Slough Borough Council (18 012 978)

Category : Children's care services > Disabled children

Decision : Upheld

Decision date : 23 Aug 2019

The Ombudsman's final decision:

Summary: Mrs X complains about the way the Council has supported her daughter and herself. The Council is at fault as Slough Children’s Services Trust delayed in carrying out a carer’s assessment. The Trusts refusal to escalate Mrs X’s complaint to stage two of the complaints procedure is also fault. These faults have not caused Mrs X a significant injustice.

The complaint

  1. The complainant, whom I shall refer to as Mrs X complains about the way the Council has supported her daughter and herself. In particular Mrs X complains Slough Children's Services Trust:
    • Delayed in carrying out DBS checks for potential carers for her daughter, and in notifying Mrs X when they were completed;
    • Wrongly reduced her daughter’s support from 2:1 to 1:1 care;
    • Failed to offer additional support when her daughter was discharged from hospital;
    • Delayed in carrying out a carer's assessment;
    • Failed to offer or provide any respite for Mrs X and her husband; and
    • Failed to respond appropriately to Mrs X's complaints or to escalate them through the Trusts complaints process.

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The Ombudsman’s role and powers

  1. 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)
  2. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
  1. 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

  1. As part of the investigation, I have:
    • considered the complaint and the documents provided by Mrs X;
    • made enquiries of the Trust and considered the comments and documents the Trust provided;
    • discussed the issues with Mrs X;
    • sent a statement setting out my draft decision to Mrs X and the Trust and invited their comments. I have considered Mrs X and the Council’s responses.

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What I found

Direct payments

  1. Once a council has decided on a person’s eligible needs, it can either provide or commission the services for the person, or if they prefer, the council can give them a cash payment (a direct payment) so they can organise their own care. 
  2. Direct payments provide independence, choice and control by enabling people to commission their own care and support to meet their eligible needs. The council has a key role in ensuring that people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

Statutory complaints procedure

  1. The law sets out a three stage procedure for councils to follow when looking at complaints about children’s social care services. At stage 2 of this procedure, the Council appoints an investigating officer and an independent person (who is responsible for overseeing the investigation). If a complainant is unhappy with the outcome of the stage 2 investigation, they can ask for a stage 3 review. If a council has investigated something under this procedure, the Ombudsman would not normally re-investigate it. However, we may look at whether a council properly considered the findings and recommendations of the independent investigation.

