Why have you sent this complaint to me as the registered care provider?

The Local Government and Social Care Ombudsman (LGSCO) has powers to investigate complaints made by people who self-fund their care or have arranged it themselves. This means they are in a direct contractual arrangement with you as their care provider.

If instead their adult social care provision has been commissioned and paid for by a council’s social services department their complaint is against the council. Please tell us if you think that is the position. The LGSCO has always dealt with complaints against councils.

If you are not the registered care provider for the service in question, or your contract for provision of this service is not with the service user, please let us know immediately.

Why has this complaint gone to the Ombudsman now?

The law says that, before investigating a complaint, we must be sure that the care provider knows about the complaint and has had a reasonable opportunity to investigate and reply to it. Otherwise, a complaint to us is premature (see Information sheet No.1).

We can decide to waive this requirement and take on a case for investigation earlier. If we do this, we will always explain why to all concerned.

Does every complainant have a right to have their complaint investigated by the LGSCO?

No. We decide which cases we will investigate, based on our jurisdiction, how old the matter is, and the initial facts highlighted in the case. We must be satisfied that there appears to be a potential significant injustice for the service user or complainant which links to the alleged shortcomings in what the provider has done.

This complaint is about our plan to change someone’s service provision in the next few weeks. Can the LGSCO stop that happening?

We can’t stop you from going ahead with your plans but we may ask you whether you can preserve current arrangements while we investigate the complaint. If our investigation finds the change is unjustified, continuing with the plan may increase the injustice to the service user or complainant, and affect any eventual remedy that is needed.

Who investigates the complaint?

We have trained investigators to deal with the cases. All have delegated powers from the Ombudsman to investigate and make decisions.

The investigator will establish what the complaint is about. They will gather relevant evidence from you and the person complaining. The investigator will carefully consider what has happened with reference to relevant legislation and guidance including our guidance on good administrative practice, your own contract commitments and policies, and other relevant information.

How do you gather the evidence?

We usually ask for information by email, and we ask for your response in four weeks. You should let us know promptly if that date can’t be met. You will have the investigator’s name and contact details so you can discuss any difficulties in providing what we require. Most providers are happy to co-operate, but we have the powers of the High Court to obtain evidence if needed. Investigators may interview the people involved, either in person but most likely over the telephone.

If some evidence you provide is confidential and cannot be shared with others, please tell us.

Once the investigator is satisfied that they have enough evidence to reach a reliable conclusion they will set out their draft decision and invite the parties to comment. The investigator will carefully consider all comments and make any changes they decide are necessary before issuing a final decision.

How does the LGSCO make decisions?

LGSCO decisions are set out in a Statement. The complainant’s identity is anonymised. This is first released to the parties concerned as a draft decision, and your comments are invited. The Statement will address the following questions:

• Was there fault or service failure?
• Did that cause the injustice claimed?
• If so, what should your organisation do to remedy that injustice?
• What can be learned from this case to prevent recurrence of fault and benefit others?

The draft decision can be changed if you, or the complainant, have new information or further arguments about the complaint that we decide should lead to a different conclusion.

The final Statement will close the case and we issue it to the complainant and the care provider. It will set out the grounds for the decision and the LGSCO’s recommendations for service improvement and remedy – if required. The LGSCO publishes most decisions on their website.

What do we have to do next?

If the case is not upheld, and you are not, therefore, called upon to provide a remedy, it is still worth considering whether you had good enough arrangements to deal with the complaint yourself.

In most justified cases we will make recommendations to put matters right and provide a suitable remedy for injustice, and a timetable for doing so. We publish guidance on remedies and make recommendations that are proportionate to our findings of injustice.

We will check you have carried out the recommendations in the timescale we asked.

Where we find that a care provider’s actions have caused injustice, we share our decision with the Care Quality Commission. They use our findings to inform targeted inspection activity.

We also publish almost all our decisions on our website (www.lgo.org.uk/decisions).

How long does it take the Ombudsman to investigate a complaint?

We aim to complete the investigation of 75% of complaints made to us within 13 weeks and 85% within 26 weeks. But complex social care complaints are among those that take us longer to investigate.

What if you refuse to carry out our recommendations?

In almost all (over 99%) of cases, organisations agree to carry out our recommendations. Many care providers comment that our independent, authoritative findings help them improve the way they work. Complaints can be an excellent insight into opportunities for improved practice.  

In rare cases care providers refuse or otherwise fail to do what we ask, or we decide they have not fully complied with our recommendations. If that happens, we can ask the provider to publish an ‘Adverse Findings Notice’ in the local press. We can, if necessary, publish the notice ourselves and recover costs.

If the complainant is still unhappy – what happens next?

Complainants can ask for a case review if they feel their case was not properly considered. As the LGSCO is a public body, we can be subject of a Judicial Review if the complainant or   service provider considers our final decision is legally unsound.

I am using this complaint to review how good our current complaints procedures are. What should I think about? Do you have a model procedure I can copy?

CQC Regulations for Service Providers and Managers, Regulation 16 sets out the expectations. We will look to that as a benchmark when deciding how effective your arrangements have proved to be. Useful information for providers on handling complaints can be found on the ‘Resources for care providers’ section on the LGSCO website.

We also know that, however good procedures are in theory, what matters most to people is the commitment providers show to implementing them, by listening to complaints openly, investigating issues thoroughly and resolving justified complaints as soon as possible.

When revising your complaints procedures or telling people about the LGSCO in your closing letters, you may find the insert below helpful. We aim to provide a seamless service to complainants, who may not always be clear whether they should go to the council that did their care needs assessment, or to the provider. We will redirect any cases if necessary.

Insert for use by adult social care providers in complaints documentation