Ms Lynette Ann Sylvia White

Profession: Social worker

Registration Number: SW85845

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 18/04/2018 End: 16:00 19/04/2018

Location: Portsmouth Marriott Hotel, Portsmouth, Hampshire, PO6 4SH

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Allegation as amended on 30 January 2018

Between October 2013 and March 2015, during the course of your employment as a Social Worker at Surrey County Council:

1. In respect of Service User 6:
a) Following a request by Service User 6, you did not:

i. follow up and/or record follow up with Service User 6 after she left you a message on 30 January 2014 advising she no longer wished to move;

ii. take steps and/or record the steps taken to try and resolve the issues with Service User 6’s current accommodation;

iii. take adequate steps to progress Service User 6’s request to move.

b) You did not record details on the RIO system of your meeting with Service User 6’s husband on or around 22 October 2014 until 17 November 2014;

c) Following your Care Programme Approach review on or around 24 January 2014, you did not complete a further review:

i. as soon as possible, upon being informed of concerns with Service User 6’s current accommodation; and/or

ii. as soon as possible, upon becoming aware of safeguarding issues relating to financial abuse; and/or 

iii. twelve months later.

d) You did not visit and/or record visiting Service User 6 between 24 December 2014 and 26 January 2015.

2. In respect of Service User 7:
a) You did not undertake your planned visit on 26 March 2014 and/or did not record notes relating to this visit;

b) Following your home visit on 8 April 2014, at which Service User 7 was not at home, you did not:
i. attempt to re-arrange the visit to see Service User 7 within two weeks and/or you did not record your attempts to do so;

ii. visit Service User 7 again until 2 October 2014.

c) Following identification in September 2014 that this case was to be transferred to another team by the end of October 2014, you failed to:

i. discuss and/or record that you had discussed the transfer with Service User 7 during the visit on 2 October 2014;
ii. conduct a transfer Care Programme Approach review;
iii. arrange transfer of Service User 7 to the Older Peoples Service.

3. In respect of Service User 8:

a) You did not visit and/or record visiting Service User 8 between 11 March 2014 and 11 May 2014;

b) Following identification in October 2014 that this case was to be transferred to another team, you did not:

i. Arrange a handover Care Programme Approach review in a timely manner;
ii. Have a transfer discussion with the care co-ordinator at Surrey Heath until 8 December 2014.

c) You did not record sufficient information relating to the transfer process on the RIO system;

d) Following the missed appointment scheduled for 18 August 2014, you did not follow up and/or record follow up to re-arrange the appointment between 19 August 2014 and 28 September 2014;
e) You did not complete a cluster review in a timely manner;

f) You did not complete a Care Programme Approach review in a timely manner.

4. In respect of Service User 9:

a) You did not close the case in a timely manner despite your entry on 8 August 2014 stating that you would be closing the case to Guildford CMHRS;

b) You did not complete and/or record a cluster review before transfer to another team;

c) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

5. In respect of Service User 10:

a) You did not complete a risk assessment in a timely manner and/or at all, following a previous risk assessment in April 2014;

b) You informed Service User 10 on 16 October 2014 his case would be transferred to the In-touch team but you did not do so in a timely manner;

c) You spoke with Service User 10’s brother on 16 October 2014 but you did not record the conversation on RIO;

d) You did not complete interventions on the care plan within a week of referral and/or in a timely manner;

e) You did not complete a cluster review in a timely manner.

6. In respect of Service User 11:

a) You cancelled an appointment on 21 August 2014 and did not rearrange the appointment and/or record attempts to rearrange the appointment until 29 September 2014;

b) On 24 October 2014 you carried out a Care Programme Approach review but you did not record it onto RIO until 10 November 2014;

c) You did not record notes relating to the meeting that took place on 7 January 2015 in a timely manner;

d) You did not complete a cluster review at the same time as the Care Programme Approach Review in March 2014 and/or in a timely manner;

e) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

7. In respect of Service User 12:

a) You did not follow up and/or record follow up in response to an email sent on 4 September 2014, until 13 October 2014 requesting a review appointment to be arranged;

b) Despite the entry on 16 October 2014 stating that the case would be closed to CMHRS and transferred to the In-touch Team you did not arrange transfer in a timely manner;

c) You did not complete a cluster review in a timely manner;

d) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

 8. In respect of Service User 13 you did not transfer and close the case in a timely manner and/or at all once this was raised in supervision on 27 October 2014.

 9. In respect of Service User 14:

a) Following your review on 13 February 2014 you did not make and/or record any further contact with Service User 14 until around December 2014;

b) You did not arrange transfer to the In-touch team in a timely manner.

10. In respect of Service User 16:

a) You did not validate a Care Programme Approach assessment record in a timely manner;

b) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

11. In respect of Service User 18:

a) You did not make contact with Service User 18 and/or record any contact between 24 December 2013 and 9 December 2014;

b) You did not transfer Service User 18 to another team in a timely manner, despite your entry on 15 December 2014 stating that they would be transferred;

c) You did not complete a cluster review in a timely manner.

12. In respect of Service User 19:

a) You met with Service User 19 on 5 November 2014 and you did not make a record of the meeting until 10 November 2014;

b) You did not record sufficient information on RIO relating to Service User 19’s transfer.

13. In respect of Service User 20:

a) You did not arrange a Care Programme Approach review in a timely manner following the previous review on 17 October 2013;

b) You did not contact Service User 20 following failed contact on 13 November 2014 until on or after 10 December 2014.

14. In respect of Service User 21
you did not complete a Care Programme Approach review by 17 October 2014 and/or at all.

15. In respect of Service User 22:

a) You did not complete and/or record a visit on 20 April 2014;

b) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

16. In respect of Service User 23:

a) You did not make and/or record contact with Service User 23 following allocation on 23 March 2014 – 9 May 2014;

b) You did not complete and/or record in a timely manner a:

i) Care Programme Approach assessment; and/or
ii) A care plan.

17. In respect of Service User 24:

a) You did not visit and/or record visiting Service User 24 between 19 November 2013 and 8 May 2014;

b) You did not ensure that the notes on the RIO system were up to date.

18. In respect of Service User 25
you did not arrange and/or record arranging a visit to Service User 25 between 8 March 2014 and 9 May 2014.

19. In respect of Service User 26 you did not ensure that there was an up to date cluster review.

20. The matters set out in paragraphs 1 – 19 amount to misconduct and/or lack of competence.

21. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.

 

Finding

Application to amend the allegation

1. Mr Ferson applied to amend three of the Particulars on the basis that they contained the following errors: the wording in Particular 4c currently “case plan” should be “care plan”, Particular 6c currently “17 January 2015” should be “7 January 2015” and Particular 18 currently “11 May 2014” should be “9 May 2014”. The Panel accepted the advice of the Legal Assessor. The Registrant did not oppose the application. The Panel concluded that the amendments were technical in nature and did not increase the scope of the allegation and that it was in the interests of justice to allow the application.

Application to hear the case in private

2. At the outset of the hearing the Panel decided that parts of the hearing should be conducted in private, pursuant to Rule 10 of the Health and Care Professions Council (Conduct and Competence Committee) Procedure Rules 2003 (“the Rules”), for the protection of the private life of the Registrant. Both parties were in support of this course. The Panel accepted the advice of the Legal Assessor.

Admissions

3. The Registrant entered formal Admissions to Particulars 1 -19.

Witnesses

4. The Panel heard live evidence from:
Witness 1 – Social Worker employed by Surrey County Council (“the Council”) as the Registrant’s Service Manager
Witness 2 – Social Worker employed by the Council as a Senior Manager

The Registrant

Background

5. In September 2013, the Registrant was employed by the Council as a Care Co-ordinator and Approved Mental Health Practitioner (AMHP) with the Guildford Community Mental Health Recovery Services. She worked on a part-time basis, two and a half days a week. She was responsible for service users with mental health problems.

