Adult social care compliments and complaints annual report

1. Purpose of report

The purpose of the annual report is to review the operation of the complaints procedure over a twelve month period and to provide information about complaints themes, the compliments received and actions being taken to improve the quality of social care services.

This report provides information about compliments and complaints received during the twelve months between 1 April 2022 and 31 March 2023.

2. Background

Local authorities and the National Health Service are legally required to establish complaints procedures to deal with complaints about their health and social care functions.

The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 applies to Adult Social Care. Similarly the NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012 applies to Public Health functions.

3. What is a complaint?

The Department of Health defines a complaint as:

‘An expression of dissatisfaction or disquiet about the actions, decisions or apparent failings of a local authority’s Adults Social Services and the National Health Service provision which requires a response’. The Adults and Health Directorate uses this definition.

In addition, it is important to note that service users or their representatives generally view complaints in its everyday sense i.e. to mean any statement about a service or member of staff that has not met the standard that they can reasonably expect.

If it is possible to resolve the matter immediately, there is no need to engage the complaints procedure.

4. Who can make a complaint?

Anyone coming into contact with Leeds City Council can make a complaint. The Corporate Complaints Procedure provides a process for all service users to use. If the complaint is about Adult Social Care or Public Health functions, the statutory complaints procedure for Health and Social Care services must be used.

A person is eligible to make a complaint under the statutory complaints procedure where the Local Authority and the Health Service have a power or duty to provide or secure a service. This includes a service provided by an external provider acting on behalf of the Local Authority. In such cases service users or their representatives can either complain directly to the provider or to Leeds City Council, as commissioner of the service.

Commissioned providers are encouraged to attempt to resolve complaints at the first point of contact in line with good practice highlighted by the Local Government and Social Care Ombudsman. However, they are equally advised to direct service users or their representatives to commissioners of the service, where local resolution is not possible or appropriate, or where the complainant remains dissatisfied.

A complaint can be made by the representative of a service user who has been professionally defined (under the Mental Capacity Act 2005) as having no capacity to make decisions as long as the representative is seen to be acting in the best interests of that service user.

Anyone can complain who is affected (or likely to be affected) by the actions, decisions or omissions of the service that is subject to a complaint.

5. The complaints procedure

The complaints procedure is a two-stage complaints system, focusing on local resolution and, if unresolved, an investigation by the Ombudsman.

The aim of the Local Authority Social Services and the National Health Service complaints regulations is to make the whole experience of making a complaint simpler, more user-friendly and more responsive to people’s needs. The emphasis is to offer a more personal and flexible approach which is effective and robust. Complaints are risk assessed. The level of investigation needed is informed by the level of risk and complexity and the wishes of the complainant.

Complaints Officers contact the complainant to agree the complaint and sought outcome. They then determine the level of risk and complexity. Options include mediation, resolution by the Service Manager or an independent investigation.

Each complaint is treated according to its individual nature and the wishes of the complainant.

In the reporting year 10,586 people received a service from Adult Social Care.

When looking at the total number of complaints of 433, therefore, 4.09% of service users or someone acting on their behalf raised a complaint about a service that they received and 786 or 7.42% of service users or their representative were happy with the service that they had received from adult social care or public health.

6. Review of compliments received

Table 1 - Compliments Received by Service Area

Service area	2022/23	%	2021/22	%
In-house Older People Residential and Day Services	223	15.6%	99	12.6%
Physical Disability Residential and Day Services	207	14.5%	-	-
Skills/Reablement	204	14.3%	191	24.3%
In-house Mental Health Residential and Day Services	132	9.3%	114	14.5%
Learning Disability Housing and Day Services	124	8.7%	79	10.1%
Independent Sector Care Homes	93	6.5%	13	1.7%
Area Social Work	83	5.8%	40	5.1%
Independent Sector Home Care	80	5.6%	10	1.3%
Hospital Social Work	67	4.7%	25	3.2%
Resources and Strategy	53	3.7%	34	4.3%
Blue Badge	33	2.3%	76	9.7%
Independent Sector commissioned (working age adults, mental health and physical impairment)	32	2.2%	2	0.3%
Learning Disability Social Work	30	2.1%	41	5.2%
Equipment and Adaptations	26	1.8%	26	3.3%
Mental Health Social Work	24	1.7%	12	1.5%
Leeds Shared Lives	13	0.9%	20	2.5%
Strategic Commissioning	1	0.1%	4	0.5%
Total	1425	100%	786	100%

6.1 1425 compliments have been received this reporting year, compared to 786 in the previous year. Compliments evidence how the Adults and Health Directorate are meeting the key qualities people expect from health and social care services i.e. being treated with dignity, respect, staff being caring, responsive to people’s needs, being effective and well-led.

6.2 Following three years of declining numbers of compliments, believed to be as a consequence of the pandemic due to some services having been paused and now adjusting to new ways of working post-pandemic, numbers of compliments have increased again to close to pre-pandemic levels (for example in 2019/20 1680 compliments were received). The Adults and Health Complaints team and frontline staff continue to encourage care users and their families to provide us with feedback either good or bad about their experience of health and social care services across Leeds. The complaints leaflets which are provided to care users at assessment or at review encourage care users or their representatives to tell us what they think of the service. Service users are informed that learning is taken from compliments in the same way as complaints and are recorded and used to influence and promote best practice.

6.3 Care users or their representatives have made compliments in person or in writing through personal thank you letters, cards, using the feedback forms or by email. As part of the continuing complaints training both Adults and Health staff and staff of commissioned care providers are actively encouraged to forward any compliments to the Complaints Team in order to ensure that they are recorded and we can learn from the said feedback.

6.4 We value the positive feedback gained from compliments just as much as the feedback we receive from complaints. The Complaints Team continuously remind service managers to send any compliments they receive directly to the Complaints Team so that they can be recorded and we can learn from them too.

Compliments were received across nearly all service areas, thanking workers for the care and support provided to care users and their representatives in a variety of ways. This included thanking social workers for “..actually listening to families and involving them in the assessment process…and that this made such a positive difference”; Social workers also being thanked for the help in making difficult situations much easier to navigate and keeping people updated with any progress; thanking staff for being responsive and acting promptly; staff thanked for being caring “I felt so ill but they made me feel better because they were concerned and caring”.

EDT being thanked at how well they responded to cases; Transitions Team being thanked for being a great help at a time of crisis…quotes such as “she cared, she didn’t fob me off or pass me onto someone else” - “you should know what an amazing person you have working for you!”

Skills and Reablement being thanked for being caring, helpful and supportive and for helping people regain some of their confidence.

Commissioning teams being thanked for the support provided to commissioned care providers especially during the covid 19 pandemic and for making the Government Guidance “digestible” and “understandable for us”.

Independent sector residential and nursing care providers being thanked for carers providing “superb” care and for being “compassionate”.

The Finance team being thanked for being diligent and professional. The Complaints team being thanked for listening and for ensuring that people’s complaints were properly investigated and resolved.

The Blue Badge team being thanked for being professional, understanding and treating people with respect during the assessment.

Included below are quotes from compliments received from care users or their representative in their own words:

Area and Hospital Social Work:

“May I offer my sincerest thanks for your outstanding care and support in working to resolve this matter. Your professionalism, understanding and care are a real credit to the work and values of Leeds Social Care Services.”

“…We were very lucky to have her as his social worker. She was so kind and caring, and went over and above expectations. Thank you also for overseeing the work she did for him and for supporting her requests. Leeds City Council should be proud of its Social Services if they are all as good as your team. With my best wishes and sincere thanks, and also on behalf of my brothers and sisters” .

Learning Disability Transitions Team

From a Consultant Paediatrician from LCH NHS Trust: "It has been a real pleasure working with you. The Transitions Team is in safe hands with you”

“She cared, she didn’t fob me off or pass me onto someone else, you should know what an amazing person you have working for you!”

Skills and Reablement

“I would just like to say what an excellent care all the staff that came to my dad gave”,

“Since you have taken over I'm highly satisfied with my personal need and care with the help of your wonderful staff and my condition is a lot better and then I can only say to every member of staff my heartfelt thank you.”

Commissioned home care providers

“I just wanted to thank you for all for your help over the past 6 weeks. I was unfortunate to suffer a broken ankle and was unable to care for my daughter who has complex needs. M and Team stepped in and provided overnight care, R was our main support worker. R was always punctual despite the poor bus service to our village, polite and respectful of our home. She was lovely with my daughter who is non-verbal and has complex medical needs, including enteral feeding and emergency seizure protocols but was not daunted, followed all procedures, carried out all her tasks that were required and was not afraid to ask if unsure. I can't thank you enough.”

