Ms Sarah Emma Cray

: Social worker

: SW04232

: Final Hearing

Date and Time of hearing:10:00 04/12/2017 End: 17:00 06/12/2017

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

: Conduct and Competence Committee
: Conditions of Practice

Allegation

Allegation (as amended at Substantive Hearing):

During your employment as a Social Worker with Nottingham City Council:


1. In regards to Service User 1, you were allocated the case on 8 June 2015 and you:
a) Facilitated the admittance of the service user to a new care home, but did not complete:
i. An Adult Social Care Assessment;
ii. Risk assessment; and/or
iii. An Adult at Risk Tool.
b) Did not review and/or visit the service user after their original admission.
c) Did not share any or any adequate information about this service user with the new care home.
d) Did not adequately consult with:
i. The service user’s Probation Officer;
ii. The Police; and/or
iii. The service user’s GP


2. In regards to Service User 2, you were allocated the case on 8 June 2015 and you:
a) Did not record information on Carefirst in a timely and/or appropriate manner.
b) Did not complete a support letter for the housing application in relation to Service User 2.
c) Did not consider and/or convene a multi-agency/professional meeting in regards to this service user.
d) Did not adequately complete appropriate risk assessment for this service user.
e) Did not complete a DASH form for this service user in a timely manner.


3. During 2015, in regards to Service User 3, you:
a) Did not promptly and/or adequately respond to concerns raised in relation to this service user on:
i. 10 March 2015 and/or
ii. 7 April 2015.
b) Did not record information on Carefirst in a timely and/or appropriate manner, including:
i. A meeting on 30 April 2015
ii. Telephone calls regarding new accommodation.
c) Did not adequately consult and/or liaise with the Police regarding a domestic abuse incident that had already been reported by this service user.
d) Did not adequately liaise with senior management with regards to concerns raised regarding this service user.
e) Did not adequately work in partnership with:
i. The service user;
ii. The service user’s carers; and/or
iii. The service user’s support worker.


4. The matters described in paragraphs 1-3 constitute misconduct and/or lack of competence.


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

Finding

Preliminary Matters

Proof of Service

1. On 11 September 2017, the HCPC sent notice of this hearing by first class post to the Registrant’s registered address. A copy of the notice was also sent on the same date by email. The notice contained the required particulars, including time, date and venue.

2. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied on the documentary evidence provided, that the Registrant had been given appropriate notice of this hearing in accordance with the Rules.

Proceeding in the absence of the Registrant


3. At the outset of the hearing, following the Panel’s finding that service of notice was in accordance with the Rules, Mr Ferson, Counsel appearing on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor, who advised that the discretion to proceed in a Registrant's absence should only be exercised with the utmost care and caution.

4. The Panel had regard to the chronology of events set out by Mr Ferson. On 16 January 2017, a Panel of the Investigating Committee had met and determined that there was a case to answer. The Registrant had sent representations to be considered by that Panel. On 7 April 2017, an amended notice of allegation was sent to the Registrant. On 31 August 2017, the Registrant sent an email to the HCPC attaching the completed pre-hearing information response form. In that form, the Registrant had indicated that she would not be attending in person, due to having no union representative, and not being able to afford legal representation.

5. On 11 September 2017, the notice of hearing was sent to the Registrant and on 16 October she was sent the witness statements and exhibits bundles for the substantive hearing. On 24 October 2017, the Registrant sent back the pro-forma response form, indicating that she would not be attending, indicating the same reasons as given on 31 August 2017. On 28 October 2017, the Registrant sent an email attaching her written responses to the particulars, having received and reviewed the documents on which the HCPC intended to rely. At the head of her written responses, the Registrant had again indicated that she would not be attending the hearing, stating:

“I am providing this written statement as I will not be attending the hearing on the above dates. I am willing to continue to fully cooperate with the HCPC in this matter but unwilling to attend in person as I unfortunately do not have full union representation and am unable to afford legal representation for this matter at the current time and do not feel comfortable attending without proper representation.”


6. Mr Ferson confirmed that there was no indication within the communications between the HCPC and the Registrant that participation in the hearing by any other means, for example by way of telephone, had been canvassed with the Registrant.

7. In the circumstances, the Panel was of the view that the Registrant had engaged with the HCPC by responding to communications and providing written responses. It was of the view that it was unfortunate that the HCPC had not canvassed with the Registrant whether she would wish to participate by other means, and asked that efforts be made that morning to make such inquiries. In the first instance, it put the matter back until 12 noon, to give the Registrant a reasonable opportunity to respond.

8. By 12 noon, no response had been received from the Registrant. The Panel, having been satisfied that the notice had been served in accordance with the Rules, and that the Registrant was aware of today’s (4 December 2017) hearing, was of the view that further reasonable efforts had been made to allow the Registrant to participate in the hearing. It was mindful that a witness was in attendance to give evidence on behalf of the HCPC.

9. In all the circumstances, the Panel was satisfied that it would not be unfair to the Registrant to proceed in her absence with the fact finding and, if relevant, the statutory ground stages, given that it had her written representations and that it had caused further reasonable inquiries to be made before proceeding.

10. During the course of the fact finding stage, the Hearings Officer received an email from the Registrant stating the following:

“Thank you for your contact. I am actually working all week so unavailable for telephone attendance. If the panel have any specific queries they need me to clarify I will do my best to respond to any messages but have provided a comprehensive statement in advance for them as I knew I would not be attending.”

As a result, the Panel made no decision at the outset of the hearing as to whether or not it would proceed in the Registrant’s absence, if the Impairment stage were reached.

Application to amend the Allegation


11. Mr Ferson, applied to make a number of amendments to the particulars. He submitted that the entirety of the proposed amendments did not affect the gravamen of the allegation, and that the written representations received from the Registrant on 28 October 2017, appeared to direct their responses to the particulars in the proposed form and did not raise any objections to them. He explained that the HCPC proposed to offer no evidence in respect of original particulars 1(c), 1(e) and 1(g), as the anticipated evidence did not support those particulars. He submitted that a number of the proposed amendments sought to add the term ‘adequately’, which would reflect the anticipated evidence, that while it was acknowledged that some actions had been undertaken by the Registrant, it was the HCPC’s position that they were not adequate in the circumstances.

12. The Panel heard and accepted the advice of the Legal Assessor.

13. The Panel decided to allow the amendments in their entirety. It was of the view that they did not materially change the nature of the allegation against the Registrant, and did not affect the seriousness of the case that she was facing. It considered that she would not be prejudiced by the proposed amendments, given that she had been informed of the proposed amendments by letter in April 2017, and had addressed her responses to the proposed amendments, not raising any objection to them.

Background


14. The Registrant is a Social Worker registered with the HCPC. At the relevant time, she was employed as a Social Worker by Nottingham City Council (the Council) in the Safeguarding Team within Adult Social Care.

15. The Registrant’s permanent employment with the Council began in December 2009 in the Older Persons Community Team. Following a departmental restructure, the Registrant joined the Safeguarding Team (the Team) in 2012. The Safeguarding Team’s role was to receive referrals regarding possible abuse committed against vulnerable adults. A Social Worker would be assigned to each referral and would be responsible for investigating further and, if necessary, commencing a safeguarding intervention.

16. The Council used an electronic case management system for storing records. This system was called Care First. The expectation was that Care First should be updated promptly by social workers to record the actions taken on each service user’s case.

17. Service User 1 was referred to the Team on 27 May 2017, in relation to an alleged assault she had suffered, committed by a resident at Studio House, where she was staying on a short term placement. Studio House was an alcohol rehabilitation centre. It was felt that Service User 1 required a higher level of support than was available there. As well as alcohol misuse, Service User 1 was diagnosed with ‘Korsakoffs’, a form a dementia caused by alcohol misuse or excessive consumption of alcohol.

18. The referral was initially allocated to BO, a Social Worker within the Team, who carried out the initial gathering of information and assessment of mental capacity. On 3 June 2015, BO went on compassionate leave and Service User A’s case was subsequently allocated to the Registrant on 8 June 2015.

19. Hatzfield House had been identified as being suitable for Service User 1’s needs in the longer term, as it provided care and support for residents to live semi-independently. The Registrant completed a care and support plan for semi-independent living and submitted it to a panel of managers for approval. On 4 August 2015, the request was approved and Service User was admitted to Hatzfield House on a long term basis on 6 August 2015.

20. The allegations against the Registrant in respect of Service User 1 are that:

• She facilitated the admittance of Service User 1 to Hatzfield House, but did not complete an adult care assessment, risk assessments or an Adult at Risk Tool;

• She did not review or visit Service User 1 after the original admission;

• She did not share any or adequate information about Service User 1 with the new care home; and

• She did not adequately consult with Service User 1’s Probation Officer, the Police or her GP.

21. Service User 2 was an elderly woman who was experiencing alleged domestic abuse from her husband. She had deteriorating health and memory loss due to Alzheimer’s disease. Care was being provided to Service User 2 by a home care agency. On 8 June 2015, the home care agency referred the husband’s obstructive behaviour and verbal abuse of Service User 2 to the Team, and the case was allocated to the Registrant on that date.

22. Service User 2 and her daughter wanted to find alternative accommodation for Service User 2, so that she could move away from her husband and his alleged abusive behaviour. The Care First records for 8 June 2015 document that Service User 2’s daughter was in the process of applying for a council bungalow and needed a supporting letter from the Social Worker. Entries for 16 June 2015 indicated that the daughter had submitted the housing application, and that the Registrant would provide a supporting letter on her return from annual leave. There are no entries on Care First between 17 June 2015 and 10 August 2015. On 14 October 2015, Service User 2’s daughter submitted a letter of complaint about the lack of intervention and assistance received from the Registrant in Service User 2’s case.

23. The allegations against the Registrant in respect of Service User 2 are that the Registrant:

• Did not record information in Care First in a timely or appropriate manner;

• Did not complete a supporting letter for the housing application;

• Did not consider or convene a multi agency/professional meeting;

• Did not adequately complete appropriate risk assessments; and

• Did not complete a DASH (Domestic Abuse, Stalking and Harassment) form in a timely manner.

24. Service User 3 had autism and was vulnerable to social and physical abuse and exploitation by others she formed relationships with. Service User 3 was a case originally allocated to the Registrant as a ‘Deputyship’ case, which meant she needed support around the management of her finances. A telephone call was received on 10 March 2015 from Service User 3’s support worker at Metropolitan Housing, an agency providing housing for people with mental health needs. Care First records show that Service User 3 had disclosed to the support worker that her partner, an alcoholic, could get angry and had been both physically and verbally abusive, and that the matter had been referred to they police. On 7 April 2017, there is a further entry in Care First of a telephone call from Service User 3’s father, stating that Service User 3 is going to be issued with an eviction notice.

