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Assessment Process

P35 – PROCEDURE V1.0 2015-04-01

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THIS PROCEDURE APPLIES IN THE FOLLOWING DIRECTORATE(S)/ UNIT(S) (please delete as appropriate)

Adult Social Care, including Cumbria Care

CONTENTS

1. INTRODUCTION/ BACKGROUND .................................................................... 2

The Care Act: Assessment ................................................................................. 2

2. PROCEDURE .................................................................................................... 4

Flow Chart – Assessment Process ..................................................................... 4

Overarching Principles ....................................................................................... 5

First Point of Contact and Initial Information Gathering ....................................... 5

Urgent Need: ...................................................................................................... 6

Signposting and prevention ................................................................................ 6

Individual with care and support needs or carer with support needs? ................. 7

Individual with care and support needs Assessment .......................................... 8

Carer’s with Support Needs Assessment ........................................................... 8

Refusal of assessment ....................................................................................... 9

Determining an Appropriate and Proportionate Assessment .............................. 9

Assessing Needs, Outcomes and Impact on Wellbeing .................................... 10

Consideration of Fluctuating Needs .................................................................. 10

DOCUMENT HISTORY ........................................................................................... 12

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1. INTRODUCTION/ BACKGROUND This document seeks to provide an overview of the procedure for assessing people’s needs for social care support – it is aimed at all staff and other stakeholders involved in the assessment process. Unless otherwise stated it applies equally to adults with care and support needs and carers with support needs. It should be read in conjunction with:

The Care Act 2014 - Part 1 Assessing Needs

Care and Support (Assessment) Regulations 2014 and

Chapter 6 of the Care and Support Statutory Guidance

Health and Care Services internal procedures and guidance This procedure is based on resources produced by Social Care Institute for Excellence (SCIE) and Research in Practice for Adults (RiPfA) and they should be acknowledged them as key references throughout this document. The Care Act: Assessment The Care Act 2014 sets out in one place, local authorities’ duties in relation to assessing people’s needs and their eligibility for publicly funded care and support. Under the Care Act 2014, local authorities must:

carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care

focus the assessment on the person’s needs and how they impact on their wellbeing, and the outcomes they want to achieve

involve the person in the assessment and, where appropriate, their carer or someone else they nominate

provide access to an independent advocate to support the person’s involvement in the assessment if required

consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support)

use the new national minimum threshold to judge eligibility for publicly funded

care and support

This applies equally to adults with care and support needs and carers with support needs. The Care Act states that the focus of assessment should be:

The person’s needs

The impact of those needs on the person’s wellbeing

What is available to meet the needs – including their own strengths and capability and their informal network

The outcomes the person needs and wants The Care Act defines wellbeing broadly in terms of the following principles which apply equally to adults with care and support needs and to carers with support needs:

• Personal dignity • Physical and mental health and emotional wellbeing

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• Protection from abuse and neglect • Control by the individual over day to day life • Participation in work, education, recreation etc. • Social and Economic wellbeing • Domestic, family and personal relationships • Suitability of living accommodation • Contribution to society

When thinking about a person’s wellbeing all of these principles must be considered. The flow chart included in the procedure section of this document (SCIE, 2015) outlines the process that must be adhered to. It sets out:

the duty upon the local authority to conduct an assessment appropriate and proportionate to the individual’s need before any eligibility determination or financial assessment is made – except in cases of urgent need

concepts that must be considered throughout all stages of the process,

recognising that the assessment requires sustained contact with individuals – important in order to recognise changes in the individual and their wider support network impacting on their wellbeing

The overall aim of adult care and support is to help people meet their needs to achieve the outcomes that matter to them in their lives and which in turn promote their wellbeing. It is important to distinguish between the two ways in which outcomes are discussed within the Care Act and guidance:

Desired outcomes (of the individual): these are the outcomes a person

wishes to achieve in order to lead their day-to-day life in a way that maintains or improves their wellbeing. They will vary from one person to another because each individual will have different interests, relationships, demands and circumstances within their own life. These are the outcomes that the assessment should focus on.

Eligibility outcomes: these are listed within the eligibility regulations. There is

one list for adults with care and support needs and another list for carers with support needs. These outcomes set out the minimum criteria that local authorities must meet in order to comply with the new national eligibility threshold for adults needing care and support and carers needing support. These are the outcomes that the eligibility determination should be based on.

