This chapter was last reviewed and/or updated April 2021.
The Quality Practice Standards (QPS) are one of the ways Lincolnshire County Council ensures best practice within Adult Social Care. They are used in conjunction with other professional standards and guidelines to set the benchmark for ‘good practice’ and drive Continuous Professional Development.
The Quality Practice Audits (QPAs) are based upon these 14 standards.
A ‘print friendly’ version of the Quality Practice Standards is available on our website.
- Standard 1 – Engaging with our customers
- Standard 2 – Strengths Based Assessment
- Standard 3 – Assessing and Managing Risks
- Standard 4 – Safeguarding Adults at Risk of Harm
- Standard 5 – Safeguarding Children
- Standard 6 – Mental Capacity
- Standard 7 – Valuing Diversity
- Standard 8 – NHS Continuing Healthcare
- Standard 9 – Outcome Focused Care and Support Planning
- Standard 10 – Maximising Choice and Control over Care Delivery
- Standard 11 – Monitoring, Reviewing and Reassessing Support Arrangements
- Standard 12 – Closing Cases
- Standard 13 – The Quality of our Recording
- Standard 14 – Carers
Standard 1 – Engaging with our customers
There is evidence of the customer being engaged with as fully as possible in all aspects of our work with them.
- All case activity should be person centred, with the person’s voice, wishes and feelings evident in their documents and records.
- Excepting assessments conducted initially over the phone, all new assessments should include face to face communication with the person.
- The person should always be given the opportunity to be seen on their own and where they do not wish to do this or we are not able to, the reasons should be recorded.
- There should be evidence that we are compliant with our statutory duties to support the person to fully understand and engage with our work and provide:
- information and advice regarding the assessment and review process;
- support with communication difficulties;
- access to independent advocacy where required.
- It is clear who our customer is – relationships dynamics have been considered to ensure that the people dealing with us on behalf of the assessed person are supportive, giving voice to the person and acting in their best interests.
Standard 2 – Strengths Based Assessment
Assessments adopt a strengths based approach with:
- a focus on what is strong in the person’s life;
- care and support needs and impact on wellbeing clearly identified;
- clear evidence of which needs are eligible for support;
- the potential use of informal support networks is explored.
- It should be evident that the assessor has oriented their assessment from an understanding of what is working well with the person, their aspirations, their relationships and opportunities to sustain and develop further networks of support.
- Assessments should be proportionate to the person’s presenting circumstances and areas of concern and risk.
- Assessments should clearly identify where the person needs care and support and the impact on their wellbeing of those needs not being met, with the eligibility determination and rationale stating which needs are eligible for support.
- Assessments should reflect a whole family approach exploring the impact of the persons needs on those around them (see Standard 5 – Safeguarding Children and Standard 14 – Carers).
- There should be evidence of input from professionals with appropriate expertise to understand the presenting situation. Neighbourhood working should be used where customers with complex or long term conditions would benefit from a joint assessment and planning.
- The assessment should evidence where options other than the provision of formal services have been considered and suggested to support the person to achieve their desired outcomes and maintain their wellbeing.
- The person should be given a copy of their assessment, providing a clear statement of their needs and eligibility, irrespective of their eligibility or whether they go on to receive formal support.
Standard 3 – Assessing and Managing Risks
The assessment, planning and case recording proportionately reflect areas of risk.
- The assessment process has identified and clearly recorded risks and potential hazardous occurrences, decision making is clear, and risk management is addressed in care and support planning.
- There has been a review of relevant case history to identify incidents, patterns and concerns where the nature of risks relate to people or children involved in the person’s support network or where the council may hold historic information.
- The person is kept at the centre of the risk assessment process and where there are identified risks, the person’s capacity to make decisions in relation to those risks is evident.
- Where the person has made decisions that put them at risk, there should be robust evidence of conversations with the person about the assessed risks and any actions to minimise risks.
- There is appropriate consideration as to whether a Risk Assessment and Management Plan (RAMP) is required where circumstances dictate a more detailed exploration of risk issues covered in routine needs assessment and support planning and that the RAMP has involved the relevant people, e.g. informal support, external agencies and / or the Safeguarding team.
- There is evidence that risks which trigger safeguarding duties have been addressed in line with Adult Care Safeguarding Policy and Procedures.
- There is evidence that cases with significant risks requiring ongoing monitoring and review receive appropriate line management oversight.
Standard 4 – Safeguarding Adults at Risk of Harm
Safeguarding concerns should be addressed effectively to support adults to live safely, with reference to the Adult Care Safeguarding Policy and Procedures.
