Mrs Angela Rizzato

: Social worker

: SW90845

: Final Hearing

Date and Time of hearing:10:00 08/01/2018 End: 17:00 10/01/2018

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

: Conduct and Competence Committee
: Caution

Allegation

Whilst working as a Social Worker at South Tyneside Council:
1. In relation to Service User A:
a) On 10 September 2015, having noted that he presented as being confused and/or reported forgetting things, you did not:
i. conduct an adequate Self-Assessment Questionnaire in that you;
1) Copied forward a previous assessment completed on 21 August 2015
2) Did not address the potential risks to Service User A in relation to his reported confusion and/or memory loss.
ii. discuss and/or escalate the case with your manager and/or a member of management;
iii. instigate frequent welfare checks and/or visits;                                                                                                                                                                                                                                                                                                                                                                                            
iv. conduct and/or record conducting a Mental Capacity Assessment
b) Between 10 September 2015 and 9 October 2015 you did not:
i. make and/or record any visits with Service User A;
ii. make and/or record any telephone contact with Service User A;
iii. seek advice from any medical professional regarding Service User A’s healthcare needs.
c) On 9 October 2015, having been informed by Person 1 of Acorn Care Agency, that the Service User had not been home for over a week, you:
i. Did not inform your manager and/or a member of management of the concerns raised by Acorn Care Agency;
ii. Did not inform your manager and/or a member of management of your intention to visit Service User A;
iii. Having attended Service User A・s home address and receiving no answer from Service User A you did not:
1) check his admission with local hospitals;
2) contact relatives to verify his welfare and/or whereabouts;
3) contact the Police to report concerns over his welfare;
4) contact your manager and/or a member of management to inform them of the situation
5) liaise with the Out of Hours Service to request follow up.
d) On the morning of 12 October 2015, having not made contact with or verified the welfare of Service User A on 9 October 2015, you did not:
i. inform your manager and/or a member of management about the lack of contact with Service User A on 9 October 2015 and/or the concerns about his welfare;
ii. take any action to verify his welfare and/or whereabouts.
2. In relation to Service User B, you did not:
a) Having been informed of concerns over the presentation of Service User B on 10, 22 and/or 24 September 2015:
i. Did not seek advice from the Safeguarding team and/or your manager and/or a member of management regarding action that should be taken;
ii. Did not complete a Mental Capacity Assessment 1;
b) Having attended upon Service User B in hospital on 28 September 2015:
i. Did not complete a Mental Capacity Assessment 2;
ii. Did not input the re-assessment and Mental Capacity Assessment 1 into the Liquid Logic system in a timely manner;
c) Did not complete and/or record an assessment of need prior to her placement in the care home;
d) Removed
e) Did not provide the care home with a support plan.
f) Did not adequately record the arrangements for and/or the transfer of Service User B to the Care Home;
3. In relation to Service User C, you:
a) Completed an inaccurate Mental Capacity Assessment on or around 25 September 2015 in that you did not consider and/or record the impact of the flu-like symptoms on mental capacity.
b) Did not record the updated Mental Capacity Assessment on the case management system following the re-assessment on 2 October 2015.
4. The matters set out in paragraphs 1 to 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:
Application to amend the particulars
1. At the beginning of the hearing, Ms Eales, counsel appearing for the HCPC, applied to amend a number of the particulars. The Registrant did not oppose the application.
2. Having heard and accepted the advice of the Legal Assessor, the Panel decided to allow the proposed amendments in full. It was of the view that the amendments were minor in nature, essentially correcting dates or clarifying the position of the HCPC, and did not materially change the nature of the allegations against the Registrant.  The Panel was satisfied that there would be no prejudice to the Registrant in allowing the proposed amendments.
Background:
3. The Registrant is a registered Social Worker, who qualified in 2012. She was employed by South Tyneside Council (the Council) as an Agency Social Worker in the Older People’s Team, from 6 July 2015 to 13 October 2015.
4. The Council used an electronic based method of record keeping, which was known as Liquid Logic. Following some training on the system, a new social worker would be provided with access to the Liquid Logic system, in which they would record their actions and interventions in the electronic case notes of service users with whom they had dealings. By the time that the Registrant left the Council, she had a caseload of 35 cases, of varying degrees of complexity, which she had been allocated.
5. Service user A was a case which had been allocated to the Registrant on 3 August 2015. Service user A was a 77 year old man who lived alone on the second floor of a building. He was in receipt of a care package, whereby Acorn Care, a domiciliary care agency, provided daily care to assist with the main meal of the day and additional domestic cleaning assistance once a week. On 10 September 2015, the Registrant visited Service User A at his home address, to complete a reassessment of the care package in place. On 9 October 2015, the Registrant attempted to visit Service User A, but received no answer from him. On 12 October 2015, Acorn Care contacted the Registrant to say that they had not been able to contact Service User A. The Registrant advised the Agency to contact the police who found Service User A dead at his home address.
6. Following the discovery of the death of Service User A, a review of the case was conducted by TT, who went through the case note entries on Liquid Logic and spoke to senior practitioners. A number of concerns regarding the Registrant’s handling of the case came to light.
7. In respect of Service User A, it is alleged that the Registrant:
• did not conduct an adequate Self-Assessment Questionnaire with him when she visited him on 10 September 2015;
• did not address the potential risks to Service User A in relation to his reported memory loss;
• did not have contact with Service User A between 10 September 2015 and 9 October 2015, either by visits or on the telephone; and
• on 9 October 2015, having been informed by Acorn Care that there had been no contact with Service User A for over a week, did not escalate matters when she was unable to make contact with him when she went to visit his home address.
8. Following the review into Service User A’s case, TT asked JF to conduct an audit of all of the Registrant’s allocated cases. Two further concerns were raised as a result, which were to do with Service User B and Service User C.
9. Service User B was an 86 year old lady who lived alone. Her case was allocated to the Registrant in August 2015. On 10, 22 and 24 September 2015, a family friend of Service User B rang the Council to report a number of concerns over the presentation of Service User B. The phone call of 24 September 2015 was to inform the Registrant that Service User B had had a fall and an ambulance had taken her to hospital. On 28 September 2015, the Registrant visited Service User B in hospital.
10. In respect of Service User B, having been made aware of the concerns of the family friend, it is alleged that the Registrant:
• did not seek advice from any of the Safeguarding team, her manager or the management team regarding what action to take; and
• did not complete a Mental Capacity Assessment (MCA).
11. Having visited Service User B in hospital on 28 September 2015, it is further alleged that the Registrant:
• did not complete a MCA or input it onto the Liquid Logic System;
• did not complete or record an assessment of need prior to Service User B being placed in a care home; and
• did not provide the care home with a support plan or adequately record the arrangements for and transfer of Service User B to the care home.
12. Service User C was an elderly lady of around 89 years, who lived alone. On 25 September 2015, the Registrant visited Service User C and conducted a MCA, at a time when the Registrant noted that she was suffering from ‘flu like’ symptoms, and concluded that she did not have capacity in respect of her finances. On 2 October 2015, following input from a Senior Social Worker, PL, who had knowledge of Service User C, a second MCA was conducted with Service User C by the Registrant and the Senior Social Worker, which concluded that Service User C did have capacity.
13. In respect of Service User C, it is alleged that the Registrant:
• completed an inaccurate MCA in that she did not consider or record the impact of the ‘flu like’ symptoms that the service user was suffering from at the time on mental capacity; and
• did not record the updated MCA of 2 October 2015 on the Liquid Logic electronic recording system.
Decision on Facts:
14. On behalf of the HCPC, the Panel heard evidence from:
• TT – a HCPC registered social worker who, at the relevant time, was the Team Manager overseeing the Older People and Physical Disability teams at the Council. Her role was to manage the senior practitioners in the two teams, who, in turn, managed the social workers and occupational therapists. Following the discovery of the death of Service User A, she reviewed the Liquid Logic case notes for Service User A, and instructed JF to audit all of the Registrant’s caseload.
• SL – a HCPC registered social worker who, at the relevant time, was a Senior Manager and Principal Social Worker with the Council. He was responsible for checking the information that TT had collated in relation to Service User A.
• JF – an HCPC registered social worker, who at the relevant time, was a Senior Social Worker within the Council, and the Registrant’s supervisor. She conducted the audit of the Registrant’s caseload.
15. The Panel was also provided with a documentary exhibits bundle, which included the Liquid Logic case management notes and assessments in respect of Service Users A, B and C.
16. The Registrant gave evidence, and provided two bundles of documents.
17. The Panel heard and accepted the advice of the Legal Assessor. Although the Registrant admitted a number of the particulars of fact, which is persuasive, the Panel recognised that it had to be satisfied that the particulars of fact were capable of proof. In respect of both the admitted and disputed facts, the Panel recognised that the burden of proving each individual fact rests always 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.
18. At the outset of its deliberations, the Panel considered the credibility of each of the witnesses who gave live evidence.
19. Considering witness TT, the Panel found that she was an experienced and knowledgeable social worker, and was credible in terms of her honesty and the content of her evidence. However, it also considered that she was somewhat rigid and inflexible in her views, particularly when alternative possibilities were put to her. The Panel recognised that she had become involved in investigating the Registrant’s practice in respect of Service User A, once his death had been discovered. In the Panel’s view she was defensive at times, and not as balanced in her evidence as the Panel would have liked. The Panel considered that this defensiveness may, in part, be due to the allegations of bullying made against her by the Registrant.
20. Considering witness SL, the Panel found that he was a straightforward and balanced witness, who did not know the Registrant, so had no personal “axe to grind”. The Panel found him a good witness of fact and had no issues with his credibility.
21. Considering witness JF, the Panel observed a notable change in her demeanour during her evidence, particularly when she was challenged in cross examination, and when she was directed to the Registrant’s bundle regarding bullying allegations. The Panel noted her outburst at the end of her evidence when she lost her temper. The Panel found her to be defensive at times and that her anger may have clouded her objectivity in some areas of her evidence. In light of this, the Panel treated her evidence with care, looking to see if there was support from other sources of evidence, before relying wholly on it.
22. In respect of the Registrant, the Panel found her to be both an honest and open witness, and that her evidence overall was credible and could generally be relied upon. It considered that, on occasion she blamed others, and occasionally, in the Panel’s assessment, overstated her defence.
Particular 1a)(i)(1):
1. In relation to Service User A:
a. On 10 September 2015, having noted that he presented as being confused and/or reported forgetting things, you did not:
i. conduct an adequate Self-Assessment Questionnaire in that you:
1. Copied forward a previous assessment completed on 21 August 2015
23. The Panel finds particular 1a)(i)(1) not proved.
24. The Panel heard evidence that copying forward a previous assessment was common practice within the team. Senior management knew that it was happening, and although there was disagreement amongst the HCPC witnesses about whether this was acceptable practice, the evidence of SL, the most senior Social Worker called by the HCPC was: ‘I can say that it is acceptable to copy forward from previous assessments as long as you do validate the information’. The Panel had regard to the Liquid Logic Assessment document itself. It noted that there was nothing surreptitious within the document, and it clearly says ‘copied forward’ on it, so anyone reading it would be aware that it had been copied forward.
25. At the top of the Liquid Logic Assessment document was a handwritten note which said ‘Sept Assessment completed by AR for SUA’. TT said that this was not her handwriting, and there was no evidence before the Panel as to who had written this note. There was nothing within the typed part of the document itself to attribute the document to the Registrant. The Registrant told the Panel that she did not know how to carry forward a document, and said that JF had copied it forward and told the Registrant to then add to it. Having decided that the Registrant was a credible witness, the Panel had no evidence to discredit that account.
26. Therefore the Panel was not satisfied to the required standard that it was the Registrant who had copied forward this document.
Particular 1a)(i)(2):
1. In relation to Service User A:
a. On 10 September 2015, having noted that he presented as being confused and/or reported forgetting things, you did not:
i. conduct an adequate Self-Assessment Questionnaire in that you:
2. Did not address any of the risks to Service User A in relation to his reported confusion and/or memory loss.
27. The Panel finds particular 1a)(i)(2) proved.
28. The Panel had regard to the Liquid Logic case notes for Service User A, and the entry by the Registrant in relation to her visit to him on 10 September 2015. She had recorded: ‘Visited [Service User A] at home this morning as he requested an urgent visit. [Service User A] present [sic] as being confused, he advised that he keeps forgetting things. I went through the assessment [of 21 August 2015] to identify any changes – nothing has changed from last assessment, accept [sic] [Service User A] was requesting support with his shopping’.
29. The Registrant’s earlier entries in the Liquid Logic case notes, recording telephone calls on 7 and 8 October 2015 with Service User A’s niece and Age Concern, indicate concerns by them as to whether Service User A was managing at home. The niece is also recorded as disclosing that Service User A had cancer and that he had deteriorated. Although this case was described by the Registrant as being a review, the Panel was satisfied that the Registrant was aware of these concerns and that her visit was generated by a telephone call from Service User A, on 9 September 2015, requesting an urgent visit.
30. The Panel accepted the evidence of TT that the Registrant did not properly escalate as a concern, that Service User was presenting as confused when she visited him on 10 September 2015. TT said that the Registrant did not follow up with a check on Service User A’s physical health, or contact his GP. She said that there were warning signs which she did not take into account with regard to his weight loss and personal safety.
31. The Panel also accepted the evidence of SL, who said: ‘The consequences of [the Registrant] not updating her assessment to include the changes that had occurred with regard to Service User A’s deterioration and his confusion meant that if another practitioner picked up the case notes to see how the service user was doing and to manage any on-going risks they may not have been aware of his deterioration. I feel that it's easy with hindsight to say this, but to be fair I do not think it was wrong for her to copy forward the assessment. I just think she should have recorded more information with regards to his deteriorating health on the assessment and this would have been acceptable’.
32. In light of the Registrant’s entry in Liquid Logic, recording that nothing had changed since the 21 August 2015 assessment, except for Service User A requesting assistance with shopping, the Panel concluded that the Registrant had not addressed the risks to Service User A in relation to his reported confusion and memory loss. The evidence of TT indicated that there were warning signs in respect of risks to Service User A’s health, which the Registrant did not address.
Particular 1a)(ii)
1. In relation to Service User A:
a. On 10 September 2015, having noted that he presented as being confused and/or reported forgetting things, you did not:
ii. discuss and/or escalate the case with your manager and/or a member of management;
33. The Panel finds particular 1a)(ii) proved on the basis of the Registrant’s admission and the documentation.
34. The Registrant said in evidence that when she visited Service User A on 10 September 2015, in her view there were no issues with how he presented. She said she found him lucid and coherent with what he told her about his life; he lived on the second floor and was able to manage the stairs; his property was exceptionally clean; and he was immaculate in his personal care. She said Service User A advised her that he was recovering from cancer and had been to visit his GP. Regarding the references to Service User A presenting as being confused and forgetful, she explained that he had advised her that he could be forgetful, but put it down to old age. She said that she had not escalated Service User A’s case to a manager, as in her view there was nothing to escalate.
Particular 1a)(iii)
1. In relation to Service User A:
a. On 10 September 2015, having noted that he presented as being confused and/or reported forgetting things, you did not:
iii. instigate frequent welfare checks and/or visits;
35. The Panel finds particular 1a)(iii) proved.
36. The Registrant accepted in her oral evidence that she did not instigate frequent welfare checks or visits to Service User A. She explained that this was because she had no concerns about Service User A’s welfare, and as such, there was no need to continue making visits. She explained that she had made one telephone call to him and left a message, but that she had not documented it on the Liquid Logic system.
Particular 1a)(iv)
1. In relation to Service User A:
a. On 10 September 2015, having noted that he presented as being confused and/or reported forgetting things, you did not:
iv. conduct and/or record conducting a Mental Capacity Assessment
37. The Panel finds particular 1a)(iv) proved.
38. The Registrant accepted in her oral evidence that she did not complete a MCA assessment, because she had no concerns in respect of his capacity. She said that at no point did she doubt his capacity.
Particular 1b)(i), (ii) and (iii)
1. In relation to Service User A:
b. Between 10 September 2015 and 9 October 2015 you did not:
i. make and/or record any visits with Service User A
ii. make and/or record any telephone contact with Service User A;
iii. seek advice from any medical professional regarding Service User A’s healthcare needs.
39. The Panel finds particulars 1b)(i), (ii) and (iii) proved, based on the Registrant’s admissions.
40. It had been the Registrant’s view at the time, that she did not think that any of these actions were required, and that no further social work intervention was required. She explained that the case had been allocated to her as a review case with regards to the care package which had been put in place three weeks earlier. She said that she should have closed the case to her, following her review, and then it would be re-allocated in due course for review. She said that the case remained allocated to her as she had not completed inputting the results of her assessment, and recognised that this was a failing on her part.