6. In her role as an AMHP, the Registrant was responsible for coordinating and carrying out Mental Health Act (MHA) assessments, and arranging admissions to hospital if the service user met the relevant criteria. After the assessment, the Registrant was responsible for writing up a report based on her findings.

7. In her role as a Care Coordinator, the Registrant was responsible for monitoring the mental health of service users with severe and enduring mental illness, completing reviews and arranging care packages where necessary.

8. On 10 February 2014, following a joint informal review of the Registrant’s work conducted by Witness 1 together with a colleague, concerns were raised that Care Programme Approach reviews (CPA’s) had not been booked by the Registrant despite the fact that the need for this had been highlighted in supervision on 8 November 2013 and 20 December 2013. It was also noted that RIO data (the electronic recording system employed by the Council) had not been kept up to date.

9. On 15 April 2014 Service User 8 sent an email raising a concern with the Registrant and asking to speak to her because he had not had any response from her in relation to his application for college funding.

10. In light of this, Witness 1 carried out an audit on the Registrant’s cases. A number of issues were raised, specifically in relation to the Registrant’s failure to contact service users, complete work in a timely manner and transfer cases to other teams. These concerns are reflected in the Particulars of the Allegation.

11. The Registrant gave evidence in the course of the HCPC hearing. She admitted the Allegation in its entirety. She presented the Panel with a number of mitigating factors relating to her personal life which she said contributed to her poor performance at the time. She expressed her remorse and described how she had reflected on her actions.

Decision on Facts

12. The Panel accepted the advice of the Legal Assessor. In reaching its decision it took into account the evidence of Witness 1 and Witness 2, together with documentation provided by them, and the Registrant’s formal Admissions.

13. The Panel found both Witness 1 and Witness 2 to be credible, reliable and concise. Their oral evidence supported their written statements. Witness 2 was honest in stating when she was unable to provide further detail requested by the Panel. The Panel noted that she had had limited contact with the Registrant and displayed no animosity towards her.

14. The Panel found the Registrant to be honest and credible. She took full responsibility and answered all questions asked of her. It was clear that she had reflected extensively since the time of the events.

Service User 6

15. Service User 6 had been diagnosed with schizophrenia, diabetes, and learning disabilities and had difficulties with communication. She was subject to Section 117 of the Mental Health Act, and so had previously been detained under Section 3 of the Mental Health Act, was no longer detained, and was entitled to receive aftercare.

16. The Panel was informed that Service User 6 had been allocated to the Registrant on 18 September 2013. It was the Registrant’s role to monitor Service User 6’s mental health by carrying out MHA assessments, writing up her assessments and reviews, and ensuring that all of the information was recorded on RIO. She was also responsible for ensuring that the support Service User 6 was receiving was meeting her care needs. She was required to carry out reviews on an annual basis, as set out in the CPA Policy. An extract from the records for Service User 6 was produced for the Panel.

1a) Following a request by Service User 6, you did not:
i. follow up and/or record follow up with Service User 6 after she left you a message on 30 January 2014 advising she no longer wished to move;
ii. take steps and/or record the steps taken to try and resolve the issues with Service User 6’s current accommodation;
iii. take adequate steps to progress Service User 6’s request to move.

17. On 13 January 2014, Service User 6 attended an outpatient appointment stating that she had concerns about t of her accommodation. She said that the other residents were noisy and one resident in particular had been causing problems. She asked to move.

18. The Registrant made an entry in the RIO notes following a home visit to Service User 6 on 24 January 2014, confirming that Service User 6 had expressed a desire to move out of her accommodation. On the same day, the Registrant noted that she had a conversation with the manager of the home who identified alternative accommodation for Service User 6.

19. After Service User 6 viewed the alternative accommodation, she left a message for the Registrant on 30 January 2014, stating that she no longer wished to move.

20. In the course of Service User 6’s Care Plan Approach Review with the Registrant on 3 February 2014, Service User 6 reverted to her original position, stating that her accommodation was not suitable because another resident’s behaviour was too boisterous. This was supported by the view of staff members, who believed that Service User 6 would benefit from new accommodation.

21. Witness 2 gave evidence that she would have expected the Registrant to follow up Service User 6’s message of 30 January 2014, but that there was no record in the relevant records of any follow up conversation between the Registrant and Service User 6.

22. On 16 June 2014, Service User 6 was seen by a member of the medical staff, and again expressed concern about her accommodation and requested to move to a ground floor flat with a bedroom and bathroom at the same level. She claimed that she had been told that this was not available at present but that it would be looked into.

23. Witness 2 told the Panel that the move should have taken place as soon as alternative accommodation had been identified, and that, as the Registrant was responsible for organising the move, she should have followed up the request and checked what Service User 6 wanted. She could also have taken steps to resolve the issues within Service User 6’s home. She told the Panel in the course of her oral evidence that the Registrant should have spoken with the home to see whether support could have been provided.

24. On the basis of this evidence, together with the Registrant’s admission, the Panel found these Sub-Particulars proved.

1b) You did not record details on the RIO system of your meeting with Service User 6’s husband on or around 22 October 2014 until 17 November 2014;

25. Witness 2 produced a copy of the notes on RIO relating to Service User 6 which indicated that whilst the Registrant had a meeting with Service User 6’s husband on 22 October 2014, the notes of that meeting were not recorded on RIO until 17 November 2014.

26. Witness 2 informed the Panel that it was standard common practise at the time for any contact made by a social worker to be recorded on RIO on the same day, or within 24 hours. She said that at a meeting on 10 December 2014 she asked the Registrant if she could explain the reason for the delay and she could not.

27. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

1c) Following your Care Programme Approach review on or around 24 January 2014, you did not complete a further review:
i. as soon as possible, upon being informed of concerns with Service User 6’s current accommodation; and/or
ii. as soon as possible, upon becoming aware of safeguarding issues relating to financial abuse; and/or 
iii. twelve months later.

28. Witness 2 informed the Panel that the CPA is a national method of working with service users who have mental health problems, which describes the process for reviewing, monitoring and recording needs, care plans and risk assessments.

29. Witness 2 said that a CPA review should be completed when there is a change of circumstance in relation to a service user or at the very least once every 12 months. She said that a CPA review was completed by the Registrant in relation to Service User 6 on 24 January 2014 but that no further review had been carried out by the time she met with the Registrant on 10 December 2014. Witness 2 said that she reminded the Registrant at this meeting that she needed to book a review in.

30. Witness 2 said that the next CPA review was conducted on 3 March 2015, which fell outside the 12 months’ requirement. She said that as Service User 6 was in a placement, she would expect a CPA review to take place at least annually. She said that this requirement was detailed in the CPA Review section of the Policy, which she exhibited.  She said that according to the policy, review meetings should be brought forward if there is a marked or unexpected change in the service user or their carer’s situation, or if there is a marked divergence from the care plan or carer’s plan. She informed the Panel that in the case of Service User 6 a number of issues had been identified, especially in relation to her accommodation, as set out earlier in this determination, and therefore a CPA review should have been arranged as soon as possible once those issues were identified. She said that there was a potential safeguarding issue in relation to the possibility of financial abuse which should have triggered a review as soon as possible as part of the safeguarding process.

31.  On the basis of this evidence, together with the Registrant’s admission, the Panel found these Sub-Particulars proved.

1d) You did not visit and/or record visiting Service User 6 between 24 December 2014 and 26 January 2015.

32. Witness 2 informed the Panel that on 26 January 2015 she discussed with the Registrant the concern that Service User 6 had not been visited since 23 December 2014. She said that this was confirmed by Service User 6’s records, which she referred the Panel to, which showed no entries after 23 December 2014 to indicate that a visit had been conducted by the Registrant.

