• The complaint
• The Ombudsman’s role and powers
• How I considered this complaint
• My assessment
• Final decision

The Ombudsman's final decision:

Summary: We will not investigate this complaint from Mrs X complaining the Care Home failed to refer her late relative for a ‘fast track’ Continuing Health Care assessment promptly. This is because the complaint does not meet the tests in our Assessment Code on how we decide which complaints to investigate. The Care Home has provided a remedy in line with our Remedies guidance, and we are unlikely to add anything more.

The complaint

1. In summary, Mrs X complains on behalf of her late mother, Mrs Y, that the Care Home failed to refer Mrs Y for a ‘fast track Continuing Health Care’ (CHC) assessment in July 2023 despite advising her it had done so at the time.
2. Sadly, Mrs Y died in November 2023. Mrs X says she then checked with the NHS and was advised it had not received any referrals. She would like to be compensated for the failings and her time and trouble taken.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse effect on the person making the complaint, which we call ‘injustice’ requiring a remedy. We provide a free service but must use public money carefully. We do not start an investigation if we decide the tests set out in our Assessment Code are not met. (Local Government Act 1974, section 24A(6), as amended)
4. We provide a free service but must use public money carefully. We do not start or continue an investigation if we decide we could not add to any previous investigation by the organisation. (Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

5. I considered information provided by the complainant which includes the Care Home’s complaints response.
6. I considered the Ombudsman’s Assessment Code.

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My assessment

7. The Care Home has:

• apologised for the delay,
• taken action resulting in Funded Nursing Care being awarded retrospectively,
• identified service improvements and, also,
• awarded £500 to Mrs Y for her time and trouble taken in complaining.

8. We will not investigate as we are unlikely to add anything by investigating. The financial remedy exceeds our usual payment recommendations for time and trouble taken in complaining.

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Final decision

9. We will not investigate Mrs X’s complaint because we are unlikely to add anything to the Care home’s investigation.

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Investigator's decision on behalf of the Ombudsman

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