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Adult Social Care Complaints Resources, Local Government and Social Care Ombudsman

February 2019: This chapter was amended to add a link to Adult Social Care Complaints Resources, Local Government and Social Care Ombudsman, as above.

1. Introduction

This document details the way in which representations made about Hull City Council Community Care Services will be addressed under The Local Authority Social Services and National Health Services Complaints (England) Regulations 2009.

The services to which this procedure applies are Community Care Services to:

  • Older people;
  • People with a physical disability and sensory impairment;
  • People with a learning disability;
  • People with mental health problems;
  • Other vulnerable people.

The overriding philosophy behind this procedure is:

  • Listening;
  • Responding;
  • Improving.

2. Principles

This procedure and associated documents are about putting the service user, and / or their representative, at the centre of efforts to resolve the issues they have raised. We recognise the importance of listening to our service users’ experiences and views about our services – particularly if they are unhappy – and we want to make it as easy as possible for them to let us know their views. The procedures will ensure that representations are dealt with in a way which is:

  • Open: information gathering about the issues raised and the way in which they have been handled will be shared in full;
  • Clear: the representation and the way in which it will be agreed at the start with the complainant;
  • Responsive: the needs of the complainant and/or service user will be taken into account in determining the method of addressing their concerns;
  • Flexible: the complaint/representation handling will be determined by the nature of the complaint and views of the complainant;
  • Proportionate: the efforts to resolve and time taken in addressing the issues raised will reflect the significance of those issues;
  • Accessible: the procedure will be easy to get access to and to use;
  • Timely: complaint handling will be conducted in a timely way – rather than subject to preset timescales;
  • Resolution focused: at all points through the process we will look to resolution.

Complaints will be dealt with in a way that is most suitable to the issues raised rather than according to a set procedure. The means of addressing the complaint will take into account:

  • The complainants’ views;
  • The nature of the complaint;
  • The potential implications for the complainant;
  • The potential implications for the organisation.

We want everyone who is involved in a complaint to feel confident in the process and will achieve this through a process which ensures:

  • Concerns are taken seriously;
  • Complaints are dealt with promptly and effectively;
  • There is a full response and a clear outcome for complainants;
  • Complaints are dealt with fairly and even-handedly;
  • All those involved in the process are treated with dignity and respect;
  • There is equality of access and standard of service for all complaints, with particular consideration for those people who may find it more difficult to use the process e.g. younger children, people with disabilities, those whose first language is not English;
  • Services learn.

3. What is a Complaint?

A complaint is any expression of dissatisfaction about a service being delivered or the failure to deliver service to a customer.

A representation, concern or comment that requires action and a response will also be dealt with according to this procedure. (The term complaint / complainant is used for ease throughout this document but should be taken to apply these other representations.) Often service users / customers and their representatives do not have to make a complaint to have these issues addressed.

A complaint / representation can be made in person, in writing, by telephone or email or through the Council’s website. It can be made at any office. Every effort should be made to assist people in making their complaint and any member of staff can take a complaint, if that is what the complainant wishes.

4. Who can Complain?

A complaint can be made by:

  • A service user;
  • Someone who has been turned down for a service to which they think they are eligible;
  • The representation of a service user / customer – can be anyone acting on their behalf with their consent;
  • The representative of a service user / customer who lacks mental capacity, as long as they are seen to be acting in the best interests of that service user;
  • Anyone who is or is likely to be affected by the actions, decisions or omissions of the service that is subject to a complaint.

A complaint can only be made by / on behalf of someone to whom the local authority may have the duty or power to provide a service.

Any decision that a complainant is not a qualifying complainant will be made by the complaints manager in consultation with the appropriate service manager and complainant informed in writing.

5. What can be Complained About?

A complaint can be made about anything that is connected with the Local Authorities exercising of its social service function. This could be:

  • Quality or amount of service;
  • Charges for a service;
  • A decision;
  • Failure to follow correct procedure;
  • Delay;
  • A service not being provided;
  • Application of assessment and eligibility criteria;
  • Attitude or behaviour of staff;
  • The impact for an individual of the application of a local authority policy.

