Referrals and Admissions

1. Introduction

It is vital that all adults, carers and other professionals who make contact with the service regarding a referral, or who are arranging admission, receive a timely and professional response. This is essential to operating within required standards, and promoting confidence in the service. First impressions for adults, carers and partner agencies who contact the service are vital.

This chapter provides information to ensure that all those being referred and admitted to the service receive the same good standards of response and care. It also outlines how the service comprehensively coordinates, monitors and records all referral and admission activity.

2. Initial Response

Although there should be one main point of contact for referrers, a referral could be received by any member of care and support or administration staff. A referral could be received phone, personal visit or email / website for example

All initial inquiries should be dealt with as a priority.

2.1 Initial referrer contact

Initial contact may be from the adult themselves, their carers / family member, friends or a practitioner who is involved in their care and support.

When initial contact is made, as much information as possible should be gathered regarding the care and support needs of the adult. This should include demographic information, their mental and physical heath needs and any mental capacity issues, challenging behaviour or safeguarding issues.  The latest care and support plan or assessment of needs / outcomes and risks should be requested from the referrer or involved practitioner.

Initial discussions should take place about how the adult’s placement will be funded, and if they are not self-funding this should include an outline plan of how funding will be secured.

3. Assessment

Arrangements for an initial assessment should be made with the designated worker in the service, the person making the referral and with the adult and their carer. The service should offer to undertake an assessment visit within the time period set out in its Statement of Purpose.

This initial assessment should gather information to establish whether the service offers the correct support for the adult concerned (see Assessment). The assessment should consider the type of service the adult needs, their thoughts and wishes about their future care, the views and opinions of their carers / family and equal opportunities and anti-discriminatory practices (see Equality and Diversity).

Following the assessment and completion of the recording process, the assessor will be able to establish if the persons needs can be safely met by the service. This decision may need to be made in discussion with relevant managers as required, depending on the complexity of the referral and assessment information.

3.1 Visits to the new service

As part of the decision making process, the adult should be encouraged to visit the service. Relevant family members and care managers should also be encouraged to visit the service. This is to help the adult and their family decide if it is suitable for them, as well as inform the assessor as to the appropriateness of the service for the adult.

A minimum half-day visit to the service should be offered, particularly if it is to be a residential placement. During the introductory visits the prospective service user should be:

• shown around the service;
• introduced to staff and all other service users;
• encouraged to stay for a meal;
• encouraged to spend time interacting with other service users or staff and being given the opportunity to be involved in their future plans and any person centred planning;
• wherever possible, and if able, service users should be given the opportunity to see documentation such as policies and procedures, health and safety issues, risk assessments and complaint procedures.

The adult should be shown which bedroom may be theirs and given the option to stay overnight where at all possible.

Other service users should be consulted about their views about the potentially new service user.

The service manager and proposed keyworker should spend time with the prospective service user and their family / representative, to discuss any questions, concerns or comments they may have. This is also an opportunity to tell the adult / family more about the services available, and also about the records that will be kept about them. The service manager should inform them of the policy and procedure on confidentiality and data protection (see Information Sharing and Confidentiality).

Any special needs the adult has should be discussed and the service manager should explain how these will be met.

4. Placement not Agreed following Assessment

If the initial assessment outcome is that the service cannot meet the care and support needs of the adult, the worker who completed it should first discuss the situation with the relevant manager.

If there is not agreement between the staff involved regarding the service’s ability to meet the needs of the adult, this should be referred to a relevant senior manager for discussion and to make the final decision.

Where it is decided that the service is not appropriate for the adult, the reasons for this should be communicated to the referrer and to the adult and their family, along with other options that may be considered more suitable for their needs. Where possible, the adult should be told in person, either by the assessor or the referrer where this is a practitioner. The decision should also be communicated in writing, stating the reasons why the service was unable to offer a placement.

5. Placement Offer Agreed

Where recommendations are agreed to offer a placement to the adult, full costings should be calculated and funding agreed by the appropriate source. This should be completed as soon as possible after the assessment decision has been communicated to those involved.

Prior to commencement of the service, where relevant it is essential to ensure that a Deprivation of Liberty Safeguards assessment has been completed and authorised (see Deprivation of Liberty Safeguards).

6. Disagreement

In the event that the placement is not offered to the adult and they, their carer / advocate disagrees with the assessor’s decision, the referral should go to the relevant senior manager for review. If the manager upholds the assessor’s decision, this should be communicated to the adult and their carer / advocate with reasons why they support the outcome.

If the adult and their carer / advocate is still dissatisfied with the decision, they should make a formal complaint to the service (see Complaints).

