London Borough of Hammersmith & Fulham (25 000 999)
Category : Adult care services > Safeguarding
Decision : Closed after initial enquiries
Decision date : 21 Jul 2025
The Ombudsman's final decision:
Summary: We will not investigate this complaint about the Council’s safeguarding enquiry after an incident involving day centre staff. There is insufficient evidence of fault in the Council’s decision not to progress to formal enquiries, and insufficient evidence any fault by the Council in other areas caused a significant injustice.
The complaint
- Mrs X complained about the Council’s decision not to progress to a formal safeguarding enquiry after an incident involving a day service her son (Mr Y) attends. Mrs X said the Council played down the event, saying it was a misunderstanding. She complained the Council failed to properly respond to her complaint.
- Mrs X said the matter caused significant distress, and she believed had the Council taken the incident seriously, a second incident would not have occurred. Mrs X wanted acknowledgement of fault, apologies and service improvements.
The Ombudsman’s role and powers
- We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:
- there is not enough evidence of fault to justify investigating, or
- any fault has not caused injustice to the person who complained, or
- any injustice is not significant enough to justify our involvement.
(Local Government Act 1974, section 24A(6), as amended, section 34(B))
How I considered this complaint
- I considered information provided by the complainant.
- I considered the Ombudsman’s Assessment Code.
My assessment
- 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 decide whether it or another person or agency should take any action to protect the person. (section 42, Care Act 2014)
- Mrs X reported concerns to the Council after allegedly having witnessed her son, Mr Y, out with others from his day centre, without the necessary two staff by his side to keep him safe.
- The Council gathered statements from three members of staff and considered these alongside Mrs X’s report. The Council found there was some confusion by day centre staff about who should have been providing Mr Y’s 2:1 support. It noted the day centre had already arranged meetings to update Mr Y’s risk assessment and risk management plan.
- The main purpose of a safeguarding enquiry is to decide what action should be taken to safeguard an individual. The Council decided not to carry out further enquiries as actions had already been identified. There is insufficient evidence of fault in how the Council came to this decision, and the evidence I have seen indicates this decision was in line with the statutory guidance. There is insufficient evidence the Council did not take the matter seriously as Mrs X alleges, but it was satisfied the actions already proposed were satisfactory.
- We could not say the second incident would not have happened had the Council carried out further enquiries in response to the first. There were different circumstances involved in the second incident, that prompted a more formal enquiry by the Council. That the second incident necessitated more formal enquiries does not mean the Council was at fault in how it responded to the first incident.
- Mrs X highlighted other areas in her complaint where she believed there was fault by the Council. For example, she says parts of staff members’ statements were omitted when the statements were read out in a meeting. Given that the Council was satisfied proportionate action was already being taken in response to the concern Mrs X had raised, the outcome would not have been different but for any fault in these additional respects. It is not therefore proportionate for us to consider these points further.
- It is not a good use of public resources to investigate complaints about complaint-handling when we are not investigating the substantive matter itself. We will not therefore investigate Mrs X’s complaint about how the Council responded to her complaint.
Final decision
- We will not investigate Mrs X’s complaint because there is insufficient evidence of fault in the Council’s decision not to progress to formal enquiries, and insufficient evidence any fault by the Council in other areas caused a significant injustice.
Investigator's decision on behalf of the Ombudsman