Mrs Victoria V Asirvatham

Profession: Occupational therapist

Registration Number: OT41405

Interim Order: Imposed on 14 Dec 2016

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 26/02/2018 End: 17:00 05/03/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Suspended

Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via tsteam@hcpts-uk.org or +44 (0)808 164 3084 if you require any further information.

 

Allegation

(as amended at the Substantive Hearing on 28 February 2018)

While registered as an Occupational Therapist and during the course of your employment as an Occupational Therapist for 2gether NHS Foundation Trust in a Band 5 post:

1. In relation to Service User 1, you: 


a. Between 11 March 2015 and 08 April 2015, conducted and/or recorded an assessment using the Model of Human Occupation Screening Tool [MOHOST], which did not contain;

(i) A comprehensive analysis of Service User 1’s occupational health needs,


(ii) Adequate clinical reasoning and/or demonstrate understanding of the use of the MOHST tool,


(iii) A summary, and/or


(iv) Recommendations for care intervention.

b. On 13 April 2015, conducted and/or recorded an assessment of Service User 1’s activities of daily living which did not contain;


(i) A summary,

(ii) An overall analysis of the Service User’s needs, and/or


(iii) An intervention plan and/or recommendations for care intervention.

c. On 30 June 2015, conducted and/or recorded an assessment/observation of Service User 1 and did not report and/or make a record of reporting Service User 1’s mental state to ward staff.

d. On 07 July 2015, conducted and/or recorded an assessment/observation of Service User 1 walking in hospital grounds which did not contain;

(i) A proper analysis of the observation,


(ii) An intervention plan, and/or


(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

e. On 29 July 2015, conducted and/or recorded an assessment/observation of Service User 1 cleaning their environment which did not contain;


(i) A proper analysis of the observation,


(ii) An intervention plan, and/or


(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

f. On 26 August 2015, conducted and/or recorded an assessment/observation of Service User 1 adapting their routine to attend lunch which did not contain;

(i) A proper analysis of the Service User’s process skills,


(ii) A plan for further intervention, and/or


(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

g. On 28 August 2015, conducted and/or recorded an assessment/observation of Service User 1 attending a chapel service, which did not contain;


(i) A proper analysis of the observation,


(ii) An intervention plan, and/or


(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

h. On 31 August 2015, conducted and/or recorded an assessment/observation with the purpose of increasing Service User’s 1’s attendance at music in mind group, which did not contain;

(i) A proper analysis of the observation,


(ii) An intervention plan, and/or


(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

i. On 03 September 2015, conducted and/or recorded an assessment/observation of Service User 1 using the bath, which did not contain a detailed analysis regarding;


(i) The Servicer User’s environment,


(ii) The limited use of transfers,


(iii) The Service User’s Mobility, and/or


(iv) The Service User’s use of equipment.

j. On 03 September 2015, conducted and/or recorded an assessment/observation of Service User 1’s shopping and banking, which did not contain;


(i) A detailed analysis of the activity and/or the environment in which the activity was conducted, and/or


(ii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

k. On 04 September 2015, conducted and/or recorded an assessment/observation of Service User 1 attending a chapel service, which did not contain;


(i) A detailed analysis of the activity and/or the environment in which the activity was conducted,


(ii) An intervention plan, and/or


(iii) Adequate clinical reasoning and/or explanation regarding the relationship between the observations and the service user’s occupational needs.

l. Between 11 March 2015 and 1 October 2015, you did not initiate a Care Plan in respect of Service User 1.

2. In relation to Service User 2, you:

a. On 09 July 2015, conducted and/or recorded a home visit assessment to assess bath transfer, which did not contain;


(i) A summary,


(ii) Adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs, and/or


(iii) Did not provide a recommendation about suitability of environment. 


b. On 24 July 2015, conducted and/or recorded an assessment involving an environmental adaption to prevent the risk of falls for Service User 2, which did not contain;

(i) Details of why the bathmat was necessary;


(ii) Details of any discussion about the risks of equipment, and/or


(iii) Details of any discussion about the safe use of the equipment.

c. On 17 August 2015, conducted and/or recorded an observation of Service User 2 engaging in an activity which could be adapted into their routine, which did not contain;

(i) Details of any discussion about the risks of equipment, and/or


(ii) Details of any discussion about the safe use of the equipment.

(iii) Adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs.

d. Did not add any new information to the Care Plan to reflect developments in Service User 2’s treatment, such as the completion of an Interests Checklist on 26 January 2015, Service User 2’s discharge on 10 February 2015 and his re-admittance in June 2015.

e. On 24 March 2016, at a joint assessment of Service User 2, completed a record of the assessment which did not contain adequate analysis of the service user’s physical presentation during the assessment.

3. In relation to Service User 3, you:

a. On 05 February 2016, conducted and/or recorded an assessment of Service User 3’s environment, which did not contain;


(i) A proper analysis of the observation and/or assessment findings,


(ii) An intervention plan, and/or


(iii) Adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs. 


b. Completed a draft Occupational Therapy Report dated 10 February 2016 which was inadequate for the following reasons:

(i) You used incorrect paperwork showing the wrong NHS Trust,


(ii) The report did not contain sufficient information about Service User 3’s occupational needs,


(iii) The report contained inaccurate ratings in the ‘Summary of Occupational Profile’ table.

4. In relation to Service User 4 you:


a. On or around 19 November 2015, you completed a Care Plan and included the requirement for weekly reviews to be conducted by the Occupational Therapist, which you then did not carry out.

b. On or around 23 November 2015, you completed a kitchen assessment and amended an existing Care Plan instead of developing a new Care Plan

c. On 07 December 2015, completed an Occupational Therapy report, which did not contain;


(i) A proper analysis of the observation,


(ii) Detailed clinical reasoning,

(iii) Detailed information about the Service User’s new environment and/or the relationship between the new environment and the service user’s occupational needs,

(iv) an intervention plan

5. In relation to Service User 5 you:


a. On 18 November 2015, completed and/or recorded an assessment to adapt Service User 5‘s routine which contained the wrong Service User 5’s name.

b. On 30 November 2015, conducted and/or recorded an observation/assessment in relation to Service User 5’s cooking skills, which did not contain;


(i) A proper analysis of the observation and/or potential risk, and/or


(ii) A strategy to support Service User 5.

c. On 09 December 2015, made a record of a conversation with a doctor which did not contain any explanation why the Service User was said to have a lack of capacity towards treatment.

d. On 11 December 2015, conducted and/or recorded observation of Service User 5 in the hospital grounds, and:


(i) Did not identify the Service User’s behaviour as a potential significant risk in the written record of the observation,


(ii) Did not identify the Service User’s behaviour may indicate the presence of mental health concerns in the written record of the observation, and/or


(iii) Did not feedback the potential risks regarding Service User 5’s presentation during the observation to the ward.

6. In relation to Service User 6 you:

a. On 20 November 2015, conducted and/or recorded an observation of the Service User engaging in tasks to adapt routine, which did not make reference to the impact of the environment. 


b. On 23 November 2015, conducted and/or recorded an observation of the Service User during a walk in the hospital grounds which did not contain:

(i) a proper analysis of the observation; and/or

(ii) a detailed analysis of the Service User’s ability to plan for the future. 


c. On 30 October 2015, conducted and/or recorded an observation/assessment of the Service User involving building rapport, which did not contain;


(i) A proper analysis of the Service User’s process skills, and/or


(ii) An intervention plan.

d. On 01 December 2015, completed an occupational therapy discharge summary, which did not contain a proper analysis of the Service User’s needs upon discharge.

e. On 01 December 2015, conducted and/or recorded an assessment using the Model of Human Occupation Screening Tool [MOHOST], which did not contain a comprehensive analysis of and/or adequate clinical reasoning regarding Service User 6’s occupational health needs at home. 