Commissioned Supported Living services

“My son is so mature, he is so independent and that’s a credit to you (manager) and the staff team for teaching him all his Independent living skills. I feel so happy because our relationship (mum and the service) is the best it’s ever been and when he comes to my house, he is excited about going home to Kingfisher and that makes me feel so happy to know he is happy. I can’t thank you all enough for everything you have and continue to do.”

Commissioned Independent sector residential and nursing care providers

“St Armands Court is excellent, they are all very helpful, kind and understanding to the residents and families. The home is well-run and I feel happy knowing that my mum is safe and well.”

“To all staff in Shire Oak House. Family cannot thank you all enough for all your care and support which you all gave to her. Thank you for going out of your way to make myself and my family feel comfortable during each visit. Knowing that my mum was cared for in her final days has given me so much peace about her passing. Lots of love from the family.”

The Adults and Health Operational Finance team

“Thank you so much for the attached information that the deferred payments have been paid in full. If Mum lives and her income depletes to the figure you have quoted then we will as you have requested get back in touch with yourselves. Not a road we anticipated we would go down but then what family does. Many thanks for all your support given to us as a family over the last 13 months it has been greatly appreciated. It shows that some of the Council’s Officers got a good grip of customers satisfaction. Please pass on our extended thanks also to Warren Smith. He was instrumental in sorting the 12 week property disregard in the very early days.”

The Adults and Health Complaints team

“Thank you so much for returning the call and your time, feel you totally understand my predicament, not just about the above, but more importantly the caring of my grandson. Your reassuring words were felt, they were from your heart and that’s a gift, thank you”

The Blue Badge team

“I had my phone assessment last Friday but I’m afraid I cannot remember the name of the assessor. I just wanted to say that the assessor was excellent and made a difficult process (for me) much easier. She was empathetic, supportive and signposted me to other council departments that could help me further. This all made a massive difference to the whole process and I just want to thank her and let the whole department know it was appreciated.”

Telecare

“Client called to say how grateful he was for the workers quick action yesterday morning, His quick response saved the clients life and he wanted to say a massive thank you for this”

Recovery Hub

“As you are certainly aware, I will be discharged from the Recovery Hub later today , and will be going home. I will be writing a formal letter of thanks as soon as possible after I get home. The standard of care I have had from you, and your staff has been uniformly high. However, I would like to acknowledge two members of staff in particular who stands out as being helpful to me whenever she has been in my room. Throughout my time here, I have always been pleased to deal with the carer who has been sorting out the arrangements for my discharge. She has been competent and always sympathetic to me and my needs and wishes. However, perhaps the best thing about her is her bubbly personality which makes her a real pleasure to deal with.”

In-house Older People’s Residential Care

Knowle Manor

“Wonderful care team and management a huge thank you for your care and support that you have shown to our mum during the most difficult of times. Knowing she was well looked after and cared for was very reassuring. You do a brilliant job and it shone through.”

Dolphin Manor

“To Everyone at Dolphin Manor, Many thanks for the care and kindness over the last 2 days. After nearly 5 weeks in hospital it was a breath of fresh air to prepare me for going home. My great thanks to all.”

In-house Older People’s Day Services

“Thank you to everyone for the love and care you gave me.”

“Mum is really enjoying her time at the day centre and speaks highly of you and your team.”

In-house Physical Disability Day Service

“Today, three staff and driver took us out on the barge. Nothing was too much trouble for them. We would not normally be able to do. Thank you so much for giving us the opportunity. You all worked so hard to give us a great outing. Also, the driver gave us a safe journey and also gave his time helping us on and off the barge. Thank you all.”

Mental Health THU

"It’s the best kind of therapy when I see you and we talk, its good to talk to somebody that understands."

Mental Health Day Services

"I look forward to you calling all week, you really cheer me up, I know I just have a good moan when you call me sometimes, and I bet you dread calling me, but I am really grateful for your calls."

“The most important thing has been making friends through the groups. I am a bit more confident than I used to be. The service has been everything to me. I would be nowhere without it.”

7. Review of complaints received

Table 2 - Complaints received by service area

	2022/23		2021/22
Service area	Number of complaints	% of total complaints	Number of complaints	% of total complaints
Total	520	100.0%	433	100.0%
Area Social Work	104	20%	93	21.9%
Learning Disability Commissioned Services	86	16.5%	55	12.7%
Finance	53	10.2%	31	7.2%
Independent Sector Care Homes	49	9.4%	23	5.3%
Independent Sector Home Care	40	8.5%	44	10.2%
Blue Badge Applications	34	6.5%	22	5.1%
Learning Disability Social Work	32	6.2%	46	10.6%
Physical Impairment Commissioned Services	26	5%	-	-
Hospital Social Work	19	3.7%	29	6/7%
Older People Direct Provision Residential Care	17	3.3%	24	5.5%
Mental Health Accommodation and Day Services	15	2.9%	15	3.5%
Mental Health Social Work	15	2.9%	13	3%
Equipment and Adaptations	14	2.7%	19	4.4%
Skills / Reablement	10	1.9%	11	2.5%
Performance and Management	2	0.4%	2	0.5%
Strategic Commissioning	2	0.4%	0	%
Advocacy	1	0.2%	0	%
Safeguarding	1	0.2%	0	%
Support services	-	-	3	0.7%
Independent Sector	-	-	3	0.7%

7.1 The Adults and Health Directorate provides a range of services in a range of settings and where the Council commissions care from the independent sector, the Ombudsman is very clear that the Council remains accountable for the actions of the commissioned service provider. It is usually best to tell the care provider and give it chance to put things right. However, if the problem cannot be sorted out there and then and the person continues to be unhappy, they have a right to complain to the Council, as commissioner of the service. In these circumstances, care users or their representatives are advised to raise concerns with the Adults and Health Directorate Complaints Team. The Complaints Team recorded 520 complaints in this reporting year compared with 433 complaints the previous year. We encourage care users or their representatives to tell us what they think if for whatever reason they are unhappy with the service so that we can act when we learn about any problems. It is, therefore, pleasing to note the slight upward trend.

The monitoring and oversight of complaints made directly to commissioned care providers is in response to recommendations made by the Ombudsman in their Annual Review of Adult Social Care Reports. The Ombudsman continue to make it very clear that it will hold commissioners accountable for the commissioned care providers’ failings and further that it is the commissioner who will be held accountable to remedy any identified failings. In view of this, Adults and Health Directorate has an Information Sharing Protocol with its commissioned care providers in relation to any complaints and compliments relating to the Council’s Adults and Health commissioned services. This should provide the Council an opportunity to gain an overview of compliments and complaints of commissioned services.

8. Nature of complaints

The most common category of complaints are as follows:

117 complaints about quality of service
79 complaints about lack of Social Work support
75 complaints challenging an assessment outcome
62 complaints about inconsistent Home Care service
61 complaints about staff attitude or conduct

Quality of service

Working Age Adults Commissioned Services

Complaints about the quality of service were made by family members who raised concerns about care providers not following care plans properly and not consulting them about their relatives’ care. Other concerns included staff shortages, the impact this has on providing quality care and support plans not being updated.

Independent Home Care Providers

Complaints about the quality of service included concerns about home care workers not following care plans, not performing care tasks properly, for example, not sufficiently encouraging service users if they refused to accept personal care or meals. Lack of communication with family members, carers not reading the care plan, call times being scheduled very close together or too far apart and home care workers not cleaning up properly.

Area and Hospital Social Work

Complaints about the quality of service included concerns about family members and service users being unhappy with the care and support plan being offered following a social work assessment; failure to communicate with family representatives, legal deputies or attorneys about care charges and other significant decisions.

Older People’s Residential Care

Complaints about the quality of service included concerns about staff not adhering to care plans and risk assessments, residents appearing unkempt, staff not notifying family members of deteriorations in their relatives condition, particularly staff not identifying UTIs or keeping the care user hydrated. Some concerns related to staff not making enough effort to encourage care users to have a shower, bath or change clothes when they had declined to do so. Complaints were received about personal possessions and clothing going missing.

Recovery Hubs

Complaints about the quality of service included concerns about staff not being responsive when residents required assistance, including some which related to food.

Lack of social work support

Area Social Work

Complaints about lack of social work support in the area teams related to delays in services being put in place, a lack of communication from the social worker or being difficult to contact. Family members complained about the lack of support when the care user has capacity and has declined services. Estranged families made complaints about Social Workers not communicating with everyone equally.

Learning Disability Social Work

Complaints about lack of social work support in Learning Disability teams related to a lack of communication and delays in allocating social workers and perceptions of delays in putting services in place.

Hospital Social Work

Complaints about lack of social work support in Hospital teams related to a lack of support being put in place upon discharge and perceptions from family members that they were given conflicting information regarding care charges by the Social Worker.

Analysis of complaints highlights the ongoing impact of the Covid pandemic as staff adjust to new ways of working including the impact of staff shortages.

Challenging assessment outcome

Blue Badge

The majority of complaints about this issue were made by people whose application for a Blue Badge parking permit had been declined. Some applicants were invited for a re-assessment.

Finance

6 complaints challenged the outcome of financial assessments. Complainants disputed the amount they were contributing towards the cost of their care or assets that were taken into consideration as part of the financial assessment and which resulted in them having to make a contribution. Some Challenges made included items which were not included as Disability Related Expense (DRE).

Area and Hospital Social Work

Complaints about this issue related to the outcome of assessments of people’s care needs, including carer’s assessments which had not resulted in the expected level of support.

Disability Services

Complaints about this issue related challenging the outcome of Occupational Therapy assessments where recommendations for adaptations to a service user’s property did not match the complainant’s expectations.

Inconsistent home care

Complaints of this nature were varied. Some related to care visits not taking place at the agreed time to there not being a settled care team and care users being unhappy about many different care workers providing care who did not know the service user’s needs, routines and preferences. Some concerns were about visits not lasting the agreed times, visits being cancelled at short notice or missed completely. Concerns were raised regarding PPE. Although it is no longer a legal requirement some care users still wish for the care workers to wear PPE..

Staff attitude/conduct

Area and Hospital Social Work

Complaints about staff attitude and conduct in Area and Hospital Social Work were often linked to a decision which the complainant did not agree with, for instance, being informed of the requirement to contribute to the cost of care or that the care and support plan did not provide the expected level of support. Some complaints against social workers were about inconsiderate actions, such as arranging visits at inconvenient times or inappropriate behaviour, such as making light-hearted comments which caused offence. Some complaints related to social workers asking necessarily personal questions, as care users or their family members found this distressing during difficult times.

Working Age Adults Commissioned Services

Complaints about staff attitude and conduct in Working Age services related to family members who felt that care workers had been rude to them. They included those from family members where there were disagreements about what was in the best interests of a relative. Some were from members of the public who alleged they had witnessed workers acting inappropriately towards care users, such as shouting at them or seeming disinterested.

Mental Health Transitional Housing Units (THUs)

Complaints about staff attitude and conduct in THUs often reflected the difficulties the care user was having in coming to terms with the transition to living independently and feeling that staff were putting pressure on them.

9. Outcome

The table below shows the outcome of complaints following an investigation. The three main categories for classifying the outcome of a complaint are “Upheld”, “Partly Upheld” and “Not Upheld”. Also included is a proportion that were “inconclusive” and those that were “Withdrawn”. It will be noted from the table that 72.1% of complaints were either upheld or partially upheld higher than the previous year when 66% of complaints were either fully or partially upheld. The increase in uphold rate is consistent with the national picture. It will be noted from the Local Government and Social Care Ombudsman’s Review of Adult Social Care Complaints that the national uphold rate in this reporting year is 75% compared with 70% uphold rate the previous year. The Ombudsman has reported in its annual review letter dated 19 July 2023 that the average uphold rate for all investigations has increased this reporting year and that organisation’s uphold rate will be higher than previous years. This is in response to the changes the Ombudsman has made to its processes, for instance, they are now less likely to carry out investigations on ‘borderline’ issues resulting in naturally finding a higher proportion of fault overall.

Outcome	2022/2023	%	2021/2022	%
Upheld	224	43.1%	161	37.2%
Partially upheld	153	29.4%	124	28.6%
Not upheld	112	21.5%	105	24.2%
Inconclusive	5	1%	11	2.5%
Ongoing	17	3.3%	22	5.1%
Withdrawn	9	1.7%	10	2.3%
Total	520	100%	433	100%

10. Formal investigation

As is standard practice, complaints requiring formal investigation are investigated by Investigating Officers who are independent of Leeds City Council. Independent investigation has proved effective in resolving complex complaints.

Appendix 7 of this report contains examples of action taken in response to investigation findings to improve the quality of services.

11. Mixed sector complaints - joint working across health and social care in Leeds

The Leeds Citywide Complaints group share expertise, learning and good practice. Leeds Healthwatch Chair the meetings of the Group.

The Council recorded 7 mixed sector complaints in 2022-23.

Poor communication runs as a theme through the majority of mixed-sector complaints. Recurring themes includes:

Poor communication with patients, care users and/or their families. Others mentioned calls not being answered or being given conflicting information between different organisations which caused confusion. A care user was discharged into a care home but their family were not informed.
Poor communication between professionals. A lack of joined up working between professional in the mental health services. One family commented that they felt no one took ownership or management of the care user’s care.
Delays in the allocation of a Hospital Social Worker which in turn delayed an assessment causing delays in the care user being discharged.
Challenging Assessment outcomes that either the process around the assessment was not explained or clearly communicated with the patient and their family. One family felt their family member should be discharged to a respite facility rather than home with a package of home care.
Lack of joined up discharge planning - again poor communication between the provider and families is the main theme alongside a lack of joined up support following discharge Families being given conflicting information between departments which caused confusion. One Service User, who was a wheelchair was discharged to a care home, but the doors were too narrow which resulted in them being confined to their room.
Poor care was also a recurring theme. Complaints were made about the lack of rehabilitation due to demands on Occupational Therapists and Physiotherapy. One family member pointed out that if the mobility of a patient can be improved, they would require less support when they are discharged.

Next steps

The group continues to work on developing a system which can draw together lessons learned from people’s experiences of health and social care across Leeds which should:

Highlight more clearly the trends in city wide complaints and develop a process to draw together and share lessons learned from the people’s experience of health and social care across Leeds.
To continue to challenge that learning is not done in ‘silos’. This means greater drawing out of actions and recommendations for improvement which relate to improving systems across Leeds. Whilst this happens already where individual cases are high profile it is not sufficiently consistent where system learning opportunities are present.

12. The Local Government and Social Care Ombudsman

12.1 The Ombudsman has statutory powers to carry out joint investigations with the Parliamentary and Health Service Ombudsman (PHSO). They operate a joint team of both health and social care investigators and undertake a single investigation which as previously stated in the report provides a more effective way of ensuring that complaints are resolved and lessons learned.

The Ombudsman’s role in providing independent redress extends to all adult social care providers registered with the Care Quality Commission (CQC). This means that the Ombudsman investigates unresolved complaints about care arranged and funded by local authorities and from self-funders.

It is in everyone’s interest for complaints to be resolved by councils and care providers before people feel the need to escalate problems to the Ombudsman. The Ombudsman’s website provides practical advice and useful tools to help support good complaint handling. They offer training, guidance documents, templates and practical advice on how to run complaints systems and for independent care providers they provide template complaints procedures which they can adapt, response letters, checklists and posters.

In view of the fall in complaints received by the Ombudsman and the high uphold rate, they are calling for mandatory signposting to increase awareness of their role and outreach support for smaller providers, annual complaint reports from care providers to encourage transparency and clarity and consistency to service users with a new set of complaints standards across the sector.

12.2 Summary of Ombudsman cases

The Council is required by Law to inform people of their right to complain to the Ombudsman if for whatever reason they are unhappy with the way the Council has dealt with their complaint. The Adults and Health Directorate complaints leaflets, therefore, provides people with the Ombudsman contact details and informs people of their right to escalate their complaint to the Ombudsman. In addition, complainants are provided with the Ombudsman contact details as part of the response letter to their complaint.

In view of the above, it is envisaged that more service users will escalate their dissatisfaction to the Ombudsman either because they would have liked something more or a different outcome from the Council in response to their complaint.

In the reporting year, 30 complaints and enquiries in total were made to the Local Government and Social Care Ombudsman compared to 33 the previous year.

The main measures the Ombudsman uses is the Uphold rate, compliance with its recommendations and satisfactory remedy provided by the Council before the complaint reaches the Ombudsman.

The Ombudsman in its Annual Review letter 2022-23 has informed all Councils that the average uphold rate for all investigations has increased this reporting year, as an outcome of its new processes. They state that this means that comparing uphold rates with previous years carried a note of caution.

