Summary: Miss Y was suspended from a day centre in 2017 without any formal process. Following this the Council failed to provide adequate provision. Miss Y missed out on services she is entitled to. This caused an injustice to her and her carer. We have made recommendations to address this.

The complaint

1. Mr X complains on behalf of Miss Y. Mr X complains the Council failed to provide adequate day services and respite care for Miss Y.
2. Mr X also complains he and Miss Y paid for services the Council should have provided. He says the Council refuses to reimburse them for this.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I have:

• considered the complaint and discussed it with Mr X;
• considered the correspondence between Mr X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mr X and the Council an opportunity to comment on a draft of this document.

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What I found

6. The Care Act 2014 introduced a requirement that local authorities should promote ‘well-being’ and “signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’…. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into”. (Care and Support Statutory Guidance, Ch 1)

Background

7. Miss Y has a learning disability and complex needs. Miss Y has lived with Mr X and his family for many years. Mr Y has a heart condition and needs rest.
8. From 2014, Miss Y attended a day centre four days a week. The Council’s review of Miss X’s needs in 2016 says Miss Y takes part in activities at the day centre, and continued to “require support to manage her behaviour”. The day centre had a ‘base’ room which it used if Miss Y needed to de-stress or have time out. There had been occasional incidents, but generally Miss Y was settled at the day centre.
9. The review says Mr X reported no concerns at home and everything was stable. The reviewing officer had concerns about Mr X’s health. The officer said Fridays could be difficult for him as Miss Y has no other support that day. The Officer requested additional support on a Friday. The review says Miss Y has “the equivalent of 6 weeks respite…via a Direct Payment. This is provided by members of [Mr & Mrs X’s] extended family”. The Council said when this ended an officer “agreed to complete the Direct Payment paperwork to reinstate this for this year”.
10. In March 2017, there was an incident between Miss Y and another service user. The Council planned a reassessment of Miss Y’s needs on 26 April 2017, but cancelled this because Mr X was in hospital.
11. The day centre completed a risk assessment in April 2017. This says staff “need to be aware and vigilant…Staff to supervise at all times and know [Miss Y] whereabouts at all times.”
12. The Council started the reassessment of Miss Y on 24 May 2017. It records that Miss Y:

• had a history of “some behaviours considered challenging”.
• very happy at home and “[council officer] considers [Miss Y] is very happy where she is and that if she can continue to stay with [Mr X] and his family this will be the best outcome”.
• attends the day centre four days a week and is “very happy and settled”.
• had no formal support on Fridays