7. In relation to Service User 7 you:


a. On 10 May 2016, conducted and/or recorded an observation during an initial contact ,which did not contain;


(i). A proper analysis of the observation,


(ii) An intervention plan, and/or


(iii) Indicate what further assessments were/will be required.

b. On 12 May 2016, completed a written record of an observation of the Service User, which;


(i) Described the activity incorrectly, and/or


(ii) Did not include detailed analysis and/or clinical reasoning for the recommendations made.

c. On 18 May 2016, conducted and/or recorded an observation of the Service User which incorrectly referred to one purpose of the assessment being re-motivation.

d. On 20 May 2016, conducted and/or recorded an observation of the Service User, which;

(i) incorrectly referred to the purpose of the observation as being re-motivation,

(ii) Did not contain a proper analysis of the observation and/or a summary, and/or


(iii) Did not contain an adequate analysis and/or clinical reasoning regarding the relationship between the observations and the service user’s occupational needs. 


e. On 25 May 2016, completed and/or recorded a record for an observation at a breakfast group which:

(i) incorrectly referred to the purpose of the observation as being re-motivation,

(ii) contained the wrong Service User’s name. 


f. On 27 May 2016, conducted an ADL assessment in the community in relation to Service User 7, which was not required as this had already been completed on 17 May 2016. 


g. On 01 June 2016, completed a written record of an observation involving a breakfast group activity, which incorrectly referred to one of the purposes of the intervention as being re-motivation.

8. In relation to Service User 8, on or around 16 April 2015 you completed a Care Plan which was inadequate, in that it:

a. did not reflect Service User 8’s Occupational Therapy needs, and/or

b. stated goals of exploring Service User 8’s routines and interests and engaging Service User 8 in meaningful activities which were insufficient to address Service User 8’s occupational needs.

9. You did not ensure that case notes entered on the RiO system were validated with a signed electronic signature in the cases of;

a. Service User 1, namely the entry dated 30 May 2016. 


b. Service User 2, namely the entries dated:


(i). 08 July 2015,

(ii) 2 September 2015


(iii) 14 December 2015,

(iv) 14 March 2016 and/or

(v)14 April 2016. 


c. Service User 3, namely the entries dated:


(i). 09 February 2016,


(ii). 11 February 2016, and/or


(iii) 23 February 2016 .

d. Service User 5, namely the entry dated 09 December 2015.

10. Your actions as described at paragraphs 1-9 amount to misconduct and/or lack of competence.

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

Finding

Preliminary Matters

Proof of Service

1. The Panel was satisfied that the Notice of hearing had been sent to the Registrant’s registered address on 13 December 2017 in accordance with the requirements of Rule 3 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”).

Proceeding in the absence of the Registrant

2. Mr Ferson applied to proceed in the absence of the Registrant.

3. The Panel accepted the advice of the Legal Assessor, who reminded the Panel of Rule 11 and the guidance given in the cases of Tait v The Royal College of Veterinary Surgeons [2003] UKPC 34, R v Jones (2003) 1 AC 1 and GMC v Adeogba [2016] EWCA Civ 162.

4. The Panel was provided with an email sent by the Registrant on 25 February 2018, in which she stated: “I have decided not to attend as it will bring memories of the past”.

5. The Panel concluded that, on the basis of the information before it, the Registrant was aware of the hearing and had decided not to attend. She had not made an application to adjourn, nor had she suggested that she wished to be represented. The Panel concluded that it was highly unlikely that an adjournment would secure her attendance in the future. Two witnesses were due to give evidence. The Panel concluded that it was in the public interest for the matter to be heard expeditiously.

6. In all the circumstances, the Panel decided to proceed in the absence of the Registrant.

Application to amend the allegation

7. Mr Ferson applied to amend the allegation. This included an application to offer no evidence in relation to particulars 2(e) and 7(b).

8. The Panel decided to allow the amendments. The application to offer no evidence was in the interests of the Registrant, and was also in the public interest as the evidence did not support the allegation. The other amendments did not alter the substance of the case and better reflected the state of the evidence.

9. At a later stage in the proceedings, Mr Ferson made a further application to amend particulars 1(l) and 8(b), and these amendments were also allowed for the same reason.

10. The allegation set out at the beginning of this determination is the allegation in its amended form.

Witnesses

11. The Panel heard from two witnesses called on behalf of the HCPC:

• RS – Head of Profession for Occupational Therapy at 2Gether NHS Foundation Trust

• HP – Band 6 Occupational Therapist at 2Gether NHS Foundation Trust

Background

12. On 8 December 2008, the Registrant was employed as a Band 5 Occupational Therapist by 2Gether NHS Foundation Trust (the Trust), which provides mental health and learning disability services. The Registrant was responsible for adult patients with severe and enduring mental illness.

13. From 2008 to 2009, the Registrant was employed in the Trust’s Older Persons Inpatient Service Occupational Therapy Department, and then, from 2009 until 2 November 2014, in the Montpellier Low Secure Unit. From 3 November 2014 to 2016, she was employed in the Wotton Lawn Inpatient Unit, which provides inpatient treatment for adults with mental illness who require hospital treatment due to an acute episode prior to returning to the community.

14. The Allegation centres on events that were alleged to have occurred whilst the Registrant was employed in the Wotton Lawn Inpatient Unit. It was alleged that, in relation to multiple service users, the Registrant failed to conduct analyses of assessments and observations, initiate Care Plans, undertake clinical reasoning, complete adequate documentation and ensure that case-notes were validated on the system.

15. The Panel heard oral evidence from RS and HP, who provided the Panel with the relevant documentation in the case, which included the Occupational Therapy records relating to Service Users 1 to 8. The particulars related almost entirely to documentary evidence exhibited, to a large extent, by RS. Both RS and HP were taken in their oral evidence through each record referenced in each particular. They confirmed the nature and importance of those records and specified the shortcomings that were said to exist in the Registrant's completion of observations, assessments, Care Plans, reports, discharge summaries and entries on RIO, the Trust’s electronic recording system.

16. The Panel was informed that a number of measures had been put in place to support the Registrant during her time at the Trust, including direct clinical supervision, both informally on a daily basis working in a team with another Occupational Therapist, and through very regular supervision sessions with her clinical supervisor. The Registrant’s caseload was described as approximately half the size of an equivalent band Occupational Therapist and comprised less complex cases. She was also provided with re-training in the Model of Human Occupational Screening Tool (MOHOST), a specialist assessment tool used in the Trust, and was given a comprehensive induction when she first moved to Wotton Lawn.

17. The Panel was provided with some material that had been sent by the Registrant, comprising an email in which she provided details of her current employment, a supervision record dated 3 April 2017, three references, and details of a training course in counselling that she plans to attend in the near future. The Registrant did not provide any submissions in relation to the Allegation itself.

Decision on Facts

18. The Panel accepted the advice of the Legal Assessor. In reaching its decision it took into account the evidence provided by RS and HP, the bundle of documentation supplied by the HCPC, and the documentation provided by the Registrant. Throughout its deliberations, it applied the appropriate burden and standard of proof.

19. The Panel found both witnesses to be credible, balanced and reliable in the giving of their evidence. It appeared to the Panel that they had both displayed a significant degree of compassion for the Registrant, and had tried their best to support her over a considerable period of time.

Particulars 1(a)(i), 1(a)(ii), 1(a)(iii) and 1(a)(iv) – Proved

20. RS provided the Panel with a copy of Service User 1’s Occupational Therapy records, which included a copy of a MOHOST assessment dated 11 March 2015 and completed by the Registrant. RS informed the Panel that a MOHOST assessment should contain an analysis of a service user’s occupational needs, a demonstration of what has been observed, the information found, and an analysis of the impact this has on the person’s daily living.

21. RS asserted that the narrative provided by the Registrant on the MOHOST assessment in this instance was lacking in analysis. It reported that Service User 1 was able to perform certain tasks and had certain issues, such as a problem with memory; however, it did not set out the impact of this on Service User 1. In particular, it did not indicate if or how Service User 1 could live independently in the community.