In terms of the causes of complaint, The Leeds City Council, Adults and Health position reflect the national picture, with Assessment and Care Planning, Residential Care, Homecare and Charging being the main causes of complaints.

A total number of complaints and enquiries made to the Ombudsman was 30 compared with 33 the previous year. The total numbers include invalid and incomplete complaints and enquiries or from people who may not have initially contacted the council and, therefore, recorded as ‘premature’ and referred back to the Council. Below is the breakdown:

0 was invalid or incomplete
0 advice given
3 of the 30 were premature and referred to the council for investigation
15 of the 30 cases were closed after the Ombudsman made initial enquiries
1 of the 30 was not upheld
11 of the 30 were upheld
The total uphold rate as reported in the Ombudsman’s report for Leeds Adults and Health was 92%
Adults and Health achieved a 100% compliance rate with the Ombudsman’s recommendations
Adults and Health achieved 27% against a national average of 11%, as reported in the Ombudsman’s Annual Review Report 2022-23. This is where Adults and Health had offered a satisfactory remedy before the complaint reached the Ombudsman.

Total: 30

A breakdown of the Ombudsman enquiries and the findings are detailed in Appendix 5 of this report.

13. Local settlements and public reports

Where the Ombudsman finds fault - he may recommend a local settlement or issue a public report. In this reporting period one complaint resulted in a public report.

One case resulted in the Ombudsman issuing a Public Interest Report about the Council’s arrangements for paying for care commissioned from a private care provider. As stated in the Annual Review letter, the Ombudsman investigation found against the Council for allowing the provider to put a second contract in place with a family whose relative was placed in the care home, to pay the difference between the Council’s rate and care provider’s private rate. The Ombudsman found such arrangements to be confusing and contrary to Government guidance and recommended that care users whose care is arranged by a Council should not pay more than the Council’s contracted rate for care.

The Council accepted the findings and recommendations and has worked with the with the Care Home Provider to resolve the complaints and has implemented the lessons learnt in order to improve services for the many.

The Ombudsman welcomed the Council’s positive and constructive response to their findings and recommendations, as reported in the Annual Review letter to the Council’s Chief Executive Officer dated 19 July 2023.

The Council agreed to pay financial remedies in local settlement of 5 complaints to the Ombudsman.

In one case the Council agreed to pay a vulnerable service user £500 remedy in recognition of the uncertainty and distress the lost opportunity to be supported by an advocate during a safeguarding investigation.

In one case the Council agreed to refund £24,454.63 in care home fees after the Council had reviewed its decision that a care user had intentionally deprived themselves of assets to reduce their contribution towards care costs.

In one case the Council agreed to pay £500 in acknowledgment of the poor care provided by the commissioned care provider and the failure to investigate the concerns raised. Although the Council had commissioned the service the Ombudsman continue to make it clear that Councils still remain responsible for the commissioned service and for the actions of the organisation providing them. In this case the Council had not had the opportunity to investigate the complaint as the complaint was dealt with by the commissioned care provider but concerns were raised with the Council in reviews. The Council also agreed to pay £250 to their relative for their time and trouble in raising and pursuing the complaint.

In one case there was fault by a home care provider which acted for the Council when their care worker refused to stop working when displaying ambiguous symptoms which were potentially covid-19. The Ombudsman found that the care provider did not communicate with the family appropriately.

When a Council commissions another organisation to provide services on its behalf the Ombudsman is clear that it remains responsible for those services and for the actions of the organisation providing them. Therefore, although the Ombudsman found fault with the service of the care provider, it made recommendations to the Council. The Council agreed to pay £240 to the complainant and £240 to the service user in recognition of avoidable distress and inconvenience.

In one case the Council incorrectly decided that a care user had deprived themselves of assets. The Ombudsman recommended that the Council pay the care user £250 for the distress and inconvenience caused and for the four month delay in providing financial support caused by this error.

The total of financial remedies provided as a result of Ombudsman investigations in this reporting year was £26,434.63 compared with £5500 the previous year.

14. Timescale performance

14.1 The statutory timescale for acknowledging complaints is 3 working days. In 2022/23 performance against this timescale was 97.7%. Good performance in acknowledging complaints within timescale has been maintained.

14.2 Whilst the statutory timescale for fully resolving a complaint is now up to six months based on level of risk and complexity, the service aims to provide an initial response to complaints risk assessed as low within 20 working days. This year performance against this timescale was 96.6% a slight decrease from 98% the previous year.

15. Compensation payments

Under Section 92 of the Local Government Act 2000, Local Authorities are empowered to remedy any injustice arising from a complaint. It is now practice to consider small ex gratia payments by way of recompense for costs incurred or compensation for a distress caused as a result of a matter complained about. In some cases it may be appropriate to waive care fees. The Local Government and Social Care Ombudsman also has powers to direct the authority to pay compensation and to recommend the amount. As noted at paragraph 13, £26,434.63 was paid as a result of outcome of Ombudsman investigations.

Payments were also offered as a result of internal complaints investigations. Including payments made as a result of Ombudsman investigations, the Adults and Health Directorate provided financial remedies totalling £50,912.20 this reporting year. This compares with £33,416.38 in the previous year.

The payments and/or waiving of fees fall into three main categories, as follows:

Payments or waivers made in recognition of fault / poor quality or delay in the provision of services

In total £38,120.53 (£20,432.56 in the previous year) was paid (or care fees waived) for this reason. Individual payments are usually modest and can reflect the reimbursing of care fees where isolated incidents have occurred or a payment in recognition of distress, anxiety and inconvenience caused as a result of failings. Larger payments can be made where a problem has persisted for a long period of time.

Fees repaid due to people being incorrectly charged

£2916.24 was paid to service users for this reason, comprising:

Where the service user had been charged for services that were either not provided, for instance, were a home care provider had not turned up for the care visit or had not stayed for the full duration of agreed time or were not required. This is when the service user had cancelled the service.

Not correctly advised

£9875.43 was paid to customers for this reason, comprising:

Where service users or their representatives had not been given adequate information about their contribution to the cost of their care. These payments are often substantial as they reflect the fact that the service user has received a backdated invoice for care fees which they were not expecting.

16. Methods of notifying complaints

16.1 There is no requirement that a complaint must be written, although a person making a complaint is always encouraged to be as specific as possible. Consequently, complaints can be received via a number of different channels and the chosen channel of communication is recorded. Leaflets providing information on how service users or their representatives can send compliments and complaints are widely available across all service areas and the leaflet contains a simple form, which people can use.

16.2 This reporting year 42.1% of the complaints which the service received were made through a commissioned care provider or directly with an internal member of staff. This also includes complaints which were dealt with at a local level via the commissioned provider. This was an increase from 23.8% from the previous year. 26.9 % chose to make their complaints by e-mail. This was a decrease compared to the previous year’s figure of 35.3%. There was a slight decrease in the numbers of people who made their complaints by telephone via the Contact Centre down to 15.2% from 16.6%. There was a decrease in people raising their complaint over the telephone from 8.3% to 5.6%. The numbers of people writing letters of complaint also decreased from 5.5%to 3.8%. The number of people making their complaint in person reduced from 3% to 1.2%, however, some of these complaints may have been made in person via their commissioned care provider or internal staff member. Use of the complaints form included in our complaints leaflet reduced from 1.6% to 0.8%. There was a slight decrease in people using an advocate to make a complaint from 1.6% to 1.2%. The numbers of formal complaints submitted by Elected Members on behalf of constituents decreased from 2.1% to 1%. 1% of people submitted their complaints via the Patient Opinion / Care Opinion websites, down from 1.4% last year. 0.8% of complaints received were made to the Ombudsman. This was a decrease from 0.5% in the previous year. 0.6% of complaints made were made to the Care Quality Commission (CQC). No complaints were received via the CQC in the previous year.

16.3 Only 22% of complaints were made by service users themselves, which was almost identical to last year’s figure of 23%. Of the people making complaints on service users’ behalf, 31% were from relatives which was a decrease from 39% followed by carers 28% up from 19%. Members of the public remained identical at 7% other professional agencies 4% down from 6%, workers and other care providers 3%, advocates 2%, solicitors 1%, friends 1% and parents of working age adults 1% down from 4%.

17. Equality monitoring

17.1 All complaints are subject to equality monitoring, which now includes all the equality characteristics protected through legislation (age, disability, gender, race, religion or belief, sexual orientation). Information is most frequently provided on ethnicity, gender and disability. No information has been provided about other characteristics. 75.4% of all complaints have ethnicity recorded, 98.3% have gender recorded, and for the second year it has been recorded that complaints have been received by people who identify as non-binary 1 or 0.2%. 67.1% of complaints were from or on behalf of people with disabilities.

