London Borough of Lewisham (25 029 853)

Category : Adult care services > Residential care

Decision : Upheld

Decision date : 13 May 2026

The Ombudsman's final decision:

Summary: We will not investigate Mr X’s complaint about the Council’s Care Home poor communication because we could not add to the previous investigation. We will also not investigate the Care Home’s actions in relation to an allegation because there is insufficient evidence of fault.

The complaint

  1. Mr X complained the Council’s commissioned Care Home delayed informing him and the family about an incident which involved his relative, Mrs Y. He also complained the Care Home did not properly investigate an allegation of harm which had also involved Mrs Y. Mr X said the matter caused him and the family distress. He wants the Council to properly investigate his concerns.

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The Ombudsman’s role and powers

  1. 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:
  • we could not add to any previous investigation by the organisation, or
  • further investigation would not lead to a different outcome, or
  • there is not enough evidence of fault to justify investigating.

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

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How I considered this complaint

  1. I considered information provided by Mr X and the Council.
  2. I considered the Ombudsman’s Assessment Code.

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My assessment

  1. Mrs Y was involved in a physical altercation which had been instigated by another resident at the Care Home. The Care Home informed Mr X and the family of the incident the following morning.
  2. Mr X said the Care Home delayed informing him and his family. The Care Home responded to Mr X’s concerns and accepted staff had delayed informing him and the family. It apologised to Mr X and explained its reasons for the delay. It said it had addressed the matter with staff to prevent a recurrence of fault. This was appropriate and what we would expect the Care Home to do. We would not be able to add to its investigation and a further investigation would not lead to a different outcome.
  3. Mr X said another resident at the Care Home told him and/or the family that Mrs Y had been involved in another physical altercation where she had been harmed by another resident. He said he made the managers aware of the allegation at the time but it failed to take any action.
  4. In response to Mr X’s concerns, the Care Home looked into the allegation and found the managers Mr X had reported the matter to, did investigate his concerns. The managers said Mr X had been misinformed about the allegation. The Care Home added, it was not able to comment further as it had no supporting evidence of the allegation and the managers who had initially looked into the concern were no longer employed at the Care Home. There is insufficient evidence of fault as the Care Home did consider the allegation at the time of it being reported.
  5. Mr X said the Care Home should have reported the allegation to the local safeguarding team. There is no expectation for councils and care providers to report every allegation and incident to safeguarding teams. They are expected to make their own judgement and consider whether there is a reasonable safeguarding concern which needs to be shared. The Care Home considered the matter appropriately and exercised its judgement in deciding how to respond.
  6. For the reasons above, we will not investigate Mr X’s complaint.

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Final decision

  1. We will not investigate Mr X’s complaint because we could not add to the previous investigation and there is insufficient evidence of fault by the Council’s Care Home.

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Investigator's decision on behalf of the Ombudsman

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