she would have taken steps to find her a more permanent care home following her discharge from hospital. She says a move from this placement into her permanent care home caused Mrs D distress and inconvenience.
4. Ms B would like a reimbursement of the fees paid to the care home as her mother did not receive rehabilitation support.

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The Ombudsmen’s role and powers

5. The Ombudsmen provide a free service, but must use public money carefully. They may decide not to start or continue with an investigation if they believe it is unlikely they would find fault, or would not add anything to any previous investigation by the bodies involved. (and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

6. I have considered information provided by Ms B over the telephone and in writing. I have also considered Ms B’s comments on a draft version of this decision.
7. I have also considered the complaint responses provided by the Council and additional responses provided by the Council following queries.

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What I found

Rehabilitation and physiotherapy

8. On 24 February 2019, Mrs D suffered a stroke and was admitted to St Richards Hospital for medical treatment. Ms B says on 12 March 2019, doctors advised the family that Mrs D was medically fit for discharge and a rehabilitation placement was being considered.
9. A patient can be considered medically fit for discharge, therefore not requiring an acute hospital bed, but may still require care services provided on a short-term basis in another community setting. Where this is the case, health professionals and social care practitioners should take steps to identify the appropriate care available.
10. Staff involved should ensure an assessment of the patients’ needs is done promptly to determine what type of bed would be most suitable for a patient’s needs. They should also ensure the person and their family receive clear information about the care the patient will receive within the acute setting and whether any costs will apply.
11. The Council and the Trust considered whether a Discharge to Assess (D2A) bed with rehabilitation support would be suitable for Mrs D on discharge from hospital.
12. A social worker, from the Council, carried out an assessment for the D2A bed on 15 March 2019. A D2A bed is only suitable if the patient can engage with the process and has the mental capacity to understand the programme and what they are being accepted for. The assessment determined Mrs D was not suitable for a D2A bed as she did not have the mental capacity required to engage in the process.
13. As Mrs D could not be discharged home directly and could not engage with a D2A bed, residential care was considered as an alternative option, based on the outcome of her assessment. The Council considered a seasonal pressures bed, which is commissioned for a short period of time over the winter period to help ease the pressures faced by local hospitals while appropriate packages of support or housing is found for them, was the most appropriate bed for Mrs D at the time.
14. The Council said it notified Ms K that Mrs D was considered unsuitable for a D2A bed and suggested a transfer into a seasonal pressure bed as she could not be discharged home. The Council discussed the costs of this care with Ms K who agreed that the costs would be met. The evidence currently suggests that Ms K signed a short stay residential respite basic charge form on 15 March 2019 agreeing to pay £125 per week towards the cost of Mrs D’s care based on the assumption that she had less than £23250 in savings.
15. Once Ms B confirmed that her mother had above the financial threshold in savings, the Council said the social worker advised her that Mrs D would be charged the full cost of her stay at the care home. On 16 March 2019, Mrs D was transferred to the care home into a seasonal pressure bed and she remained there until 16 April 2019.
16. While Ms B says her sister only signed the short stay charge form because she considered her mother would receive rehabilitation support, I cannot see any evidence of this within the records. Instead, records currently show the Council discussed the possibility of a D2A bed with Ms K, but that following an assessment determined Mrs D would be unsuitable given her level of cognition at the time and that this decision was communicated to Ms K. I have also seen evidence that a short stay charge form was discussed with Ms K prior to Mrs D’s transfer to the care home and she had understood that fees would be applicable before her mother’s admission.
17. The Council’s final response is in line with the correspondence I have seen on record that suggests Ms K was aware that her mother was paying for her own care in a seasonal pressures bed and not a D2A bed as she was unable to engage with rehabilitation at the time.

Care and Support in the Home

18. Ms B’s complained that care home staff did not assist with her mother’s care needs on an occasion. The care home, in its complaint’s response, said there was no record of this incident within its records. It apologised if this incident had taken place and said it would remind staff of their duties. This appears to be a reasonable response to acknowledge Ms B’s concerns and it is unlikely an investigation by the Ombudsman would achieve anything further for Ms B on this matter.

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Final decision

19. The Ombudsman will not investigate Ms B’s complaint. This is because an investigation by the Ombudsman is unlikely to find fault or achieve anything further for Ms B.

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Investigator's decision on behalf of the Ombudsman