Summary: We will not investigate this complaint about poor care records, missing items, breach of care standards and lack of inventory dating back to 2017. This is because we could achieve nothing more than Ms B has been advised by the Care Provider even if we investigated.

The complaint

1. Ms B complained about missing items belonging to her godmother, Mrs D, and missing or depleted care records which resulted in her not being able to get enough information for the NHS to properly consider a retrospective Continuing Health Care (CHC) assessment dating back to 2017. Ms B says the Care Provider should have undertaken a checklist for CHC funding, and says there were missed opportunities for the NHS to consider funding. Ms B says Mrs D had significant health needs. Ms B also complained the Care Provider failed to undertake an inventory of Mrs D’s belongings when she moved into the home or anytime during the time she lived there between 2016 and 2018 and items went missing. Ms B wants an apology from Mrs D’s care provider for the lack of concern showed, acknowledgment it accepts responsibility for distress caused to her, compensation for the lack of records and missing items, and reimbursement of the legal costs Mrs D's estate has incurred in pursuing care fees which should not have been paid because she was entitled to free NHS care.

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The Ombudsman’s role and powers

2. We investigate 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 continue an investigation if we decide:

• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is another body better placed to consider this complaint,
• there is no worthwhile outcome achievable by our investigation.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

3. 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)

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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 B engaged legal representatives to apply for retrospective CHC funding for Mrs D and was awarded CHC funding from July 2018 up until Mrs D’s death in February 2022. Ms B successfully applied to the NHS for retrospective CHC funding for Mrs D for the period 21 July 2017 to 31 December 2017. However, she is concerned Mrs D’s estate should be refunded the money paid for the period 1 January 2017-20 July 2017 which was refused by the NHS because, according to Ms B, the Care Provider’s records were not comprehensive enough to award CHC funding for this period.
7. Ms B is concerned about the lack of care records for the period of time Mrs D lived in the home. The Care Provider disputes this and says Mrs D’s care records are an adequate record of the care Mrs D received during this period. We will not consider this point now as we cannot make a finding that Mrs D’s care records resulted in poor or lack of care or remedy any injustice to Mrs D even if we investigated and found evidence of poor care in 2017. Ms B’s complaint and request for reimbursement of legal costs is related to this point. Ms B alleges if the care records were more detailed and contained evidence of the nursing care Mrs D received, she would now be able to make a claim to the NHS for retrospective CHC funding. However, we could not reach this view, or say Mrs D received different care to that recorded in the case records. The Care Provider has explained the records show the care Mrs D received at the time. It is the CCG’s decision whether to award CHC funding. Ms B as the applicant can tell the CCG why she disputes the Care Provider’s views and records and say what nursing care Mrs D received. But it is up to CCG to get all information it needs to decide an application.
8. Ms B is concerned the Care Provider did not undertake an inventory of Mrs D’s belongings and some items were missing. We could not make a finding on what happened to the missing items or say Ms B or Mrs D was caused a significant injustice because there was no inventory in 2017. If Ms B has evidence the Care Provider was responsible for the missing items she can ask the small claims court to consider whether the Care Provider was liable for the loss, and it would be reasonable for her to do this.

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Final decision

9. We will not investigate Ms B’s complaint because we could not achieve a different outcome to that provided to Ms B by the Care Provider.

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Investigator's decision on behalf of the Ombudsman