Summary: We will not investigate a complaint about the care a Nursing Home provided to one of its residents. It is unlikely an investigation would find fault.

The complaint

1. Mrs Z moved into a Nursing Home in the spring of 2025. She remained a resident for around four months until she was admitted to hospital.
2. Warrington Borough Council (the Council) arranged Mrs Z’s placement and paid for it for just over a month. The Council was ultimately responsible for Mrs Z’s care during this time. Mrs Z then began paying the full cost of the placement. During this period the Nursing Home acted as a provider of privately funded adult social care. For this period Indigo Care Service Limited was responsible for the social care the Nursing Home provided for Mrs Z. In mid‑June 2025 the NHS found Mrs Z to be eligible for NHS Continuing Healthcare (CHC) funding and began paying the full cost of Mrs Z’s placement. During this period the Nursing Home was an NHS-funded provider. Indigo Care Services Limited continued to be responsible for Mrs Z’s care, but now for providing an NHS service.
3. One of Mrs Z’s daughters, Mrs Y, complains that for the duration of Mrs Z’s admission to the Nursing Home:

• Council staff failed to arrange medical tests to establish whether any of Mrs Z’s problems were treatable. Mrs Y said this was despite staff having been told of relevant diagnoses.
• Nursing Home staff failed to respond to Mrs Z’s declining weight, and associated behaviour and symptoms, appropriately. Mrs Y said the Nursing Home failed to do enough to ensure Mrs Z received appropriate medical tests, or was admitted to hospital, and failed to do enough to meet Mrs Z’s nutritional needs.
• Nursing Home staff inappropriately gave medication to Mrs Z, for the purpose of sedation, by putting it in her food and did so without a best interest meeting.

4. Mrs Y said failings in Mrs Z’s care contributed to her rapid decline and multiple painful falls and injuries. Mrs Y said they contributed to prolonged weight loss and suffering. Mrs Y said the proper management of Mrs Z’s medical conditions could have helped to prevent Mrs Z from: pacing; falling; experiencing cognitive changes; and, losing a significant amount of weight.
5. Mrs Y said she was deeply upset watching Mrs Z suffer injuries and weight loss. Further, Mrs Y said she was caused avoidable time and trouble by having “constantly…to fight” to ensure the Nursing Home provided appropriate care.

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The Ombudsmen’s role and powers

6. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA).
7. The Local Government and Social Care Ombudsman investigates complaints about adult social care providers. (Local Government Act 1974, sections 34B, and 34C, as amended)
8. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we would find fault, or
• it is unlikely we could add to any previous investigation by the bodies, or
• we cannot achieve the outcome someone wants.

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

9. I considered Mrs Y’s submissions to the Ombudsmen and the Council’s and the Nursing Home’s responses to her complaints. I also considered relevant law, policy and guidance and the LGSCO’s Assessment Code.
10. Mrs Y had an opportunity to comment on my draft decision.

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What I found

11. Clinicians diagnosed Mrs Z with Alzheimer’s Disease in the early 2020s. Mrs Z also had other significant health diagnoses.
12. In early 2025 Mrs Z lived with one of her daughters and attended a day centre three times a week. Mrs Z’s daughter was struggling with her caring duties and requested emergency respite.
13. Mrs Z moved into a Nursing Home in the spring of 2025. The Council arranged the placement for Mrs Z. Mrs Y said at this time Mrs Z had fluctuating memory, issues with “extreme anxiety” and was rapidly losing weight and falling frequently.
14. The Council authorised Deprivation of Liberty Safeguards (DoLS) soon after Mrs Z moved into the Nursing Home. She was under constant supervision and control and was not free to leave the Nursing Home, for her own safety and wellbeing.
15. During Mrs Z’s time in the Nursing Home she was seen and/or reviewed by:

• Staff from the Later Life and Memory Service,
• Staff from the Enhanced Care Home Support Team,
• GPs, and
• Dieticians.

16. Throughout Mrs Z’s stay in the Nursing Home Mrs Y raised concerns about various aspect of Mrs Z’s care and her health, including about: Mrs Z’s weight loss; Mrs Z having falls; and, Mrs Z being in pain.
17. In early May, a doctor reviewed Mrs Z and advised staff to take her to hospital. Mrs Z went into hospital and returned to the Nursing Home on the following day. At this time the Council began a safeguarding enquiry into concerns about bruises Mrs Z had and about her weight loss.
18. In mid-August a GP and a consultant agreed Mrs Z needed to go into hospital to investigate the underlying cause of her weight loss. Mrs Z went into hospital.
19. The Council and the Nursing Home responded to complaints from Mrs Y in October 2025. They did not identify any failings in Mrs Z’s care. They both said staff at the Nursing Home had followed the advice and guidance of health professionals.

Analysis

20. Mrs Y’s complaint stems from her view that Mrs Z’s diagnosis of Alzheimer’s Disease did not fully and properly explain the reason for all Mrs Z’s behaviours and symptoms; most notably, her refusal to eat and drink adequately and her unsteadiness on her feet. Mrs Y considers that other medical conditions were significant contributory factors. She considers these other conditions could have been more effectively understood and treated. Mrs Y believes the appropriate treatment of all Mrs Z’s conditions would have reduced Mrs Z’s symptoms and behaviours and, in turn, improved her health and wellbeing.
21. Mrs Z was cared for in a Nursing Home. As such, there is an expectation that health-qualified staff, alongside care staff, should have been able to effectively monitor Mrs Z’s overall health and meet her individual needs. A failure to have adequate professional curiosity about the cause of the resident’s issues, or a failure to properly act on any concerns, would be fault. However, staff within a nursing home would not be expected to have a detailed medical knowledge. Rather, staff would be expected to refer the resident to, and collaborate effectively with, other relevant professionals where they had any concerns about the resident’s health.
22. From the complaints and safeguarding papers I have seen there is evidence a range of professionals were involved in Mrs Z’s care from early in her placement at the Nursing Home. In addition to the teams and professionals noted in paragraph 15, Mrs Z also had interactions with an out-of-hours doctor and paramedics. There is also evidence of Mrs Z undergoing blood tests, her medication being changed and doses adjusted, and professionals referring her to hospital for further assessment.
23. It is likely an investigation would consider it appropriate that the Nursing Home relied on health professionals to investigate the nature and cause of Mrs Z’s symptoms. And an investigation would likely consider it was appropriate for the Nursing Home to have expected health professionals to initiate and pursue suitable medical tests and treatment. It would have been for the Nursing Home to monitor Mrs Z, to continue to raise concerns as they happened, and to follow instructions given by health professionals.
24. In this context it appears unlikely an investigation would have a realistic prospect of finding fault on the part of the Nursing Home (or Council, when it was responsible for the Nursing Home’s actions). It seems probable an investigation would find evidence that the Nursing Home sought appropriate support and advice.
25. There does not appear to be a realistic prosect of the Ombudsmen finding fault and recommending financial redress and, for this reason, we will not investigate this complaint.

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Decision

26. We will not investigate Mrs Y’s complaint. This is because it is unlikely an investigation would be able to find evidence of fault.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman