Summary: Ms D complains the Council failed to provide suitable support to her and safeguard her. The Council is at fault for failing to make proper transition arrangements for Ms D, to consider safeguarding alerts and for failing to complete carers’ assessments. This has caused uncertainty about whether Ms D and her family would have had services earlier which would have met their needs more suitably and reduced the distress caused by the Council’s lack of action. To remedy the complaint the Council will, apologise to Ms D and her family, make symbolic payments and service improvements.

The complaint

1. Ms C complains on behalf of Ms D, and Ms D’s grandparents Mr X and Mrs X, about the Council’s failure to provide suitable support to Ms D and her grandparents since transitioning from children to adults services. Ms C also complains the Council has failed to safeguard Ms D leaving her in unsuitable housing and at risk.
2. Ms C says the Council’s inaction and the failure to provide respite support has also resulted in a decline in Ms D’s grandparents’ health.

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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 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)
4. 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

5. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
6. I am aware that some matters are ongoing. I have exercised discretion to consider matters up to 18 November 2024 when Ms D went into temporary accommodation. I have not considered matters after this date as these would be new matters. If Ms D is unhappy, she or Ms C will need to make a new complaint so the Council has an opportunity to consider them first before escalating the matter to the Ombudsman.

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How I considered this complaint

7. I considered evidence provided by Ms C and the Council and relevant law, policy and guidance.
8. Ms C and the Council had an opportunity to comment on my draft decisions. I considered any comments received before making a final decision.

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What I found

What should have happened

Transition arrangements

9. When a child reaches 18 years, they are legally an adult. Responsibility for meeting their needs moves from the council’s children services to its adult services. The legal basis for assessing their needs changes from the Children Act 1989 to the Care Act 2014.
10. A transition assessment must give an indication of what care and support needs are likely to be eligible for support once the child turns 18. The council should also consider creating a personal transition plan, including key milestones.
11. If the council is going to meet needs under the Care Act after someone turns 18, it must create a care and support plan and produce a personal budget. This needs to be done early enough that the package of care and support is in place at the time of transition.
12. Advocacy should be provided for the young person where necessary, and the council must provide independent advocacy for young people having a transition assessment, provided certain conditions are met.

Mental Capacity Act

13. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.

Mental capacity assessment

14. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established they lack capacity. A person should not be treated as unable to make a decision:

• because they make an unwise decision;
• based simply on: their age; their appearance; assumptions about their condition, or any aspect of their behaviour; or
• before all practicable steps to help the person to do so have been taken without success.

Social Care Assessment

15. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
16. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Carer’s Assessment

17. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
18. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

Care Plan

19. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

Reviews

20. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Safeguarding

21. 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)

Complaints

22. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. The Council’s, “Adult care complaints policy”, the “Policy” says it will aim to respond within 15 working days and for complex cases no later than six months. The Policy says the Council will tell complainants when they should expect to receive a response.
23. A single stage procedure should be enough. The council should include in its complaint response:

• how it considered the complaint;
• the conclusions reached about the complaint, including any required remedy; and
• whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• details of the complainant’s right to complain to the Local Government and Social Care Ombudsman. (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

