SOCIAL SERVICES DEPARTMENTAL PROCEDURE NO:€¦ · Web viewThe Care Manager will liaise with their Service Manager to ensure funding for care is agreed on an interim basis until

LEARNING DISABILITIES UNPLANNED REFERRAL – SHORT STAY SERVICES

SOCIAL SERVICES DEPARTMENTAL PROCEDURE NO: 03/05

UNPLANNED REFERRAL PROTOCOLS FOR SHORT STAY SERVICES ( ADULT LEARNING DISABILITY)

DATE: 4th January 2005

EFFECTIVE DATE:

11th January 2005

CATEGORY: Learning Disabilities

KEYWORDS: Unplanned Referral – Short Stay Services

ISSUED BY: Lucy Butler

CONTACT: Lucy Butler, Service Manager Strategy, Learning Disabilities, Trafalgar House, Winchester, SO23 8UQ (01962 847671)

PROCEDURES CANCELLED OR AMENDED:

None

REMARKS: All staff need to know the procedure for making unplanned referrals to short stay services (adult learning disabilities)

SIGNED:

DESIGNATION: Jill Stannard, Assistant Director, Adults.

YOU SHOULD ENSURE THAT:-

You read, understand and, where appropriate, act on this information

All people in your workplace who need to know see this procedure

This document is properly filed in a place to which all staff members in your workplace have access

document.doc 1 (Proc03/05 – Jan 2005)


PURPOSE

To ensure that all staff involved in making or receiving unplanned admissions to in-house short stay services (Adult Learning Disabilities) are clear of the process both prior to and during the admission.

SCOPE

The procedure applies to ALL staff making or receiving referrals to in-house short stay services (Adult Learning Disabilities).

POLICY

All relevant staff to be aware of their responsibilities when making an unplanned referral to an in-house short stay service, and the need for 72 hour planning meeting following admission.

REFERENCES TO LEGAL, CENTRAL GOVERNMENT AND OTHER EXTERNAL DOCUMENTS

National Care Standards Act (2000)

HAMPSHIRE COUNTY COUNCIL AND SOCIAL SERVICES DEPARTMENT REFERENCES

None

DEFINITIONS

Unplanned admissions; admissions which can not reasonably be planned for due to a breakdown in a person’s home situation or other unforeseen circumstances.

ROLES

Unit Manager or their nominated deputy will ensure initial referral information outlined in Appendix 1 is completed.



Care Manager will make sure adequate information is gathered before making referral, ensure adequate arrangements are in place to make the placement safely and set a time for 72 hour review upon admission.

Team Manager will chair 72 hour review .

Service Manager to resolve disputes and take decisions when conflicts arise. Service Manager to agree any extra financial arrangements needed and report any unplanned admissions to the next County Resource Group.

AUTHORITY TO VARY THE PROCEDURE

Jill Stannard, Assistant Director , Adults


LEARNING DISABILITIES UNPLANNED REFERRAL - SHORT STAY SERVICES

PROCEDURECONTENTS

1. Background2. Preventative / Minimisation work3. Actions in the event of an unplanned admission4. Following unplanned admissionAppendix 1 Unplanned referral questionnaire for short stay learning disability servicesAppendix 2 72 hour review following unplanned admission

LEARNING DISABILITY SERVICESUNPLANNED REFERRAL PROTOCOLS FOR SHORT STAY SERVICES:-

1.0 BACKGROUND

1.1 The need for occasional unplanned referrals to in-house services is recognised, as a response to unpredictable and unexpected set of circumstances whereby an individual is in need of support at very short notice.

1.2 The services required are generally residential, and currently are provided within short-stay services.

1.3 Unplanned referrals for residential services are to respite/short- stay services, but occasionally to long-stay services where vacancies exist.

1.4 Such referrals can have a number of knock-on effects upon the availability and quality of respite/short-stays to other people and their carers.

