Mrs Victoria V Asirvatham

Profession: Occupational therapist

Registration Number: OT41405

Interim Order: Imposed on 14 Dec 2016

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 27/02/2020 End: 13:00 27/02/2020

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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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) Details of any discussion about the safe use of the equipment.
(iii) [Not proved]
 
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

Preliminary Matter

1. During the course of the Registrant’s submissions to the Panel she made reference to a number of personal matters that necessitated an application for them to be heard in private. There was no opposition to this course and the Panel granted leave for this part of the proceedings to be heard in private.

Background

1. The Registrant is a registered Occupational Therapist (OT). 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 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 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.

5. The Final Hearing panel decided that the appropriate and proportionate Order was a Suspension Order for a period of twelve months.

6. At the first review hearing, that panel found that the Registrant’s fitness to practise remained impaired and extended the period of suspension for a further twelve months.

7. In providing its reasons for this determination, the panel complimented the Registrant on her attendance at the hearing and took the view that she was enthusiastic and motivated in relation to her role as a support worker and her desire to return to practice as an OT. However, the panel also expressed its concern that the Registrant had not understood the seriousness of her lack of competence and said that she, during the course of her evidence, had failed to focus on the most serious findings made by the panel at the final hearing. Her level of insight, the panel added, was limited and it found no evidence that the Registrant had remediated her deficiencies to the full.

8. At today’s hearing, the Registrant provided a large number of documents which confirmed that she had been working successfully over the last year in her position as support worker, and had attended and completed relevant training, for example Assessment, Motor and Process Skills (AMPS) course. These papers included a reflective essay in which, amongst other things, she stated that she recognised that she still needs to improve “her care planning, setting goals, treatment planning and interventions”. She added that she needed to be supervised by an Occupational Therapist regularly in order to maintain the quality of work expected of a professional.

9. Also provided to the Panel were testimonials, including one from the Registrant’s supervisor which spoke well of her employment as a support worker and one from a nurse who has worked with the Registrant since November 2016 which attested to her compassion, honesty and empathy.

Decision

10. The Panel took all of the above matters into account, listened with care to the submissions made and paid due regard to the relevant HCPTS Practice Note. It accepted the advice of the Legal Assessor.

11. It is plain to the Panel that the Registrant has cooperated fully with the regulatory process and has done her upmost to provide this Panel with as much information as possible in relation to what has been happening to her over the past 12 months. The Panel commends her for this and recognises that she has gained further insight into her deficiencies – encapsulated by her recognition that, if permitted to return to work, she needs the supervision of a senior OT.

12. This fact, amongst others, persuades the Panel that her fitness to practise remains impaired on both public protection and public interest grounds. The Panel did give consideration to imposing a Suspension Order but felt this would be disproportionate in the circumstances. Her improvement in insight and remediation is such that, in the Panel’s judgement, the appropriate and proportionate order to impose is that of a Conditions of Practice order for a period of 18 months – this to take effect when the current order of suspension expires on 30 March 2020. The conditions are as follows:

 

Order

The Registrar is directed to annotate the HCPC Register to show that for 18 months from the date that this Order takes effect, you, Mrs Victoria V Asirvatham, must comply with the following conditions of practice:

1. Before undertaking work as an OT you must satisfactorily complete the HCPC return to practice requirements and forward confirmation of so doing to the HCPC.
2. You must place yourself and remain under the supervision of your workplace supervisor, registered by the HCPC or other appropriate statutory regulator and supply details of your supervisor to the HCPC within one month of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.
3. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
4. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).
5. You must meet with your supervisor on a monthly basis to formulate a personal development plan designed to address the deficiencies in the following areas of your practice:
 
I. Assessment observation
II. Clinical reasoning
III. Treatment planning and evaluation
 
6. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

7. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.
8. You must maintain a reflective practice profile detailing every occasion when you conduct assessment and observations, clinical reasoning, and treatment planning and must provide a copy of that profile to the HCPC on a monthly basis or confirm that there have been no such occasions in that period, the first profile or confirmation to be provided within one month of the Operative Date.

Notes

The Order imposed today will apply from 30 March 2020. 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 Conditions of Practice
20/02/2019 Conduct and Competence Committee Review Hearing Suspended
26/02/2018 Conduct and Competence Committee Final Hearing Suspended