What happened here

  1. Mrs X’s daughter, Y has complex medical conditions. Mrs X is her primary carer and finds this role very demanding. She asked the Council for support. Slough Children’s Services Trust delivers children’s services for the Council.
  2. A social worker assessed Y’s care needs in December 2015 and discussed the types of services the Trust could put in place to support the family. The social worker advised they could be considered for three or fours hours of respite support each week to allow Mrs X a break from her caring role. The assessment states this is not what Mrs X wanted and she did not feel it would benefit her.
  3. The Trust re-assessed Y’s needs in November 2016. The assessment concluded that Mrs X needed support in terms of respite care and carers to help meet Y’s personal care needs. The social worker recommended direct payments to fund eight to ten hours of care each week, and the exploration of other respite provision.
  4. In January 2017 a respite service, Company Z met with Mrs X and Y to discuss what care they would like. Following this meeting, Company Z advised the Trust that based on Y’s needs, care would need to be carried out on a 2:1 basis. Based on its discussion with Mrs X, Company Z believed Mrs X would prefer funding for hydrotherapy and other specialised services they can take Y to themselves, rather than a respite service. Mrs X disputes this. She states she enquired about flexibility of provision and Company Z misconstrued her request as wanting funding for hydrotherapy.
  5. The Trust agreed to the 2:1 support and met with Mrs X to discuss how many hours support she needed. Mrs X states there were heated exchanges throughout this meeting and does not consider it was a profitable meeting.
  6. The notes of this meeting state Mrs X queried how the decision to provide 10 hours respite per week had been reached. A social worker explained that during their visit they had discussed support for two hours a day, Monday to Friday as the family was not used to Y being away from home at weekends.
  7. Mrs X suggested 20 hours per week would be appropriate, but the social worker said the Trust would not commit to 20 hours per week without knowing how those hours would be used. The social worker considered 15 hours would be sufficient and suggested 10 hours could be used in the week and five at a weekend. Mrs X wanted the hours to be flexible and agreed to seven hours in the week and eight at the weekend. The social worker confirmed this was an interim arrangement and would be reviewed.
  8. The Trust confirmed Mrs X could use Company Z’s services for support while the direct payments were being set up.
  9. Direct payments for this respite started on 27 April 2017. The difficulty in finding suitable carers and time taken to obtain DBS checks meant Mrs X could not immediately employ carers to carry out the full support package.
  10. At a Child in Need review in July 2017 a social worker noted Y had 2:1 support and stated 1:1 support would be appropriate. Mrs X was concerned that Y chokes and 2:1 support would be required if Y started to choke. She also stated she needed a second carer to support with carrying Y upstairs to the toilet. The records show Mrs X asserted it would not be respite for them if Y did not receive 2:1 support.
  11. The Trust’s records note Y’s school reported she had never choked at school. Y had choked at home in 2015 and 2016, and Mrs X had managed the incident. The records also note that two carers carrying Y upstairs is not advised or practical. The social worker had discussed the downstairs toilet with the OT who could visit and explore options.
  12. The Trust wrote to Mrs X in August 2017 confirming it did not consider Y needed 2:1 support and that her needs could be met with 1:1 support. Mrs X disagreed with this decision.
  13. Mrs X and her advocate met with a social worker in October 2017 to discuss the respite care. Notes of this meeting state Mr X was concerned the assessment that 2:1 support was not required was at odds with the provisions set out in Y’s Education Health and Care plan (EHCP). Mrs X maintained that Y needed 2:1 support with moving and handling. The Trust agreed to seek clarification from the Occupational Therapist (OT) on the moving and handling plans.
  14. The OT contacted Mrs X in October 2017 and offered to carry out a further moving and handling review. Mrs X declined this offer.
  15. The Trust arranged to visit Mrs X to carry out a carer’s assessment in November 2017. The notes of the assessment meeting state there was insufficient time to explore the issues Mrs X raised. Mrs X agreed to let the officer know when she was available to complete the assessment. Ms X advised the officer in February 2018 that she would not be available until March 2018.
  16. As Y’s carer was going on holiday in December 2017 Mrs X contacted the Trust in November 2017 with details of another carer and requested a DBS check.
  17. In December 2017 Mrs X made a formal complaint to the Trust about the support it had provided. Mrs X complained the Trust had not provided DBS links for the carer she had identified. As Y’s carer was now on holiday this affected her ability to ensure Y had regular support.
  18. Mrs X also complained the Trust had told her, without any justification, that the 2:1 support would end. Mrs X was concerned that Y had a life limiting condition and was currently in hospital, but the Trust was not showing any sense of urgency in providing her with support.
  19. In addition, Mrs X complained she had tried to raise her concerns with the Chief Executive at the Trust but had not received an acknowledgement or response.
  20. The Trust’s response confirmed it had sent the DBS link to the proposed carer at the email address Mrs X had provided on 16 November 2017. It asked Mrs X to confirm the address was correct and suggested the email may have gone into the carer’s spam folder.
  21. In relation to the reduction from 2:1 to 1:1 support the Trust referred to the meeting on 23 October 2017 when the social worker explained the OT assessment did not indicate Y needed 2:1 support. As Mrs X disagreed with the decision the Trust had agreed the OT could visit and complete an updated assessment. The OT offered a home visit and reassessment, but Mrs X had declined the offer.
  22. The Trust stated the plan indicated all of Y’s areas of need were being met and invited Mrs X to identify any additional needs so the Trust could address them. It also confirmed it had no record of any emails directly from Mrs X to the Chief Executive, but an officer was responding to concerns raised by Councillors.
  23. Mrs X disputed the Trust’s response. She states the meeting in October 2017 discussed a range of issues, and she referred the social worker to Y’s EHCP which stated Y needed 2:1 care to “cover moving and handling”. Mrs X states they were under the impression this had been agreed and that there would be no changes to the 2:1 provision. She did not decline the OT’s visit but understood a reassessment was not necessary as the provision would not change.
  24. Mrs X stated that throughout her dealings with the Trust there had never been a sense of urgency in relation to Y’s condition. She did not feel she should have to reiterate the needs that were not being met. Mrs X also referred to the social worker’s comment at the carer’s assessment that there was nothing they could offer her.
  25. The Trust changed Y’s direct payments to fund 1:1 support on 1 March 2018.
  26. The Trust carried out a further assessment of Y’s needs in April /May 2018. This assessment concluded 15 hours of 1:1 support each week was sufficient to support her parents to meet Y’s needs. The assessment recommended a discharge meeting be held whenever Y was discharged from hospital to explore support for the family during the recuperation period. It also recommended the family consider accepting the respite support offered.
  27. Mrs X remains unhappy with the level of support the Trust provides and has asked the Ombudsman to investigate her complaint.
  28. In response to my enquiries the Trust acknowledges there was a delay in starting a carer’s assessment for Mrs X. Having started the carer’s assessment, it was then difficult to arrange a time when Mrs X was available to complete it.
  29. The Trust states a Child and Family (C&F) assessment can incorporate a care’s assessment. The C&F assessment completed in May 2018 records Mrs X as Y’s primary carer and identifies Mrs X’s needs. It concludes that with the package of care in place Y’s needs are met. It also notes that Mrs X chooses not to utilise all the respite on offer so she can access respite for herself.
  30. The Trust has reiterated that the decision to reduce the support from 2:1 to 1:1 was discussed at a meeting in October 2018.
  31. The Trust acknowledges it is good practice for a hospital discharge planning meeting to be held, if a child’s needs have changed following admission to hospital. The social worker and their manager have discussed arranging discharge meetings in the future.
  32. In relation to Mrs X’s complaints the Trust notes its initial response advised Mrs X her complaint could be escalated to stage two if she was not satisfied. To proceed to stage two Mrs X would need to state which aspects of the Trust’s reply she was not happy with and what further outcomes she required.
  33. The Trust states it refused Mrs X’s request to escalate her complaint to stage two of its process as it had tried its utmost to answer and resolve all of her concerns. It did not consider a stage two investigation would change the outcome of the stage one investigation. The Trust states it had also accepted Mrs X’s desired outcome, which was to carry out a carer’s assessment.