1.5 Many unplanned referrals seem by default, to evolve into medium/long-stay placements, thus “blocking” either a designated emergency bed, or a short-stay bed.

1.6 Clear protocols for the management of unplanned referrals need to be established and implemented, to ensure the best possible outcomes for those individuals experiencing the emergency, and for those individuals requiring planned short-stays, which are affected by unplanned admissions.

1.7 Where possible, events that could lead to unplanned admissions should be anticipated, and appropriate plans developed to prevent the emergency, or minimise any effects. If circumstances change and a breakdown is deemed likely care managers and providers should act promptly in order to avert a crisis taking place.

1.8 In all events, contingency plans should be drawn up to consider options in light of an emergency.

1.9 Unplanned admissions refer to an unplanned response to a crisis situation where there may be a break down in the person’s residential situation which renders the person homeless. A planned emergency would be a situation where a relative may have to go into hospital for treatment therefore the person may require accommodation for longer than is generally offered.

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1.10 All unplanned admissions should be made in accordance with recent legislation issued by the Commission for Social Care Inspection (CSCI) and should be compliant with their guidance and standards.

1.11 Specific to the above are Standard 25 ( that long stay beds should not be mixed with short stay/ respite/ emergency beds) and Standard 4.1 of National Care Standards Act (2000) which states that emergency admissions should be avoided wherever possible.

2.0 PREVENTATIVE / MINIMISATION WORK

2.1 Some unplanned admissions have an element of predictability, and thus are subject to either preventative work, or work that will reduce the distress caused when the predicted event occurs.

2.2 Care should be taken to recognise and respond to any early indications of potential unplanned admissions. This may involve close liaison with provider services, especially for individuals without an allocated Care Manager. Each Area should establish/maintain systems whereby provider services (in-house and non-HCC) can inform Care Management Teams of any concerns relating to client welfare, and this must cover those people without an allocated Care Manager.

2.3 Where a potential emergency is predicted (e.g. death of an elderly relative, deterioration in health, eviction etc) wherever possible, early interventions should be planned which will either:-

Prevent the emergency occurring (e.g. early provision of domiciliary support that may prevent placement/family breakdown)

Prevent an emergency developing from the event (e.g. identification of suitable placements in advance)

Reduce the potential for avoidable distress cause through the event occurring – e.g. ensuring that an individual is familiar with any support services that may be required

3.0 ACTIONS IN THE EVENT OF AN UNPLANNED ADMISSION

3.1 All possible support options should be explored, and priority consideration given to those options which will reduce the distress for the individual. As much familiarity as possible should be maintained, both in the environment and support.

3.2 Where a referral to a residential service is necessary, the Care Manager has a duty to provide the following:-

Clear, concise and full assessment of need, including those special needs arising from the nature of the emergency. This is in line with CSCI requirement standard 2.1 that all service users admitted to residential care have a full assessment of their needs carried out prior to admission

Clear and full risk assessment, and the identification of factors that may contribute to the in-house risk assessment. This should include



existing plans to minimise and manage risk. The risk assessment needs to be accurate and current

Any information about the individual that may have contributed to the unplanned admission occurring, especially where this may put other residents at risk

Detail on what is required from the service for the individual. This will involve clear objectives and an early indication of timescales. Additional resources should be identified and agreed (by the Care Manager and service manager) prior to the placement being made

Only in exceptional circumstances will the placement be made without the care manager having undertaken a face to face assessment of the person’s needs and having obtained, first hand, information from people key to the service user

The Care Manager will contact the unit manager, or their nominated deputy, and complete the unplanned referral questionnaire for short stay learning disability services (see appendix 1)

3.3 The Unit Manager, or their nominated deputy, should give consideration to the information provided, and make an informed judgement regarding the ability of the Unit to respond appropriately, and the need for support from specific professionals e.g. psychologist, community nurse if required. This consideration will involve :-

Impact on the residents, or planned admissions

Potential risk to others

Compatibility issues, especially where abuse of other residents has been an issue

Resource issues, including any specialist skills which may be required (e.g. following situations of abuse) to enable or support unit staff in providing a service

Other unplanned referrals using the service at the time, and the potential for blocking resources, which in turn could contribute to emergency situations arising for other people

3.4 Response to the Care Manager should be given as soon as possible, but within two hours from receipt of all relevant information.

