London Borough of Tower Hamlets (19 012 853)

Category : Education > Special educational needs

Decision : Upheld

Decision date : 07 Dec 2020

The Ombudsman's final decision:

Summary: Mrs X complains the Council failed to plan properly for her disabled daughter, Miss T. She says this meant Miss T was unable to move into her university accommodation on time, delaying her transition towards independent living. The Council did not effectively coordinate planning for Miss T’s care, which caused her and Mrs X an injustice. The lack of planning caused avoidable distress. Mrs X also complains Council officers dismissed Miss T’s needs at a meeting attended to address the assistance she required. We consider that on balance, the Council should have been more sensitive to Miss T’s needs at the meeting, which would have been possible with better planning. We have made recommendations to acknowledge the distress caused and suggested service improvements to help avoid such issues arising in the future. The Council has agreed to our recommendations.

The complaint

  1. Mrs X complains the Council’s approach to helping her disabled daughter prepare for university was poor. She says that when she and Miss T attended a meeting to discuss future care arrangements it was clear officers had already decided to limit the care package available to Miss T, without properly considering her needs. Both Miss T and Mrs X were distressed by statements they say Council officers made at the meeting. As a result, Mrs X says Miss T considered not attending university. In any event, she says that because of a failure to acknowledge and plan to meet Miss T’s needs in a timely manner, Miss T was unable to begin living at her university accommodation for almost a full term.

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The Ombudsman’s role and powers

  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)
  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. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.

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How I considered this complaint

  1. I spoke with Mrs X and read the complaint file.
  2. I researched the relevant law and guidance.
  3. Mrs X, Miss T and the Council were given the opportunity to make comments on the draft decision. Neither party asked for amendments to be made.

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What I found

Relevant law

  1. The Equality Act 2010 sets out the legal obligations local authorities and others have towards disabled children and young people: They must make reasonable adjustments, including the provision of auxiliary aids and services, to ensure they are not at a substantial disadvantage compared with their peers. This duty is anticipatory – it requires thought to be given in advance to what might be required and what adjustments might need to be made to prevent any disadvantage. (Special educational needs and disability code of practice: 0 to 25 years, January 2015, (“The Guidance), page 16)
  2. The Guidance says councils should support young people with high aspirations to realise their ambitions in relation to higher education and independent living, enabling people to have choice and control over their lives and the support they receive, their accommodation and living arrangements. (The Guidance, 1.39)
  3. Local authorities must carry out a transition assessment of anyone when there is significant benefit to the young person or carer in doing so, and if they are likely to have needs for care or support after turning 18. The provisions in the Care Act relating to transition to adult care and support are not only for those who are already receiving children’s services, but for anyone who is likely to have needs for adult care and support after turning 18. (Care and Support Act Statutory Guidance, para 18.8)
  4. That a young person is ‘likely to have needs’ means they have any likely appearance of any need for care and support as an adult. (Care and Support Act Statutory Guidance, para 18.9)
  5. The onus is on the local authority to contact the young person or carer to agree the timing of the transition assessment, rather than leaving the young person or carer in uncertainty or having to make repeated requests for an assessment. (Care and Support Act Statutory Guidance, para 16.5))
  6. An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Local authorities should inform the individual of an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process.” (Care and Support Act Statutory Guidance, para 6.29)
  7. The Care Act 2014 says that councils and their partners should work together to ensure effective and well supported transition arrangements are in place; that assessment and review processes for care plans are aligned and that there is effective integration with health services. Young people and their families should not be expected to repeatedly provide duplicate information to different services, or to attend numerous reviews, or receive support that is not co-ordinated and joined up. (The Guidance, 3.56)
  8. Councils should plan a smooth transition to higher education before ceasing to maintain a young person’s EHC plan. Once the young person’s place has been confirmed at a higher education institution, the local authority must pass a copy of their EHC plan to the relevant person in that institution at the earliest opportunity, where they are asked to do so by the young person. (The Guidance, 8.46)
  9. For the most part, transition to adult services for those with EHC plans should begin at an appropriate annual review and in many cases should be a staged process over several months or years. (The Guidance, 8.65)
  10. Poorly timed and planned transition to adult services will have a detrimental effect on achievement of outcomes and may result in young people requiring far longer to complete their education or leaving education altogether. This can have a negative impact on their health and care needs and it is essential that the transition between children’s and adult’s services is managed and planned carefully. (The Guidance, 10.23)

Background

  1. I have not recorded everything that has happened but only those facts I consider are relevant to my investigation.
  2. Miss T is 19. She has cerebral palsy affecting all four limbs. This means she needs to use a wheelchair and has complex needs. Mrs X has always been her full-time carer. Miss T requires help with all daily living activities.
  3. Miss T’s 2017 Education, Health and Care plan (“EHC plan”) set out that Miss T had no social care needs relating to safeguarding. But she would need to access services from Social Care in relation to her disability, to promote independence. It said that any mentoring or access to assistive technology would be provided by the Children with Disabilities (CWD) or Adults with Disabilities team.

The referral

  1. In November 2018 Mrs X called the Council’s CWD team. She requested a Care Act Assessment for Miss T, explaining that Miss T was thinking of attending university the following year and may be going away from home.
  2. The records show the CWD team forwarded the referral to the Adult Social Care team. The records show the Adult Social Care team questioned this referral as Miss T was still 17.
  3. A social worker contacted Mrs X. The records show Mrs X was upset and complained that the CWD team had dismissed her request for an assessment. She said she had been told she would have to wait until the following year, when Miss T was 18.
  4. Her concerns were reported to the CWD team. Mrs X was told a manager would call her back. I have not seen any records to show this happened.
  5. Five days later Mrs X called the Council again. She again requested an assessment for Miss T. The records show a note was made saying: “Made referral to adult services but apparently adult services are saying this needs to be dealt with by children’s services.”
  6. I have not seen any records showing Mrs X’s request was actioned further.
  7. In the meantime, on 12 December 2018, the Council completed Miss T’s annual review form for her EHC plan. Under the heading, ‘What is important to the child or young person’, it stated:
  • Securing a place on a university degree course of her choice.
  • Preparing to study away from home next academic year and ensuring that everything is in place to ensure this change can happen smoothly.
  1. The review stated that Miss T would need to be assessed by Adult Social Care as soon as possible to get a package of support ready to help her live independently at university. It said this would be done by the end of February 2019.
  2. It also said an occupational therapy assessment, to provide advice to transition to university regarding equipment etc, would be completed by the end of February 2019.
  3. At the end of January 2019, after Miss T turned 18, a CWD social worker sent a referral form to the Adult Social Care team, alerting the team to Miss T’s request for an assessment.
  4. This appears to have been picked up a week later. It was noted that the case had been passed for an assessment so that Miss T could have a package of care at university.
  5. Over a month later the case notes show it was considered a social worker would need to liaise with the CWD team to handover.
  6. On 19 March 2019 a social worker called Mrs X. Mrs X said an assessment was needed within the next two weeks as Miss T was beginning to apply for university places and it was necessary to know what Miss T would need in terms of support. The social worker said she would try and arrange an assessment for the following week.
  7. On 28 March 2019, the case notes recorded Miss T’s case as a ‘transition case’ and allocated a social worker to complete an assessment.
  8. Two weeks later a social worker, SW1, contacted the CWD team. She was told that Miss T was not known to the CWD team.
  9. SW1 contacted Mrs X, who told her, on 11 April 2019, that Miss T would be going to University P in September 2019. She confirmed that Miss T wanted to live on campus. A meeting was arranged to discuss Miss T’s needs on 24 April 2019.
  10. At the meeting Miss T stressed that she would like to live on campus and to get the same experience as her peers. Mrs X said Miss T would need help with her personal care and cleaning because of her disability.
  11. The case notes show the case was discussed by Council officers on 9 May 2019. They observed that University P had confirmed accommodation was available that was wheelchair friendly. It was noted that Miss T was anxious at night-time and required assistance.
  12. On 25 May 2019 a Council occupational therapist, OT1, was contacted. She advised that the university would have to assess Miss T when she moved into the accommodation.
  13. On 3 June 2019 another officer appeared to disagree with this view. She said that, “…assessing [Miss T] in her home dwelling (her halls of residence) being a social care issue not an educational one.” She provided the Council with a contact number for the Disability and Dyslexia Service at University P.
  14. Shortly afterwards, officers considered and then decided against providing reablement support for Miss T before she started at University P. It had been initially suggested that it would be useful for Miss T to determine the level of support she would need. It was then decided it would be better to work with the occupational therapist to ascertain what level of support Miss T would need.
  15. On 17 June 2019 one of the social workers involved with the case noted that, “…it was very unclear how much support [Miss T] will require when she goes to university and leaves home for the first time.”
  16. On 20 June 2019 SW1 pressed OT1 for advice on care package support. She also asked for more information on the type of equipment that Miss T would need at University P.
  17. On 28 June 2019, Mrs X wrote to the Council. She stressed that University P had said social care should not depend on their support as it is completely separate and provides completely different services to Miss T.
  18. On 1 July 2019 the case notes recorded:

“…there is some confusion over who is responsible for what aspect of the assessment and planning to marry with what the university is able to offer as a disabled student.”

  1. It was stressed that, “A coordinated approach needs to happen quickly to ensure that all support and provisions are in place prior to [Miss T] starting University.”
  2. A social worker, SW2, contacted Mrs X shortly afterwards to obtain a contact number for University P.
  3. The Council has shown me a Care Assessment that it appears to have written for Miss T on 5 July 2020. It notes that Mrs X said Miss T needed 24-hour care due to her physical needs as well as her mental health needs.
  4. Miss T’s independent living advisor contacted the Council shortly afterwards to ask if the care and support plan was to incorporate Miss T’s need to have support during the night, seven nights a week.
  5. A meeting was arranged between Mrs X, Miss T, the key social workers involved and a university disabilities advisor. The meeting was held at the university on 22 August 2019.

The meeting

  1. Mrs X said she and Miss T found officers at the meeting were “…uncompassionate and thoughtless”, to the extent that Miss T reconsidered attending university. She says that after the meeting Miss T had to have an emergency meeting with her psychologist and see her GP.
  2. Below, I shall summarise their recollection of key parts of the meeting. I shall also set out the Council’s response to the allegations and what is recorded in Council case notes in italics.
  • The suggestion of seeing Miss T’s accommodation ‘was deemed by [officers] to be ‘previous’.

When officers visited the room, they found it was unsuitable for Miss T. Housing services said they had another room available, which they would update on the following week.

  • A senior practitioner started the meeting by saying that Miss T would not receive the care she required to experience university life to its fullest.

The records show that Mrs X was told that Adult Social Care had not authorized night time support and that this would still need to be reviewed. In the Council’s complaint response to Mrs X it said that there must have been a misunderstanding as the Council had not completed its needs assessment at that stage.

  • The Council suggested Miss T use incontinence pads rather than receive support to use the toilet.

The records show officers suggested Miss T could use incontinence pads. It was reported that Miss T said she was not incontinent, and this would impact on her personal dignity. In complaint correspondence the Council said this suggestion was made “…to reduce the need for formal resources in view of the need to provide cost effective solutions to meet eligible social care needs.”

  • Information provided by Mrs X about turning Miss T during the night was ignored.

It was reported that Mrs X said that equipment provided to avoid Mrs X having to turn Miss T during the night did not work. The Council said it was not clear why and an assessment was needed to determine this.

  • The team had not read any of the information Mrs X had provided about Miss T before the meeting.

In its complaint correspondence, the Council said staff did not have detailed information relating to Miss T’s functional abilities as the assessment was still ongoing. It said not all the medical reports were available to the authority at that stage.

Shortly after the meeting, on the same day, Council officers contacted Miss T’s medical professionals to learn more about her mental health issues and other health issues.

  • It was suggested that Miss T should use medication to ease her anxiety. She was also told she could phone someone to ease her anxiety during the night, even though Miss T is unable to do so because of her disability.

The Council said medication was suggested because during the meeting Mrs X described Miss T’s difficulties and it was thought that maybe the therapy she was receiving was insufficient to manage her anxiety.

  • Social workers explained they had tried to access a care home for Miss T.

The Council said this discussion was in relation to supported living accommodation.

  • The senior social worker sought to make comparison between the difficulties Miss T experienced because of her disabilities and her own experiences of originating from a little town in Spain with little money.

The Council said this was a misunderstanding as the officer understood that Mrs X was asking her about her own experiences at university. She was not seeking to make any comparison.

  1. Mrs X and Miss T say they left the meeting feeling the Council had made its mind up not to provide 24-hour care. The Council records say that they were told the Council would be in contact once the case had been discussed with their legal team and they had explored the matter with other healthcare professionals. In response to my enquiries, it apologised if Mrs X and Miss T felt any distress during the meeting and says this was not the intention of staff.
  2. In complaint correspondence the Council responded that it had not made a decision about Miss T’s care at that stage. It says that while it appreciated that Miss T suffered from anxiety, panic attacks and leg cramps at night, it was important to understand the severity, frequency and impact on her in order to conclude an assessment of her need.
  3. After this point, the Council continued its enquiries with medical professionals to ascertain precisely what Miss T’s needs were. Mrs X started to become very anxious as time was running out before Miss T would be due to start university.
  4. The Council asked her to sign a consent form to enable the Continuing Healthcare (CHC) team to assess how Miss T’s healthcare could be supported. Upon receiving the consent form and the checklist completed by Mrs X, the social worker said that a full CHC assessment had been triggered. She coordinated with the CHC team saying that an assessment was required urgently as Miss T was due to be starting university in three weeks.
  5. On 27 August 2019 Mrs X asked the Council if there was any clarity over what hours of care would be provided per day. She was trying to source care cover and said she could not advertise for care that she did not know would be provided.
  6. The Council was not able to provide clarity at that point. It asked Mrs X to answer some questions about what University P would be able to provide by way of support.
  7. Mrs X was confused as to why the Council needed extra medical reports. She felt she had already provided enough information. The Council responded that a CHC assessment was now needed to assess the support that Miss T required at night due to pain, repositioning issues and health anxiety.
  8. On 29 August 2019, as requested Mrs X provided the Council with a list of Miss T’s daily requirements.
  9. On 12 September 2019, four days before her start date at University P, social workers and Mrs X and Miss P visited her proposed accommodation. The equipment was not ready at that stage.
  10. There were a number of other problems before Miss T could move into her accommodation.
  11. Upon receipt of all the relevant medical records, Miss T’s comprehensive care-package was approved in mid-October 2019.
  12. Her care plan was not fully authorised until 8 November 2019. Mrs X says that because she could not advertise for the full package of care that was required until that date, Miss T was not able to move into her accommodation until early December 2019.
  13. Mrs X says she used an interim package of care that had been approved to support Miss T to attend university lectures. She also attended university with Miss T on occasion so that Miss T did not miss out. She feels it was regretful that Miss T was not able to begin her course in her accommodation like her peers.
  14. Mrs X also put off returning to work herself. She is now in full time employment and has also begun to study herself.
  15. Mrs X was concerned that she had to struggle to obtain the care Miss T needed. She was concerned that others should not have to go through the distress she says that she and her family endured throughout the process.

Council’s response to the complaint

  1. The Council says that it began the initial Care Act Assessment in April 2019. It says that both its early assessments of Miss T were at her home. It says that it was not until meeting Miss T at the university that the social worker and occupational therapist could assess how and what her new environment would look like as well as the barriers, type and level of support she would need in her new residence.
  2. It says that even though it was aware Miss T had a university place in May 2019, it did not have the information it needed about the type of room she would have and the equipment needed until the meeting of 22 August 2019. It says delay was also caused because the university was closed between June and August 2019. It says the social worker and occupational therapist could only arrange meetings around the university’s availability to attend meetings.
  3. It also says it was explained to Miss T that she could start university anyway because she lived locally and could participate in social events outside of formal opportunities.

Analysis

  1. In Miss T’s annual review in December 2018 she expressed what was important to her. It was to prepare to go to university. She wanted to ensure that everything was in place so that this could happen smoothly. This did not happen, and I consider the Council is at fault.
  2. The Council’s action plan was to ensure that what was important to Miss T was actioned by February 2019. Sometimes it is not always possible to make things happen as and when a person might like and there might be understandable reasons for delay. But I have not seen evidence that indicates this is the case. The Council’s fault caused Miss T an injustice in that she was not able to move into her university accommodation at the same time as her peers, something that had been important to her and something that I consider it likely could have been achieved, but for the Council’s approach to her case.

The initial referral

  1. The Council took from 23 November 2018 to 23 April 2019 to begin Miss T’s Care Act Assessment. Her request for an assessment was passed back and forward between the CWD team and Adult Social Care team before it was actioned. Both teams questioned whether they were the appropriate team to consider Miss T's assessment, with the CWD team eventually saying that Miss T was ‘not known’ to it. This was not the case as Mrs X had initially asked the CWD team for help. Miss T should have been known to the Council beforehand in any event as her EHC plan shows it was responsible for any mentoring or access to assistive technology. But even if it did not provide a care package to Miss T, she requested help from the team in November 2018. She became known to the team at that point.
  2. The Care Act is clear that Miss T did not have to be in receipt of a care package from children’s services to be considered for transition to adult services. Her case should have been approached in a similar way to other transition cases.
  3. Her transition should have been handled in good time and effective planning should have been in place to achieve her aims. However, contrary to Care Act Guidance Mrs X had to chase up her requests for an assessment. This is fault.
  4. The Adult Social Care team questioned whether it was to early to assess Miss T as she was not 18 yet. The Care Act Statutory Guidance sets out an example of when it might be appropriate to assess a young person with complex needs who wants to move out of home and will require living support. In the example it provides, it was considered that a lengthy transition, in order to get used to a new environment and new educational setting, was necessary. The young person in the example was 15 and expected to move out of home when she was 18-19. It was considered that transition planning should start when she was 16. The Guidance states:

“…if a transition assessment were to take place later, the local authority would be at risk of not promoting wellbeing in the areas of family relationships (because [the young person] could temporarily need to live with her parents while solutions are found at the last minute, which would not be appropriate) and control over day-to-day life (because [the young person] would very likely not have the same range of choices if planning and preparation were to be truncated).”

  1. While every case is different, this example should have provided some guidance for the Council when approaching Miss T’s case. Miss T has complex needs. Her EHC plan and Annual Review stress how important it was for her to make her own way in the world. The Council was at fault for not helping her plan at an earlier stage and for not acting quicker when Mrs X made the initial referral.
  2. In my view the lack of coordination between teams and the evident lack of understanding about the materially important role that timely planning had to play to ensure Miss T and her family’s wellbeing, had unintended but distressing consequences for Miss T and her family. I will summarise these below after addressing other aspects of the complaint.

The Assessment

  1. I do not accept that the Council was unable to effectively assess Miss T’s care needs until the meeting at University P in August 2019. The records show that Miss T’s room was not available at that stage and so I do not see why the Council waited for the catalyst of this meeting before making necessary enquiries into Miss T’s care and support needs. This should have been done at an earlier stage. The Council was aware from at least May 2019 that Miss T required support at night because of anxiety.
  2. It is the case that some equipment was not ready for Miss T in September 2019 and this delayed her starting date. But the real problem was that the Council did not fully understand the extent of Miss T’s needs to enable it to put together a comprehensive care package in time for her start date. It should have done. Because of its delay in putting together her care package Mrs X could not advertise for the care that was necessary to support Miss T. She could not move into her accommodation until early December 2019, meaning she missed almost a full term in her accommodation at the beginning of her course.
  3. The Council was aware Miss T had complex needs. It should have anticipated that any assessment would need to start as soon as possible to make sure everything was in place, not just in terms of equipment but in terms of meeting her other health needs. But it failed to make the necessary enquiries into her healthcare requirements until after the meeting in August 2019. It was because it had done such little preparation by the time of this meeting that officers “…did not have detailed information relating to Miss T’s functional abilities.”
  4. There also appears to have been a concerning lack of coordination between the officers involved in the assessment. There is little evidence of a coordinated approach in this case. The records show that as late as June 2019 there was concern about how best to support Miss T. In July 2019 it was apparent that a “…coordinated approach needs to happen quickly.” This should have been the case from the start.
  5. As set out above, the guidance is clear that planning should not have been left to the last minute. In this case, as late as the end of August 2019, the Council asked Mrs X for a list of Miss T's needs. She was asked to provide information about what the university could provide. This was not her role. She was asked for a contact number for the university, even though the social worker in the case had been provided with the relevant number for the university in early June 2019. The records appear to show the Council made a desperate dash to provide a comprehensive package for Miss T. But this work should have been completed at a much earlier stage. This is fault.

The 22 August 2019 meeting

  1. I cannot make findings on a lot of what was said at the meeting that Mrs X and Miss T say they found particularly upsetting. It could be the case there were some misunderstandings. I was not there.
  2. But it is concerning that three weeks from Miss T’s starting date at university, officers knew so little about her abilities and presented such little understanding about how important it was to her to be independent. She was upset that officers suggested she use incontinence pads. I consider that, on balance, if officers had compiled more information about Miss T’s needs and aspirations by this point, they would have been aware that as she was not incontinent, she would not want to consider this option.
  3. Basic enquiries about her mental health would, I find likely, have meant that medication was not suggested as an option to relieve the need for support during the night.
  4. I find that the core issue at the heart of this complaint, a lack of planning, led to Council officers having an insensitive approach to a meeting that understandably unsettled Miss T. This is fault causing injustice.
  5. However, after the meeting, the Council made the necessary enquiries and ultimately, Miss T was provided with a supportive care package. Therefore, while I have made a recommendation to acknowledge the avoidable distress caused by the approach taken at this meeting, I consider the injustice was limited.

Conclusions

  1. The Council failed to plan effectively for Miss T’s transition to university. This caused Miss T and Mrs X an injustice. Mrs X had to struggle to access the assessment Miss T was entitled to. She was also forced to advertise twice for carers for Miss T and had to delay going back to work herself while she and her husband provided support to Miss T in her first term of university.
  2. During the assessment process the records show there was some confusion about what should be assessed and by whom. Three weeks before Miss T was to start university, officers had little understanding of her basic care needs and had to make last minute enquiries of the relevant medical professionals. Miss T felt unsupported and worried by the Council’s approach. It was very important to her start university alongside her peers and to go through the experience that other students go through, establishing early bonds and becoming more independent. This was always going to be a challenging time for Miss T but it is likely that it would have been much easier if planning had started at an earlier stage. The guidance warns that poor planning can have a detrimental effect on young people aspiring to transition. I find that the Council’s approach caused Miss T avoidable distress.
  3. Mrs X had supported Miss T for almost 18 years. When she asked for help from the Council, she found its approach was initially frustrating and then unsupportive. It is understandable that this was her impression.
  4. Miss T is now doing well at university and Mrs X says the Council has provided a good package of care.
  5. I have made recommendations aimed at reducing the risk of others having to undergo similar difficulties.

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Recommended/agreed action

  1. Within one month of our final decision, the Council should:
      1. Apologise to Miss T and to Mrs X for the faults identified in this decision.
      2. Pay Mrs X the sum of £500 to acknowledge the distress occasioned by the Council’s poor approach to her request for an assessment for Miss T.
      3. Pay Miss T the sum of £200 to acknowledge the distress caused by the Council’s approach at the 22 August 2019 meeting.
      4. Pay Miss T the sum of £1000 to acknowledge its failure to ensure it effectively planned her transition to living in university accommodation alongside her peers in time to start her course.
  2. Within two months of our final decision, the Council should:
      1. Complete a review of what happened in this case. The Council should address any learning points and provide a copy of the review to the Ombudsman and to Mrs X and Miss T.
      2. Provide training to the occupational health, CWD and Adult Social Care teams regarding transition between teams and effective coordinated planning for those with complex needs.
  3. The Council should provide evidence it has completed all of the above to the Ombudsman.

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Final decision

  1. I have found the Council at fault and made recommendations, which it has accepted, to remedy the injustice caused. I have now completed my investigation.

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Investigator's decision on behalf of the Ombudsman

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