Where complainants haven’t provided this information, the Complaints Team checks the social care record (CIS) and uses the information available there if it has been recorded. A breakdown of the equality related information provided by complainants is detailed in Appendix 6 of this report. It will be noted from the table that the proportion of people from a none UK/white background making a complaint is lower than both the proportion of the same groups within the overall population as well as well as the proportion of the same group receiving a social care services. This is an established trend. Work will be done to gain a better understanding of the reasons for the lack of recourse to the complaints procedure for the non-UK/white service users and carers.

18. Lessons learned

18.1 Where a complaint has been upheld, it is often the case that the manager undertaking the resolution of the complaint will make recommendations on how the service should be improved to avoid a similar situation arising for another service user. These actions will be brought to the attention of the complainant and there is a system in place for recording the action and the person with responsibility for implementing the action. Appendix 7 of this report contains some examples of the lessons learnt during the course of the reporting year and actions taken to improve the quality of service.

19. Service user satisfaction surveys

19.1 The Complaints Team sends a satisfaction questionnaire to all complainants after they have received a response to their complaint. The purpose of the questionnaire is to seek complainants’ views on how easy they found it to complain and how satisfied they are with key aspects of the process and outcome. The return rate in this reporting period was 2% of the satisfaction questionnaires which were returned. 88% were either very satisfied or quite satisfied with the response to their complaint. The main reservations complainants had about completing the satisfaction questionnaire was that ‘they were not sure it would do any good” or they “were unsure who to complain to”. The Complaints Team is looking into how the satisfaction questionnaire return rate can be improved.

20. Developments / updates - 2022/2023

Although still below the pre-pandemic figures, it is pleasing to note that in the 2022/2023 reporting year, the numbers of compliments and complaints have increased. As previously mentioned, the number of compliments increased from 786 to 1425 and the number of complaints increased from 433 the previous year to 520. The Complaints Team continue to deal with increasingly more complex complaints and the challenge of operational managers who act as investigating officers in some complaints having to support front line service delivery. This particularly can affect timescale performance in resolution of complaints. Commissioning Officers too have been supporting front line commissioned care providers so they too have had challenges in trying to resolve and/or investigate complaints within the agreed timescale. Finance Officers too have been involved in providing support payments to commissioned care providers hence challenges in trying to maintain good performance in resolving complaints.

The focus for the Complaints Team has been to maintain good customer service by focussing on good communication by keeping complainants informed of any progress.

21. Training

The Adults and Health well established complaints training helps Adults and Health staff and commissioned care provider staff improve their complaints handling.

In response to the Covid-19 pandemic, the complaints training was re-designed to online delivery which has continued to be delivered via online delivery. In the reporting year the training was delivered to internal staff but mainly to staff of commissioned care providers covering Homecare, Supported Living, Residential and Nursing Care staff. The training was delivered in September, October and November.

Attendees fed back that they enjoyed the training and found it informative and that it will improve their practice.

22. Guidance for dealing with unreasonable behaviour from service users

Occasionally the behaviour or actions of some service users or their representatives has made it very difficult for staff to deal with them. In a small number of cases the actions of individuals become unreasonable and can be considered to be unacceptable because they involve abuse of staff and has a huge impact on Council resources.

In view of this, Adults and Health Directorate has Guidance for staff to guide them when dealing with customers whose behaviour is unacceptable or unreasonable and with action that can be taken.

23. Protocol on complaints handling with commissioned service providers

The Local Government and Social Care Ombudsman has made it clear that where a Council commissions care from the independent sector, that the Council remains accountable for the actions of the provider it has commissioned. In view of this, Leeds City Council, Adults and Health Directorate has a protocol with its commissioned service providers.

The purpose of the protocol is to provide a framework for collaboration in handling complaints and ensuring regular communication in relation to commissioned services between Leeds City Council, Adults and Health Directorate and its commissioned service providers. This should also allow the Council to gain an overview of service user feedback in relation to commissioned services as well as provide an opportunity to collate information to ensure that learning points arising from compliments and complaints are used to inform contract monitoring and/or used to improve services and inform commissioning activities.

The protocol is also extended to Spot Providers. The Complaints and Commissioning Teams continue to remind providers to share information as requested in the protocol.

Providers are reminded to feedback on how the Protocol can be improved. The Council will update the Protocol as we learn from both customer feedback and staff. Providers are reminded to ensure that responses to complaints are thorough and for them to share these with the Council’s Complaints and Commissioning Teams. This practice is in response to the Ombudsman’s practice which states that they will treat the commissioned care provider’s response as the Council’s final response, as follows:

“The care provider has responded to the complainant about the matter. The law says we can treat its complaint response as your Council’s response. We do not expect people to go through two successive complaints procedures, so we are satisfied we do not need to refer the matter back to you”.

In view of the above, the Council’s practice has been to ask commissioned service providers to send all copy responses to complaints responses for Leeds City Council, Adults and Health commissioned services to the Adults and Health Complaints Team at complaints.socs@leeds.gov.uk and to the Adults and Health Commissioning Team at olderpeoplescare-homes@leeds.gov.uk; Homecare.Providers@leeds.gov.uk and waa.contracts@leeds.gov.uk

24. Review of information literature for service users and their representatives

24.1 Monitoring and review of information for service users or their representatives in order to try and ensure that the Complaints Procedure is accessible is one of ongoing monitoring, development and review.

24.2 Deaf people using British Sign Language can contact the Complaints Team using mobile telephone number 07800 005 460.

25. Complaints handling - national developments

25.1 Equality and Human Rights Commission report following their inquiry to examine social care decision making by local authorities in England and Wales published on 28 February 2023:

This is a helpful report. The EHRC has highlighted a number of areas where, nationally, social care practice could be improved, for instance:

They found that information is not always clear and accessible
They talk about concerns that most information being provided online can be a barrier for older and disabled people who have the highest rate of not using the internet. That this practice, therefore, raises issues for local authorities on whether their provision of information is effective
They also talk about people having to ask for information in an accessible format may act as a barrier for those who need those formats
Also highlighted is that people are not being informed about their statutory rights and people are finding it difficult to find information

Adults and Health Directorate’s practice of encouraging people to speak up when things are not right so it can act when it learns about problems and changing the language on complaints leaflets to “Tell Us What You Think” is highlighted on page 18 of the report, as good practice

25.2 Local Government and Social Care Ombudsman (LGSCO) Review of Adult Social Care Complaints 2022/2023. The Ombudsman published its Annual Review of Adult Social Care complaints in September 2023. The Ombudsman reported that nationally they upheld 75% of complaints they investigated, an increase of 5% from the 2021-22 reporting year. The Ombudsman state that ‘most worryingly’ the complaints they have received has plateaued following a fall of complaints during covid, after years of rising complaints numbers. The Ombudsman is concerned about the fall in numbers given the well publicised issues with unmet demand in Adult Social Care, which means they expect to see an increase in complaints.

The Ombudsman is also concerned about the consistently few complaints received from private (self) funders than they would expect given their share in the market. Although there are likely to be a range of reasons for the decrease in numbers, the Ombudsman believes that a lack of proper signposting to their services plays a role.

In order to strengthen the public voice in Adult Social Care, the Ombudsman is calling for

Adult social care independent care providers to be required to signpost complainants to the Ombudsman service, enshrining in law what providers should already be doing
Providing information on how to make a complaint should be done at the start of any care journey and the details of the Ombudsman service should be clearly displayed in all care settings and in all complaint procedures
A new set of complaints standards across the sector to encourage transparency, clarity and consistency

The Ombudsman’s Complaints Annual Review Report has also highlighted that the Ombudsman works closely with partners across the social care landscape to share intelligence and experience of complaints. This includes sharing information about complaints investigations with the Care Quality Commission (CQC) in order to inform regulatory action.

It is also reported that the Local Government and Social Care Ombudsman are signatories of the Emerging Concerns Protocol. This is a mechanism for sharing information and intelligence that may indicate risks to people who use services, their carers, families or professionals.

As reported in previous years, it has reiterated that it will hold commissioners to account for their commissioned service providers’ failings. It encourages all councils and care providers to have systems in place to ensure learning from complaints is shared widely.