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2. PROCEDURE Flow Chart – Assessment Process

SCIE 2015 www.scie.org.uk

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Full process map accessible at: http://www.scie.org.uk/care-act-2014/assessment-and-eligibility/process-map/files/assessment-and-eligibility-process-map.pdf Overarching Principles

The assessment process is iterative and there are six key themes which need to be considered throughout the assessment process. At each stage in the process the following must be considered: Mental Capacity – the assessment process must ensure that, as far as possible,

individuals who may lack capacity to ask for, or engage with, a needs assessment are fully supported and that the process is person-centred and compliant with the Mental Capacity Act. Advocacy and Participation Support – the assessment process must ensure that a person can be fully involved in the needs and carer’s assessment and when appropriate, facilitate that person’s involvement. . Impact on the family and carers (whole family approach) – the assessment process must take a holistic view of the impact on the whole family and other people

the authority may feel appropriate and any potential need for a carer’s assessment. Safeguarding – any identified safeguarding issues must be acted upon as they

occur. If it appears that the prison is experiencing, or at risk of, abuse or neglect, the local authority must carry out a safeguarding enquiry. Strengths-based approach – the assessment process must consider the individual

person’s strengths and capability as well as any support which may be available from their wider network and in their community. Ensuring assessment is proportionate and appropriate – the form of assessment must be appropriate to support the individual’s involvement. It will be as extensive as is required to establish the extent of a person’s needs and also will always be person-centred and based on their individual circumstances. This applies equally to adults with care and support needs and carers with support needs. First Point of Contact and Initial Information Gathering

Under the Care Act the assessment process begins at first point of contact and includes all information gathering from this point onwards to the point at which eligibility is determined. Therefore, this stage in the process will involve input from staff in different roles as appropriate. Staff involved in this stage of the process must:

give the person, from their first contact, as much information as possible about the assessment process, in a format that is accessible to the person;

identify whether the person may lack capacity and steer people seeking support to appropriate information and advice;

undertake proportionate and appropriate assessments of any adult or carer with an appearance of need, irrespective of any presumptions of the eligibility of the person’s needs or financial situation;

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seek to establish the total extent of needs through the assessment before considering the person’s eligibility for care and support.

This applies equally to adults with care and support needs and carers with support needs. Information gathered at first contact at this stage might usefully establish the basic facts about:

whether the person has the capacity to understand and articulate their own needs

whether the person has difficulty communicating their needs (e.g. due to autism or profound and multiple learning disabilities, mental health needs or dementia)

whether the person faces any safeguarding issues

whether a specialist with specific training and expertise is required to support the individual to participate in the assessment process e.g. if the individual is deafblind

the person, their needs, expected outcomes in day-to-day life and the overall impact of the current circumstances on their wellbeing

Urgent Need:

The Care Act 2014 provides the local authority with the power to meet urgent need without undertaking an assessment or making a determination of eligibility, regardless of the person’s ordinary residence. This applies equally to adults with care and support needs and carers with support needs. There will be instances where it is obvious that immediate action is required, and in such cases it is likely that the assessment process will be paused to be resumed later when a fuller assessment can be conducted. Circumstances under which needs could be classified as urgent include, for example:

people who are terminally ill

rapid deterioration in an adult’s condition

the occurrence of an accident

a specific issue such as a stroke

evidence of a safeguarding issue

unsafe living quarters. Signposting and prevention

Following the completion of the initial information-gathering and provision, a decision needs to be taken as to which whether the assessment process should stop, or be paused, to test the effect of preventative services or other interventions as appropriate. This decision should take account of the person’s needs, circumstances and preferences: This is a two stage process involving: a. offering information and advice and/or referring to preventative services

b. continuing with or pausing the assessment process

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The information gathered to this point in the process should be used to make a decision on whether to continue with the assessment or to pause it. If a decision is taken not to proceed with the assessment the following should be considered:

Pause: whether to pause the assessment process to establish the benefit of any identified preventative interventions and the extent to which these prevent the person’s needs from progressing.

Prevention: if a full assessment is not taken forward appropriate steps must be taken to prevent, delay or reduce the escalation of care and support needs. Whatever level of prevention is implemented it is important that this is reviewed and the person returns to the assessment process if and when appropriate.

Signposting: the person must not exit the assessment process without information and advice on how to reduce or meet their needs and how to prevent, reduce or delay the development of needs. They should therefore be offered:

information and advice on coping with their condition or needs referral to preventative services or organisations in the community

who can provide relevant support It is important to note that prevention may be considered at different levels and may be utilised at any appropriate point in the assessment process:

primary prevention/promoting wellbeing (e.g. by supporting access to universal services)

secondary prevention/early intervention (e.g. targeted support to provide a few hours of support to a carer, or adaptations at home to reduce the likelihood of falls)

tertiary prevention/intermediate care and reablement (e.g. support to regain specific skills or provide support to improve a carer’s life).

The local authority’s responsibilities for prevention apply to all adults, including:

people who have no current needs for care and support adults with care and support needs, whether eligible and/or met by the local

authority or not carers, including those about to take on a caring role or who have no current

support needs, and those with support needs not being met by the local authority or another organisation.

This is an important step in ensuring the assessment is centred on the needs of the person and is appropriate and proportionate to the individual’s circumstances. This applies equally to adults with care and support needs and carers with support needs. Individual with care and support needs or carer with support needs? This step is designed to facilitate a decision as to which type assessment is appropriate to identify the person’s needs – e.g. an assessment for an individual with

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care and support needs, or for a carer with support needs. It must explore the total

extent of the needs of the individual so that the assessment can be proportional. The assessor must consider how these needs impact on the individual’s wellbeing and

explore who else might be affected by the person’s situation i.e. any associated carer or carers. Individual with care and support needs Assessment

The assessment of an individual with care and support needs must seek to

establish:

a complete picture of the individual’s needs,

what outcomes they want to achieve in their day-to-day life and

what impact this has on their wellbeing. This must happen irrespective of any future determination of eligibility and is important in establishing the total extent of the person’s needs. During the assessment the local authority must consider all of the adult’s care and support needs, regardless of any support being provided by a carer. Where the adult has a carer, information on the care that they are providing can be captured during assessment, but it must not influence the eligibility determination. However, it is important to understand what impact the provision of care may have on any carer’s wellbeing. If the information provided indicates that the carer might have needs for support due to their caring responsibilities, then a carer’s assessment must be offered to that

individual. Carer with support needs Assessment

The carer assessment must seek to establish:

the carer’s needs for support

the practical and emotional sustainability of the caring role

the willingness and ability of the carer to continue to provide this support.

The carer’s potential future needs for support It must also consider:

the impact of their support needs on their wellbeing

the outcomes the carer desires from daily life

the impact of their caring responsibilities on their ability to work, access education, training or recreation

whether support could help achieve these outcomes

whether the adult, their support network and the wider community can contribute towards meeting the outcomes the person wants to achieve

whether the carer would benefit from preventative support or information and advice.

This must happen irrespective of any future determination of eligibility and is

important in establishing the total extent of the carer’s needs and, importantly, the sustainability of the current arrangements.

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Refusal of assessment

There is no absolute requirement for an individual to have an assessment, for example, if they do not feel they need care or do not want local authority support. If an individual refuses an assessment there is no requirement to undertake one unless it appears that the person either lacks capacity and that carrying out a needs assessment would be in the adult’s best interests or the person is at risk of abuse and neglect. Under these circumstances an assessment must be carried out regardless of the person’s refusal. Determining an Appropriate and Proportionate Assessment

There are various approaches to conducting an assessment. However all assessments undertaken must be appropriate and proportionate to the needs and

circumstances of the individual and remain so for the duration of the assessment process.

The principle of proportionality means that an assessment must go as far as

is necessary to establish a complete picture of the person’s needs.

The principle of appropriateness means that an assessment must be carried

out in a manner that has regard to the person’s wishes, preferences and outcomes, the complexity of the person’s needs and any potential fluctuations of those needs. Additional support may need to be provided (e.g. understanding may be aided through the provision of accessible information or independent advocacy).

These principles apply equally to assessments involving adults with care and support needs and carers with support needs. All assessors must have the skills, knowledge and competence to carry out the

assessment in question and ensure that the person needs are fully understood and considered. The assessment must be person-centred, which may include provision of support in

circumstances where there are capacity issues or specific difficulties in communication. For example, a person with autism, blindness or deafness (or deafblindness), learning disabilities, mental health needs or dementia. All assessments of adults who are deafblind, including where a deafblind person is carrying out a supported self-assessment jointly with the authority must involve an assessor or team that has training of at least QCF or OCN level 3, or above where the person has higher or more complex needs. People are regarded as deafblind “if their combined sight and hearing impairment causes difficulties with communication, access to information and mobility. This includes people with a progressive sight and hearing loss.” (Think Dual Sensory, Department of Health, 1995.) What constitutes an appropriate and proportionate assessment needs to be kept under constant review throughout the assessment and eligibility process to ensure the process fits the person’s overall needs. Any of the following assessment methods may be appropriate:

Face-to-face assessment

Supported Self-assessment

Online or telephone assessment

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Joint assessment (i.e. with other agencies such as Health)

Combined assessment (i.e. individual and carer) Assessing Needs, Outcomes and Impact on Wellbeing

The assessment must provide sufficient information for the assessor to be able to establish:

what the person’s needs are

how they impact on the person’s wellbeing,

what outcomes they are seeking to achieve in their day-to-day life,

how care and support, or in the case of a carer, support, can contribute to the achievement of those outcomes.