13. The assessment says Mr X asked friends and neighbours for support on Fridays but said this could sometimes be difficult to arrange. He needed support because he has heart problems and needs rest during the day. He asked for a direct payment for four hours to enable him to employ a personal assistant to support Miss Y on a Friday. I have seen no evidence the Council acted on this request.
14. The day centre records show Miss Y continued to be challenging at times. It recorded eight ‘incidents; between March 2017 and July 2017. The Council describe the incidents as “…on occasions she will run and ‘charge’ along corridors with no regard for who may be in the vicinity”. The incident reports confirm this.
15. In June 2017, following a discussion between two members of the day centre staff about complaints from other parents the day centre “… felt they could not allow [Miss Y] to stay at [day centre]. It requested a review of Miss Y’s needs.
16. The day centre recorded an incident on 18 July 2017. This says Miss Y had been running around and anxious all day, was hitting out randomly, and needed extra staffing input. The day centre suspended Miss Y.
17. Mr X says he received a phone call asking him to keep Miss Y at home, whilst ‘something’ was sorted out. He was not told details about the incident.
18. The Council updated Miss Y’s assessment on 20 July 2017 to reflect the change in circumstances.
19. The Council held a crisis meeting at the day centre on 21 July 2017; officers from social services and the day centre attended. I have seen no evidence the Council invited Mr X. The records say “…all agreed that [Miss Y] could be supported 1-1 at (at a different day centre)”. The notes continue Mr X could use his direct payments, usually used for transport/respite, to fund family support for Miss Y while the Council organised the new placement.
20. The Council says it told Mr X and he was satisfied with the interim plan, and that “he has people who can help with support for the next week. [Council officer] advised that DP hadn’t been paid but that [Mr Y] would keep a record & claim back”.
21. The Council says a placement of the other day centre was not possible as it could not provide 1-1 support.
22. On 1 August 2017, the Council recorded it had received no ‘returns’ for direct payments from Mr X., and “there would be no more payments until these had been received”.
23. Mr X says for years he received money from the Council for respite care for Miss Y. He says the Council paid this into his account, but he cannot recall signing an agreement. He does recall signing a form to receive the payments. The Council provided evidence of direct payment receipts signed by Mr X and his wife. This shows the monies paid and the period included. There is no evidence to show the Council provided Mr X with supplementary information about the terms and conditions of direct payments.
24. Mr X says he heard nothing, and nobody kept in touch, and this went on for months. He says he kept asking why Miss Y could not go back to the original day centre with 1-1 support.
25. In August 2017, Mr X told the Council family members could not continue to support Miss Y due to their own caring commitments.
26. The Council made enquiries with another day service provider in August 2017, the service did not have sufficient staff to provide 1-1 support.
27. In September 2017, Mr X told his social worker he no longer wanted to receive monies directly for Miss Y’s respite. He asked for a commissioned service. Following this he received no respite care. The Council says it identified a respite facility for Miss Y in September 2017, but due to a “procedural flaw” there was a delay in Miss Y accessing the service.
28. Miss Y was without any day services for six months. Mr X says he struggled to care for Miss Y on the days his wife worked. He started to use used his own money to pay friends and relatives to take Miss Y out for the day. This cost him around £50 a day. Mr X kept handwritten receipts. He told the Council about this in October 2017, but the Council refused to reimburse him saying it had not agreed the expenditure and Mr X previously said extended family could no longer support Miss Y. Mr X says when he ran out of money he used Miss Y’s savings. He says Miss Y had around £6000 in savings, but he had to use this to pay for her support.
29. In October 2017, another service provider assessed Miss Y but was unable to provide a service. The Council approached an outreach service to provide activities for Miss Y. Mr X was initially dissatisfied it was only offering Miss Y 10 hours per week. Miss Y’s social worker was away from work for three months, so Mr X’s social worker provided support to Mr X in discussions with the outreach service. The outreach service assessed Miss Y in December 2017 and agreed she would start in January 2018.
30. In January 2018, the Council records say Mr X “is in need of a break” and it held a discussion to speed up access to respite care.
31. In January 2018 Miss Y started attending the outreach service two days a week. Mr X says these were described as ‘taster days’ which included swimming and a day out in town. He says these were one off activities, not planned regular activities. The service reported difficulties managing Miss Y’s behaviour. Mr X says the outreach service was not suitable for Miss Y. He says a staff member told him ‘they’ did not know what to do with Miss Y. Mr X believes Miss Y’s needs would be best met in a day centre setting.
32. In January 2018, the Council arranged various dates for Miss Y to visit the respite facility accompanied by Mr X. Mr X says the visits were at unsuitable times. Visits were either in the afternoon when he needed to rest, or clashed with his medical appointments.
33. In March 2018 Mr X’s daughter cared for Miss Y for twelve nights whilst Mr X was on holiday.
34. The Council held a multi-disciplinary meeting in May 2018. Mr X was not invited. It produced a new support plan in May 2018. This says Miss Y receives 2-1 outreach support 10 hours a week and it planned for 1-1 respite care 42 nights a year, but this was not yet in place. It records that “[Miss Y] needs to access respite in order for her current placement to be maintained”.
35. In May 2018, the Council told Mr X to contact the respite facility direct to arrange visits. Mr X did this and Miss Y had twelve one nights stays between May 2018 and August 2018. Mr X was told these were ‘taster’ stays. He did not understand the nights would be taken from the allocated respite allowance. If he had, he says he would not have agreed to so many nights as one night stays do not benefit him.
36. Mr X says the respite facility works well. The manager of the facility used to be the manager at the day centre Miss Y attended. During a recent stay staff from the original day centre took Miss Y out. Mr Y says he does not understand why the day centre previously said it could not manage Miss Y.
37. In July 2018, the Council made a referral to Occupational Therapy and requested input from’ Challenging Behaviour’. It also obtained advice from its legal team as it believed Mr X was unsupportive of the options it gave him.
38. Mr X was dissatisfied with the lack of progress from the Council and sought the support of his MP. The MP advised Mr X to follow the Council’s complaints procedure. Mr X submitted a formal complaint to the Council in August 2018. The Council sent Mr X a ‘complaint action plan’ on 23 August 2018. Mr X received a response to his complaint on 26 October 2018. The author acknowledged the Council was not providing Miss Y with the level of day services she was entitled to. It upheld Mr X’s complaint about this and apologised to him. The Council said it intended to complete a full assessment of Miss Y’s needs as soon as possible.
39. The Council made enquiries at a newly opened day centre in October 2018. It says it made “several attempts to progress this without success”.
40. The Council began a reassessment of Miss Y in November 2018. The assessor records Mr X’s dissatisfaction with the current day service, that it did not meet Miss Y’s needs, and that she needed more days. He wanted the Council to consider other provision. The assessor recorded “…I am in agreement that support should be increased and alternatives considered”.
41. A different council officer visited Mr X in December 2018, “to discuss with [Mr X] the review process and to confirm further visit to meet with [Miss Y]…”.
42. In January 2019, Mr X’s MP wrote to the Council.
43. The Council allocated Miss Y new social worker in January 2019. The social worker visited Mr X and Miss Y. Mr X asked for twelve nights respite in March 2019. The social worker contacted the respite facility to arrange this, and also contacted the new day centre facility to refer Miss Y for assessment.
44. In February 2019, the outreach service reported Miss Y’s behaviour difficult to manage. The records show Mr X remained dissatisfied with the support provided and had no confidence in the outreach service’s ability to meet Miss Y’s needs. His relationship with the staff broke down.
45. The council held a review on 21 February 2019. The Council says it is now considering offering Miss Y a ‘bespoke service’ at the day centre which suspended Miss Y.
46. Mr X says, in total, Miss Y had five social workers. On two occasions, social worker’s left and the Council did not tell Mr X. The Council says this is because both workers left at short notice for personal reasons. Mr X says his own social worker has had to provide him with support to address issues relating to Miss Y.