Analysis

  1. There is no evidence of delay in the Trust carrying out DBS checks. According to a Government website, it usually takes around 8 weeks to obtain a DBS certificate, but it can take longer if the details given for the check are incorrect or several police forces need to be involved in the check. The documentation available shows Mrs X provided details of a prospective carer on 13 November 2017, and the Trust sent that carer an email with a link for DBS checks on 16 November 2017. This email was not returned to the Trust as undelivered. According to the Trust’s records the carer completed the link on 23 January 2018. The delay in the carer completing the link will have added to the time it took to complete the DBS checks.
  2. The Trust considers Y’s needs can be met with 1:1 support. Mrs X disagrees with this decision, but this decision is based on officers’ professional judgement. The Ombudsman does not generally question the merits of a decision unless there is evidence of fault in the way it was taken. That is not the case here.
  3. The OT’s home assessment highlighted Y needed 1:1 support. The Trust offered to arrange for the OT to visit and review Y’s moving and handling needs, but Mrs X did not take up this offer. The trust states that the reference to 2:1 support in Y’s EHCP was in place at the parents’ request and that this was to be reviewed.
  4. The respite provision was reviewed during the assessment in April/ May 2018 and the Trust concluded it was sufficient.
  5. Y was admitted to hospital twice in late 2018 and early 2019. Mrs X states Y’s needs increase for a period when she is discharged from hospital, but the Trust did not offer any additional support. There is no evidence Mrs X asked the Trust for additional support when Y returned home or specified what additional assistance she needed. But the Trust acknowledges it is good practice to hold a discharge meeting if a child’s needs have changed following admission to hospital. This has been included as a recommendation in Y’s assessment in April 2018.
  6. The Trust accepts there was a delay in beginning the carer’s assessment. This assessment is still incomplete as Mrs X was unable to arrange a time to meet with the officer again. Mrs X disputes the Trust started a carer’s assessment. She states the officer who visited said they did not know why they had been asked to visit and could not offer Mrs X anything. But the documentation shows the officer arranged the visit specifically to carry out a carer’s assessment.
  7. The delay in starting a carer’s assessment amounts to fault, but I do not consider it has caused Mrs X a significant injustice. The C&F assessment completed in May 2018 identifies Mrs X’s needs as Y’s carer and notes that Mrs X does not utilise the full respite available to her. Given Mrs X’s concerns about leaving Y solely in the care of others, it is likely that had the Trust completed a carer’s assessment sooner, the position would be the same.
  8. The Trust’s records show that Mrs X has been offered 11 nights a year respite at a hospice but has not used it. A charity has also offered to provide two hours respite a fortnight, but Mrs X has not used this.
  9. The Trust’s refusal to escalate Mrs X’s complaint to stage two of the complaints procedure is also fault. Government statutory guidance on the Social Care complaints procedure is provided in a document called Getting the Best from Complaints. This guidance states

‘Where a complaint is accepted at Stage 1, the complainant is entitled to pursue their complaint further through this procedure except in the case of cross boundary issues. In all other instances, once a complaint has entered Stage 1, the local authority is obliged to ensure that the complaint proceeds to Stage 2 and 3 of this procedure, if that is the complainant’s wish.’

  1. Although it was fault not to escalate Mrs X’s complaint, I do not consider it caused Mrs X a significant injustice as she was able to make her complaint to the Ombudsman. But the Trust should review its complaints procedure to ensure it meets its obligations under the statutory complaints’ procedure.

Agreed action

  1. The Council and Trust have agreed to provide training and review the way the Trust implements its complaints procedure to ensure it considers complaints in accordance with the statutory complaints procedure. The Council should provide the Ombudsman with evidence of this training and review within three months of the final decision.

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Final decision

  1. The Council is at fault as Slough Children's Services Trust delayed in carrying out a carer's assessment. The Trusts refusal to escalate Mrs X's complaint to stage two of the complaints procedure is also fault. These faults have not caused Mrs X a significant injustice.

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Investigator's decision on behalf of the Ombudsman

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