33. Witness 2 said that the frequency of visits required depended on the needs specified in RIO and that in this instance she would have expected a visit to have been carried out between 23 December 2014 and 26 January 2015. She said that the potential consequences of not visiting are that the Service User's needs are not met, the risks then escalate and mental health can deteriorate.

34. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 7

35. Service User 7 was diagnosed with schizophrenia. He was not detained under the Mental Health Act. He was allocated to the Registrant on 21 March 2014. An extract from the records of Service User 7 was produced to the Panel

In respect of Service User 7:
2a) You did not undertake your planned visit on 26 March 2014 and/or did not record notes relating to this visit;

36. Witness 2 referred to a case note dated 21 March 2014 which identified that a review had been booked with Service User 7 for 26 March 2014. However, there was no note on RIO to show that the visit took place. The Registrant’s next entry related to a home visit on 8 April 2014, when the Registrant did not see Service User 7, but saw a support worker instead.

37. Witness 2 said the reason a visit was needed was to monitor Service User 7’s mental health and to review Service User 7’s placement. The consequence of a lack of visit was that there was no record of relevant activity and no continuity of care and a fellow professional looking at the notes would be unaware of the current situation.

38. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

2b) Following your home visit on 8 April 2014, at which Service User 7 was not at home, you did not:
i. attempt to re-arrange the visit to see Service User 7 within two weeks and/or you did not record your attempts to do so;

ii. visit Service User 7 again until 2 October 2014.
39. Witness 2 referred the Panel to an entry on RIO which recorded that the Registrant attempted to visit Service User 7 on 8 April 2014 but he was not in. She then spoke with his support worker and agreed to arrange a further visit. There was no evidence within the RIO records of any further attempt made by the Registrant to visit Service User 7 until 1 October 2014, when he was out, whereupon the Registrant undertook a further home visit on 2 October 2014, when he was in. Witness 2 informed the Panel that the Registrant had therefore been unable to monitor his mental health between April and October 2014.

40. Witness 2 said that further to the failed visit in April 2014 she expected the Registrant to rearrange the visit to see Service User 7 as soon as possible and certainly within two weeks because by then a date had been set for a review. She said that the Registrant admitted to her that she had not rearranged a meeting, but did not provide any reasons for her failure.

41. On the basis of this evidence, together with the Registrant’s admission, the Panel found these Sub-Particulars proved.

2c) Following identification in September 2014 that this case was to be transferred to another team by the end of October 2014, you failed to:

i. discuss and/or record that you had discussed the transfer with Service User 7 during the visit on 2 October 2014;
ii. conduct a transfer Care Programme Approach review;
iii. arrange transfer of Service User 7 to the Older Peoples Service.

42. Witness 2 informed the Panel that the summary of caseload concerns compiled by Witness 1 on 20 November 2014 indicated that in the course of a meeting with the Registrant on 26 September 2014 Service User 7 was identified as being eligible for transfer to the Older Peoples Services’ Locality Team. It was expected that the case would be transferred by the end of October 2014. Despite the fact that this had been communicated to the Registrant, the RIO notes contained no entry to show that she mentioned this to Service User 7 during her visit with him on 2 October 2014.

43. Witness 2 said that the Registrant had responsibility for transferring Service User 7 and that in order to do so a transfer CPA Review needed to take place. However, the records revealed no evidence of a CPA Review being carried out or the transfer being arranged.

44. On the basis of this evidence, together with the Registrant’s admission, the Panel found these Sub-Particulars proved.

Service User 8

45. Service User 8 was a male with a diagnosis of psychosis. He was allocated to the Registrant on 1 November 2013. He stopped engaging with the service, explaining that he felt let down by the lack of support that he received from the Registrant and had lodged a complaint.


3. In respect of Service User 8:
a) You did not visit and/or record visiting Service User 8 between 11 March 2014 and 11 May 2014;
46. Witness 2 produced the progress notes on RIO which evidenced that the Registrant did not visit Service User 8 between 10 March 2014 and 12 May 2014. Witness 2 informed the Panel that visits to Service User 8 should have been carried out fortnightly or monthly, and that this would have been set out in the Care Plan. The fact that the Registrant did not visit Service User 8 for two months was far too long, especially given that it was clear he was struggling from low mood, feelings of helplessness, worthlessness, hopelessness and uselessness. In addition, the Registrant received an email on 15 April 2014 which made it clear that Service User 8 had tried to make an appointment with her as he was anxious about his college funding.

47. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

3b) Following identification in October 2014 that this case was to be transferred to another team, you did not:
i. Arrange a handover Care Programme Approach review in a timely manner;
ii. Have a transfer discussion with the care co-ordinator at Surrey Heath until 8 December 2014.

48. Witness 2 referred to a note entered on RIO by Witness 1 on 20 October 2014 noting that Service User 8 wished to transfer his case to Surrey Heath Community Mental Health Recovery Service (CMHRS) as soon as possible. Service User 8 had moved address and had registered at a different General Practitioner’s (GP) Surgery, in a different locality, and therefore had requested his care be transferred to that Locality Team.

49. The Panel was referred to a letter dated 27 October 2014, in which the Registrant mistakenly wrote to Waverley Community Mental Health Recovery Service to transfer the case to their services. On 28 October 2014, she wrote to Surrey Heath CMHRS and requested a transfer of care to their team.

50. Witness 2 explained that in order to progress a formal transfer the social worker must first write, and then agree a formal handover. In this instance, the formal handover was not undertaken, and therefore the case did not progress as it should. The records revealed that on 29 October 2014, the Registrant was contacted by Surrey Heath CMHRS, who wanted to discuss the referral because the transfer was not clear. Witness 2 said that the Registrant did not have the transfer discussion with the care coordinator at Surrey Heath CMHRS until 8 December 2014. In oral evidence Witness 2 said that she would have expected the discussion to have occurred the day after the written request.

51. On the basis of this evidence, together with the Registrant’s admission, the Panel found these Sub-Particulars proved.

3c) You did not record sufficient information relating to the transfer process on the RIO system.

52. Witness 2 informed the Panel that RIO revealed a note dated 28 October 2014 stating ‘New referral sent to Surrey Heath CMHRS. Previous referral to Waverley CMHRS sent in error’. Witness 2 said that this information was not sufficient, and she would expect to see more detail.  She said in evidence that the note did not explain why the case was being transferred or what care outcomes it was hoped would be achieved.

53. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.
3d) Following the missed appointment scheduled for 18 August 2014, you did not follow up and/or record follow up to re-arrange the appointment between 19 August 2014 and 28 September 2014;

54. Witness 2 referred the Panel to an entry made by the Registrant on RIO which recorded that Service User 8 was due to attend an appointment on 18 August 2014 but did not attend. The record revealed that she then tried to contact Service User 8 by phone and sent him a letter. There was no evidence of any further follow up on the missed appointment until 29 September 2014 when the Registrant recorded that she had sent Service User 8 a letter requesting contact. Witness 2 stated that she would have expected the Registrant to keep attempting to make contact with Service User 8 until she got a response and/or a new date.
55. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.
3e) You did not complete a cluster review in a timely manner;

56. Witness 2 informed the Panel that the level of funding allocated to a service user will depend on the cluster that the service user is placed in. She said that when Witness 1 carried out the case audit on 9 May 2014 she noted that Service User 8 required a cluster review and one had not taken place. This should have been done as soon as possible after 9 May 2014. According to the records a Cluster Assessment and Allocation form was completed by a doctor on 21 July 2014. Witness 2 said that the Registrant should have carried out a cluster review within a day or so to determine the level of risk and appropriate funding.

57. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

3f) You did not complete a Care Programme Approach review in a timely manner.

58. Witness 2 referred the Panel to an entry which showed that on 9 May 2014, Witness 1 noted the need for a CPA review. Witness 2 said that the records revealed that the Registrant did not carry out a CPA review until 10 December 2014, some seven months after the request, which was not acceptable. Witness 2 stated she would have expected a review to take place as soon as possible. In the event, the formal CPA review was carried out by a doctor. Witness 2 accepted that the notes revealed the Registrant met Service User 8 in the building as he was leaving the CPA, however there was no note of a formal CPA review having been conducted by her.

59. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 9

60. Service User 9 was diagnosed with schizophrenia and was living in a residential care home. The Registrant was allocated as his care coordinator on 1 November 2013 at a time when he was due to be discharged from the Registrant’s team and transferred over to the Locality Team due to his age. The Panel was provided with an extract from his records.

4a) You did not close the case in a timely manner despite your entry on 8 August 2014 stating that you would be closing the case to Guildford CMHRS;

61. Witness 2 referred the Panel to an entry made by the Registrant on Rio that she would be closing the case of Service User 9 to Guildford CMHRS. However, at a meeting on 26 September 2014 between the Registrant and Witness 1 and Witness 2, it was established that the case had not been closed, despite the fact the need for closure had been raised in the supervision meeting on 22 August 2014. The Registrant made no response when this was raised at the meeting held on 26 September 2014.

62. Witness 2 said in oral evidence that the case should have been closed as soon as possible because the Service User was not with the correct team. Instead, according to Witness 1, the case remained on the Registrant’s open caseload until 10 December 2014, which had an impact on the workload of the team.

63. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.
4b) You did not complete and/or record a cluster review before transfer to another team;

64. Witness 1 said that in the course of her case audit on 9 May 2014, she discovered that a cluster review had not been completed on this case despite the fact that Service User 9 was being transferred to another team and required a cluster review to be carried out.

65. The Panel was shown an email dated 9 June 2014 from Witness 1 to the Registrant reminding the Registrant to carry out the cluster review. However, the records revealed no case information to show that this was carried out.

66. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.
4c) You did not complete interventions on the care plan within a week of   referral and/or in a timely manner.

67. Witness 2 informed the Panel that care plans should be updated electronically on RIO and it is important they remain up to date and accurate to ensure continuity of care. She said in oral evidence that if the Registrant had completed any interventions on the care plan in relation to Service User 9 she should have documented a progress report to that effect, whereas there was no such record on the system.

68. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 10

69. Service User 10 was diagnosed with schizophrenia and was resident in a nursing home. The Registrant was allocated as care coordinator to this service user on 8 October 2013. The Panel was provided with an extract from the records on RIO.

5a) You did not complete a risk assessment in a timely manner and/or at all, following a previous risk assessment in April 2014;

70. The notes on RIO showed that on 16 October 2014, the Registrant visited Service User 10 and then transferred the case to the In-Touch team. The Panel was informed that the In-Touch Team are responsible for supporting and assisting people in residential care. On 31 December 2014, the Registrant emailed the In-Touch team to make the referral. On 2 March 2015, the Registrant called the In-Touch team to chase up the email. No further notes were recorded on RIO.

71. Witness 2 informed the Panel that a risk assessment is usually carried out as part of the CPA assessment and is the responsibility of the care coordinator. She said that risk assessments are carried out face to face with the service user, and cover particular topics, such as self-harm, mood, and whether the service user is considered to be a risk. The risk assessment should be updated at a minimum of every three to six months, or if something changes.

72. According to the records a Psychiatric Liaison officer carried out a risk assessment with Service User 10 on 8 April 2014. Witness 2 said that it would be expected that a follow up risk assessment would be completed within three to six months of that date, between July and October 2014. However, in the course of a meeting with the Registrant on 10 December 2014 it was raised that a risk assessment had still not been carried out. Witness 2 informed the Panel that there was no evidence on RIO that an assessment was ever carried out by the Registrant.

73. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

5b) You informed Service User 10 on 16 October 2014 his case would be transferred to the In-touch team but you did not do so in a timely manner;
5c) You spoke with Service User 10’s brother on 16 October 2014 but you did not record the conversation on RIO;

74. Witness 2 referred the Panel to an entry on RIO which indicated that the Registrant met with Service User 10 on 16 October 2014. The Registrant documented that she would call Service User 10’s brother to update him, and would transfer the case to the In-Touch Team.

75. In the course of the Capability Meeting on 10 December 2014 the Registrant confirmed she had spoken to the brother of Service User 10 on 16 October 2014. She accepted that this communication had not been recorded on RIO. She also accepted that she had not transferred the case to the In-Touch Team.

76. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

5d) You did not complete interventions on the care plan within a week of referral and/or in a timely manner;

77. Witness 2 informed the Panel the case audit carried out by Witness 1 on 9 May 2014 highlighted that the Registrant had not completed interventions on the care plan for Service User 10. Witness 2 stated in oral evidence that she would have expected an intervention to have been completed within one week of referral.

78. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved
5e) You did not complete a cluster review in a timely manner.

79. Witness 2 referred the Panel to the case notes which showed that a cluster review was completed on 11 February 2014. In an email from Witness 1 on 9 June 2014 the Registrant was reminded that a further cluster review needed completing. The cluster review would have been due at the CPA meeting. However according to the records the only Cluster Review that took place occurred on 11 February 2014, as evidenced in the case note for this date.

80.  On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 11

81. Service User 11 was diagnosed with psychosis and was in residential care. The Registrant was allocated as his care coordinator on 14 March 2014. The Panel was provided with an extract from his records.

6. In respect of Service User 11:
a) You cancelled an appointment on 21 August 2014 and did not rearrange the appointment and/or record attempts to rearrange the appointment until 29 September 2014;

82. In oral evidence Witness 2 referred the Panel to a case note dated 21 August 2014 that a meeting scheduled for that day had been cancelled by the Registrant due to unforeseen circumstances and that she would re-arrange the appointment the next day. The RIO progress notes did not contain a reference to any further contact until 29 September 2014 when it was noted that the Registrant had arranged a CPA review for Friday 24 October 2014.

83. Witness 2 said that in the course of her meeting with the Registrant on 26 September 2014 the issue of the cancelled visit was raised, to which the Registrant made no response at the time.

84. Witness 2 said in evidence that it was not acceptable to have waited over a month to arrange to see Service User 11.

85.  On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

6b) On 24 October 2014 you carried out a Care Programme Approach review but you did not record it onto RIO until 10 November 2014;

86. Witness 2 referred the Panel to the progress notes on RIO which showed that a CPA review was carried out by the Registrant with Service User 11 on 24 October 2014. Witness 2 said that the CPA review should have been recorded on the system immediately, and if not, within 24 hours. However no note of the CPA review was recorded onto the RIO system until 10 November 2014 at 13:10.

87. Witness 2 stated that the CPA review notes dated 24 October 2014 indicated that alternative accommodation would be more suitable for Service User 11. Service User 11 moved accommodation on that same day (24 October 2014). The updated information about where he was moving to was therefore not available on the system between 24 October 2014 and 10 November 2014. Witness 2 stated that if anything had happened to Service User 11, the Service would not have known where he was placed.

88. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

6c) You did not record notes relating to the meeting that took place on 7 January 2015 in a timely manner;

89. Witness 2 referred the Panel to an entry on RIO which stated that the Registrant had a meeting planned for 7 January 2015. Witness 2 told the Panel that she spoke with the manager at the residential home where the meeting was planned, who confirmed that the meeting had in fact taken place.