- It is evident that consideration has been given to potential safeguarding issues with Safeguarding Adults concerns recorded where appropriate.
- It is evident that the practitioner has demonstrated professional curiosity to explore with the person the safeguarding concerns, and establish an understanding of the situation, their wishes and the outcome they want to achieve.
- It is evident the person’s capacity to make decisions has been assessed and evidenced and actions are consensual wherever possible. Where the person lacks capacity to give consent, practice will be in accordance with the Mental Capacity Act (MCA).
- The response is centred around the person’s wishes and feelings and reflects the principles of Making Safeguarding Personal and the Care Act, with evidence of communication with the person throughout all stages of the process.
- Consideration is given to knowledge of previous occurrences and risks and patterns of abuse, with evidence that a full case history has been obtained and any historic files stored offsite have been requested and reviewed.
- All communication between Assessment Teams and Safeguarding practitioners is clearly recorded by the case worker who initiated the communication and any agreed actions and advice is clearly recorded.
- The care and support plan reflects measures to respond to safeguarding concerns, with a robust Risk Assessment and Management Plan evident in all situations where there is an ongoing risk of harm.
- Domestic abuse issues are considered and addressed in line with Lincolnshire’s Domestic Abuse procedures – see Lincolnshire County Council’s Domestic Abuse website.
- Where there are concerns that more than one person in a relationship is experiencing harm, including where they may also be a perpetrator, we have ensured that all people experiencing harm are subject to a DASH risk assessment.
- There is evidence within the customer’s record that safeguarding cases have had regular oversight by Lead Practitioners, and any actions and decisions are recorded.
- Appropriate warnings and alerts have been recorded in the person’s record, and any related records of both victims and perpetrators will flag specific risks.
Standard 5 – Safeguarding Children
Assessment or review episodes should establish where children are present in the same household or in regular contact with the customer or carer, and any child welfare concerns should be explored.
- The assessment process should adopt a whole family approach and evidence that there has been consideration of any safeguarding children issues throughout, with appropriate consideration given to joint working with Children’s Services Early Help or Safeguarding teams.
- There should be accurate recording of relationships of any children that are in contact with or impacted by the care needs of customers, the nature of the relationship is covered in the family and relationships section of assessments, and importantly, they are recorded and appropriately linked in related case records.
- The assessment should show exploration of the impact on carers who are also caring for children and appropriate consideration of working with the Lincolnshire Carers Service.
- The record will evidence appropriate case discussions with line managers, clear decision making and rationale including consideration of risk factors.
- The assessment process should reflect an awareness and understanding of the impact of domestic abuse and the effect of repeated domestic abuse incidents on children or the victim – see Lincolnshire County Council’s Domestic Abuse website.
- There should be effective, timely and secure information sharing which is accurate, proportionate, necessary and only shared with those who need it to allow a full consideration of the risks to children and victims living with domestic abuse at the earliest opportunity.
Additional Guidance: Quality Practice Standards – Additional Guidance Standard 5 – Safeguarding children
Standard 6 – Mental Capacity
It is clearly demonstrated that the legal requirements of the Mental Capacity Act have been adhered to.
- There is evidence the practitioner has considered the person’s capacity to make specific decisions at all key points in the episode using the five statutory principles of the Mental Capacity Act.
- Where needed, there is a capacity assessment which clearly defines the decision it relates to and states the causal nexus i.e. the impairment of, or a disturbance in the functioning of, the mind or brain that is the cause of the person’s inability to make a decision.
- Best interest meetings and decisions are clearly recorded with the decision-maker clearly identified and evidence of Best Interests Checklists informing the decision.
- Where appropriate, the worker has involved other professionals’ assessments of cognitive functioning to inform their assessment of the person’s capacity to make the decision being considered.
- The worker has identified existing Lasting Power of Attorneys (LPAs) or Court Orders and obtained copies for the customer’s record to confirm scope of authority.
- The Deprivation of Liberty Safeguards (DoLS) have been considered, where the care and treatment commissioned and provided results in the person being under constant supervision and control and is not free to leave. This applies to people in care homes, hospitals, commissioned community settings, or in their own homes.
- Appropriate use of Independent Mental Capacity Advocates (IMCA) and advocacy and support can be evidenced.
- Where someone has capacity but there is concern that they may be making decisions under duress or which place them at high risk, the principles of the doctrine of Inherent Jurisdiction have been considered and addressed where appropriate.
Additional Guidance: Quality Practice Standards – Additional Guidance Standard 6 – Mental Capacity
Standard 7 – Valuing Diversity
Issues of diversity, equality and human rights are addressed throughout the assessment and plan.
- Assessment and support planning will be sensitive to any relevant characteristics protected by the Equality Act, acknowledging how they impact on the person’s wellbeing and how they may be addressed.
- The assessment and support planning process will show consideration of the person’s relevant background, their culture, their current or past lifestyle, their upbringing, past experiences, their current or past working experience and promote related strengths.
- The process will be sensitive to the cultural or religious requirements of the assessed person or their carers and guided by the person’s wishes.
- The episode will encompass the principles of dignity, fairness, equality and respect as set out in the Human Rights Act 1998.
- Interpreters and culturally sensitive support have been used to support the person through the assessment and support planning process where required.
- The person’s ethnicity will always be recorded within their case record.
- There should be evidence of promoting choice and flexibility in support planning and brokering, which enables specific needs relating to protected characteristics to be addressed.
- Any deficiencies in support and unmet needs, resulting from religious or cultural requirements, will be recorded and notified to service commissioners through the correct procedure.
Additional Guidance: Quality Practice Standards – Additional Guidance Standard 7 – Valuing diversity
Standard 8 – NHS Continuing Healthcare
It is clearly demonstrated that the process for considering a person’s eligibility for NHS Continuing Healthcare (CHC) has been followed in compliance with the National Framework and local processes.
- There is evidence that the practitioner has considered the customer’s eligibility for NHS Continuing Healthcare as part of their assessment, documenting all relevant health issues and rationale for whether a Healthcare Checklist is required.
- Where a Healthcare Checklist is required there will be evidence that consent to assess for Continuing Healthcare eligibility has been recorded.
- There is written evidence that the practitioner has appropriately informed and involved the customer and their family or representative in the CHC process.
- There is evidence that the practitioner has taken the appropriate action to engage a health professional to coordinate a Multi-Disciplinary meeting to undertake a Decision Support Tool.
- There is evidence that a copy of the completed Checklist and any supporting documents have been sent to the Continuing Healthcare Team (see Local Contacts) by secure email.
- In cases that progress to completion of a Decision Support Tool (DST), there is evidence that the practitioner has appropriately participated and the recommendation is recorded.
- If there is a split recommendation where the practitioner disagrees with the other members of the Multi-Disciplinary Team (MDT), there is evidence that they have provided the coordinator with a written rationale to support their individual recommendation.
- There is a record of the outcome of the Decision Support Tool.
- In cases where a health professional requests an Adult Care practitioner to participate in a DST/MDT meeting, there is evidence of an appropriate response.
- There is evidence of completion of the CHC monitoring form within the person’s electronic case record.
Standard 9 – Outcome Focused Care and Support Planning
Care and support plans will:
- be developed as far as possible by the person with the support of whoever they choose;
- focus on the outcomes the person wants to achieve in response to their assessed care and support / safeguarding needs;
- reflect the strengths and assets of the person and their support networks.
- The person should be as actively involved as possible in creating their plan, with it recording how they have been involved in developing it.
- Plans should reflect and address the care and support needs identified in their assessment and acknowledge the person’s hopes and aspirations in setting the outcomes they want to achieve in meeting their needs.
- The plan should adopt a strengths based approach, evidencing that the person’s own strengths, capabilities, relationships and community resources have been utilised to meet outcomes.
- Plans should reflect the input and advice of relevant professionals, including Neighbourhood Teams, to ensure complex and long term conditions are managed effectively.
- The record should evidence that the person has been informed of their agreed personal budget through the use of the letter template which is available on the electronic case record.
- The record will evidence that the person is in full agreement with and has a copy of their plan.
Standard 10 – Maximising Choice and Control over Care Delivery
People will be given information, advice and access to support to benefit fully from self-directed care and support.
- The customer record will evidence that direct payments and pre-payment cards have been promoted as the default delivery method for ongoing care and support in full or part.
- The person will be advised about the support available from Penderels to help them receive direct payments, and their choices should be recorded and referrals made where required.
- The person should be given time and opportunity to consider direct payments, including consideration of short term arrangements to support later transition to direct payments.
- When Direct Payments / Pre-payment cards are chosen as the delivery method for the personal budget, the practitioner must follow direct payment policy and procedure including verifying the identity of the person holding the card account.
- There should be evidence that the person has been given freedom to choose how they use their direct payment to meet the outcomes in relation to the care and support needs which have led to the direct payment.
Standard 11 – Monitoring, Reviewing and Reassessing Support Arrangements
- Support arrangements will be monitored and checked to ensure they are meeting outcomes;
- Reviews shall ensure that care and support plans continue to meet needs and support the person to achieve their outcomes, with any changes or actions reflected in care and support plan.
- It is evident for people not entering a review cycle (e.g. people receiving only equipment) that involvements have remained open to the assessor until checks are made to ensure the intervention is in place and effective.
- It will be evident that reviews have considered the effectiveness of the plan in meeting the person’s outcomes, and considered where there is opportunity to make changes to the plan and budget to meet needs differently.
- There will be evidence of appropriate communication with the customer, their representative, and other relevant agencies and professionals to monitor and establish the effectiveness of support arrangements including involving an advocate where needed.
- Where there is a need for cases to remain open for ongoing case work or professional support, the person’s need and rationale is clearly evidenced in the record and involvements remain open, including the purpose.
- It should be evident from the review that any significant changes in the need have triggered the recording of a new needs assessment.
- It will be evident that any changes to a person’s support stemming from a review or reassessment will be incorporated in the plan and a revised plan has been shared with the person and their support providers.
- A copy of the completed review and any reassessment should be made available to the person and a record made of whether a copy was received.
- The frequency and nature of future reviews will be clear with reviews scheduled and recorded in the person’s case record, with a light touch review arranged within 6-8 weeks of a new care package being established, and thereafter annually or as required.
Standard 12 – Closing Cases
The decision to close cases or episodes of active involvement is clear with a closure summary and decision recorded in the customer record.
- Decision making and rationale for closing cases is clear and recorded accurately.
- The record will evidence that the person or their representative has been informed that involvements are ceasing or transferring, and advised what they can expect next from Adult Care and who to contact if any issues arise with their support.
- Involvement closures and case transfers will be completed at the appropriate point and will not be completed without the worker carrying out the tasks expected of them prior to closure.
- Cases will not remain open to practitioners without clear and evidenced justification for ongoing involvement.
- The correct case closure workflow process will be followed in the electronic record.
Additional Guidance: Quality Practice Standards – Additional Guidance Standard 12 – Closing cases.
Standard 13 – The Quality of our Recording
The quality of the case recording conforms to the Adult Care Recording Guidance.
- All recording should be of a good written standard, including grammar and spelling.
- Recording should be clear, concise, factual and proportionate, with any opinion expressed clearly distinguished and attributed.
- Recording shall be person centred and recorded in a way that would be meaningful to the person if they were to request access to their record.
- Records will show where there has been information and advice given in relation to care and support arrangements, including financial implications for receiving proposed care and support.
- The record will show clear rationale of all key decisions made with a record of people involved in the decision and their rationale.
- Where a management decision and direction has been given relating to case work, this will be recorded clearly in the case notes.
- Case notes will include only information which is relevant to that case.
- Where emails are copied in to case notes, they only include information relevant to the person, and the case note does not include long or repeated conversation trails.
Standard 14 – Carers
Informal carers will be identified and Carers Assessments will be undertaken where it appears carers have need for support.
- There will be evidence that carers have been advised of our duty to assess their needs and:
- what arrangements have been made to ensure the needs are assessed;
- what information and advice has been provided to carers;
- where carers have declined an assessment.
- All carers should be given information and advice about sources of further support, community resources and preventative services to promote sustainability of care and support arrangements.
- Checks will be made from the outset to determine whether the person already has involvement from the Carer’s Services and whether there are any opportunities for joint working.
- Where appropriate, there will be evidence of a referral for a carer’s assessment to the Carer’s Services which should include a brief background, the urgency, and the reason for the referral.
- The assessment will evidence a whole family approach and ensure the impact of being a carer on the whole family is understood.
- There should be consideration of family group conferencing where this may support families to sustain support arrangements.
- Assessments should clearly state the nature and intensity of the informal support provided and demonstrate an understanding of the impact on any carer’s wellbeing and the sustainability of caring roles.
- Carers should be involved and consulted in the cared for person’s assessment and review, and the carers section of the needs assessment should be directed to the carer and any actions taken in relation to the carer recorded in the cared for person’s assessment.
- All carers are added to the customer’s record as a relationship and linked to all related people between families.
- Any young carers have been identified, given information and advice, and referred for an Early Help Assessment.
- Children and young people who have or are at risk of taking on caring roles should be identified with evidence of liaison with Children’s Service and Young Carers support services being engaged to address any welfare, educational or support needs.
Additional Guidance: Quality Practice Standards – Additional Guidance Standard 14 – Carers.