Included in the Ombudsman’s Annual Review Report is data on how each local authority and/or independent care provider complied with its recommendations to remedy complaints about them. As previously stated, Leeds City Council, Adults and Health Directorate achieved a 100% compliance rate, percentage of cases the Ombudsman were satisfied that it had successfully implemented the Ombudsman recommendations.

Lessons to be learnt from the Ombudsman’s findings are shared with staff via the complaints training and when the Head of Complaints attends area social work teams’ management meetings.

25.3 The Ombudsman issues guidance documents where they identify common themes or practice issues. During the reporting year, the Ombudsman published three practitioner guides, as follows:

Good record keeping for care providers

The guide aimed specifically at independent adult social care providers stresses the importance of keeping good records. Among the complaints they upheld about care providers, poor record keeping was a common factor. The guide highlights cases they investigated that uncovered records being fabricated after a serious incident, incorrect medication given because records were not updated and treatment being delayed because of inaccurate records.

Section 117 aftercare

This guide was produced with the Parliamentary and Health Service Ombudsman (PHSO) and sets out the common mistakes the Ombudsman finds in complaints about the aftercare of patients receiving support under the Mental Health Act. The guide is aimed at both Councils and Integrated Care Boards who have joint responsibilities to provide Section 117 aftercare services.

Deprivation of capital

This guide focuses on the often-complex issue of deprivation of capital decisions. Particularly helpful to financial assessment practitioners, it sets out the Ombudsman’s approach to investigating complaints from people where their local authority has decided they have intentionally deprived themselves of capital when assessing how much they should contribute to their care fees.

26. Other priorities to be taken into account during 2022/23 include:

Continuing to contribute to gathering intelligence and sharing this widely so that lessons learned from compliments and complaints can inform service improvements.
Continuing to contribute to support the Council to achieve its Best City Ambition, one which recognises the strengths and opportunities which the Council has within these difficult times, to be a place that prioritises people, partners and businesses working together as Team Leeds.
Continuing to contribute to the Best Council ambition to be efficient, enterprising and a healthy organisation and meeting this by ensuring that staff are effective and have the right knowledge and skills to continue to improve complaints handling.
Continuing to contribute to the Council Climate strategy by adopting practice which contributes to addressing this emergency.
Continuing to contribute to the Council achieving its vision of a more enterprising Council, working with partners and businesses who are more civic and a more engaged public.
Via the compliments received continuing to evidence how the Adults and Health Directorate is meeting the key qualities and priorities that people expect of keeping people safe from harm, people feeling safe and people living with dignity and staying independent for as long as possible. The Complaints Service is another useful tool for indicating where services may need adjusting and/or where they are not working well.
Continuing to work closely with operational and support services’ teams, sharing lessons learned from service user feedback to inform commissioning activities and service improvements.
Continuing with the Complaints training via virtual classroom on the statutory complaints procedure, incorporating learning from service user feedback. Post pandemic, the training will be both classroom and virtual.
Continuing to provide briefings to voluntary sector organisations so that they understand the health and social care complaints procedure so that they can effectively support people who may wish to access the complaints process.
We will continue to push forward a learning culture throughout the organisation. We will continue to do this by ensuring learning is followed up by simple action plans with the Heads of Service at the time the complaint is closed. Learning which has a wider impact will be shared widely with the relevant teams/partners.
We will continue to monitor and evaluate information to ensure that the complaints procedure is accessible to all service user groups.
Continuing to promote the complaints service across all Adults and Health operational teams by attending their management team meetings to share key messages, the national picture and the impact this will have on their practice.

27. Conclusion

Despite financial constraints faced by the Council that necessitate tough decisions around service provision, care users’ expectations of what they can reasonably expect from the Council remains very high. Care users feel empowered to hold the Council to account and to escalate their complaints to the Ombudsman as can be noted by the number of complaints made to the Ombudsman.

When a Council commissions another organisation to provide services on its behalf the Ombudsman holds the Council responsible for those services and for the actions of the organisation providing them. So, although they may find fault with the actions of the commissioned care provider, the recommendations to remedy any injustice is made to the Council. In view of this, the impact of commissioned services’ failings has potential reputational and financial risks for the Council as well as increasing pressure on both the Council’s Commissioning and Complaints Teams in terms of volume, complexity and the need to ensure that the quality of complaints handling within commissioned care services is good in addition to continuing to strengthen our systems with commissioned care providers.

Review of compliments and complaints has provided an opportunity to assess some of the ongoing impact of the Covid-19 pandemic, some care users still expect/want staff to observe the covid rules. It can be noted from the compliments recorded in the annual report that despite the challenges overall health and social care and its commissioned care providers has continued to respond well to some of the ongoing challenges.

At a time of such pressure, it is now more important than ever to listen to public concerns in the form of complaints as they provide free intelligence to spot problems that can lead to responsive, engaged and improved services. As can be evidenced in appendix 7, the complaints informed service improvements, informed training. Some complaints data and analysis informed individual Managers to take the initiative at service/team level or with individual staff members to address areas for development and local improvements.

Complaints are a crucial early warning sign when something has gone wrong and the person complaining could be without a crucial service at a critical time. Our strategy, therefore, is to continue to encourage as many people as possible to provide us with this feedback so that issues can be resolved early and for these to drive service improvements.

The focus for the Complaints Team is to continue to ensure that we communicate clearly with complainants and keep them informed of progress.

As in previous years, it is important that the Council takes even greater measures to evidence that lessons learned from complaints are used to improve and maintain the quality of the services it provides and commissions. Complaints continue to be a complex and difficult service area with potential for both reputational and financial risks for the Council.

If you would like to comment on this report, or to receive it in large print, Braille or other format, please contact: complaints.socs@leeds.gov.uk

Complaints Service, Leeds City Council, Adult Social Care, PO Box 848, Leeds, LS1 9PQ.

Telephone: 0113 222 4405.

Email: Judith.kasolo@leeds.gov.uk

Complaints Team Members include:

Judith Kasolo, Head of Complaints

Dominic Wyatt, Complaints Manager

Tina Price, Senior Complaints Officer

Sarah Jones, Complaints Officer and

Ayesha Iqbal, Complaints Co-ordinator

Appendix

Appendix 1 - Compliments received by service area

Service area	2022/23	%	2021/22	%
In-house Older People Residential and Day Services	223	15.6%	99	12.6%
Physical Disability Residential and Day Services	207	14.5%	-	-
Skills/Reablement	204	14.3%	191	24.3%
In-house Mental Health Residential and Day Services	132	9.3%	114	14.5%
Learning Disability Housing and Day Services	124	8.7%	79	10.1%
Independent Sector Care Homes	93	6.5%	13	1.7%
Area Social Work	83	5.8%	40	5.1%
Independent Sector Home Care	80	5.6%	10	1.3%
Hospital Social Work	67	4.7%	25	3.2%
Resources and Strategy	53	3.7%	34	4.3%
Blue Badge	33	2.3%	76	9.7%
Independent Sector (working age adults, mental health and physical impairment)	32	2.2%	2	0.3%
Learning Disability Social Work	30	2.1%	41	5.2%
Equipment and Adaptations	26	1.8%	26	3.3%
Mental Health Social Work	24	1.7%	12	1.5%
Leeds Shared Lives	13	0.9%	20	2.5%
Strategic Commissioning	1	0.1%	4	0.5%
Total	1425	100%	786	100%

Appendix 2 - Complaints by service area

	2022/23		2021/22
Service area	Number of complaints	% of total complaints	Number of complaints	% of total complaints
Total	520	100.0%	433	100.0%
Area Social Work	104	20%	93	21.9%
Learning Disability Commissioned Services	86	16.5%	55	12.7%
Finance	53	10.2%	31	7.2%
Independent Sector Care Homes	49	9.4%	23	5.3%
Independent Sector Home Care	40	8.5%	44	10.2%
Blue Badge Applications	34	6.5%	22	5.1%
Learning Disability Social Work	32	6.2%	46	10.6%
Physical Impairment Commissioned Services	26	5%	-	-
Hospital Social Work	19	3.7%	29	6/7%
Older People Direct Provision Residential Care	17	3.3%	24	5.5%
Mental Health Accommodation and Day Services	15	2.9%	15	3.5%
Mental Health Social Work	15	2.9%	13	3%
Equipment and Adaptations	14	2.7%	19	4.4%
Skills / Reablement	10	1.9%	11	2.5%
Performance and Management	2	0.4%	2	0.5%
Strategic Commissioning	2	0.4%	0	%
Advocacy	1	0.2%	0	%
Safeguarding	1	0.2%	0	%
Support services	-	-	3	0.7%
Independent Sector	-	-	3	0.7%