Following the assessment the individual must be given a written record of their needs or carer’s assessment. As a minimum this must include:

the adult’s care needs – including any supporting information from any combined or joint assessment

the carer’s support needs – including any support information from any combined or joint assessment

the individual’s outcomes – which in this context refer to the outcomes set by the person for themselves and not those associated with the eligibility determination

the impact on the individual’s wellbeing of their care needs

any care being provided by a carer Consideration of Fluctuating Needs

The point at which the individual’s needs are assessed may not be a true reflection of their condition over time. Needs may fluctuate dependent on:

a physical or mental condition– which may mean that the individual has good and bad days, or parts of a day, or are well for weeks or months at a time e.g. multiple sclerosis or bipolar affective disorder

changing circumstances – such as changes in employment or education, or the transition to adult services

carers’ needs might fluctuate, for example because of school holidays or changes in employment or in the case of young carers when transitioning to adulthood.

For adults with care and support needs

a condition, with corresponding good and bad days, may affect the person very differently over time, for example:

physical – conditions such as multiple sclerosis or Parkinson’s mental – such as bipolar affective disorder or depression.

Environment: for example, changes such as cold weather in winter can impact on mobility and pain due to arthritis.

Changing circumstances: for example, if the person has caring responsibilities for a child of school age, the demands of term-time and holidays may have a varying impact on their wellbeing.

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For carers with support needs

a condition, with corresponding good and bad days, may affect the person very differently over time, for example:

physical – conditions such as multiple sclerosis or Parkinson’s mental – such as bipolar affective disorder or depression.

The impact of the fluctuations in the needs of the person they provide care for on their own wellbeing. The demands of coping with a bad day or series of bad days may have significant physical and emotional impact on their own wellbeing.

Their circumstances, for example: changes in employment which place more demands on their time,

reducing the time they can dedicate to their wellbeing outside caring responsibilities

a single parent with children at home will face the demands of holiday and term-time childcare

a divorced parent will face varying demands on their time depending on whether the child/children are with them.

The process of assessment ends for people with needs that have been deemed ineligible. However, a record of the person’s assessment and needs should be recorded for reference in the future if their circumstances change. At this point the assessor should refer ASC-P36 Procedure Eligibility and Guidance – Eligibility. Local authorities must consider whether the individual’s current level of needs is likely to fluctuate and what their on-going needs for care and support are likely to be. This is the case both for short-term fluctuations, which may be over the course of the day, and longer term changes in the level of the person’s needs. In establishing the on-going level of need local authorities must consider the person’s care and support history over a suitable period of time, both the frequency and degree of fluctuation.

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DOCUMENT HISTORY

RELATED DOCUMENTS

OTHER RELATED DOCUMENTS

Guidance – Assessment

ASC-P14 Procedure Risk Taking for Positive Outcomes

Guidance – Reablement Planning

Guidance – Just Checking

Guidance – Telecare Provision from Adult Social Care

ASC-P3 Procedure Case Recording Standards

ASC-P9 Procedure Safeguarding

Guidance – Accessible Information

IAS Guidance

LEGISLATION OR OTHER STATUTORY REGULATIONS

The Care Act 2014 - Part 1 Assessing Needs

Care and Support (Assessment) Regulations 2014

Chapter 6 of the Care and Support Statutory Guidance

DOCUMENTS SUPERSEDED BY THIS PROCEDURE

N/A

APPROVAL AND REVIEW

Original Author: Louise Johnstone

Current Author: (If different to original author)

Authorising Assistant Director:

Amanda Evans

Approved By: (Insert groups/ bodies and dates)

Care Act Programme Board – 18/2/15 Directorate Management Team – 02/03/15 Legal Services – Comment received 13/02/15

Consultation: (Insert details of who has been consulted on this procedure)

Date Originally Published:

Date of Next Review:

DOCUMENT CHANGE HISTORY

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Version No

Date Issued by Reason for change