Summary: Mr X complained about the standard of care the Council provided to a child he adopted and how it looked into his reports about this. There was no fault in how the Council investigated Mr X’s complaints or the recommendations it made. But it failed to address all the injustice caused to Mr X and his family by the faults identified. The Council agreed to make a payment to Mrs X and carry all the recommendations from the statutory complaints process.

The complaint

1. Mr X complains the Council provided inadequate care to a child he and his wife adopted and how it looked into his reports about this.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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)
5. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Office for Standards in Education, Children’s Services and Skills (Ofsted), we will share this decision with Ofsted.

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How I considered this complaint

6. As part of this investigation, I considered the information provided by Mr X and the information provided by the Council. I sent a draft of this decision to Mr and Mrs X and the Council and considered comments received in response.

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What I found

Children’s statutory complaints procedure

7. Section 26(3) of the Children Act (1989) says all functions of the Council under Part 3 of the Act may form the subject of a complaint under the statutory complaints procedure.
8. Complaint investigations under the statutory procedure consist of three stages:
• Stage 1: Staff within the service area complained about try to resolve the complaint. This stage should take up to 10 days (or 20 days for complex cases).
• Stage 2: An Investigating Officer (IO) and an Independent Person (IP) investigate the complaint. The IO writes a report which includes details of findings, conclusions and outcomes against each point of complaint (i.e. “upheld” or “not upheld”) and any recommendations to remedy injustice to the complainant. This stage should take 25 days (or 65 days for complex cases).
9. Once the IO has finished the report, a senior manager should act as adjudicating officer. They will consider the complaints, the IO’s findings, conclusions, and recommendations, as well as any report from the IP, and the complainant’s desired outcomes. The adjudicating officer should write to the complainant with their decision on each complaint.
• Stage 3: A review panel considers the complaint. Following the panel, the members write a report containing a brief summary of the representations and their recommendations for resolution of the issues (The Children Act 1989 Representations Procedure (England) Regulations 2006 19(2)). It should take no longer than 35 days for the panel to issue its report.
10. The Council must send its response to the panel’s recommendations to the complainant within 15 days of receiving the panel’s report. The response should set out how the council will respond to the recommendations and what action it will take. If the council deviates from the panel’s recommendations it should explain its reasoning in the response.
11. Unless there is evidence of fault in the investigation process, the Ombudsman will not usually re-investigate a complaint which has been through the full procedure. This is because a properly conducted investigation is independent and robust.

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Background

12. Mr X and his wife, Mrs X, adopted a child, Y, in 2018. Before this Y lived with a foster carer for just over one year.
13. After adopting Y, Mr and Mrs X raised concerns about Y with the Council. Mr and Mrs X also said they raised concerns about Y during their introduction week with Y. These included concerns about Y being neglected, undernourished, not socialised and having a medical condition which later required surgery. Mr and Mrs X also raised concerns about Y having delayed development.
14. In June 2020, Mr and Mrs X wrote to the Council and asked for financial support with Y’s nursery fees. This was on the basis Mrs and Mrs X and the headteacher of Y’s proposed primary school felt it would be in Y’s best interests to start school the following year. This meant Y would have another year of nursery. The Council responded to Mr and Mrs X in September 2020 and said they could not have financial support. The Council provided no reasons for this decision or any details on how Mr and Mrs X could take this further.

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The Council’s statutory complaints process

15. Mr and Mrs X first complained to the Council in October 2020. They complained the Council refused to provide funding to support them with nursery fees and did not tell them how they could appeal this. They also complained the Council and Y’s previous foster carer neglected Y, before Mr and Mrs X adopted Y.
16. The Council provided its stage one response in December 2020. The Council:
• Apologised for not stating a clear appeals process in its letter refusing finance support.
• Said Y was seen by several different health professionals during the foster care placement and none reported global development delay and reported he was within his expected centiles on health assessments.
• Did not find evidence Y was neglected in foster care. The Council said it considered case notes, care review forms and interviewed relevant social workers.
• Said Mr and Mrs X were made aware of the challenges Y presented with such as biting and hitting and discussed these with medical and social care professionals. The Council said Mr and Mrs X also signed the adoption placement report. This stated they accepted there was no guarantee Y would not have development needs and had discussed Y’s health with consultant and foster carer and were ready to respond to issues that develop with Y.
• Could not find evidence the foster carer fabricated material for the life story work. The Council said the foster carer did attend informal support groups with other foster carers who verified this. Visits from professionals were recorded and raised no concerns about Y.
17. The stage one response recommended the Council included in its adoption funding decision letters information about a clear and transparent appeals process. The stage one response also recommended the Council developed a policy about meeting socialisation needs of a child and shared this with all foster carers.

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Stage two investigation

18. The stage two investigation defined Mr and Mrs X’s complaints as:
• Complaint 1 – Parental views and supporting evidence provided to the Council must be given sufficient weight to ensure Y’s needs are and will continue to be adequately met and to provide assurance that concerns raised have been considered and acted upon.
• Complaint 2 – That parents are provided through the Stage 2 complaints process to challenge “appeal” against the decision not to financially support Y’s nursery placement and to have their voices heard and be listened to as part of this process.

Stage two findings

19. The IO did not uphold complaint 1. The investigation decided there had not been failings by professionals involved in Y’s case which resulted in neglect of Y’s medical and development needs. In relation to the standard of care for Y, the IO found there was no evidence Y was neglected in the care of the Council.
20. The IO did find that the Council should have arranged feedback to Mr and Mrs X when they raised concerns about Y after Y had been placed into their care. The IO report said a professionals meeting should have been held to consider the concerns Mr and Mrs X raised about Y. The Council also should have better recorded the decision not to further investigate the concerns raised by Mr and Mrs X.
21. The IO partially upheld complaint 2. The IO accepted the Council did not explain to Mr and Mrs X its decision not to award finance assistance to them or inform them of an appeals process to challenge this decision. However, the IO found if Mr and Mrs X made the same request for financial assistance, the outcome would remain the same and financial assistance would not be awarded.

Stage two recommendations

22. The stage two investigation made the following recommendations:
• Pay Mr and Mrs X £1,000. £300 for time and trouble in making the complaint. £700 for the anxiety and worry caused to the family for the delays in processing the financial assessment, failure to provide correct appeal information, and delays in acting on the stage one recommendations.
• Financial assessments – Outcome letters sent following the completion of financial assessments should provide clarity, rationale of decision making and an explanation of the criteria the parents have been judged against. In addition, a link to the statutory complaints procedure should be included on the letter.
• Foster Carers Annual Review – The annual review should reflect whether a foster carer has been subject to a complaint. Both the supervising social workers report and the independent chairs report should reflect parents’ concerns and how these concerns were acted upon by the Council.
• Adoption procedures – The Council should carry out a full review and update of adoptions procedures to reflect the new business processes after the introduction of the Regional Adoption Agency.
• Procedural requirements – The Foster carer annual review meeting in 2021 must reflect the concerns Mr and Mrs X’s raised during the summer of 2018. The chairs report needs to evidence action taken by the Council to address these concerns and any training needs for staff involved in Y’s care.

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Stage three review

23. Mr and Mrs X remained dissatisfied with the stage two investigation and brought the complaint to a stage three panel. The panel considered the complaint on 13 December 2021.
24. For complaint 1, the panel changed the finding from not upheld to upheld. The panel found it could not evidence the Council had properly considered and acted on the concerns Mr and Mrs X raised after they adopted Y. The panel also found some contradictions with the stage two investigation. Namely that it said it would not consider the standard of care Y received in foster care but then went on to consider this and make a finding.
25. The panel also changed the findings of complaint two from partially upheld to upheld. This was because Mr and Mrs X had not been asked to provide confirmation on how they arrived at the figure for Y’s nursery costs.
26. The panel made the following recommendations:
1. The Council offer an apology for not adhering to the timescales set out in the Stage one and Stage two processes.
2. The Council should consider offering Mr and Mrs X a meeting with a senior manager to explore a way forward with the aim of reaching a resolution on the issue of the alleged lack of care of Y whilst in foster care.
3. The Council, having had regard to all the information submitted by Mr and Mrs X and the IO and the IP, should consider reviewing their decision in relation to the request for financial assistance.
4. The guidance to Investigating Officers should be revised to advise that the key points of complaint raised at Stage one should form the basis of the Stage two Statement of Complaint which should be quality assured and checked with the Complaints Manager.
27. Following the panel meeting, the Council wrote to Mr and Mrs X. The Council agreed to carry out recommendations 1, 3 and 4, but did not consider recommendation 2 was necessary as it could prolong the complaint and Mr and Mrs X wanted to complain to the Ombudsman.

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Findings

Consideration of Mr X’s complaints

28. It is not our role to reinvestigate matters which have already been subject to a properly conducted and independent investigation. To do so would not be a good use of public resources. Instead, our role is to consider the following:
• was the investigation properly conducted and are the conclusions evidence based. If not, would the Ombudsman reach a different view based on the information available to us?
• did the Council offer a proportionate remedy for the injustice caused by fault? If not, would the Ombudsman recommend any further remedial action?
• has the Council fully implemented any agreed remedy? If not, has the delay caused any further injustice to the complainant?
29. I am satisfied the stage two investigation and stage three panel review were properly carried out. The IO reviewed the appropriate information and interviewed the relevant officers as well as discussed the complaint with Mr and Mrs X. While the stage three review panel changed the findings of the stage two investigation, and found some contradictions, I do not consider this made the complaints process flawed. The recommendations made during the complaints process were appropriate.
30. I acknowledge the Council decided not to carry out recommendation 2 of the panel review. The reasoning for this was it did not want to prolong the complaint as Mr and Mrs X were going to approach the Ombudsman and we may have decided the complaint had not reached the end of the complaint procedure. This was not a valid reason to refuse to carry out this recommendation. The complaints procedure had clearly ended as evidenced by the stage three panel response.
31. It would have been right for the Council to have offered Mr and Mrs X a meeting with a senior manager. This would have allowed the Council to consider all of Mr and Mrs X’s outstanding concerns about the care Y received in foster care. This was a missed opportunity to resolve this issue with Mr and Mrs X.
32. The Council has also not considered or remedied the injustice caused to Mr and Mrs X for the missed opportunities to consider the concerns they raised after they adopted Y. Had the Council properly looked into these concerns it may well have been able to avoid Mr and Mrs X making a complaint. As a result, I have made recommendations to address this.

Time taken to complete the complaints process

33. The stage three panel recognised the Council took too long to complete stage one and stage two of the complaints process. The Council has apologised for this delay.

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Agreed action

34. Within one month of my final decision, the Council agreed to carry out the following:
1. Pay Mr and Mrs X £500 to reflect the missed opportunity to consider and act upon the concerns Mr and Mrs X raised about Y after Y was placed with them.
2. Arrange a meeting with Mr and Mrs X and a senior manager in line with the stage three panel’s recommendation.
3. Provide evidence to the Ombudsman the Council has carried out the recommendations made at stages two and three of the complaints process.
35. The Council should provide us with evidence it has complied with the above actions.

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Final decision

36. I have completed my investigation and found the Council was at fault which caused injustice. The Council has agreed to the above actions to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman