Assessment

GUIDANCE V1.0 2015-04-01

CONTENTS

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

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

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

2. PRACTICE GUIDANCE ............................................................................................. 5

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

Assessment Process .................................................................................................. 5

First Point of Contact and Initial Information Gathering .............................................. 6

Urgent Need:.............................................................................................................. 7

Signposting and prevention ........................................................................................ 7

Individual with care and support needs or carer with support needs? ......................... 9

Individual with care and support needs Assessment .................................................. 9

Carer with support needs Assessment ..................................................................... 10

Refusal of assessment ............................................................................................. 10

Determining an Appropriate and Proportionate Assessment .................................... 10

Supported Self-assessment ..................................................................................... 11

Face-to-face assessment ......................................................................................... 12

Online or telephone assessment .............................................................................. 12

Joint assessment (i.e. with other agencies) .............................................................. 12

Combined assessment (i.e. individual and carer) ..................................................... 12

Assessing Needs, Outcomes and Impact on Wellbeing ........................................... 13

What does significant impact mean? ........................................................................ 13

Delivering a supported self-assessment ................................................................... 15

Delivering a joint assessment ................................................................................... 16

Working through the assessment form ..................................................................... 17

Analysing the information ......................................................................................... 18

Recording Desired Outcomes .................................................................................. 18

Consideration of Fluctuating Needs ......................................................................... 18

How can an accurate picture of fluctuating needs be established? ........................... 20

DOCUMENT HISTORY .................................................................................................. 22

1. INTRODUCTION / BACKGROUND This document seeks to provide practice guidance in relation to 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

Care and Support (Assessment) Regulations 2014 and

Chapter 6 of the Care and Support Statutory Guidance

Health and Care Services – Assessment Guidance (ADD Ref) Guidance 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:

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 • 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. There is no hierarchy in the areas of wellbeing listed above – all are equally important. There is also no single definition of wellbeing, as how this is interpreted will depend on the individual, their circumstances and their priorities. Wellbeing is a broad concept applying to several areas of life, not only to one or two. Therefore, using a holistic approach to ensure a clear understanding of the individual’s views is vital to identifying and defining wellbeing in each case. The flow chart included below (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.

Flow Chart – Assessment Process

SCIE 2015 www.scie.org.uk

2. PRACTICE GUIDANCE 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: At each stage in the process the following must be considered: Mental Capacity – the assessor 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 assessor must ensure that a person can be fully involved in the needs and carer’s assessment and when appropriate, facilitate that person’s involvement. In this context ‘advocacy’ means supporting a person to understand information, express their needs and wishes, secure their rights, represent their interests and obtain the care and support they need. The requirement to provide independent advocacy applies equally to individuals requiring care or support and to carers with support needs. Impact on the family and carers (whole family approach) – the assessor must take a holistic view of the impact on the whole family or other people the authority may feel appropriate and any potential need for a carer’s assessment. Safeguarding – the assessor must act upon any identified safeguarding issues as they occur. Where necessary the safeguarding process should run parallel to the assessment process and is not subject to any eligibility considerations. The assessor should recognise that they must make a similar response where it considers that a carer is at risk of harm or abuse Strengths-based approach – the assessor 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. When looking at this potential support, assessors should consider whether such networks have the capacity to continue to meet the adult’s needs on a regular basis. This helps to ensure the assessment is person-centred and focuses on both their individual and wider network’s strengths rather than on their condition. Ensuring assessment is proportionate and appropriate – This step details the requirements to ensure that the form of assessment is appropriate to support the individual’s involvement. This means it will be as extensive as is required to establish the extent of a person’s needs, will always be person-centred and will be based on their individual circumstances. ‘Proportionate’ and ‘appropriate’ are concepts that must be applied to all assessments and are not in themselves a form of care assessment. This applies equally to adults with care and support needs and carers with support needs. Assessment Process The assessment process is one of the most important elements of the care and support system. It starts when local authorities begin to collect information about the person. The

objective is to place the individual in control of the assessment process and enable them to lead as fully in the process as they wish to. The Care Act states that the focus of assessment should be:

To identify what needs a person may have

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 – asking people about outcomes in an assessment helps to keep information-gathering focused on the purpose.

(RIPFA, 2014) Good practice on undertaking assessments can be found in the following RIPFA publications. Good assessment: Practitioners’ Handbook Practice Tool: Supporting good assessment 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;

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

The following should also be considered:

whether the person has an immediate network of support and how this network contributes to the individual achieving their desired outcomes

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

It is important to consider that many of the people who qualify for independent advocacy under the Care Act may also qualify for a mental capacity advocate (MCA). The same advocate can therefore provide support as an advocate under the Care Act and the Mental Capacity Act. This ensures that the person receives seamless advocacy support and also avoids them having to repeat their stories for support under different legislation to different advocates 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. If it is established that the individual faces an urgent need a decision can be made whether to provide support without first conducting an assessment or eligibility determination. Under these circumstances steps should be taken to meet the identified urgent care needs immediately. The individual should also be informed that a more detailed needs assessment, an eligibility determination; establishment of ordinary residence and, in relation to individuals with care and support needs, a financial assessment will follow the intervention. This applies equally to adults with care and support needs and to carers with support needs. Signposting and prevention This builds on the provision of initial information provided at first contact and may run concurrently, particularly in cases where there is no urgent need identified. This is important in ensuring the assessment is centred on the needs of the person and is appropriate and proportionate to the individual’s circumstances. Following the completion of the initial information-gathering and provision it may be possible to identify an early or targeted intervention, such as universal services, a period of reablement or provision of equipment or minor household adaptations which could prevent, reduce or delay the progression or development of an individual’s needs. In these

circumstances the assessment process can be paused so that any benefit to the adult from the intervention may be determined. If such an opportunity to try a preventative service is not identified the assessment will continue without pause. Where 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 the 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 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 This applies equally to adults with care and support needs and carers with support needs. 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. 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 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.

Good Practice Point – Identifying what the assessment is for: Prior to contacting the person review the information gathered initially at first point of contact stage and any other information we have that is relevant. Decide if there is anything else you need to know before you contact the person, for example, are there any communication needs or is an advocate required. It is important to identify who has the information that is likely to be relevant. This starts with the person themselves, but may include their informal network and other people who are working with them. It is critical to ensure that at this point no assumptions are made in respect of the person’s needs or what support might meet these. The Care Act assumes that the person is the expert in their own situation and that, whilst ultimately a jointly produced understanding will result, the assessment should start with their views, wishes feelings and beliefs. (RIPFA, 2014)

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

whether the person has an immediate network of support and how this network contributes to the individual achieving their desired outcomes

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

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. The local authority is not required to meet any needs which are being met by a carer who is willing and able to do so, but it should record where that is the case. .

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. 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.

The outcome of the carer’s assessment will provide an understanding of the sustainability of the carer’s input in the short, medium and long term. The general principles of assessment also govern a carer’s assessment. For instance, the format of assessment must be appropriate to the carer’s circumstances. 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. 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 or 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 any assessment 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. In considering the specific assessment to be applied the following should be considered:

Where can the assessment take place?

Who will conduct the assessment?

Are there any specific communication needs to be addressed?

When will the assessment take place?

What is the mental capacity of the adult with care needs?

Who has been consulted?

Who will be involved? Any of the following assessment methods may be appropriate: Supported Self-assessment A supported self-assessment is one way of carrying out an assessment. It is led by the individual and supported by the local authority. A self-assessment can only be offered if the individual is willing and able to carry it out. The assessor should provide as much or as little support as the individual needs to do this. In carrying out a supported self-assessment all of our legal duties under the Care Act must be met in the same way as it would if it was carrying out the assessment in any other format, including identifying the person’s needs and outcomes and carrying out the assessment in an appropriate and proportionate way. Supported-self assessments should collect the same information about the individual as they would through another assessment format (such as face-to-face). The individual should be provided with access to the same information to that which an assessor acting for the authority would have, for example, the information gathered at first point of contact, any previous referral, assessment, support plan or review information relating to the person.

Face-to-face assessment A face-to-face assessment is conducted between the person requiring care and support and a practitioner or other approved assessor, for example, a representative from a carers’ organisation or specialist sensory loss assessor. Online or telephone assessment An online or telephone assessment may be an appropriate way of carrying out an assessment if, for example, the person who needs care and support has less complex needs, or is already known to the local authority and it is carrying out a re-assessment following a change in the person’s needs or circumstances. Assessments can only be undertaken via telephone or online, provided that the local authority has made sure it has fulfilled its duties in relation to the assessment and the need for safeguarding, independent advocacy and assessing mental capacity. Joint assessment (i.e. with other agencies) A joint assessment, where relevant agencies work together to avoid the person undergoing multiple assessments (including assessments in a prison, where local authorities may need to put particular emphasis on cross-agency cooperation and sharing of expertise) is a good way to fit around the needs of an individual. Doing joint assessments with more than one agency or local authority requires good practice in sharing information and working together to ensure needs are accounted for and provided for in a coordinated way. This should include transition assessments to reflect the changes in circumstances and desired outcomes on a young person’s transition to adult care and support – which applies equally for people in need of care and young carers, which should be conducted as joint assessments. Combined assessment (i.e. individual and carer) A combined assessment is where an adult’s assessment is combined with a carer’s assessment and/or an assessment relating to a child so that interrelated needs are properly captured and the process is as efficient as possible. If either of the individuals to be assessed disagrees with the proposal to combine assessments, the assessments must be carried out separately. Other questions to consider prior to determining the most appropriate and proportionate assessment type include:

Have you considered the individual’s capacity to understand and carry out a supported self-assessment, and understood what limitations they might have?

Have you made sure that the individual has all the information needed in order to lead the assessment process?

Have you agreed with the individual what information needs to be included as part of the assessment?

Have you made sure there is an independent advocate in place where required?

Is the individual aware of which other professionals, if any, need to input into the assessment and what support is needed to contact them? Are there any other assessments in progress? If so, could they be carried out jointly or as a combined assessment?

If there is a carer and an adult supported self-assessment to be completed, have you considered, jointly with the adult and the carer, that the same assessor supports both self-assessments?

Have you taken into account a whole-family approach – identifying how the

individual’s needs for care and support impact on family members or other people in their support network?

Is a specialist practitioner with specific training and expertise required to support an individual who is deafblind?

Assessing Needs, Outcomes and Impact on Wellbeing The information collected during the assessment process must be accurate and sufficient enough 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 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 and whether this is significant

any care being provided by a carer What does significant impact mean? The term ‘significant’ is not defined in the regulations, and must therefore be understood to have its every day meaning. A given situation could have a ‘significant impact’ on one individual but not on another. Therefore, professional judgement and analysis of the information gathered in the assessment are crucial to establishing whether there is indeed ‘significant impact’ on the individual’s wellbeing. Consideration must be given to the adult’s needs and their consequent inability to achieve the relevant outcomes. It is important to look at the consequential effect on their daily lives, their independence and their wellbeing. The following are examples of what ‘significant impact’ could mean:

Significant impact could be a consequence of a single effect: this means that the inability to achieve two or more outcomes affects at least one of the areas of wellbeing in a significant way.

Significant impact could be a consequence of a cumulative effect: this means that the individual may have needs across several of the eligibility outcomes, perhaps at a relatively low level, but as these needs affect the individual in various areas of their life, the overall impact on the individual is significant. For example, an adult is

struggling to manage and maintain their nutrition, personal hygiene and toilet needs as their standards are reducing due to low social interaction and decreasing mobility around the home. The adult is consequently very close to becoming unable to meet most of the outcomes. It could be argued that the adult does not meet condition 3 of the eligibility criteria for adults with care and support needs due to the level of needs being relatively low. However, taking a holistic view of the level of impact of the individual’s mobility needs, and the accumulation of a number of the ‘low/medium’ levels of needs, this adds up to ‘significant impact’ in the adult’s wellbeing.

Significant impact could be a consequence of a domino effect: this means that currently the individual may have needs in relation to few eligibility outcomes, but it can be anticipated that in the near future other outcomes will be affected, causing a significant impact on the individual’s wellbeing. For example, an individual has identified needs around their inability to maintain relationships with their family and in making use of facilities or services in the local community, but currently does not have any problems with managing and maintaining their nutrition, personal hygiene or a habitable home environment. However, the individual is depressed, affecting their ability to interact socially. As a result, their emotional situation is decreasing further to the extent that it is clear that in the near future they also will not be able to manage or maintain nutrition, personal hygiene or a habitable home. Therefore, the impact on the individual’s wellbeing is significant.

Any assessment undertaken must be proportionate to the needs and circumstances of the individual and remain so for the duration of the assessment process. However, all assessments, regardless of the method by which they were carried out, must be sufficiently comprehensive and accurate to enable eligibility to be determined. Therefore, for all assessments and especially for supported self-assessments, assessors need to consider the following: Is the information gathered comprehensive?

Are there any gaps which are not proportionate to the needs or circumstances? Have all needs, not only presenting needs, been captured? Has the individual

clearly defined their desired outcomes? Do you need to include anyone else's views or input? With relevant consent, have

all views of members of individual social network been considered? Have other professionals dealing with the individual provided their views?

Is the information gathered accurate?

Is the information consistent? If mobility is poor, is this reflected appropriately in other needs? If individual has a health condition, is this reflected in all the needs? If an individual has no social network support, and no ability to undertake certain

tasks, is this clearly captured? Do you need to check the information with someone else? If there is no certainty/clarity on mobility, or impact of health, is it worth checking

with physio or District Nurse/GP? Is any evidence needed to confirm information? Consider asking the individual to demonstrate their mobility, or ability to prepare

food, etc.

Identifying what the story is - doing the assessment

It is essential that you keep in mind who the assessment is about and what it is for. The person being assessed should always be informed of what information is being gathered and why. N.B. The Care Act 2014 states that “No matter how complex a person’s needs, local authorities are required to involve people, to help them express their wishes and feelings, to support them to weigh up options, and to make their own decisions. The person should, therefore, be encouraged and supported to participate as fully as possible in the assessment process irrespective of whether it appears they lack capacity. This may include using observation and taking account of other verbal or non-verbal cues. When supporting with the person to identify their needs information gathered should:

Reflect what is important to the person in terms of promoting their wellbeing and maintaining their independence

Be professionally recorded but reflect the persons views, wishes, feeling and beliefs

Be underpinned by observations and fact, especially if recording opinions, whether of the practitioner, the person or any other stakeholder

(RIPFA, 2014)

Delivering a supported self-assessment Before commencing a supported self-assessment process practitioners need to make sure that the supported self-assessment can accurately and completely reflect the individual’s needs, desired outcomes and impact of needs on their wellbeing. It is important for practitioners to bear in mind that the supported self-assessment is an iterative process, and that they will be called upon at different points in the process if the person being assessed decides that this is appropriate or needed. In order to deliver a supported self-assessment, the following steps should be followed:

Other questions to consider include:

Have you considered the individual’s capacity to understand and carry out a supported self-assessment, and understood what limitations they might have?

Have you made sure that the individual has all the information needed in order to lead the assessment process?

Have you agreed with the individual what information needs to be included as part of the assessment?

Have you made sure there is an independent advocate in place where required? Is the individual aware of which other professionals, if any, need to input into the

assessment and what support is needed to contact them? Are there any other assessments in progress? If so, could they be carried out jointly or as a combined assessment?

If there is a carer and an adult supported self-assessment to be completed, have you considered, jointly with the adult and the carer, that the same assessor supports both self-assessments? Have you taken into account a whole-family approach – identifying how the individual’s needs for care and support impact on family members or other people in their support network?

Is a specialist practitioner with specific training and expertise required to support an individual who is deafblind?

As part of their responsibility the practitioner will use their skills and experience, working with the individual, to judge/assess the individual’s ability to conduct their ‘self-assessment’ satisfactorily and as independently as possible, as well as finding out how much support each individual will need to complete the process. Here are two examples. The first example is where the individual is clear about their presenting needs, which cover several of the eligibility outcomes. However, they lack the insight to understand their position relating to areas other than the presenting needs. For example, they may be fully aware of their difficulty in maintaining their nutrition and personal hygiene, but not aware of the impact their situation has in terms of developing or maintaining personal or family relationships. Alternatively, they may be fully aware of their difficulty in maintaining social relationships, and feel isolated, but lack awareness of the impact this has in their motivation and ability to maintain nutrition and personal hygiene. In this instance, the practitioner, having prepared the individual fully and having provided prompts and guidance to enable the individual to complete as much as possible on their own, will agree with the individual that they contact the practitioner when they do not feel able to continue with or complete the assessment. The second example is where the individual is clear about their needs, but finds it difficult to express their desired outcomes. Here the practitioner, after talking the individual through the assessment material and process, may agree with the individual that they will complete the section about their needs, then call in the practitioner again when completed. Then the practitioner can support the individual in describing their desired outcomes for one of the identified areas/needs, so that the individual can do the same for all the other areas. The individual could call the practitioner to go through the entire assessment to ensure its accuracy and completeness or could call for guidance on specific parts that they do want to complete on their own before the assurance process. Delivering a joint assessment Individual with care and support needs, or equally carers with support needs, may have health needs as well. Undertaking a joint assessment ensures that all of the persons health and care needs are being dealt with in a joined up way.

Having a joint assessment ensures that all of the person’s needs are being assessed and the relevant agencies can work together with the person to prepare a joint plan to meet their care and support and health needs. The Act contains all the necessary powers for joint assessments and support planning, plus the duties to co-operate to provide a mechanism for one of the authorities in a case like this, to require the cooperation of the other, if needed. Where relevant, the local authority may use the cooperation procedures set out in the Care Act to require cooperation from the CCG, or other relevant partners. Providing joint care and support and health plans will avoid duplication of processes and the need for multiple monitoring regimes. Information should be shared as quickly as possible with the minimum of bureaucracy and in accordance with agreed data sharing protocols. Assessors should work alongside health and other professionals where plans are developed jointly to establish a ‘lead’ organisation which undertakes monitoring and assurance of the combined plan. Consideration should be given as to whether a person should receive a personal budget and a personal health budget to support integration of services. The benefits of joint assessments apply equally to adults with care and support needs and carers with support needs. Working through the assessment form The assessment should be holistic and support the person to think about all aspects of their life and needs. However, it is also important to ensure it is proportional and appropriate - concentrating more on those domains where the individual has identified a need is important to them and impacts on their wellbeing. The wording of the form is designed to promote the use of open questions, for example:

Please tell us about this aspect of your life now and if anything has changed for you. Include things like:

what is most important to you about how you spend your time including any that have cultural or religious significance

what is good that you would like to stay the same, any support you already get to help you spend your time doing things you value or enjoy

what, if anything you would like to change, the outcomes you want to achieve Please give us details of any family, friends, neighbours, or other organisations who support you with this area of your life. If you feel that any of the above has a significant impact on your wellbeing please tell us here

Some of the sections within the assessment form now include questions designed to capture information about the person’s quality of life and how they feel about this. These quality of life questions are used to help draw out different aspects of people’s wellbeing in line with principles defined in the Care Act. It is important to support people to answer these questions as this will assist with analysis, decision making and support planning. It may be necessary to be flexible in how the question is asked to enable the person participate. However, it is important to use an open questioning technique when phrasing exchanges. Where a person appears to lack

capacity to understand or answer a question you should take account of any non-verbal cues. (RIPFA, 2014) For more information refer to guidance around asking the quality of life Guidance on having conversation about outcomes can be found in the RIPFA Practice Tool: Working with outcomes Analysing the information Analysis helps us to make sense of the information and look at how the different parts fit together to build up a picture of what the meaning of the situation is. As you are gathering the information, you should be weighing up its usefulness – based on what it tells you and where it comes from. Once you have a picture, you can then properly analyse what the information means. The analysis, which should be evident in each of the assessed domains, should explain:

What needs the person has

The impact of these needs on their wellbeing

The level of significance the person places on the need

The outcomes the person wishes to achieve – taking account of strengths, assets and options for achieving them

The following should also be considered:

whether the person has an immediate network of support and how this network contributes to the individual achieving their desired outcomes

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

It should also aid understanding of the situation by the person, and anyone else who requires it to support them, and clearly demonstrate what this means for the persons wellbeing. It is important that you clearly record the needs the person wishes to be met and the outcomes they wish to achieve. Assessors are referred to the Case Recording Standards for good practice on recording information during the assessment process. Recording Desired Outcomes Desired outcomes identified through the assessment and analysis process should be recorded in the persons own words wherever possible. The person should be supported to score each by thinking about where they are currently in relation to achieving it. Consideration should be given to how the person’s desired outcomes fit with the specified outcomes in the eligibility criteria. 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. The assessment should consider the person’s care and support history over a period of time which captures the need in terms of frequency and degree of fluctuation. 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 To provide an accurate assessment of care needs – whatever form that assessment takes – the ‘good’ and ‘bad’ must be fully explored over a suitable period of time to provide as complete a picture of the range of fluctuation as possible. It is important to note that ‘suitable’ length of time in this instance will vary from person to person. Fluctuation may be short term over the course of a day or longer term over weeks or months. Example issues to consider in relation to fluctuating needs include:

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.

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 to the appropriate eligibility procedures and/or guidance.

Understanding the person’s history will enable a complete picture of their needs to be established, which may show a relatively ‘good’ condition (manageable periods) interspersed with episodic ‘bad’ (negative) events or a generally ‘bad’ standard (creating a challenging impact on wellbeing), interspersed with more severe episodes. An understanding of these issues will allow the local authority to develop as appropriate:

subject to eligibility determination, contingency planning for events built into care plans to allow rapid response to access extra support

the provision of preventative interventions to delay or prevent the development of further needs in the future.

It is also important to recognise that fluctuation in needs may also have implications when considering eligibility and an accurate assessment of this is vital to ensure a correct determination is made.

How can an accurate picture of fluctuating needs be established?

Determining the extent of fluctuating needs is a decision that must be made on a case-by-case basis but, in practice, practitioners will be required to:

Establish what impact can be reasonably expected from knowledge of people with similar conditions or circumstances, which can be based on the practitioner’s own experience and may also require advice from someone with expert knowledge about a specific condition.

Encourage the person and their carer to keep a diary to record the ‘good’ and ‘bad’ days to ensure need, and the impact it has on desired outcomes individually and collectively, is captured in its totality wherever possible to ensure the record is as holistic as possible.

Establish how long a ‘suitable time’ might be to assess need fluctuation – for example, ask the person a series of questions, along the lines of:

How are you today? (Is it a ‘good’ day?) How long since you last had a bad day or series of bad days? How often does it get bad? How long is it since you have felt at your best?

Establish the extent of the fluctuation in relation to severity, duration and frequency – for example, you could ask:

How good/bad does it get? What does a ‘bad’ day or series of days prevent you from doing? (To

establish the impact of the fluctuation on desired outcomes) How often do things change? Who helps you on a bad day? What helps you on a good day?

If the person cannot answer these questions due to capacity or communication issues, ask the opinion of their carer or advocate and other relevant healthcare professionals on these issues.

The impact on carers must also be considered – first by establishing if they themselves have a condition requiring care and support, and then by establishing:

the extent to which the fluctuation in the person’s needs has an impact on their wellbeing

the extent to which their circumstances and environment cause a fluctuating impact on their wellbeing.

If the carer cannot answer these questions due to capacity or communication issues, ask the opinion of their advocate.

DOCUMENT HISTORY

RELATED DOCUMENTS

RELATED DOCUMENTS

ASC-P34 Procedure Assessment ASC-P35 Procedure Eligibility

Guidance – Eligibility

ASC-P41 Procedure Ordinary Residence

ASC-P3 Procedure Case Recording Standards

ASC-P9 Procedure Safeguarding

Guidance – Accessible Information

IAS Guidance

DOCUMENTS SUPERSEDED BY THIS GUIDANCE

APPROVAL AND REVIEW

Original Author: Cheryl Page / Louise Johnstone

Current Author: (If different to original author)

Approved By: (Insert groups/ bodies and dates)

Care Act Programme Board – 12/03/15 Legal Services – 02/03/15

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

Last Approved By:

Date Originally Published:

Date of Next Review:

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