Particular 1c)(i)
1. In relation to Service User A:
c. On 9 October 2015, having been informed by Person 1 of Acorn Care Agency, that the Service User had not been home for over a week, you:
i. Did not inform your manager and/or a member of management of the concerns raised by Acorn Care Agency;
41. The Panel finds particular 1c)(i) proved.
42. The Panel considered the Registrant’s evidence that she had been sat next to JF when she received the phone call from Acorn Care telling her that they had been unsuccessful in their contact with Service User A. While the Panel accepted that she had been sitting next to JF on receiving the telephone call from Acorn Care, it did not consider that it was sufficient, in the circumstances, for the Registrant to rely on her manager overhearing the conversation as a means of ‘informing’ her manager of the situation. This was potentially a serious matter, which, in the Panel’s view, needed to be properly discussed with the manager, so that all of the concerns, in relation to the circumstances and potential risks could be addressed. Therefore, the Panel was satisfied to the required standard that the Registrant had not informed her manager of the concerns raised by Acorn Care.
Particular 1c)(ii)
1. In relation to Service User A:
c. On 9 October 2015, having been informed by Person 1 of Acorn Care Agency, that the Service User had not been home for over a week, you:
ii. Did not inform your manager and/or a member of management of your intention to visit Service User A;
43. The Panel finds particular 1c)(ii) proved.
44. The Panel accepted the evidence of TT and SL on this point, to the effect that had a manager been properly informed of the situation, the Registrant would have been instructed to visit Service User A accompanied by another person, or follow the lone working policy. In light of this, the Panel accepted JF’s evidence that had she known that the Registrant was intending to visit Service User A, she, JF, would have accompanied the Registrant.
45. The Panel was of the view that even if the electronic white board was not working to record her lone visit, it was incumbent upon the Registrant to alert her managers in another way that she was making a lone visit. The Registrant told the Panel that she had been aware of the lone working policy at her previous place of employment. The Panel was satisfied that even if the Registrant was not aware of the specific details of the Council’s lone working policy, her knowledge of her previous employer’s policy would have alerted her to the need to inform someone else of her intention to visit Service User A alone. The Panel was therefore satisfied to the required standard that the Registrant did not inform a member of management of her intention to visit Service User A.
Particular 1c)(iii) (1), (2), (3), (4) and (5)
1. In relation to Service User A:
c. On 9 October 2015, having been informed by Person 1 of Acorn Care Agency, that the Service User had not been home for over a week, you:
iii. Having attended Service User A’s home address and receiving no answer from Service User A you did not:
1.check his admission with local hospitals;
2. contact relatives to verify his welfare and/or whereabouts;
3. contact the Police to report concerns over his welfare;
4. contact your manager and/or a member of management to inform them of the situation
5. liaise with the Out of Hours Service to request a follow up.
46. The Panel finds particulars 1c)(iii) (1), (2), (3), (4), and (5) proved on the basis of the Registrant’s admissions.
47. In respect of the entry in Service User A’s Liquid Logic case notes for 9 October 2015, made by the Registrant, she recorded: ‘phone call from Acorn – not seen Service User A for over a week’. This was inputted by the Registrant herself, and the Panel was satisfied that it was more likely than not that she was recording the information which had been given to her on 9 October 2015, including that Service User A had not been seen by a carer at Acorn Care for over a week. The Panel was, therefore, satisfied to the required standard that having been provided with this information, the Registrant should have carried out each of the actions as set out in sub-particulars 1c)(iii) (1), (2), (3), (4), and (5).
Particular 1d)(i)
1. In relation to Service User A:
d. On the morning of 12 October 2015, having not made contact with or verified the welfare of Service User A on 9 October 2015, you did not:
i. inform your manager and/or management about the lack of contact with Service User A on 9 October 2015and/or the concerns about his welfare;
48. The Panel finds particular 1d)(i) proved, on the basis of the Registrant’s admission.
49. The Registrant accepted that she had not taken any action in the morning of 12 October 2015, and said she had been required to provide duty cover for another Social Worker, so the first opportunity for her to take action arose at 3:30pm.
Particular 1d)(ii)
1. In relation to Service User A:
d. On the morning of 12 October 2015, having not made contact with or verified the welfare of Service User A on 9 October 2015, you did not:
ii. take any action to verify his welfare and/or whereabouts.
50. The Panel finds particular 1d)(ii) proved.
51. The Registrant in her oral evidence accepted that she did not take any action in respect of Service User A until around 3:30pm on 12 October 2015.
Particular 2a)(i)
2. In relation to Service User B, you:
a. HavIng been informed of concerns over the presentation of Service User B on 10, 22 and/or 24 September 2015:
i. Did not seek advice from the Safeguarding team and/or your manager and/or a member of the management regarding action that should be taken;
52. The Panel finds particular 2a)(i) not proved.
53. The HCPC made no positive submissions on this point. The Liquid Logic case notes for Service User B record that the Safeguarding team was already involved in this case as at 4 September 2015, which was before the first telephone call by Service User B’s friend to raise concerns about Service User B’s presentation. The Registrant also gave evidence that she had discussed this case with a senior Social Worker, HT, who knew the lady and had a great deal of knowledge of Service User B’s case. In the circumstances, the Panel was not satisfied to the required standard that the Registrant had not informed Safeguarding or management.
Particular 2a)(ii)
2. In relation to Service User B, you:
a. HavIng been informed of concerns over the presentation of Service User B on 10, 22 and/or 24 September 2015:
ii. Did not complete a Mental Capacity Assessment 1;
54. The Panel finds particular 2a)(ii) proved.
55. In light of the wording of particular 2(b), the Panel interpreted particular 2(a)(ii) as referring to the period of time from 10 September 2015 (date of first telephone call) to 27 September 2015 (the day before attending upon Service User B in hospital). The Registrant accepted in her oral evidence, as a matter of fact, that she did not complete a MCA in this time.
56. The Panel noted that the Liquid Logic care note entry for 15 September 2015 records that the Registrant had been trying to build up a rapport with Service User B, visiting her weekly and that she had visited Service User B at her home address on 11 September 2015. The entries also record that the Registrant had called Service User B’s GP on 21 September 2015, and was liaising with her and a number of care professionals with a view to arranging a risk management meeting.
Particular 2b)(i)
2. In relation to Service User B, you:
b. Having attended upon Service User B in hospital on 28 September 2015;
i. Did not complete a Mental Capacity Assessment;
57. The Panel finds particular 2b)(i) not proved.
58. The HCPC made no positive submissions on this point. The Liquid Logic care note entry for 28 September 2015, records: ‘Visited [Service User B] on ward 19 at SSD. Completed a reassessment and MCA1 around accommodation needs – [Service User B] lacks capacity in this area.’ In light of this entry, the Panel was not satisfied to the required standard that the Registrant had not completed a MCA in respect of Service User B.
Particular 2b)(ii)
2. In relation to Service User B, you:
b. Having attended upon Service User B in hospital on 28 September 2015;
ii. Did not input the re-assessment and Mental Capacity Assessment 1 into the Liquid Logic system in a timely manner;
59. The Panel finds particular 2b)(ii) proved.
60. The Registrant accepted in evidence, as a matter of fact, that she had not inputted the MCA on the Liquid Logic system by the time she had left the Council on 13 October 2015.
Particular 2c) and 2e)
2. In relation to Service User B, you:
c. Did not complete and/or record an assessment of need prior to her placement in the care home;
e. Did not provide the care home with a support plan.
61. The Panel finds particulars 2c) and 2e) proved.
62. The Registrant accepted in oral evidence that, as a matter of fact, she had not completed an assessment of need or a care plan in respect of Service User B before she left the Council. She explained that in terms of Service User B’s placement needs, she had only reached the stage of making inquiries with a number of care homes as to whether they would be appropriate placements for Service User B, and to request the respective care homes to undertake their own assessments of Service User B. The Registrant disputed that it had been her who had arranged the placement of Service User B to the Windsor care home, which is recorded in the Liquid Logic notes by another social worker on 14 October 2015, as having occurred on 12 October 2015. She said that as far as she was aware, when she left the Council, on 13 October 2015, Service User B remained in hospital.
Particular 2f)
2. In relation to Service User B, you:
f. Did not adequately record the arrangements for and/or the transfer of Service User B to the Care Home;
63. The Panel finds particular 2f) not proved.
64. The Liquid Logic entry by the Registrant for 7 October 2015, records that she had a telephone conversation with the care home manager at Chichester Court. The entry records that the Registrant was advised by the manager that he had no beds, had a waiting list, and that he apologised that that he was not able to help. The entry goes on to record: ‘he advised that he has no beds, he joked advising unless the council will allow home to have bunk beds’. The Panel noted that this was a telephone call with a care home, which was not where Service User B was in fact placed. In any event, the Panel was not satisfied that the recording of the ‘bunk beds’ comment meant that arrangements for or transfer of Service User B were inadequate. However, they considered it served no obvious purpose.
Particular 3a)
3. In relation to Service User C, you:
a. Completed an inaccurate Mental Capacity Assessment on or around 25 September 2015, in that you did not consider and/or record the impact of the flu-like symptoms on mental capacity.
65. The Panel finds particular 3a) proved.
66. The Panel acknowledged that there were a number of factors recorded in the Liquid Logic case notes in respect of Service User C, which indicated that a MCA may need to be carried out for her. There is an entry by another Social Worker on 11 September 2015, noting that the case was with Safeguarding from March 2015. There are further entries recording concerns by police and the care agency providing domiciliary care that she was was the subject of financial abuse. The entry for 18 September 2015, records that a male had been arrested for fraud. The Registrant said in evidence that the police were keen to obtain a witness statement from Service User C, but had contacted the Council with a view to ensuring that it was appropriate for them to take a statement.
67. The Panel noted that the Registrant had not carried out the MCA alone, but had been accompanied by another Social Worker. However, on the particular day that the MCA had been carried out, around 25 September 2015, the Registrant had recorded that Service User C had ‘flu-like’ symptoms. The Panel accepted the evidence of TT and SL of how such symptoms may affect the outcome of a MCA, and so should not be undertaken on that day, as the conclusion would be inaccurate.
68. Although the Panel noted that the Registrant had recorded in the MCA document that the MCA may need to be repeated, due to Service User C having ‘flu-like symptoms, the Panel was satisfied to the required standard that the Registrant should not have completed the MCA on 25 September 2015, and that it was, therefore, more likely than not that the MCA which she did complete was inaccurate. The Registrant, herself, acknowledged in evidence that she probably would not have carried out the MCA on the day if she had not been under pressure from police to do so.
Particular 3b)
3. In relation to Service User C, you:
b. Did not record the updated Mental Capacity Assessment on the case management system following the re-assessment on 2 October 2015.
69. The Panel finds particular 3b) proved.
70. The Registrant accepted in evidence that she did not input the second MCA which was undertaken with PL on Friday 2 October 2015, as she had not had time before her contract was abruptly terminated on 13 October 2015. She said that she anticipated that it would take her two hours to input the information. She explained that JF had agreed that the afternoon of 9 October 2015, would be for her to input the MCA re-assessment with the assistance of JF, but that other record keeping work requirements had meant that it had not been possible to input the MCA information that afternoon and on 13 October 2015 she left the Council.
71. Following the announcement of the decision on facts the hearing was adjourned part-heard due to a lack of time to proceed. All parties agreed upon dates that they could be available and it was announced on record that the case would reconvene on the 08, 09 and 10 January 2018 which were the first three consecutive dates that the Panel was available. Earlier individual dates had been identified but the Registrant indicated her wish for the dates to be consecutive.