25. The allegations against the Registrant in respect of Service User 3 are that the Registrant:

• Did not promptly and/or adequately respond to concerns raised on 10 March 2015 and 7 April 2015;

• Did not record information on Care First in a timely or appropriate manner in respect of a meeting on 20 April 2015 and telephone calls regarding new accommodation;

• Did not adequately consult or liaise with Police regarding a domestic abuse incident;

• Did not adequately liaise with senior management with regards to concerns raised regarding Service User 3; and

• Did not adequately work in partnership with Service User 3 herself, or her parents or her support worker.

Decision on Facts


26. On behalf of the HCPC, the Panel heard evidence from PC, the Investigating Officer. The Panel was also provided with a documentary exhibits bundle, which included:

• PC’s Investigation Report and relevant accompanying appendices;
• Summaries of the investigative interview with the Registrant;
• Witness statements taken by PC during the course of her investigation  from JP (Registered Manager Hatzfield House), BO (Initial Social Worker allocated to Service User 1), IM (A Team Manager in the Safeguarding Team with a role including the supervision of senior practitioners) , CB (Senior Social Work Practitioner and supervisor of the Registrant) and AF (Senior Community Care Officer within the Adult Social Care Training and Development Team);
• Copies of the Care First electronic case files for Service User 1, Service User 2 and Service User 3;
• Copies of relevant forms completed in respect of the service users.

27. On behalf of the Registrant, the Panel was provided with her representations prepared for the Investigating Committee Panel, together with those prepared for the substantive hearing.

28. The Panel heard and accepted the advice of the Legal Assessor. In respect of the facts, the Panel understood that the burden of proving each individual fact is on the HCPC and that the HCPC will only be able to prove a particular fact if it satisfies the required standard of proof: namely the civil standard, whereby it is more likely than not that the alleged incident occurred.

29. The Panel recognised that PC, as the Investigating Officer, did not have first hand knowledge of the matters alleged and her evidence derived from the Care First records, in respect of Service Users 1, 2 and 3, and statements taken from other members of staff. In respect of PC’s evidence, the Panel found her to be a credible witness with a good depth of knowledge. She fairly conceded points, which were not supported by the documentary evidence and she would not speculate on areas which she had not investigated, or on which she had no knowledge. The Panel had the benefit of having copies of documentary evidence gathered, and noted PC’s evidence was consistent with the documentation.

30. The Registrant did not attend, but the Panel did not hold her non attendance against her. It had regard to her recorded responses in the investigatory interviews, as well has her written representations in respect of the allegation. Although the Panel was mindful that these responses had not been given on oath, or tested by questioning, the Panel noted that her responses included accepting a number of the factual particulars.

Particular 1
In regards to service user 1, you were allocated the case on 8 June 2015 and you:
a) facilitated the admittance of the service user to a new care home, but did not complete:
i. an Adult Social Care Assessment;

31. The Panel finds particular 1(a)(i) proved.

32. The Panel was satisfied that the Registrant had facilitated Service User 1’s admission to Hatzfield House. She had completed a care and support plan for semi-independent living and submitted it to a panel of managers for approval. On 4 August 2015 the request was approved and Service User 1 was admitted to Hatzfield House on a long term basis on 6 August 2015.

33. PC explained that an adult social care assessment is an in depth analysis of a service user’s care needs, which identifies a number of desired outcomes in a service user’s case and sets out plans and actions to be taken to achieve these. She said that the Registrant had completed a number of documents in respect of Service User 1, indicating that the Registrant had given some thought to Service User 1’s care needs and personal circumstances. However, the Care First records showed that no adult social care assessment was completed prior to Service User 1’s admittance to Hatzfield House. She said that such an assessment was important for the safeguarding of Service User 1 due to the complex needs and behavioural issues present in the case.

34. The Registrant in her representations said: ‘I acknowledge that a full assessment of needs and risks was not completed for Service User 1 and that this was an oversight on my part which had potentially serious consequences for both Service User 1 and the care home’.

35. The Panel had regard to the evidence of PC, as well as the admission by the Registrant. It was satisfied that the Registrant had not completed an Adult Social Care Assessment.

Particular 1
a) facilitated the admittance of the service user to a new care home, but did not complete:
ii. Risk assessment;

36. The Panel finds particular 1(a)(ii) proved.

37. PC explained that a risk assessment: “identifies challenging or alarming issues present in a service user’s case which have the potential to cause harm to the service user and the people around them”. She said that the Care First records showed that no risk assessment was completed prior to Service User 1’s admittance to Hatzfield House.

38. The Registrant in her representations said: “I acknowledge that a full assessment of needs and risks was not completed for Service User 1 and that this was an oversight on my part which had potentially serious consequences for both Service User 1 and the care home”.

39. The Panel had regard to the evidence of PC, as well as the admission by the Registrant. It was satisfied that the Registrant had not completed a Risk Assessment.

Particular 1
a) facilitated the admittance of the service user to a new care home, but did not complete:
iii. An Adult at Risk Tool.

40. The Panel finds particular 1(a)(iii) proved.

41. PC explained that an Adult at Risk Tool (ART) was an extension of a risk assessment, being a standalone assessment that provides a more detailed analysis of the risks and contains a care plan at the end, which is given to both the service user and the care provider. She said that as the issues in Service User 1’s case would have identified a number of risks present, then it would be standard practice to complete an ART. This could then have been provided to Hatzfield House and allowed them to make an informed decision on Service User 1’s care needs.