What happened

Provision of support

24. Ms D has complex social care needs arising from hearing loss, behavioural and learning difficulties. Ms D lived with her grandparents, Mr X and Mrs X. On 2 August 2022 the Children’s services team completed a referral to the Preparing for Adult Life (PfAL) team. The referral identified Ms D had significant behavioural problems (requiring one to one support at school) and support needs that would continue into adulthood.
25. From May 2023 Ms D’s family arranged care for Ms C for two hours per week. The Council funded this later.
26. On 22 September 2023, Ms D’s eighteenth birthday the Council completed a Care Act assessment. The assessment identified:
• Ms D had a college placement which she enjoyed and could independently access the community if she knows the route. Travelling by bus is difficult as Ms D would not know when to leave the bus;
• Ms D has a Personal Assistant (PA) for two hours per week to support her independence;
• Ms D needs help understanding the value of money. She has financial deputies who manage her money.
• Mr X and Mrs X had difficulties supporting Ms D as she could at times be emotionally deregulated leading to physical aggression and self harm;
• Ms D needed support with some aspects of her personal care, her medication, wearing and considering weather suitable clothing, and some domestic care tasks;
• Ms D finds it difficult to develop and maintain personal relationships.
27. On 18 October an officer visited Ms D to talk about regulating her emotions. The officer records the Learning Disability Health Team would support Ms D and her grandparents with dealing with her emotions.
28. In November the Council updated Ms D’s support plan which included the existing seven hours of PA support and a further two hours of PA support to give Mr X and Mrs X a break. Ms D also agreed to a weekend a month in a care home and a weekend a month extra PA support to provide respite for her grand parents.
29. Over the next few months the Council tried to source a care home for respite but could not find a placement which had a vacancy and could meet Ms D’s needs. The Council unsuccessfully approached Ms D’s PA to see if they could offer extra support. Over the same period there were frequent calls from Mr X and Mrs X about Ms D’s escalating behaviour, their concerns over her safety and the need for support. By the end of February 2024 the Council held a Multi-Disciplinary Team (MDT) meeting with Learning Disability health nurses and Intensive Support Service Nurses for their advice in supporting Ms D.
30. On 19 February the Council referred Mr X and Mrs X for a carer’s assessment
31. In March the Council assigned a new PfAL officer for Ms D who reassessed Ms D’s needs. It included views from Ms D, Mr X and Mrs X, the Learning Disability nurse, and Ms D’s PA. The assessment identified Ms D had extra needs. There is however no evidence of an updated support plan following this assessment.
32. In June and July Mr X and Mrs X continued to contact the Council about Ms D’s safety when she was out, smoking/vaping, potential drug use, inappropriate relationships with others and physical aggression towards them. Mr X told the Council he did not feel they could continue much longer and sought extra respite. The Council approached organisations for respite care and extra PA support, it also advised Mr X that should Ms D become aggressive he should call the police. There was also a follow up MDT meeting which included a Learning Disability Psychologist.
33. A support plan dated 15 July records Ms D rejecting residential respite care or additional PA support with people she did not know. It records Mr X and Mrs X’s concerns as they were at breaking point and Ms D’s behaviour was worsening. They also raised their concerns that contacting the police would be morally wrong.
34. On 29 July Ms C told the Council Mr X had a stroke and the Council would need to source a placement for Ms D. The Council advised Ms C that Ms D did not need a residential placement and recommended she apply to the local housing register. The Council emailed Ms C confirming the family would support Ms D to apply for the local housing register, prompt and save the taxi service and bus timetables to Ms D’s phone, contact the police if Ms D became violent, and discuss living independently.
35. On 2 August the MDT put Ms D on the Care Program Approach (CPA). The CPA is a co-ordinated approach for people with complex mental health needs. On 16 August the Council confirmed Ms D had an allocated housing officer and that Ms D did not need specialist accommodation but would need a support package. Following Ms C’s further concerns about Ms D’s physical aggression the Council told Ms C Ms D no longer agreed to respite care either in a care home or through additional PA support. The Council had therefore stopped looking at respite options.
36. In September following further episodes of concern for Ms D, Ms C contacted the Council saying the family could not cope and for the Council to put Ms D into care. Ms C also raised further safeguarding concerns about Ms D’s risk. The Council completed a safeguarding referral for Mr X and Mrs X but took no further action. Ms C told the Council Ms D would have to leave Mr X and Mrs X’s home by 7 October.
37. The Council discussed supported accommodation for Ms D. Ms C agreed with this option.
38. Ms C continued to make further calls about different safeguarding issues related to Ms D in the community. On 30 October professionals at an MDT meeting raised concerns about the lack of respite and questioned Ms D’s capacity to make decisions on some occasions. The PfAL officer explained Ms D did not meet the criteria for respite care in a care home and the Council was now considering social housing with a support package.
39. In November Ms D agreed to, and the Council provided, 2 hours of care support twice a week. Following Mr X and Mrs X making Ms D homeless she moved into temporary accommodation on 18 November.