Appendix 3 - Complaints - how received

How received	2022/23	%	2021/22	%
Via a Worker/commissioned provider	219	42.1%	103	23.8%
Email	140	26.9%	153	35.3%
Corporate call centre	79	15.2%	72	16.6%
Telephone	29	5.6%	36	8.3%
Letter	20	3.8%	24	5.5%
In Person	6	1.2%	13	3%
Via an Advocate	6	1.2%	7	1.6%
Via an elected member	5	1%	9	2.1%
Patient Opinion	5	1%	6	1.4%
Form	4	0.8%	7	1.6%
Via the Ombudsman	4	0.8%	2	0.5%
CQC	3	0.6	-	-
Healthwatch	0	-	1	0.2%
Care Opinion	0	-	1	0.2%
Total	520	100%	433	100%

Complaints - received from

Complainant - how involved	2022/23	2021/22
Relative	159	160
Carer	144	83
Service User	113	99
Member of Public	37	29
Other Agency	20	24
Worker/commissioned provider	15	3
Advocate	10	3
Parent	7	18
Solicitor	7	-
Friend	7	-
Other	1	14

Appendix 4 - Timescale performance

	Acknowledged within
	% within 3 days	% after 3 days	% within 20 days	% after 20 days
Resources	100%	-	95%	5%
Social Work and Social Care Provision	99.1%	0.9%	98%	2%
Strategic Commissioning	90.6%	9.4%	97%	3%
Public Health	-	-	%	0%
Total	97.7%	2.3%	96.6%	3.4%

Appendix 5 - Breakdown of Ombudsman complaints and enquiries received between 1 April 2022 and 31 March 2023

	Outcome
	Invalid or Incomplete	Advice given	Referred back for local resolution	Closed after initial enquiries	Not Upheld	Upheld	Total
Assessment and Care Planning							5
Charging							1
Safeguarding							3
Transport (including blue badges)							0
Direct Payments							0
Disabled Facilities Grants							0
Residential Care							4
Home Care							3
Supported Living							0
Total	0	0	3	15	1	11	30

Appendix 6 - Complainants by ethnicity provided by complainants

Ethnicity	2022/23 number	%	2021/22 number	%
White British	336	64.6%	267	61.7%
Not known	128	24.6%	114	26.3%
Asian Other	16	3.1%	12	2.8%
Black Other	14	2.7%	12	2.8%
White Other	7	1.3%	-	-
Any other ethnic group	5	1%	17	3.9%
White Irish	4	0.8%	-	-
Indian	2	0.4%	3	0.7%
Pakistani	2	0.4%	-	-
White and Black Caribbean	2	0.4%	-	-
Refused Information	2	0.4%	-	-
Black African	1	0.2%	1	0.2%
Mixed Other	1	0.2%	-	-
Black Caribbean	-	-	4	0.9%
Chinese	-	-	3	0.7%
Total	520	100%	433	100.0%

Complainants by gender

Gender	2022/23 number	%	2021/22 number	%
Female (including Trans)	284	54.6%	252	58.2%
Male (including Trans)	218	41.9%	162	37.4%
Not known	9	1.7%	9	2.1%
Joint (married / partnership)	8	1.5%	8	1.8%
Non-Binary	1	0.2%	2	0.5%
Total	520	100.0%	433	100.0%

Complainants by disability provided by the complaints

Disability	2022/23 number	%	2021/22 number	%
Disabled	349	67.1 %	243	56.1%
Not known	145	27.9%	151	34.9%
Non-disabled	26	5%	39	9%
Total	520	100.0%	433	100.0%

Appendix 7 - Learning from complaints

A number of service improvements have been made in response to customer feedback. Key themes of service improvements have included the training and performance management of staff, review of processes and policies and the revision of communication. Some examples can be found in the table below.

