Summary: Ms X complains the Council failed to recognise that a malicious safeguarding concern had been raised about her, resulting in it investigating the concern and subjecting her to supervised contact with her son. The Council accepts it should have started making safeguarding enquiries when it first received the concern in December 2023 and has apologised. There is no other evidence of fault by the Council.

The complaint

1. The complainant, Ms X, complains the Council failed to recognise that a malicious safeguarding concern had been raised about her, resulting in it investigating the concern and subjecting her to supervised contact with her son.

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The Ombudsman’s role and powers

2. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with an organisation’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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What I have and have not investigated

4. I have investigated the Council’s handling of the safeguarding concern. I have not investigated the actions of individuals who do not work for or on behalf of the Council, including those who care for Ms X’s son. This is because their actions fall within the remit of the Parliamentary & Health Service Ombudsman, not the Local Government & Social Care Ombudsman.

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How I considered this complaint

5. I have considered evidence provided by Ms X and the Council, as well as relevant law, policy and guidance.
6. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

7. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

What happened

8. Ms X’s son, Mr Y, lives in supported living accommodation. He has significant needs for care and support arising from autism and a learning disability. An Integrated Care Board funds his care.
9. Mr X’s 2023 care plan identified food intolerances arising from two medical conditions.
10. On 21 December 2023 the Council received a safeguarding concern from a nurse. It referred to continuing disputes with Ms X about her son’s needs and how to meet them. This included a dispute about the cause of her son’s mouth ulcers. It said Ms X put them down to reintroducing foods, including soya, into his diet. But the nurse said medical professionals had found no evidence to support this claim. The nurse said Mr Y had swollen and sore lips on 18 December, after spending the previous day with his mother. The nurse said Ms X brought an over -the-counter medication, which breached an order by the Court of Protection. The concern also accused Ms X of fabricating an illness.
11. On 5 January the Council received a further safeguarding concern. This said Mr Y developed a sore and swollen lip the day after visiting his mother.
12. On 9 January the Council decided to take no further action over the safeguarding concerns.
13. On 7 March 2024 the Council triaged three safeguarding concerns “around supervised contact with the family” and Mr Y. It decided to make safeguarding enquiries under Section 42 of the Care Act.
14. On 29 April the Council decided it was in Mr Y’s best interests to make enquiries into the safeguarding concerns, as he lacked the mental capacity to make that decision for himself.
15. The Council held a multidisciplinary team meeting on 7 May. It told Ms X about the safeguarding allegations and that they would be reported to the Police as they involved physical abuse. Ms X agreed to accept supervised contact with her son.
16. The Council produced a safeguarding action plan for Mr Y on 28 May. This provided for supervising Ms X’s visits to her son until the Council completed its safeguarding investigation “to minimise future events”.
17. On 5 June the Police told the Council they were closing the criminal investigation. Ms X asked if unsupervised contact could now resume. The Council told her supervised contact had to remain in place.
18. On 13 June the Council noted there was not enough evidence that Ms X caused her son’s mouth ulcers. It asked for an urgent meeting to review the supervised contact with her son. At a multidisciplinary meeting held on 24 June, it was agreed that Ms X could have unsupervised contact again with her son. The Council told Ms X about the decision and that there was no substantial evidence to support the allegations made against her.
19. Ms X complained to the Council about its handling of the safeguarding concerns in June. She said the allegations made against her had been malicious.
20. On 19 July the Council apologised to Ms X for the delay in completing its report into the safeguarding concerns. It said there was no clear evidence to support the allegation, so would close the case with a “non-substantiated” decision.
21. The Council updated the safeguarding action plan on 31 July. This confirmed the end of Ms X’s supervised visits with her son. It said to:
• arrange a thorough medical examination to address and treat Mr Y’s “ulcer mouth sores”;
• create a detailed risk assessment plan based on Mr Y’s medical needs;
• maintain open, transparent and empathetic communication with Ms X, reporting any mouth ulcers to her, especially after family visits;
• review and revise safeguarding protocols to ensure they were aligned with the six principles of safeguarding (empowerment, prevention, proportionality, protection, partnership and accountability);
• ensure staff safeguarding training was up-to-date, with a focus on appropriate responses and the importance of timely action;
• develop a positive and cooperative relationship between Ms X, the care provider and the funding authority, by encouraging open dialogue, mutual respect and a shared commitment to the adult’s well-being.
22. When the Council replied to Ms X’s complaint in August, it said:
• a nurse had raised concerns on 21 December 2023;
• it apologised for the initial delay, and referred to “some triage in respect of gathering information”;
• on 24 April 2024 it assigned social worker A to lead the safeguarding enquiry, who experienced some delays in getting information which required analysing;
• it had now completed the safeguarding enquiries and found the concerns “not substantiated”;
• there was no evidence the safeguarding was raised maliciously, but accepted the provider should have discussed their concerns in advance with Ms X;
• it accepted Ms X had raised concerns with her son’s care provider about his “continuous sore mouth/throat/ulcers”, a condition he had had for many years;
• there was a delay in referring the safeguarding concerns to the Police. But the Police’s decision to end their involvement did not mean the safeguarding process should end;
• it had followed safeguarding principles when leaving the supervised contact in place;
• the Council had shared its findings with the NHS on 11 June and asked it to consider whether restrictions should remain in place. A meeting did not take place until 24 June. It accepted this was a difficult time for Ms X;
• it accepted there was an element of uncertainty during safeguarding enquiries.
23. The Council partially upheld Ms X’s complaint on the basis that, while it was necessary for it to make safeguarding enquiries, there was a delay in continuing the process.

Is there evidence of fault by the Council which caused injustice?

24. The Council accepts it should have started making safeguarding enquiries when concerns were first raised in December 2023 and has apologised. There is no basis to ask the Council to do more than that. Ms X did not know about the delay and was only not told about the concerns in May 2024, shortly before her visits started being supervised.
25. The Council was not at fault for making enquiries into the safeguarding concerns about Ms X. The fact that the Police did not take any action against her did not mean the safeguarding issues were resolved. The decision not to charge Ms X meant the Council had to consider, on the balance of probabilities, whether the allegations against her could be substantiated.
26. Nor was the Council at fault over the decision to have Ms X’s visits to her son supervised, while the safeguarding enquiries were ongoing. Councils have to consider putting safeguards in place while they carry out enquiries. This had to take account of the potential harm to Mr Y. That the outcome of the enquiries showed the safeguards were not needed, does not mean the Council was wrong to put them in place.

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Decision

27. I find fault causing injustice which has already been remedied.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman