Actions Following a Care and Support Plan Review

Under Section 27 of the Care Act 2014, the local authority must keep Care and Support Plans under periodic review. This means they must have a system or process in place to ensure that reviews are carried out and monitored in a manner appropriate to the needs and circumstances of the person whose plan it is.

Because every person is different, the Care Act does not specify the frequency in which a Care and Support Plan review must take place. That said, the statutory guidance does expect the local authority to endeavour to carry out a Care and Support Plan review as follows:

1. A review of a new service or Care and Support Plan should be carried out within 6-8 weeks of the service/change commencing;
2. A review of an on-going stable Care and Support Plan should take place no less than 12 months after the date of the 6-8 week review, and then no less than once every 12 months after that;
3. Where the person's needs or circumstances are likely to change reviews should be arranged as required to monitor the situation and respond to changes in a timely way (thus keeping the plan under review).

Note: If the person is in receipt of a Direct Payment, statutory timeframes for review of the Direct Payment do apply. Wherever possible, Care and Support Plan reviews should always be aligned with Direct Payment reviews to reduce duplication for both the person and the local authority.

For further guidance about Direct Payment reviews see: Reviewing a Direct Payment

Decisions about the timeframe for review must consider:

1. The complexity of the needs being met by the plan;
2. The likelihood of deterioration or improvement in the person's needs or circumstances;
3. The complexity of the plan itself (for example the level of on-going involvement required to manage the plan);
4. The level of on-going risk to the person (from fluctuating needs or abuse and neglect);
5. The risk that the plan will breakdown; and
6. Whether any on-going monitoring activity is planned in between scheduled reviews.

Decisions about the timeframe for review must have regard for:

1. The views of the person about the timeframe for review;
2. The views of any carer about the timeframe for review;
3. The views of anyone else involved in the Care and Support Plan; and
4. The impact on Wellbeing of the timeframe proposed.

If you are unclear about an appropriate timeframe for review you should seek the advice of your line manager.

If the person (or their representative) is not happy with the timeframe for review that has been decided you must make them aware of their right to complain.

People and carers can be directed to the Croydon Council website for information about the adult social care complaints process.

Please also see information in the Local Resources area.

The agreed timeframe for the next review should be clearly recorded on the review record and the Care and Support Plan.

Where a short timeframe has been agreed you should record the rationale for this, especially if another person or team may be asked to carry out the next review.

Where you are making arrangements for someone else to carry out the next review (rather than carrying it out yourself) you must make sure that you have recorded this in a way that will ensure the review takes place at the agreed time.

You must let the person with Care and Support needs know how they (or anyone else) can request an unplanned review outside of the agreed timescale if:

1. The Care and Support Plan is not working as intended;
2. Their needs change (increase or decrease);
3. Their circumstances change;
4. The plan is affected by any change in the circumstances of an informal carer (for example if a carer is able to provide more or less support than anticipated in the plan).

In all cases whenever there has been a change to the Care and Support Plan, or whenever an unchanged Care and Support Plan has been signed-off following a review you must provide a copy of the current Care and Support Plan to the person.

If you are of the view that the person will experience substantial difficulty understanding the plan then you must make sure that appropriate support is in place, including consideration of the duty to provide an independent advocate.

If an independent advocate is already in place they should be informed when the plan has been provided so they can support the person to understand it.

Where the review was carried out jointly with another organisation to avoid duplication (for example housing or health) a copy of the plan must be made available to the other person that carried it out with you.

A copy should normally be shared in full with any carer unless the person has capacity and has asked you not to share the plan, or to share only part of the plan. In this case you will need to discuss and agree which elements of the plan are to be shared having regard for confidentiality.

In all other cases a copy of the Plan can only be shared with the person's consent (or in their best interests if they lack capacity to consent).

If the person consents (or lacks capacity and a best interest decision is made) a copy of the plan should be shared with the service provider who is responsible for providing Care and Support to the person.

A copy must also be shared with anyone that the person requests you share a copy with, even if they were not involved in the planning process itself.

Concerns about a request

Sometimes the person will request a copy of the plan is provided to a person who was not involved in the process. You must provide a copy of the plan to anyone that the person requests you to unless:

1. They lack capacity and you make a decision that sharing would not be in their best interests; or
2. You are concerned that doing so could put the person (or another vulnerable adult or child) at risk of abuse or neglect.

If this situation arises you should seek advice from your line manager and decide whether:

1. To share the record in full as requested;
2. To share the record partially, omitting sections where information could put the person at risk; or
3. To decline to provide a copy of the record (although the person can of course still choose to make a copy available from their own record).

Sometimes the person (or their representative if they lack capacity) may ask for amendments to be made to the Care and Support Plan. You should:

1. Consider the request;
2. If the person whose Care and Support Plan it is has not made the request, consult with them (or their representative if they lack capacity); and
3. Review any evidence or information you have which may support or refute the request.

If you reach an agreement with the person about the need to amend the plan you should do so.

The amended plan will need to be signed off but this should be done in a proportionate way to reflect the level of the changes made to the plan. This may or may not involve a full sign off process.

The amended plan should be circulated to the same people as the original plan, unless the person requests otherwise.

If you are unable to reach an agreement with the person and you feel that an amendment is not required you should not make the amendment. You should be clear about your reasons for not making the amendment and you must make the person aware of their right to complain about your decision.

The Care and Support Plan can require revision following a review for a number of reasons. Some revisions will require a change to the personal budget but some will not.

Whenever you revise a Care and Support Plan you should refer to the various sections of the Care and Support Planning Procedure as required, facilitating an effective conversation.

The Care and Support planning procedure also contains appropriate links to:

1. The procedure for signing-off a plan;
2. Funding procedures; and
3. Financial assessment procedures.

Whenever you revise a Care and Support Plan you should also consider the need to revise any carer's Support Plan at the same time.

Examples of changes in circumstance that decrease a personal budget

1. An informal carer intends to provide increased levels of care (reducing the need for formal support);
2. The person no longer wishes to attend a day service, but will be going to a community group with a reduced cost instead;
3. There is going to be a change in service provision and the cost of this is less than the current provision;
4. Some needs are going to be met by an alternative provision, such as health or housing.

Examples of changes in circumstances that do not change the personal budget

1. The person will be changing the days that they receive formal support because of a change in college/work patterns;
2. The person has new outcomes that existing services will be supporting them to meet;
3. A new contingency plan within the same budget has been agreed.

Examples of changes in circumstance that increase the personal budget

1. The service provider has failed and the only appropriate alternative has an increased cost;
2. The needs of the person have not changed but an informal carer is no longer able to provide the same level of Care and Support;
3. The person was sharing costs of support with another person and that person no longer requires the support.

You must revise the Care and Support Plan so that all of the changes being proposed are reflected in it. The date of the next planned review should also be clearly recorded.

You must also revise other areas of the plan affected by the change in support/services, including any:

1. Changes to the method of managing the personal budget;
2. Changes to the personal budget; and
3. Changes to the contingency plan to manage risk.

See: Signing Off a Care and Support Plan and Agreeing a Final Personal Budget for further guidance.

The Care Act requires you to make proportionate and appropriate arrangements to monitor the Care and Support Plan whenever this is required.

Examples of situations when monitoring may be required include:

1. If the plan is deemed unstable even with contingency;
2. If the person's needs are expected to change in the short term (impacting on the level of support they will need);
3. If there is a likely risk of deterioration in needs or circumstance without monitoring;
4. As part of ongoing MDT involvement;
5. If you are co-ordinating the follow up of an action plan agreed at review;
6. To manage the risk from abuse or neglect.

The arrangements to monitor must be:

1. Proportionate and appropriate to the person's situation and risk;
2. Agreed with the person (or their representative if they lack capacity) and any carer; and
3. Agreed from a strengths based approach to promote resilience of the person and their informal networks of support.

If you are unclear about the need to monitor you should seek advice from your line manager.

Recording monitoring arrangements

Monitoring arrangements must be clearly recorded.

Where you are making arrangements for someone else to monitor the situation (rather than monitoring it yourself) you must make sure that you have recorded this in a way that will ensure the monitoring activity takes place at the agreed time.

Monitoring should take place as agreed unless:

1. There is a need to revise the monitoring arrangements (due to an unexpected change in need or situation);
2. There is a need to carry out a different Care and Support function (for example a reassessment); or
3. Monitoring is no longer proportionate or necessary.

Any monitoring activity carried out should be clearly recorded and you should use supervision effectively to discuss and agree the need for continued monitoring.

When reducing or ending monitoring activity you should do this with regard for:

1. The person's views about the need to monitor;
2. The carer's views about the need to monitor; and
3. The impact on the person's Wellbeing of any decision (including their personal resilience).

Future reviews

Where monitoring of a Care and Support Plan is on-going consideration should be given to any subsequent statutory reviews being 'light touch' in nature.

If monitoring is no longer appropriate or required you should:

1. Ensure that a statutory review date is agreed and clearly recorded;
2. Explain to the person (or their representative) what steps to take should their needs or situation change;
3. Provide any information and advice as required; and
4. Cease monitoring activity.

If you are unclear about the need to monitor you should seek advice from your line manager.

If the person (or their representative) is not happy with any decision to reduce or end monitoring arrangements you must make them aware of their right to complain.

People and carers can be directed to the Croydon Council website for information about the adult social care complaints process.

Please also see information in the Local Resources area.

Following the review process you should consider any need to request a reassessment of the person's financial resources.

It is not lawful for the Local Authority to charge a person more than they can afford. Equally people should contribute what they are able to, so you have a duty to notify the team with responsibility for financial assessment if you become aware that:

1. A person's financial situation has changed (either improved or deteriorated);
2. A person is having difficulty making their contribution;
3. The personal budget is going to be changed;
4. The person is going to be using informal or non-chargeable services to meet some or all of their needs.

You should explain to the person (or their representative if they lack capacity)that you are going to be requesting a further financial assessment and why. You should provide them with information and advice as required about the financial assessment process. This is particularly important if the person has not had a financial assessment before.

See the Financial Assessment Procedure for further guidance.

Following a financial assessment the contribution that the person has been assessed to make must be clearly recorded:

1. On the person's Care and Support Plan;
2. On internal financial contribution recording systems.

The start date for any financial contributions should correspond with the start date for the associated Care and Support services (when these have changed) or the date that the financial assessment was carried out (when services have not changed) unless a decision has been made otherwise through the financial assessment process.

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).

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 commissioning service are responsible for ensuring that regulated Care and Support services are safe and of a high standard when:

1. They are commissioned by the Local Authority (services provided in the Local Authority area or outside of it); or
2. They are being used by people who have a Direct Payment (services in the Local Authority area); or
3. They are available to people who self fund or use a Direct Payment (services in the Local Authority area only).

You should notify the commissioning service if you have general concerns about any of the following:

1. Domiciliary Care Providers commissioned by the Local Authority (either in the local area or outside of it);
2. Domiciliary Care Providers available in the local area but not commissioned (used by people with a Direct Payment or self-funders);
3. Residential and nursing homes commissioned by the Local Authority (either in the local area or outside of it)
4. Residential and nursing homes available in the local area but not commissioned (used by self-funders);
5. Reablement services provided or commissioned by the Local Authority;
6. Regulated day services (those providing personal care) commissioned by the Local Authority or available in the local area;
7. Any other regulated Care and Support provision (for example Care and Support provided as part of a residential college placement).

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.

The commissioning service 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 commissioning service 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.

Unregulated Care and Support services are generally services that do not provide personal care, and so do not have to be registered with the Care Quality Commission. They include:

1. Some day services;
2. Prevention services provided by housing;
3. Health services;
4. Colleges and training centres;
5. Advocacy services;
6. Voluntary and charitable services.

If the services are commissioned by the Local Authority you should report concerns to the commissioning service in the same way that you would report a concern about a regulated Care and Support service.

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 commissioning service.

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 Support Services 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.

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. A Reablement support worker;
5. Support workers in Local Authority day services;
6. 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.

To raise concerns you should follow the process and guidance set out in the Whistleblowing Policy and Procedure, which can be accessed in the Local Resources area.