42. The Registrant in her representations partially admitted this particular. She said: “It was not general practice within the team at the time to complete this form for all safeguarding cases…On reflection I can see that this would have been very beneficial in this case and should have formed part of a complete assessment and would certainly complete this in the future”.

43. The Panel had regard to the evidence of PC, as well as the admission by the Registrant. It was satisfied that the Registrant had not completed an Adult at Risk Tool.

Particular 1
b) Did not review and/or visit the service user after the initial admission.

44. The Panel finds particular 1(b) proved.

45. PC said that the Registrant should have visited Service User 1 after her admission to Hatzfield House, to check how she was settling into her new home. She said that this would be standard procedure in most instances where a service user is placed in new accommodation. A telephone to the service may have been an acceptable alternative. A review of the placement was also required after six to eight weeks. PC said that there was not record of any contact being maintained by the Registrant with either Service User 1 or Hatzfield House following Service User 1’s placement there.

46. The Registrant in her representations accepted that she had not reviewed or visited Service User 1, and giving the reason for that as mistakenly assuming that the review of Service User 1 would be undertaken by the new authority as the new care home was in another local authority’s area. She went on to explain that she recognised that this was a mistake and that she should have done more to ensure that the new authority were completing this and had all the necessary information to do so. PC made clear that the responsibility for the review lay with the Registrant and not the receiving authority.

47. The Panel had regard to the evidence of PC, as well as the admission by the Registrant. It was satisfied that the Registrant had neither reviewed nor visited Service User 1, following her placement.

Particular 1
c) Did not share any or any adequate information about this service user with the new care home.

48. The Panel finds particular 1(c) proved to the extent that the Registrant did not share adequate information.

49. PC explained that initially, JP, the manager of Hatzfield House, had said she had not received a completed Hatzfield House Referral Form. During the course of PC’s investigation, it was discovered that the Registrant had sent an email to JP attaching the completed referral form on 29 July 2015, but JP had not received it as it had gone into her junk mail. PC said that she reviewed the referral form, and it briefly mentioned Service User 1’s mental health issues, previous alcohol abuse, previous threats made, fire safety risks and previous allegation of sexual assault. However, she said that the issues were too briefly stated to constitute adequate disclosure of information, and did not cover Service User 1’s vulnerability moving to a new home or the risks she could pose to others.

50. The Registrant in her representations said that she had completed some assessment paperwork in the case, including the Citizen’s Report Plan and Care Support Plan, as well as the referral questionnaire.

51. The Panel acknowledged that the Registrant had shared some information with the care home, in the form of the emailed referral questionnaire. It also recognised that her recollection that she had spoken to the care home manager was borne out by JP’s comment that she had been called by the Registrant. However, there was no record in Care First to suggest that the the Citizen’s Support Plan and Care Support Plan paperwork completed by the Registrant, had been shared with the care home. 

52. The Panel accepted the evidence of PC, and was satisfied that the information which the Registrant had shared with the care home was inadequate, as it did not enable the home to properly decide if it could meet the needs of Service User 1 and address risks.

Particular 1
d) Did not adequately consult with:
i. The service user’s Probation Officer;
ii. The Police; and/or
iii. The service user’s GP.

53. The Panel finds particulars 1(d)(i), (ii) and (iii) proved.

54. PC explained that liaisons with other professionals such as GP’s, probation officers and the Police are a standard part of any safeguarding intervention, and that the Registrant would have had training on this. In relation to Service User 1’s Probation officer and GP, PC said that they would have held lots of information regarding Service User 1. In relation to the Police, PC said that they should have been contacted regarding the alleged sexual assault that Service User 1 had suffered. PC’s evidence was that the Registrant had not contacted Service User 1’s Probation Officer. She had previously contacted the GP, but this was limited to Service User 1’s capacity to manage her finances. She had contacted the Police, but this was not until 25 August 2015, when the decision had been made not to pursue the matter further.

55. The Registrant in her representations said that she accepted that there should have been fuller consultation on this case and that there should have been consultation with Service User 1’s Probation Officer. She recognised that in hindsight a more thorough consultation was required for the safeguarding of Service User 1 and that she would ensure that she would do this in the future. 

56. The Panel had regard to the evidence of PC as well as the acceptance of the Registrant and was satisfied that the Registrant had not liaised adequately with the Probation Officer, the Police or the GP in respect of Service User 1.

Particular 2
In regards to Service User 2, you were allocated the case on 8 June 2015 and you:
a) Did not record information on CareFirst in a timely and/or appropriate manner
.

57. The Panel finds particular 2(a) proved.

58. PC had interviewed the Registrant as part of her investigation 25 January 2016. During that interview, the Registrant identified three conversation which she had regarding Service User 2’s case, but which she had not documented on Care First, namely:

a. 30 June 2015, a message from Service User 2’s daughter saying she had been unsuccessful on the bid for the bungalow and was unhappy more had not been done to support the housing application;

b. A telephone call, made straightaway to a David at Gedling Housing; and

c.  A conversation to a second lady at Gedling Housing.

59. PC explained that none of these conversations was recorded in Care First. She explained that not recording information promptly could potentially lead to inappropriate actions being taken by Social Services.

