WCC CARE MANAGEMENT PROCEDURES
1 INTRODUCTION PAGES 2-7 2 SERVICE INFORMATION PAGES 9-21 3 ENQUIRY/CONTACT PAGES 22-24 4 REFERRAL PAGES 25-30 5 ELIGIBILITY PAGES 31-34 6 ASSESSMENT PAGES 35-45 7 SUPPORT PLANNING PAGES 46-50 8 CARERS PAGES 51-58 9 CONTINUING HEALTHCARE PAGES 59-60 10 RISK ASSESSMENT/MANAGEMENT PAGES 63-75 11 SUPPORT PACKAGES IN THE PAGES 76-83 COMMUNITY 12 RESIDENTIAL AND NURSING CARE PAGES 84-99 PACKAGES 13 MONITORING AND REVIEWS PAGES 100-105 14 DIRECT PAYMENTS PAGES 106-112 15 OCCUPATIONAL THERAPY PAGES 113-128 SERVICES 16 HOSPITAL DISCHARGE AND PAGES 129-132 COMMUNITY EQUIPMENT 17 JOINT WORKING ARRANGEMENTS PAGES 133-135 18 SERVICE USER AFFAIRS PAGES 136-140 19 MANAGING INFORMATION PAGES 141-146
January 2010 1 1. INTRODUCTION
Care Management Procedures
The purpose of these procedures is to provide guidance to care managers or other professionals carrying out care management functions or other responsibilities delegated to care managers, on behalf of the City of Westminster.
These procedures consist of or make reference to the relevant services, policies, other procedures and relevant forms, related to care management.
The document will be reviewed annually and updated as and when changes occur.
Using the Procedures
- These procedures need to be implemented in accordance with City of Westminster’s Equality and Diversity Policy,
- Actions involved, need to be taken within Health and Safety procedures,
- Any related work should be carried out within legislation and statutory guidance and related Council Policies and Procedures, AND
- Requirements of one’s registration with a Professional Body, where appropriate
The Westminster Standard
January 2010 2 Serving our customers is the most important thing we do. For this reason we are committed to delivering excellent customer service. By 2012 we want to be the best in Local Government. We will be defined by our standard of customer service, the Westminster Standard, and it is through this we will exceed the expectations of the people we serve.
WE DEAL WITH THINGS WITHOUT BEING TOLD
WE MAKE IT EASY
WE DON'T NEED TO BE ASKED TWICE
OUR CUSTOMERS MAKE US BETTER
WE TAKE RESPONSIBILITY
WE SERVE OTHERS AS WE WISH TO BE SERVED
Adult Social Services Mission is to:
Ensure that all vulnerable adult residents of Westminster have the opportunity to achieve the best possible health and well being,
Are enabled to have as much choice and control in their lives as they wish,
Are able to make an active contribution to the community and
Are free from discrimination or harassment.
Adult Social Services – care management duties and responsibilities summarised
The Social Services has a
- Duty to assess people who may be eligible for services (NHS and Community Care Act 1990), and
January 2010 3 - Are required to provide for their needs if the person is assessed as eligible for service under the Fair Access to Care Services (FACS) Guidance, at the FACS level at which the Council has agreed that they will provide a service.
- Duty to inform a carer of their entitlement to an assessment, and carry out the assessment if they request it
- Duty to apply the Mental Capacity Act in their work with People
- Responsibility to investigate where they become aware that a Person who is eligible for services or their carer is at risk of abuse or likely to be at risk of abuse
- Duty to prevent delayed discharges from hospital or to be charged where delay occurs
- Duty to provide sufficient Approved Mental Health Professionals to undertake assessments under the Mental Health Act
- Duty to work with the health services to provide services to people subject to Section 117 of the Mental Health Act
- Duty in relation to receiving people into Guardianship, under the Mental Health Act
- Duty to have sufficient Best Interest Assessors in place to complete assessments in relation to the Mental Capacity Act Deprivation of Liberty Safeguards
- Responsibility to commission care that does not deprive a Person of their liberties, where possible.
- Responsibility to work with other agencies, in particular the Health Service, to provide a seamless approach to assessment and care provision, and to safeguard vulnerable people
- Responsibility to promote independence, and have systems in place to allow People to self direct their care i.e. to make choices in relation to how their care needs will be met so that they retain maximum control over their lives, and therefore, the
January 2010 4 - Duty to discuss and promote Direct Payments with People who are eligible for services, as a way to meet their eligible needs, and
- Responsibility to make Personal Budgets available to all and a choice of personalised services.
Working Principles
- People who use services are citizens and they have rights - People are individuals and therefore, respect differences and work with difference - People make their own decisions - Shifting from a welfare approach i.e. knowing what is good for a Person, to deciding with the Person, what they see as an appropriate way to meet their outcomes - Achieve outcomes for well-being rather than for dependency; Promoting Independence and Enabling People to have maximum choice and therefore, control over their lives - Working positively with risk, and applying proportionate responses to risk - Apply the Mental Capacity legislation.
Aims
We support people to
live independently stay healthy and recover quickly from illness exercise maximum control over their own life and where appropriate the lives of their family members sustain a family unit which avoids children being required to undertake inappropriate caring roles
January 2010 5 participate as active and equal citizens both economically and socially have the best possible quality of life irrespective of illness or disability regardless of age retain maximum dignity and respect (Putting People First 2007 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati onsPolicyAndGuidance/DH_081118 )
Outcomes for people We will work with people to identify outcomes which promote: - Improved Health - Improved Quality of Life - Making a Positive Contribution - Exercise of Choice and Control - Freedom from Discrimination or Harassment - Economic Wellbeing - Personal Dignity (Our Health, Our Care, Our Say 2006 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati onsPolicyAndGuidance/Browsable/DH_4127552 )
Expectations from Care Management Provision
1. To support vulnerable adults to live at home, or in other community settings, and to move people into residential or nursing homes only as a last resort.
2. To apply FACS (Fair Access To Care Services Guidance) with consistency, to ensure equity in service provision and therefore ensuring the effective targeting of resources to meet the specific needs of vulnerable adults as per Council priorities.
January 2010 6 3. To promote self directed care.
4. To assess and provide services with a full understanding of risk, as demonstrated through risk assessments and risk management plans, contingency planning, and an emphasis on positive risk taking where appropriate.
5. To safeguard vulnerable adults and where restrictions have to apply to safeguard the Person, these will be proportionate to seriousness of harm, and will be managed in a way that empowers the individual to manage their situation and the risk, if possible.
6. To commission flexible, high quality, and outcome based services for people and carers which promote the principles of independence, diversity, dignity, equality, best value and that meet registration requirements, and council expectations
7. To work in partnership with people who use services, other council departments, statutory agencies, health and independent providers, to develop and offer a range of flexible, efficient and effective services, across the City
8. To respond in a timely way to all contacts from the public; responding in way that ensures professionalism, fairness and accessibility for all.
9. To work within legislation, statutory guidance, and Council Policies and Procedures
10.To record all matters related to work undertaken in relation to their duties and responsibilities appropriately, and to make all necessary entries on SWIFT, AIS and ESCR in a timely way.
Performance Management
Care Management is performance managed through a number of performance indicators as part of the government approach to evaluate and improve performance and to predict future needs.
January 2010 7 National Indicator Set – Key indicators for care management
No. Description NI Adults receiving Self Directed Support 130 NI Assessment waiting times - % of adults assessments completed in 4 weeks 132 NI Care package waiting times - % of adults initial care packages completed in 4 133 weeks NI Carers receiving carer services or advice and information 135 NI Adults supported (at home) to live independently through social services 136 NI Adults aged 18 to 64 with learning disabilities in settled accommodation 145 NI Adults aged 18 to 64 with a learning disability in employment 146 NI Adults aged 18 to 69 in contact with secondary mental health services in settled 149 accommodation NI Adults aged 18 to 69 on CPA in contact with secondary mental health services in 150 employment
January 2010 8 2. SERVICE INFORMATION
Older People/Physical Disability Service (OP/PD)
Phone Contact
0207 641 1444
0207 641 1175 (main number)
E-mail Contact [email protected]
Fax numbers
OP/PD South x3167
OP/PD North x5426
This service works with people who
- are over the age of 18 who have eligible needs that relate to being physically disabled or to ageing
- are under the age of18, where the young person is receiving services in Children services and may require services when they reach the age of 18.
The Customer Service Centre (CSC) is usually the first point of contact for people wanting information about services. The CSC has information that enables them to signpost people to appropriate services within the Council or outside of the Council. The CSC will transfer all callers where the Person needs more than signposting, to the Access Team, except where the Person is allocated to a worker in a team, in which case they will transfer the call directly to the allocated worker.
Letters faxes and e-mails where the Person is not allocated are dealt with by the Access team, for this service. The Access team will also see people who present in person.
January 2010 9 The Access Team only works with people who would usually be referred to the OP/PD service.
The Access team may
- signpost the Person to appropriate services, or
- assess and close the case because the Person is not eligible for services or
- support the Person to complete an assisted self assessment questionnaire, identify eligible needs and put services in places to meet these needs or
- Refer a complex case directly to the relevant team in OP/PD
(See below for further information on the ACCESS team)
Learning Disability Service (WLDP)
Telephone: 0207 641 7411
Duty [email protected]
Information and general advice: [email protected].
Fax No: 7641-7429.
Website: www.westminster.gov.uk/wldp
This service is joint service comprising of health and social services staff, which works - with people with a Learning Disability who are over the age of 18, who have a significant cognitive impairment i.e. an IQ of 70 or below, and also, significant social functioning impairment that is present from early childhood - jointly with Children’s services to assess those in transition from 16 onwards
January 2010 10 - With mental health services to manage people with a learning disability who also have mental health needs, via the Care Programme Approach (CPA) process. The service is being transformed as the results of a review are implemented. (Please refer to WLDP operational procedures in the Learning Disability section, for details of how the department operates).
People ring 0207 641 7411, to speak to the team administrators about a service related to the functions of the Adult Social Services. CSC transfers the case to the allocated worker, if the case is allocated, or to the Team Administrators of the Learning Disability Partnership. Where a call is received by the team administrators, this call will be passed to the allocated worker, if relevant, or to the Duty worker, or they may signpost the Person to more appropriate services.
Letters faxes and e-mails where the Person is not allocated are dealt with by the Team Administrator or the Duty Worker. The team will also see people who present in person at their office.
The Duty Worker may
- signpost the Person to appropriate services, or
- assess and close the case because the Person is not eligible for services or
- support the Person to complete an assisted self assessment questionnaire, identify eligible needs and put services in places to meet these needs or
- refer the case to their manager where the case requires allocation
Care Management as a function is undertaken by the Case Manager who can be either health or social care staff, within this Service.
Mental Health Service (MH) (including Mental Health Act Assessments)
January 2010 11 Duty Phone and Fax Numbers
West End CMHT Duty
Phone: 020 75346685 Fax: 020 75346643
Paddington CMHT Duty
Phone: 020 72669600 Fax: 020 72669611
Victoria CMHT Duty
Phone: 020 82372136 Fax: 020 82372287
Abbey Road CMHT Duty
Phone: 020 73283453
Fax: 020 73726365
This service is a joint service between health and social care and works with people that have a severe and enduring mental illness who
- May have social care needs or
- Health and social care needs.
- May need to be assessed under the Mental Health Act 1983 (as amended by the MHA 2007)
People or someone on their behalf, may telephone the CSC or call the Duty Officer directly to request a service related to the functions of the Adult Social Services or related to their Mental Health needs. CSC will provide the Caller with the number of the relevant team to contact.
In the South of the borough, GP alignment is in place - GPs are allocated Liaison nurses who visit the surgeries to assess People who are referred. This
January 2010 12 process is to be rolled out throughout the borough under the Modernisation agenda.
Other referrals are received by Duty. Where a call is received by the Duty team, this call will be passed to the allocated worker, if relevant; otherwise, it will be managed on Duty where a decision may be made or allocation recommended.
Letters faxes and e-mails where the Person is not allocated are dealt with by the Duty Worker. The team will also see people who present in person at their office.
The Duty Worker may
- signpost the Person to appropriate services, or
- assess and close the case because the Person is not eligible for services or
- support the Person to complete an assisted self assessment questionnaire where the needs are social care related only, identify eligible needs if the Person meets the eligibility criteria and arrange for services to be put in places to meet these needs or
- complete a Mental Health Assessment form and a Risk Screening tool where the needs may be of a combination of health and social care and deal with the case there and then or
- refer the case to their manager where the case requires allocation for either health or social care services
- refer the case to the appropriate AMHP if a MHA is required
Care Management as a function is undertaken by the Care Co-ordinator who can be either health or social care staff, within the Mental Health Services.
(The Care Programme Approach Procedure applies – refer to the procedure in the Mental Health Section of the Intranet)
(Refer to AMHP Approval Policy and Procedure in the Mental Health Section on the Westminster Intranet)
January 2010 13 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/do cuments/digitalasset/dh_087073.pdf (MHA Code of Practice)
Hospital Discharge Team
Phone Contact
0203 312 1522
Fax Number
0203 312 1292
For individuals who are in-patients within acute hospitals, they will be subject to Section 2 and Section 5 notifications under the Community Care (Delayed Discharges Act) 2003.
When it is likely a ‘patient’ will require Social Services on discharge from hospital a Section 2 notification will be given to the hospital discharge team by the registered nurse. This notification indicates the length of stay expected in hospital and gives a minimum of 3 days notice to complete an assessment of need. The ‘patients’ circumstances, condition and progress will be regularly reviewed and if discharge is postponed a cancellation notice will be sent to Social Services.
When an agreement has been reached by the multidisciplinary team including Social Services that the ‘patient’ can be discharged the registered nurse will issue a Section 5 notification.
This Team completes a contact assessment to determine eligibility and ensures that a community care assessment is completed so that services are in place to enable a timely and safe discharge from hospital.
January 2010 14 Calls related to Hospital Discharge should be transferred to the Hospital Discharge Team.
(Refer to referral and allocation pathway for Hospital Discharges in the OP/PD section on the Intranet)
(Community Care Delayed Discharge Act 2003 http://www.opsi.gov.uk/acts/acts2003/ukpga_20030005_en_1)
Deprivation of Liberty Safeguards (DOLS)
Phone Contact
Deprivation of Liberty administrator 0207 641 5630
Deprivation of Liberty Safeguards Lead 0207 641 5200
Fax Number
0207 641 1593
Email contact [email protected]
This is an assessment and authorisation service related to the legislative duties under the Mental Capacity Act Deprivation of Liberty Safeguards, managed by the Council on behalf of the Council and the PCT through a Partnership Agreement.
Appropriately trained workers are appointed as Best Interest Assessors to complete assessments
(Refer to Best Interest Assessor Policy on the Mental Capacity Act page on the Intranet)
January 2010 15 The Council acts as a Supervisory Body to commission assessments and authorise applications for Deprivation of Liberty, where the qualifying criteria are met.
(Refer to the DOLS procedure on the Mental Capacity Page on the Intranet)
Care Managers are required to commission care, where possible, that does not deprive a Person of their liberty.
(Refer to the DOLS policy on the Mental Capacity page on the Intranet) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/do cuments/digitalasset/dh_087309.pdf (Deprivation of Liberty Safeguards Code of practice)
This service also provides guidance to staff employed by the Council and NHS Westminster on matters related to the Mental Capacity Act.
Any calls related to this service should be directed to the Deprivation of Liberty Safeguards Administrator, and in their absence, the Deprivation of Liberty Safeguards Lead.
E-mails are passed by the Safeguarding Administrator to the DOLS lead to address.
Faxes are dealt with within the Safeguarding Service
Forms
This assessment and authorisation process does not use any local forms, and works totally with the forms issued by the Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPo licyAndGuidance/DH_089772
January 2010 16 Safeguarding Adults Referrals (SA)
Phone contact
0207 641 5222
Fax Number
0207 641 1593
Email contact [email protected]
Website: www.westminster.gov.uk/safeguardinagdults
Safeguarding vulnerable adults is a responsibility given to adult social services to lead on. It involves coordinating the safeguarding process, undertaking investigations, putting protection plans in place and monitoring alerts. A safeguarding alert can be raised for any adult that at the time of the incident occurring is within the borough boundaries of Westminster. The Person does not have to be ordinarily resident in Westminster.
A Safeguarding referral can be received by any team on any of the above numbers. The receiving team will check in SWIFT whether the case is allocated. If the case is allocated, the safeguarding referral will be forwarded to the relevant team. If not, in discussion with the Safeguarding Adults Team, the referral will be forwarded to the most relevant team for risk assessment by a Safeguarding Adults Manager who will decide whether or not it progresses under safeguarding or another procedure.
Referrers will be encouraged to complete the Safeguarding Adults 1 form that is available to down-load from the Safeguarding website and document store,
January 2010 17 and to send a copy to the Safeguarding Team for case-tracking and audit purposes.
Forms
SA1 – Safeguarding Alert Form
SA2 – Safeguarding Strategy Meeting Form
SA2A – Strategy Discussion Template
SA3 –Safeguarding Investigation Report Template
SA4 – Safeguarding Multi-Agency Case Conference Form
SA5 – Safeguarding Protection Plan Template
SA6 –Safeguarding Adults Checklist
(Refer to Westminster Safeguarding Adults Procedures on www.westminster.gov.uk/safeguardingadults and No secrets Guidance on http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati onsPolicyAndGuidance/DH_4008486 )
Appropriate Adult Referrals
Contact
Relevant Duty Team for people known to services
Volunteer service for people not known to services 0207 641 8055 or mobile number 07793516049
Request for an Appropriate Adult for vulnerable person in police custody should be directed to the Duty service of the Relevant Team that will best be
January 2010 18 able to undertake this role, within the context of the Person’s diagnosis and presentation at the time.
A Voluntary Service is in place for those people who need this service that are not receiving services from the Adult services.
Joint Homelessness Team (JHT)
Phone Contact
Duty – 9am-5pm, Monday to Friday on 0207 534 6711
This team works with People who are homeless and have mental health needs.
