Summary: We will not investigate this complaint about the care Mrs Y received in a care home and the Care Provider reneging on its agreement to refund care fees. Complaints about the care itself are late, and we could not achieve the outcome Ms X seeks as there is insufficient evidence of fault in the Care Provider’s decision not to refund fees.

The complaint

1. Ms X complains about the care her mother (Mrs Y) received in a care home. The Care Provider has reneged on an agreement to reimburse care fees for March to November 2020, which would amount to over £35,000. Ms X has experienced distress. She wants the Care Provider to honour its agreement.

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The Ombudsman’s role and powers

2. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
3. The Ombudsman investigates 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 may decide not to continue with an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• we cannot achieve the outcome someone wants.

(Local Government Act 1974, section 24A(6))

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How I considered this complaint

4. I considered information provided by the complainant.
5. I considered the Ombudsman’s Assessment Code.

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My assessment

6. Ms X raises complaints about the quality of care her mother, Mrs Y, received, from 2015 until her death in December 2020. Ms X also raises complaints about how the Care Provider dealt with her requests for clarification of Mrs Y’s care fees from 2019. We usually expect complaints to be brought to us within 12 months of events. Ms X could have brought these complaints to us much sooner.
7. I have considered that some of the period after these events was spent by Ms X raising her concerns and seeking a remedy from the Care Provider. She suggested in January 2021 it should refund fees. For four months between November 2021 and March 2022, she says she understood the Care Provider to have agreed to her request. However, she could have brought her complaint to us sooner when the Care Provider sent her a final response, in March 2022, saying it would not refund the fees. Ms X brought her complaint to us after a further five months, in August 2022. There is not a good reason for the overall delay in Ms X bringing these issues to us and we should not therefore investigate events that occurred earlier than August 2021.
8. The complaint that the Care Provider reneged on an agreement of November 2021, to refund care fees, is closely related to the earlier events that are now too late for us to consider. The alleged agreement was to remedy the impact of those earlier events. However, given that this was more recent and within the timescales to bring a complaint to us, I have considered whether we could investigate that in its own right as a standalone complaint.
9. However, the alleged agreement was verbal and was not made in writing. I could not now say what exactly the Care Provider agreed to, and whether the person had all relevant facts available to them at the time of the conversation. The same person wrote the final response to Ms X’s complaint in March 2022, which stated Ms X’s request was disproportionate in light of the overall care Mrs Y had received. There is not enough evidence this decision was made with fault or conflicted with an earlier valid agreement.
10. As we will not investigate the earlier, substantive complaints themselves, it is not for the Ombudsman to recommend a refund of care fees in the absence of a formal agreement. The amount that Ms X seeks is over and above what the Ombudsman could achieve in any event, and it is open to Ms X to take legal advice on the option of making a claim through the courts instead.

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Final decision

11. We will not investigate Ms X’s complaint because parts of it are too late, and we could not achieve the outcome she seeks in any event.

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Investigator's decision on behalf of the Ombudsman