60. The Registrant in her representations accepted that she did not record these conversations with housing on Care First, but said that she felt that was a failure on her part to record, rather than to act.

61. The Panel had regard to the evidence of PC as well as the acceptance of the Registrant and was satisfied that the Registrant had not recorded the information on Care First.

Particular 2
b) Did not complete a support letter for the housing application in relation to Service User 2.

62. The Panel finds particular 2(b) proved.

63. The Panel was satisfied that the Care First entries by the Registrant for 16 June 2015 confirmed that Service User 2’s daughter had completed a housing application and that the Registrant would provide a letter in support, on her return from annual leave, which was from 17 to 29 June 2015. It was also satisfied that there were no entries made by the Registrant within Care First between 17 June 2015 and 12 August 2015, when there was an entry to the effect that the housing application had been rejected.

64. The Registrant in her investigation interview and her representations accepted that she did not complete a supporting letter for the housing application, but explaining that the reason for this was that the information that she had received from the housing department was that they would be processing Service User 2’s application by the ‘homelessness’ route and therefore a supporting letter was not required. There was no evidence to support this assertion.

65. The Panel was satisfied that the Registrant had not provided a supporting letter to accompany the housing application submitted by Service User 2’s daughter.

Particular 2
c) Did not consider and/or convene a multi-agency/professional meting in regards to this service user.

66. The Panel finds particular 2(c) proved.

67. PC explained that a multi-professional meeting would have brought together all of the professionals involved in Service User 2’s care and could have helped provide a way forward to help her exit the relationship with her husband. She said that such a meeting was an expectation rather than an obligation.

68. The Registrant in her representations accepted that she had not considered or convened a multi-agency meeting, but attributed this to one not being requested by Service User 2’s daughter, or a senior manager.

69. The Panel was satisfied that the Registrant had neither considered nor convened a multi-agency meeting for the professionals involved in Service User 2’s care.

Particular 2
d) Did not adequately complete appropriate risk assessments for this service user.

70. The Panel finds particular 2(d) proved.

71. The Registrant accepted that she had not undertaken an assessment of risk tool as she considered that Service User 2 moving would address the risk. However, she did not consider the time this would take and the risks in Service User 2 remaining in her home with the alleged perpetrator. PC accepted that the Registrant had completed a DASH (Domestic Abuse, Stalking and Harassment) but there was a lack of information within this to consider and address the risk.

72. The Registrant in her representations referred to not utilising an assessment of risk tool, which she said was a relatively new form within the department.

73. The Panel was satisfied that the Registrant did not adequately complete appropriate risk assessments, and those forms which she did complete, did not have sufficient information to constitute adequate risk assessments.

Particular 2
e) Did not complete a DASH form for this service user in a timely manner.

74. The Panel finds particular 2(e) proved.

75. PC said that the initial referral was received on 8 June 2015, and the first visit by the Registrant to Service User 2 was on 15 June 2015, but the DASH form was not completed until the Registrant’s second visit to Service User 2 on 14 September 2015. PC accepted that if the Registrant’s focus on that first visit had been on other issues, then it would have been acceptable not to complete the DASH form at that first visit, however, it should have been re-visited a few days later. 

76. The Registrant in her representations fully accepted that the DASH form should have been completed earlier, at her initial visit.

77. The Panel was satisfied that the Registrant had not completed the DASH form until her second visit on 14 September 2015, and that this was not in a timely manner, being some 3 months after the issues raised in the initial referral.

Particular 3
During 2015, in regards to Service User 3, you:
a) Did not promptly and/or adequately respond to concerns raised in relation to this service user on:
i. 10 March 2015 and/or
ii. 7 April 2015.

78. The Panel finds particulars 3(a)(i) and 3(a)(ii) proved.

79. The Panel had regard to the entries in the Care First records by the Registrant. The first was for 10 March 2015, in which she had recorded that a telephone call was received from Service User 3’s support worker at Metropolitan Housing, an agency providing housing for people with mental health needs. The support worker advised that Service User 3 had made disclosures to her about her partner, to the effect that he could get angry, was an alcoholic and had been both verbally and physically abusive and that the matter had been referred to the Police. The next entry was for 7 April 2015, in which the Registrant had recorded that Service User 3’s father had telephoned, requesting a meeting as Service User 3 was about to be served with an eviction notice.

80. PC explained that no further action was recorded on Care First as having taken place in respect of either telephone call.               

81. The Registrant in her representations explained that Service User 3’s support worker was due to visit Service User 3 on 13 March 2015, a day when the Registrant was unable to attend due to her part time working pattern. She said she recalled contacting the support worker the following week and being told that no further support was required at the time as Service User 3 was having no further contact with the alleged perpetrator and no action taken by the Police. There was no record of this discussion.

82. The Panel was satisfied from the evidence of PC, that it was the Registrant’s responsibility to respond to the concerns, which had been raised on both 10 March 2015 and 7 April 2015, and leaving the matter to the support worker with a follow up phone call the week after, was not an adequate response in the circumstances.

Particular 3
b) Did not record information on CareFirst in a timely and/or appropriate manner, including:
i. A meeting on 20 April 2015
ii. Telephone calls regarding new accommodation.

83. The Panel finds particulars 3(b)(i) and 3(b)(ii) proved.

84. The Registrant’s electronic diary showed that a meeting was scheduled for 20 April 2015. PC explained that during the formal investigation she had contacted the father of Service User 3 to ascertain whether or not that meeting had taken place. She had been able to confirm with the father that it had.

85. The Registrant in her representations said that she could not recall the circumstances as to why there had been no recording due to the time that had subsequently elapsed, but acknowledging the importance of accurate and timely record keeping. 

86. The Panel was satisfied that the only two entries relating to Service User 3, recorded by the Registrant in the Care First records were the entries relating to the phone calls received on 10 March 2015 and 7 April 2015. It was, therefore satisfied that the Registrant had not recorded any details of the meeting of the 20 April 2015 or any telephone calls in respect of new accommodation on Care First.

Particular 3
c) Did not adequately consult and/or liaise with the Police regarding a domestic abuse incident that had already been reported by this service user.

87. The Panel finds particular 3(c) proved.

88. PC explained that the Registrant should have liaised with the Police so that she could have acted as an advocate on Service User 3’s behalf and gain an understanding of what the Police intended to do with the information.

89. The Registrant in her representations said that she relied on the support worker telling her that the Police were taking no further action. The Registrant accepted that she should have confirmed the incident with the Police directly, and would certainly do so in future cases.

90. The Panel was satisfied that he Registrant did not adequately liaise with or consult with the Police in respect of the alleged domestic abuse incident which had been reported to them.

Particular 3
d) Did not adequately liaise with senior management with regards to concerns raised regarding this service user.

91. The Panel finds particular 3(d) proved.

92. PC confirmed that there was no record within Care First to indicate that the Registrant had liaised with senior management to discuss the concerns.

93. The Registrant in her representations said that she felt it likely that she did have at least some informal discussions with senior management, as that would be her usual practice, and she accepted that there was no record of this.

94. The Panel was satisfied that even if the Registrant did have informal discussions, this was not adequate, as adequate liaison with senior management would have involved recording such discussions within the service user’s records.

Particular 3
e) Did not adequately work in partnership with:
i. The Service User;
ii. The Service User’s carers; and/or
iii. The Service User’s support worker.

95. The Panel finds particulars 3(e)(i), 3(e)(ii) and 3(e)(iii) proved.

96. The Panel understood the HCPC case in respect of Service User 3’s carers to refer to her parents. PC said that in her investigation, when she had contacted Service User 3’s father he had said that nothing had happened following the meeting that he and his wife had had with the Registrant on 20 April 2015.

97. The Registrant in her representations accepted that there should have been more and better communication with Service User 3, her carers and support worker in this case. She further accepted that this fell short of the standards that she would expect of herself and that the HCPC would rightly expect of her.

98. The Panel was satisfied that the Registrant had not worked adequately in partnership with either Service User 3 herself, her parents or her support worker.

Decision on Grounds


99. The Panel next considered whether the matters found proved as set out above, amounted to misconduct and/or lack of competence. The Panel heard and accepted the advice of the Legal Assessor. The Panel was aware that any findings of lack of competence and/or misconduct were matters for the independent judgement of the Panel.

100. The Panel did not consider that the three service users, the subject of the factual particulars, represented a fair sample of the Registrant’s practice, such as to demonstrate a lack of competence on the Registrant’s part. The Panel, therefore, considered the statutory ground of misconduct in respect of each service user.

101. The Panel considered that the Registrant was an experienced Social Worker. She had worked as a Social Worker at the Council since 2009, and had been deployed in the Safeguarding Team for three years. The facts found proved represent three service users for whom she was responsible in that time. All three were highly vulnerable, presenting with complex needs and in crisis, having been allocated to her as a result of alleged sexual, psychological and physical abuse perpetrated against them.

102. The Registrant had received relevant training for her role on the Safeguarding Team, including in Safeguarding and Investigations. In the Panel’s judgement, the facts found proved amounted to failings on the part of the Registrant, in that she had failed to discharge her professional obligation as a Social Worker to carry out appropriate risk assessments in order to address safeguarding needs.

103. In respect of Service User 1, the Panel considered that the Registrant’s actions and omissions were serious and fell far below the standards to be expected of a Social Worker. The lack of an Adult Social Care Assessment and Risk Assessment meant that while some of her needs were identified, proper care plans were not put in place to address them. The lack of information passed on to Hatzfield House hindered their ability to provide effective care and support to Service User 1 once she had been placed with them.

104. In the Panel’s judgment, the failings of the Registrant had a direct impact on Service User 1. The lack of information to Hatzfield House meant that they were not sufficiently prepared to meet Service User 1’s complex needs and contributed to the deterioration of the placement, to the extent that Service User 1 was given notice to leave. These failings in respect of Service User 1 were serious and amounted to misconduct.

105. In respect of Service User 2, the Panel considered that the Registrant’s actions and omissions were serious and fell far below the standards to be expected of a Social Worker. Service User 2 was vulnerable and in crisis. The Registrant’s failings involved core areas of a Social Worker’s practice, in particular, safeguarding, assessing responding to risk, obtaining and sharing information with other relevant professionals and record keeping. The Panel was of the view that the Registrant had failed to adequately appreciate and act upon risk, or share information as required by a professional with responsibility for a Service User’s care.

106. In the Panel’s judgment, the Registrant’s lack of action and appropriate record keeping left Service User 2 potentially exposed to risk. These failings in respect of Service User 2 were serious and amounted to misconduct.

107. In respect of Service User 3, the Panel considered that the Registrant’s actions and omissions were serious and fell far below the standards to be expected of a Social Worker. An allegation of abuse was disclosed to the Registrant in March 2015, which had also been reported to the Police. In the Panel’s view, the Registrant failed to act appropriately on those concerns, having taken the decision to leave the responsibility to follow up the concerns to a support worker, rather than discharging her own professional duty as a Social Worker.

108. In the Panel’s judgement, the Registrant had also failed to adequately liaise with or work in partnership with the relevant carers and professional parties, including senior management and Police, and those actions which had been undertaken had not been documented, so that any other professional looking at the Care First records would not know what actions had been taken or were still required. In the Panel’s judgement, these failings in respect of Service User 3 were serious and amounted to misconduct.

109. The Panel considered that the Registrant had breached the following Standards of conduct, performance and ethics:

• 1 – You must act in the best interests of service users.
• 5 – You must keep your professional knowledge and skills up to date.
• 7 – You must communicate properly and effectively with service users and other practitioners.
• 10 – You must keep accurate records.

Decision on Impairment

110. At the end of the first day of the hearing (4 December 2017), in light of the Registrant’s email stating that she was not able to participate in the hearing either in person or by telephone, but would answer any questions which the Panel may have, the Panel asked the Hearings Officer to send a further email to the Registrant. This email invited the Registrant, if she wished to do so, to provide up to date information to the Panel about her circumstances, which may be relevant to the Impairment stage if it were reached. It attached a copy of the HCPTS Practice Note on Impairment for her information. It invited the Registrant to respond with such information by 10am on 6 December 2017.

111. The Registrant sent an email to the HCPC at 21:44 on 5 December 2017. It provided information on the areas identified by the Panel as relevant in respect of the Impairment stage. The Registrant had not requested any adjournment within that email, nor given any indication that she wished to participate at the Impairment stage, either in person or by telephone. In light of this email, the Panel concluded that it would not be unfair to the Registrant to continue with the Impairment stage of the hearing.

112. The Panel took account of the submissions made by Mr Ferson on behalf of the HCPC and all of the representations submitted by the Registrant, including those in her recent email of 5 December 2017.

113. The Panel heard and accepted the advice of the Legal Assessor. It had regard to the HCPTS Practice Note on Impairment and in particular the two elements of impairment, namely the ‘personal component’ and the ‘public component’.

114. The Panel first considered the ‘personal component’.

115. The Panel was of the view that the Registrant had, in the past, placed three vulnerable service users at unwarranted risk of harm. There were indications within the papers that the Registrant had some insight into her failures within her practice. There had been some admissions to her employer during the disciplinary process, and there were her detailed representations provided in October 2017 in which she accepted failings in relation to the three service users, and acknowledged their potential to cause harm to the individual service users. Her representations also indicated that she would seek to act differently in the future. The Panel noted that, at that stage, the Registrant did not fully accept full accountability for her failures which, she had in part attributed to a loss of confidence as a result of a poor appraisal and some missed supervisions.

116. In the Panel’s view, the Registrant’s key failures had been in respect of safeguarding and risk assessment; not being proactive in her role as a Social Worker, either in sharing information or adequately consulting with professionals and carers involved in the procedures as well record keeping failures. It was of the view that these were fundamental breaches of the social work profession, which is charged with supporting some of the most vulnerable in society. If there were similar failings in the future, then this would be liable to place service users at risk of harm.

117. The Panel was of the view that each of these key failures was capable of remediation, and the most recent information submitted by the Registrant on 5 December 2017 indicated that she had started to take steps in this regard, including putting strategies in place in respect of record keeping, and undertaking relevant training. She also indicated a willingness to undertake further remedial action in order to facilitate a future return to practice as a Social Worker.

118. In her most recent representations, the Registrant had confirmed a future wish to return to work as a Social Worker. She identified that her current role had given her the opportunity, in part, to remedy some of the issues in respect of her practice, in particular in respect of carrying out risk assessments, support plans and referrals. She had also been able to link her current experience in housing matters back to how she had failed in relation to Service Users 2 and 3.

119. The Panel recognises there is a public interest in retaining the services of an experienced Social Worker. However, the Panel was mindful of the Registrant’s position that she had not practised as a Social Worker, in effect, since October 2015. While she had been employed in a relevant social care setting since December 2016, the Panel did not have before it corroborative evidence of the specific training undertaken or courses attended, nor references from her current employers attesting to the standards to which she was now working. In the absence of such evidence, the Panel was unable to assess the extent of the remediation.

120. In all the circumstances, given the length of time for which the Registrant had not actively practised as a Social Worker and the absence of corroborative evidence to satisfy the Panel that the Registrant now had fully remediated her practice, it could not rule out that there remained a risk of repetition of the failures by the Registrant. Accordingly, the Panel concluded that, in respect of the personal component, her fitness to practise was currently impaired.

121. The Panel went on to consider the ‘public component’.

122. The Panel was of the view that the Registrant’s failings in respect of the three service users had brought the profession into disrepute, and would have had an adverse impact on her employer’s reputation. In light of this, and that the risk of repetition could not be ruled out, the Panel was of the view that the public would expect the Regulator to take action in order to protect members of the public. It therefore concluded that public confidence in the reputation of the profession would be undermined if a finding of impairment were not made in this case. Similarly, the Panel concluded that professional standards would be undermined if it did not make a finding of Impairment. Accordingly, in respect of the ‘public component’ the Panel concluded that the Registrant’s fitness to practise is currently impaired.
 
Decision on Sanction

123. Having determined that the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel next went on to consider whether she was impaired to a degree which required action to be taken on her registration.

124. The Panel took account of the submissions of Mr Ferson on behalf of the HCPC and those of the Registrant. It also had regard to all of the material previously before it.

125. The Panel accepted the advice of the Legal Assessor and it exercised its independent judgement. It had regard to the Indicative Sanctions Policy (the Policy) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive but to protect members of the public and to safeguard the public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

126. Before considering the individual options open to the Panel, it considered the aggravating and mitigating features, which have previously been identified at the misconduct and Impairment stages of this case.

127. The Panel considered the following to be the significant aggravating factor:

• These were three highly vulnerable service users with complex needs, who were at a time of acute crisis.

128. The Panel considered the following to be the significant mitigating factors:

• The Registrant had cooperated with the internal investigation by the employer;
• The Registrant had made admissions both in the internal investigation and in her representations at the outset of the substantive hearing;
• The Registrant had demonstrated some insight, albeit she had not demonstrated full accountability for her failures;
• The Registrant had indicated a willingness to address the issues within her practice; and
• The Registrant had shown a good level of engagement with this substantive hearing.

129. The Panel first considered whether any sanction was necessary. Given the seriousness of the misconduct, the risk of repetition and therefore risk to service users, the Panel did not consider that this was a case where it was appropriate to take no action. The Panel concluded that some form of sanction was necessary to protect the public as well as maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour.

130. Given that the Panel had ruled out that this was an appropriate case for no further action, it concluded that mediation was also not an appropriate outcome in this case.

131. The Panel did not consider that a Caution Order would meet the criteria as set out in paragraph 28 of the Policy which reads: ‘A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the Registrant has shown insight and taken appropriate remedial action’. Although the Panel considered that the Registrant had shown some insight and had taken some remedial steps and was willing to undertake more, as previously identified, the Panel did not consider that the failings in this case were isolated, limited or minor in nature. It had also not been satisfied at the Impairment stage that there was a low risk of repetition. A Caution Order, therefore, was not appropriate in this case, as it would not serve to protect the public or satisfy the wider public interest.

132. The Panel next considered a Condition of Practice Order. The Panel noted its earlier finding that the Registrant’s failings were capable of remediation. It noted that the Registrant had recognised in her most recent representations that further steps were required on her part before returning to unrestricted work as a Social Worker. The Panel considered that there were identifiable areas within the Registrant’s practice which had the potential to be remediated.

133. The Panel was of the view that it would be possible to formulate workable conditions which would both protect the public and address the wider public interest. The Panel had regard to paragraph 33 of the Policy which reads: ‘Conditions will rarely be effective unless the registrant is genuinely committed to resolving the issues they seek to address and can be trusted to make a determined effort to do so.’ The Panel had been impressed by the Registrant’s most recent representations, and was reassured that the Registrant would be willing to resolve her failings and willing to abide by conditions. 

134. The Panel considered that the length of the Order should be for three years. This was in recognition that the Registrant was not intending to immediately return to practice as a Social Worker, but had expressed a wish to return in the future. The Panel acknowledged there a public interest in allowing an experienced Social Worker to return to the social work profession. The Panel considered that the length of the Order would allow the Registrant the time and the opportunity to return to practice at a time when this was appropriate to her, and once she had returned, to achieve full remediation and fully developed insight. The Panel noted that, in any event, the Registrant had the ongoing obligation in respect of her registration to ensure that she kept her skills and knowledge up to date through maintaining a portfolio of her continuing professional development. Further, the Panel would remind the Registrant she has a right to ask for an early review of the Order if she feels it has achieved its purpose within the 3 year period.

Order

ORDER: The Registrar is directed to annotate the HCPC Register to show that for a period of 3 years from the date that this Order takes effect, you, Miss Sarah Emma Cray, must comply with the following conditions:

1. You must work with a supervisor, registered with the HCPC as a Social Worker, to formulate a Personal Development Plan to address the following areas of your practice:

A. The quality and timeliness of your record keeping;

B. Undertaking assessment of need in respect of individual service users to the required standards.

C. Undertaking assessments of risk in respect of individual service users to the required standard;

D. Working in partnership with service users, carers and other relevant parties; and

E. Understanding when it is necessary to seek advice from a line manager or senior practitioner.

2. Within 2 months of gaining employment as a Social Worker, you must forward a copy of the Personal Development Plan to the HCPC.

3. You must meet with your supervisor on a fortnightly basis for the first three months of your employment as a Social Worker. If your supervisor deems satisfactory progress has been made in relation to your Personal Development Plan, this may, after three months and at the discretion of your supervisor, reduce to monthly supervision.

4. 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.

5. You must complete a reflective practice profile in respect of the first three occasions where you have been involved in safeguarding issues as a Social Worker and discuss this with your supervisor.

6. You must promptly inform the HCPC if you take up employment as a Social Worker and provide details of that employment.

7. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

8. 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 Social Work;

B. Any agency you are registered with or apply to be registered with (at the time of application) for employment as a Social Worker and;

C. Any prospective employer (at the time of your application) where you apply for work as a Social Worker.

Notes

This Order will be reviewed again before its expiry.

Hearing history

History of Hearings for Ms Sarah Emma Cray

Date Panel Hearing type Outcomes / Status
04/12/2017 Conduct and Competence Committee Final Hearing Conditions of Practice