22. Further, the MOHOST assessment did not contain clinical reasoning, which RS described as the utilisation of assessment findings to determine the impact of the service user’s illness or condition on their occupational performance or participation (their function), for use in planning and justifying interventions or future support need. RS said that it had been intended that the MOHOST assessment produced by the Registrant for Service User 1 would be used as the basis for an application for a number of care packages. A colleague had reviewed it and concluded that the level of ability that the Registrant had scored for Service User 1 differed significantly from his own findings. The Registrant’s score would not have enabled Service User 1 to access the appropriate levels of support in the wider community.

23. RS said that the MOHOST assessment which the Registrant completed did not include either a summary or recommendations for the care intervention that should be provided by Occupational Therapy. It did not provide an overall picture of the Service User’s condition, nor did it provide an explanation of her needs, the support required or the action to be taken by Occupational Therapy to enable Service User 1 to live independently in the community.

24. On the basis of this evidence, the Panel found particular 1(a) proved in its entirety.

Particulars 1(b)(i), 1(b)(ii) and 1(b)(iii) – Proved

25. RS informed the Panel that on 13 April 2015, the Registrant completed an assessment of Service User 1’s daily activities. She asserted that the assessment, a copy of which was provided for the Panel, did not contain a summary setting out an explanation of what had been completed in the assessment, what had been found, what Service User 1’s strengths and challenges were, and what the Registrant’s recommendations were for Service User 1.

26. RS said that the assessment was insufficient, as throughout the assessment the Registrant tended to limit her record to a description of what she had observed, rather than analysing Service User 1’s needs and stating the implications. RS said that the Registrant should have set out what she observed, what the impact of this was on Service User 1, and what was required of Occupational Therapy to support that.

27. Further, RS said that the Registrant did not set out an intervention plan or recommendation for Service User 1 in her assessment, which would have set out the ongoing treatment required for Service User 1 in response to the observations that had been made. RS said that this was critical because the assessment would be shared with other professionals involved in the care of a service user, and is designed to provide information regarding their needs.

28. The Panel concluded that the evidence of RS was that 13 April 2015 was the date when it was recorded and not the date on which it was conducted. On that basis, the Panel found particular 1(b) proved in its entirety.

Particular 1(c) – Proved

29. RS informed the Panel that the Registrant conducted an observation for Service User 1 on 30 June 2015, in which Service User 1 displayed behaviour which could have indicated a deterioration in her mental health, and this should have been reported back to the ward staff. The Registrant had included in the assessment that she was not happy to engage on a one-to-one basis with Service User 1, as the Service User was angry and could be unpredictable. However, there was no evidence that this had been fed back to the ward staff. This had important implications for the safety of the ward staff and other service users.

30. On the basis of this evidence, the Panel found particular 1(c) proved.

Particulars 1(d)(i), 1(d)(ii) and 1(d)(iii) – Proved

31. RS informed the Panel that the Registrant conducted and recorded an observation for Service User 1 when she had walked in the hospital grounds with the Service User on 7 July 2015. RS said that this observation was too descriptive and lacked a proper analysis. The Registrant should have included an analysis of the implications for Service User 1 of what she had observed. This should have explored what the observations indicated in relation to the ability of Service User 1 to perform certain tasks.

32. RS said that the observation should have contained an indication of what the intervention plan was to be. She said that an Occupational Therapist needs to demonstrate they have undertaken a certain piece of work, what the outcome of this work is, and what the plan is in terms of what happens next. This is particularly important in the context of a Multi-Disciplinary Team on the ward. The intervention plan is an important part of a service user’s treatment.

33. RS said that the Registrant’s observation did not contain thorough reasoning regarding the observations of Service User 1 and what her occupational needs were. Under the section entitled “Process Skills”, the Registrant described how Service User 1 had repeatedly changed her mind regarding whether or not to have breakfast. This should have led the Registrant to question how this would impact on Service User 1’s day-to-day decision-making. Further, the Registrant had recorded that Service User 1 needed help fetching cutlery, but did not indicate how Service User 1 could undertake this task without some level of support going forward.

34. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 1(d)(iii), which specified a lack of explanation, because this was duplicitous with particular 1 (d)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 1(d) proved in its entirety.

Particulars 1(e)(i), 1(e)(ii) and 1(e)(iii) – Proved

35. RS informed the Panel that the Registrant conducted and recorded an observation for Service User 1 on 29 July 2015 which did not include a proper analysis or clinical reasoning of what she had observed. The Registrant identified issues around: Service User 1’s motivation; that Service User 1 needed a prompt for memory; and that on occasions Service User 1 had engaged without any prompting. The Registrant had therefore recognised that Service User 1 struggled and needed support. However, there was no analysis of what the overall implications were. She said that Service User 1 had indicated that she regularly cleaned her room but did not plan on washing her clothes that day. There was no further discussion as to why this may have been the case. There was nothing in the observation which indicated how Service User 1’s needs would impact on her day-to-day living. The observation stated that Service User 1 had breathing difficulties when carrying certain items. There was nothing in the assessment to indicate what was causing these issues or whether Service User 1 would be able to perform tasks in the future.

36. RS said that there was no intervention plan or a summary provided as part of the observation. There was therefore nothing to indicate how any actions taken as a result of the observation would fit in with Service User 1’s wider intervention and treatment plan provided by the Multi-Disciplinary Team.

37. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 1(e)(iii), which specified a lack of explanation, because this was duplicitous with particular 1(e)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 1(e) proved in its entirety.

Particulars 1(f)(i), 1(f)(ii) and 1(f)(iii) – Proved

38. RS informed the Panel that the Registrant conducted and recorded an observation on 26 August 2015 of Service User 1 adapting her routine to attend a lunch. This contained a set of statements about matters observed, but no information or analysis about what the impact of these observations were on Service User 1. There was therefore no discussion about whether there were issues around Service User 1’s memory or her ability to recall certain events. The Registrant observed that Service User 1 was unable to organise herself to attend the lunch and instead required instructions, but there was no analysis of whether Service User 1 had the process skills to prepare herself to engage in this particular activity. The implications of the observation and what interventions may be required were not explored.

39. RS said that the Registrant’s observation did not provide a plan for further intervention. Service User 1 had continually been observed displaying the same issues and RS would have expected the Registrant to analyse the care that was being provided to help Service User 1 manage her needs. This could have included the use of certain verbal prompts or putting in place individual tailored measures to support Service User 1 in order to help increase her independence. This was particularly important as Service User 1 was a resident on an acute unit where she was unlikely to remain for a substantial period of time. However, there was no plan which would cover how this Service User would cope in the wider community.

40. RS said that the Registrant did not display adequate clinical reasoning by discussing the relationship between what she had observed and the Service User’s needs. She had detailed what she had observed, but there was no discussion of what the implications were and what the Registrant’s suggestions were to manage that. The Registrant had identified that Service User 1 did not use her inhaler and needed help when managing the stairs; however, the Registrant did not appear to have given any thought to how Occupational Therapy could provide support.

41. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 1(f)(iii), which specified a lack of explanation, because this was duplicitous with particular 1(f)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 1(f) proved in its entirety.

Particulars 1(g)(i), 1(g)(ii) and 1(g)(iii) – Proved

42. RS informed the Panel that the Registrant conducted and recorded an observation on 26 August 2015 of Service User 1 attending a chapel service. She said there was very little analysis of what the Registrant had observed. There was an indication of a small improvement in Service User 1’s abilities; for example, instantly engaging with the Registrant. The notes were contradictory in part, indicating on the one hand that Service User 1 was warm and pleasant to interact with, but on the other that she only interacted when she was prompted. The Registrant noted that Service User 1 had laboured breathing and was not using her inhalers, but did not indicate that the Registrant had been encouraging Service User 1 to user her inhaler prior to each observation. The Registrant observed that Service User 1 was now independently able to make a cup of tea; however, there was no analysis or discussion of how this compared to the observations that had been made before and what the implications were.

43. RS said that the clinical reasoning in the observation was inadequate and that there was no discussion of what the intervention plan should be going forward. 44. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 1(g)(iii), which specified a lack of explanation, because this was duplicitous with particular 1(g)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 1(g) proved in its entirety.

Particulars 1(h)(i), 1(h)(ii) and 1(h)(iii) – Proved

45. RS informed the Panel that the Registrant conducted and recorded an observation of attending a ‘music in mind’ group on 31 August 2015. She said that this observation again did not contain a proper analysis of what the Registrant had seen. The Registrant recorded that Service User 1 was warm and approachable and socialising in a group; however, there was no consideration of the fact that this differed from the observations that had been made before. The Registrant did not consider whether there had been any improvement in Service User 1’s condition. Service User 1 had engaged in a new activity with a larger group; however, there was little analysis of what this meant and how Service User 1’s engagement with others could be used as part of the Occupational Therapy plans.

46. RS said that there was no indication of an intervention plan going forward.

47. RS said that she would have expected that if Service User 1 had been able to positively engage with the larger group, a plan could have been put in place which would encourage her to do this more often. She said that there had not been proper analysis or demonstration of clinical reasoning outlining the relationship between the observations that had been made and Service User 1’s occupational needs going forward.

48. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 1(h)(iii), which specified a lack of explanation, because this was duplicitous with particular 1(h)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 1(h) proved in its entirety.

Particulars 1(i)(i), 1(i)(ii), 1(i)(iii) and 1(i)(iv) – Proved

49. RS informed the Panel that the Registrant conducted and recorded an observation of Service User 1 on 3 September 2015. She said that the Registrant should have included in her assessment further information about the environment in which the assessment had taken place. She should have set out what the implications of the environment were, how Service User 1 was able to mobilise around the environment, what equipment was needed and what support was in place in order to facilitate that. RS said that this was particularly important as the environment was unfamiliar for Service User 1. The assessment was not conducted in Service User 1’s own house and the purpose of the assessment was to understand whether the Service User had the skills and ability to undertake the task alone, and what level of support would be needed in order to do this in the future.

50. RS said that the Registrant stated that Service User 1 was able to get in and out of the bath (an action known as a ‘transfer’); however, there was little detail of what this involved. The Registrant did not set out whether there were adaptations to make it easier for Service User 1 to get in and out of the bath. The Registrant did not set out what level of support was required and whether Service User 1 needed prompting in order to complete the task. RS said that this was important, as there could be implications if someone was not present to help Service User 1 get in and out of the bath.

51. RS said that there was very little information recorded in the assessment about Service User 1’s mobility and how she walked around the bathroom area. The Registrant did not discuss how Service User 1 mobilised from one place to the other and there was no discussion or information provided about the bath, such as its size. She said that if the assessment was being completed in order to understand Service User 1’s ability to complete the task independently, there should have been discussion about how this would have translated to another environment. The Registrant did not discuss whether it was safe for Service User 1 to complete this task independently, or if she had needed prompts in order for her to get in and out of the bath due to her process skills. This was an area which the Registrant should have planned around. The Registrant did not provide that level of clinical analysis. There was also no discussion about the Service User’s use of equipment in order to enable her to complete the task. From the observation that the Registrant recorded, there was nothing to help someone reading the assessment understand what support Service User 1 required to complete the task, independently or otherwise.

52. On the basis of this evidence, the Panel found particular 1(i) proved in its entirety.

Particulars 1(j)(i) and 1(j)(ii) – Proved

53. RS informed the Panel that the Registrant conducted and recorded an observation during a visit with Service User 1 out to the wider community on 3 September 2015. RS said that this assessment would have been undertaken in order to observe how Service User 1 functioned within the wider world outside the hospital environment. The purpose of the assessment would be to take Service User 1 into a busy environment and observe how she was able to participate in activity and any impact this may have had upon her mental state. It would have been expected that the Registrant would have discussed any changes in Service User 1’s behaviour when she was interacting in a busy environment. The Registrant should have recorded what the impact of this different environment was on Service User 1 and there should have been some discussion of the type of environment that the Registrant had taken Service User 1 to. There was an absence of clinical reasoning in terms of whether Service User 1 could have completed the visit to the outside environment independently. There was no discussion of the type of things that might hinder Service User 1 in independently completing this task.

54. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 1(j)(iii), which specified a lack of explanation, because this was duplicitous with particular 1(j)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 1(j) proved in its entirety.

Particulars 1(k)(i), 1(k)(ii) and 1(k)(iii) – Proved

55. RS said that on 4 September 2015, the Registrant completed an observation of Service User 1 attending a chapel service. She said that this was an activity that would have taken place outside the Trust and was a familiar activity for Service User 1. However, there was no recognition of what type of activity this was, the environment of the activity, and how this impacted on Service User 1’s ability to undertake it. There was no analysis of how the observations undertaken during this activity translated or impacted upon Service User 1’s mental health.

56. RS said that there was no intervention plan formulated as a result of the observations.

57. RS said that there was a lack of clinical analysis and reasoning, as there was little discussion about what the observations implied. The Registrant recorded that Service User 1 had difficulty reading a hymn book, yet there was no analysis of whether it had become more difficult for her to do this task. The Registrant did not consider what this meant or what was needed in order to support Service User 1 in completing this task in the future.

58. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 1(k)(iii), which specified a lack of explanation, because this was duplicitous with particular 1(k)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 1(k) proved in its entirety.

Particular 1(l) – Proved

59. RS explained that a Care Plan provides an overview of the assessment, the intervention undertaken with service users, and what the expected outcomes are. It should identify the needs of the service user and what plan is in place in order to meet those needs. It is an important part of the record system. It is needed in order to communicate to the wider Multi-Disciplinary Team the work that has been undertaken with the individual and what the individual’s needs are.

60. RS said that she could find no record of a Care Plan for Service User 1 during the time that the Registrant was the allocated Occupational Therapist between 11 March 2015 and 1 October 2015.

61. On the basis of this evidence, the Panel found particular 1(l) proved.

Particulars 2(a)(i), 2(a)(ii) and 2(a)(iii) – Proved

62. RS produced the service user records for Service User 2. RS informed the Panel that on 9 July 2015, the Registrant completed a home visit with Service User 2 in order to undertake a bath transfer assessment. She said that the purpose of completing a home visit is to understand whether the environment is suitable for a service user’s needs. She said that an assessment of a home should include a discussion of any adaptations of the environment to meet the service user’s needs. This requires a detailed analysis of what is observed and what steps should be taken in response.

63. RS said that the observations recorded by the Registrant described the cluttered environment in Service User 2’s home, and there should have been an analysis of whether it would be difficult for Service User 2 to undertake daily living in those circumstances. RS accepted that the Registrant described how Service User 2 would benefit from the use of a handrail when transferring in and out of a bath, to which Service User 2 had said that he did not want one. However, the Registrant should then have considered how to keep Service User 2 safe in his home environment in light of this observation. Furthermore, the Registrant’s assessment was contradictory, in that at one point it described the kitchen as tidy and accessible and yet at another it indicated that access to the kitchen and bathroom was made difficult by the presence of a mattress and armchair in the way.

64. RS said that the assessment did not contain a summary.

65. RS said that as the Registrant had recognised that Service User 2’s home environment was cluttered, she should have questioned whether the home was suitable for Service User 2 to walk safely around. The Registrant had recorded that there was a mattress on the floor near the doorway, but had not considered whether this could have made it difficult for Service User 2 to walk through. RS pointed out that the hospital environment is specialised for the needs of inpatients, and is not a cluttered environment. Assessing the needs of a service user in the hospital setting is very different from assessing them in their home environment. The Registrant needed to consider how her observations translated into a recommendation regarding where Service User 2 lived and whether the home environment was suitable. She needed to consider whether the home environment adequately supported the needs of Service User 2.