3.5 Where there are additional resource implications (e.g. the individual requires special equipment, or their needs cannot be safely met within existing staffing levels) this should be clearly identified. Identification of responsibility for funding/providing additional resources must be agreed prior to any placement, and agreements must be honoured.

3.6 Standard 3.1 of The National Minimum Standards for Care Homes (Adults) concerns the registered person’s requirement to satisfy that the home can meet the needs of individual’s admitted to the home. There may be a tension between this and operational demands, particularly when no immediate



alternatives are available in the short term. When a referral for an unplanned admission to a home is made and this tension is present, the Service Manager for the area will need to take direct management of the issue, so a resolution to the competing needs of the commissioning and provider sectors is achieved.

3.7 Responsibilities for enabling the individual to travel to the service must be agreed by the Care Manager and the Unit Manager, or nominated deputy. Provision of transport must not compromise the safety or quality of the service provided to other people.

4.0 FOLLOWING UNPLANNED ADMISSION

4.1 It is essential that appropriate long term arrangements are identified and implemented as soon as possible, for the following reasons:-

To enable the individual to settle as soon as possible in new accommodation, or return to existing accommodation

To release the short-stay bed for use by other people

4.2 Where the referral was through the out of hours service, and no Care Manager has previously been involved, allocation will take place the next working day.

4.3 The Care Manager will be responsible for calling a Planning Meeting within 72 hours ( see Appendix 2). It will be adhered to as it provides the home and service user with a clear timescale and is to ensure planning for the person to move on starts as early as possible. It is acknowledged that this timescale could be tight for care managers especially if the admission were to happen on a Friday but the meeting is to plan the next steps with all appropriate people. If the end of the 72 hour period falls on a weekend or bank holiday, the planning meeting must take place first thing the next working day after. The meeting will involve :

Care Manager

Team Manager or Service Manager

Unit Manager or Service Manager

Client and representatives/carers

Other involved parties who may contribute (e.g. Day Service staff)

This meeting will be chaired by a Team Manager and outcomes and decisions will be clearly recorded with time frames. All outcomes for the service user should be based upon the principles of person centred planning and they should be involved as much as possible in planning and making decisions about future care.



The purpose will be to identify the short and if necessary medium term actions and responsibilities, required to enable appropriate services to be identified for developed, and provided/purchased. The Care Manager will liaise with their Service Manager to ensure funding for care is agreed on an interim basis until the next County Resource Meeting.

4.4 All unplanned admissions should be reported to the next County Resource Group, to identify future care for the service user concerned.



APPENDIX 1HAMPSHIRE COUNTY COUNCILSOCIAL SERVICES DEPARTMENT

UNPLANNED REFERRAL QUESTIONAIRRE FOR SHORT STAYLEARNING DISABILITY SERVICES

NAME CLIENT REFERENCE

DOB

ADDRESS

TELEPHONE NUMBER

NEXT OF KIN

ADDRESS

TELEPHONE NUMBER

EMERGENCY CONTACT

CARE MANAGER

DIRECT LINE

FULL ASSESSMENT ON SWIFT, UP TO DATE Y/N

IS PERSON KNOWN TO SERVICEY/N

DETAILS OF REASON FOR REQUEST FOR UNPLANNED ADMISSION/OBJECTIVE OF STAY



PROPOSED LENGTH OF STAY

MEDICAL CONDITIONS

MEDICATION DETAILS

CULTURAL/ETHNIC NEEDS

Does the person have any dietary requirements or allergies to food?

EMOTIONAL WELLBEING- is person distressed, anxious, experiencing symptoms of mental health? WHAT SUPPORT WOULD ASSIST THEM?

WILL THE PERSON REQUIRE MOBILITY SUPPORT? ARE THERE SPECIFIC ENVIRONMENTAL ISSUES (e.g. stairs, bathing aids)? Can use stairs?

EXPECTED SUPPORT NEEDS-night time cover, need for one to one?

EXTRA SUPPORT AGREED Y/N

BY WHOM?

TRANSPORT ARRANGED?

HOW LONG FOR?

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For the following it is expected that the Care Manager will visit the Unit prior to admission to fully discuss

Presenting behaviours

Risks to self and others

Existing guidelines and interventions

72 hour review bookedY/N

Date and time

OTHER AGENCIES

General PractitionerTelephone Number

Consultant PsychiatristTelephone Number

Any on call arrangementsTelephone Number

Admission agreed by

ANY OTHER INFORMATION

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APPENDIX 2HAMPSHIRE COUNTY COUNCILSOCIAL SERVCIES DEPARTMENT

72 HOUR REVIEW FOLLOWING UNPLANNED ADMISSION

NAME CLIENT REFERENCE

ASSESSMENT OF SUPPORT NEEDS/PLAN OF CARE

PERSONAL CARE NEEDS and what support is required

CULTURAL / ETHNIC / SPIRITUAL NEEDS describe these and what support is required to meet these

MEALTIMES – to include any dietary needs, level of independence, dis/likes, aids/adaptations, support required, seating/environment

HEALTH- to include general physical/mental well being, any conditions, allergies, medication details

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COMMUNICATION - to include how individual communicates their needs, level of understanding and comprehension, use of Makaton, other non verbal communication systems

DAILY LIVING SKILLS - to include mealtime preparation, money management, use of telephone etc

COMMUNITY LIVING SKILLS- does individual access community independently, what support required

CHALLENGING BEHAVIOUR / RISK TO SELF AND OTHERSPlease describe behaviours/risks

Has risk assessment been completed and control measures introduced

Are guidelines and interventions available and being followed

Are all staff fully conversant with above?

How ?

Who was involved in devising risk assessment, guidelines, interventions- Care Manager, Community Nurse, Consultant Psychiatrist, key-worker, Unit Manager?

PLAN OF STAY

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Objectives of stay- to include what is expected from provider services, e.g. stop gap / containment, to work with individual to reduce challenging behaviours, period of assessment prior to move on etc

SHORT TERM- next month

LONG TERM- six months or longerIt is an expectation that anyone admitted on an emergency basis, should not still be in Unit after six months (and hopefully much sooner than this)

Date of next Review (to take place monthly for al individuals admitted on an emergency basis. Care Managers to attend)

ANY OTHER INFORMATION

This is only the start of the assessment and care planning process. A more detailed care plan, using a person centred approach is to be developed with the individual as more information is gathered and the individual makes their wishes known.

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DEPARTMENTAL DISTRIBUTION LIST

DEPARTMENTAL MANAGEMENT TEAM

J CliftonS LoveA BrookerJ StannardD Ward

County Managers (Strategy & Operational)Group Finance ManagersComplaints Officer I UnwinOffice Service Manager G LimbLibrarian J MayChief Executive's Department K Phillipson/H EnrightCounty Treasurer's Department (Audit) S HardingRecords Manager C HardieDevelopment and Training Officer (Adults) G Richardson

PARTNERSHIP MANAGERS

SERVICE MANAGERSService Managers (Adults)

UNIT MANAGERS

Unit Managers (Learning Disabilities)

ADULTS

Strategic Manager (User and Carer Support) G Woollan

Project Co-ordinator C Gaston

Strategic Service Manager (Learning Disability) L ButlerSenior Administrative Assistant V Money

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Documents

SOCIAL SERVICES DEPARTMENTAL PROCEDURE NO:€¦ · Web viewThe Care Manager will liaise with their Service Manager to ensure funding for care is agreed on an interim basis until