Ombudsman upholds care home’s complaint about funding for resident

The Local Government and Social Care Ombudsman has found Leicester City Council at fault in relation to a lack of funding support for a resident in a care home, finding that its actions led to a “financial shortfall” and a “missed opportunity to reduce the risk of harm to the Home residents”.

Outlining the background to the case, the Ombudsman said the complainant, Ms A, had complained on behalf of a residential care home about a lack of funding by Leicester City Council and the local integrated care board for the increased support the care home provided to a resident.

She noted that the resident, (Mr B)’s needs increased leading to assaults on staff and residents which meant he needed more support.

She said the circumstances of the complaint led to residents, staff and visitors being assaulted and having to provide more support to prevent this. She told the watchdog this support had not been paid for by either the council or the ICB.

Ms A told the watchdog that she asked the council if it would fund Mr B’s increased level of support until he was found eligible for Continuing Healthcare (CHC), from the period June to September 2023.

The council told her it would not fund the increased support for this period as this was a health need and so any support would not be funded by the Council but would need to be funded by the NHS, the report noted.

The ICB said it was not aware of Mr B before August 2023 and so had no way of agreeing funding prior to this.

Analysing the case, the Ombudsman said: “There is no record in the council’s records of the Home contacting the Council in June 2023 about Mr B’s behaviour. There is a record in July 2023 and with the Mental Health Act assessment and the medication being changed, it was right to wait until the end of August until a checklist was carried out.”

For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC Checklist.

The Ombudsman observed: “The National Framework also states that funding comes from when the person is found eligible, not from the date of the checklist. […] In view of this I do not find fault with the Council in relation to not ordering a checklist earlier.”

However, the watchdog noted that the council was responsible for Mr B’s care up until he became eligible for CHC and when he required extra support it declined to provide this support to the Home.

The Ombudsman said: “Even though the In Reach Team was involved and a CHC assessment process was ongoing, the Home were still needing extra support to deal with Mr B’s behaviours. The Council was responsible for meeting this urgent need for the period the Home was providing extra support until Mr B was found eligible for CHC. The Council did not provide this support or provide funding for it. This was fault on its part which led to a financial shortfall for the Home.”

Turning to the issue of safeguarding, the Ombudsman found that the council did not carry out a safeguarding enquiry to see what preventative action could be taken, which was fault.

The Ombudsman concluded that it found fault with the council in relation to funding and safeguarding, leading to a financial shortfall and increased risk for the Home.

To remedy the injustice caused, the watchdog recommended the council to:

• Write to the home to apologise for the financial shortfall and missed opportunity to reduce the risk of harm caused by its failings in funding and safeguarding.
• Pay the home the amount it spent on providing extra care to Mr B from August 2023 to when he was found eligible for CHC in September 2023
• Remind its staff of the importance of carrying out safeguarding enquiries when care home residents are at risk of harm.

The Ombudsman did not find fault with the Integrated Care Board.

A Leicester City Council spokesperson said: “We acknowledge the Ombudsman’s findings and have taken action to address the recommendations made.”

Lottie Winson