66. In his closing submissions, Mr Ferson invited the Panel to delete the words “regarding the relationship between the observations and the service user’s occupational needs” from the wording of particular 2(a)(ii). On that basis, and on the basis of the evidence provided by RS, the Panel found particular 2(a) proved in its entirety.

Particulars 2(b)(i), 2(b)(ii) and 2(b)(iii) – Not Proved

67. RS informed the Panel that on 24 July 2015, the Registrant completed an assessment involving the installation of a bath mat in Service User 2’s home. In her witness statement, RS stated that the Registrant did not explain why the bath mat was needed. Further, she did not indicate to Service User 2 the implications of using a bath mat.

68. In her oral evidence, however, RS accepted that she may have been overcritical in her analysis of this aspect of the Registrant’s work. She accepted that the use of a bath mat is self-evident, and that given the simplicity of the equipment she would not expect the assessment to contain much more than the Registrant had in fact provided.

69. The Panel therefore found particular 2(b) not proved on the basis of the evidence given by RS in the course of her oral evidence.

Particulars 2(c)(i) and 2(c)(ii) – Not Proved
Particular 2(c)(iii) – Proved

70. RS informed the Panel that on 17 August 2015, the Registrant recorded an observation of Service User 2 engaging in a colouring-in activity. RS said that the observation was very narrative and did not contain a proper analysis. There was no discussion of why the activity was being completed and what the implications of the activity were. She should have recorded why the activity was being completed; for example, whether this was something that Service User 2 was going to continue to complete at home. There was a lack of clinical reasoning concerning why this activity was being used as part of a treatment session, which meant that there was no rationale setting out what had been observed and how it would relate to Service User 2 engaging in a meaningful occupation moving forward.

71. In her oral evidence, RS accepted that she would not expect to see evidence of the matters particularised in particulars 2(c)(i) and 2(c)(ii).

72. In his closing submissions, Mr Ferson invited the Panel to delete the words “regarding the relationship between the observations and the service user’s occupational needs” from the wording of particular 2(c)(iii). On that basis, and on the basis of the evidence provided by RS, the Panel found particulars 2(c)(i) and 2(c)(ii) not proved, but 2(c)(iii) proved.

Particular 2(d) – Proved

73. RS informed the Panel that the record of the Care Plan for Service User 2 showed that between January and February 2015, the Registrant routinely accessed the Care Plan but did not record any new information, despite new developments taking place in Service User 2’s case, such as an Interests Checklist completed on 26 January 2015 and Service User 2’s discharge from Wotton Lawn on 10 February 2015. Following his re-admittance in June 2015, RS said that this information should also have resulted in the Care Plan being updated.

74. On the basis of this evidence, the Panel found particular 2(d) proved.

Particular 2(e) – No evidence offered

Particulars 3(a)(i), 3(a)(ii) and 3(a)(iii) – Proved

75. RS produced the Occupational Therapy records for Service User 3, which showed that the Registrant had recorded an observation that she had made of Service User 3 walking to a coffee shop at a neighbouring hospital on 5 February 2016. RS said that the record was inadequate, in that it did not detail the implications regarding Service User 3’s future treatment.

76. RS said that the record did not contain an intervention plan. As a result, the Registrant did not record what tasks Service User 3 could carry out independently in future, whether the Service User needed an Occupational Therapist to support him, and what steps should be put in place going forward.

77. RS said that there was no analysis of what the Registrant had observed and what the implications were for the future. RS said that, having reviewed the Registrant’s observation, it was RS’s view that Service User 3 was reasonably independent and there was a possibility that he would be safe living in the community. However, there was nothing contained in the observation giving consideration to this.

78. Mr Ferson invited the Panel to put a line through the words “adequate analysis and” in particular 3(a)(iii), because that part of the particular was duplicitous in light of the allegation made in particular 3(a)(i). On that basis, and the basis of the evidence set out above, the Panel found particular 3(a) proved in its entirety.

Particulars 3(b)(i) and 3(b)(ii) – Proved
Particular 3(b)(iii) – Not Proved

79. RS produced for the Panel a draft Occupational Therapy report that had been completed by the Registrant on 10 February 2016. RS informed the Panel that this had been reviewed by a Band 6 Occupational Therapist.

80. RS took the Panel to the report, which showed that the Registrant had used the wrong NHS Trust paperwork.

81. RS said that the report contained a very narrative summary. The reviewing Band 6 Occupational Therapist had recorded that the information recorded in ‘Food & Drink Preparation’, ‘Household and Cleaning Maintenance’ and ‘Finances’ sections was inaccurate. In the final section marked ‘Pattern of Occupational Lifestyle’, the Registrant recorded that Service User 3 needed support to organise his day with activities, but did not describe what this support was. As a result, the information that was contained within this report was not accurate and would not help inform another member of the Multi-Disciplinary Team what the future needs of this Service User would be. There was a lack of the clinical reasoning that was needed to translate the observations into an analysis of Service User 3’s needs.

82. The reviewing Band 6 Occupational Therapist had recorded that a number of ratings the Registrant had used in the ‘Summary of Occupational Profile’ table were inaccurate. The table is a summary of the scores from a MOHOST assessment and provides an overall assessment of a service user’s occupational performance and participation, and therefore highlights any areas where they may need support in order to improve or indicate future care needs.

83. In her oral evidence, RS said that there was scope for a difference of opinion and clinical judgement, but that the Band 6 Occupational Therapist had given reasons for his score whereas the Registrant had not. RS also said that she agreed with the conclusion reached by the Band 6 Occupational Therapist.

84. The Panel found particulars 3(b)(i) and 3(b)(ii) proved, but 3(b)(iii) not proved. The evidence of the Band 6 Occupational Therapist in relation to particulars 3(b)(i) and 3(b)(ii) was supported by the evidence of RS. However, the Panel gave less weight to the evidence provided by the Band 6 Occupational Therapist, as this was hearsay evidence, and in relation to 3(b)(iii) the Panel had not been provided with sufficient detail regarding his rationale in concluding that the report contained inaccurate ratings.

Particular 4(a) – Proved

85. RS produced the Occupational Therapy records for Service User 4, which included the Care Plan completed by the Registrant.

86. RS informed the Panel that on 19 November 2015, the Registrant recorded in the Care Plan that weekly reviews were to take place with Service User 4 to review and plan his activity programme. RS stated that this would have been appropriate, as most service users do not stay long in Wotton Lawn. She said that it is important that Care Plans are regularly reviewed and changed as clinically indicated in order to ensure that the purpose of occupational therapy is clear and the wider Occupational Therapy team and Multi-Disciplinary Team can gain a sense of progress being made against the planned care. However, there was no indication in the case notes that the Registrant had carried out weekly reviews of the needs of Service User 4.

87. On the basis of this evidence, the Panel concluded that as there was nothing in the notes to indicate that the weekly reviews had been carried out, that it was more likely than not that they had not been carried out, and, accordingly, the Panel found particular 4(a) proved.

Particular 4(b) – Not Proved

88. RS informed the Panel that the Registrant completed a kitchen assessment of Service User 4 on 23 November 2015, but did not create a new Care Plan or substantially amend the existing one; she merely recorded that the kitchen assessment had been completed. The Registrant recorded that Service User 4 was safe and independent in the kitchen and demonstrated an ability to support independent living. RS said that a new Care Plan should have been created or a decision made that this Service User no longer required Occupational Therapy.

89. The Panel concluded that the word “instead of” inferred a duty to develop a new Care Plan, whereas RS had only said that it was best practice to develop a new Care Plan rather than amending an existing one. The Panel concluded that the Registrant’s actions amounted to an amendment to the existing Care Plan. In those circumstances, the Panel was not satisfied that this particular had been proved to requisite standard, and the Panel found particular 4(b) not proved.

Particulars 4(c)(i), 4(c)(ii), 4(c)(iii) and 4(c)(iv) – Proved

90. RS informed the Panel that the Registrant completed an Occupational Therapy Report for Service User 4 on 7 December 2015. RS said that the analysis contained numerous statements about the Registrant’s observations but no indication of what the implications were, or what should then be done in order to help Service User 4 move to a position where he was no longer staying in hospital. RS said that for the same reasons, the report displayed a lack of clinical reasoning.

91. RS said that the report also lacked detail in terms of the environment Service User 4 was moving to. It recorded that Service User 4 had concerns about how he would be able to cope in this new environment and adapt to living away from his family. However, there was nothing about how Service User 4’s concerns would impact on his ability to live independently. RS said that one of the aims for Occupational Therapy when people leave hospital is that they are able to maintain their ability to live successfully in the community. If they are not supported appropriately in line with their needs, there is a high chance that their mental health will deteriorate again and they will be readmitted to hospital.

92. RS said that there was no intervention plan in the report. There was nothing to adequately inform someone reading it what had been assessed for Service User 4.

93. In his closing submissions, Mr Ferson clarified that he did not rely on the second part of particular 4(c)(iii), which specified a lack of detail about the relationship between the new environment and the service user’s occupational needs, because this was duplicitous with particular 4(c)(i), which referred to a lack of analysis. On that basis, and on the basis of the evidence summarised above, the Panel found particular 4(c) proved in its entirety.

Particular 5(a) – Proved

94. RS produced the Occupational Therapy records for Service User 5. RS took the Panel to an assessment completed on 18 November 2015, in which the Registrant recorded the Service User’s name incorrectly. RS surmised that another Service User’s notes had been recorded in Service User 5’s records.

95. The Panel found particular 5(a) proved on the basis that the Registrant had recorded an assessment which contained the wrong Service User’s name.

Particulars 5(b)(i) and 5(b)(ii) – Proved

96. RS informed that Panel that on 30 November 2015, the Registrant completed an assessment observation of Service User 5’s independent living skills by undertaking a cooking activity in the Occupational Therapy kitchen. In the observation, the Registrant described Service User 5 as “jumping” in the kitchen, being angry and making comments about his girlfriend being raped. RS said that there was no analysis of how Service User 5’s current mental health symptoms impacted on his ability to undertake the activity, nor of any deterioration in his condition. There was no recognition of methods that the Registrant or Service User 5 utilised to manage the situation; for example, in the form of detailing strategies that could be used to help Service User 5 refocus on the task, manage his level of distress or, alternatively, suggest revisiting the task at another time. There was no reference to how Service User 5’s presentation might impact on daily living tasks outside of the hospital or any consideration of the need for a reduction in his symptomology before discharge.

97. On the basis of this evidence, the Panel found particular 5(b) proved in its entirety.

Particular 5(c) – Proved

98. RS said that on 9 December 2015, the Registrant recorded a conversation with a doctor in which she was asked to provide a second opinion on Service User 5’s capacity to consent to his treatment. RS said that it is common for a doctor to ask a second opinion from a non-medical professional such as an Occupational Therapist. RS said that it is the responsibility of the Occupational Therapist to report how a service user presents during Occupational Therapy, what impact their current presentation is having on their functional ability, and any evidence of a person’s insight into their condition and how this impacts on their ability to consent towards treatment.

99. RS said that she would have expected the note to contain more information about what the Registrant had said, and the information recorded should have stated why this service user lacked or did not lack capacity.

100. On the basis of this evidence, the Panel found particular 5(c) proved.

Particulars 5(d)(i), 5(d)(ii) and 5(d)(iii) – Proved

101. RS informed the Panel that the Occupational Therapy record indicated that the Registrant took Service User 5 outside of the hospital grounds on 11 December 2015. RS said that whilst the Registrant recorded that Service User 5 was agitated and angry, she did not record whether this indicated a level of risk. The Registrant had recorded that Service User 5 walked out into the middle of the road, but she did not acknowledge that this was a risk to his safety.

102. RS said that there was nothing to indicate that the Registrant reported this information to the ward team so that it could be taken into account in Service User 5’s ongoing care and treatment.

103. RS said that the Registrant did not acknowledge that Service User 5’s behaviour indicated serious mental health concerns, the implications of which should have been reported to the ward because of potential risk to staff and other service users.

104. On the basis of this evidence, the Panel found particular 5(d) proved in its entirety.

Particular 6(a) – Proved

105. RS produced the Occupational Therapy records for Service User 6, in which the Registrant recorded an observation of Service User 6 walking outside the hospital to a coffee shop and to chapel on 20 November 2015. RS said that there was nothing in the observation that described the impact of this environment on Service User 6.

106. RS said that an observation conducted outside the hospital should discuss the environment and how this impacted on the Service User’s performance and ability to complete the task. This should then describe whether the Service User is able to function in a different environment outside the hospital. RS said that the Registrant referred to the fact that Service User 6 was distracted by the colour green, but did not elaborate any further, which she should have done.

107. On the basis of this evidence, the Panel found particular 6(a) proved.

Particulars 6(b)(i) and 6(b)(ii) – Proved

108. RS informed the Panel that the Registrant recorded an observation of Service User 6 walking in the hospital grounds on 23 November 2015. RS said that this observation was very narrative and lacked an analysis of how this activity could become a regular part of Service User 6’s routine. She said that the purpose of observing behaviour, such as during a walk in the hospital grounds, is to engage the Service User in something meaningful which can be incorporated into their routine in the future.

109. RS said that the observation recorded Service User 6’s intention to bring in a model kit. However, this was not expanded on and there was no analysis or comment of the potentially significant change in presentation that this evidenced. RS said that the ability to bring in a model kit demonstrated a degree of motivation. There was no analysis of Service User 6’s motivation to continue with this task in the future or how this related to the Service User’s occupational participation and performance.

110. On the basis of this evidence, the Panel found particular 6(b) proved in its entirety.

Particulars 6(c)(i) and 6(c)(ii) – Proved

111. RS said that the Registrant completed an observation of Service User 6 on 30 October 2015 with the stated aim of building rapport with him. RS said the Registrant recorded a section entitled ‘Process Skills’; however, there was nothing contained in it other than very minimal information. The Registrant discussed Service User 6’s communication skills and the fact that Service User 6 became anxious that he could not cooperate, which led RS to question whether his current mental health had an impact on his ability to engage in processes and recall information. However, this was not explored in the Registrant’s observation.

112. RS said there was no Occupational Therapy plan outlined at the end of the observation. RS said that it is important to build rapport; however, there was no plan setting out how the Registrant aimed to achieve this and what the ongoing intervention would be.

113. On the basis of this evidence, the Panel found particular 6(c) proved in its entirety.

Particular 6(d) – Proved

114. RS informed the Panel that the Registrant recorded a Discharge Summary for Service User 6 on 1 December 2015 which was very descriptive but did not contain substantial information regarding the implications of Service User 6 living independently in the future. It did not provide an overview of what Service User 6’s needs had been during his stay in hospital. For example, the Registrant recorded that Service User 6’s anxiety had impacted on his ability to meet the demands of routine occupations in the hospital, but there was no discussion of what this meant for Service User 6’s ability to cope at home. There was no description of the level of support Service User 6 would require in order to live independently.

115. RS said that a Discharge Summary should provide an overall picture of a service user’s occupational performance and participation, challenges on admission, the interventions undertaken with them, and the resultant level of ability on discharge. A poorly written Discharge Summary means that the information is not available to other Occupational Therapists or team members who must understand what the service user’s needs are and, if required, to support an application for funding for a care package. If this information is not accurate, it could result in a service user’s needs not being adequately met.

116. On the basis of this evidence, the Panel found particular 6(d) proved.

Particular 6(e) – Proved

117. RS produced the MOHOST assessment that the Registrant completed for Service User 6, which included a statement that he was observed to function better in his home environment than the hospital environment. However, the Registrant did not explore this further and why the home environment was more supportive. The Registrant recorded that Service User 6 had anxiety which impacted on his ability to manage in the hospital. However, RS said that a service user’s needs are often different in the home environment and the Registrant did not explore whether this anxiety could have been an issue for Service User 6 in the home environment, or what support could be put in place to address this.

118. On the basis of this evidence, the Panel found particular 6(e) proved.

Particulars 7(a)(i), 7(a)(ii) and 7(a)(iii) – Proved

119. RS produced the Occupational Therapy records for Service User 7, which showed that the Registrant completed an initial contact with Service User 7 on 10 May 2016. RS said that the aim of an initial contact is to begin to understand a service user’s circumstances and to assess the impact of their current illness on their occupational performance, as well as the action to be taken in response. The Registrant completed an initial contact for Service User 7 and gave some consideration to his needs, but did not consider what that meant or what should happen next. The analysis was therefore lacking.

120. RS said that the Registrant’s observation recorded that a further assessment would be needed. However, there was no indication provided of what further assessments might be required or when these would take place.

121. RS said that there was no intervention plan for this Service User.

122. On the basis of this evidence, the Panel found particular 7(b) proved in its entirety.

Particular 7(b) – No evidence offered

Particular 7(c) – Proved

123. RS informed the Panel that the Registrant completed an observation on Service User 7 on 18 May 2016. She said that when completing an entry to record an intervention on Care Pathway, there are a range of different reasons that an Occupational Therapist can input for the assessment being completed. In this instance, the Registrant recorded that one of the reasons was “re-motivation”. RS said that re-motivation is used when a service user has withdrawn from all activity and needs specialist support to re-engage in occupations. In this instance, Service User 7 had demonstrated a considerable degree of motivation by coming to a breakfast group and had completed the tasks required of him, demonstrating a level of independence in making choices. This did not fit with problems around motivation. RS said that it appeared that the Registrant had either made an error when completing the entry on Care Pathway, or had not understood the Service User’s condition, which had led to re-motivation being selected when that was not the issue.

124. On the basis of this evidence, the Panel found particular 7(c) proved.

Particulars 7(d)(i), 7(d)(ii) and 7(d)(iii) – Proved

125. RS informed the Panel that the Registrant completed an observation of Service User 7 playing the piano on 20 May 2016. The purpose of this was again listed by the Registrant as re-motivation, which RS said was incorrect given that Service User 7’s notes indicated he had been engaging frequently with Occupational Therapy and other individuals.

126. RS said that the Registrant’s observation again contained numerous descriptive statements of what she had observed but lacked any real clinical reasoning or analysis. She did not explore the implications of what she had seen, such as Service User 7 freely engaging with playing the piano, or Service User 7’s ability to conduct the activity independently. There was no consideration as to how this activity could be incorporated into Service User 7’s routine going forward, or what it implied for his ability to live independently in the future.

127. On the basis of this evidence, the Panel found particular 7(d) proved in its entirety.

Particulars 7(e)(i) and 7(e)(ii) – Proved

128. RS said that in an observation on 25 Mary 2016, the Registrant detailed a service user with a different name from Service User 7. She said that this entry appeared to have been made on the wrong service user’s file, as it differed in content to all the other notes.

129. On the basis that the Registrant had incorrectly recorded this observation, the Panel found particular 7(e) proved in its entirety.

Particular 7(f) – Proved

130. RS took the Panel to the Occupational Therapy records for Service User 7, which indicated that the Registrant had completed an Activity of Daily Living (ADL) assessment for Service User 7 on 27 May 2016. RS explained that an ADL assessment focuses on someone’s ability in daily living tasks so as to identify how their current illness or situation may impact on how they can complete these. On 27 May 2016, the Registrant assessed Service User 7’s ability to undertake a trip to a local supermarket. However, the records indicated that the same ADL assessment had been completed previously on 17 May 2016. RS said that another activity could have been chosen which would have provided better information to support Service User 7 living independently or, if there was a need for re-assessment, this should have been outlined and the areas of task performance which required further assessment identified.

131. On the basis of this evidence, the Panel found particular 7(f) proved.

Particular 7(g) - Proved

132. RS informed the Panel that the Registrant had entered an observation for a group session Service User 7 attended on 8 June 2016 and selected the purpose of the observation as re-motivation. RS said that this again appeared to be inappropriate, as Service User 7 was attending a group activity which indicated that he was motivated to engage with others.

133. On the basis of this evidence, the Panel found particular 7(g) proved.

Particulars 8(a) and 8(b) – Proved

134. HP produced a Care Plan completed by the Registrant on or around 16 April 2015 in relation to Service User 8. Service User 8 suffered from Deep Vein Thrombosis (DVT) and was not eating or drinking. HP said that the Registrant appeared pleased with this Care Plan, but HP had serious concerns about the proposals set out in it. This was because Service User 8’s major issues (extreme self-neglect, leg ulcers, DVT, and not eating or drinking) were not identified or reflected in the Care Plan, whereas these were the crucial occupational therapy needs.

135. HP said that the Care Plan should have focused on Service User 8’s self-care issues. The risks of DVT could have been addressed by Occupational Therapy staff, whilst the physiotherapists and nursing team could have encouraged mobilisation. The Care Plan should also have specified that Service User 8 would be encouraged to eat or drink each time she was seen by Occupational Therapy staff, as well as identifying the support which would be given to her to enable her to shower and wash. However, in her Care Plan the Registrant said that she would explore Service User 8’s routines, interests and would try to engage her in meaningful activity. HP said that this would be suitable for a service user presenting with depression who was mobilising but not engaging in activities they enjoy. However, it was wholly inappropriate for an inpatient in Service User 8’s condition, whose major issues needed to be reflected in the Care Plan.

136. On the basis of this evidence, the Panel found particular 8 proved in its entirety.

Particulars 9(a), 9(b)(i), 9(b)(ii), 9(b)(iii), 9(b)(iv), 9(b)(v), 9(c)(i), 9(c)(ii), 9(c)(iii) and 9(d) – Proved

137. RS said that when Occupational Therapy notes are entered onto the Trust’s electronic record system, RIO, they can be saved as incomplete to allow an Occupational Therapist to complete them. Once the notes are completed they should be validated, which is the equivalent of a signature. The Panel saw the relevant Trust policy, where it was clearly stated that validation of these notes is a requirement. The Panel was also told that there is a reminder to this effect on the screen.

138. RS said that if notes are not validated, they are not considered complete and therefore are not part of the formal record for that service user. If notes are unvalidated, information is not available to other team members. The level of care and service provided to a service user could suffer as a result, as the Occupational Therapy records would not include all the relevant information about them.

139. RS said that there were numerous examples for Service User 2, Service User 3, Service User 4 and Service User 5 where the Registrant had not validated her notes. As a result, these notes may not have been visible to other healthcare professionals and key information not available to other sections on the electronic case note system.

140. On the basis of this evidence, the Panel found Particular 9 proved in its entirety.

Decision on Grounds

141. The Panel accepted the advice of the Legal Assessor, who addressed it on the meaning of lack of competence, misconduct and impairment. She referred to the cases of Roylance v GMC (No 2) [2001] 1 AC 311 and Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Paula Grant [2011] EWHC 927.

142. The Panel first considered whether the facts found proved amounted to a lack of competence.

143. The Panel considered that it had been provided with a fair sample of the Registrant’s practice over a reasonable period of time, in that the material before it related to a timeframe stretching from March 2015 to February 2016 and comprised a total of eight service users and approximately 40 entries in the records made by the Registrant.

144. When considering whether the Registrant’s proficiency in practice had been found to be unacceptably low, the Panel judged the Registrant on the basis of her role as a Band 5 Occupational Therapist, which was defined in her job description: "Provide evidence based, occupational therapy assessment and intervention to optimise the service users' ability to engage with their environment in line with the principles of social inclusion and/or recovery".