Points of access to the service are through the Duty system, street outreach or agency outreach. The team undertakes statutory and emergency assessments of its own clients but does not undertake emergency work generally. The team does not accept referrals of clients already engaged by or in receipt of locality mental health services
(Please refer to operational policy for this service in the Mental Health Section on the Intranet)
Substance Misuse (SMT)
Phone contact
Duty System - Monday – Friday 2.00pm-5.00pm on 020 7641 7470
The SMT is a Social Services care management team whose main purpose is to assess and care manage drug and alcohol users requiring residential, day
January 2010 19 care or other treatment programmes that have to be funded. The majority of these services are abstinence based and therefore most people referred to the SMT will want to achieve abstinence and will need to be abstinent at the point of entry to most day and residential programmes
(Please refer to operational policy for this service in the OP/PD section on the Intranet)
Emergency Duty Team
Phone Contact
0207 641 6000
Weekdays 5pm - 9am (Mon - Thurs)
Weekends 5pm Friday - 9am Monday
24 hour service through BANK HOLIDAYS
This team provides an emergency service to people of Westminster in relation of community care responsibilities and safeguarding issues; outside of office hours
(Refer to EDT procedures and Referral Forms on the General Care Management section on the Internet).
Occupational Therapy services
Referral to Occupational therapy services occurs following a community care assessment or a functional assessment, and a determination of eligibility. It is made internally via the care management service.
(Refer to OT referral procedure in the general care management section of the Intranet)
January 2010 20 People with No Recourse to Public Funds
This is a specialist area and specific staff with knowledge in this area deal with all referrals that come under this ruling.
Referrals are managed through the Duty process in relevant teams and services.
People who are Deaf or Hard of Hearing
Referrals for services may follow from an eligibility assessment by care management or may be made directly.
Contact Number: 0207 641 2673
January 2010 21 3. ENQUIRY/CONTACT
A Person or someone on behalf of the Person may make an enquiry which can be a request for information, assessment or assistance. A request for information that results in the person being diverted to other resources i.e. that do not lead to an assessment or the transfer of a call to allocated worker does not count as a referral
If the Person is requesting assistance or an assessment in relation to Community Care services, the worker dealing with the request should determine whether the person is the responsibility of Westminster Social Services. To be eligible for an Assessment, the person referred must:
be a resident of Westminster, or be homeless in Westminster, and
where possible, have been referred with their consent, or have self- referred
Contacts re: Safeguarding Adults or Mental Health Act Assessments or Unlawful detention under the Deprivation of Liberty Safeguards will usually be made by a third party rather than the Person themselves, and can apply, in addition, to people who are not the responsibility of Westminster.
Meaning of 'ordinary resident'
There is no definition of 'ordinarily resident' in the National Assistance Act 1948 and the term should be given its ordinary and natural meaning subject to any interpretation by the courts.
The meaning of 'ordinarily resident' or 'ordinary residence' has been considered by the courts and regard must be had to such cases as:
Shah v London Borough of Barnet (1983) - Lord Scarman stated that “unless … it can be shown that the statutory framework or the legal
January 2010 22 context in which the words are used requires a different meaning I unhesitatingly subscribe to the view that 'ordinary resident' refers to a man’s abode in a particular place or country which he had adopted voluntarily and for settled purpose as part of the regular order of his life for the time being, whether of short or long duration”.
Levene v IRC (1928) - Viscount Care said that 'ordinary residence' connotes residence in a place with some degrees of continuity and apart from accidental or temporary absences. http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/Ordinaryreside nce/DH_079346
Legal section has advised that, if someone moves out of our area or into our area, the financial responsible authority is where they are deemed to be permanently resident. Permanence would be decided by the Court based on what the intention of the person was. So if someone moves out of Westminster and lives with relatives or friends, even if they still had a residence in Westminster, they would no longer be Westminster’s financial responsibility if they could be shown to have no intention to return to Westminster. If the person has no current or recent address, the Local Authority where the person presents themselves is responsible.
Who deals with an Enquiry?
- Customer Service Centre
- Team Administrators
- Duty Worker
(See Service Information pg 9-22)
Outcomes of Enquiry
- That the Person is not eligible for services from Westminster and therefore does not receive an assessment
January 2010 23 - That the Person needs advice or information and that advice and information is given at the point of contact, and no assessment is required
- The request is better dealt with in another service within or outside of the Council and the Person is signposted to the appropriate service, and no assessment is required
- The Person needs an assessment or Westminster has other statutory duties towards the Person, or in relation to the presenting situation
An enquiry or contact that does not lead to an assessment is not a referral.
January 2010 24 4. REFERRAL
An Enquiry that leads to an assessment is referred to as a REFERRAL.
Types of Referrals
1. Request for assessment for Community Care services. This request will usually be made by the Person themselves, or another person on their behalf with their consent, or on behalf of a Person, for whom someone may have concerns about risks, or on behalf of Person who they reasonably believe lacks capacity and could benefit from the assistance of the Social Services. 2. Request for a Carers Assessment by a Carer whose Cared- for is eligible for services (the person does not have to be a in receipt of services in order for the Carer to receive an assessment, they just have to be eligible for services) 3. Referral from a hospital to arrange the discharge of patient, made by ward staff 4. A Safeguarding Alert – a concern raised by the Person themselves, or someone else where they know or suspect that the Person is suffering abuse or at risk of abuse 5. Request for a Mental Health Act Assessment – a referral from another local authority or health authority or a Nearest Relative for an Approved Mental Health Professional to be appointed for a Person from Westminster to undertake a Mental Health Act Assessment. 6. Request for services by a Person who has No Recourse to Public Funds 7. Request for an Appropriate Adult by the police, for a vulnerable person, who is in the custody of the police. 8. An alert that an unlawful detention is occurring in a care home or a hospital by any person or a Request for an authorisation for a Deprivation of Liberty by a care home or hospital.
January 2010 25 Referral type 1 and 3 results in an assessment under the CCA 90.
Referral type 2 and 4 may lead to an assessment under the CCA 90.
The remainder of the Referrals require specific responses.
Standards for Referrals
1) The referrer will receive a call back from an appropriate person within 2 working days to confirm receipt of referral, and to inform them of the process that will be followed in relation to the case, and also the timescales within which the process will be completed 2) The referrer will be given a telephone number to contact to receive progress on the case
A Contact Assessment determines whether the Person is eligible for services from Westminster (refer to Eligibility section, pg 33-36), and therefore should be completed for each person who requests an assessment or a community care service, or any person for whom such a service has been requested where appropriate, because of their vulnerability or because they are deemed to lack capacity in relation to this matter.
The ACCESS team completes the contact assessment for people referred to the OP/PD service.
In all other teams, there are provisions in place to complete these assessments within the duty service.
The assessments are completed within 2 working days.
A Contact assessment gathers relevant information to
- Make an evidenced based decision regarding eligibility (see section on Eligibility)
January 2010 26 - Establish whether there is Mainstream or Community Resources that could meet their needs. Give appropriate information and advice to enable independence. - Ascertain whether their request falls within other legislative duties and responsibilities that are delegated to the Council - Ensure that any further allocation is made within the appropriate service so that the Person is not passed from one team to another and therefore, finding themselves having to repeat their situation many times over, thus affecting their experience of the service - Avoid delay, and assist with prioritisation, and appropriate and timely intervention within the team.
The following information should be gathered for a request for an assessment, as minimum:
- If this is a third party referral, does the Person who is being referred know about the referral? Does the person have capacity to consent to the referral? - Is there a Lasting Power of Attorney or Court Appointed Deputy in place? - Why is the Person being referred? - What are the specific issues? - Does the Person have a disability? - What are the risks? - What are the immediate risks? - Is there a carer involved? - Is there more than one carer? - Are there children under 18 living at the address? - Are there any other vulnerable adults living at the address? - What support is currently received – by whom – frequency? - Is anyone able to provide necessary support as an interim measure? - Expectations of referrer/Person?
January 2010 27 It is important for the Care Manager/Access Officer to ascertain whether the Person is receiving maximum entitlements in terms of finance, including benefits, an outcome of which could mean that the Person manages their own needs and remains in control of their own life and choices.
The following information is required for a request for a carer assessment:
- Who is their cared-for? Is he/she known to services? - Has he/she been assessed for services? - Was he/she assessed as being eligible for services? - What are the caring issues? - What is the effect on the carer? - Are there immediate issues? - Are there any other vulnerable adults or children in the home? - What are the risks to the carer, cared-for and any other vulnerable person? - How immediately is support is required? - Is there anyone that can provide care?
If the ACCESS team or Relevant Officer in other services identifies a Safeguarding issue in relation to a Child or Adult they must act promptly to alert the Children’s/Adults Safeguarding Services to the concern.
Self Funders
People who are self-funding are entitled to an assessment of need and should not be kept waiting longer for assessment due to their financial status. Usual timescales for completion of the assessment apply.
Outcome of Contact Assessments
January 2010 28 - The Person is not eligible for services i.e. they do not meet the FACS criteria at the level at which the Council has agreed to fund services
- During the assessment the issue of concern is resolved through signposting, appropriate information and advice, and no further work is required on the case.
- A Person is eligible but does not require services
- The Person meets the eligibility criteria for Preventative services or small/temporary changes to care packages, these are put in place and recorded appropriately, thus requiring no further assessment from the team
- The Person needs are complex or risk is high, and determining their needs requires further assessment, in which case the case is transferred to the appropriate team for allocation (OP/PD only) or needs allocation within the team.
Before a decision is made to close the case at this point, sufficient information should be gathered to ensure that
- A Person who could be in receipt of services is not excluded
- Non-intervention will not lead to significant deterioration
- The Person or a vulnerable adult or a child is not at risk.
Meeting Needs following Contact Assessment
The ACCESS team and the Duty teams can provide for needs at the stage of assessment. These needs can include
- Referral to the Re-ablement Team
- Referral to C.M.H.T or Dependability
- Referrals to Charities
- Referral for Benefits check
- Support with completing benefit forms
- Registration of Disability
January 2010 29 - Information/advice on mainstream, community resources.
(If no further services are required at this stage then the case could be closed.)
- Setting up Preventative Services
- Referral for Telecare
- Small variations to care packages
- Short term but inexpensive crisis intervention packages
Discussions about managing needs through Personal Budgets should also be discussed with People who receive services at this point. However, it is recognised that where the need is immediate, services will need to be put in place, pending the set up of a Direct Payment.
Review
Services provided at this stage also warrant a review as per requirements as stated in the procedures for each provision, and where these are short term, to enable continuity should be provided by the team setting up the service, otherwise at least the first review should be completed by said team, and the case transferred to the review pool for ongoing review.
Forms
Contact Assessment Form
FACS grid
FACS form
An Enquiry that leads to an assessment is a Referral and should be recorded on SWIFT
Follow SWIFT guidelines for recording all other Referral types.
January 2010 30 5. ELIGIBILITY
Refer to the Guidance on the DOH website: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA ndGuidance/DH_4009653
Introduction
Before the introduction of Fairs Access to Care Services (FACS) guidance (2003), the local authority had a duty to assess but did not have to meet need if resources were not available to meet need. This resulted in inconsistency in terms of who would and who would not receive services. In order to address the inconsistency, FACS was introduced, and local authorities were asked to identify a level out of the 4 levels (see below), at which they would provide services (taking into account their resources). The local authority was then required to meet the eligible needs within the agreed bands. Exceptions are where a Person is not eligible due to not being an Ordinary Resident of Westminster or by virtue of their immigration status; however, the latter group may become eligible under certain circumstances.
The FACS guidance is under review but remains relevant at the time of writing this document.
The framework is graded into 4 bands, which describes the seriousness of the risk to independence or other consequences if needs are not addressed. The four bands are (see framework):
CRITICAL
SUBSTANTIAL
MODERATE
January 2010 31 LOW
Standards for determining eligibility
1) The application of the FACS criteria should be consistent throughout all service areas
2) The criteria should apply fairly to all people in a service area
3) The determination of eligibility should be recorded with appropriate evidence
Westminster and FACS
Westminster has agreed to provide services to People who meet the Moderate level of FACS Eligibility.
In order to be eligible for services the Person will need to be assessed. Their needs are then rated against a grid to determine their eligibility for services. If the Person’s needs fall within the banding that the Council has agreed to fund services, then the person is eligible for services and needs must be met. If the person falls outside the band and is therefore, not eligible for services, they should be advised to and can be supported to access services within the community in order to prevent deterioration.
Not all needs can be met by the Council for example, health needs and not all needs need to be met by the Council; the person’s social network can meet needs, as can the community network, and also universal services that are increasingly becoming more inclusive can absorb need.
The Council also cannot finance the eligible needs of a Person who has been financially assessed as being able to purchase their own care.
January 2010 32 A council is responsible for managing its budgets and do not have to meet needs in the way that a person might wish it although they will make every attempt to be person centred and focus on community options, for instance, 24 hour care in the community versus 24 hour care in a residential home. A council can opt for what is value for money as long it objectively meets the needs of the Person. It also has to take into account any risks, when reaching its conclusion
Determining Eligibility - Process
When determining eligibility these factors need to be taken into account, risks to independence, in the following areas.
Health
Quality of life (including dignity, functional ability, being able to access the community, to be involved in the community)
Choice
Economic well being
Psychological well-being
Environment
Family and Social Network
Other Risk Factors
When arriving at a conclusion, assessors should gauge the needs against the grid issued by the DH and internal guidance from Westminster and record their evidence for their decisions
Guidance is available for MH services (see attached)
Guidance is available for OP/PD services (see attached)
Guidance is available for SMT service (see attached)
January 2010 33 Guidance is available for the JHT service (see attached)
Forms
Demonstrate decision against FACS grid
Complete FACS form
People with No Recourse to Public Funds
In some instances a Person who is not a citizen may be eligible for some support, if not providing the service will be in breach of community treaty rights or their human rights. This is a specialist area of work that involves specific assessments.
The Substance Misuse Team has written a policy on assessments under the Nationality, Immigration and Asylum Act 2002 which can serve as a reference for all teams when working in this area (Refer to the policy on the general care management page on the Intranet).
Staff must ensure that they work closely with the Legal services in relation to these cases, and with guidance from their managers.
January 2010 34 6. ASSESSMENT
Legislation
The National Health Service and Community Care Act 1990 made assessment of need for community care services a duty of local authorities.
Where it appears to an authority that
‘any person for whom they may provide or arrange for the provision of community care services may be in need of such services’ the authority must carry out an assessment of need for services and decide whether the need calls for the provision of services.
Other guidance
Independence, wellbeing and choice
Support provided by the Social Services focuses on enabling the Person to achieve well-being through
- Promoting independence,
- Maintaining people in the community,
- Promoting choice of how their needs will be met, and
- Enabling the Person to have maximum control over their lives,
All of which will could involve positive risk taking. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPo licyAndGuidance/DH_4106477
Self Directed Care
January 2010 35 Whereas the Social Services continues to have a responsibility to assess eligible needs, the Personalisation agenda places an emphasis on choice and control so that People are given greater control to provide the information to inform their needs through the use of self assessments/assisted self assessments, and enable systems where the Person has optimum choice and control over how support is designed and delivered to meet their eligible needs
(Putting People First, DH 2007).
LAC (DH)(2008)1: Transforming adult social care http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/LocalAu thorityCirculars/DH_081934
Individual Budgets, Personal Budgets and Direct Payments
The systems that enable the delivery of self directed care are where People are given a budget to spend on their eligible needs; therefore, a Person may receive
- An Individual Budget which is funding from various streams to meet their needs, or
- A Personal Budget which is funding solely from Community Care, which may be paid as a Direct Payment which is a cash payment in lieu of community care provision.
Staff are required to discuss Direct Payments with People who may be eligible for services, including those People that lack capacity to manage this type of care provision as long as it is in their best interest and there is someone who will manage these on their behalf, as an option for meeting needs. Staff, however, can only provide for eligible needs and cannot support a plan that results in unacceptable risk.
Standards for Assessments (including self assessment questionnaires)
January 2010 36 - The Person will be communicated with in a way that they understand and enables them to fully participate in the assessment
- Assessments that are of PRIORITY LEVEL 1 (these are cases with high risk, usually where there are no options to manage the risks on an interim basis without community care support) will receive an assessment visit within 3 working days, or sooner where necessary
- Assessments that are of PRIORITY LEVEL 2 (these are cases where there are interim measures in place to manage risks but they are not sustainable for a long period) will receive an assessment visit within 7 working days
- Assessments that are PRIORITY LEVEL 3 ( these are all other cases) will receive an assessment visit within 14 days
- Assessments of all PRIORITY LEVELS in OP/PD, Substance Misuse and Joint Homelessness Team, Mental Health Services and Learning Disability services will be completed within 4 weeks, as per Performance Indicators
- In all cases, where Children are moving into Adult services in a planned way, the assessment process will be longer but will result in a service being available where the Person is eligible, by their 18th birthday
- Assessments, including statements of need and how needs will be met; of all PRIORITY LEVELS will be sent to the Person being assessed, and their Carer or IMCA or Advocate, if relevant, by the date of completion as stated above.
Summary of Process so far
An Enquiry has become a referral.
A Contact Assessment has been completed and the matter resolved at that stage. A review will be arranged if services have been provided. This review may take place in the ACCESS team or by a Placement Monitoring Team.
A Contact Assessment has not been completed and the case is transferred to a team in OP/PD, or for allocation in other services.
January 2010 37 This section relates to the Assessment process beyond the Contact Assessment, but the Legislation and Statutory Guidance applies to Contact Assessments as well.
Allocation
The Team Manager will appoint a relevant care manager or assistant care manager or another appropriate professional, based on qualification and experience, and with the right skills, taking into account their caseload, to complete the assessment. The allocation will take into account the complexity of the case and the urgency with which intervention is required.
Types of Assessment
1) Functional Assessment
2) Self Assessment
3) Continuing Care Assessment
Functional Assessment
A Functional Assessment is completed where the need is solely for equipment. The care manager will determine eligibility for services and make a referral for basic equipment if required. They may also make a referral to an Occupational Therapist if a more complex functional assessment is required.
Supported Self Assessment
Introduction
The Council expects Assessors to use the Supported Self Assessment Questionnaire (SAQ) to complete assessments with People who are new to the services or whose needs have changed (except for those People that are likely to meet the Continuing Care criteria, or those People that are assessed
January 2010 38 as lacking capacity with regards to the decision about their accommodation and the best interest decision is that they should move into residential care).
An SAQ should be used where a Person may move to residential care. Although at present, personal budgets are not available to people who move to residential care, the Person, if they know what funding they may be entitled to, may be able to identify ways to manage their care in the community.
The SAQ comprises of 3 sections,
- the first relates to the Person’s finance (assessors must assess whether the Person is receiving their maximum entitlements to benefits and other funding entitlements),
- the second relates to the Person’s view of their situation and
- the third section is the Professionals assessment.
The assessment cannot depend solely on information that the Person provides because although the Person may know best, what they need in order to meet their needs and should have choice and be in control and be responsible, the duty to assess still sits with the Local authority as per the Community Care Act (R(B) v Cornwall County Council 2009). The Local Authority also still needs to determine eligibility (FACS) and has a responsibility not to put a Person at unacceptable risk.
Completing the SAQ
When completing the SAQ, a Care Manager may want to ask some of the following questions
Supported decision tool (some questions that may be asked –DH 2009)
1. What is important to you in your life?
2. What is working well?
3. What isn’t working so well?
January 2010 39 4. What could make it better?
5. What things are difficult for you?
6. Describe how they affect you living your life
7. What would make things better for you?
8. What is stopping you from doing what you want to do?
9. Do you think there are any risks?
10. Could things be done in a different way, which might reduce the risks?
11. Would you do things differently?
12. Is the risk present wherever you live?
13. What do you need to do?
14. What do staff/organisation need to change?
15. What could family/carers do?
16. Who is important to you?
17. What do people important to you think?
18. Are there any differences of opinion between you and the people you said are important to you?
19. What would help to resolve this?
20. Who might be able to help?
21. What could we do (practitioner) to support you?
(Independence, choice and risk: a guide to best practice in supported decision making Department of Health 2009)
Issues for the practitioner to consider
When using the tool with the individual, consider carefully the following aspects of the person’s life and wishes:
• dignity
January 2010 40 • diversity, race and culture, gender, sexual orientation, age
• religious and spiritual needs
• personal strengths
• ability/willingness to be supported to self care
• opportunities to learn new skills
• support networks
• environment – can it be improved by means of specialist equipment or assistive technology?
• information needs
• communication needs – tool can be adapted (braille, photographs, simplified language)
• ability to identify own risks
• ability to find solutions
• least restrictive options
• social isolation, inclusion, exclusion
• quality of life outcomes and the risk to independence of ‘not supporting choice’
(Independence, choice and risk: a guide to best practice in supported decision making Department of Health 2009) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPo licyAndGuidance/DH_074773
The Care Manager has to complete their own assessment and in addition to information given by the Person, may want to gather information in the following areas:
- Family situation – including personal details, members of the household and ages. These details should enable the Assessor to have a dialogue about these members of the family, including children, and their vulnerability in relation to the difficulties that Person is
January 2010 41 presenting, or their own difficulties. It is important to note that people are part of a wider network, and difficulties that a person encounters can send ripples into the network, affecting therefore, more than just that person. A holistic approach is required to affect effective changes in such situations.
- Services That Are Currently Provided – is the Person receiving services from any source currently, what services and to what end? This includes paid and unpaid support, from the health, social care, private or voluntary sector. Are these time limited? How successful are these to achieving the outcomes the person seeks?
- What type of support (and how often), does the Person receive from family and friends and their informal social network? Is this support sustainable?
- Person’s past medical, educational history and social history
- Any available assessment reports
- Forensic history – any criminal convictions, what are these for, any ongoing cases? Who is supporting the Person with this? Has he a solicitor etc
- Care Programme Approach – is the person subject to CPA – which team, contact details
- Current Legal Status – Detained, S117, DOLS
- Generally – Is there a Deputy or Attorney in Place?
- Has the person made an advance decision – where is this held?
The assessment process must gather information, where the Carer is willing to be assessed, about the Carers situation. The carer may have a joint assessment or separate assessment. What does the carer do for the cared for? How does this impact on their opportunities to work or study, and have a social life? What is the impact on their health and their other responsibilities? Is it sustainable? The finding must be taken into account when determining eligibility and determining needs. (See carers section)
January 2010 42 Where complex situations and risks exist, assessments will often require the input of other professionals, including some health assessments.
Any assessment should gather information that is pertinent to the assessment and avoid unnecessary intrusion and invasion of privacy; however, care should be taken not to be too minimalistic in information gathering so that needs are not properly identified and risk factors missed.
It is important that the care manager takes a long term view to assessment, to avoid the Person being re-referred and also to effect a change that will have the most impact on promoting their independence for the longest time possible.
Assessors must act on concerns swiftly to prevent harm, further harm, abuse or unacceptable risk to a child or an adult.
Assessment Decisions
The Assessor must discuss their assessment findings with the Person. If the Person disagrees with the Assessor, the Assessor should aim to resolve these but if they remain unresolved and the Assessor is able to evidence their findings, these should be recorded in the SAQ. The Person must be notified of their right to complain and also the procedure for making complaints.
FORMS
Contact Assessment
FACS grid
FACS form
SAQ
Risk Assessment
Carers Assessment
January 2010 43 SAQ and People who lack Capacity
A Person, who has been assessed as lacking capacity in relation to having Direct Payments, is also entitled to have their needs met through Direct Payments, where there is someone who will manage these on their behalf.
An SAQ should be completed for a Person that lacks capacity in relation to their care and treatment, where the best interest decision is that their needs are not managed in Residential Care, and reference should be made to the following, in the SAQ:
- that the Person is supported (an informal carer or/and an advocate or IMCA as per legislation)
- that mental capacity assessments are completed for every decision where the Person is deemed to lack capacity, and
- that each decision where the Person is assessed as lacking capacity, is linked to the best interest decision making process, (decisions can be made in multi-disciplinary meetings, but the Person who is carrying out the act must be satisfied that the act that is being carried out is in the Person’s best interest and the decision maker for social care matters is the community care assessor)
A Carers assessment should be offered to a carer (refer to the definition in carers section), and if they take this up, the findings have to be considered when determining the eligible needs to the Person.
Where the best interest decision is that a Person that is assessed as lacking capacity in relation to his care and/or treatment moves into residential care, a FACE form should be completed.
Assessors must act on concerns swiftly to prevent harm, further harm, abuse or unacceptable risk to a child or an adult.
January 2010 44 FORMS
SAQ6
Risk Assessment
Carers Assessment
FACE Overview Form
FACE Mental Capacity Form
January 2010 45 7. SUPPORT PLANNING
Indicative Budget
The SAQ once completed, is submitted to the Resource Allocation Team (RAS) who provide an indicative personal budget for the Person, i.e. an amount of money that is available in order to meet the needs of the Person as identified by the SAQ. The RAS team will also indicate the maximum financial contribution that the Person will need to make towards the package. Where the amount of funding allocated entitles the Person to apply for to the Independent Living Fund (ILF), the Care Manager should make such an application.
Independent Living Fund
To qualify for ILF, the Person must:
get at least £320 worth of support a week or £16,640 a year from social services. This support could be something like going to a day-centre or getting money from a direct payment scheme;
get the higher rate care component of Disability Living Allowance (DLA);
be at least 16 and under 65. You must apply before your 65th birthday. The funding can continue after your 65th birthday as long as you still meet all the other conditions;
be living in the United Kingdom (UK);
have less than £23,000 in savings/capital (this includes any money your partner has. http://www.ilf.org.uk/
Once the Person knows how much they have to spend, they can then proceed with determining how they want their needs to be met. They will need to complete a support plan. A Care Manager can assist them with
January 2010 46 creating the plan, and will give them all the advice they need. The care manager must advise the person that they have the option of being offered external brokerage rather than support planning from the care manager.
The Care Manager will need to notify the Person that
- The Support Plan has to meet the eligible needs, and cannot place the Person at unacceptable risk
- The way the Person manages their needs within the budget cannot include anything that is illegal
- The budget in indicative and may still change
- The final plan and cost has to be authorised by a Manager
Support Plan
A Support Plan must demonstrate
- What is important to the person - What the person wants to change or achieve - How will the person be supported - How will the person use their Individual Budget - How will the person’s support be managed - How will the person stay in control of their life - What is the person going to do to make this happen
And how it meets the following outcomes
1) Improved Health 2) Improved Quality of Life 3) Making a positive contribution 4) Exercise of Choice and Control 5) Freedom from discrimination and harassment 6) Economic Well being 7) Personal Dignity and Respect
Support Planning Principles (City of Westminster)
January 2010 47 Following a completed SAQ and RAS indicative allocation, support planning should be undertaken using the following principles.
The RAS allocation is indicative and is the upper funding limit for the support plan. It should be made clear to the Person receiving services, that this is not a guaranteed budget, and they may receive a reduced budget if the support plan can be provided for less. The actual budget is agreed when the support plan is authorised.
Support plans must show value for money.
People who have had a previous care package, expenditure should not be greater than was previously given, except where there has been a change in need requiring a more expensive resource. The cost of the support plan should be the same as or less than the indicative budget. The personal budget should allow greater flexibility within the support received but should not cost more.
Support plans should be outcome focussed and include an action plan to show how the support plan will be implemented.
Each support plan should have a contingency plan clearly described, which addresses any risks. However the contingency plan does not necessarily occur additional costs, and where additional costs are requested these should be proportional to the contingency need.
Where respite is required, this should usually be linked to a Carer’s Assessment. However, it may be agreed that respite is attributed to the Person, in which case it will form part of the Person’s support plan.
January 2010 48 Support Planning should not include expenditure on holidays if this incurs an additional cost. However, if the cost of the holiday can be met within the cost of the weekly support plan, this may be agreed.
The resource allocation is approved when the support plan is agreed. However, if during the course of the year the service user has been able to make savings in their support plan, they may be able to use the saved funding on other services if these support the outcomes identified in the support plan. However, this must be authorised by the team manager/service manager.
Expenditure for Items of furniture, computers or white goods will not be agreed unless it can be shown that this provision means a reduction in other expenditure in the support plan. Consideration should be given to community care grants/loans and other resources) e.g. U can do IT for computer provision.)
Wider resources should be used whenever possible. This will involve accessing universal services from other departments and using other community resources.
Funding should be accessed from other sources when appropriate such as the Independent Living Fund, Access to Work etc.
People must be given the opportunity to access advocacy in the process.
The Person must be given the opportunity to use external brokerage, and it must be clearly explained that they can either access assistance with support planning from the care manager, or they can be offered external brokerage.
January 2010 49 ‘Support Plans can be written in different ways. They may be short or long - with pictures or just text. The person can write it themselves or have someone else write it for them.’
(In Control Guidelines, What makes a good Support Plan.) http://www.in-control.org.uk/site/INCO/Templates/Library.aspx? pageid=134&cc=GB
It is important to note that the support plan is the Person’s document that puts them in control of their lives and so they should be able to own it and this can only happen if it is communicated in a medium that they understand.
The Actual Budget
Once the Support Plan has been completed, it will need to be signed off by the Team Manager. However, if the indicative budget is above £250/- per week, the Service Manager will have to authorise it or if above £1300/- per week, the Assistant Director of Social Services will have to authorise it. Only then, it can be submitted to the RAS team, for an agreement on the actual budget.
January 2010 50 8. CARERS
(Refer to the Carers Strategy – Towards a New Westminster Strategy for Carer 2009-2012)
Legislation
Carers (Recognition and Services) Act 1995
Defines a carer as anyone “who provides or intends to provide a substantial amount of care on a regular basis”
Anyone who is employed, or who volunteers for a voluntary organisation, to work with the Person, is excluded from the definition of a carer.
The carer may request an assessment from the local authority assessing someone under s.47 NHSCCA 1990 when the cared for person is assessed
States that Local Authorities are obliged to (1) carry out a carers assessment on request and (2) take that assessment into account when making decisions about the provision of services for the cared for person
Carers and Disabled Children Act 2000
States that a carer has a right to a separate assessment, (whether or not the cared for person is assessed)
Duty to assess, and to decide (1) whether the carer has needs in relation to the care provided which could be met by local authority services and (2) if so, whether to provide them – which could be support provided directly to the carer, or additional support provided to the cared for person. Services provided to the cared for person to support the carer exclude services of an intimate nature, as these would be defined as services provided directly for the cared for person.
Local Authorities permitted to provide Direct Payments to carers.
Local Authorities can provide voucher schemes for short breaks for carers.
January 2010 51 Carers and Equal Opportunities Act 2004
Amends the 1995 Act and the 2000 Act to give an obligation to Local Authorities to inform carers of their right to an assessment, and to offer an assessment before making a decision about the needs of the cared for person.
Restates that where the cared for person has refused an assessment, a carers assessment must still be offered.
States that the carer’s assessment must include consideration of whether the carer works or wishes to work, and their access to leisure and training.
Other issues to consider:
A carer has a separate right to an assessment of their own needs, under NHS&CC Act 1990. If it appears that the carer has needs of their own, which may be met by the provision of community care services, a duty to carry out a care management assessment would arise This would be in addition to offering and carrying out an assessment of their needs as a carer.
The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care 2007 has clarified that carers do not lose their entitlement to a carers assessment when the person they are caring for is entitled to NHS continuing care.
Where the cared for person lives in a different local authority from the carer the responsibilities for offering and providing a carer assessment remain with the local authority who is responsible, under the NHS&CC Act 1990, for the cared for person. However Local Authorities should co-operate in ensuring that carers are supported.
City of Westminster Standards
January 2010 52 1) All carers will be offered an assessment
2) All current carers will be reviewed annually
3) All carers will be supported to maintain their own well-being, in the assessment process
Who is a Carer?
According to the ‘Carers’ & Disabled Children Act 2000’ a carer is defined as “An individual aged 16 or over who provides or intends to provide a substantial amount of care for another individual aged 18 or over” on a regular basis. Although the Act does not take into account the needs of younger carers’ (under 16 years) they should be included.
Excluded from the definition of a carer are paid care workers, and volunteers from a voluntary organisation.
Who is entitled to a Carers’ assessment?
Carers are people who ‘provide, or intend to provide, a substantial amount of care on a regular basis’ to a Person who is receiving Community Care services or is eligible for such services.
How do we decide what is ‘substantial and regular’?
The guidance suggests that local authorities should determine their definitions of substantial and regular care, City of Westminster have decided to adopt a flexible approach. It may be that the care provided is not frequent or offered on a routine basis. For example, supporting a person with a severe mental health problem may not be regular but it may have a significant impact on the carer in anticipating or trying to prevent the next crisis.
January 2010 53 Right of a Carer to an Assessment
Carers should be made aware of their own right to an assessment. Information should be given concerning advice available from Carers Centres. Carers
Assessments can be kept separate and confidential.
The assessment determines his or her ability to provide and to continue to provide care for the cared for person.
Carers’ assessments should be offered to all carers if the cared for person is someone who is eligible for community care services. However, the carer must be informed that the completion of an assessment may not lead to the provision of a service. As with all assessments this will be dependent on the carer’s level of need.
Carers’ have a right to an assessment of their needs, even where the cared for person has refused an assessment, provided the cared for person would be eligible for services.
Carer’s Situation
Where an individual is dependent upon others to meet their care needs the support required by those carers should take into account the following:-
• their status or relationship with the individual
• the care they provide
• their expressed needs for support
• their wishes and preferences
• the nature of the relationship and attitude toward the individual
• the state of their mental and physical health
January 2010 54 • their other commitments (family, job)
• the impact of caring on those other commitments
• their future prospects and the financial consequences
• the emotional or physical stress they are experiencing
• their likely future capacity and willingness to care
In addition for Young Carers, i.e. carers under the age of 18, the assessment must consider the impact on them by virtue of their age, and their own development.
Account should be taken of the tasks undertaken, time, frequency and ongoing nature of the involvement, and also the level of supervision needed by the cared for person. In considering whether the care is regular, it is not only the time spent each week: a caring role which is life long, or which is subject to the fluctuating and unpredictable needs of the cared for person, will fall within the definition. Caring duties range from helping with the shopping to giving 24 hour care and support.
The prime focus of an assessment must continue to be the needs of the user. If these are satisfactorily met the needs of the carer may be too. When providing services for a Person who is receiving care from Young carers, provision should seek to alleviate them off some of their caring roles. If a Young person continues to provide significant care , a referral should be made to Children’s services, as the Young Person may meet the criteria for a “Child in Need”.
Practitioners should also be alert to those carers who may need a community care assessment in their own right. In such cases the carer becomes a potential service user. A separate referral is needed and an assessment is undertaken.
January 2010 55 When completing a carers’ assessment, it is helpful to consider if caring for someone is having a significant effect on the carers’ life and well being, and on the well being of the cared for person.
Is the caring role sustainable?
How great is the risk of the caring role becoming unsustainable?
Throughout the assessment process for the Person, carers should be fully aware of their entitlement to be involved and to be consulted, within the constraints of confidentiality.
In deciding how to meet the needs of the person being cared for the care manager must have regard to the results of the carers assessment.
It is also important to consider how we could respond to help the carer in times of crisis or emergencies, one way may be to develop with the carer a contingency or emergency plan, to this end an emergency carers card has been produced.
Carers Support Services
How do we identify the need for a carers support service?
A carer’s support service can only be provided when it has been identified as a need and is an outcome of a Carer’s Assessment, or the carer’s section of the Overview assessment.
The carer must be providing a ‘regular or substantial’ amount of care.
What can’t we provide as a carers support service?
January 2010 56 Any service that is of an ‘intimate nature’; this is defined as a service that involves ‘ physical contact such as lifting, washing, grooming, feeding, dressing, bathing or toileting the person cared for’ (1).
What can we provide as a carers support service?
Domestic tasks – such as shopping, cleaning, laundry; but these can only be provided as a carers support service if the carer gives ‘regular and substantial’ care to the person being cared for.
Meal preparation – but not if the carer would be also making the meal for themselves.
Day care – if the carer is providing a substantial amount of care and needs a break, we could provide one day a week day care. However, the person being cared for must be able to benefit from this service.
Professional Support – this could be advice and / or emotional support. This service can only be provided by an allocated worker and ended when a case is ready to go onto the review system.
Equipment – it is unlikely that a piece of equipment is identified to support the carer, but if it is then it can be provided as carers support.
1. Regulation 2 (1) of the Carers (Services) and Direct Payments (Amendment) (England) Regulations 2001
Storage of Information
January 2010 57 A Carers assessment is held in the Cared For’s paper file or the J Drive. It can also be filed separately.
Sharing Information
The Carers Assessment is confidential to the Carer and may only be shared if the Carer gives consent to share it or where not sharing the information will lead to risks to the Carer or others.
January 2010 58 9. CONTINUING HEALTHCARE
The national framework for NHS continuing healthcare and NHS-funded nursing care - July 2009 (revised) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPo licyAndGuidance/DH_103162
The Assessment Process
NHS Continuing Healthcare Checklist June 2009 is used to ascertain whether a Person will need a full assessment of their Healthcare under the Continuing Healthcare Criteria. A Care Manager can use this tool when completing a Community Care Assessment. The Care Manager should have received training in order to use the tool. The Care Manager must consider whether rehabilitation will result in an improvement to the Person’s health and must make referrals to this end. If using this tool, decisions must be recorded and signed. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/di gitalasset/dh_103328.pdf
If a full assessment is required then the assessment is completed by the Health Care Manager, but must be supported by a Social Care Assessment using the FACE Overview form. NHS London has devised a Health Needs Assessment form that is completed by the Health Care Manager. The Health Care Manager can call upon appropriately trained professionals to complete to complete specialist assessments. The target for completing assessments is 28 days. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/di gitalasset/dh_103329.pdf
(Decision Support Tool)
January 2010 59 If a Person requires a more urgent assessment then the Fast Track Pathway tool is used. The assessment is carried out by the Health Care Manager. NHS London has devised a Fast Track Care Plan form. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/di gitalasset/dh_103327.pdf
Fast Track Pathway Tool
Carers assessments
Carers are entitled to assessments even where the Person may become eligible for continuing healthcare funding.
(Refer to carers section)
NHS funded nursing care
‘NHS-funded nursing care’, introduced in October 2001, is the funding provided by the NHS to homes providing nursing, to support the provision of nursing care by a registered nurse for those assessed as eligible. If an individual does not qualify for NHS continuing healthcare, the need for care from a registered nurse should be determined. If the individual has such a need and it is determined that the individual’s overall needs would be most appropriately met in a care home providing nursing care, then this would consequently lead to eligibility for NHS-funded nursing care. Once the need for such care is agreed, the PCT’s responsibility to pay a flat rate contribution towards registered nursing care costs arises. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/di gitalasset/dh_106225.pdf Currently the referral for assessment for NHS funded nursing care stems from a Community Care Assessment. The framework for Continuing Healthcare states that consideration should, in the first instance, be given to whether the Person meets the Continuing Healthcare Criteria rather than the NHS funded nursing care criteria.
January 2010 60 Therefore, where it appears that a Person’s predominant need is related to their health, the care manager must complete the Continuing Healthcare Checklist along with a Community Care Assessment. If the checklist suggests that the Person is likely to meet the Continuing Healthcare criteria, then a referral should be made to the Health Manager to complete this. The Care Manager will have to complete a Community Care assessment as this is required as part of the process for determining eligibility for Continuing Health care. If the Person does not meet the Continuing Health care criteria, then a decision can be made about their eligibility for NHS funded nursing care.
Decision Making
All decisions regarding Continuing Healthcare and HNS funding Nursing Care are made at multi-disciplinary panels.
There are separate panels for Mental Health, Learning Disability and Older People/Physical Disability services.
A single appeals process is planned for all decisions.
Meeting Continuing Health Care Needs
Where a Person’s continuing health care needs are met in a nursing home or a hospital, the Health Care Manager arranges it and reviews it.
Where a Person’s over 65 who is registered with a GP in Westminster, has continuing care health care needs that are to be met in the community Care
January 2010 61 Managers from the Council set up the package and they will attend the review of these care packages which will be undertaken by the Health Care Manager. As the Person will not be eligible for charging, the Care Manager will need to ensure that this is communicated to the finance department.
Meeting Needs in the Interim (pending decision)
Where a Persons needs warrant that these are met prior to a decision is reached, the service that has carried out the assessment and identified the needs should ensure that Person’s needs are met, and not await a decision.
Discussions must be had with the corresponding body who may become responsible for the costs that arrangements are being put in place to meet needs, and agreements reached about reimbursements for costs incurred.
Meeting Needs of People who are assessed as not meeting the criteria for Continuing Healthcare
People who are assessed as not meeting the criteria for continuing healthcare, become the responsibility of social services, if arrangements have to be made to meet need, unless they do not meet the criteria because they are financially able to meet their own needs.
(Refer to previous sections re: procedures for providing for these needs)
January 2010 62 10. RISK ASSESSMENT AND RISK MANAGEMENT
Positive Risk Taking, Risk Assessment and Risk Management
Context
Changes in health and social care policy stress the importance to maintain people in the community and enhance their opportunities in the community, to provide them with choice in managing their needs and to enable them to have control over their own lives so as to enable their well-being.
People do not usually make a choice to move into residential accommodation and will do so only as a last resort.
Residential, Nursing or Hospital environments by virtue of the fact that they are group living environments, inevitably result in restrictions being applied to individual choices and can affect people’s rights.
Health and social care services have always had a responsibility to support people to continue to live in their own homes. A risk averse approach by health and social care professionals has usually meant that the identification of risk or the perception that risk would lead to people to being placed in residential homes. Recent government guidance reemphasises that people should be enabled to live in the community as far as is possible.
Principles 4 and 5 of the Mental Capacity Act 2005 relate to people who lack capacity and state that
January 2010 63 “An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.”
Therefore, even when working with People that lack capacity, there is requirement to apply the least restrictive options, where that is possible, when deciding what is in their best interest.
The Mental Capacity Act 2005 emphasises that people who have capacity, make their own choices, and recognises that sometimes these choices can be unwise.
Some risks that capacitated people take can put other people at risk.
Staff have a responsibility to themselves and their colleagues that they assess risks that may place them in danger, and to follow the Council procedures where risks exist to safeguard themselves, and to use the procedures to make colleagues aware of the risk.
Understanding Risk
Risk in life is inevitable. Just because a Person becomes a consumer of services from the Social Services does not mean that these risks will be removed. The inevitability of risk that applies to any person that lives in the community will continue to apply to the Person the Social Services are charged with providing services to.
January 2010 64 The issue for Care Managers is whether
- the risks that apply to the Person are over and above that which applies to any other Person in the community - these risks arise as a result of choice or vulnerability, - the resultant effects of the risk and - their benefits, and - whether the Social Services has a responsibility to intervene, and if so, - how they will intervene.
The Social Services have a duty of care to apply relevant processes to matters of risk. Negligent acts occur when processes are not followed, not when a risk comes to fruition even though all processes have been followed.
.
Risk to Self
Where a Person makes a choice to do something that to the Care Manager appears unwise and poses risks to the Person themselves, the Care Manager must undertake a Capacity Assessment in the first instance if the Person is willing to participate in the assessment. The Capacity Assessment serves to clarify whether the Person is making a capacitated decision regarding this choice, with an understanding about the risk that is involved.
In some cases, a Person may have a mental disorder or other diagnoses; in such cases the Care Manager must work with the Mental Health Services or the relevant team to manage risks.
If the Person is assessed as having capacity in relation to the decision at the point in time, and there is no option to stop them from carrying out that choice,
January 2010 65 except where another legislative framework can be applied. The Care Manager can continue to guide them, and advise them, in order to enable them to change their mind if their choice is unwise.
The Care Manager must complete a risk assessment and alert their manager to the risk. Depending on the level of risk a multi-disciplinary risk management meeting may be convened to manage the fall out from this decision.
If a Person is assessed as lacking Capacity, the decisions made and acts done on their behalf must be done in their best interest. The Person is entitled also to take risks that provide them with benefits. Whereas attention should be paid to what the Person might have done when they were capacitated, the Person cannot be placed at disproportionate risk.
It is not acceptable to make a generalised statement about risks just because of a Person’s diagnosis, or a generalised statement about capacity. Each decision needs a capacity assessment, and a proportionate response to the risk that this poses.
Risk to others
Where a Person’s capacitated decision will lead to risk to other people, a decision needs to be made through a risk assessment about the level of risk, whether the risk is imminent, who the risk is to and if it is criminal by nature. If it is criminal matter then the police should be notified. If the risks are to a child then the Children’s services should be notified. If the risk is to a vulnerable adult, the Westminster Safeguarding Procedures should be followed if the person lives in Westminster or the relevant Safeguarding Adults service in the
January 2010 66 authority where the person is resident. In all above instances the Care Manager must alert their manager to the risk in a timely way.
In some cases a capacitated Person making such a decision may have another diagnosis, in such a case the Care Manager must liaise with the relevant services.
In some cases a capacitated Person may be involved in a situation of domestic violence, in such a case the MARAC (Multi – Agency Risk Assessment Case Conference) processes could be followed (see MARAC procedures)
In some cases the Person may be an offender who has a mental disorder, in such a case MAPPA (Multi Agency Public Protection Arrangements) processes could be followed. (see MAPPA procedures)
Risk from others
Where such a Person is a consumer of Adult Social Services or could be eligible for Community Care services, a Safeguarding Adults alert should be raised.
Where police involvement is required the matter should be reported to the police in a timely way.
Such a Person may be a subject of domestic violence (Refer to procedure for Identifying Risks to Domestic Violence Victims – guidance for assessment), in which case the MARAC procedures could apply.
January 2010 67 The Person may be at risk from an offender, the MAPPA processes could apply.
Risk of Exploitation
If the Person who is being exploited is a consumer of Adult Social Services or could be eligible for Community Care services, the Safeguarding Adults Procedures apply
Risk to Independence
When a Care Manager completes an assessment under the Community Care Act they assess the risk to a Person’s independence if needs relate to health, choice, control, practical living skills, social involvement, family relationships and responsibilities, involvement in work and education and contribution to society
They provide for the Persons eligible needs under the FACS guidance.
When providing for these needs, the Care Manager applies the principles of maintaining and enhancing independence, promoting choice and enabling personal control over the situation, and they must meet need in the least restrictive way. This way of working necessitates that risk assessments are conducted in a routine way and risk management plans are put in place with the Person involved in the decision making around how to negotiate the related risks of living with additional care needs in the community, and a framework to support them. The process of risk management should consider preventative, responsive and supportive measures to reduce the potential negative consequences of the risk and promote the potential benefits of taking
January 2010 68 appropriate risks. An important aspect of managing risks in the community is contingency planning.
Services available in an emergency
In the event that a person has no access to heating and they are at serious risk, the council has policy allowing the purchase of heaters (refer to Supply of Heating Appliances policy in general care management section on the Intranet)
If people are not at home when services call, there is a No Response Protocol to ascertain whether they are safe (on the same page as above)
Emergency Response Service responds to emergencies for People living in the Community (Refer to the Emergency Response Protocol on the same page as above)
Telecare services can support risk management plans.
Emergency duty team (emergencies or monitoring out of hours)
Duty Services in OP/PD, WLDP and Mental Health (during working hours)
Personalisation and risk
Managing risks positively supports the enablement of person to benefit from the personalisation agenda.
As vulnerable people take responsibility for managing their own care through Personal budgets, safeguarding issues should be anticipated and risk assessments and risk management plans that ensure that the Person continues to enjoy choice and control over how they want their care provided, should be in place, for these to be successful.
A contingency plan must be put in place to support failure of support services to meet needs.
January 2010 69 Risk and People that Lack Capacity
A capacity assessment relates to a decision, at a point in time. If a Person is assessed to lack capacity with regards a decision, the law requires that the decision or the act to be done is done in the Person’s best interest. In making decisions on behalf of a Person that is assessed as lacking capacity, the decision maker should pay heed to how they would have managed the issue if they had capacity, however, the Person cannot be placed at risk. Least restrictive options should still apply where possible.
Restraint (people who lack capacity) Anybody considering using restraint must have objective reasons to justify that restraint is necessary. They must be able to show that the person being cared for is likely to suffer harm unless proportionate restraint is used. • If restraint is being considered, is it necessary to prevent harm to the person who lacks capacity, and is it a proportionate response to the likelihood of the person suffering harm – and to the seriousness of that harm? • Could the restraint be classed as a ‘deprivation of the person’s liberty’? • Does the action conflict with a decision that has been made by an attorney or deputy under their powers?
Deprivation of Liberty and People who lack capacity
An authorisation to deprive a Person who lacks capacity may be given to Care Home or Hospital where such an application is made and an assessment process has concluded that that it is in the best interest of the Person, to protect them from harm and it is a proportionate response to seriousness of harm.
Assessing Risk
January 2010 70 A Risk Assessment involves weighing up the potential benefits and harms of exercising one choice of action over another, identifying the potential risks involved, and developing plans and actions that reflect the positive potentials and stated priorities of the consumer of Community Care services. Where benefits outweigh the risks, the risks are worth considering in a planned way so as to manage these in order to achieve the benefits.
A risk is deemed acceptable, when there are adequate control mechanisms in place and the risk has been managed as far as is considered to be reasonably practicable. The potential benefits should outweigh the potential harm
Some points to consider when completing a risk assessment
- Who or what is at risk? - What are the specific risk factors? - What are the circumstances within which the risk is posed? - What are the likely effects? - How does the Person who is at risk perceive the risk? - Has the Person’s capacity been assessed? - How does anyone involved with the Person at risk perceive the risk? - What measures have been taken by the Person or others involved with them to manage the risks? - Are there any precedents to the risk behaviour i.e. what is the Person’s risk history? What measures are in place to manage the risks? What measures have worked in the past? - What has been the Person’s past attitude to risk taking? - What are the strengths, and abilities of the Person and their network to manage the risk?
The Care Managers investigative skills are vital to this assessment. The Care Manager needs to be able to listen to what is being said. The Care Manager must ask all pertinent questions, no matter how uncomfortable they feel, so that a proper assessment is completed and appropriate measures of
January 2010 71 interventions are applied. The Care Manager must also identify the strengths of the Person and their abilities to manage the risk, as well as their usual strategies in managing difficulties.
The measures that are applied may be unnecessary, intrusive, and legislatively unsound and even disabling, if the assessment is not properly conducted. Furthermore the risks to the Person could increase as a result of ineffective measures.
The Assessor may call upon other agencies to provide them with information to inform their risk assessment. Agencies should cooperate with such a request, if people are likely to be at significant risk.
Managing Risk
The purpose is to manage risk – it is not always possible or necessary to eliminate it.
The assessment will provide information about the risks and the risk management plan states the way in which the risks will be managed.
Risk management is about a collaborative approach to working with Person, c arers, families and other involved professionals. It takes into account the Persons wishes, abilities, coping strategies, and that of their network, in deciding the plan. Managers and staff are equally accountable for risk management and managers have an additional responsibility to create an environment where their staff are enabled to promote positive risk taking.
Managers should hold staff to account for being risk averse in supervision.
The Person must be involved
- The Person must be involved in the discussions about how the risks will be managed. If a Person has capacity, unless they are involved
January 2010 72 and agreeable to how the plan will be put into action, it is unlikely to be effective. - Where a Person lacks capacity with regards the issue in question, they should be represented by someone either from the family who is able to help with decision making that is in the Person’s best interest, or an advocate, and in some safeguarding cases, an IMCA. (Refer to the IMCA guidelines on the Mental Capacity page on the Intranet)
The Person must be asked how they want the risk to be managed. In order to make that decision the Person must have access to information about the options that are open to them.
The Person must be encouraged and enabled to use their own strengths, abilities and personal resources to manage the risk with support, if that is possible, so that they remain in control and do not become powerless.
An action should aim to eliminate unacceptable risk but achieve an outcome that is of value to the Person and that maximises the benefits for them. It should take into account their anxieties, and whether it could have unintended consequences.
There may be several possible approaches to managing the risk. Do not automatically go for the ‘safest’ option. Consider possible negative consequences for the client. For example, admitting someone to residential care may seem an obvious way of managing some risks. However, the advantages in terms of risk avoidance may be outweighed by the negative consequences of loss of independence and community participation.
Long term gains and short term risks need to be considered, so that at times a short term heightened risk may have to be tolerated in order to achieve long term gains. This type of action needs the cooperation of the Person and their social network and a proper plan to manage the risk while it is still live
January 2010 73 A multi-disciplinary risk management plan may be put into effect either through the Safeguarding Adults procedures, the MARAC, MAPPA or other meeting.
The council may seek a judgement from the High Court some high risk cases.
Recording the Risk Assessment and Risk Management Plan
The Care manager must keep comprehensive notes on the information gathered through the assessment process, the views of all parties, and their analysis of the information to arrive at the conclusions that they have reached. All decisions should be supported by evidence and the thought process that underpins it.
Care Managers should complete the appropriate forms for risk assessment and risk management within the respective services
Forms
Generic Risk assessment form and Risk Assessment Action Sheet
Risk Assessment and Risk Management Plan for OP/PD
Risk Profile FACE form
Notes related to the Risk Management plan must also be comprehensive, to include the discussions had, and any actions that have been agreed, with timescales and names of people responsible for the action against each action. The plan should be signed by all parties and is jointly owned by the people involved in creating it. Any disagreements should be recorded.
(Refer to the Risk Management Policy for the Mental Health Services on the Mental Health Page on the intranet)
January 2010 74 (Refer Risk Assessment guidelines, Physical Intervention policy and Crisis Management Policy for the Learning Disabilities service on the Learning Disability Page on the Intranet)
January 2010 75 11. SUPPORT PACKAGES IN THE COMMUNITY
Personal Budget Management
The Personal Budget, where it involves the Person purchasing their own support package, is currently made available via Direct Payments, either payable directly to a Person, via a Trust, or via a Pre- paid card.
A Personal Budget can be managed by care managers on behalf of the Person.
Some amount of a Personal Budget can be managed by Care Managers on behalf of the Person and some by the Person themselves via a Direct Payment.
Meeting Need – Prevention
People usually want to live independent lives that do not require any intervention from social services. Where a Person has been assessed are having eligible needs, the intention should be to enable the Person use their own strengths and network to meet their needs, and to negotiate adaptations within universal services to accommodate the needs of people. Where services are availed to the Person, the intention should be to return the Person to a state of Normalisation at the earliest opportunity.