Independent Sector Supported Living	Lessons learned/action taken to improve the service
The parents of a service user who has a learning disability complained about the high turn-over of staff at the establishment and that the staff do not wear name badges. They highlighted “The Hello my name is” campaign. They also highlighted that they felt the communication was poor.	The commissioned care provider has taken a number of measures to improve recruitment and retention in their services. These include paying a higher rate for working weekends, a leaflet drop across the city and increasing payments in their refer a friend scheme. They also advertise on a number of social media platforms, their website and in the local areas where services are based. A letter was sent out to all families from the Service Manager with details of up-to date contact numbers for each property and contact numbers and email addresses for the management team.
A relative visiting a care user complained on the behalf of the care user. They observed that despite the care user advising the care staff that they had been incontinent in bed the care staff proceeded to administer the other care tasks instead of assisting the care user to change.	Staff were given further training around person centred support and communicating effectively and continence promotion training.
Concerns were raised by a parent that a care user had gained weight but was still wearing the same sized continence pads.	Staff to be proactive when monitoring weight. If a prescription needs to be changed to do it as soon as possible and make sure the right size of stock pads are there.
Finance
A complaint was made regarding the decision not to offer a care user a deferred payment option in respect of their property when going into residential care. The complainant was advised that due to the care user going into an interim service prior to them going into the care home they would not be eligible for a deferred payment option.	An apology was made and Officers in the team are undertaking further training in respect of deferred payment agreements.
A complaint about the Council’s blanket policy requiring an application for deputyship before it could carry out a financial assessment to determine contribution to care costs was found to be at fault. The Ombudsman found that the Council was at fault for not explaining why it would not exercise discretion to depart from its usual policy in this case.	In response to the lesson learnt from this complaint, staff guidance which forms part of mandatory training has been drawn up. It provides guidance for officers dealing with challenges from representatives who do not have relevant financial legal status to act for clients who lack financial capacity when the client requires a financial assessment. Officers involved in this area of work should refer to this guidance if and when a challenge to the Council’s policy and procedures presents itself.
Commissioned Residential Care and LCC A and H Finance (Charging): The complaint was about the care their relative received whilst resident at a residential care home commissioned by the Council. The placement was arranged and part-funded by the Council before the care user went on to self-fund for a time. Part of the complaint is also about charges made for care.	Lessons learnt included: The Council was to end its practice of allowing care providers to enter contracts with clients (or their relatives) to make additional charges for care that run concurrently to contracts the Council had entered with the same care provider to provide the client’s care at a lower cost. The Care Provider reviewed its standard terms and conditions and removed a clause that refers to a shortfall between the rate paid by the local authority and the Care Provider’s “full amount of charges”. The Care Provider amended its standard terms and conditions and inserted a clause that where it charges fees in lieu of a resident giving notice, those fees will be reduced in the event it re-lets the resident’s room within the period of that notice.
A family member raised concerns about the care user receiving incorrect invoices for their home care service.	Invoices are paid on the information provided by the commissioned home care provider. A credit was provided to the care user which reflected the delivered hours of care not the invoiced hours. The outdated billing system has already been acknowledged by the senior management and there was ongoing development and automation work taking place to update the billing system.
Concerns were raised about the delays in setting up a deferred charge when a service user went into a residential care home.	The Council plan to move to an online system to allow electronic upload of documents and a list of required documents to make the process much swifter
Assessment and Care Planning - area social work	Lessons learned
A complaint about the process to determine when the care user would reach the threshold to be eligible for Council support involved the social work team to refer the matter to the Office of Public Guardian (OPG). However, the failure by the social work team to share the response from the OPG with the Finance Team benefitted the family member by at least £38K from the error in not taking account of the OPG letter	The consequences of the poor communication was shared with all social workers via the regular staff Communications Bulletin.
Parent of a service user complained that the Council had not adhered to the agreed communications protocol. That as a result, they suffered avoidable uncertainty and worry about what the Council was doing for their child, who is a vulnerable adult.	All the relevant staff were reminded to ensure they comply with the communication protocol.
A family member and carer of a care user who had vascular dementia complained that their opinions were not considered as part of the assessment, instead the Social Worker put a lot of impetus on what the service user said they were able to do, which in reality was not the case. As a result, an insufficient care package was put in place. This caused a lot of stress and strain on the carer. The care user’s name was spelt incorrectly on the correspondence.	The Social Worker has been given additional training. The Manager of the service will look into how information can be communicated clearly. Work will be done with the team as to how they can alleviate the strain on carers. Peer checking has been introduced for outgoing mail.
The family of care user complained that they were unable to contact the Social Worker despite leaving several messages.	Social Worker’s voicemails will be reviewed for when they are on annual leave or on sick leave. Weekly meetings were implemented with the Social Worker on their return to work to ensure that casework goals were being met in an efficient manner.
Direct Payments: Ms X complained that the Council had not dealt properly with direct payments to Mrs Y. The Council was found to be at fault because it failed to carry out reviews of the direct payments, delayed a further review and did not provide sufficient support to Mrs Y.	The Council identified necessary service improvements as a result of Ms X’s complaint, including the restructuring of the Direct Payment service adding more resources in order to ensure that audit requests are followed up efficiently.
Telecare	Lessons learned
A care user complained that the service had made an incorrect claim that the fall pendant had set off the alarm.	The alarm was triggered as there was a ‘handshake failure’. This is where contact has been lost between the unit in a client’s home and the call centre. The operative will make several attempts to call the care user but will call 999 if they do not get a reply. As a lesson learnt from this complaint, a new Service Terms and Conditions document has been created to give to all new customers to make it clear to customers what the service will do, what it can’t do, how it will respond to alerts and how it will react in certain circumstances. This will make it clearer to people who use the service what can happen when an alert is made on the system.
Leeds Community Equipment Service
A care user complained that some equipment was left with their neighbour as they were out. The equipment was to assist with toileting and was not boxed. This caused great embarrassment to the care user.	The usual drivers are aware not to leave items should a care user be out. On this occasion a contractor was used. In future Managers will take more time to brief contractors on expectations, either in a meeting or an email. This will also be discussed in staff training.
Commissioned Residential Care	Lessons learned
A complaint about the quality of care received at a commissioned care home when the care user fell and injured themselves	Service improvements which have been implemented include: Clinical risk assessments to be completed for residents at high risk of falls and residents to be continuously assessed following admission. Risk assessments to be updated with any changes. Falls checklist to be completed following a fall and 24 hour observations to be completed. ReSPECT forms to be checked on admission and information sent to GP for updating. Information on MAR sheets to be accurate and clear. The Care Provider to follow up with residents’ health appointments. The Learning from this was shared with the staff team via team meetings.
A relative had raised concerns that the service user who resides in an extra care housing scheme who was assessed as nil charge but was paying for their home care service.	The Social Worker advised the commissioned provider that the service user’s placement was to be funded by the Council this should have included the home care element. The service user was being invoiced directly by the commissioned provider so the invoices were not coming via the Council, as remedy to the complaint all of the charges were refunded back to the service user. Additional training was provided to Social Workers.
The partner of a disabled care user complained that the care user was not being supported to take a bath or shower. Concerns were also raised regarding the conduct of one of the staff members in the care home, the service user felt bullied.	Personal hygiene charts were checked which concluded that there was a lack of shower/baths being taken. The charts did not document whether bathing had been offered but declined by the care user. In response to this complaint, additional checks were introduced to check both the standard of care and record keeping. Unannounced monitoring visits were introduced and a survey was sent to residents and their families which they could respond to anonymously and make any suggestions for improvement.
Recovery Hubs	Lessons learned
The family of a service user raised concerns after the service user suffered several falls, four of which were over two days.	The service agreed to put 121 Support if it was required and to review this after a 72-hour period. Hourly ‘check sheet’ were introduced following a fall which would note if equipment was working correctly and that the care user was wearing the equipment. A monthly falls analysis group was introduced to see it there were any themes and to scrutinise events leading up to the fall to establish if there were any trends.
The family of a care user was frustrated with the poor level of communication following the care user’s admission. They were not advised of the Covid restrictions in place around visiting nor that the care user was required to isolate. The care user was given an incorrect dose of their prescribed medication over two days.	A leaflet will be given to all new care users at the start of their stay. To ensure families receive information as soon as possible this will be sent electronically. The service has a procedure in which medication is checked by two members of staff before being administered. The error occurred due to the dispensing instruction being transcribed incorrectly. All staff involved in this error have had a reassessment of their competency to transcribe medication.
A complaint was received from a daughter of a care user regarding the lack of response from the staff at the service when the care user pressed the bell for assistance. The complainant found it distressing that her calls were unanswered by the service especially when she was trying to get things in place for the care user’s discharge.	Following the complaint, the Manager of the service has amended their exit questionnaire to include a specific question on call bell responsiveness. The Manager will be able to use the findings from these to quickly address any areas for improvement. The service has acquired a new mobile phone and adjusted the staffing cover for reception to ensure that the phones are manned during peak times and to ensure that calls are answered in a timely manner.
Independent Sector - Home Care	Lessons learned
Concerns were raised regarding carers not staying for the allocated time but recorded that they had done so.	A credit note was issued to the service user in recognition of the underdelivered care. memo was issued to all staff to remind them that they must stay for the allotted time unless all of their tasks have been completed and the care user or their family say they may leave. This should be reported the office so it can be documented. Regular service reviews to be carried out. Initially at 6 weeks after the service has commenced and thereafter every six months. Electronic call audits were also to be undertaken.
The relative of a Service User raised a complaint about carers leaving early on the allocated visits and not ensuring that their relative was wearing their falls wrist band.	The carers had been leaving early due to the care user making this request. In future the senior manager will address issues such as this with the care user or their families. All carers have been reminded to check the care user is wearing their falls wrist band before leaving.
The relative of a care user complained that the carers were not spending the allotted time with the care user. That they were not completing all of the agreed care tasks, were leaving the care user’s home in a ‘mess’ and complaints which had previously been raised had not been dealt with.	An email was sent to all staff reminding them to spend the full duration with the client to provide social interaction along with completing required tasks, and this was also raised during staff team meetings. An apology was made that previous complaints had not been addressed under the commissioned care provider’s complaints procedure.
In-house Mental Health Residential	Lessons learned
Concerns were raised about the behaviour of other residents using the service. The resident complained that other care users were belittling their sexuality. Other residents or their visitors were noisy and ringing her door bell.	The Manager of the service met with a representative of the Landlord and a Housing Officer for the commissioned service. In the meeting they discussed behaviours of concern and devised an action plan to manage these. The commissioned provider drew up an Acceptable Behaviour Contract for any tenants who may require this.
Hospital Social Work	Lessons learned
Concerns were raised following a care user who was hospitalised following suffering a fall at home. The family felt the fall was avoidable and should have been supported more by the Social Worker.	The Manager of the service will be discussing with the Social Work Team the importance of considering Telecare equipment for all those assessed under The Care Act 2014 either due to an identified high falls risk or as a preventative measure.
A complaint was received from the family of a service user when the service user received an invoice for a home care service following the care user’s discharge from hospital. The family complained that at no time were they advised that they would be charge for this service.	The Hospital Social Worker had failed to tell the complainant that there would be a cost for the care or that a financial assessment would be required so the home care fees were waived. The lesson to be learnt is that there is a cost to not providing information. This is reinforced via complaints training and feedback at management meetings.
Skills/Reablement	Lessons learnt
A complaint was made by a care user who is Muslim and felt their cultural needs were not being observed. That too many different carers were attending to their personal care. Visitors are required to either remove their footwear or use shoe coverings. The care user felt that the shoe coverings should be provided by the service as an essential requirement. As a service improvement the care user felt that more Muslim support workers could be employed.	Ensure that the Support Workers and administrative staff attend the mandatory Equality and Diversity training, included the required refresher training. Ensure that the administrative staff are made aware that the service does provide the shoe coverings if this has been identified by a Case Officer. The service aims to recruit support workers from a more diverse background by advertising vacancies in Muslim community centres
Accessible Information	Lessons learnt
A care user made a complaint regarding a survey they received. They found many of the questions confusingly phrased and not applicable to their current care and support situation.	As part of the complaint investigation a manager liaised with the RNIB regarding the process of translating the survey and liaised with a local organisation regarding their process for translating information into a screen readable format. The Translation and Interpretation policy was updated with a section on providing screen readable documents.
Independent Sector	Lessons learnt
A complaint was made by the daughter of a disabled service user following a deep clean of her parent’s home. They were upset by which items had been thrown away into the skip.	Apologies were given that some items were put in the skip without the service user’s knowledge or authority. As a result of the complaint: staff will attend specific training about hoarding and decluttering* staff will attending refresher training in reference to mental health two staff to attend appointments with people who need support around hoarding/decluttering. this reflects the complexity of the issue and will hopefully mitigates against potential misunderstandings that may occur

Complaints and Compliments, Adults and Health Directorate

Merrion House, 5th Floor East

110 Merrion Centre

Leeds City Council, LS2 8BB

Telephone: 0113 378 3080

Mobile: 07800 005 460

Textphone: 0113 222 4410

Email: complaints.socs@leeds.gov.uk.