Summary: Mr B complained the Council’s occupational therapy service for children did not assess his brother’s needs correctly or give him the right equipment. Mr B says Mr C missed out on services he was entitled to and this delayed his development and led to the deterioration of their parent’s health. The Ombudsman has not found fault with the Council.

The complaint

1. Mr B complained the Council’s occupational therapy service for children did not assess his brother’s needs correctly or give him the right equipment.
2. Mr B says Mr C missed out on services he was entitled to and this delayed his development and led to the deterioration of their parent’s health.

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What I have investigated

3. Mr B complained about the Council’s actions from 2005 onwards. I have decided to investigate Mr B’s complaint from June 2018 onwards. I have limited the time frame of the investigation because Mr B could have complained to the Council earlier.
4. Mr B complained about the Council’s occupational therapy service for children and its children’s trust. This complaint will consider the actions of the Council’s occupational therapy service for children. The actions of the children’s trust are being investigated separately.
5. During the investigation, Mr B raised concerns about the implementation of a Disabled Facilities Grant (DFG). This complaint will not be considered in this investigation because it has not been through the Council’s complaint procedure and is premature.

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The Ombudsman’s role and powers

6. 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)
7. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
8. The law says we cannot normally investigate a complaint unless we are satisfied the Council knows about the complaint and has had an opportunity to investigate and reply. (Local Government Act 1974, section 26(5))
9. 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

10. I considered:
• Mr B’s complaint and the information he provided;
• documents supplied by the Council;
• relevant legislation and guidelines; and
• the Council’s policies and procedures.
11. Mr B and the Council had an opportunity to comment on a draft decision. All comments were considered before this final decision was reached.

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What I found

Legislation and Guidance

12. I have set out below some key points about the Council’s children’s occupational therapy service.
13. The service is for children and young people who have a disability which impacts on their daily activities, or the safety of those caring for them.
14. The service assesses need, offers advice and guidance, provides equipment, and makes recommendations for adaptions and training.
15. Family members can refer to the service using the service’s referral form. Once the service receives a referral it contacts the child’s parent or carer to arrange an assessment. The Council states that, “due to a high demand for occupational therapy services, the waiting time can vary.”
16. Following an assessment, the service will send the family any recommendations it makes in writing and, if it is the appropriate service, will work with the family to deliver the recommended level of support.
17. A disabled facilities grant (DFG) is awarded by the housing authority to make adaptations to the home which are ‘necessary and appropriate’ to meet the disabled occupant’s needs, where it is ‘reasonable and practicable’ to carry out such adaptations.

What happened

18. This chronology includes key events in this case and does not cover everything that happened.
19. Mr B is the representative for his brother Mr C. Mr C has cerebral palsy and a learning disability; Mr C cannot communicate using words. Mr C was 18 in June 2019.
20. Mr B and Mr C live with their parents, siblings and other family members. One of their bothers, Mr D, also has cerebral palsy and a learning disability. Mr C and Mr D are cared for full-time by their parents and the other family members.
21. The Council’s occupational therapy service for children received a referral for Mr C in June 2018. In July 2018, occupational therapists from the children’s and adult’s services visited the family to carry out a joint assessment of Mr C and Mr D. Mr B and Mr C were at college when they visited. Mr B says the Council did not tell them about this visit. He asked for a new occupational therapist because they had lost confidence in the one that attended their home. The occupational therapy service assigned a different occupational therapist to Mr C and Mr D.
22. Occupational therapist completed a joint assessment Mr C and Mr D in July 2018. Mr B acted as the family’s representative and highlighted the difficulties Mr C’s parents were having with manual handling. The assessment recommended the following was provided:
• bathroom adaptations via a Disabled Facilities Grant (DFG);
• a crash mat; and
• specialist seating.
23. The therapist also gave the family advice about caring for Mr C. A family member signed to say they agreed with the recommendations. The therapist said an engineer should consider whether the family’s step lift needed to be replaced; it had been fixed in June 2018.
24. The occupational therapy service ordered a crash mat and specialist seating for Mr C. It contacted Mr B for the information it needed to apply for a DFG to pay for the adaptations needed in their shower room. In August 2018, the equipment provider told the occupational therapy service the family had declined the specialist seating on delivery.
25. The contractor the Council uses to provide equipment reviewed the family’s step lift in October 2018. It fixed the problems it found leaving the step lift in working order.
26. The occupational therapy service made an application for a DFG for the family in October 2018 and then closed Mr C’s case. The occupational therapy service wrote to Mr C’s parents. It told them what action it had taken, that it had closed his case and the family could make a new referral if his medical condition or circumstances changed.
27. Mr B contacted the Council in December 2018 to complain the specialist seating it ordered for Mr C was not delivered. The Council contacted the equipment provider which said it tried to deliver the seating in August 2018, but the occupants refused to accept the seating because it was too big; Mr B disputes this.
28. Mr B told the Council it had not provided Mr C with enough support. He asked why the occupational therapy service had not referred Mr C to children’s services. The Council explained the occupational therapy service did not automatically refer children to children’s services and that this would happen if there were safeguarding concerns or at the request of the family. The Council advised for it to be able to reorder specialist seating for Mr C, Mr B would need to make a new referral to occupational therapy for his brother. The Council said it would assign the case to Mr C’s previous occupational therapist to speed up the process. The Council gave Mr B details of an advocacy service.
29. Mr B made a new referral to the occupational therapy service for children at the beginning of February 2019. Mr B requested Mr C’s room was adapted to be a sensory room and for the Council to consider providing a hoist. The occupational therapy service told Mr C’s parents that because of the demands on the service it had placed Mr C on a waiting list for an assessment. The service told them to tell the Council if there were significant changes in Mr C’s needs or he needed an urgent assessment.
30. Mr B told the Council in March 2019 that if they did not get help there would be a risk of carer breakdown or injury. Mr B said the Council needed to consider Mr C’s feeding, changing and his emotional needs. Given the urgency of the reassessment, the Council responded by offering Mr C an appointment at the beginning of April 2019.
31. The occupational therapy service assessed Mr C at school and at home in April 2019. The service spoke to Mr B and Mr C’s mother via an interpreter. They raised further concerns about the impact of caring for Mr C and explained he was having an operation which would reduce his mobility during recovery. They also shared that Mr C’s behaviour could be challenging. The assessment recommended:
• the family’s bathroom was remodelled and reception rooms knocked through;
• a ceiling hoist and changing table was installed;
• Mr C was provided with a low entry bed; and
• Mr C was given a special chair to use at school.
32. The occupational therapy service added the recommendations for house adaptations, including providing a ceiling hoist and changing table, to the family’s DFG application. The service said it would arrange for the family’s step lift to be replaced.
33. The occupational therapy service shared the assessment with the adult occupational therapy service, the hospital where Mr C was going to have an operation and his school. It also held a meeting with Mr C’s school, his social worker, and Mr B to complete a continuing health care checklist.
34. Mr C had surgery on his foot. The hospital’s occupational therapist completed an assessment and provided Mr C with a low entry bed, a midi hoist and two medium slings.
35. Mr B asked the Council to consider underfloor heating being installed as part of the DFG because Mr C moves around by crawling.
36. In May 2019, the Council’s step lift contractor completed a feasibility report for the new step lift. Mr B consented to the contractor building a wall to enable a new step lift to be installed. The Council arranged for the work to be completed in July 2019. Mr B asked for the work to be re-scheduled to during Mr C’s school holiday. The new step lift was installed in August 2019.
37. Mr B told the contractors in June 2019 that the family’s existing step lift was faulty. The contractor visited the family and found no problem with the step lift.
38. Mr B complained in July 2019 the Council had not provided Mr C or their family with services and provision they were entitled to. The Council did not uphold Mr B’s complaint.
39. In August 2019, Mr C’s physiotherapist recommended the Council provide a specialist chair for him to use at school. Once the chair was delivered, the occupational therapy service for children closed Mr C’s case. Mr B complained about the chair, and the occupational therapy service for children advised him to contact the adult service because Mr C was now 18.
40. Mr B asked the Council to escalate his complaint to Stage Two of the Council’s complaint procedure. The Council sent Mr B its Stage Two investigation response in August 2019 and said its position remained the same, it did not uphold his complaint.

Analysis

41. The occupational therapist service assessed Mr C each time it received a referral. The service arranged for an interpreter to be present at the assessments so family members who did not speak English could take part.
42. The occupational therapists who completed the assessments identified the equipment and house adaptations that were required to meet Mr C and his family’s needs. The service arranged for the equipment to be provided and made an application for a DFG for adaptations to their home.
43. The occupational therapists gave the family advice and guidance about how to safely care for Mr C and they were shown how to use the step lift by the contractor.
44. Where there was no fault in the way a Council’s made a decision, the LGSCO cannot question the merits of that decision. I have not seen any evidence of fault with the way the Council assessed Mr C and therefore I cannot question the merits of its recommendations for equipment and adaptations.
45. Mr B says the Council did not deliver specialist seating it ordered for Mr C following his July 2018 assessment. The evidence provided by the Council confirms that its contractor attempted delivery, but the family did not accept the seating.
46. Mr B was unhappy that in July 2018, two occupational therapists visited the family home without telling the family beforehand. Although this was a mistake by the Council it is not significant enough to justify a finding of fault. Following the incident, the Council reallocated Mr C to a new occupational therapist at Mr B’s request.

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Final decision

47. I have completed my investigation and do not uphold Mr B’s complaint.

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Parts of the complaint that I did not investigate

48. I have not investigated the actions of the Council before June 2018 because the complaint is late. Mr B has also complained about the service provided to Mr C by the children’s trust. The actions of the children’s trust are being investigated separately.
49. During the investigation, Mr B raised concerns about the implementation of a Disabled Facilities Grant (DFG). This complaint was not be considered in this investigation because it had not been through the Council’s complaint procedure and was premature.

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Investigator's decision on behalf of the Ombudsman