At the resumed hearing:
72. The Registrant participated in the resumed part of the hearing by telephone. She gave evidence and provided further documentation to the Panel.
Decision on Statutory Ground and Impairment:
73. The Panel considered whether the facts found proved, amounted to misconduct and/or lack of competence, and if so, whether by reason thereof, the Registrant's fitness to practise is currently impaired.
74. The Panel considered the submissions made by Ms Eales on behalf of the HCPC. She stated that the HCPC did not advance a statutory ground in respect of Service User B, given the context identified by the Registrant in her evidence, and the Panel’s findings at the facts stage.
75. In relation to Service User A, Ms Eales submitted that the facts amounted to the statutory ground of either misconduct or lack of competence. Ms Eales highlighted that SL had explained that the consequences of not addressing or recording the relevant matters, meant that if another practitioner were to pick up the case, they would not be aware of any deterioration in the service user’s state of health. Ms Eales submitted that TT had identified that there were warning signs regarding the deterioration in health of the service user and that, by not visiting Service User A between 10 September 2015 and 9 October 2015, the Registrant did not know whether he had improved or deteriorated in that time. In relation to the Registrant’s unsuccessful visit on 9 October 2015, Ms Eales drew the Panel’s attention to SL’s evidence, which was that anyone should have realised that urgent action was required, given the serious risks involved, namely that Service User A had cancer, was frail and had not been seen for over a week. 
76. In relation to Service User C, Ms Eales submitted that the facts amounted to the statutory ground of either misconduct or lack of competence. Ms Eales submitted that the impact of the Registrant’s decision that the service user did not have capacity was that there was a risk that the result of that decision may have been to take away Service User C’s control over her finances. 
77. Ms Eales submitted that the Registrant’s shortcomings amounted to a number of breaches of ‘Your duties as a registrant, Standards of conduct, performance and ethics’ and the ‘Standards of proficiency of Social Workers’.
78. In relation to Impairment, Ms Eales invited the Panel to refer to the HCPTS Practice Note on Impairment. In respect of the public component, she submitted that the Panel should consider whether the Registrant had understood and remedied her shortcomings, and whether there was a risk of repetition. In respect of the public component she submitted that the Panel should take into consideration the need to uphold professional standards in the profession.
79. The Panel considered the evidence given by the Registrant together with the documentary evidence provided by her, including the further documentation provided at this resumed part of the hearing, namely minutes of supervision for 24 October 2017 and certificates of relevant training attended between 31 May 2016 and 4 September 2017, including courses in Adult Safeguarding and Mental Health Awareness.
80. The Registrant told the Panel that, having left South Tyneside Council, she went to work as an Adult Social Worker at North Tyneside Council (NTC) in Community Adult Social Care Services. Initially, she worked as an Agency Social Worker from November 2015 to July 2016, and then as a permanent member of the Team from 4 July 2016 to 15 October 2017. She provided positive references from senior colleagues, including her Manager, from that employment, together with supervision records and an Individual Performance Review dated 19 May 2015. The Panel was also provided with a positive ‘Reference Check Form’, dated 28 December 2017, from her Manager at NTC in respect of an employment application.
81. 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 and impairment were matters for the independent judgement of the Panel.
82. The Panel was aware that consideration of impairment only arises in the event that the Panel judges that the facts found proved do amount to misconduct and/or lack of competence. It took account of the Registrant’s admissions in relation to the facts: both in respect of those particulars admitted at the outset of the hearing, and those effectively admitted in her evidence.  It was also aware that what has to be determined is current impairment; that is looking forward from today.
Decision on Grounds:
83. The Panel noted that the HCPC made no positive submissions on grounds in respect of Service User B. Although the Panel had found as a matter of fact that the Registrant had not completed a Mental Capacity Assessment before Service User B’s admission into hospital on 28 September 2015, the Panel was mindful of the steps that the Registrant had been taking in that time, which included weekly visits to the service user’s home to try and build up a rapport with her, and liaising with the GP and other health care professionals with a view to arranging a risk management meeting. Although the Panel had also found as a matter of fact that the Registrant had not completed an assessment of need or a care plan before Service User B’s placement in the care home, the Panel was mindful that the Registrant had left South Tyneside on 13 October 2015, and by the time she left, she had not arranged the placement, and her understanding had been that the service user remained in hospital. In light of the context in which the facts found proved occurred, it was the Panel’s judgement that the Registrant’s omissions did not amount to either misconduct or a lack of competence in respect of Service User B.
84. In relation to Service User C, the Panel had regard to the context in which  the facts had occurred, namely that the Registrant had been accompanied by another social worker and two police officers when she conducted the Mental Capacity Assessment, and there was strong evidence to suggest that the service user was being financially exploited by the neighbour. The Panel acknowledged that the Registrant’s actions had been well intentioned, in that she had been trying to protect an elderly and vulnerable service user from financial exploitation. In light of this context, it was the Panel’s judgment that although this indicated a lack of experience on the part of the Registrant at the time, it was not so serious as to cross the threshold so as to amount to misconduct. The Panel was not of the view that it could be categorised as a fair sample of the Registrant’s work, such that it demonstrated a lack of competence on her part. In reaching this view, the Panel had regard to the Registrant’s evidence in which she accepted that she should not have conducted the assessment on that day, and the Panel noted that she had been aware of the potential implications of ‘flu like’ symptoms on such an assessment, noting in the symptoms in the record and that the assessment may need to be re-visited.
85. In relation to Service User A, the Panel was of the view that this was a series of poor decisions and omissions for the period from 7 September 2015, when the Registrant was first contacted and made aware of concerns for the service user, through to the afternoon of 12 October 2015, when police attended his address and discovered that he had passed away. The Panel was of the view  that these poor decisions and omissions amounted to failures on the part of the Registrant, which fall short of what would be proper in the circumstances, as characterised by Lord Clyde’s definition of misconduct in the case of  Roylance v GMC (No.2) (2000) 1 AC 31.
86. In the Panel’s view, the concerns raised by the service user’s niece and Age UK on 7 and 8 September 2015, were important warning signs that a vulnerable service user’s health may be deteriorating and that he may not be managing at home. The information volunteered by the niece included that he had cancer and had deteriorated. On 9 September 2015, the service user, known to be a proud man, reluctant to accept assistance from outside agencies, had telephoned the Registrant to request an urgent visit. The Registrant did visit the next day, and recorded that Service User A reported confusion and memory loss.
87. By the time of the visit on 10 September 2015, during which the service user had reported confusion and memory loss, the Panel was satisfied that there were sufficient warning signs for the Registrant to require safeguarding action on her part, rather than to treat the visit simply as a review of the care package which had been put in place on 21 August 2015. In the Panel’s view, the safeguarding actions which the Registrant should reasonably have taken at that time included: escalating the case to a Manager (particular 1(a)(iii)), instigating frequent follow up welfare checks and visits (particular 1(a)(iii)), and conducting a Mental Capacity Assessment (particular 1(a)(iv)).
88. The Panel considered that after her visit on 10 September 2015, the safeguarding actions which the Registrant should reasonably have taken included: making visits to Service User A (particular 1(b)(i)), telephoning him (particular 1(b)(ii)), and seeking advice from medical professionals in respect of Service User A’s physical and mental health needs (particular 1(b)(iii)). It was during the week before 12 October 2015, that Service User A had passed away from natural causes. The Panel was of the view that had the Registrant instigated and then undertaken frequent visits and telephone contact, his death may have been discovered earlier.
89. The Panel considered that by 9 October 2015, when the Registrant was put on notice by the Care Agency that it had been unsuccessful in contacting Service User A, urgent safeguarding action was required by the Registrant. Although she attempted to visit on 9 October 2015, once she had been unsuccessful in making contact with him, and in the knowledge that she, herself, had not had contact with him since 10 September 2015, it was incumbent upon her to take immediate action to escalate the case to a Manager and/or call the police herself.
90. In light of the series of poor decisions and omissions in respect of Service User A, the Panel was satisfied that they amounted to failures which fell far below the standards to be expected of a Social Worker. In the Panel’s judgment, the facts found proved in respect of Service User A therefore amount to misconduct.
91. The Panel identified breaches of the following standards:
HCPC Standards of Conduct, Performance and Ethics:
• 1 – You must act in the best interests of service users
• 7 – You must communicate properly and effectively with service users and other practitioners
• 10 – You must keep accurate records.
HCPC Standards of Proficiency for Social Workers in England:
• 1.1 – know the limits of their practice and when to seek advice or refer to another professional
• 1.3 – be able to undertake assessments of risk, need and capacity and respond appropriately
• 2.2 – understand the need to promote the best interests of service users and carers at all times
• 2.3 – understand the need to protect, safeguard and promote the wellbeing of children, young people and vulnerable adults
• 4.1 – be able to assess a situation, determine its nature and severity and call upon the required knowledge and experience to deal with it.
Decision on Impairment of Fitness to Practise:
92. Having determined that the Registrant's actions amounted to misconduct, the Panel went on to consider whether her fitness to practise was currently impaired as a consequence of that misconduct.
93. The Panel had regard to the HCPC's Practice Note on impairment, and, in particular, the two aspects of Impairment, namely the ‘personal component’ and the ‘public component’.
94. The Panel first considered the ‘personal component’. Aside from the shortcomings in respect of one service user, the Panel was of the view that this was not a case where there were concerns regarding the Registrant's general skills or competence as a Social Worker. It had regard to the fact that the Registrant had subsequently worked for nearly two years at NTC in the role of a Social Worker in the Adult Social Care Team. The references previously provided in addition to the one submitted on 09 January 2018 attested positively to her high standards of practice in that employment, and the Managerial comments in the Individual Performance Review, dated 19 May 2017, confirmed that she was consistently working well within the Team.
95. The Panel had regard to the relevant training courses which the Registrant had regularly attended, covering the period from May 2016 to September 2017, particularly in relation to Adult Safeguarding, Mental Health Awareness and Information Governance.
96. It was clear to the Panel that the Registrant had extensively reflected on her actions and omissions in respect of each of the three service users, but particularly in relation to Service User A, whose case she said she thought about every day. She had reflected on her shortcomings both personally as well as in supervision with her Manager at NTC. Her reflections included further discussion of the findings of fact with her Manager, following the announcement of those facts. The Panel was satisfied that the Registrant had demonstrated good insight and remorse into her own failings, having reflected on how she would ensure such failings would not recur and outlining the steps she would take in future. The Registrant had provided a specific example, whilst at NTC, of a similar situation, where she took positive steps to safeguard the service user, which included escalating the matter to a Manager and contacting the GP.  
97. The Panel was satisfied that the Registrant had amended her practice so that she double and triple checked the information she was provided with and that she recorded it in the records. The Panel accepted her evidence that in her employment at NTC, she had had regular supervisions with management, and since leaving South Tyneside Council, she had carried out some 40 to 50 Mental Capacity Assessments, each one of which she had put before a manager to approve, and the feedback on them had been consistently good. The Panel was also reassured by the fact that while the Registrant was at NTC, she had become fully trained on the Liquid Logic System, which was being implemented whilst she was there. The Panel considered that the Registrant’s insight included an understanding of the importance of accurate and timely record keeping, stating that if it was not written down then it had not happened.
98. The Panel was satisfied that the previous failures of the Registrant were capable of remediation, and that she had, in fact, remedied her practice, as evidenced by the references and supporting documentation in respect of her subsequent employment at NTC, the relevant training courses she has undertaken, and her own extensive reflections on her failings.
99. In light of the above, given the good level of insight and the extensive remediation  demonstrated by the Registrant, the Panel concluded that there was a low risk of repetition.
100. Therefore, in respect of the ‘personal component’ the Panel concluded that the Registrant’s fitness to practise is not currently impaired.
101. The Panel then went on to consider the ‘public component’. It was of the view that Service User A had been an elderly, vulnerable and frail service user, and the Registrant had not personally had contact with him for over 4 weeks by the time that she was contacted by the Care Agency to say that they had not been able to contact him. Over those 4 weeks she had not undertaken reasonable safeguarding actions in respect of him, and this was compounded by her failure to take urgent safeguarding action on 9 October 2015, once she had been unable to make contact with him on her attempted visit.
102. In the Panel’s view, it is paramount that the public is able to have confidence that a social worker charged with the care of a vulnerable service user, will act on the potential safeguarding concerns. This includes safeguarding action at the time of a Social Worker being made aware of concerns, as well as an ongoing duty to visit regularly, identify any concerns and take action on these.
103. In all the circumstances, the Panel concluded that a finding of Impairment was required to declare and uphold proper standards of conduct and behaviour. It was of the view that public confidence in the profession and the Regulator would be undermined if it did not make a finding of Impairment, as the public would be left with the impression that no steps had been taken to draw to the Registrant’s attention, the unacceptability of her failures in respect of Service User A over the course of 4 weeks.
104. Accordingly, in respect of the ‘public component’ the Panel concluded that the Registrant’s fitness to practise is currently impaired.
Decision on Sanction:
105. 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 it was impaired to a degree which required action to be taken on her registration.
106. The Panel took account of the submissions of Ms Eales on behalf of the HCPC and those of the Registrant. It also had regard to all of the material previously before it.
107. 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.
108. The Panel first considered whether any sanction was necessary. It looked at paragraph 8 of the Policy, which reminds Panels that even if it has determined that fitness to practise is impaired, it is not obliged to impose a sanction. It says: ‘This is likely to be an exceptional outcome, but for example, may be appropriate in cases where a finding of Impairment has been reached on the wider public interest grounds… but where the registrant has insight, has already taken remedial action and there is no risk of repetition.’ Whilst on its face much of this appeared to apply to this case, the Panel was not of the view that this was an exceptional case, justifying such a course. Having previously indicated that a finding of Impairment was required to mark the misconduct, the Panel concluded that some form of sanction was necessary to maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour.
109. The Panel then considered whether to make a Caution Order. Having regard to the Policy, it was of the view that paragraph 28 was particularly relevant in this case. It starts: ‘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.’
110. Although the Panel was of the view that the misconduct could not be described as a lapse, given that it related to a series of poor decisions and omissions, on the Registrant’s part, it was satisfied that the other elements identified in paragraph 28 were present in this case. The misconduct was limited to a single service user and the Panel had found that there was a low risk of repetition, given the Registrant’s good insight and extensive remediation.   
111. The Panel also had regard to that part of paragraph 28 of the Policy, which reads: ‘A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate’. In relation to this, the Panel was mindful of its earlier findings to the effect that the Registrant has shown good insight, has demonstrated extensive remediation, the misconduct related to one service user, and so could properly be described as out of character for her usual practice and the risk of repetition was low.
112. The Panel further had regard to its earlier findings that the Registrant was not impaired in respect of the ‘personal component’. It found that there were no issues with her general skills or competence as a Social Worker, and that she had remediated her practice. In light of this, the Panel concluded that that there were no meaningful practice restrictions which could be imposed on the Registrant’s practice and so a Conditions of Practice Order was not appropriate in her case, and any more onerous sanction would be wholly disproportionate and unduly punitive in the particular circumstances of this case.
113. In all the circumstances, therefore, the Panel determined that the appropriate and proportionate sanction in this case is a Caution Order.
114. The duration of the Caution Order will be for the minimum period of one year. The Panel recognised the impact that these proceedings had had on the Registrant, over the two and a half years since she had been referred to the HCPC.  A longer period was not, in the Panel’s view, required to maintain public confidence in the profession and the regulatory process, and any longer period would have a punitive effect on the Registrant.

Order

The Registrar is directed to annotate the register entry of Mrs Angela Rizzato with a caution which is to remain on the register for a period of one year from the date this order comes into effect.

Notes

This resumed Conduct and Competence Committee hearing from 03 - 06 July 2017 took place on 08 - 10 January 2018.

Hearing history

History of Hearings for Mrs Angela Rizzato

Date Panel Hearing type Outcomes / Status
08/01/2018 Conduct and Competence Committee Final Hearing Caution
03/07/2017 Conduct and Competence Committee Final Hearing Adjourned part heard