Swindon Borough Council caused injustice to a woman whose daughter died while in its care, the Local Government and Social Care Ombudsman has found.
The LGSCO's report found Swindon at fault in the case where Mrs X complained about its failure to provide information about her deceased daughter’s care while she was a looked after child.
The Ombudsman said Swindon was unable to show it made any meaningful enquiries about what happened the night Mrs X’s daughter died.
Swindon has agreed to apologise, make a symbolic payment of £1,000, make enquiries about what happened and to reflect on its practices.
Mrs X’s daughter Y died in November 2017, but the council did not provide a final response to Mrs X’s complaint until June 2019, leading the Ombudsman to use his discretion to investigate even though the relevant events were more than a year old.
Y was severely disabled with cerebral palsy and spastic quadriplegia and was entirely dependent on others for all aspects of daily living.
She mostly lived with her family but spent several nights over the course of the year at a local residential care home, and this gave her ‘looked after child’ status.
In November 2017, Y was staying at the care home for a short period of respite care and was found unresponsive in the morning.
A multi-disciplinary meeting the next day concluded that there were no safeguarding concerns arising from Y’s death.
Mrs X felt the authorities had been too quick to assume the cause of death because of Y’s severe disabilities and wanted to know what happened in the hours beforehand.
She lodged a formal complaint and asked Swindon for a range of information, none of which the council said it had.
The Ombudsman found: “It is fair to say [Mrs X] was left in the dark about where to go for the answers she needed” and the council’s responses, “did not provide any information at all about Y’s final hours. I share the view of Mrs X that they were vague and unhelpful.
“From the evidence I have seen, this is because the council did not know the answers to the questions being asked. And as Y’s corporate parent, and the local authority that had commissioned the respite care, it should have done.”
A social worker told the Ombudsman: “It was not the role of social care to make additional enquiries as this could have delayed or caused confusion to the police investigation”, and this meant the council did not make any enquiries of the care home
The Ombudsman’s report concluded: “While I agree the council had a limited role in the immediate aftermath following Y’s death, it did not mean the council had no further obligations to answer the questions raised by Mrs X.”
It added: “At the very least I would expect any commissioner who had placed a looked after child in a care home who then died to have asked to see the daily care records.
"The council’s failure to do so is fault. There was further fault when it failed to do so when Mrs X asked entirely reasonable questions about the care her daughter received.”
The council has been contacted for comment.
Leader of the borough council David Renard told the BBC: "We accept the findings of the ombudsman and have improved our processes and provided additional training to staff to ensure families are fully supported in similar circumstances.
"The ombudsman is satisfied we have implemented all of the recommendations for each of the six upheld cases that were investigated.
"We always strive to provide the very best services we can for our local residents and take all complaints and feedback extremely seriously."