7. Admission

Following agreement of the placement, an initial care and support plan should be developed with the adult, their carer / advocate, the allocated keyworker and any other relevant involved professionals.

This should include all relevant information from the care and support plan received from the local authority, where this has been completed. This should include an initial risk management plan (see Positive Risk Taking and Risk Assessments).

Any funding for additional resources required for the placement should be agreed in advance of the intervention starting. This may include specialist resources or additional staffing hours for example. This must be included in the costings agreed with the relevant body / person. Admission cannot take place unless this signed agreement has been received.

A transition plan should be agreed with the adult, their carer / advocate and other relevant agencies involved in care and support of the adult. The assessment findings should be used to form the basis of the transition plan, and identify key actions and individuals responsible for  implementing those actions.

The plan also forms part of the introduction process to the placement, and should include the adult, as appropriate, and their carer / advocate being informed of relevant policies and procedures, for example health and safety and risk assessment processes.  It will also form the basis of the care and support plan (see Care and Support Planning) and should include equality and diversity issues specific to the adult, such as cultural and religious beliefs, and access to other groups and organisations as the adult requires.

All new service users (excluding those on short term or respite placements) should have a review of their care and support plan within 12 weeks following their admission (see Review of Care and Support Plans).

8. Residential Care Admissions

8.1 Moving in

All information relating to the new service user should be shared with the whole staff team unless deemed too sensitive and then it will be at the discretion of the service manager.

On the day the adult moves in, the keyworker (or other designated person) should be at the service to welcome them and their accompanying relatives or friends.

The keyworker should remain with the adult and show them to their room and help them unpack, with their family. The service user’s possessions should be recorded on the service’s personal property Inventory in their care and support plan. This includes any cash, valuables and medication which should be checked, witnessed, recorded and appropriately stored. Any irregularities or discrepanices should be immediately queried before the family / friends depart.

The adult should be shown around the service again and introduced to everyone.  Emergency procedures, particularly the fire evacuation procedure should be explained.

The keyworker should check with the adult and their relatives / friends, that all personal details are complete and correct, particularly contact details of those who should be contacted in the case of an emergency for example. They should also discuss and initiate the adult’s agreed individual care and support plan.

The adult’s family or friends should be given the following information:

• the keyworker’s name and work contact details;
• the name, address and telephone number of service;
• a copy of the service’s Complaints policy and procedure (see Complaints).

The admitting member of staff should record all relevant information in the service’s recording system as specified. They should also ensure that they inform all necessary professionals and services of the adult’s admission.

The adult should be referred to the local GP surgery and make an appointment for them to attend a new patients’ visit as soon as possible (except for a short term respite admission).

Following admission, during the initial assessment period the service manager should ensure the adult’s needs are fully assessed so a more comprehensive and detailed care and support plan can be devised (except for short term respite admission).

The care plan should confirm who, if anyone, is acting on behalf of the adult (for example a court appointed deputy or someone with Lasting Power of Attorney).

A fire drill should be held within seven days of admission.

8.2 Emergency admissions

Prior to an adult being admitted in response to an emergency situation arising, as much information as possible relating to them must be forwarded to the appropriate staff within the service.

Even in the case of an emergency admission, a Deprivation of Liberty Safeguards assessment is completed prior to admission where possible or with urgency after admission, where relevant (see Deprivation of Liberty Safeguards).

In most cases it should be possible to plan in advance so a standard authorisation can be obtained before the deprivation of liberty begins. There may be exceptional circumstances where the need for deprivation of liberty is so urgent that it is in the best interests of the person for it to begin while the application is being considered, that a standard authorisation need not be sought before the deprivation begins.

The service manager should discuss with appropriate staff the needs of the adult to ensure they are prepared to respond safely and appropriately to the adult’s emergency admission. This may include additonal staffing, resources and provisions for example.

Costings must be agreed and signed by funding authorities at all times prior to an emergency admission. An emergency admission can only be accepted where costs have not been agreed with a referring body, prior to admission, with the written permission of a designated senior manager in the service.

During the first week of the emergency placement, a full assessment must be completed to ensure the service is appropriate and in line with the adult’s assessed and funded individual care and support needs.

8.3 Respite admissions

In the case of a short term respite admission the same considerations should be given to referral, introductory visits and moving in as specified above.

Deprivation of liberty safeguards assessments should be completed prior to admission or with immediate effect after admission where it is likely that the adult’s placement may become permanent.

A comprehensive report should be completed by the allocated keyworker, reviewing the respite placement with the adult and their family / representative at the end of the placement. This report should be shared with all relevant parties.

9. Placement Review

See also Review of Care and Support Plans

The adult’s placement / service should be reviewed as part of the care management process.