145. The Registrant had been responsible for service users who were extremely vulnerable and often acutely unwell.

146. RS explained that when conducting observations and/or assessments with service users, an Occupational Therapist is required to analyse the reasons for the behaviour observed, the impact of them on a service user’s ability to function in the community, and the intervention needed to provide support. All the information should be properly recorded in clear, succinct and straightforward language within the service user’s records in order to enable other professionals to identify, and also work with, the recommendations of the Occupational Therapist. RS explained that analysis and subsequent Care Plans should conclude with an overall summary of the service user’s occupational needs and functions. In relation to the Service Users for whom the Registrant was the allocated Occupational Therapist, consideration should have been given to the Service Users’ return to the community. The Panel found that the Registrant failed in these regards.

147. RS made it clear that the need to conduct assessments and observations in the manner described was set out in the Registrant's job description. It formed part of the core set of competencies for Occupational Therapists, emphasised and underlined by the training the Registrant received at the Trust and reiterated in her weekly supervisions, and was fundamental to the work undertaken by Occupational Therapists in respect of service users in whatever capacity.

148. The Panel heard that the risk to service users of the Registrant's failures differed depending on the assessment or observation being carried out. Collectively, a failure to provide proper analyses and interventions may have left service users’ needs unidentified and therefore unsupported, which had the potential to cause a stagnation in their treatment and deterioration in their health. The incorrect recording of information had the potential to give an incomplete and potentially misleading picture of the service users’ progress and treatment whilst in the unit. Furthermore, the Registrant's failure to report information to other staff could have put them at risk, especially when dealing with individuals who presented as aggressive or erratic in their behaviour and could have put other service users at risk.

149. The Panel took account of the fact that although the Registrant worked in a challenging environment, she had a significantly reduced caseload and had been provided with a great deal of support and assistance. The Panel concluded that the Registrant had been unable to meet the standards required of her in her role throughout the relevant time. She had not managed to fulfil the fundamental responsibilities that she had towards her service users and colleagues. In the circumstances of the case, the Panel concluded that lack of competence had been made out.

150. In those circumstances, the Panel did not go on to consider the issue of misconduct.

Decision on Impairment

151. In considering whether the Registrant is currently impaired by reason of her lack of competence, the Panel accepted the advice of the Legal Assessor and took note of the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’”.

152. The Panel concluded that whilst the Registrant’s lack of competence was, in theory at least, capable of remediation, she had not in fact provided any evidence that she had remedied it. Within the timeframe of the allegation, she had been provided with continuous training and support and yet her performance remained below the acceptable level. The Panel had not been provided with any up-to-date material to suggest that the position was now different. She had provided the Panel with three references, but it did not appear that she had informed her referees of the existence of the current proceedings. She had provided material relating to her current employment as a support worker at a Specialist Rehabilitation Service for women with Personality Disorders; however, the Panel was unable to ascertain the extent to which that employment had any connection to the Registrant’s employment as an Occupational Therapist.

153. The Panel considered that the Registrant had demonstrated an alarming lack of insight. Both RS and HP had given evidence of the Registrant's inability to take on board the concerns that were raised with her practice and properly address those shortcomings. They described brief "sparks" of improvement in the long period she was supported. These were followed by a relapse into further sustained failures to properly carry out assessments in relation to service users. The Registrant’s lack of insight was apparent; for example, in relation to her dealings with Service User 8, who was highly vulnerable and acutely unwell. The Registrant completed a Care Plan which she presented to HP as a piece of work she was proud of but which, upon review, revealed a complete disconnect between the care which the Registrant had planned and the Service User’s needs. That lack of insight persisted despite the extensive support which the witnesses set out in detail. The compassion exhibited by both witnesses for the Registrant was clear in their oral evidence and they had made a great deal of effort to support the Registrant, which unfortunately appeared to have little real impact on her practice. There was no evidence that the Registrant recognised the effect that her shortcomings had on service users and colleagues.

154. The Panel had no hesitation in concluding that through the Registrant’s persistent failings in the past, the Registrant had presented a risk to the public, and further, that she would continue to present a risk to the public if she were to be allowed to return to unrestricted practice. The Panel therefore found the Registrant to be currently impaired on the basis of the personal component.

155. The Panel also concluded that through her persistent inability to reach the standards required of her, the Registrant had breached a fundamental tenet of her profession and that her continued poor practice in her dealings with vulnerable patients in an acute mental health unit had brought the profession into disrepute. It was the judgment of the Panel that public confidence in the profession and in the HCPC would be undermined if a finding of impairment were not made in the circumstances of the case.

156. The Panel therefore finds that the Registrant is currently impaired on both the personal and the public component.

Decision on Sanction

157. In reaching its decision on sanction, the Panel accepted the advice of the Legal Assessor and took into account the HCPC Indicative Sanctions Policy.

158. The Panel kept in mind that the purpose of sanction is not to be punitive, but is to protect members of the public, to maintain proper standards within the profession, and to uphold the reputation of the profession and its regulator.

159. In considering whether to make an Order, and the nature and duration of any order to be made, the Panel applied the principle of proportionality, weighing the Registrant’s interests against the need to protect the public and the wider public interest.

160. The Panel took into account both mitigating and aggravating factors.

161. The Panel concluded that the following were mitigating factors:

• The lack of any adverse findings made by any regulatory body;

• The sympathetic approach taken by the Registrant towards service users;

• The fact that the Registrant had engaged with the proceedings, albeit to a limited extent.

162. The Panel concluded that the following were aggravating factors:

• The risk of harm to highly vulnerable and acutely ill service users, and also colleagues;

• The persistent and repeated conduct;

• The Registrant’s lack of insight, remorse, or apology.

163. The Panel considered the sanctions available to it in ascending order of severity.

164. The Panel concluded that to take No Further Action or to impose a Caution Order would not be sufficient to protect the public, maintain confidence in the profession and maintain confidence in the regulatory process. It could not be said that the Registrant’s failings had been isolated, limited or minor in nature; to the contrary, the Panel had found that the failings had been persistent and there was high risk of recurrence. There had been no evidence of remediation placed before the Panel, and the Registrant’s insight appeared to be very limited.

165. The Panel then considered a Conditions of Practice Order, but concluded that this would be neither appropriate nor workable. The Panel concluded that the Registrant lacked insight, that there had been persistent and serious overall failings, and that she posed a risk of harm. She had not attended the hearing and the Panel could not be satisfied that the Registrant would abide by any conditions that the Panel might see fit to impose. In any event, the Registrant had already been provided with the equivalent of a Conditions of Practice Order in the course of her employment, to no effect.

166. In those circumstances, and because the Panel has found that the Registrant’s actions amounted only to a lack of competence and not misconduct, the only remaining sanction available to the Panel is suspension from the Register.

167. The Panel concluded that a period of 12 months’ suspension was appropriate and proportionate, and would give the Registrant sufficient time to attempt to address the shortcomings in her practice.

168. The Panel concluded that a future panel would be helped by:

• the Registrant’s attendance;

• evidence of insight;

• details of keeping her professional practice up to date;

• testimonials relating to current paid or unpaid work on the basis that those giving the reference can confirm that they are aware of these proceedings.

Order

That the Registrar is directed to suspend the registration of Mrs Victoria V Asirvatham for a period of 12 months from the date this order comes into effect.

Notes

This Order will be reviewed again before its expiry.

Hearing History

History of Hearings for Mrs Victoria V Asirvatham

Date Panel Hearing type Outcomes / Status
27/02/2020 Conduct and Competence Committee Review Hearing Hearing has not yet been held
20/02/2019 Conduct and Competence Committee Review Hearing Suspended
26/02/2018 Conduct and Competence Committee Final Hearing Suspended
04/10/2017 Conduct and Competence Committee Interim Order Review Interim Suspension
07/07/2017 Investigating committee Interim Order Review Interim Suspension