Monitoring and Review

Monitoring should always be considered when:

1. equipment is provided short term only;
2. there are delays in providing equipment or an adaptation;
3. there is a need to maintain involvement and direct support was deemed disproportionate;
4. it is not clear whether the person or carers will use equipment effectively; or
5. further intervention in the short term may be likely (for example, reassessment or direct support).

The purpose of monitoring can be to:

1. confirm that equipment is meeting eligible needs as intended;
2. establish whether equipment that is provided on a short term basis is still required;
3. confirm that any urgent or interim direct support or equipment being provided is meeting needs as intended;
4. establish progress in the provision of equipment or an adaptation;
5. identify the need for additional support to use equipment safely and effectively; or
6. review the effectiveness of equipment in meeting needs that fluctuate;
7. identifying the best time to re-assess needs (when this was anticipated).

Monitoring arrangements must be agreed with:

1. the person (or their representative if they lack capacity); and
2. any carer.

The frequency and method of monitoring should be proportionate to the nature of the equipment being provided, and the needs and circumstances of the person. It could include:

1. face to face visits to the person (required if they lack capacity);
2. a meeting involving the person, any carer and any service providers that use the equipment;
3. telephone contact with the person, any carer and any service provider;
4. e-mail communication.

Monitoring arrangements should be clearly recorded. Where you are making arrangements for another practitioner to carry out monitoring activity (rather than providing it yourself), you must make sure that you have recorded this in a way that will ensure monitoring activity takes place at the agreed time.

When monitoring, you should make effective use of any information that is available about:

1. the effectiveness of the equipment being provided;
2. the person's needs or circumstances.

Information could include:

1. records of contact with the person, carer or provider in between formal monitoring activity;
2. reports from professionals (for example, a social worker or GP);
3. records relating to safeguarding concerns or enquiries.

Any monitoring activity carried out should be clearly recorded. In particular, you should record:

1. whether the equipment, works or adaptation is meeting needs as intended;
2. whether there have been any issues with the equipment;
3. whether the person still requires the equipment (when it was provided short term);
4. whether any changes to monitoring activity are required.

Decisions about altering monitoring activity must be made with regard for:

1. the views of the person;
2. the views of any carer;
3. the impact of the decision on the person's wellbeing.

You should seek the advice of your line manager about the need to alter monitoring activity if this is not clear.

Whenever monitoring activity is altered you must record:

1. the rationale for any decision made;
2. how you have given regard to the person's views and the impact of the decision of wellbeing; and
3. how you have given regard for the views of any carer.

Indicators that it may be appropriate to end monitoring include:

1. the person and any carers are consistently using equipment safely;
2. equipment is being used appropriately and effectively to meet needs and promote independence;
3. everyone who was identified as being in need of direct support has received it;
4. there are no concerns about sustainability of safe use.

Upon ending monitoring, you must provide the person (or their representative if they lack capacity) with the following in writing:

1. information and advice about maintaining and repairing equipment;
2. any other information and advice requested, or that you feel would be beneficial;
3. what they should do if their needs change;
4. what to do if the equipment no longer appears to be meeting their needs; and
5. what they should do if they (or a carer) requires further direct support in the future to use the equipment safely.

You should familiarise yourself with available local guidance that confirms who is responsible for maintaining or repairing equipment in a range of circumstances.

Closing the case

You can proceed to close the case when:

1. there are no outstanding actions for the Occupational Therapy service following monitoring; and
2. the person has been provided with all information and advice required (or that would be beneficial) as set out above.

If equipment is part of a Care and Support Plan and you have been actively involved in providing direct support or monitoring equipment, works or an adaptation you should:

1. establish when the statutory review of the Care and Support Plan is going to be carried out; and
2. notify the practitioner or service with responsibility for carrying it out of your involvement.

In all other cases you only need to partake in the review of a Care and Support Plan when requested to do so by the practitioner or service with responsibility for its review.

Note: If you have been asked to provide information as part of a statutory Care and Support Plan review you should provide:

1. the information that has been requested; and
2. any other information that you feel is relevant to the review process.

All information sharing should be carried out with regard to the Caldicott Principles, Data Protection legislation and local information sharing policies.

Note: If you receive a formal request to take part in a joint Care and Support Plan review you must co-operate with this request unless, by doing so, you are prevented from carrying out your own duties under the Care Act or any other legislation.

For further information about the duty to co-operate under the Care Act, see: Co-Operation.

Following the review, you should be provided with, or given access to, a copy of any formal written record made, which you should read to ensure that it reflects what was discussed, agreed and the overall outcome of the review. If you feel amendments are required, you should consult with the practitioner or service that prepared the record. It is their responsibility to decide whether to make the amendments.

You should make your own proportionate record of the review conversation in the person's file if:

1. you feel it is appropriate to do so; and
2. doing so will be of benefit for the purpose of monitoring or the provision of direct support.

LCC Local Occupational Therapy Guidance for the review of moving and handling 

The need to review will be by exception and clear clinical reasoning. The guidance below indicates some of the considerations when making your decision.  This guidance is not prescriptive, and practitioners should consider this from a standpoint that a review can be requested and completed whenever change occurs rather than when the calendar dictates.  We would not expect reviews to be routinely undertaken where formal care providers are involved unless by exception.

The following should be considered by practitioners when deciding if a scheduled review is required.

• If Moving and Handling is completed by a family member/informal carer where the task could impact on their health and wellbeing;
• Informal carers where manual handling is a new requirement for them;
• Potential changes in behaviour of the client during moving and handling;
• Where the clinical presentation of need is complex and likely to change eg. significant or rapid deterioration in the functional ability of the client or significant weight loss or gain;
• The complexity of the care provision and environmental/home dynamics;
• Whether there is equipment used or a particular technique, that requires ongoing adaptation and monitoring.

See more information about what you need to do - Moving and handling  

For information about the use of lifting equipment for lifting people, see: Lifting equipment used for lifting people at work.

Practitioners might also want to refer to updated Mosaic guidance to support this change.

Process and workflow following an assessment

The process and workflow to be used after an assessment is as follows:  

• If it is determined that a review is required, the case should be sent to the Virtual Moving and Handling box as per the workflow steps, with clear clinical reasoning for the review; documented in the notes section;
• It is important for clients and carers to take an active role in the process and be able to contact the service should any changes occur. Therefore, every client and care provider must receive a letter, along with their moving and handling plan. This letter provides the contact information should they need to notify us of a change in need and indicates if the client will be reviewed;
• The standard letters are available from the moving and handling workflow and are as follows:
• Letter to the client ending involvement;
• Letter to the client setting a future review;
• Letter to the care provider ending involvement;
• Letter to the care provider setting a future review;
• If no review is indicated, the case is closed according to the current Mosaic workflows;
• If the team receive new information that is requesting a review or re-assessment, the case will be triaged at duty and progressed for a new OT specialist assessment and allocated.

Process and workflow for historic reviews

The process and workflow to be used for scheduled Moving and Handling reviews are as follows: 

• Existing case for review has been scheduled through Mosaic - cases are in the Virtual Moving and Handling Box with a date allocated for the review;
• Cases for review will be allocated
• Every client/and or care provider will be contacted by the practitioner who will undertake a telephone review/face to face review as required;
• As each case is allocated to a practitioner, they will undertake the review as required and, at that point, a clinical decision will be made to determine whether a future review is required;
• The outcome will be recorded in the case work record and the moving and handling review documentation will be updated accordingly;
• The case will be closed with NFA unless deemed appropriate for a future review;
• The future review is set according to individual needs and clinical reasoning;
• The standard letters will all be available from the moving and handling workflow and will be as follows:
• Letter to the client ending involvement;
• Letter to the client setting a future review;
• Letter to the care provider ending involvement;
• Letter to the care provider setting a future review;

Summary

In summary, the OT service will move towards a more proactive strength-based approach and will undertake reviews based on need and clinical reasoning.

If no replacement equipment is needed and the person simply no longer needs what is in place (for example, if they move into a care home that provides the equipment), you should make arrangements for the equipment to be returned to stores. This is regardless of whether the item is:

1. standard stock;
2. Non contract special (NCS).

If the equipment is recorded on a Care and Support Plan, you must notify the practitioner responsible for maintaining and reviewing the plan of:

1. the equipment that has been removed; and
2. the basis on which the equipment was removed.

You can consider closing the case when:

1. any unused equipment has been removed; and
2. there are no outstanding actions for the Occupational Therapy service.

If monitoring, review or direct support identifies that equipment may no longer be required because of a change in need, you must carry out a proportionate reassessment of need to determine that:

1. the person's needs have changed; and
2. the equipment is no longer the most appropriate or proportionate way to meet needs.

You should not remove existing equipment until replacement equipment is in situ unless:

1. continued use of existing equipment poses significant risk to the person or carer; or
2. the existing equipment is unsafe because it is faulty.

If the equipment is recorded on a Care and Support Plan, you must notify the practitioner responsible for maintaining and reviewing the plan of:

1. the equipment that has been removed;
2. the basis on which the equipment was removed; and
3. any new equipment that has been provided.

You can consider closing the case when:

1. any used equipment has been removed;
2. you have confirmed that any new equipment is in place and being used as intended to meet eligible needs;
3. there is no need to provide direct support or monitoring;
4. there are no outstanding actions for the Occupational Therapy service.

Before closing the case, you must provide the person (or their representative if they lack capacity) with the following in writing:

1. Information and advice about maintaining and repairing the new equipment;
2. Any other information and advice requested, or that you feel would be beneficial;
3. What they should do if their needs change;
4. What to do if the equipment no longer appears to be meeting their needs; and
5. What they should do if they (or a carer) require further direct support in the future to use the equipment safely.

If, as part of any conversation you have with a person or their family, you become concerned that a vulnerable adult or a child is experiencing, or at risk of, abuse or neglect you must respond appropriately.

See Safeguarding Adults, which also includes information about how to raise a children's safeguarding concern.

If you are concerned that an adult or child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialling 999.

If the safeguarding concern has been raised during a statutory review, a decision will need to be made about the need to pause the review process to allow a safeguarding enquiry to take place.

You must consider any appropriate action required to authorise deprivations of liberty whenever:

1. the person lacks capacity to make decisions about the care and support provided to them; and
2. you feel the level of restriction being imposed on the person is depriving them of their liberty; or
3. you feel the level of restriction required to meet their care and support needs following any reassessment to take place is likely to deprive them of their liberty.

See: Recognising and Responding to Deprivations of Liberty.

Under section 5 of the Care Act, the Local Authority has a duty to maintain an effective and efficient market of services for meeting care and support needs in the local area. A key part of maintaining a market place is understanding what is working and not working about the marketplace. It is therefore important that you report any concerns you have about any organisation providing any kind of care or support.

The local marketplace includes:

1. services that are commissioned by the Local Authority;
2. services that are provided by the Local Authority (for example, Reablement);
3. services used by self-funders and people who have a Direct Payment;
4. universal services available to all residents; and
5. services provided by partner agencies (for example, health or voluntary services).

A Contract Management Framework has been introduced to enable the Commercial Team to assess the services commissioned and monitor the quality of care delivered. Therefore, it is important that Contract Officers gather as much information as possible to continually evaluate the standard and quality of care provided. Contract Officers work in teams to provide a Lincolnshire wide service, to include; (i) Strategic, (ii) Residential, (iii) Home Care and (iv) Specialist Services. Working to promote closer working relationships with area teams and health colleagues, to effectively monitor care delivery and to ensure information is shared in a timely manner, to promote better outcomes for service users.

Any Adult Care practitioners visiting a provider or a customer are invited to provide feedback on a range of issues including care plans, the environment/setting and staffing matters, using the Poor Practice Form.  Contract Officers will also use these forms to analyse any trends in information.

See: Poor Practice Concern Form, which can be found in Safeguarding in the Local Resource Library.

When completed please return the form to poorpracticeconcerns@lincolnshire.gov.uk.

Where you are providing details about a particular incident involving a person with care and support needs you should:

1. make the person aware that you are raising the concern and why; and
2. establish whether they consent to be contacted as part of any further information gathering if required.

In all cases, you must take appropriate steps to manage the risk to an individual posed by the poor practices of a service provider. Effective ways of managing the risk could be:

1. raising a Safeguarding concern;
2. arranging an alternative provider (there is a duty to do this when a regulated provider fails);
3. agreeing monitoring arrangements.

The Commercial Team will determine the most appropriate response to the concern that has been raised, which could include:

1. contract renegotiation with a commissioned provider;
2. agreeing and monitoring an action plan with the provider;
3. a temporary stop on the use of a provider;
4. a large scale safeguarding response;
5. joint work with another Local Authority (when the provider is not local);
6. a recommendation to information and advice services not to signpost to a provider;
7. notification of concerns to the Care Quality Commission;
8. a letter to people who use a service.

You may be asked to support the Commercial Team by providing additional information or assisting in any investigation process they undertake. You are required to co-operate with any request under the Care Act unless doing so will:

1. prevent you from effectively carrying out other duties under the Care Act; or
2. prevent you from effectively carrying out duties under any other legislation.

If the services are provided by a partner organisation (such as health, housing or education) there will be local arrangements in place to report concerns. If you do not know what these arrangements are you should:

1. speak to your line manager; or
2. speak to the Commercial Team.

Where you are providing details about a particular incident involving a person with care and support needs, you should:

1. make the person aware that you are raising the concern and why; and
2. establish whether they consent to be contacted as part of any further information gathering, if required.

When concerns arise about the practice of a Personal Assistant, you should discuss your concerns with:

1. the person with care and support needs (or their representative if they lack capacity);
2. any carer; and
3. the person receiving the Direct Payment (if this is not the person or the carer).

Depending on the nature of the concern, it could be resolved through:

1. a conversation with the Personal Assistant to discuss the concerns and identify action required to resolve them;
2. the provision of training to the Personal Assistant (for example, manual handling training);
3. a review of the working conditions and requirements in the contract to make sure that the tasks to be completed are clear.

If specialist information or advice is required or requested (for example, relating to employment law) you should contact a suitably qualified person or organisation as required.

If presenting issues cannot be resolved, or you remain concerned about the continued suitability of the personal assistant, you should consider:

1. any monitoring arrangements required;
2. the need to add a condition to the Direct Payment, that the Direct Payment cannot be used to employ the Personal Assistant; or
3. the need to end the Direct Payment.

Any decision must have regard for:

1. the views of the person with care and support needs;
2. the views of any carer;
3. the views of the person receiving the Direct Payment (if this is not the person with care and support needs); and
4. the impact on the person's wellbeing.

You should seek the advice of your line manager and the team responsible for managing Direct Payments as required.

Concerns about a Personal Assistant providing support to others

If you know that the Personal Assistant is providing care and support to other individuals in the local area, you must consider any further action required. This could be:

1. notifying the team responsible for managing Direct Payments of the concerns so they can take appropriate action to notify others;
2. raising a safeguarding concern in respect of another individual being supported by the Personal Assistant.

Concerns about a Personal Assistant who is part of a local register

When a Personal Assistant is part of a local register of PAs, it is important that any unresolved or ongoing concerns are reported to the organisation or person responsible for managing the register.

This will allow for the register to be updated and consideration given to the ongoing suitability of the PA to be included on it.

The Local Authority values openness, transparency and candour and encourages you to raise concerns as soon as possible about the practice of any individuals (whether they are employed by the Local Authority or not) that you feel:

1. compromises the safety or wellbeing of a person with care and support needs; and/or
2. compromises the safety or wellbeing of a carer with support needs; and/or
3. compromises the safety of a child.

Examples of individuals employed by the Local Authority include;

1. a social worker;
2. an occupational therapist;
3. unqualified workers in social work or occupational therapy services;
4. support workers in Local Authority day or provider services;
5. individuals employed in other areas of the organisation (such as housing officers and teachers in Local Authority schools or colleges).

Examples of individuals employed by other organisations include:

1. Health professionals (for example, a community or district nurse, a GP, a Psychiatrist or Psychologist, a Speech and Language Therapist. An Optician or a Dentist);
2. Police Officers;
3. a support worker in a charitable organisation;
4. an advocate.

Whistleblowing is part of the Public Interest Disclosure Act 1998 (PIDA). Under the Act you:

1. must be provided with a safe space in which to raise the concerns;
2. must be taken seriously;
3. cannot be subjected to any detrimental or unfavourable treatment and victimisation by the Local Authority or individuals as a result of making a disclosure.

Legally you do not have to provide any hard evidence to support a whistleblowing disclosure but, if you have any evidence, you should always provide it. This could be:

1. details of when a specific incident occurred;
2. a witness statement written by you or that has been provided to you;
3. other documentary evidence (for example, an e-mail or letter).

If you require further advice about whistleblowing before making a disclosure you can contact the Whistleblowing Helpline:

1. by telephone on 08000 724 725;
2. by e-mail at enquiries@wbhelpline.org.uk.

Concerns should be raised in line with local whistleblowing policy and process.

See. Whistleblowing policy – Introduction and scope - Lincolnshire County Council