Matters that should be dealt with through other procedures will not be dealt with as a complaint:

  • Disciplinary or grievance proceedings;
  • Criminal investigations;
  • Where a statutory appeals process is in place;.
  • The complainant intends to take legal proceedings in relation to the substance of the complaint;
  • Allegations relating to safeguarding.

However if some aspects of a complaint are being addressed through other processes it does not mean that the entirety of the complaint should not be progressed. Issues that can be considered under the Complaints Procedure, as long as they do not compromise any other process, can still be addressed this way. It is possible for two procedures to run side by side.

If at any point in dealing with a complaint it becomes apparent that there are issues that should be addressed through other procedures that part of the complaint will be suspended and moved to another procedure as appropriate and the complainant informed.

6. Direct Payments

Service users and their representatives cannot raise issues under this procedure for a service that they arrange and pay for themselves through Direct Payments or a personal budget. Issues can be dealt with under this process that relate to the Local Authorities role in Direct Payments or Personalised Budgets, for example in assessing for amount of service or in the advice and assistance given in setting up such payments.

7. Contracted Services

Community Care Service (Adults) is increasingly working with the independent sector in commissioning services for service users. When people have concerns about these services we believe that they should have the same rights and standards in getting those concerns addressed as users of in-house services. Therefore, although all commissioned services are required to have their own procedures in place, service users can choose to have their concerns addressed through this procedure by coming to Community Care Services rather than the provider.

8. Single Integrated Complaints Process

This complaints procedure reflects the requirements and principals of ‘Making Experiences Count’, a procedure which is designed to ensure that there is a single complaint process across all health and social care organizations. This will provide a unified approach to complaints about integrated services and where complaints are made across organisations. Hull City Council’s Community Care Service is required to ensure that there is coordinated handling for such complaints and to advise and support complainants through the process.

9. Interagency

This complaints procedure reflects the requirements and principals of ‘Making Experiences Count’, a procedure which is designed to ensure that there is a single complaint process across all health and social care organizations. This will provide a unified approach to complaints about integrated services and where complaints are made across organizations. Hull City Council’s Community Care Service is required to ensure that there is coordinated handling for such complaints and to advise and support complainants through the procedure.

10. Delegations

Accountability for complaints management ultimately lies with the Chief Executive of Hull City Council; however the complaints resolution function will be delegated to the Head of Community Care Services.

This function is discharged by the Complaints Manager or the manager of the service receiving the complaint according to the process set out below.

11. Process

11.1 On Referral (frontline resolutions)

If a frontline member of staff receives a complaint direct they must take the following steps.

Confirm details of:

  • Complainant;
  • Service user;
  • Complaint;
  • Desired outcome.

Consider whether the issues can be resolved locally and promptly. If yes:

  • Agree with the complainant the steps that will be taken to resolve and by whom;
  • Timescale for response;
  • Form of response;
  • Make a record of the issues on service areas recording system for these representations;
  • Record responses.

If no:

  • Forward complaints to complaints manager;
  • Advise complainant (using guidance for frontline staff);
  • If a complaint is received by or forwarded to a team leader they should:

Consider whether local resolution has been tried / is appropriate.

If yes, follow steps as above.

If no, undertake complaint screening or, for more complex complaints, forward to complaints manager.

12. Complaint Screening

Complaint screening allows us to begin to look at the significance, or potential significance, of the complaint for the complainant and for the organisation and so indicates the way in which we should deal with the complaint. To screen the complaint the attached tool should used. Factors to take into account when screening a complaint are:

  • The likelihood of reoccurrence;
  • The degree of risk for the service user;
  • Degree of risk for the organisation;
  • Complainants’ views.

The complaint screening tool gives us three alternative ways of dealing with the complaint, starting at low impact issues (green), to moderate (amber) and potentially high impact – those with the greatest significance for service users and the service (red). They are dealt with progressively in ways that are increasingly formal and independent.

See also Complaints Initial Assessment Tool Procedure.

12.1 Green complaints

These complaints will be dealt with by the team leader or senior assessment officer for the service area responsible. If appropriate, a manager from another service area or independent investigator will be appointed.

The complaint / representation will be acknowledged within three working days.

If not already confirmed the complaint will be confirmed with the complainant, desired outcome established and the remit of the enquiries and time of response agreed. This should be done within ten working days.

Team leader will gather the necessary information in reaching a view on the complaint by:

  • Speaking with the complainant / service user;
  • Speaking with the relevant staff;
  • Consulting diary records;
  • Consulting any other records / documents as are necessary.

The responsible team leader will reach their conclusions on the complaint based on this information:

  • Write the response;
  • Identify any areas for action / service improvements;
  • Ensure that actions and improvements are carried out.

This complaint should be concluded within twenty working days of the complaint being agreed, this can be extended further with the agreement of the complaint if the complaint becomes more complex.

12.2 Amber complaints

Once it is identified that the complaint assessment indicates a complaint of moderate potential impact a complaint resolution plan must be drawn up. This will be done by the complaints manager or a nominated person in consultation with the complainant. The purpose of this is to assess and clarify the boundaries of the complaint investigation.

Consultation will take place with the relevant senior manager to agree the most appropriate and proportional way to investigate the complaint.

If appropriate, a manager from another service area or independent investigator will be appointed.

The findings will be reported back to the senior manager and complaints manager and decisions made about:

  • Whether the complaint is upheld or not;
  • What actions are required;
  • Any learning for service improvements;
  • Whether a meeting is needed.

The response to the complaint will be written by the investigator and will be sent out in the form of a report that addresses the substance of the complaint with a covering letter written by the senior manager outlining what actions will be taken to try and resolve the complaint. Included in this letter should be any lessons learnt for service improvement.

12.3 Red complaints

These complaints are the most complex and require a greater degree of formality and independence to address and resolve.

For these complaints the complaints manager will complete the resolution plan and in consultation with the relevant senior manager appoint an investigating officer. The investigating officer may be independent of the local authority and will be independent of the service area concerned.

The investigating officer will undertake the following in respect of the complaint:

  • Meeting with the complainant and confirming the complaint with them;
  • Interviewing staff;
  • Consulting all records;
  • Seeking any specialist advice / information.

The investigating officer will put together a complaint report and this will be discussed with the appropriate senior manager and complaints manager before any responses made to the complaints.

13. Resolution Planning

For all complaints that are assessed as being medium or higher impact after screening (Red and Orange) a complaint resolution plan must be drawn up. Resolution plans can be drawn up for complaints screened as low if the person dealing with the complaint wishes to do so.

The plan sets out the complaint and the means by which the issues raised will be resolved. In drawing the plan up it must reflect:

  • The complaints view;
  • The outcome that they are looking for;
  • Timescales for completion of actions to resolve their concerns.

The resolution plan will not be finalized until it is agreed with the complainant. Resolution plans will be sent to the complainant for them to agree and sign once the signed copy is received the actions set out within it can start.

14. Investigation Guidance

See also Complaints Guidance for Investigating Officers and Managers.

Medium and high complaints will usually be dealt with through investigation. More complex complaints and those categorized as high (Red) can be addressed through investigation by someone completely independent of the service concerned. The process will be:

  • Complaint resolution plan is agreed;
  • Complaints manager will appoint an investigator;
  • Investigator will confirm the complaint with the complainant and agree the remit of their investigation.

The Investigating Officer must gain a full understanding of the complaint and in order to do so will gather information by:

  • Interviewing the complaints, staff and anyone else who can assist;
  • Looking at relevant records and documents.

On the basis of this information the Investigating Officer will form an opinion about whether the complaint is upheld or not and make recommendations about resolution or redress.

If the complaint is being made on behalf of a service user they should be seen to confirm whether the complaint reflects their wishes and views, if they are not seen then an explanation for not doing so should be included in the report.

15. Findings

When the investigation / enquiries are completed a report will be prepared and will include:

  • Information about the process of the investigation;
  • Description of the complaint;
  • The information gathering;
  • Whether the complaint is upheld or not on the basis of the information;
  • Recommendations for resolution;
  • Recommendations for service learning and improvement.

16. Adjudication

See also Adjudication Process Procedure.

For all complaints that have been assessed as medium or high potential impact an adjudication meeting will take placed with the manager who has been delegated to reach a decision on behalf of the Chief Executive who is the Responsible Person

For orange / medium impact issues this will usually be the relevant senior manager.

For high / red complaints this will usually be the relevant senior manager or Head of Service.

The adjudication meeting will address:

  • The findings of the investigation;
  • The response to the complaint;
  • Any learning points and actions that need to be taken within the service;
  • Whether the Adjudication Officer or the Investigating Officer should meet with the complainant to explain the outcome of the complaint and / or any actions that will be taken.

17. Response

See also Complaints Resolution Flowchart.

If the complainant is dissatisfied with the response to their complaint then the complaint manager in consultation with the Investigation Officer responding manager will consider:

  • The reason for the dissatisfaction;
  • Whether this is a new complaint;
  • Whether the investigation adequately answered the issue first time round;
  • Whether there is any new information.

If it is felt that after this consideration there are grounds to revisit some or all elements of the complaint then this will be agreed with the complainant. If it is decided that there are no grounds to do so then the complainant will be advised of the next stage of the process, which is referral to the Ombudsman. They will be given the necessary information to enable them to do this.

18. Persistent Complainants

See also Persistent or Vexatious Complaints Procedure.

From time we will come across complainants who seek to raise a number of complaints or that become unreasonable in their conduct or expectations around contact. Whilst every effort should be made to address objectively any concerns that are raised we must also seek to be proportionate and not to expose staff to unreasonable behaviour.

19. Learning

It is a vital part of the process that services learn from the representations that are made about their provision. The process that addresses complaints will identify any areas for improvement or learning and will make suggestions for the actions that will be taken. This will be addressed in the response. Where necessary action plans will be drawn up and responsibilities assigned.

The person responsible for ensuring that these actions are followed through will be the person designed by the Responsible Person.

20. Mediation

See also Mediation Procedure.

For some representations it will not be appropriate, or possible, to resolve them through the process of enquiry and response. Particularly where there has been a breakdown in the relationship between the service and the service user or where emotions are running high. In these circumstances mediation is an option that will be considered.

The complaints manager will make the necessary arrangements after gaining the agreement of both those concerned. This agreement will be reflected in the complaint resolution plan.

Mediation by an independent mediator will allow both sides to:

  • Express their views;
  • Think about how to put things right;
  • Come together to reach a solution.

21. Recording

The Complaints Manager will keep a file on each complaint, containing all reports, letters, records of meetings and any other relevant papers. An electronic database of all complaints will be maintained. The electronic case file will not have detail of the complaint in it but will have a ‘flag’ to indicate that a complaint has been made and that the record of this is kept by the Complaint Manager.

Each establishment should have a complaint file. Care should be taken to make sure that this is not kept anywhere that would make it readily accessible, for reasons of confidentiality.

A complainant may have worries about the complaint not being kept private, if this is the case the detail of the complaint could be kept out of the establishment complaint file and a record placed simply giving the date of the complaint, the person making it and the date it was resolved. (Detail about the complaint will be kept on the Complaint Manager’s complaint file).

22. Monitoring

The Complaint Manager will ensure that records are kept of each complaint received including; the type of complaint, outcome of each and whether timescales were met and where possible statistical information about complainants. All learning will be recorded and reported back to the service areas above. The Annual Complaints Report will include a full breakdown of this information along with a summary of learning and service improvement and a review of the operation of the complaints procedure.