90. In her written response to Witness 2’s Summary Update Report, the Registrant stated that she entered the record of the meeting held on 7 January 2015 on RIO on 9 February 2015.
 
91. Witness 2 gave evidence that the record of the meeting should have been completed on RIO either immediately or within 24 hours.

92. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

6d) You did not complete a cluster review at the same time as the Care Programme Approach Review in March 2014 and/or in a timely manner;

93. In her case audit of 9 May 2014, Witness 1 noted that Service User 11 had not had a cluster review. She reminded the Registrant of this in an email on 9 June 2014. Witness 2 gave evidence that the cluster review should have been conducted as soon as possible, and should have been done in the CPA review on 21 March 2014. However, it was not completed until 1 December 2014.

94. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

6e) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

95. In her case audit of 9 May 2014, Witness 1 noted that Registrant had not documented any care plan interventions. She reminded the Registrant of this in an email on 9 June 2014.

96. Witness 2 gave evidence that the CPA was dated 21 March 2014 but the interventions were not updated until 21 July 2014.

97. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 12

98. Service User 12 was in a nursing home with a diagnosis of psychosis. He was allocated the Registrant as his care coordinator on 1 November 2013. The Panel was provided with an extract from his records.

7. In respect of Service User 12: 
a) You did not follow up and/or record follow up in response to an email sent on 4 September 2014, until 13 October 2014 requesting a review appointment to be arranged;

99. At a meeting on 26 September 2014, Witness 2 raised with the Registrant that Service User 12’s residential care home had emailed her on 4 September 2014 to request a review take place. The email was documented on RIO but there was no record on RIO to show that the Registrant had responded to this request until 13 October 2014 when there was an entry to the effect that a home visit had been booked for 16 October 2014.

100. Witness 2 said that when the Registrant received the request from the residential care home on 4 September 2014, she should have responded within a week as this was considered to be best practice.

101. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

7b) Despite the entry on 16 October 2014 stating that the case would be closed to CMHRS and transferred to the In-touch Team you did not arrange transfer in a timely manner;

102. Witness 2 referred the Panel to a note in RIO of a visit made by the Registrant to the home of Service User 12 which took place on 16 October 2014. The note stated that the case should be closed to CMHRS and transferred to the In-Touch Team.

103. At a meeting between Witness 2 and the Registrant on 20 November 2014, it was noted that the case was still open. At a further meeting on 10 December 2014 the Registrant had not transferred the case to the In-Touch team. She was asked why this had not happened and she said that she did not know. She was asked to do this by 10 December 2014, to which she agreed.

104. The Registrant closed the case to CMHRS on 17 December 2014. In evidence Witness 2 said that the case should have been closed as soon as possible after 16 October 2014.

105. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

7c) You did not complete a cluster review in a timely manner;

106. Witness 2 said that the case audit conducted by Witness 1 on 9 May 2014 stated that Service User 12 required a cluster review and the Registrant was reminded of this in an email on 9 June 2014. Witness 2 in her written statement recorded that this cluster review should have been completed on 17 February 2014 as indicated on the RIO case notes.

107. Witness 2 referred the Panel to the minutes of a meeting which was held on 26 September 2014.  The record disclosed that the cluster reviews were now up- to- date following the work in supervision earlier in the year. However they were not recorded on the system until 17 December 2014.

108. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

7d) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

109. Witness 2 told the Panel that the case audit carried out by Witness 1 on 9 May 2014 stated that the Registrant had not documented the care plan interventions. The Registrant was reminded of this by email on 9 June 2014.

110. Witness 2 said that the interventions on the care plan should have been completed by 26 September 2014 according to the meeting notes, but they were not completed on the system until 31 December 2014, as documented in the progress notes. Witness 2 said that it is expected that the notes would be completed as soon as possible.

111. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 13

112. Service User 13 was in residential care diagnosed with psychosis. Service User 13 was allocated to the Registrant as his care coordinator on 13 February 2014. The Panel was provided with an extract from his records.

 8. In respect of Service User 13
you did not transfer and close the case in a timely manner and/or at all once this was raised in supervision on 27 October 2014.
113. Witness 2 said that the case of Service User 13 could have been closed on 26 September 2014 because the Service User was by then over 60 years old.
 
114. Witness 2 said that during a supervision session with the Registrant on 27 October 2014, Witness 1 identified that the case could be closed for that reason. Witness 2 said that in fact the case remained open until 10 December 2014.

115. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 14

116. Service User 14, diagnosed with psychosis, resided in supported living. The Registrant was allocated to the Registrant as her care coordinator on 13 February 2014. The Panel was provided with the service user records for Service User 14.

9a) Following your review on 13 February 2014 you did not make and/or record any further contact with Service User 14 until around December 2014;

117. Witness 2 referred the Panel to an entry in the records which indicated that the Registrant carried out a CPA review and review of placement in relation to Service User 14 on 13 February 2014. There was no evidence of any further contact made by the Registrant with Service User 14 until 30 December 2014. The RIO case notes ended on 17 December 2014. The Panel saw a copy of the CPA review dated 30 September 2014 and accepted the evidence from Witness 2 that the case notes had not been updated since 17 December 2014.

118. Witness 2 said that Service User 14 was a new service user on the Registrant’s caseload and she would have expected the Registrant to see Service User 14 every three to six months, and perhaps more depending on Service User 14’s needs.

119. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

9b) You did not arrange transfer to the In-touch team in a timely manner.
120. Witness 2 said that due to the age of Service User 14, the Registrant should have transferred her to the In-Touch Team in February 2014.

121. The Registrant’s supervision records indicated that during supervision with Witness 1 on 27 October 2014, it was identified that the case of Service User 14 could be closed as she was over 60 years old. During a meeting with the Registrant on 20 November 2014, Witness 1 identified that Service User 14’s case was eligible to be transferred to the In-Touch Team. According to the supervision records the Registrant was asked to transfer Service User 14 to the In-Touch Team by 17 December 2014. However, on 24 December 2014, the case was still open. Service User 14 was discharged from the team on 30 December 2014, but was not referred to In Touch until 5 January 2015. Witness 2 said in oral evidence that she would have expected this to have occurred as soon as possible after 27 October 2014.

122. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 16

123. Service User 16 was diagnosed with schizophrenia and was in residential care. He was allocated to the Registrant as his care coordinator on 18 October 2013. The Panel was provided with an extract from his records.

10a) You did not validate a Care Programme Approach assessment record in a timely manner;

124. Witness 2 referred the Panel to a record of a supervision meeting with the Registrant and Witness 1 on 29 April 2014 in which it was highlighted that Service User 16’s CPA assessment remained non-validated on RIO at the time the case audit was carried out on 9 May 2014.

125. Witness 2 said in oral evidence that she would have expected the validation to have been completed immediately after 29 April 2014.

126. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

10b) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.

127. The Panel was taken to an entry which indicated that on 27 April 2014 the Registrant attended supervision with Witness 1 who highlighted that the Registrant had not recorded interventions on the care plan. This was still the case when Witness 1 carried out her case audit on 9 May 2014.

128. Witness 2 said in oral evidence that the care plan intervention should have been completed straightaway after the issue was raised on 27 April 2014.

129. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 18

130. Service User 18 was diagnosed with schizophrenia. The Registrant was allocated as her care coordinator on 1 November 2013. The Panel was provided with an extract from her case records.

11a) You did not make contact with Service User 18 and/or record any contact between 24 December 2013 and 9 December 2014;

131. The Panel was taken to the relevant part of the progress notes which indicated that the Registrant saw Service User 18 for an annual review on 23 December 2013.There was no evidence of any further visits or contact until 10 December 2014.

132. Witness 2 said she would have expected the Registrant to visit Service User 18 at least every six months, in accordance with good practise, but this had not been done.

133. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

11b) You did not transfer Service User 18 to another team in a timely manner, despite your entry on 15 December 2014 stating that they would be transferred;

134. The record suggested that the Registrant visited Service User 18 on 15 December 2014 for an annual review, and in the course of the visit she said she would transfer the care management to Kent.

135. In her response to Witness 2’s Summary Report, the Registrant said that she transferred this case to Kent on 10 February 2015. Witness 2 said that this is supported by records on RIO, which show that the Registrant referred the case to the central team on 10 Feb 2015 and her last entry was on 11 February 2014.

136. Witness 2 said that the Registrant stated in a meeting on 10 December 2014 that she was going to transfer this case on 15 December 2014. Witness 2 said that this is when she should have completed it, and that she should not have waited almost two months before doing so.
 
137. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

11c) You did not complete a cluster review in a timely manner.

138. Witness 2 said that on 29 April 2014 Witness 1 identified that Service User 18 required a cluster review, and that this was still required at the time of her case audit on 9 May 2014. Witness 2 said that the documentation indicated that the issue had been rectified by 9 June 2014. Witness 2 gave evidence that this was not timely.

139. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 19

140. Service User 19 was diagnosed with schizophrenia and was living in a nursing home. Service User 19 was allocated the Registrant as her care coordinator on 1 November 2013. The Panel was provided with an extract from Service User 19’s records.

12a) You met with Service User 19 on 5 November 2014 and you did not make a record of the meeting until 10 November 2014;

141. Witness 2 informed the Panel that on 10 November 2014 the Registrant sent an email referring to a meeting that had taken place with Service User 19 on 5 November 2014. A note of a meeting between the Registrant and Witness 1 that occurred on 20 November 2014 confirms that the Registrant agreed she did not record the visit of 5 November 2014 on RIO until 10 November 2014.

142. Witness 2 said that the visit should have been recorded immediately or within 24 hours.

143. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

12b) You did not record sufficient information on RIO relating to Service User 19’s transfer

144. Witness 2 referred the Panel to RIO in which there was only one entry relating to Service User 19’s transfer, namely that on 2 December 2014 two calls were made, one to the social worker at the Hospital and one to the Discharge Coordinator, and that Service User 19 had been transferred to Woking Locality for care management. On 2 December 2014, the Registrant sent a letter to Woking Locality Team to clarify she would be care coordinator. This was not followed up.

145. Witness 2 said that in relation to the transfer she would have expected more information and in her oral evidence she clarified that this meant: “what was done, what was going to be done, actions by whom, what was expected and by what date”.

146. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 20

147. Service User 20 was diagnosed with schizophrenia and was residing in supported living. Service User 20 was allocated to the Registrant as her care coordinator on 7 November 2013. The Panel was provided with an extract from the records for Service User 20.

13a) You did not arrange a Care Programme Approach review in a timely manner following the previous review on 17 October 2013;

148. Witness 2 took the Panel to the records which showed that the Registrant completed a CPA review on 17 October 2013. Witness 2 said that during her supervision session with Witness 1 on 12 September 2014, she was reminded that Service User 20 had six monthly reviews. Witness 2 said that this requirement would also be in the care plan. During the subsequent supervision session on 25 September 2014, Witness 1 noted that the CPA review was due by 17 October 2014. The Registrant was due to see Service User 20 on 25 September 2014. The Registrant documented in the progress notes that the agreed plan after the visit on 25 September 2014 was to book the CPA. On 27 October 2014 the records indicate that the Registrant was reminded in her supervision session that the CPA was overdue. The records indicate this had still not been completed by the time of her supervision sessions on 19 November 2014, 20 November 2014, 10 December 2014, and 17 December 2014.

149. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

13b) You did not contact Service User 20 following failed contact on 13 November 2014 until on or after 10 December 2014.

150. On 25 September 2014, the Registrant noted in the progress notes that the next home visit with Service User 20 would take place on 13 November 2014.  Witness 2 pointed to the fact that there is no record of a visit taking place on 13 November 2014. Witness 2 said that when she was questioned about this during the meeting on 10 December 2014, the Registrant said that she was on sick leave and so she did not see Service User 20 on this date. When Witness 1 asked if she rearranged the appointment, she said she did not think to phone to find out if the appointment had taken place in her absence. The next recorded contact on RIO between the Registrant and Service User 20 was on 20 December 2014. 

151. Witness 2 said that the Registrant should have arranged a follow up with Service User 20 when she returned to work. She should have been visiting him in the community fortnightly, or at least monthly, depending on how things were going.

152. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 21

153. Service User 21 was diagnosed with schizophrenia and was in supported living. Service User 21 was allocated to the Registrant as care coordinator on 7 November 2013. The Panel was provided with an extract from the records for Service User 21.

14. In respect of Service User 21
You did not complete a Care Programme Approach review by 17 October 2014 and/or at all.

154. Witness 2 informed the Panel that the records indicated that during her supervision session with Witness 1 on 12 September 2014, the Registrant was reminded that Service User 21 should be having six monthly CPA reviews. The records on RIO indicated there were home visits on 27 March 2014, 28 August 2014, and 24 September 2014. In the subsequent supervision on 25 September 2014, the Registrant was told that the CPA review was due by 17 October 2014. On 27 October 2014, Witness 1 highlighted that the CPA review for Service User 21 was overdue. Despite being reminded in each further supervision session, the CPA review had not been arranged at the time Witness 2 wrote a letter to the Registrant in relation to the matter on 26 January 2015. According to the Registrant’s response to the summary report, she booked and completed the CPA review on 24 February 2015 despite the fact it had been overdue since October 2014.

155. Witness 2 said that CPA reviews for Service User 21 should have been carried out every three to six months as he was living in the community.

156. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 22

157. Service User 22 was diagnosed with schizophrenia and was living in the community in supported living. Service User 22 was allocated to the Registrant on 18 September 2013. The Panel was provided with an extract from the records for Service User 22.

15a) You did not complete and/or record a visit on 20 April 2014;

158. The Panel was referred to Witness 1’s audit of 9 May 2014 in which she stated that the Registrant had arranged to see Service User 22 on 20 April 2014 but there was no information on RIO to suggest she had visited Service User 22 on 20 April 2014.
 
159. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

15b) You did not complete interventions on the care plan within a week of referral and/or in a timely manner.
160. The Panel was taken to the note of a supervision meeting conducted by Witness 1 with the Registrant on 29 April 2014. The note showed there had been no interventions on the care plan for Service User 22. This remained the case by the time of Witness 1’s case audit on 9 May 2014 and her supervision meeting on 9 June 2014.

161. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 23

162. Service User 23 was diagnosed with schizophrenia and was living in residential care. He was allocated to the Registrant on 23 March 2014 for urgent placement review as there were concerns that he had been giving money to his brother. An extract from the records for Service User 23 was produced for the Panel.

16a) You did not make and/or record contact with Service User 23 following allocation on 23 March 2014 – 9 May 2014;

163. In Witness 1’s case audit dated 9 May 2014, it was noted that the progress notes in relation to Service User 23 showed no indication of any contact made by the Registrant until 9 May 2014 when she booked a visit for 19 May 2014.

164. Witness 2 said that the Registrant should have contacted Service User 23 as soon as possible after allocation, and definitely within one week, as the situation was potentially one of financial abuse and should have been dealt with urgently.

165. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

16b) You did not complete and/or record in a timely manner a:
i) Care Programme Approach assessment; and/or
ii) A care plan.
166. Witness 2 referred the Panel to the entry on RIO dated 19 May 2014 which recorded that the Registrant had conducted a home visit, and that it was her intention to complete a CPA review and care plan. However, there was no further entry on RIO or other documentation to suggest that this had been completed. The Panel heard from Witness 2 that, if the records were not documented on RIO it was the understanding of the agency that the work had not been undertaken.

167. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 24

168. Service User 24 was diagnosed with schizophrenia. He was allocated to the Registrant on 18 October 2013. The Panel was provided with an extract from the records.

17a) You did not visit and/or record visiting Service User 24 between 19 November 2013 and 8 May 2014;

169. The Panel heard that when Witness 1 carried out her case audit, she noted that the Registrant had not been to see Service User 24 since 18 November 2013. On 9 June 2014, Witness 1 emailed the Registrant, noting that the Registrant was to have visited Service User 24 on 30 May 2014, but there were no notes on RIO to suggest that this visit had taken place.

170. Witness 2 referred the Panel to the progress notes, which suggested that the Registrant visited Service User 24 on 18 November 2013. A further appointment was arranged by phone for 6 December 2013 and the Registrant was unable to attend on that date and cancelled the appointment. On 10 February 2014, the Registrant arranged an appointment by phone which Service User 24 did not attend. The Registrant then attempted to make contact by phone, but there was no further contact until 9 May 2014 when the Registrant carried out an unannounced home visit.

171. Witness 2 said that regardless of the attempts made by the Registrant to make contact by phone, she should have visited Service User 24 every month, and every three months at a minimum. There had been no home visit carried out between November 2013 and May 2014 and this was not acceptable.

172. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

17b) You did not ensure that the notes on the RIO system were up to date.
173. The Panel was taken to an email sent by Witness 1 to the Registrant on 9 June 2014 noting the Registrant had made an entry on RIO saying she planned to visit Service User 24 on 30 May 2014 and no later entry was made by the Registrant indicating that this had taken place. Witness 1 had reminded the Registrant that progress notes should be completed within 24 hours of seeing a service user.

174. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 25

175. Service User 25 had a history of substance misuse. He resided in the community in supported living accommodation. He was allocated to the Registrant on 7 November 2013. The Panel was provided with an extract from his records.

18. In respect of Service User 25
 you did not arrange and/or record arranging a visit to Service User 25 between 8 March 2014 and 9 May 2014.

176. Witness 2 referred the Panel to the progress notes on RIO which showed that the Registrant had visited Service User 25 on 7 March 2014 and recorded that the next appointment was due to take place on 21 March 2014. There was no further record of contact until 9 May 2014.

177. The Panel heard that Service User 25 sent a letter to the Registrant, received by the Service on 28 April 2014, saying that he had attended his appointment on 25 April 2014 but the Registrant had not been present, and he had received no further contact from her.

178. In her audit on 9 May 2014 Witness 1 highlighted that Service User 25 needed to be seen as a matter of priority as he was a self-harm risk.

179. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Service User 26

180. Service User 26 had been diagnosed with a brain injury. She resided in a nursing home. She was allocated to the Registrant as care coordinator on 1 November 2013. The Panel was provided with an extract from her records.

19. In respect of Service User 26
you did not ensure that there was an up to date cluster review.

181. Witness 2 gave evidence that on 29 April 2014 and 9 May 2014, it was highlighted to the Registrant that the cluster review for Service User 26 was out of date; the last cluster review had taken place on 7 January 2014. Witness 2 told the Panel that the review was completed by the time of her subsequent supervision on 9 June 2014.

182. On the basis of this evidence, together with the Registrant’s admission, the Panel found this Sub-Particular proved.

Decision on Grounds

183. The Panel gave careful consideration to all the evidence and to the submissions made by the Registrant and by Mr Ferson. The Panel accepted the advice of the Legal Assessor who addressed the Panel on the meaning of lack of competence, misconduct and impairment. She referred to the cases of Roylance –v- General Medical Council No 2 [2001] 1 AC p311, Cohen v GMC [2008] EWHC 581 and Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Paula Grant [2011] EWHC 927.

184. The Panel first considered whether the facts found proved were so serious as to amount to misconduct.

185. The Panel took into account the evidence given by Witness 1 and 2 regarding the nature of the potential risks that service users had been exposed to, and the policies and procedures that were supposed to have been followed by the Registrant in carrying out her work. The Panel noted that the Registrant was, at the time of the allegation, an experienced social worker, and that she accepts that she knew what the policies were and understood what was expected of her.

186. The Panel found that service users were exposed to the following risk factors:

• Lack of continuity of care
• Being left ignored and in limbo
• Not being listened to and therefore risking disengagement
• Risks not being monitored or managed
• Lack of management and validation of case notes, including unreliability of information relating to service users
• Exposure to inadequate healthcare and/or necessary funding resources
The Panel concluded that these factors exposed service users to the potential risk of an escalation in their mental health problems, as well as having an adverse effect on the workload of the social work team.

187. The Panel took into account the Registrant’s failure to complete the CPA in relation to Service User 6 which led to the non-assessment of the potential for financial abuse of a vulnerable adult.

188. In considering the issue of misconduct the Panel concluded that the Registrant had breached the following HCPC Standards of Conduct, Performance and Ethics:

1. You must act in the best interests of service users.

5. You must keep your professional knowledge and skills up to date.
7. You must communicate properly and effectively with service users and other practitioners.
12. You must limit your work or stop practising if your performance or judgement is affected by your health.

189. The Panel concluded that the Registrant had also breached the following Standards of Proficiency for Social Workers in England:

2.2 understand the need to promote the best interests of service users and carers at all times.
2.3 understand the need to protect, safeguard and promote the well- being of children, young people and vulnerable adults.
2.4 understand the need to address practices which present a risk to or from service users and carers, or others.
3.2 understand the importance of maintaining their own health and wellbeing.
8.11 be able to prepare and present formal reports in line with applicable protocols and guidelines.
9.1 understand the need to build and sustain professional relationships with social users, carers and colleagues as both an autonomous practitioner and collaboratively with others.
9.4 be able to support service users and carer’s rights to control their lives and make informed choices about the services they receive.
10.1 be able to keep accurate, comprehensive and comprehensive records in accordance with applicable legislation, protocols and guideline.
11.2 recognise the value of supervision, case reviews and other methods of reflection and review.
14.3 be able to prepare, implement, review, evaluate, revise and conclude plans    to meet needs and circumstances in conjunction with service users and carers.

190. It was the judgement of the Panel that each of the facts found proved amounted to misconduct. The Panel considered that the evidence provided in relation to the breaches to the Standards of Conduct, Performance and Ethics and the Standards of Proficiency constituted serious misconduct and demonstrated that the Registrant’s behaviour fell seriously short of what was expected of a social worker in the circumstances.

191. The Panel did not conclude that the Registrant’s behaviour amounted to a lack of competence. The Panel found that the Registrant had held the requisite knowledge and skill to carry out her work, and the matters found proved amounted to a reckless failure on her part to follow up meetings, record updates, keep notes, and follow due process, thereby leaving service users exposed to potential risk of harm as set out above.

Decision on Impairment

192. In considering whether the Registrant is currently impaired by reason of her misconduct the Panel accepted the advice of the Legal Assessor and took note of the Practice Note on Fitness to Practice provided by the HCPC.

193. In reaching its decision the Panel was mindful of the case of Cohen v GMC and asked itself whether the conduct was easily remediable, whether it had been remedied and whether it was highly unlikely to be repeated. The Panel was also mindful of the test endorsed in the case of Grant –v- NMC and considered:

• whether the Registrant had presented and/or continues to present a risk to patient
• whether the Registrant had brought and/or is liable to bring the profession into disrepute
• whether the Registrant had breached and/or is liable to breach one of the fundamental tenets of the profession

194. In relation to insight the Panel noted that the Registrant now fully accepts her failings and did not dispute the potential risks that service users were exposed to. The Panel noted the remorse that the Registrant expressed and the fact that she now takes full responsibility for her failings. The Registrant had reflected that there was an element of self-preservation in her behaviour at the time and acknowledges that she did not take steps to inform her employer about the difficulties she was experiencing. The Panel concluded that the Registrant, in her oral evidence, recognises the risks she exposed both service users and herself to. The Panel noted that in her reflection, the Registrant was able to identify her shortcomings and had developed strategies to deal with those issues. The Panel noted that she has also been open and honest with her current employers about her previous difficulties and about the HCPC investigation. The Registrant said in evidence that in the course of the hearing she had found it hard to listen to evidence which described how bad the standard of her practice had been at the time of the allegations, and that she now felt ashamed. The Registrant now understands the triggers for her behaviour and she has developed coping strategies for the management of those issues. She informed the Panel that she was undergoing various domestic pressures at the time of the allegation which she described to the Panel, and said that if she had her time again she would have had a career break in order to deal with those issues.  She also said that she would make more use of a peer mentor, more active use of supervision, plan her work better and improve her IT skills. She said that she would not take on more work than she could realistically do. She said that she is more aware of the tendency to take on too much work instead of concentrating on completing work in hand. She said that in the future she would monitor the responsibilities that she would take on. The Panel noted that the Registrant had carried out an intensive reflection on what had gone wrong and what she could do to put it right. The Panel noted that the Registrant’s domestic situation at the time, which she said had affected her behaviour, had now changed.

195. In relation to remediation, the Panel noted that the Registrant had now completed a Post Graduate Masters Degree in Safeguarding Adults: Law, Policy and Practice. She had also investigated accessing a place on a course in AMHP refresher training which would involve one day a week to be reapproved. Since September 2017 the Registrant had been working in social care with the Salvation Army, and she identified for the Panel the transferability of components of this role to the role of social work, for example the importance of timely recording, key worker role holding case work responsibility, and welfare interventions, including dealing with funding and housing issues. Furthermore, the Panel noted that the work the Registrant is currently undertaking demonstrates that she is able to respond to the needs of vulnerable adults, and comply with all of the requirements of the role, for example, the Salvation Army policies and procedures, including record keeping, timeliness, and management of cases and care interventions. The Registrant has maintained this new role in social care since September 2017 and the Panel notes that the role requires shift work and flexibility. This demonstrated to the Panel the Registrant’s commitment and ability to adjust to new working challenges.  She has undertaken all the mandatory training required as part of that role.

196. In relation to the risk of repetition, the Panel found that the Registrant had demonstrated clear insight and remediation and that she had accepted that her failures fell short of what the public and service users can expect from a professional social worker. Taking into account all the evidence the Panel concluded that the risk that the Registrant will repeat her misconduct in future is low.
197. The Panel then moved on to consider the public component, and whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.

198. The Panel concluded that the Registrant’s fitness to practice is currently impaired on the public component alone. In so concluding the Panel took into account:
 
• the number of vulnerable service users involved
• the potential risks to the service users, as identified in this determination
• the length of time over which the behaviour was evidenced

199. The Panel therefore finds that the Registrant’s fitness to practise is currently impaired.

Decision on Sanction

200. The Panel heard submissions from both parties and heard and accepted the advice provided by the Legal Assessor.
201. The Registrant informed the Panel that she was currently working as an assistant support worker for the Salvation Army. She said that she wanted to return to work as a registered Social Worker and had applied to Portsmouth City Council for a place on a refresher course with the Mental Health Team commencing in September. She said that this would involve working one day a week for a year and undertaking a 23-day placement in a mental health service setting. She would be supervised and assessed during the course of the programme and would be required to produce assessments and reports. She recognised that she had been out of practice for 3 years, that her legal knowledge was out of date and that she required retraining before returning to social work. She urged the Panel to impose a Caution.

202. The Panel kept in mind that the purpose of sanction is not punitive but is designed to protect the public interest. The Panel took into account the current Indicative Sanctions Policy published by the HCPC. The Panel applied the principle of proportionality weighing the Registrant’s interests against the need to protect the public interest. The Panel was aware that it is required to look at the least restrictive sanction first before moving up the level of seriousness.

203. The Panel took into account the following mitigating and aggravating circumstances:
Aggravating:

• The misconduct had involved numerous vulnerable service users over a prolonged period of time (some 1 ½ years), resulting in exposure to risk of harm
• The Registrant continued with her behaviour despite repeated reminders not to do so by her supervisors
• The Registrant indulged in an element of self-preservation which overrode her duty to inform her employers of the personal difficulties she was undergoing at the time
• The Registrant’s actions had impacted on the workload of her own and other social work teams
Mitigating:
• The Registrant’s good character and unblemished career
• Her excellent references and testimonials from, for example, her current employer, the Salvation Army, who confirmed that the Registrant was complying with all relevant training requirements and policies, and the reference she obtained from her previous employer which had enabled her to obtain her current job
• Her full engagement with HCPC proceedings
• The admissions entered by her to the entirety of the allegation
• Her high level of remorse and genuine insight
• Her high level of reflection about the effect of her actions on service users and on herself
• Her ready acceptance that she will need to retrain before recommencing work as a social worker
• Her high level of commitment to her profession
• Her completion of a Post Graduate Masters Degree in Safeguarding Adults: Law, Policy and Practice
• The coping strategies that she had now put in place, such as peer support mentoring and taking steps to increase her IT skills
• Her increased openness with her family, and current employer
• The severe adverse personal circumstances that she faced at the time of the allegation, all of which had now been resolved, including.

No action:

204. The Panel concluded that to take no further action would undermine confidence in the profession and in the regulatory functions of the HCPC in light of the seriousness of the facts found proved.
Caution:

205. The Panel bore in mind Paragraph 8 of the Indicative Sanctions Guidance which indicated that whilst to take no action was likely to be an exceptional outcome, nevertheless it may be appropriate in cases where a finding of impairment has been reached on the wider public interest grounds alone and where the Registrant had insight, had already taken remedial action and there was no risk of repetition.

206. The Panel accepted that this could not be described as a case where the lapse had been isolated, limited or relatively minor in nature. However, the Panel had concluded that the risk of recurrence was low, the Registrant had shown a high level of insight, and the Registrant had taken appropriate remedial action.
207. The Panel was highly influenced by the unusually high number of mitigating factors present in the case, and in particular the unique factors pertaining to the Registrant’s personal life at the time, as set out earlier in this determination, all of which had now been resolved.

208. In those circumstances the Panel concluded that a Caution Order was the appropriate and proportionate order to impose in order to uphold proper professional standards and public confidence in the profession.

209. The Panel gave consideration to a Conditions of Practise order but concluded that this would be disproportionate in light of the number of mitigating factors present, and the fact that the Panel’s finding of impairment had been based on the wider public interest alone. The Panel concluded that the public would conclude that in light of the mitigating factors in this case, and in particular the personal difficulties that the Registrant was dealing with at the time, all of which had now been overcome, a caution order was sufficient to uphold proper professional standards and public confidence in the profession. The Panel was mindful of the fact that the Registrant would be unable to return to work as an approved mental health professional without undertaking further training, including supervision, as she had not practised as a social worker for over three years.

210. The Panel concluded that the Caution Order would apply for a period of three years to reflect the seriousness of the misconduct.

211. The order will apply on the expiry of the appeal period.

Order

That the Registrar is directed to annotate the register entry of Ms Lynette Anne Sylvia White with a caution which is to remain on the register for a period of 3 years from the date this order comes into effect.

Notes

If no appeal is made this order will take effect when the 28 day appeal period has lapsed.

Hearing History

History of Hearings for Ms Lynette Ann Sylvia White

Date Panel Hearing type Outcomes / Status