Coursework Cover Sheet

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Department and assessment information:

School Name:

School of Health, Social Work & Sport

Assessment title:

Portfolio

Course Title: Social Work

Module Title: Law and Safeguarding

Module Code: SW1070

Year of Study: 2023/24

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Well-being

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Adult Case study

Wahida is a woman who is fiercely independent and worked as an accountant for 30 years. Wahida is estranged from her son Arun, who works full time and lives with his own family 50 miles away. Wahida expressed to her friends and family clearly and many times throughout her life that she does not want to go into a care home.

Wahida has a diagnosis of small vessel disease with she also has osteoarthritis which impacts upon her mobility, and which has resulted in some falls at home. Wahida is also hearing impaired. Wahida has been managing her personal care and most of her day-to-day tasks relatively independently. Wahida goes out shopping to the town centre and visits her extended family network each week.

Wahida has more recently deteriorated in terms of her symptoms of small vessel disease, and she is experiencing increased short term memory issues and irritability. There are concerns that Wahida has vascular dementia.

Within the last week, a local shop keeper rang the Police when Wahida became confused about her change. She had begun to become agitated towards him and then almost fell over. Wahida appeared to be unkempt in her appearance. The Police Community Support Officer (PCSO) asked Wahida if she was ok, but Wahida became agitated. The PCSO escorted Wahida to her home.

The PCSO found that Wahidas front door was left completely unlocked. The central heating was broken on in the property despite it being December. There was no food in the fridge. When the PCSO asked Wahida about what she eats every day, she advised her that she was Absolutely fine!. The PCSO found that the living room was cluttered with many items. The PCSO found that the bath and shower were bone dry with old completely spent toiletries. The PCSO found that Wahida was relying upon an electric heater in her bedroom which was found under a blanket on her bed.

The PCSO discussed with Wahida that she was going raise an urgent safeguarding and Wahida looked at him blankly. The PCSO also felt, that on balance of probability that Wahida lacked mental capacity to give consent to contact Adult Social Care and that it would be in Wahidas best interest for her to make contact.

Question 1 (600 words) LO1, LO2

What are the main legal provisions that provide for the assessment of Wahidas care and support needs?

Starting point

Always start at recognising Article 8 Human Rights Act 1998.

Then consider core duties under the Care Act 2014.

Under s.1(1) the local authority must promote wellbeing when carrying out any of their care and support functions in respect of Wahida.

Wellbeing is defined in s.1(2) and means:

personal dignity; physical and mental health and emotional well-being; protection from abuse and neglect; control by the individual over day-to-day life; participation in work, education, training or recreation; social and economic well-being; domestic, family and personal relationships; suitability of living accommodation; the individual's contribution to society.

Role and responsibility of the social worker is to think about s.1 the underlying principle of Wellbeing.The social worker will ask questions to Wahida around these nine domains as part of the social care assessment. Some will be more pertinent to Wahida than others.

Dont forget Wahida is seen as best placed to judge her own wellbeing.

Also look at s.1(3a-h) and the CSSG 1.14. Dont forget the 8 (a to h) key principles and standards which Social Workers must have regard to in Practice under the Care Act 2014. Therefore, the local authority must have regard to her views, wishes, feelings and beliefs. You should not make assumptions as to what matters most to the person. This is critical to a strengths-based approach.

You would also need to consider the Equality Act 2010. The local authority, as a public authority, has a duty under s.149 to eliminate discrimination, advance equality of opportunity and foster good relations. Does Wahida meet one of the protected characteristics?

Assessment under the Care Act 2014

Starting point is the duty to prevent needs arising under s.2. The local authority needs to consider what, if anything, can be done to prevent harm before it develops or reduce or delay needs that are worsening e.g. through re-ablement, intermediate care, early intervention etc.

Likewise, s.4 places a duty on the local authority to establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers. Not only does information and advice help to promote peoples wellbeing by increasing their ability to exercise choice and control, it is also a vital component of preventing or delaying peoples need for care and support.

Given the situation for Wahida, it is unlikely that preventative services would be sufficient, and he should be offered an assessment under s.9: Assessment of an adult's needs for care and support.

S.9 Need Assessment

Wahida has the right to an assessment under s.9.

S.9 Where it appears to a local authority that an adult may have needs for care and support, the authority must assess

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<!--[endif]-->whether the adult does have needs for care and support, and

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<!--[endif]-->if the adult does, what those needs are.

Where it appears to the local authority that an adult may have needs for care and support, the authority must assess regardless of their views on;

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o

<!--[endif]-->level of needs for care and support s.9(3)

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o

<!--[endif]-->level of financial resources s.9(3).

The assessment must involve Wahida (s.9.5) and her carer.

Dont forget Wahida has the right to refuse an assessment if she has capacity to do so under s.11. Unless she lacks capacity to refuse the assessment and the local authority is satisfied that carrying out the assessment would be in her best interests, or she is experiencing, or is at risk of, abuse or neglect (s.11(2)).

The assessment must be in accordance to s.9(4) and include an assessment of;

(a) the impact of the adult's needs for care and support on their wellbeing,

(b) the outcomes that the adult wishes to achieve in day-to-day life, and

(c) whether, and if so to what extent, the provision of care and support could contribute to the achievement of those outcomes.

The local authority has a duty under s.67 to provide an independent advocateto represent and support the person for the purpose of facilitating involvement unless there is an appropriate other to represent and support the person. Wahida may have Arun to support her in her case.

The assessment must be carried out in an appropriate and proportionate manner (s.12).What does appropriate mean?

Appropriate

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<!--[endif]-->6.35 The assessment must be person-centred throughout.

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<!--[endif]-->6.37 should establish the individuals communication needs and seek to adapt the assessment process accordingly.

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<!--[endif]-->6.40 should give consideration to the preferences of the individual with regards to the timing, location and medium of the assessment.

Proportionate

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<!--[endif]-->Consider level of complexity of need but they might not want all their needs met!

Prevention

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<!--[endif]-->It is during the assessment that the LA can identify needs that could be reduced, or where escalation can be delayed and help people improve their wellbeing by providing specific preventative services, information on other community services or other universal services.

The assessment must be person-centred throughout. It should establish the individuals communication needs and seek to adapt the assessment process accordingly. It should give consideration to the preferences of the individual with regards to the timing, location and medium of the assessment.

The CSSG describes a number of ways that an assessment can be undertaken. These include via telephone, online, face to face, supported self-assessment, combined assessment with carer, joint or integrated assessment or transition assessment. What do you think would be appropriate with Wahida?

Both Wahida and Arun have a right to a written copy of the assessment (s.12(3)).

S.10 Carers Assessment

The local authority has a duty to undertake a carers assessment under s.10 where it appears a carer may have needs for support.

Sections 10 (5) (6) (7) specify the conditions of a carers assessment.

CSSG (6.18) Carers assessments must seek to establish not only the carers needs for support, but also the sustainability of the caring role itself, which includes both the practical and emotional support the carer provides to the adult. [there] must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care.

CSSG (6.19) The carers assessment must also consider the outcomes that the carer wants to achieve in their daily life, their activities beyond their caring responsibilities, and the impact of caring upon those activities. This includes considering the impact of caring responsibilities on a carers desire and ability to work and to partake in education, training or recreational activities, such as having time to themselves.

Question 2 (500 words) LO1, LO2, LO3

There are some concerns about Wahidas ability to make decisions for her care and residence. What decisions does she need to make and how would you go about assessing her capacity to make these?

What decision/s does Wahida need to make?

Wahida has expressed that she wants to remain in her own home. Other people (family, GP, Professional) may hold a different views and Wahida j may face risks by remaining in her own home.

The choice for Wahidais:

Option 1 = Wahida could go into a Care Home

Option 2 = Wahidacould stay in her own home with an increased care package

However, you need to start with the 5 statutory principles in s.1 of the Mental Capacity Act 2005.

MCA Principle 1: A person (Wahida) must be assumed to have capacity (to make this decision) unless it is established that s/he lacks capacity. (section1(2))

<!-- [if !supportLists]-->

<!--[endif]-->Wahida, therefore, needs to be supported to make this decision herself.

MCA Principle 2: A person (Wahida) is not to be treated as unable to make a decision unless all practicable steps to help her to do so have been taken without success. (section1(3)).

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<!--[endif]-->How would you support Wahida to make a decision? Think about practical steps, relevant information, communicating in an appropriate way, making her feel at ease and supporting the person.

Dont forget to adhere to Principle 3: A person is not treated as unable to make a decision merely because they make an unwise decision.

Principles 4 and 5 relate to Wahida if she is assessed as not having capacity to make a specific decision.

If you feel that within the dialogue with Wahida that Wahida lacks mental capacity to make the identified decisions about how and where her care needs would be best met, and all practical steps have been exhausted, then what would you need to do?

Remember anybody who claims that an individual lacks capacity should be able to provide proof.

They need to be able to show, on the balance of probabilities, that the individual lacks capacity to make a particular decision, at the time it needs to be made (section 2(4)).

The definition of capacity is in s.2(1);

A person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.

Dont forget it is decision specific and time specific.

The MCA Code of Practice 2007 (4.11 4.13) defines a two-stage test of capacity:

1. Is there an impairment of, or disturbance in the functioning of the persons mind or brain? This is also known as the diagnostic test.

2. If so, is the impairment or disturbance sufficient to cause the person to be unable to make that particular decision at the relevant time? This is also known as the functional test.

For the diagnostic test, can you identify any evidence of an impairment or disturbance in in the functioning of the mind or brain for Wahida?

Wahida has a potential diagnosis of Alzheimers disease. She has experienced a recent deterioration in terms of her symptoms relating to dementia. This would indicate that she meets the diagnostic test. Dont forget Wahida doesnt actually need a formal medical diagnosis for this test.

The inability to make a decision i.e. functional test is found in s.3(1).

The person is unable to make a decision if they are unable:

to understand the information relevant to the decision; or

to retain that information; or

to use or weigh that information as part of the process of making the decision; or

to communicate his decision (whether by talking, using sign language or any other means).

If Wahida is unable to do any of these four elements, then she is unable to make a decision.

Dont forget the causative nexus. The inability to make the decision has to be linked to the diagnostic test. So, the inability to make the decision is because of the identified impairment or disturbance in the mind or brain (see PC & NC v York Council [2013]).

So, in summary. Does Wahida have an impairment or disturbance in the functioning of the mind or brain (diagnostic test)? Is Wahida able to make the identified decision (functional test)? Is there a direct link between the diagnostic test and the inability to make the decision (causative nexus)?

If Wahida does lack capacity to make specific decisions, then any act done, or decision make must be in his best interests (s.4).

Question 3 (400 words) LO1, LO2, LO3, LO4

What are the safeguarding concerns for Wahida? What are your legal responsibilities in relation to these?

Safeguarding s.42 of the Care Act 2014.

CSSG (14.7) Safeguarding means protecting an adults right to live in safety, free from abuse and neglect.

Under s.42(1) if a local authority has reasonable cause to suspect that an adult;

(a) has needs for care and support (whether or not the authority is meeting any of those needs),

(b) is experiencing, or is at risk of, abuse or neglect, and

(c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it, then;

(2) The local authority must make enquiries to enable it to decide whether any action should be taken in the adult's case and, if so, what and by whom.

6 key principles of safeguarding (14.13):

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<!--[endif]-->Empowerment

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o

<!--[endif]-->Prevention

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o

<!--[endif]-->Proportionality

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o

<!--[endif]-->Protection

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o

<!--[endif]-->Partnership

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o

<!--[endif]-->Accountability

Safeguarding must be personal. CSSG (14.15)

There needs to be a balance between protecting people from harm and empowering people to make their own decisions.

What are the key risks, signs and symptoms of possible safeguarding concerns for Wahida?

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<!--[endif]-->Confused when out

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<!--[endif]-->Unkempt in appearance

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<!--[endif]-->Became agitated

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<!--[endif]-->Risk of falls

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<!--[endif]-->Door left unlocked

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<!--[endif]-->No heating

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<!--[endif]-->No food in fridge

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<!--[endif]-->Cluttered living room

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<!--[endif]-->Bath/ shower bone dry and old toiletries

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<!--[endif]-->Using an electric heater that was found covered

How do these fit into the categories of abuse and neglect identified in 14.17?

The assessment for care and support should run parallel to the safeguarding enquiry and the enquiry should not disrupt the assessment process or the local authority meeting eligible needs. See CSSG 6.54 & 6.57.

Dont forget about the ethical dilemmas that run through the case study.

How do you think Wahidas needs should be best met? How do you think Wahida would like her needs met? How do you think Arun would like his mums needs met?