Mrs Victoria V Asirvatham
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Allegation
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. Not proved.
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) Not proved.
(ii) Not proved.
(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) Not proved.
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. Not proved.
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
Background
1. The Registrant is a registered Occupational Therapist. On 8 December 2008, she was employed as a Band 5 Occupational Therapist by 2Gether NHS Foundation Trust (the Trust), which provides mental health and learning disability services. She was responsible for adult patients with severe and enduring mental illness.
2. From 2008 to 2009, the Registrant was employed in the Trust’s Older Person’s 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.
3. On 26 February 2018 to 2 March 2018 a Panel of the Conduct and Competence Committee considered an Allegation that the Registrant’s fitness to practise was impaired in relation to her responsibilities for eight separate service users over the period March 2015 to May 2016. The Registrant had failed in a wide range of areas of core occupational therapy skills including the adequacy of her assessments and observations, the adequacy of her clinical reasoning, failures to initiate or implement Care Plans, and failures in respect of her case notes. The difficulties persisted despite the support provided by the Registrant’s managers of a reduced caseload, a less complex case load and supervision.
4. The Final Hearing panel considered that the Registrant’s proficiency in practice was unacceptably low and constituted a lack of competence.
5. At the time of the Final Hearing, the Registrant was working as a Support Worker in a Specialist Rehabilitation Service for women with Personality Disorders. The information provided by the Registrant did not enable that panel to conclude that the Registrant had remedied the deficiencies in her practice. The Final Hearing panel also considered that the Registrant had demonstrated an alarming lack of insight. There was no evidence that the Registrant recognised the effect that her shortcomings had on service users and colleagues. In these circumstances, the Final Hearing panel concluded that the Registrant continued to present a risk to the public if she were to be allowed to return to unrestricted practice and that her fitness to practise was impaired.
6. The Final Hearing panel decided that the appropriate and proportionate Order was a Suspension Order for a period of twelve months. The Final Hearing panel indicated that a Review Panel would be assisted by the Registrant’s attendance, evidence of insight, details of keeping her professional practice up to date, and 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.
Decision
7. Ms Dyas submitted that the Registrant’s fitness to practise remains impaired and that the appropriate and proportionate Order was a continuation of the Suspension Order.
8. The Registrant submitted a large volume of documentation to the Panel. This included material relating to her employment as a Support Worker. She continues to be employed in that same position at a Specialist Rehabilitation Service for women with Personality Disorders. This documentation included positive testimonials from her managers and supervision notes. Although the Final Hearing panel specified that the testimonials should indicate that the referees were aware of the proceedings, this was not confirmed in any of the references provided.
9. The documentation also included information relating to the Registrant’s application for a role as an Occupational Therapy Assistant. She was unsuccessful in this application and received feedback on her application.
10. The Registrant provided training certificates from Cruse Bereavement Care. The Registrant was training to become a counsellor for Cruse, but has decided to put this training on hold while she focusses on her registration status. Her current position is that she works as a volunteer at Cruse.
11. The Registrant provided documentation relating to activities she has undertaken to keep her knowledge and skills up to date. She has recently been reading Occupational Therapy textbooks and she has started to prepare a reflective essay based on her reading. She provided examples of her use of a reflective learning tool applied to events that occurred during her work as a Support Worker. The Registrant has also made a booking to attend a specialist course on occupational therapy assessment.
12. The documentation also included the Registrant’s submissions in which she apologises that she put service users at risk due to her incompetence.
13. The Registrant gave evidence to the Panel. She answered questions from Ms Dyas and from the Panel.
14. The Registrant submitted that she wished to return to practise as an Occupational Therapist. She said that she recognised that she would need a period of support and supervision from a Band 6 Occupational Therapist.
15. The Panel first considered whether the Registrant’s fitness to practise remains impaired.
16. It is positive that the Registrant attended the hearing and that she is enthusiastic and motivated both in relation to her current role as a Support Worker and in relation to returning to practise as an Occupational Therapist. The Registrant explained that she enjoys her work at the Rehabilitation Unit and therefore she has not looked for employment as an Occupational Therapy Assistant elsewhere.