The Council’s response to my enquiries

47. The Council says it cannot easily meet Miss Y’s needs in a traditional day service. It acknowledges “there have been gaps when due to sickness and pressure on the Team there was no allocated worker… I acknowledge that the current level of commissioned support is less than was previously available to her…”.
48. The day centre says it “does not operate a policy of exclusion, however we do suspend or change placement should the individual or others be put in danger. In its current configuration we feel that [we] cannot provide a safe placement for [Miss Y]. We have evidence at our respite unit that [Miss Y] is best supported on a bespoke 1:1 basis in her own environment and this has been discussed with the social worker. We are currently working with Salford City Council to resolve the issue by reconfiguring some space within the centre to provide a more structured and controlled environment which is not shared by others. The commissioners are currently considering the cost implications of the restructuring”.

Current situation

49. Mr X says the Council recently held a multidisciplinary meeting, which he attended. Following the meeting he received a report, but he says he is not clear about what will happen next.
50. The council has allocated Miss Y a new social worker. Mr X says he has developed a positive relationship with this officer.
51. Miss Y still has two days outreach service and two days help from family members. Mr X received a letter from the outreach service recently saying it would not be supporting Miss Y from 2 June 2019.
52. Miss Y recently had a trial day at the newly opened day centre, and there are two more planned. Mr X says the visit was a success and he believes the facility could meet Miss Y’s needs. Mr X believes Miss Y would benefit from attending five days a week. He says Miss Y thrives on structure and routine.
53. Mr X says he is astonished to learn that the Council is considering the day centre from which Miss Y was suspended in July 2017.

Analysis

54. There are numerous failings by the Council in this case.
55. In March 2017, Miss Y began displaying challenging behaviour, the day centre arranged a review of Miss Y’s needs. It also completed a risk assessment. This was good practice. The risk assessment concluded staff should be vigilant and be aware of Miss Y’’s whereabouts at all times. This proved insufficient and further incidents were reported. The Council completed a reassessment of Miss Y in May 2017 but failed to deal with the issues relating to her behaviour, and her needs arising from this. There was no meaningful outcome for Miss Y. This is fault.
56. Miss Y continued to display challenging behaviour. Again, the Council failed to respond properly. It had no clear plan to address the situation. This was another missed opportunity to deal with the situation.
57. Any decision to suspend or remove services should be taken as part of a formal process, and in consultation with carers or relatives. This did not happen here. The Council failed to involve Mr X. He received a telephone call from the day centre asking him to keep Miss Y at home ‘for a few days’. Miss Y’s suspension from the day centre stemmed from a discussion between two staff members. The focus appeared to be on the perceived risk to other service users, and a complaint from a relative, rather than the presenting needs of Miss Y. This was service led not person led. The Council says it does not operate a policy of exclusion, but it did exclude Miss Y.
58. Following the suspension, the Council held a crisis meeting, in which it discussed possible 1-1 support at another day service. It is difficult to understand why the Council did not consider providing such support earlier.
59. Although the Council held numerous meetings and completed assessments, no meaningful action followed. There appeared to be no strategy, a lack of direction, and no sense of urgency The Council’s actions were reactive not proactive. Consequently, Miss Y was without any day services for six months, and has been without a full service for twenty-two months. Mr X has had to care for Miss Y full time with no support or breaks whilst dealing with his own ill-health. The gap in service was unacceptable and caused Miss Y and Mr X a significant injustice.
60. The Council arranged for Miss Y to have two days outreach service. This was insufficient and left Mr Y without provision for three days. The Council failed to consider Miss Y’s specific needs, and whether the outreach service would meet these needs. Miss Y had to fit into the service because it considered it the only available option. The support was community based and did not provide the routine and consistency Miss Y needed. This caused Mr X further frustration.
61. From March 2017, Mr X was asking the Council for formal support for Miss Y on Fridays. The Council failed to respond, despite it being aware of Mr X’s health issues and his need to rest during the day. This is fault.
62. The records show the Council agreed Mr X could use respite monies to fund informal support on a temporary basis. Mr X kept receipts. The support was vital to Mr X as he needs to rest in the afternoon. The Council then stopped the direct payments, saying it had not received ‘returns’. Consequently, Mr X had to use his own money and then Miss Y’s savings. He should not have had to do so. This is fault causing injustice.
63. Mr X submitted receipts for all the informal support provided to Miss Y. The Council refused to reimburse him saying the support had not been commissioned or agreed. The Council had agreed and it should have reimbursed the costs.
64. The Council has a duty to provide respite care for Miss Y. The gap in respite care provision is unacceptable and caused Mr X a significant injustice. This only added to the strain Mr X was under. It is only because of the informal support provided by Mr X’s daughter, that he was able to have a break.
65. The Council says it did not tell Mr X about the change in Miss Y’s social workers because both workers left for personal reasons. It would have been good practice for the Council to inform Mr X that the officers were no longer in post. It did not need to divulge the reasons.

To summarise

66. Miss Y was suspended from a day centre in 2017 without any formal process. This happened because the Council failed to respond properly to incidents of challenging behaviour. After the suspension, the Council failed to provide adequate provision. It also delayed in providing respite care. Miss Y missed out on services she is entitled to. This impacted greatly on Mr X.

Agreed action

67. To remedy the injustice the Council should:

• provide Mr X with a written apology for the failings identified above;
• pay Mr X £1500 for the time and trouble he has been put to pursuing this matter with the Council and the Ombudsman, and the distress and inconvenience cause to him whilst Miss Y has been without full day service entitlement;
• ensure a decision is taken about providing Miss Y with a full day service, in consultation with Mr X;
• establish how much Mr X has spent funding day support for Miss Y since July 2017, and reimburse him in full;
• establish how much Miss Y has spent funding day support and reimburse her in full.

68. The recommendations should be completed within one month of my final decision. Where this is not possible, the Council should provide me with an explanation of the delay and an update on progress.

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Final decision

69. There is fault by the Council causing injustice. The above action is a suitable way to settle the complaint.
70. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman