Summary: Mrs X, on behalf of her son Mr Y, complained the supported accommodation commissioned by the Council did not meet Mr Y’s needs. The failure to provide the support set out in Mr Y’s care plan for the first few weeks of the placement amounts to fault.

The complaint

1. Mrs X, on behalf of her son Mr Y, complained:

• The Council significantly withdrew support from the Specialist Autism Service when Mr Y moved into the accommodation.
• The accommodation did not give him support for the first few weeks as contracted to do and this did not reflect his needs as identified in his care and support plan.
• The accommodation provided him with limited support, of a practical nature rather than emotional. It did not provide as much as he paid for nor what is included in his care plan.
• The accommodation has had many different workers supporting him and arrangements kept changing.
• The accommodation did not respond appropriately when he said he had taken an overdose of tablets.

2. Mrs X says the failure to provide appropriate support caused Mr Y distress and ultimately led to the breakdown of the placement.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), 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. As part of the investigation, I have:
• considered the complaint and the documents provided by the complainant’s representative;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with the complainant and his representative;
• sent my draft decision to both the Council and the complainant and his representative and taken account of their comments in reaching my final decision.

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What I found

6. Mr Y is an adult with autism, learning difficulties and mental health problems. Following an incident at Mrs X’s house in 2019, Mr Y was arrested and then discharged to respite supported accommodation on a temporary basis. Mr Y was the subject of a safeguarding investigation after being targeted by other residents who stole money and possessions. It was decided this accommodation was not suitable for Mr Y’s needs.
7. In September 2019 Mr Y moved into supported mental health accommodation (the accommodation) where he had his own flat and support was available on site. It had been decided that Mr Y’s mental health was his most significant need and that this was a suitable placement.
8. Mrs X makes several complaints about Mr Y’s time at the support accommodation from September 2019 onwards. I will deal with each complaint in turn.

The Council significantly withdrew support from the Specialist Autism Service when he moved into the accommodation.

9. As part of his care package, Mr Y received support hours from the Specialist Autism Service (SAS). Following a social care resource allocation panel meeting in September 2019, the amount of SAS support was reduced. Mrs X says her son was given the choice of continuing with his activity session or keeping his one-to-one support. Mr Y chose to keep the one-to-one support. The Council says the decision to reduce SAS support had been made at the panel meeting the previous year.
10. The Council has not been able to provide a copy of the minutes of the panel meetings to show why this decision was made. However, it has provided a copy of a letter from the panel chair to social care managers following the meeting in September 2019. This explains the decision had been made at a panel meeting the previous year but not implemented. The Council says the SAS support was not reduced because of the move to the accommodation.
11. On the basis of the information I have seen, I take the view, on balance, that the decision to reduce the SAS support was not made as a direct result of Mr Y’s move to the accommodation. When making enquiries to the Council I asked it to provide minutes of the panel meeting which discussed the reduction of SAS support and asked it explain why the support was reduced. The Council has failed to respond to both points and this is fault. The Council should keep copies of minutes where significant decisions are made. The fault on this point only adds to the dissatisfaction experienced by Mrs X and Mr Y.

The accommodation did not give Mr Y support for the first few weeks as contracted to do and this did not reflect his needs as identified in his care and support plan.

12. Mr X moved into the accommodation on 30 September 2019. Information provided by the accommodation provider says that it was commissioned to provide 9.65 hours of core support as follows;

• Verbal prompts to undertake personal hygiene and for household tasks such as laundry;
• Support to shop for food, clothes and essential household items. Requires someone to accompany him due to difficulties with anxiety and social interaction;
• Prompts and encouragement and practical support to make and keep appointments. May require someone to accompany him to medical and other formal appointments;
• Support to interpret written information;
• Requires on-going support to form and maintain relationships and to ensure does not become socially isolated.

13. The accommodation provider was also commissioned to provide 7.7 hours for night time support. This was because Mr Y does not sleep well and will often stay up all night. Mr Y required support to remind him to go to bed and to encourage him to maintain healthy sleep patterns.
14. The accommodation provider has produced copies of the daily case notes in respect of Mr Y. The notes record the staff interaction with Mr Y and details the support offered. The records show there was little contact between Mr Y and staff for the first few weeks of his stay.
15. On Tuesday 8 October, a member of staff spent time with Mr Y. A note dated 9 October says that staff will try to spend time with Mr Y every day and Mr Y will attend the weekly coffee morning. Staff also showed Mr Y how to use the washing machine.
16. On 10 October, Mr Y attended the weekly coffee morning. The notes do not indicate any substantial contact between staff and Mr Y until 24 October when he again attended the weekly coffee morning. The note dated 23 October indicates Mrs X visited and expressed her concerns and that Mr Y needed more support and one-to-one time with staff. The note of 25 October states staff visited with Mr Y and played video games.
17. Mr Y spoke with his keyworker on 29 October and it was agreed help would be provided with laundry and shopping. The notes state the worker would book this in the diary “to start this support straight away.” The next day, a staff member visited Mr Y to help with his laundry but he declined the help.
18. The diary notes show that from then onwards there was weekly assistance offered to Mr Y for his shopping and laundry. Mr Y did not always accept the help offered for his laundry but did regularly go shopping with a worker.
19. In response to the complaint about the lack of support for the first few weeks Mr Y moved into the accommodation, the Council says that support was offered to Mr Y when he remained on site. It says that during the initial period Mr Y spent the majority of 22 days off site sometimes staying overnight with Mrs X. It says it was the fact Mr Y was off site that had a detrimental effect of the level of support offered and provided.
20. I have carefully considered what happened in the first few weeks. I note the first keyworker meeting took place on 29 October and that it was only after this that regular support sessions were booked in and took place. I have seen nothing to suggest the accommodation provider made attempts to make regular appointments with Mr Y before this date. I consider this is fault.
21. The accommodation provider was commissioned to provide prompts and weekly support to Mr Y because of his mental health issues and autism. To wait for a month to do this was not in line with Mr Y’s support plan. Part of the care needs refer to the fact Mr Y needs support to form and maintain relationships. It was therefore not in line with his care plan to wait for Mr Y to initiate contact. Once contact was made by the keyworker and regular appointments made, Mr Y engaged with the workers and support was provided. To suggest the problem was Mr Y’s because he went off site, in my view, is ignoring Mr Y’s needs and the reason why he was in supported accommodation.

The accommodation provided Mr Y with limited support, of a practical nature rather than emotional. It did not provide as much as he paid for nor what is included in his care plan.

22. Mr Y’s care and support plan sets out the type of support needed to meet his eligible care needs. While this is detailed as 9.65 daytime support hours and 7.7 night time support hours, the Council says this was regarded as a contribution towards the core hours of the accommodation to enable it to be staffed 24 hours a day. It says that Mr Y does not have any commissioned individual support hours and his core support consists of weekly shopping and support with laundry. It says the hours stated in the support plan are not all direct support hours.
23. Mrs X say the emotional support is really just talking to Mr Y and engaging and taking an interest. She says that some workers were better than others. The daily records show that workers did call in on Mr Y and sometimes spent time with him but that he wasn’t always receptive. I would not expect them to force Mr Y to engage if he did not want to as he is an adult with capacity to make his own decisions.
24. The care plan does not specifically provide for emotional support. The eligible needs are practical in nature while there is some reference to ensure Mr Y is not socially isolated. Mr Y still has some one-to-one support from the specialist autism team.
25. In response to this complaint, the Council said the hours of support are provided as part of a supported living placement and that this includes encouragement of social engagement with other residents and not one-to-one support. While I understand why Mrs X would have liked the Council to provide more emotional support for Mr Y, I am not persuaded there is anything specific about this in his care plan or that the Council failed to provide it.

The accommodation has had many different workers supporting Mr Y and arrangements kept changing.

26. The accommodation includes staff cover 24 hours a day. As a result, staff work shifts and may not always be available at the same time each week. Mr Y was allocated a key worker but he was unable to provide all the support for Mr Y.
27. While I accept it would be better for Mr Y to have the same worker in order to build the relationship, I am not persuaded it was fault this did not happen. I am satisfied Mrs X and Mr Y knew the nature of the accommodation before he moved in and there is nothing to suggest he was promised he would have the same worker all the time.
28. Reading the daily notes, I can see that there was some flexibility regarding the support provided to Mr Y. It appears this worked both ways. There were instances when Mr Y was not ready at the pre-arranged time and so it was changed to later in the day or to another day.
29. I am not persuaded there is any fault on this point. The nature of the accommodation meant that support was provided as needed and flexibility was part of this. There was never any commitment that the same worker would provide all the support, and this could not be achieved.

The accommodation did not respond appropriately when Mr Y said he had taken an overdose of tablets.

30. Mr Y says that when out shopping on 28 July 2020, he told his keyworker he had taken an overdose of 14 tablets. Mr Y says the keyworker said that was a silly thing to do and then did not report the incident to management.
31. The accommodation provider carried out an investigation as a safeguarding concern. An officer discussed the alleged incident with the keyworker and Mr Y. The report shows the keyworker was aware of the correct procedure to report such a disclosure. The keyworker denied the incident took place.
32. Mr Y said he had made the disclosure on a Tuesday when out shopping but could not remember the actual date. Mr Y said he had taken the overdose of tablets the day before and had not told any member of staff at the time but did tell his mother.
33. The investigation report concluded that it could not reach a clear outcome on the issue. It noted Mr Y said he had informed his mother at the time but that she had not discussed it with staff. It was felt this was unusual due to her level of involvement with Mr Y and his care. The report also looked at concerns about the level of care and concluded the placement had irrevocably broken down.
34. Mrs X made her own safeguarding report to the Council about this incident. This investigation noted the accommodation provider’s safeguarding report was of poor quality. It also noted Mr Y reported that he took a second overdose because the keyworker did not report the first one and he felt let down by the service.
35. This safeguarding investigation identified lessons that had been learnt as follows:

• Support with undertaking investigations and report writing
• A review of the referral process including a review of the available information about the service to ensure stakeholders are aware of the limits of the service
• A review of the information given to residents and families about the service and its policies
• A review of practices within the service to ensure they fit with person centred care and planning
• A review of training within the service to ensure staff understand the specific mental health needs of residents

36. The report noted that while there was learning for the service resulting from Mr Y’s experiences, no resolution had been found for Mr Y. He left the accommodation and is currently living back at home with his mother while other accommodation options are identified.
37. Based on the information provided, I am unable to take a view on whether there was fault on this issue. The investigation carried out at the time was unable to reach a conclusion and I do not consider there are any further investigations I could carry out to change this. I am pleased to note the Council’s safeguarding investigation has resulted in lessons learnt and provided for service improvements. While this does not directly resolve Mr Y’s situation and did not provide the outcome he sought, I hope he can see that his involvement with the safeguarding investigation has resulted in positive changes that should prevent similar problems for future residents.

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Agreed action

38. To remedy the injustice caused as a result of the fault in this case the Council should, within one month of my final decision, take the following action:

• Apologise to Mr Y; and
• Pay Mr Y £150 to recognise the distress experienced.

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Final decision

39. I have completed my investigation with a finding of fault for the reasons explained in this statement. The Council has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman