Service improvements

Swindon Borough Council

Showing service improvements between 1 April 2021 and 31 March 2026

Find out more about service improvements

When we find fault, we can recommend improvements to systems and processes where they haven’t worked properly, so that others do not suffer from these same problems in future. Common examples are policy changes; procedural reviews; and staff training. Service improvements from decisions are published for 5 years and those from reports are published for 10 years.

Showing 1 - 5 of 5 cases with service improvements

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Downloads the current filtered list of service improvement decisions for Swindon Borough Council as a CSV file.

  • Swindon Borough Council (24 014 388)

    Category: Adult care services Date: 26-Nov-2025

    Summary

    Mrs X complained about the Council’s handling of her late mother’s care. We found fault because the Council was too slow to begin assessment and planning processes, too slow to share care cost information and did not always follow up on actions or effectively communicate with Mrs X. This caused her avoidable distress, frustration and uncertainty. To remedy this injustice, the Council has agreed to apologise and make a symbolic payment to her.

    Service improvements

    The Council will provide us evidence of its improved financial procedures related to Care Act financial assessments and sharing of information about care home costs. These process changes will help to ensure financial assessments are started in a timely manner and that those paying their own care home fees are aware of the costs at the earliest opportunity.

  • Swindon Borough Council (23 019 908)

    Category: Adult care services Date: 14-Nov-2024

    Summary

    Mr X complained about how the Council handled Mrs Y’s care and the family’s requests for a residential placement. He also complained about the Council’s safeguarding actions after Mrs Y suffered injuries following a medical emergency. Mr X said this distressed Mrs Y and her family. There was fault in the way the Council did not complete appropriate assessments, delayed completing the safeguarding investigation and did not follow its complaint process. Mr X and Mrs Y were caused uncertainty and distressed by the fault identified. The Council should apologise, make a financial payment and provide guidance to its staff.

    Service improvements

    •Remind relevant staff of the importance of effective complaint handling.•Remind relevant staff of the Council duties under the Care Act 2014 relating to assessments and safeguarding concerns.•Remind relevant staff of the Council duties under the Mental Capacity Act 2005.

  • Swindon Borough Council (20 011 171)

    Category: Adult care services Date: 18-Aug-2021

    Summary

    Mrs B complained about information an NHS Trust provided to the Council’s commissioned care home provider when her late father was discharged from hospital in December 2019. She complains a Surgery prescribed antibiotics but failed to send the prescription to the pharmacy. She also said the Home delayed in following up on the medication her father needed, and this contributed to his untimely death. We found the Trust at fault for poor record keeping when it dealt with the discharge, but it improved. Faults in the way the Surgery made an electronic request for medication and the Home’s failure to take follow up action caused delay in the medication being received. The Surgery and the Home also missed an opportunity to report the incident to the Council so it could consider its safeguarding procedures. The authorities have agreed to our recommendations and the Council will monitor the Home to ensure it improves the way it records discharge information and it will provide safeguarding training if necessary. The Surgery will remind its staff of the importance of reporting safeguarding concerns to the Council when dealing with incidents relating to patient safety. The Home and the Surgery will apologise to Mrs B for the missed opportunity which contributed to doubt she has about the events which occurred.

    Service improvements

    The Council will monitor the Home toensure it improves the way it records discharge information and it will providesafeguarding training if necessary.

  • Swindon Borough Council (20 000 973)

    Category: Adult care services Date: 19-Aug-2021

    Summary

    Mrs C complains about the Council’s management of her late father’s care home charges. There was delay in providing a full statement of account, and a failure to take action in respect of Mr B’s pension. The Council has agreed to the Ombudsman’s recommendation that it reimburse the £218.00 probate charges, in addition to the £262.07 it has already agreed to write off. It has also put in place measures to improve its management of client accounts.

    Service improvements

    The Council has put in place additional checks to review all debts with the officers managing cases, upon the receipt of Deputyship Orders; and will undertake regular meetings to review the debts owed by service users with the team as a whole.

  • Swindon Borough Council (19 016 113)

    Category: Adult care services Date: 24-Oct-2021

    Summary

    Mrs D complains about her father-in-law, Mr E’s discharge planning by the Council and subsequent care in a nursing home and a hospital. We found fault with some aspects of Mr E’s care and have made recommendations to the Council and Home to improve their services. We did not find fault with the Hospital.

    Service improvements

    Due to the systemic failings in Deprivation of Liberty Safeguarding assessment we recommended the Council produce an action plan to address the delays in carrying out the assessments with details about how these changes will be audited and monitored.

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