Complaint

40. On 16 September 2024 Ms C complained to the Council. The Council’s policy says it will respond within 15 days but this did not occur and Ms C contacted the Council on 7 October asking for a response.
41. The Council responded on 11 October it:
1. apologised for the delay;
2. explained that Ms D had an assessment and support plan from October 2023 and safeguarding was unnecessary;
3. the PfAL Assistant Practitioner had been working with Ms D and had assessed supported housing as suitable to meet Ms D’s housing needs with extra support if needed;
4. respite was agreed but the provider was unable to provide support at an appropriate level. The Council explained that it needed to balance risks with the need to promote Ms D’s independence;
5. reassurance it had made a referral for assistive technology.
42. Ms C responded on 14 October saying:-
1. the complaint response was late and did not address all the complaints;
2. the Council failed to provide respite and only provided extra support at the last minute when Mrs X needed hospital treatment;
3. the Council has meetings and discussions with plans but takes no action;
4. there is no communication between housing and social services about who is responsible for meeting Ms D’s housing needs.
43. The Council contacted Ms C on 22 October asking to discuss the complaint as part of the review process. The Council sent Ms C a review response on 18 November. It:
1. apologised for the delay in the initial complaint response and its failure to address all the complaints. It accepted and apologised about the Team Manager not returning calls;
2. advised Mr X did not meet the threshold for formal safeguarding enquiries;
3. offered a referral for a carer’s assessment for Mr X and Mrs X;
4. advised that it had provided respite by increasing the extra support provided to Ms D from PA’s. The Council could not initially identify a care home and it now considered respite in a care home was unsuitable. The Council said it needed to balance respite support with Ms D’s independence. It said it would keep this under review;
5. acknowledged and apologised for the delay in Ms D’s transition assessments;
6. had assessed Ms D as needing housing and a care package and Ms D had capacity to decide where she should live.
44. Ms C complains the Council has failed to support and safeguard Ms D and her grandparents. She complains the Council has neglected Ms D’s mental health and inappropriately passed the onus of support onto the police.

Was there fault causing injustice?

Safeguarding

45. Ms D is a young vulnerable adult who wants to live independently. Throughout the chronology of events the family has consistently raised concerns about Ms D. The Council has provided no records of actions it has taken about safeguarding alerts family have made about Ms D. The failure to properly consider safeguarding alerts is fault.
46. The Council did not treat these concerns as safeguarding. It said this was restrictive and impinged on Ms D’s right to make unwise decisions; which under the Mental Capacity Act she is at liberty to do. I am aware the Mental Capacity Act says there should be a presumption of mental capacity and a person’s unwise choice does not mean they do not have capacity to make a decision. However I consider in this case there was enough concern to rebut the presumption of capacity and complete a capacity assessment. This was because:-
• Ms D becomes emotionally deregulated at which point she may not have capacity to make decisions;
• concern was raised by family members and others that Ms D did not have capacity to make some decisions.
47. The Council should have properly considered Ms D’s capacity either as part of safeguarding or as part of its general duties under the Care Act. If the Council assessed Ms D had capacity but was still at risk it was still under a duty to compile an action plan to minimise the risks to Ms D.
48. This also applies to Mr X and Mrs X who were also vulnerable adults. The Council says Ms D’s aggression on Mr X did not meet the threshold of abuse. It is unclear how the Council made this decision. The failure to properly record this decision is fault. The Council is also at fault for failing to tell Ms C why safeguarding had not progressed.
49. The Council advised Mr X and Mrs X to call the police if there was physical aggression. However the Council did not look at ways in which Mr X and Mrs X could be supported with the aggression. It did not complete a risk assessment or compile an action plan to minimise the risks in particular after Mr X and Mrs X said it felt morally wrong to contact the police when Ms D had health difficulties.

Support prior to independent living

50. The Council failed to consider Ms D’s needs when she transitioned from children to adult services. Ms D had complex needs which would continue after she reached adulthood. However it did not assess Ms D’s needs until her eighteenth birthday. The delay in assessing Ms D is not in line with the Care Act and is fault.
51. The assessment identified Ms D’s needs and her wish for independent living. It also identified Mr X and Mrs X were finding it difficult supporting Ms D. The Council arranged for Ms D’s care package to continue into adulthood. The Ombudsman is unable to challenge a professional judgement where there is no procedural fault. I consider there was procedural fault by the Council because:
• there was no multidisciplinary assessment of Ms D’s needs which resulted in ad hoc decisions. Although professionals were later involved and held frequent multi-disciplinary meetings the Council should have sought their input before Ms D reached 18 and as part of the initial transition/care assessment;
• there was no consideration about the effect Ms D’s behaviour was having on her carers and no carers’ assessment offered until five months later. Had this been considered before Ms D reached 18, extra support could have been provided which may have prevented the situation deteriorating as it did;
• the initial support plan did not have details about what respite would best meet both Ms D’s and her grand parents’ needs;
• there was no clear plan about what Ms D needed for her to manage independent living including what sort of housing and support she needed.
52. Once the Council decided it would provide monthly respite in the form of residential care and extra PA support it made efforts to source a residential placement. This was not however supported by an assessment. The Council at first could not find a care home to meet Ms D’s needs and later stated Ms D did not need 24 hour care. The Council’s decisions during this period appear to be ad hoc at points suggesting Ms D needed 2:1 support and others no support. I consider the failure to properly reassess Ms D’s needs is fault.
53. The Council told Mr X and Mrs X it would provide respite services that it failed to deliver. It did not approach an alternative PA provider for extra support until July 2024, more than six months after the Council had agreed the extra monthly support. This was service failure and raised Mr X and Mrs X’s expectations of the support they would get.
54. The Council failed to update Ms D and her grandparents about its decision making in a timely manner which caused frustration about what actions the Council was pursuing. As there is potentially a conflict between Ms D and her grandparents the Council should have also considered whether Ms D needed an advocate.