17. The Panel noted that the Registrant has expressed her regret in relation to her past lack of competence. However, the Panel was concerned that the Registrant did not demonstrate that she understood the seriousness of her lack of competence. It was serious because of the potential impact on service users and because it concerned the fundamental core skills of an Occupational Therapist. The Panel agreed with the submissions made by Ms Dyas that in her evidence the Registrant did not focus on the most serious findings made by the Final Hearing panel. The Registrant had not completed her reflective essay, which was the most important document for the Panel to assess her level of insight. The Panel was concerned that the Registrant has not focused on this issue given the finding made by the Final Hearing panel that the Registrant had demonstrated an alarming lack of insight.
18. The Panel was encouraged that the Registrant is engaging with the HCPC and that she has spent time and effort preparing for this hearing. However, the Panel took the view that the Registrant’s reflection on the findings made by the Final Hearing panel has been limited. The Panel recognises that it is not easy for the Registrant to look back to a time in her life which was difficult for her from a personal point of view. However, as a responsible professional, she needs to consider carefully the criticisms made by the Final Panel and develop a plan for remedying her deficiencies.
19. The Panel decided that the Registrant’s level of insight was limited.
20. In her preparation for this hearing the Registrant has focused on providing the Panel with a large volume of documentation relating to her current role. While this information provided the Panel with a picture of the Registrant’s responsibilities as a Support Worker, it did not demonstrate that the Registrant has remedied any of the deficiencies identified by the previous Panel.
21. Although the Registrant explained to the Panel that she has identified risks to service users in her current role and has been active in responding to the risks she identified, this did not address one of the key and persistent failures which was in the quality of her Occupational Therapy assessments of service users. There was no evidence that the Registrant has made attempts to use her current working environment to develop or improve her ability to properly assess service users and make appropriate plans. For example, she has not used any of her service users to develop case studies to demonstrate her own observations and planning. There was no evidence that she had discussed any case scenarios with her mentor or another Occupational Therapist.
22. The Registrant is well respected and well regarded in her current role which is positive, but the Panel did not find evidence that she has remediated the deficiencies identified by the previous Panel.
23. The Panel therefore concluded that there remains an ongoing risk of repetition and that the Registrant’s fitness to practise remains impaired.
24. The Panel next considered the appropriate Order, having regard to the HCPC Indicative Sanctions Policy. The Panel kept in mind that the purpose of a 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. The Panel applied the principle of proportionality and considered the sanctions available to it in ascending order of severity.
25. The Panel decided that to take no further action or to impose a Caution Order would not be sufficient to protect the public. The Panel has found that the Registrant continues to lack insight, professional knowledge and that there is an ongoing risk of repetition.
26. The Panel next considered the option of a Conditions of Practice Order. The Panel did not consider that the Registrant has made sufficient progress since the Final Hearing for this Panel to formulate conditions of practice which would be workable and sufficient to protect the public. In the Panel’s judgment, the Registrant would need to demonstrate the development of insight and progress towards remediating the deficiencies in her practise before conditions of practice would be appropriate. The Panel noted that the deficiencies cover fundamental Occupational Therapy skills and that the level of support provided by the Registrant’s previous managers had been insufficient to prevent a repetition of the same basic failings.
27. The Panel therefore decided that it was appropriate to continue the current Suspension Order. The Panel considered that the appropriate length of the extension was twelve months. In the Panel’s view, the process of remediation and providing evidence to the Panel was likely to take twelve months.
28. The Registrant has the right to the request an early review of the Suspension Order and she may decide to do so if she is able to make quicker progress than the Panel anticipates and is in a position to demonstrate to a Review Panel that she has developed insight and is making good progress in remediating the deficiencies in her practice.
29. The Panel concluded that a future review Panel would be helped by:
• evidence that the Registrant has developed her skills and knowledge of Occupational Therapy assessment and treatment planning and can apply these (e.g. by using case studies);
• a reflective statement based on the findings of the Final Hearing panel;
• evidence that the Registrant has kept her professional skills and knowledge 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
ORDER: The Registrar is directed to suspend the registration of Mrs Victoria V Asirvatham for a further period of 12 months on the expiry of the existing order.
Notes
This order will be reviewed again before its expiry on 30 March 2020.
Hearing History
History of Hearings for Mrs Victoria V Asirvatham
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 01/09/2022 | Conduct and Competence Committee | Review Hearing | Conditions of Practice |
| 03/09/2021 | Conduct and Competence Committee | Review Hearing | Conditions of Practice |
| 27/02/2020 | Conduct and Competence Committee | Review Hearing | Conditions of Practice |
| 20/02/2019 | Conduct and Competence Committee | Review Hearing | Suspended |