Before providing Community Care funded services, Care Managers must
- determine whether the Person is receiving their maximum income so that they can meet their own needs i.e. are they receiving the benefits that they are entitled to (Care Managers can refer them for a benefits check)
- consider whether there are other sources of income that could provide for their needs e.g. charities
- ascertain whether they have sufficient funds to meet their own needs
January 2010 76 - assess whether the Person’s needs can be met by themselves through their own resources or their network
- Make sure appropriate items of equipment are provided, particularly when this will enable someone to stay more independent, requiring less or no social care services
- identify whether there are resources in the community that can meet the Person’s needs e.g. voluntary services or universal services
- negotiate with universal services to adapt to accommodate the Person
And/or
- use assistive technology ( refer to the telecare procedures on the general care management page on the intranet) and/or
- refer for preventative services
(refer to the Procedure for Commissioning Preventative Domiciliary Services for adults which enables provision of shopping, cleaning, laundry and escorting, Preventative Services For Adults over The Telephone which enables provision of link alarm, key holding service or meal service, Preventative Bathing Services which enables provision of bathing equipment or home bating service, Hospital Discharge Guidance on Provision of Community Equipment on the general care management page on the intranet)
Or, where appropriate
- make a referral to the re-ablement service to rehabilitate people back to independence (Refer to the Re-ablement service policy on the general care management page on the Intranet)
Meeting Need – Short Term Intervention
When providing a Community Care funded intervention the Care Manager must bear in mind that
January 2010 77 - This should be provided only where it is required to manage the eligible need and related risk
- They have a duty to apply consistency in determining eligibility so that only people that are eligible for services receive services from the council
- They have a responsibility to ensure that when a service is provided it is only provided for the time that it is required.
Some people will need a short term intervention to achieve their goal of returning to normal life. The Care Manager has a responsibility to ensure that people are not disabled unnecessarily and therefore, must ensure that objectives and appropriate timescales are set and a timely review is arranged.
Care Managers should step down services – an ongoing reduction of funded services while incorporating universal services into the support plan or ending services that have met objectives at the appropriate time.
Meeting Need – Ongoing Needs
The most vulnerable people will have ongoing needs.
Attempts should be made to integrate the Person’s needs into universal services.
Carers may require respite from caring. As well as traditional respite, respite can be provided through direct payments.
People should be enabled to live in the Community, rather that moved into residential care.
Selecting a Provider
January 2010 78 If the individual has Moderate to Substantial needs that can be met in the community, they will be assisted in the Support Planning process to explore all of their options.
Once they have received their Indicative Resource Allocation, they will receive full information and advice on a wide range of options, including:
Making full use of all services in the charity and voluntary sector. Exploring informal support options – (Friends, neighbours.) Having a Direct Payment to privately purchase and manage their support. Using their Personal Budget to choose a Care Provider that will be managed by the council. Using their Personal Budget for an Individual Service Fund with a provider of their choice.
A Support Plan will not be agreed of it puts the Individual at an unacceptable level of risk. However, with Personal Budgets and Direct Payments, The Individual can have greater choice, flexibility and control over selecting a provider to help them achieve their objectives.
Where a Care Manager is engaged by the Person to identify a Provider, the Care Manager must ensure that the provider meets the expectations of the Council and they must check the Care Quality Commission’s Inspection Reports of the Agency. Care Managers must commission cost effective, quality and safe services.
Westminster has contracted a range of services to support people in the community; these services are vetted, monitored and quality assured. If the standards fall in the contracted service, serious consideration should be given to offering alternative care for the Person and de-commissioning the service i.e. advising other care managers not to use the service until standards
January 2010 79 improve. This decision and subsequent action will be taken following discussion with the line manager, members of the relevant placement panel and the Safeguarding Adults Team.
The Council can expect the Care Manager to use contracted services over and above other services if these services objectively meet the needs of the Person.
The Care Manager must engage the Person in any discussions about who they are considering and why and how they will meet the objectives of the support plan. If the Person is assessed as lacking capacity, services should be identified in line with Best Interest decisions.
When services are commissioned, a contingency plan must be completed.
Contingency Planning – Westminster Guidance
The use of Contingencies in support plans is good practice and WCC would expect that Care Management Staff pay particular attention to planning for and articulating any contingencies which may arise.
Inclusion of contingencies in Support plans as blanket monetary allocations will not be approved; any contingencies should be built into a contingency plan.
Any contingencies should be built into the support plan. A section should be included in the support plan which articulates and plans for contingencies. This includes the following:
- Emergency contact details, together with any another pertinent details. - Specific plans to deal with ad hoc events (e.g. Carer being sick).
January 2010 80 - Clear actions should be outlined in terms of how to deal with such events. - It must be clear who is responsible for what.
Should a need for additional funding arise due to circumstances which could be categorised as a contingency the Person may make an application for emergency funding to Care Management. This will be dealt with through current processes by either putting emergency care into place or following the re-assessment process. Any such plans should also be included in the support plan.
Confirming the Agreement
The key terms and costs of the agreement with the independent service provider must be confirmed in writing (see sample agreement letter SS.CM.4A), keeping a copy on file. This forms a legal contract and may be used in the event of any disagreement.
Implementation
Using the Support Plan the Care Manager must ensure that the Person and, if appropriate, their carers and relatives, understand what services have been arranged and when to expect them. They should be given a contact name and telephone number for the organisation providing the care. The Person should also be given a care management contact name and telephone number should they wish to discuss matters relating to the service provision.
The support package should be monitored to ensure that the services are provided as arranged, in accordance with the support plan, and that they are meeting the Person’s eligible needs as specified and the objectives set in the plan.
January 2010 81 The support package should be reviewed after an agreed period, ideally within the first four weeks of implementation, or if there is a significant change in circumstances.
Finances
Once the Support Plan has been signed off and indicative budget has been authorised by the relevant manager or agreed at the weekly panel ( as per WLDP procedures), the Care Manager sends this to RAS team who sets the actual budget and make known the contribution that the Person has to make to the support package.
The Support Plan can be made up of various funded services.
Each will need an agreement to be signed, and the finance officer notified. A Financial Authorisation Form (SS.CM.4) should be completed for all spot purchases, identifying all costs.
Invoices
All invoices, from any independent sector organisation involved in providing care to a Person as part of a care package arranged by a Care Manager, should be made out to the “City of Westminster”. They should be sent “for the attention of” either the relevant Care Manager or the relevant Finance Officer to their workplace.
The Care Manager should check and sign the invoice to ensure that the service has been provided as agreed and that the fees are correct. It should then be passed to the locality Finance Officer for payment. Checked invoices should be recorded on a Financial Flow Sheet (form finflow for Older People and Disabilities).
Invoices need to be processed quickly. If the Care Manager is going on leave, they should arrange for someone else to do the processing for them. If the Care Manager is ill, the Team Leader should monitor the invoices.
January 2010 82 If there are any disputed items on the invoice, the Care Manager should take these up directly with the organisation. If they are unable to resolve the matter, the Care Manager should discuss it with their line manager.
Person’s Contribution
The Person, their broker, or representative in charge of their finances, will be invoiced by finance for their contribution.
(See People’s Affairs for information on Waivers in charging and other related issues and finance)
January 2010 83 12. RESIDENTIAL AND NURSING CARE
CONTEXT
(Refer to guidance on “Ordinary Residence” earlier in the Handbook)
The overriding priority of the Department is to assist people to continue to live as independently as possible in their own homes or in other settings in the community. Residential or Nursing Homes will only be considered when remaining in a residence in the community, is no longer viable.
Care Managers making a recommendation to place someone in residential care will need to demonstrate that they have tried and/or considered all options for providing for the Person in the Community; including living with support in the home, living with family or friends, adult family placement schemes, group living, sheltered housing and extra care housing.
An SAQ is completed with all new entrants to services or those whose needs have changed. If a Person knows what their indicative budget is, they may think creatively about ways in which they can manage their needs in the community rather than considering admission into residential care.
A Person may, despite options being available in the community, choose to move to residential care. A Care Manager that finds that their assessment does not concur with the choice the Person is making should discuss this with their team manager, where the Person expects the Social Services to contribute to or pay fully for the care provided in the Home.
Most people, however, move to residential care, as a last resort. Often, the Person will have been known to services for some time and packages of care will have continuously increased in line with increased need linked to deterioration of health and/or social functioning. At a point in time, it becomes
January 2010 84 apparent that the Person can no longer manage in the community i.e. all community options have been exhausted, and the Person is agreeable to considering residential care. In such a case, a comprehensive assessment should be completed and a care plan.
If a Care Manager assesses that a Person’s needs should be met in Residential Care and the Person refuses such care, the Care Manager should complete a Mental Capacity Assessment and if the Person is assessed as having capacity then the Care Manager has to accept their decision even if it is an unwise decision (Principle 3, MCA 2005). The Care Manager can continue to work with them to persuade them to a different way of thinking but they cannot go against the Person’s decision, except if another legislative framework is applied (see below for legislation related to removal of People from their homes). The Care Manager should however, complete a risk assessment related the decision the Person has made and put a Risk Management plan in place which may involve a range of professionals or agencies (Refer to Risk Section in the Handbook)
Where a Person has been assessed as lacking capacity in relation to their care and treatment, and a best interest decision is that the Person moves into residential care, then a comprehensive assessment should be completed and should be accompanied by a Mental Capacity Assessment and an evidenced best interest decision. Any such decision should have considered whether there are any less restrictive alternatives for placement.
If a Person is being considered for care in a Nursing Home, some of their care may be eligible to be paid by NHS Westminster. A comprehensive assessment should be completed in such a case (please refer to the continuing healthcare procedure below).
A Care Manager will need to discuss any case where residential or nursing care is being considered with their line manager. The Line Manager has the
January 2010 85 role in ensuring that all measures have been explored to enable the person to live in the community. The line manager will need to ensure that the Care Manager is not being risk averse and that they have considered the risks and the potential benefits of taking risks.
The line manager will need to get agreement from the Service Manager to pursue a placement in a care setting.
Nursing or Residential Placement?
If the Person cannot be supported at home, the Care Manager will have to assess whether their needs can be met by a Residential Home, or whether the person requires Nursing Care.
The following guidelines would suggest that a Residential Home would be appropriate:
the need for care and attention must be established through a multi- disciplinary assessment
all alternative community-based packages of care must have been fully explored and found not to be feasible. The reasons should be recorded
the Person should normally be able to transfer from bed to chair/ wheelchair, but they may need assistance
the Person should be mobile (if necessary, use equipment or wheelchair) within their room, even though they may need assistance with longer distances
the Person should be able to undertake some personal care (washing and feeding)
the Person should not be regularly doubly incontinent
January 2010 86 the Person might display some challenging behaviour but should not have a recent history of violence towards others, nor actions dangerous to others
The Person must agree to such a placement if they have capacity, or be placed in such a placement only if it is in their best interest if they have been assessed as lacking capacity.
The following guidelines would suggest that a Nursing Home was appropriate:
the person requires qualified nursing intervention at regular intervals throughout the day and night which cannot be provided in their existing environment or by a District Nurse visiting a residential home
the person has multiple medical problems requiring life sustaining systems or injections/drug administrations which can be carried out only by qualified nursing staff
the person requires significantly more frequent and more complex care in a number of areas outlined in the Residential Care criteria
The Person must agree to such a placement if they have capacity, or be placed in such a placement only if it is in their best interest if they have been assessed as lacking capacity.
Selecting a Provider
Any Nursing Home or Residential Home in which a Westminster resident is placed by Westminster City Council either as part of a block contract or as a spot contract must be registered by the Care Quality Commission (CQC). The Home must be registered for the appropriate category for Person to be placed.
Block Contract
January 2010 87 Westminster has contracted a range of providers to provide residential accommodation to residents of Westminster who are assessed as requiring this provision; these services are vetted, monitored and quality assured. The Council runs two in house residential homes that provide care to older people.
The Council already has contracts signed with these providers.
The Council can require that People whose needs can be objectively met in these services are placed in them, where places are available.
i) Lancashire Review: 1997
The Lancashire case confirms limits to the notion of choice within Community Care, and the importance of distinguishing between a need and the means to meet it. Lancashire took resources into account in making a decision to cease supporting an elderly woman in her own home, and instead to meet her needs in a nursing home. The High Court and Court of Appeal found in favour of the council, stating than an assessed need for “24 hour care” gave the Authority the option of providing home support services or a residential placement, and in making that choice of how to meet the need, the Authority could take account of resources
Spot Contracts
A consideration of a service outside of the contracted services will require that the Care Manager ensure that the provider meets the Council’s expectations in terms of quality, cost effectiveness, safe, and legislatively bound services. The Care Manager will have to consider that latest CQC report and will also need to contact the Safeguarding Adults Service in the area where the home is based to ascertain whether there are any concerns; before agreeing the placement.
If the Council has used a Provider before, they will have a contract in place with the Provider. This arrangement can be found on SWIFT. If this is the
January 2010 88 case, the Care Manager does not have to have a further contract signed for each individual that they place there. The Care Manager will have to have to get a contract signed for any new provider and will not be allowed a place a Person in a home that has refused to sign a contract with the Council (this refusal will also be noted on SWIFT).
If the Person has a preference for particular accommodation, the Care Manager should arrange for care in that home provided that:
The accommodation is suitable overall in relation to the Person’s assessed needs
The weekly cost of the placement is not above City Council’s maximum charge ceilings
There is a vacancy
The home is willing to be contracted to provide the place
The home is registered with the Commission for Social Care Inspection.
Third Party Top Up
The Department is responsible for the full cost of any placement it makes in residential or nursing home care. A service user can be placed in more expensive accommodation than the maximum charge level if there is a relative or friend (known as a third party) willing to pay the difference.
If a third party top-up is considered necessary, it must be negotiated between the service user/ representative and the provider, although the agreement must be approved by the Council. The signed agreement must be in place in advance of the Person entering the home.
The maximum charge level is the cost of accommodation that the Care Manager judges to meet the assessed needs of the Person. Where this level
January 2010 89 exceeds the levels set by Westminster, it should be agreed in writing with the Head of Commissioning.
Any contribution by a third party to meet the cost of a higher-priced home must have the agreement of the City Council. If there is a question of third party involvement in paying the fees, from the outset the Care Manager should make clear to the resident, the third party and the home:
that failure to keep up payments will normally result in the resident having to move to accommodation which falls within the Westminster price bands
that payments made by a third party will be treated as the client’s income and will be taken into account in full (Note: while this will not reduce the Council’s share of the fee it is essential that Placements are advised of any such arrangement)
that a rise in the accommodation's fees will not automatically be shared equally between the Department and the third party
that if the accommodation fails to honour its contractual conditions, the Department reserves the right to terminate the contract giving the usual notice
that a resident is not able to use their own resources to pay for more expensive accommodation (Note: in other words capital or income disregarded in the financial assessment cannot be used by the resident to purchase better facilities)
It will be usual for both the resident and the third party to pay their contributions directly to the home.
The third party contribution is the difference between the actual fee and the maximum amount that the Department would pay to meet the assessed needs of the service user.
Self Funders
January 2010 90 It is also important for the Care Manager to gain a general insight into an individual’s finances early in the assessment process. As service users with high incomes and capital above £23,000.00 could be liable to pay for their own care.
A Person who self funds is entitled to an assessment if they request such an assessment. No Care Plan is required as a service is not being commissioned. The Person should be encouraged to make their own arrangements directly with a nursing or residential home. Contact with such individuals could include giving general advice and information, how to identify suitable establishments, identifying someone to act on their behalf, giving advice about alternatives to residential nursing home care etc.
As a general guideline, People who are able to make their own arrangements should have sufficient funds to pay for at least one year’s care. The amount of capital needed will vary depending on the individual’s income and the cost of the chosen home but will be approximately £40,000. Care Managers should advise people who are making their own arrangements that they should apply for Attendance Allowance, which will reduce the amount of their weekly costs considerably.
They should also be advised that equity with other People who use services, will apply if they become eligible for services from the Council.
Placements and People who lack Capacity
The Council has a duty to commission care that does not deprive a Person of their liberty where possible, and as such when considering a provider to provide residential or nursing care to a Person that lacks capacity in relation to this decision, the Care Manager must be sure that the home will manage the individual in way that places only the necessary restrictions on them, and that they are aware of the legislation that relates to people who lack capacity.
January 2010 91 The Care Manager must give the home a copy the Deprivation of Liberty Safeguards Joint Procedures.
Placements Standards and Safeguarding
If the standards fall in the any service, serious consideration should be given to offering alternative care for the Person and de-commissioning the service i.e. advising other care managers not to use the service until standards improve. This decision and subsequent action will be taken following discussion with the line manager, members of the relevant placement panel and the Safeguarding Adults Team.
Placement, Contracts and Finance 0.1 Placement Costs The weekly cost of Block Contract placements has been agreed as part of the contract and do not need to be negotiated by Care Managers for each placement. Spot purchased placements do however usually need to be negotiated with the home for each placement
The City Council sets annual price ceilings for the weekly cost of spot purchased placements for residential and nursing care. Before discussing placement options, the Care Manager must be aware of these ceilings.
Ceilings are, in the first instance, for negotiation purposes, to ensure the City Council does not pay prices above the market rate. In addition, where a Person or their representative requests a placement in excess of the ceiling, and refuses any suitable alternatives proposed by Care Manager, the use of third party top-ups should be considered. Team Managers should check what negotiations have taken place before agreeing the cost for the placement.
January 2010 92 The Care Manager must then complete a financial authorisation form. The form must be passed to the Service Manager for signature to approve the funding.
The Service Manager can agree the placement if the fee is below the appropriate ceiling. Where a service user is to be placed at a rate above the ceiling, whether or not a third party top-up is requested, the Assistant Director Health and Social Care must authorise the placement. This agreement should be confirmed in writing
Panels
The Older People/Physical Disability Service does not hold a panel, except where the Persons care package may include a nursing element funded by health or where the care package will be funded under the Continuing Healthcare criteria.
The Learning Disabilities Team consider all funded services at panel
Mental Health Services hold placement panels
Substance Misuse team also holds a placement panel
(Refer to WLDP Funding Protocol on the WLDP intranet page)
(Refer to The SMT’s Placement panel terms of Reference, and Funding Decision Process, Determining and Setting up a placement policy, on the OP/PD intranet page)
0.2 Financial Assessment The financial assessment is carried out by the Residential and Community Finance Team. The Care Manager is responsible for sending the Placement Financial Authorisation Form, authorised by a Service Manager, to the Residential and Community Finance Team. The Care Manager must ensure that details are on the form of who is dealing with the Person’s finances.
January 2010 93 The Placement Financial Authorisation Form should be completed as early as possible before the start of the placement or at the latest within one week after the start of the placement.
Once the placement is identified and authorised by the relevant manager or panel, the Care Manager will need to
- complete a contract with the Home, except where the home is part of the block contracts or is service with whom the Council has already got a contract due the fact that someone has been placed there before ( in the latter case you will need to verify that a contract exist, via SWIFT). A Residential Accommodation that has not and does not agree to sign a contract with the Council, cannot be used to place people.
- complete a Residents agreement which must be signed by the Service Manager
- provide the home with a completed a pre-admission form
- issue them with the care plan against which the provision will be measured at each review
- inform the Residential Charging Team that the placement has been made and provide them with information about who will be managing the Person’s finances
- Entered the placement as a Provision on SWIFT on the date the placement commences (see SWIFT Procedures.) This is essential as entering the provision notifies the Charging and Placements Section who will calculate the user’s contribution towards the cost of the placement and pay invoices from the providers. No invoices will be paid unless the placement is entered on to SWIFT.
- provide any information related to ownership of property and finance to the Charging Team
- arrange for the person to be moved to the new placement in a sensitive way
- complete reviews until permanence is confirmed
January 2010 94 - remain involved until the Person is settled or if the an authorisation to Deprive the Person of their Liberty has terminated.
- address any matters related to finance so that the Person is in receipt of money in their new home
- support the Person with terminating their tenancy, where appropriate
Financial Contributions
The financial assessment will determine whether the person has assets over that which the Council is liable to pay for. If so, the Person’s contribution would normally be the full cost of the placement, which the Person or their representative is responsible for paying, until their assets reach the level at which the Council becomes responsible for payment. The Person should be advised to inform the City Council (Charging and Placements Section) when their assets are approach this level. At this point the City Council would begin contributing towards the cost of the placement and the user would be advised of their new level of contribution.
The term self-funder should be restricted to people who arrange their own placements without Local Authority involvement. People whose contribution covers the whole cost of the service should be described as people who pay 100% contributions under the charging assessment system.
If the Person is unable to manage their own finances and no satisfactory arrangements are in place to assist them, a Care Management assessment and Care Plan should be completed and the placement treated as though the local authority were funding from the outset. A Court of Protection application should be made and Charging and Placements Section should be advised of any arrangements
On occasions the Council acts as an appointee or Court appointed deputy to manage people’s finances or make decisions regarding property and finance,
January 2010 95 but they will do this only if there is no other alternative. Care Managers that find they are working with a Person who they think will require this service should talk to The Client Affairs Team in the Council
A Person who is receiving services under S117 of the Mental Health Act is not liable to charging in relation to S117 services.
(Refer to the SMT’s charging policy on the OP/PD intranet page)
(Refer to the CNWL S117 policy and the WAMHS charging policy on the Mental Health Page on the Intranet)
1. PLACEMENT ADMISSION
1.1 Pre-Admission Meeting
The Care Manager should where possible arrange a Pre-Admission Meeting at the nursing/residential home with the Person and/or carer/relative and the Home/Hostel manager. In some cases it may be more appropriate for the Home/Hostel manager to visit the service user in hospital.
At the Pre-Admission Meeting the Care Manager should;
discuss the care plan for the Person
ensure that the home will provide the services required to meet the Person’s assessed needs
where applicable, establish whether the home will accept the service users furniture and/or pets
establish the date of admission, and any services needed by then
set the date of the Admission Review Meeting which should be during the sixth week of the placement.
1.2 Two-week Check
Within two weeks of admission the Care Manager should visit the home and speak with the resident in order to establish that he or she is settling and that any initial difficulties that may have arisen are being dealt with. If a visit to the home is not practicable, telephone contact should be made.
January 2010 96 1.3 Admission Review Meeting
The Care Manager must hold an admission review within six weeks of the placement commencement date and the review must be recorded on SWIFT. The review should held in accordance with the resident’s wishes (if he or she is able to express a view). Ideally, those present at the review should include the resident, a relative or friend of the resident (if the resident wishes), a relevant manager from the home, the resident’s key worker and the Care Manager.
Exceptionally, it may not be appropriate for the resident to be present throughout all of the review (e.g. because of their inability to understand or contribute to the discussion due to their mental impairment). If this is the case, the Care Manager should endeavour to include the resident briefly at the beginning or end of the review to establish their views, or speak with them in their own room prior to the review meeting.
If it is known, or suspected, that there may be areas of difficulty which the resident may be unwilling to raise in front of the home’s staff, the Care Manager should ask to speak with the resident in private prior to the review meeting taking place. The Care Manager should ensure that any areas of concern, which the resident has raised at any such prior meeting, are dealt with appropriately in the review.
It may sometimes be appropriate to involve an independent advocate on behalf of residents at the admission review. This is especially the case if the resident is uncertain whether the transition to residential or nursing home care is what they really want and if they have no-one other than the placing Care Manager to consult with.
The review meeting should be held in a place free from any interruptions or distractions (e.g. the residents’ room, or another quiet room not required for other purposes for the duration of the review). There should be a full discussion of how the first weeks of the placement have gone and any problems should be identified and action agreed to deal with these as appropriate.
January 2010 97 Making the Placement Permanent
If it is agreed that the placement can be made permanent, the Care Manager will end their involvement. It is essential that there should be clarity at this stage about who is taking responsibility for giving up the resident’s tenancy, sale of their property (if they own one) and the disposal of any belongings that they no longer require.
The case should then be referred to the Placement Monitoring Officers who will carry out an annual review on all placements. These will from 1st April 2004 be reassessments and will be entered on SWIFT as reassessments. However Placement Monitoring Officer’s will use the term review when discussing them with People and relatives, as using the term reassessment can cause anxiety by implying the likelihood of a change of placement. At this stage, the Care Manager must ensure the SWIFT entry is complete; if when taking on the placement for monitoring the monitoring officers discover an incomplete entry on SWIFT, the relevant Team Manager must be informed, so that they can ensure that the information is corrected.
1.4 If the Placement cannot be confirmed as Permanent
If it is not possible to confirm the placement as permanent, the Care Manager should remain involved until any problems, which have been identified, have been resolved. Very exceptionally, an alternative placement may have to be found, or the resident may return home. If it is not possible to confirm the placement at the six-week review, the Care Manager should ensure that the resident’s Housing Benefit entitlement continues beyond the normal limit of eight weeks (if they are in receipt of this benefit); otherwise, rent arrears may accrue. A date for a follow-up meeting should be arranged, usually within a maximum of another six weeks.
2. EMERGENCY PLACEMENTS FOR OLDER PEOPLE AND PEOPLE WITH PHYSICAL DISABILITIES
If the procedures detailed above are started as soon as the need for a placement is identified, the number of instances where the Person is placed without full documentation being in place should be extremely limited.
January 2010 98 In the event that there is insufficient time to complete the procedures above, in the first instance the Service Manager must be advised of the case, in advance of the placement commencing.
The Team Manager agrees and approves admission to residential and nursing care and signs the assessment form. The placement should be reviewed within 3 working days.
A nursing or residential home can be found by the Care Manager, Person, or the user’s family.
It should be noted that emergency admissions to nursing home care are quite uncommon and care managers should check that a hospital admission is not indicated.
The same price bands exist for emergency placements as with ordinary placements. The same criteria for the service user’s financial assessment and contribution stand.
FORMS
FACE Assessment Form
FACE Risk Profile Form
FACE Mental Capacity Form
Care Plan
Pre-admission questionnaire
Contract
Financial Authorisation Form
January 2010 99 13. MONITORING AND REVIEWS
Monitoring
Newly set up care packages need to be reviewed in a timely way to ensure that they are effective, but after no more than 4 weeks.
Residential/Nursing home placement should be reviewed within 6 weeks of the Person moving into to home.
Where care packages are unstable or there are problems in a placement, further reviews should be held in order to address matters in a timely way, or change the arrangements, if required.
Short Term Reviews
Where a short term intervention has been proposed, then a review needs to take place at the time that the procedure for the service outlines, or at the time when the Care Manager has proposed a review, whichever is earlier.
Where preventative services have been put in place reviews should be held as per the respective service procedures.
Review or Reassessment
A Review should be held if there is likely to be a change to the Person’s care/support plan, but the Person’s needs should be reassessed if there has been or there is likely to be a significant change to the Person’s circumstances, which will affect their needs and the way these will need to be managed.
Annual Reviews
January 2010 100 Once a placement has been made permanent a review takes place, at least annually.
Other community based ongoing services are also reviewed yearly, unless the procedures state a different timescale.
An annual review should take place in person.
Some types of reviews may take place over the telephone (see telephone review procedures)
Who should complete a review?
The review must be completed by a representative from the local authority (commissioner) or an independent person, and not by anyone who has a vested interest in the care package. Due to distance, the Local Authority where the Person is in placement may be commissioned to complete a review.
Who should be involved in the review?
Everyone that is involved in providing a service within the care/support plan, and any other professionals who have become involved since the care plan was drawn up and also, volunteers. They do not all have to attend the review but the final document should include their views and contributions to the persons care. Family and friends that are interested in the Person’s welfare should be included unless the Person does not want them to be included.
An IMCA may be appointed to support the individual (this is a discretionary power under the MCA 2005), and is advised if there have been significant issues at the home, or the person is showing signs of dissatisfaction with the home which could result in a move. An IMCA can only be appointed to attend a review if there is no one else (an informal person) to consult, and if the
January 2010 101 Person has been assessed as lacking capacity around their care and treatment or their accommodation. An advocate may be appointed whether the Person has capacity or not and whether the Person has an informal person to support them. Advocacy and IMCA services are accessed in the area that the person is residing, and not the originating borough.
An interpreter or a person or tools to support the communication medium of the Person may be engaged to enable the Person to participate as much as is possible in the Review.
Respect should be shown to their culture and religion when undertaking a review.
What must the Reviewer do? Residential/Nursing Placements
The reviewer must look at the case notes at the care home, the accidents and incidents related to the Person that is being reviewed, talk to the Person on their own about the year that has passed (they may want a familiar person present and this should be accommodated, and where there is an advocate they should be included in this meeting), any concerns and their future objectives.
The reviewer must consult with all services involved in providing care to the Person as well as any one interested in the care and welfare of the Person, and must consider the views of anyone with a Lasting Power of Attorney or a Court Appointed Deputy, that is attorney or deputy for personal welfare issues.
The reviewer must check the CQC report for the Care Home and check with the local safeguarding service whether there have been any safeguarding
January 2010 102 concerns. The reviewer must check the CQC report for any domiciliary service involved in providing care before the review.
The reviewer should consider the environment and the Person’s room, in the review
The Reviewer must review the Person’s capacity where it was previously assessed that they lacked capacity in relation to specific decisions.
Where the Person needs an assessment under the MCA, the Reviewer will undertake this, before the review.
What does the review involve?
The Review evaluates the year that has passed and any new concerns as identified by their checks. It reviews the tasks/objectives identified in the care/support plan. The reviewer must hold all people to account for what they were required to do in the previous care plan.
The Review ensures that there are no safeguarding issues in relation to the Person and their finances.
The Review reassesses the risks, revises the risk management plan.
The Review where a Person remains incapacitated in relation to decisions, revisits the best interest decisions made in relation to decisions to decide whether these remain in the Person’s best interest. Where new decisions are made these should be accompanied by Mental Capacity assessments and decisions should follow the best interest guidance. The Reviewer should also
January 2010 103 ensure that they are purchasing care that does not Deprive the Person of their Liberty if that is possible or where deprivation of liberty is occurring, that an application for authorisation is made. The Reviewer therefore will need to consider the restrictions and restraints that are applied to the Person, and ascertain whether these are proportionate to the risk of harm. They should inform the Home if an application for authorisation should be made. The Reviewer, must monitor, that the application is being made and should contact the DOLS office in Westminster to inform them to expect the application.
The Reviewer evaluates the quality of service and the cost of the services against the care/support plan and against new needs, and whether this remains the appropriate service/s for the Person in relation to their eligible needs. This evaluation may lead to negotiation for reduced costs, or increased cost. It may also identify that changes are likely in the future so that the Person may need to move, in which case, there is need to feed this back into the Care Management process. It may also identify that the costs related to the Person may change due to deterioration, in which case the Reviewer must feed this back into the financial planning process.
Where deterioration in health has occurred the reviewer must consider whether the Person may be eligible Continuing Healthcare.
Outcome of Review
The Reviewer may conclude that
- the Person is no longer eligible for services.
- services need to continue
- new objectives need to be set
January 2010 104 If the review identifies that standards have fallen in the contracted service, serious consideration should be given to offering alternative care for the Person, and de-commissioning the service i.e. advising other care managers not to use the service until standards improve. This decision and subsequent action will be taken following discussion with the line manager, members of the relevant placement panel and the Safeguarding Adults Team.
If service deficits i.e. unmet needs, are identified these should be reported to the Team Manager.
If further funding is required then the processes for authorisation of increased funding should be followed.
Review and change in FACS level for funding
A Review of care must be completed for each person whose care package will reduce due to a change in the agreed FACS level that that Council will fund.
Access to the Review Paperwork
The Person or their representative should sign the review documentation. Any disagreements should be recorded. The Person must be informed of their right to complain.
All parties involved in providing services receive a signed copy of the Review, as does the Person and their carer, if relevant.
January 2010 105 14. DIRECT PAYMENTS
The Community Care (Direct Payments) Act 1996
This Act gives local authorities the power to make cash payments for community care services direct to some individuals, so that they can purchase some or all of the services, which the authority has assessed them as needing. Local authorities can make direct payments for any community care service except permanent residential care or services provided by the local authority. The 1997 regulations allow authorities to make direct payment to service users over 18 and under 65; and to carers over 16, who have been assessed as needing community care services.
Health and Social Care Act 2001 – The Power to provide Direct Payments under the 1996 Act was superseded by the 2001 Act which gives the Secretary of State the power to make regulations related to direct payments.
Regulation in 2003, require all Local Authorities to make direct payments who (within a prescribed description) are eligible and who want them. Carers can also receive Direct Payments following a decision to provide to their assessed needs.
Regulations in 2009, have declared that People who lack capacity and some people with mental health needs can also receive Direct Payments.
Refer to the 2009 DH Guidance for Local Authorities on Direct Payments http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/di gitalasset/dh_104895.pdf
CARE MANAGEMENT PROCEDURES
Direct Payments
1 Eligibility
January 2010 106 Direct Payments are available to promote independent living and to give People as much choice and control over who assists them, when and how.
People must meet the following criteria in order to receive direct payments:
Assessed as needing community services under the NHS Community Care Act 1990 16yrs plus be willing and able to manage direct payments with or without support, or where a Person lacks capacity have someone who will manage these on their behalf be able to make choices with or without support, over who they want to assist them and how the assistance should be delivered, or have such decisions made in their best interest, if they are assessed as lacking capacity be a carer who has received a carers assessments and a decision has been made to provide services to the carer. Direct Payments can be given to all client groups, with some exclusion for people with in Mental Health needs or People who use Drugs and/or Alcohol.
Further details can be found in the Policy & Practice Guidance issued by DOH. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/docum ents/digitalasset/dh_104895.pdf
A Direct Payment should be offered as the first choice of service to People who meet the eligibility criteria. Only then should we offer services arranged by Social and Community Services.
January 2010 107 People may receive assistance in how they manage the Direct Payments including forming circles of support or setting up user controlled trusts.
WHAT DIRECT PAYMENTS CAN BE USED FOR:
employing an assistant to maximise the flexibility on how needs are met. arranging assistance with essential activities, such as help with personal care and help in the home (bathing dressing, toileting, getting up and going to bed, cooking cleaning, shopping making a meal). to purchase respite care. A maximum period of four weeks for any single episode of respite care in any 12-month period is allowed. Stays of less than four weeks are seen as a single episode. Additional residential care beyond this four weeks should be arranged by a care manager in the usual way.
N.B
A person receiving a Direct Payment may employ a partner, spouse or cohabitee or any close relative living in the same house. However, this should only be in exceptional circumstances. A local authority may decide that a certain circumstance is justified it is satisfied that this is the most appropriate way of securing the relevant services.
Direct Payments may not be used for:
the purchase of local authority services eg day care the purchase of residential or nursing home care
January 2010 108 Purchasing health or housing services
2 Joining the Direct Payments Scheme
Care managers are responsible for carrying out the assessment of need using an SAQ, and developing a support plan with the Person and carer. The Care Manager is also responsible for ensuring that there is a network of support if this is necessary to enable someone to use the scheme. For this enabling process, joint work with the support scheme provided by Penderels Trust, is encouraged.
Care managers are required to have a basic understanding of Direct Payments so that they can have initial discussions with People about what is involved and whether they would like to consider it. They should provide the Person with information on Direct Payments.
If a Person is eligible for Direct Payments and is interested in pursuing it, it is recommended that they be referred to the Independent Living Adviser (ILA) at Penderels. I.L.A.s can help with issues such as recruitment, job descriptions, advising on health and safety, employer/employee relations, dealing with emergencies, taking out public liability insurance, tax and National Insurance. They will offer more support initially to help People to set up their assistance.
The need for support for most people should decrease once they have gained confidence on the scheme. As such, People should be encouraged to be as independent as early as possible.
The Person is responsible for Health & Safety but Social Services should ensure that they have been given appropriate advice and equipment. An Occupational Therapy assessment should be offered.
January 2010 109 Once the Person has discussed Direct Payments with the I.L.A, and understands what is involved, the Agreement between Westminster City Council and the Person must be signed.
The Person is required to open up a Direct Payments bank account. Where people receive money from the Independent Living Fund (ILF) a joint account for Direct Payments and ILF only may be used. For information on the ILF criteria please refer to ILF guidance.
People may receive a combination of services and Direct Payments. Where a Person’s situation fluctuates, he/she should be given as much support as possible to stay on the Direct Payments if this is what is wanted. People may come off Direct Payments at any time if they wish to. Contingencies should be in place to address any breakdown in services.
3 Finances
Westminster is pays Person a set amount per hour. This price is inclusive of salary and on costs such as National Insurance, holiday pay, public liability insurance, pay roll costs. An initial one off payment of £150 may be made to pay for advertising costs or for insurance or other administrative costs as agreed by the care manager following completion of a commissioning form. The Residential and Community Finance Team need to be informed if this is required. Back pay for Direct Payments is not authorised.
The commissioning form must be authorised and sent to the Residential and Community Finance team. Payments will start once
assistants are recruited
January 2010 110 a start date is agreed the Person’s bank account details are provided.
The Care Manager must inform the Residential and Community Finance Team of any changes to the care package so that payments are adjusted accordingly and the correct changes are made.
Where a Person has died or stopped Direct Payments, Charging and Community Finance are responsible to recoup any money left in the service user’s account, minus, tax, National Insurance and salary owed.
4 Retention Pay
In the case of a service user needing hospitalisation, retention pay may be paid at 75% of the employee’s pay for up to a maximum of four weeks in a year. People are required to inform care management when hospitalisation occurs. The situation must be reviewed after two weeks following hospitalisation. In exceptional circumstances, where losing a personal assistant could cause breakdown of a care package, the team manager may agree to extend retention pay. The care manager must inform the Residential & Community Finance Team when pay should be reduced to 75%.
Retention pay should not be paid when the Person goes on holiday or respite and does not need the help of an assistant. People should plan their holiday and respite to coincide with employee leave arrangements. They should be encouraged to give employees adequate notice. Social & Community Services are responsible to ensure that identified needs are being met.
5 Police checks – families with children under 18 years
January 2010 111 Where there are children under18 years of age in a family, the parent is responsible for the safety and protection of the children. The care manager should discuss getting police checks with the parent. If there is direct work involved with the children to support a disabled parent in the parenting role, the parent especially should consider the necessity for a police check to be carried out. Social services can arrange for a police check from the Criminal Records Bureau. The same procedures apply as with parents employing carers for disabled children. The lead for Direct Payments for disabled children can be contacted for advice.
6. Review process
A Person on Direct Payments must be monitored and reviewed as with any other person receiving services under the NHS Community Care Act 1990 or children’s legislation. The review must take into account whether Direct Payments are meeting assessed need, whether the Person is managing the processes and whether monitoring paperwork and bank statements are being returned to Charging & Finance on a quarterly basis.
People who continue to refrain from sending their paperwork to Charging & Finance should be offered support to complete the paperwork if they need it. After support has been offered and the paperwork work is outstanding for more than 3 months, service users should be given a deadline for completing the paperwork and the manager should consider stopping Direct Payments.
January 2010 112 15. OCCUPATIONAL THERAPY SERVICES
OCCUPATIONAL THERAPY INTERVENTION
The service provides assessment for people who are severely disabled or have multiple disabilities where Occupational Therapy input is considered necessary as part of the assessment process, or where major adaptations may be required. The following is likely to apply:
People will require a high level of care. Care Management Services regard a full assessment of the Person’s functional abilities to be beyond their level of competence. Occupational therapy intervention is required to plan and co-ordinate hospital discharges for people who have experienced sudden, major changes in their functional abilities, such as following Strokes, Spinal Injuries, Amputations, Cranial Haemorrhages or major surgery/treatment. In order to promote continuing independence, for example, Multiple Sclerosis. Advice/assessment where more than one person in a family unit is disabled and the family require advice to facilitate independence. People who may contemplate caring for a disabled relative who is no longer able to live independently in their own home because of their functional difficulties. Acute or rapidly deteriorating conditions affecting the person’s functional abilities, for example, Cancer, Multiple Sclerosis, Motor Neurone Disease.
ELIGIBILITY FOR THE SERVICE
The provision of services will be subject to eligibility under the Fair Access to Care Services criteria.
January 2010 113 Many people may also be eligible for registration as permanently and substantially disabled*. *As described by the Chronically Sick and Disabled Persons Act 1970
Permanently: the condition is deemed life long with no prospects of recovery, or there is likelihood of further deterioration, or the condition is terminal.
Substantially: there is significant loss of functioning affecting the person’s ability to carry out essential activities of daily living, i.e. having severe difficulty in performing an essential task e.g. getting up from a chair or toilet, at a stage when the inability to perform a task affects a carer’s ability to continue caring, or makes a person dependent on other services.
Where a request is specifically for a major adaptation the referral should have been properly screened by the locality teams and other options have been considered e.g. where a request is made for a shower adaptation, a bathing assessment is first carried out.
Where a request is for assessment and follows up work, the referral constitutes an explicit need for assessment by an Occupational Therapist. Assistant Care Managers (ACMs) and Care Managers (CMs) are able to assess for certain equipment. Training for ACMs and CMs to enable assessment and provision of equipment is provided.
Care Managers who are qualified occupational therapists have the option to use the Dependability contract for work with their own clients or when working with duty cases e.g. they might refer to Dependability for adaptation work for a particular client. Occupational therapists who are Care Managers work primarily as Care Managers and use their professional occupational therapy skills to support their work.
January 2010 114 Before sending a referral to Dependability, care management should check with Westminster Rehabilitation Service (WRS) if the Person is known to them, and consider the rehabilitation potential of the service user. If WRS are already involved, then there must be a clear rational for referral to Dependability. Information about WRS involvement should be included on the referral to Dependability.
If care management are considering referring a service user to both Westminster Rehabilitation Service and Dependability, staff should discuss the circumstances with their team manager / disability policy officer, to ensure there is clear justification and to avoid inappropriate duplication of involvement of both services.
OCCUPATIONAL THERAPY CONTRACT – DEPENDABILITY
Dependability is the contractor for occupational therapy assessment and major adaptation services in Westminster (2004-2009). The service covers the whole of the City and is provided by qualified occupational therapists.
Referrals to Dependability can be made by the Older and Disabled People Care Management Teams, Learning Disabilities Partnership, and by the Mental Health, Joint Homelessness and Substance Misuse Services for people who have a physical disability. Children and Families Division use their own paediatric occupational therapists.
All referrals must come through these care management teams. Other staff cannot refer directly e.g. hospital occupational therapists, district nurses, and any requests must be filtered through the relevant care management team.
January 2010 115 The Dependability contract is for use when care management staff do not have the expertise to carry out assessments for equipment and minor adaptations. It is expected that assessments for simple equipment and minor adaptations will be carried out by CMs and ACMs in accordance with the training they have received.
Referrals can be made for three types of service:- a) Assessment and Follow Up Work b) Assessment for Major Adaptation of Property. c) Consultancy and Advice.
3. Assessment and Follow Up Work
This element of the service has been included to provide high quality, responsive and detailed assessments for people who are experiencing difficulties carrying out activities of daily living.
Following assessment, Dependability will co-ordinate the following as appropriate:
provision of equipment and minor adaptations advice re: assistive techniques referrals to agencies such as Age Concern, Westminster Rehabilitation Service, Wheelchair Service liaison with GPs and DNs
Dependability will provide their assessment together with the ISA to the locality teams if the need for more complex care management assessments is identified, or services such as domiciliary care or Westminster Meals Service are deemed necessary.
January 2010 116 Referrals can be made to Dependability to assess the housing needs of people with a physical disability. These housing assessments relate to the following:
Assessing the feasibility of adapting a Person’s existing property Assessing a Person’s individual needs and recommending to Assessment and Advice in the Housing Department the type of housing required to achieve maximum safety and independence within their environment
Viewing potential properties for suitability for re-housing/major adaptation.
There is also the process for Housing Assessment and Advice to make direct referrals to Dependability under a separate part of the contract. (see section 5).
4. Assessment for Major Adaptation to Property.
If after the screening by the locality team it is clear that a Major Adaptation is the preferred option, then a referral should be made to Dependability.
Care Managers with an occupational therapy qualification are able to co- ordinate Major Adaptations for their own allocated cases as appropriate.
Examples of Major Adaptations include:
Over-bath showers Level/low access showers Special baths Stair lifts or through ceiling lifts Ramps or step lifts Ground floor WC or specialised WC
January 2010 117 Ground floor extensions to provide bedroom/bathroom for a disabled person Ceiling tracking hoists Kitchen adaptations Sliding doors
Funding for Major Adaptations for owner occupiers, privately rented accommodation and council lessees (for adaptations within flats) is via a Disabled Facilities Grant (DFG), and people will be subject to a means test to determine if they will be required to contribute towards the cost of the adaptation.
Dependability works closely with Environmental Health, Private Sector Housing and Westminster Home Improvement Agency to co-ordinate major adaptations for private sector residents.
For Council Tenants the responsibility for carrying out major adaptation work rests with the Property Services Team at CityWest Homes.
Housing Associations have responsibility for carrying out work in their own properties although in some circumstances, may apply for a Disabled Facilities Grant.
Adaptations that are recommended following assessment are prioritised by Dependability as follows:
Urgent 1. Any adaptation for a child.
January 2010 118 2. Any adaptation to assist someone who has a rapidly deteriorating condition, which would be exacerbated without assistance. E.g. Muscular Dystrophy, Motor Neurone Disease, or a terminal illness 3. Any adaptation to facilitate Hospital Discharge. 4. Any adaptation to prevent admission to hospital where the person has a regular and substantial care component to enable then to remain within the community, where without the adaptation there would be a serious impact on the person or the carer
High 1. Any adaptation to prevent falls, which then may require admission to hospital. 2. Any adaptation to prevent deterioration where a person has a progressive illness, e.g. Parkinson’s disease or Multiple Sclerosis. 3. Any adaptation, which is to facilitate access to the toilet where the person is using temporary equipment.
Standard
1. Any adaptation to facilitate access either within the home e.g. a stair lift, or out of the home, e.g. a ramp. 2. Any adaptation which provides access to bathing. Where service user needs are prioritised as standard, there may be a substantial waiting time for the adaptation work to be commenced. This is due to limited resources of all the housing bodies.
A Person’s needs may potentially change during the period they are awaiting major adaptation work to commence. This may just require notification to Dependability for a follow up to check the situation out. If however there has been a substantial change in needs and a new specification or re-prioritisation may be required, then a new referral may be necessary. Discussion with the senior occupational therapist at Dependability or the Disability Policy Officer may be advisable prior to referral.
January 2010 119 The booklet ‘Help with Adaptations to your home’ provides information about the various processes within the adaptations process.
Consultancy and Advice
Referrals to Dependability requesting consultancy visits to be carried out jointly with the allocated Care Management or ACM are appropriate where the Care Manager or ACM:- a) has identified an area of need which requires the expertise of an occupational therapist, AND b) has acquired skills in assessment for simple equipment and minor adaptations but requires advice and support from an occupational therapist.
Consultancy and Advice visits are single joint visits where the occupational therapist will assist with the assessment and provide written recommendations to the referrer. It is the responsibility of the referrer to follow up any action identified, with the support of the occupational therapist. If a full occupational therapy assessment or major adaptation is indicated, then a separate referral will need to be made. Locality staff can also contact Dependability direct for professional guidance and advice instead of a Consultancy and Advice visit. This may be by telephone after the recommendations have been made by Dependability.
In addition, consultancy meetings are held regularly with Dependability for staff that prescribe equipment. Meetings are held in Lisson Grove for staff in the north of Westminster and at City Hall for staff in the south.
January 2010 120 REFERRAL PROCEDURES
Referrals to Dependability are made using the SWIFT Database. The specific guidance for making referrals is detailed in the SWIFT procedures available on the intranet. The referral be agreed and prioritised by a nominated Team Manager who has had relevant training.
Referrals should be made using the following categories:
Assessment and Follow Up Code DAFU This is potentially the most frequent type of referral where an assessment is required and there is also the strong likelihood of equipment or other action necessitating a follow up visit.
Assessment Code DAS Referrals for an assessment only, is likely to be used when there is an indication that a single visit may be required. This might be applicable for a housing assessment (which should be clearly marked), or to give advice to an informal carer.
5. Major adaptation Code DAMA Major adaptation referrals are likely where care management have already assessed and provided equipment and needs have changed, or routine equipment will not meet the needs of the service user. Complex structural work would require this level of assessment and the associated activity necessary to progress such works.
Dependability will carry out an initial assessment visit for all above categories and from this identify the most appropriate way forward with the service user. The codes are used in the referral process to provide an indicator of the referral focus.
January 2010 121 6. Consultancy and advice Code DCA These referrals are for a single joint visit with a member of the Dependability team. The occupational therapist will assist with the assessment and provide written recommendations for the referrer. It is the responsibility of the referrer to follow up any action identified, with the support of the occupational therapist.
Referral Information
It is important that good information (including full details of GP, telephone contact numbers) is provided at the point of referral. This is entered free text onto the SWIFT system by care management staff.
Where a referral is a CRISIS, for a housing assessment, or ‘Decent Homes’ refurbishment, this should be clearly identified.
Reason for referral – this should indicate the peoples needs and abilities, not just a potential outcome/recommendation Social history – home situation, carers (informal and formal), support services Details of any other services involved (e.g. Westminster Rehabilitation Service, mental health team)
Functional difficulties/diagnosis If registered physically disabled Equipment provided to date and any tried unsuccessfully Possible options/peoples perception of solutions Interpreter requirements where appropriate Contact details of original referrer and any request for liaison, feedback or a joint visit (where care management is acting as third party for a referral e.g. from hospital occupational therapist) Any risk factors to be considered
January 2010 122 You may have additional information to send through, e.g. hospital occupational therapy reports, medical reports. These should be sent direct to Dependability clearly indicating that they relate to a specific referral. Please ensure that you state in the referral text that you will be sending additional information.
Where a case is complex, or there are significant care related issues it can be beneficial to request on your referral that you are contacted by the allocated occupational therapist prior to their assessment visit, or to carry out a joint visit.
It is possible to monitor the progress of the referral within the data base system. Details of the date the referral is despatched to Dependability will be recorded. When Dependability intervention is complete, details of work carried out are sent back to the referrer.
Please make sure all associated personal details are complete and correct. Delays occur if this information is not on SWIFT or if the information is incorrect.
Confirming referrals with service user
Care management should send every service user referred to Dependability a copy of the Westminster Adults Services Occupational Therapy information leaflet, together with a covering letter confirming that the referral has been made to Dependability.
Despatch of Referrals
January 2010 123 The contracts officer at City Hall identifies referrals on the SWIFT system via a business objectives report, and these are despatched daily to Dependability.
The general performance target for assessment is within 10 working days of the referral being received by Dependability.
Dependability does not operate a waiting list as all assessments should be made within this timescale unless there is a specific reason e.g. not suitable for the Person.
Crisis assessments will be assessed within 2 working days of referral. It is important to alert the Contracts Officer to these referrals to enable Dependability to be notified with as much notice as possible.
It is advisable that the referrer check the SWIFT data base within a week of the referral data entry, to ensure that their referral has been fully processed.
Dependability will provide the service user with an Individual Service Agreement (ISA) at the end of their assessment.
Follow up of Referrals / Liaison with Dependability
Unless there are queries regarding a referral, Dependability will go ahead and arrange assessment and any follow up or additional action required.
Referrers will not automatically be contacted regarding the outcome of the referral and therefore should be proactive where necessary if they require specific information following assessment or a typed report for a particular reason.
January 2010 124 Administrative staff at Dependability are able to provide information about the status of a referral (received, allocated, date of visits etc), but it is advisable to discuss any specific issue with one of the senior occupational therapists, one of whom is usually available in the office. If necessary, arrangements can be made for the assessing therapist (who is usually self employed) to contact the referrer.
Dependability will provide the referring care management team with an Individual Service Agreement (ISA) for each Person after their assessment. These will normally be sent in batches (couriered to the Contracts Officer for internal posting) unless there is a priority action required by care management. It is important that all ISAs are checked by care management on receipt for any recommendations that have implications for care management in terms of providing additional services.
Where duty cases are referred to Dependability, care management should place the case for an initial three month review. Dependability should be contacted to establish the progress of the case and any outstanding work required. This is particularly relevant to cases where major adaptations are required. At that time, the case should be placed for a subsequent progress review (timescale will depend on circumstances).
Cases will be kept open by Dependability until they have completed that intervention. On closure, all assessment and other documentation will be returned to the referring care management team.
Reviewing maintainable equipment
January 2010 125 Where Dependability have provided the Person (via Medequip) with equipment that requires servicing and therefore annual review, care management must ensure that such cases are identified and entered onto SWIFT to facilitate this review action (Dependability do not currently have access to SWIFT)
Contract Monitoring Processes
Feedback about quality of service process issues can be provided to the Contracts Department or the Disability Policy Officer. Contract monitoring meetings are held on a quarterly basis with Dependability.
HOUSING ASSESSMENT AND ADVICE DIRECT REFERRALS
Housing Assessment and Advice have a specific component within the Dependability contract to facilitate direct referral for occupational therapy housing assessments.
The target for undertaking housing assessments that are sent direct from the Housing Assessment and Advice team is 2 days of receipt of referral by Dependability.
Nature of direct referrals A direct referral may be made for:
Assessment of peoples housing needs Assessment of a specified property with a view to a named Person, being appropriate. General assessment of a property’s suitability for disability facilities.
January 2010 126 Direct Referral Criteria Where a case is actively open or allocated to care management, then a referral to Dependability will be made via care management/Adults Services team as per normal procedures. (In these cases an assessment will be carried out within the 10 working day time frame and not the 2 day time frame which applies to referrals direct from housing).
Direct referrals can be made when:
The Person is not known to care management and there is no indication for care management to be involved. The Person is known to care management but the case is closed or has a review status. There is a requirement for an assessment of a property without an associated Person identified at that time.
Process i) The nominated officer at Housing Assessment and Advice contacts the relevant care management or Adults Services team to identify if a Person is known and to check the case status. ii) If the case is allocated or actively open, the assessment and advice officer will liaise with the allocated/duty worker and request a housing assessment be made to Dependability. iii) If the case meets the direct referral criteria, then the housing assessment and advice officer completes a housing assessment referral form. Where a referral is for a property assessment only, then the referral form is the only form to be completed. Where a referral is for a named individual, then the basic personal information form must also be completed as fully as possible. iv) The completed referral form, and basic personal information form (where relevant), is faxed to: Dependability (on 020 8537 3360) Contracts Officer at Adults Services (Shenaz Munogee on 020 7641 3455) for contract monitoring purposes.
January 2010 127 The local Adults Services office for the Person’s file where relevant. v) Dependability completes the relevant assessment(s) and supply the report to the nominated officer at Housing Assessment and Advice and with a copy to the relevant Adults Services office. vi) If Dependability identify health or social care needs during their assessment, they should make the necessary referral to the relevant service provider.
Dependability Limited
Telephone: 020 8991 3714 or 020 8998 3707
Facsimile: 020 8998 5771
Location: Imex House, 6 Wadsworth Road, Perivale, Greenford, Middlesex. UB6 7JJ
Email: [email protected]
Westminster Integrated Community Equipment Service
Procedures and details on the Westminster Integrated Community Equipment Service are provided with the Medequip catalogue.
This can be found on the WIRE under Documents, Integrated Community Equipment Service Autumn 2007
16. HOSPITAL DISCHARGE -GUIDANCE ON PROVISION OF COMMUNITY EQUIPMENT
The Westminster Integrated Community Equipment Service is important in facilitating the independence of service users returning home from hospital.
January 2010 128 There is some variation in the procedure, depending on whether the hospital has direct ordering authority with Westminster’s community equipment service. The good practice and duty of care principle that a prescriber should follow up the issue of equipment is fundamental, but where prescribers do not have direct order access, this may not always be achievable.
Direct Ordering of equipment by hospital therapists
Key hospitals, either located within Westminster borough, or who take significant numbers of residents from Westminster, have direct access to the Westminster Community Equipment Service.
This means that they have:
An allocated ordering reference code
A copy of the Westminster Equipment Catalogue
JC230 equipment order forms
Access to special equipment via normal authorisation procedures (authorisation is via nominated head/senior therapists within their organisation and health or social care specials panel member)
Responsibility for follow up for all the equipment they prescribe.
There should not normally be a requirement for care management or Westminster Rehabilitation Service to be involved in specifically following up equipment in these cases, unless there are ongoing/changing needs.
January 2010 129 Private / NHS Hospitals unable to order community equipment direct
Hospitals outside of the borough, or private hospitals, often have only a small number of Westminster residents using their services. In these situations, the hospital therapists do not normally have direct access to the equipment service.
Westminster residents who are receiving private medical care are eligible for equipment from the community equipment service under the normal procedures. In these situations, the hospital will normally make a referral to the relevant care management team to provide the equipment.
Mobility equipment should however normally be provided via the hospital.
Referrals may be made where appropriate by the hospital to Westminster Rehabilitation Service where there are specific rehabilitative needs in addition to equipment requirements. However it is the hospital’s OT’s responsibility to ensure that the arrangements for equipment ordering and delivery to necessitate a safe discharge from hospital are organised prior to discharge.
It is important that care management/rehabilitation service:
Receive an occupational therapists assessment report that supports the request for the equipment. It should be clarified if a home visit has been done to identify if the equipment being requested will be appropriate to the Person’s environment.
January 2010 130 Obtain detailed specification of equipment items that they are being asked to order on the hospital therapist’s behalf.
Discuss with the hospital occupational therapist to clarify where the equipment needs are not explicit. This may be best achieved where the member of care management/rehabilitation staff has experience of equipment prescription and the stock catalogue items.
Establish whether the hospital occupational therapist will carry out a follow up visit (this is not normally the case for those hospitals unable to order direct).
Carry out the necessary follow up if the hospital occupational therapist is unable to implement this. The follow up will need to be timely, and usually carried out by either an assistant care manager, rehabilitation assistant, or occupational therapist. The type of equipment being provided will influence decisions about speed of visit and level of expertise required, and should be agreed with the hospital occupational therapist prior to discharge. Depending on the complexity of a case and concerns expressed by the hospital occupational therapist, a joint home visit by care management/Dependability and the Rehabilitation Service may be appropriate. The above information provides guidance for care management teams and Westminster Rehabilitation Service. There will be occasions when individual situations do not necessarily fit in with this guidance. Professional judgements will need to be made at such times on a case by case basis.
List of hospitals / bedded units authorised to order direct:
St Mary’s Hospital Chelsea and Westminster Hospital St Thomas’ Hospital Charing Cross Hospital Middlesex Hospital St Pancras Hospital Royal Brompton Hospital Camden and Islington Palliative Care Team Hammersmith Hospital Royal London Homeopathic Hospital Royal Marsden Hospital Royal Free Hospital Hospital of St John and Elizabeth St Charles Hospital
January 2010 131 Princess Louise Hospital St John’s Hospice Trinity Hospice University College Hospital CNWL Mental Health Units National Hospital for Neurology, Queens Square. Robertson Unit, Willsden Athlone House Rehab Unit Norton House Rehab Unit Ellesmere Rehab Unit (K&C) Royal National Orthopaedic Hospital, S Marie Curie, Hampstead tanmore Wolfson Centre, St George’s Healthcar e NHS Trust
17. Joint Working Arrangements
Joint Working between Teams within Social Services
January 2010 132 In some cases where needs cross over different service areas, there is a need for these service areas to work together. In such cases, the Team Manager in the team that has accepted the Person as someone eligible for service will contact the Team Manager in the team best placed to support the case by telephone. If the request to work together is rejected, the Team Manager will raise the case with their Service Manager who will liaise with the Service Manager of the supporting team. Where a resolution is not reached at this point, the Director for Operations in adult services will make the final decision about how the case is managed.
Where the case is accepted for joint working the original team will retain lead responsibility unless a decision has been reached that the case is better led by the supporting team.
The Supporting Team will remain involved while they have a role in the case, and will close the case when their input is no loner required.
Transfer of Cases between teams within Social Services
On occasions, following further investigation, it becomes apparent that a Person’s care will be better managed in another team. Where this does occur, the process as above applies, except when the case is transferred, the case is closed in the original team.
Working with Children Services
Everyone has a responsibility to protect a child from abuse and to work on the premise the welfare of a child as the Child’s needs are paramount (Children Act 1989). Staff in Adult Social Services have a duty to protect children and also needs to ensure that where a child in is need, their case is referred to the Children Services.
January 2010 133 (Please refer to the Joint Working Protocol for Working with Children Services on general care management page on intranet)
(Please refer to Procedure for Assisting Disabled Parents to get Children to school on same page)
Transition
Adult Services also have a responsibility to avail Young People who are moving from Children Services to Adult Services, a smooth transition, if they will require services in Adult Services.
To this end, the Transition Steering group and the Transition Operational group have been set up to steer the direction of transition and to consider each Child that will require early intervention to ensure that services are in place for them if they are eligible for these, for when they turn 18.
The Steering Group and the Operational Group comprises of representatives from Children and Adult services
(Refer to the Westminster Transition Pathway on general care management page on the intranet)
(Refer to Transition from CWDT to WLDP Practice Guidelines 2009 on WLDP intranet page)
Working with Housing
A protocol is in place for Care Managers working with Housing.
Arrangements are in place to support Care Managers in their role to enable people to live in the Community through the use of quota of local authority rentals being made available to house people who Care Managers identify need alternative housing.
(Refer to Protocol for Liaison between WCC adult services and City West Homes on general care management page, on the intranet)
January 2010 134 Working with other Organisations
S75 arrangements are in place to enable smooth arrangements between health and social care, when working with people in Mental Health and Learning Disability Services and some Older Peoples services.
Joint appointments are also made between health and social care, to enable joint commissioning of services for People who use health and social care services.
Joint arrangements are in place to institute the MARAC, MAPPA s and Safeguarding Adults procedures
18. People’s Affairs
HOME CARE CHARGING
January 2010 135 Staff should provide the Person with a Charging leaflet and also explain this to the Person. Staff can use the Charging Ready Reckoner to support them with any questions related to charging and community services
Charging Policy
Under Westminster City Council’s Charging Policy service users are not charged for:
assessment by care managers, assistant care managers or Home Care assessors, or advice from them
health services, or
mental health community care services
Other services are charged for. There are two types of charge:
a weekly payment based on income, spending, commitments, saving and the cost of services received.
Charging System
The charging system is laid out in detail in the booklet, “Fairer Charges for Home Care”. A copy of the booklet should be given to the Person, and gives a detailed outline of the Westminster charging procedures.
As part of the Charging Policy all service users can ask for a free Welfare Benefit check. In order to arrange this service, please send a referral to the Charging Team who manages the contract. This involves a visit from a Benefits expert who will check that all benefits to which the service user is entitled have been claimed. This work is undertaken by a Contractor on behalf of the Council. Because these Benefits experts will be visiting service
January 2010 136 user’s homes it is important that you notify the Charging Team of any particular difficulties relating to access, communication, violence etc.
People are invoiced every 4 weeks and are not asked to pay for any week in which they did not receive a service. All service users are recorded on SSID.
The Charging Policy is administered centrally in City Hall by the Residential and Community Finance Team based on the 8th Floor at City Hall.
Procedures
All Provisions must be entered on SWIFT. See SWIFT guidelines regarding inputting provisions.
The Residential and Community Finance Team will access information about People receiving services from SWIFT.
Care Managers should advise the Person that there will be an assessment to see if they are required to pay a charge for their Community Care. They should also be given a charging leaflet.
Exemptions and Waivers
The Director of Social Services has delegated authority to exempt or reduce the charge payable on grounds of financial hardship.
People requesting such action should be advised to:
write to the Charging Team giving details of their income and expenditure, and indicate how much a week they feel they can afford to pay.
Requests by a Care Manager on behalf of the Person should include the same information.
January 2010 137 All requests are considered on an individual basis by a Waiver Board comprising the Assistant Director and the Head of Finance who make recommendations to the Director of Social Services.
Service users who disagree with the decision of the Director have a right of Appeal to a panel consisting of two Councillors and an independent person.
FINANCIAL ASSESSMENTS FOR SERVICE USERS ENTERING RESIDENTIAL OR NURSING HOMES
Introduction
Currently Westminster carries out an assessment of a service user’s financial circumstances if a Person is to enter into nursing or residential accommodation. This is because:
Section (21) (1) (a) of the National Assistance Act 1948 places a duty on Local Authorities to provide residential accommodation for persons who by reason of their old age, infirmity or other circumstances are in need of care and attention which is not otherwise available to them.
Section (22) of the Act requires that people, for whom this accommodation is provided, pay for their accommodation. Westminster will reduce the amount a resident has to pay if the resident satisfies the authority that they cannot afford to pay. In order to do this they must complete a Financial Circumstances Residential and Nursing Home Assessment form. Once completed and signed by the Person and Care Manager this form is sent to the Residential and Community Finance Team in City Hall for the formal financial assessment to be completed. The Residential and Community Finance Team then inform the Person and the home of the contribution. (See Section: RESIDENTIAL AND NURSING HOME CARE.)
The method by which Westminster calculates the reduction in charges is common to all local authorities and is prescribed by the Secretary of State and laid down in great detail under the Charging for Residential Accommodation Guide (CRAG).
January 2010 138 The financial assessment form has been designed to aid people in satisfying the Authority of their qualification for a reduced contribution. It is important that these forms are completed correctly if the Person is to gain maximum reduction. It is the responsibility of the Care Manager to ensure that the appropriate documentary evidence to substantiate claims is attached to the form.
Level of Support
Assessed contributions are calculated on the basis of a Person's income and capital.
If a resident deprives themselves of capital so as to pay a reduced amount Westminster will consider them as still possessing the capital disposed of and will calculate their contribution accordingly. If in doubt, the Care Manager should contact the Team Leader of the Charging Team.
CLIENT AFFAIRS TEAM
The Client Affairs Team manage the finances of People who use services, who are unable to deal with their own affairs due to mental incapacity or severe physical disabilities, and who have no relatives or friends to undertake these responsibilities for them, through the use of Appointeeship or if appointed to act as a Deputy under the MCA 2005.
It also protects the property of People who are eligible for services, who go into hospital and other accommodation as per duties under the National Assistance Act.
Arrangements can also be made for storage of the Person’s property and also for boarding of animals.
January 2010 139 Applications will be accepted from care management teams on the appropriate referral form. The service is offered within office hours only and does not provide an emergency service.
(Refer to the following on the Intranet
Leaflet for Care Managers
Advice for Care Providers
Power to Manage Service User Affairs)
PROTECTION OF PROPERTY OFFICER:
Collette McCarthy 020 7641 2274
CLIENT FINANCIAL AFFAIRS TEAM SUPERVISOR:
Caroline Savage 020 7641 3346
19. MANAGING INFORMATION
January 2010 140 This section summarises and makes reference to policies/procedures related to managing information. For further details please refer to the policies/procedures
(Refer to the General Information Sharing Protocol for North West London Health and Social Care)
Caldecott Guardian: A Caldicott Guardian is a senior person responsible for protecting the confidentiality of patient and service-user information and enabling appropriate information-sharing. The Guardian plays a key role in ensuring that the NHS, Councils with Social Sevices responsibilities and partner organisations satisfy the highest practicable standards for handling patient identifiable information.
Phillip Berechree 0207 641 2048
Staff must be aware of the overall protocol as above that governs information sharing between the organisations that have signed to the agreements which are:
Central and North West London NHS Trust Chelsea and Westminster Healthcare NHS Trust Kensington & Chelsea PCT London Borough of Westminster Royal Borough of Kensington and Chelsea Royal Brompton and Harefield NHS Trust St. Mary’s NHS Trust Westminster PCT
Common Law duty of Confidentiality
January 2010 141 The general position is that, if information is given in circumstances where it is expected that a duty of confidence applies, that information cannot normally be disclosed without the data subject’s consent.
In practice, this means that all patient information, whether held on paper, computer, visually or audio recorded, or held in the memory of the professional, must not normally be disclosed without the consent of the patient. It is irrelevant how old the patient is or what the state of their mental health is; the duty still applies.
The four sets of circumstances that make disclosure of confidential information lawful are:
_ where the individual to whom the information relates has given consent;
_ where disclosure is in the overriding public interest;
_ where there is a legal duty to do so, for example a court order; and
_ where there is a statutory basis that permits disclosure
Therefore, under common law, a staff member should first seek the consent of that data subject.
Where this is not possible, an organisation may be able to rely on disclosure being in the overriding public interest. However, whether a disclosure is in the public interest is not a decision to be taken lightly. The judgement to be made needs to balance the public interest in disclosure with both the rights of the individual(s) concerned and the public interest in maintaining trust in a confidential service. Solid justification is therefore required to breach confidentiality and specialist or legal advice should be sought before the information is disclosed. Any decision to disclose should be fully documented.
Disclosures required by court order should be referred to the organisations legal advisers as promptly as possible, so that any necessary representations may be made to the court, for example to limit the information requested.
January 2010 142 If a disclosure is made which is not permitted under common law the patient can bring a legal action not only against the organisation but also against the individual responsible for the breach. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/do cuments/digitalasset/dh_079619.pdf
Refer to Information Sharing Guidance for Practitioners and Manager on the Every Child Matters website
It contains a flowchart on Page 13, to help in decision making about whether to share information http://www.dcsf.gov.uk/everychildmatters/resources-and-practice/IG00340/
Access to Records Policy – Refer to policy, guide and flowchart on Care Management Intranet Page)
Case File Audit – refer to procedure on Care Management intranet page
Case Recording – Refer to Quality Assurance Framework
City of Westminster Social and Community Services Document Management Policy February 2001
What does this policy cover?
This policy aims to promote high standards in the management of all records throughout the department. Although “records” are traditionally manuscript and print records, this policy should also be applied to
January 2010 143 photographs, sound recordings, film, and videotape. In particular this policy also covers computer disks and records held in an electronic form, such as e-mail, Word, Excel and database files.
It gives guidance to managers and staff on how long records must be kept. This is referred to as the retention period. The policy details the retention periods of key document series, and where possible states the appropriate authority for that length of time. Review suggests that you should not automatically destroy the file without first reviewing it.
Records that hold personal data about identifiable living individuals are subject to the Data Protection Act 1998, and the policy indicates where this is likely. Managers should contact the department’s Data Protection Liaison Officer (DPLO) for further advice (x2255).
Records that are vital are those that are essential to the running of a section or department. Following a major disaster what records would be required for business continuity? Managers should evaluate these risks and consider making duplicate copies or back-ups to protect vital records.
Some records from your section may have historical value and thus a sample should be kept permanently. The policy indicates when you should contact the City Archivist (x5180) before disposing of these records.
Please refer to the departmental Access to Records Policy and local procedures for file creation, classification and maintenance. See also The Code of Governance (http://intwwwemm01/corporate/net- it/cow_pol/codeofgovernanc_/officers_/default.htm) and the Corporate Security policy (http://intwwwemm01/corporate/net-it/corpsec/) for further advice.
January 2010 144 Records and Information Security Policy May 2009
This policy defines the responsibilities of individuals with respect to information use and to the provision and use of information processing systems. The policy is concerned with information held by the Council and used by Council employees, contractors and partners. It relates to information held in all formats.
Appropriate information access and security involves knowing what information exists, permitting access to all who have a legitimate need and ensuring the proper and appropriate handling of information.
Information security Best Practice Guide September 2008
This guide is designed to provide you with advice on how best to handle, store and transfer confidential information, including personal information, sensitive personal information and information that is of commercial value to the City Council. The Data Handling Grid, which is appended to this document, sets out the general expectations of staff when dealing with information.
Records Management & Freedom of Information Policy (February 2003)
This policy supports the implementation of the Codes of Practice issued by the Lord Chancellor’s Department on managing records1 and dealing with requests for information under the Freedom of Information Act 2002. It establishes the Council's commitment to public access to information and the effective, economic and efficient management of its records to support open government.
1
January 2010 145 SWIFT
Staff must ensure timely inputs into SWIFT to meet legislative duties, reporting needs and also ensure prompt payments to providers
January 2010 146