Support for carers

55. Mr X and Mrs X are vulnerable adults and both had health needs. There are a multitude of records where they contacted the Council for help and support saying they could not cope and were at risk. Mr X had a stroke after one such call and Mrs X could not properly recuperate after receiving medical attention.
56. The records show two referrals for carers’ assessments but there is no evidence the Council completed them. The failure to complete carers’ assessments is not in line with the Care Act and is fault.

Complaint handling

57. The Council is at fault for failing to respond properly to Ms C’s complaint. The Council considered the complaint within six months. The Council did not however follow its policy as it failed to tell Ms C when she would receive a complaint response.
58. The Council did not refer Ms C to the Ombudsman after its initial response. This causes ambiguity about whether there is in fact a two stage complaints procedure which would not be in line with the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009).

Injustice

59. Ms D has complex needs. I cannot say had the Council acted without fault the situation would not have worsened as it did. Nor can I say but for the faults Ms D would not have been at risk or Mr X would not have had a stroke. Ms D and Mr X and Mrs X however have the uncertainty that but for the faults I have found the situation may have been different and they would not have faced the prolonged distress and frustration.
60. I have considered our remedies guidance and because of the multiple failures, the length of time, the vulnerability of the complainants, and the frustration, distress and anxiety the Council’s lack of action has caused to both Ms D and her grandparents I have gone above our usual tariff for uncertainty.
61. Ms C has also had time, trouble and frustration in pursuing the complaint.

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Action

62. I have found fault with the Council’s actions. I consider the agreed actions are suitable to remedy the personal injustice caused and to improve future practise.
63. Within one month of the final decision the Council will:
1. apologise to Ms D about the Council’s delay in assessing her for transition into adulthood, properly consider whether safeguarding was appropriate, failing to properly assess her needs and faults in the complaint handling;
2. apologise to Ms D’s grandparents for failing to consider their needs as carers and the impact on them from the delays in assessing Ms D’s needs;
3. make Ms D a symbolic payment of £500 in recognition of the uncertainty, distress, and anxiety the Council’s failures have caused;
4. make Mr X and Mrs X a symbolic payment of £1500 in recognition of the uncertainty, distress and anxiety the Council’s failures have caused;
5. make Ms C a symbolic payment of £150 for her time and trouble in pursuing the Council to address the complaint;
6. complete a holistic, person centered assessment for Ms D which includes her views and those of involved professionals and relevant family members;
7. based on the assessment, produce a support plan which addresses the needs identified which includes Ms D’s need for accommodation and care support;
8. consider whether there are any risk factors which the Council should consider as part of safeguarding procedures or as part of its wellbeing duties under the Care Act which includes consideration about Ms D’s mental capacity;
9. offer Mr X and Mrs X a carer’s assessment;
10. consider whether Ms D needs an advocate.
64. Within three months of the final decision the Council will:
1. provide training/a reminder to staff who respond to complaints about the need to address all substantive complaints or explain why they are not being considered;
2. review the complaints policy so it is in line with government guidance and a one stage response;
3. provide an action plan about how the Council intends to prevent future delays in transition assessment and planning;
4. review this complaint and consider how communication between the parties could have been managed better;
5. remind relevant staff through a staff circular, team meetings, training or supervision about considering when to act on safeguarding alerts where people are vulnerable but have capacity to make decisions, recording safeguarding alerts and follow up action; and providing feedback to people who have made a safeguarding alert;
6. remind relevant staff through a staff circular, team meetings, training or supervision about completing capacity assessments when concerns have been raised which rebut the presumption of capacity.
65. The Council should provide us with evidence it has complied with the above actions.

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Decision

66. I find fault causing injustice. I have closed the complaint and ended my investigation based on the agreed actions above.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman