Inspection of arrangements for assessment and care management of children in need in the Isle of Anglesey

Date of Inspection Date of Publication

: :

February - March 2011 25/05/2011

Care and Social Services Inspectorate Wales CSSIW

The Care and Social Services Inspectorate was set up in 2007 as an operationally independent division of the Welsh Assembly Government. Under the terms of the Care Standards Act 2000, we:

Register social care services to operate. Inspect services across all sectors. Help keep people safe, and investigate possible breaches of the Care Standards Act and supporting regulations by providers. Deal with complaints concerning adult and childrens services. Work towards improving social care services. Seek to ensure people get the right help at the right time from local services. Reinforce standards in regulated services and encourage providers to run better services. Promote joint work with other national regulators.

We aim to ensure the experiences of people who use, or need, local services are at the heart of our work.

Inspection of Childrens Assessment and Care Management

Isle of Anglesey February - March 2011 Inspection Team Lead Inspector Team Inspectors : : Marc Roberts Angela Mortimer Rob Gifford Shirley Harkins

This report is available from our website www.cssiw.org.uk Please contact us if you need other formats at cssiw@wales.gsi.gov.uk Acknowledgements The inspectors would wish to thank all the children and young people, families, carers and staff who participated in this inspection.

Contents
1. 2. 3. 4. Introduction Summary of the performance of the Isle of Anglesey Council in the assessment and care management of children Context Key findings under the headings:
Compliance with national policy, statutory guidance and regulations; The range of support services appropriate to the needs of children and families; The supervision and management support of staff supporting children and their families. Effective, consistent, performance management and quality assurance of the services achievement of outcomes for children and families.

Introduction
CSSIWs 2009-10 performance evaluation identified the need for fieldwork activity to understand the performance of many councils with regard to the timeliness of initial and core assessments. The CSSIWs 2009-10 performance evaluation of the Isle of Anglesey Council found that the councils performance in relation to initial assessments and core assessments was a cause for concern. The percentage of initial assessments carried out within 7 working days was 36% against a target of 100% and the percentage of core assessments, completed within the required 35 working days, and at 21% was the lowest in Wales. A team of inspectors from the Care and Social Services Inspectorate Wales inspected the Isle of Anglesey Childrens services for 4 days in February and March 2011. The inspections prime focus was to evaluate the quality of support to children, in need and their families from council services, and those which, the council commissions and operates in partnership. The inspection team looked at the cases of children who had received an initial assessment by the childrens services department. The cases had been referred to the council between the 1st of April 2010 and the 30th of June 2010: some cases had limited involvement, others had involved extensive contact. The inspection team looked at: Compliance with national policy, statutory guidance and regulations The range of support services appropriate to the needs of children and families; The supervision and management support of staff supporting children and their families. The performance management and quality assurance of the services achievement of outcomes for children and families.

Before visiting the Isle of Anglesey Council the inspection team reviewed a range of documentation about how the council was delivering and managing support for children and families in need of assistance. The inspection team examined a number of cases that had received an initial assessment and support from the childrens services. The inspection team met with social workers, managers, children, families and other partner organisations. The inspection team gathered evidence from all these activities. The report is intended to be of interest to the general public, and in particular those people who use the services in the Isle of Anglesey. It will assist the council and other agencies in working together to improve the lives of children and their families through the provision of services to meet their needs.

Summary
This inspection looked at assessment and care management of children in need in Anglesey and did not focus on the safeguarding of children. However the inspection provided evidence that indicates that there are serious failings regarding the safeguarding of children and consequently merits further inspection work. The inspection found that the assessment and care management of children in Anglesey is poor. The quality of many assessments was poor. There were delays in assessing complex and serious cases. Assessments were not completed in timely manner. The childrens services department was restructured its teams in October 2010. A permanent appointment has been made to the head of childrens services post and is to start April 2011. There was no evidence of improvement in practice in the active case files seen by inspectors in March 2011. In 2009-10 in Wales 65% of initial assessments were completed within the timescale of 7 working days. The councils performance in Anglesey in 2010-11 was 49% in the first quarter of the year, 53% in the second quarter and 44% in the third quarter. In 2009-10 63% of core assessments in Wales were completed in the timescale of 35 working days. The councils performance in Anglesey in 2010 -11 was 20% in the first quarter of the year, 25% in the second quarter and 25% in the third quarter. The leadership arrangements have not been able to support the change agenda to secure necessary improvements in assessment and care management. This is demonstrated in the lack of improvement over the past 5 years. Also the inspection found poor communication with staff and partner agencies, the lack of a performance management culture and the absence of a quality assurance system. The council has failed to achieve the necessary improvement over many years and it is uncertain if it will be able to do so in the future.

What the Isle of Anglesey did well to support outcomes for children
Compliance with national policy, statutory guidance and regulations. Structured assessments and reports are prepared for child protection conferences.

The range of support services appropriate to the needs of children and families. The council makes considerable use of Y Gorwel to support children and families who have experienced domestic violence. The council works well with some partner agencies in planning and providing multi agency support for families.

The supervision and management support of staff supporting children and their families. Social Workers reported that they were supervised regularly and appraised annually. Social Workers positively described the support that they received from their team leader.

The performance management and quality assurance of the services achievement of outcomes for children and families. In 2010 social work teams were involved in evaluating their performance and opportunities for development.

Recommendations for improving outcomes in the Isle of Anglesey

Compliance with national policy, statutory guidance and regulations. The council needs to ensure quality and timely assessments and interventions to protect, support and manage the risks for children. Departmental standards and procedures are needed that describe the roles and functions of teams and the departments expectations in relation to social work practice. The council needs to review its thresholds for intervention and develop a shared understanding within the service and with partners regarding the thresholds. Risks for children should be assessed, analysed and recorded as part of the initial and core assessment process. Assessments need to consistently record and analyse information to support robust decision making and plans for children in need.

The range of support services appropriate to the needs of children and families. The council should complete its commissioning strategy, identifying service gaps through its needs analysis. The council will publish its draft strategy by June 2011 and should implement the strategy by April 2012.

The supervision and management support of staff supporting children and their families. The council needs to embed a performance management system and culture to review and plan its services. Individuals, teams and childrens services need to have specific, measurable, realistic and stretching targets. Operational Managers need to be supervised regularly as it was not evident that this was the case. The council needs to provide guidance and training regarding appropriate and effective assessment and care management.

The performance management and quality assurance of the services achievement of outcomes for children and families. Significant risks within the service need to be identified by managers in the service and managed corporately. Leadership is needed that provides a pace of change that is sufficient to deliver improvements in the service. The council needs to provide sufficient resources and capacity to deliver the improvements in the service. The council needs to provide leadership through clear communication of its vision to staff and partner agencies. A performance management system and culture needs to be embedded that describes and supports the agreed objectives for the service, teams and individuals. The council needs to urgently develop consistency in the implementation of expected and articulated standards in the work of its staff. A quality assurance system needs to be urgently established that supports the council in effectively managing its responsibilities towards children in need. The council needs to develop a confident and competent workforce with sufficient capacity to provide a consistent and effective service.

Context
The Joint Review of the Isle of Anglesey County Council Social Services Department was published in 2007 and was the result of field work undertaken in February to May 2006. There were six areas for improvement identified in the key findings. The second area for improvement was improving the timeliness and quality of assessments in Childrens and Mental Health Services. The Review of Childrens Safeguarding Arrangements Isle of Anglesey County Council was published in October 2009 as a result of field work in April 2009. The report concluded that the quality of initial and core assessments needs to be more consistent and further improvements made in the completion of assessments within required timescales. The ability of social work staff to provide consistent good quality practice and for middle managers to support them is being affected by the staffing difficulties. (Page 2) The council has established an Improvement Board in March 2010 to drive the required improvements in childrens services. There have been some improvements in service provision since then; there has been limited progress in addressing some key practice areas for example the timely completion of core assessments. On the 31st of March 2010 the rate of childrens names placed on the child protection register was 21 per 10,000 of the population under the age of 18. The rate in Wales was 43 per 10,000. At this time the number of Looked after children was 53 per 10,000 and the Wales Average was 82. There were 265 children in need per 10,000 under the age of 18 and the Wales average was 300. At the 31st of March 2010 there were 15 social workers and no senior practitioners per 10,000 of the population under the age of 18. This was significantly below the Average in Wales of 23 social workers or senior practitioners per 10,000 under 18 in the population. The childrens services department has faced challenges in addressing staff absence and recruitment over the past two years. During this period the council has engaged external consultants to complete some management tasks during the absence of the Lead Operations Manager. In June 2010 the Acting Director of Social Services was permanently appointed to the post. The Director established two new roles; a Head of Children Services and a Head Adult Services. A consultant was commissioned to act as interim Head of Children Services. However, a permanent appointment has been made and the new head of services takes up this key role in April 2011 The council reorganised the social services directorate in October 2010 in response to initial assessments, core assessments and child protection enquiries taking too long to complete. Childrens Services are currently fully staffed although there will be further absence with 5 social workers taking planned maternity leave. The council is currently exploring options to cover these temporary vacancies. 9

The council is using paper and electronic files, the electronic systems are developing slowly and a development group regarding the Integrated Childrens System is part of the Improvement Board. Staff morale was identified by managers as being very low at the time of this inspection. Managers say that there are a number of factors that have contributed to this including the high caseloads staff had been holding, changes in the departments structure and management arrangements and wider uncertainties regarding the councils future. The job evaluation process was not proceeding and this had caused issues for recruitment and as a result had added to the frustration of staff.

Key findings
Compliance with national policy, statutory guidance and regulations.
There has been a lack of effective management to review the departmental procedures and protocols. The departmental procedures do not describe the structure roles of the teams and the work that they undertake. The procedures fail to communicate what is expected of a social worker in undertaking the core functions of assessment and care management. The review of policies and procedures is one of the projects monitored by the Project Board and work is ongoing. The council responded in a structured way to some child protection concerns. There were examples of child protection enquiries being undertaken in a systematic manner and collated on one form. The council succeeds in getting information from the police at an early stage that is beneficial for initial consideration and later work with the family. The reports produced for child protection conferences gave examples of structured assessments of the childs circumstances. The council is planning to provide services in some circumstances when the childs health or development is likely to be significantly impaired without services or where there is a statutory obligation to provide service or where there is likelihood of imminent family breakdown. The council is planning to assess childrens circumstances where the child possibly is unlikely to achieve or maintain a reasonable standard of health or development without services. From discussions with managers and staff it was evident that there was a lack of understanding and consequently inconsistent application of the thresholds across the workforce. Service users said that it was difficult to access support but some positively described the assessment processes. Some service users said that they had benefited significantly from the help they received. In one case a mother said that she would not be here today if the social services had not helped her. Also the maternal grandmother said that social services had really involved them. There were good examples of joint working such as the tripartite planning and funding of a case and the monthly planning meetings that facilitated this work. A number of agencies said that the accommodation panel was an important meeting for facilitating communication between agencies.

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The council provided examples of practice where assessment and care management of children in need were compliant with policy and guidance. In these examples there were written assessments, plans and reviews in place. However, the case files demonstrated inconsistent recording and inconsistent use of documentation. The files did not consistently follow the social work processes with clear decision making. Social workers, managers and partners said that child in need plans were made on a multi agency basis in meetings. The councils supervision policy states that the worker should record on the case file when a case is discussed in supervision and important decisions in respect of individual cases will need to be recorded on the case file. However from the case file reading we found this to be very inconsistent Around three quarters of the case files read by inspectors during the fieldwork contained chronologies and genograms. There was evidence of recent work being done on the quality of the files. Some initial assessments recorded the opinions of the main carer and made little analysis of needs and risk. An example of this is in a case where concerns existed regarding a six year old girl whose mother was intoxicated while caring for the child. The initial and core assessments reflected only the mothers views and presented these views as statements of facts. The case was closed prior to the conclusion of the police action. None of the assessments covered the fact that mother was sentenced to a 12 months probation order for neglect. Social Services managers said that before the restructure in 2010, social workers would pick up Initial Assessment when on duty. The Initial Assessments would not be completed and the cases would remain dormant on their caseload. A social worker explained it was a very difficult for the childrens services, and very difficult to complete work in a timely way with a caseload of 63 cases. During the April, May and June 2010 some workers had caseloads of over 50 cases. However on the 31st of January 2011 the highest social worker caseload was 35 cases. In March 2011 the inspectors saw social workers with caseloads of between 12 and 24 cases. The national guidance for assessing children in need says that agencies should be consulted and involved as appropriate as part of the Initial Assessment. However this was not routinely undertaken. Other agencies said that they were not consulted or involved in initial assessments even though they were actively involved with the families. However some agencies gave examples of visiting families jointly with the social services and assessing situations together. The usual practice in the department is for social workers not to discuss the Initial Assessment with their line manager although the councils Initial Assessment Form provides for this to be recorded. One manager said that the form is normally signed without a discussion with the social worker; as is consistent with the department's procedures. The majority of the assessments were not completed within the expected time scales. Inspectors recorded, from the files they saw, five out of twenty five initial referrals completed within the 7 working days deadline and no core assessments completed within the 35 working day deadline.

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There was evidence of considerable delays in decision making and associated actions with complex cases. In one case seen by inspectors a nine month old baby girl with complex health needs, whose name was on the child protection register in another county moved in to the area. A child protection conference was held at the end of May 2010. The recommendations had not been implemented by the end of September 2010 by which time the child returned to live in the county where she had lived previously. The inspectors saw cases with an acceptance of high levels of risk over prolonged periods with no explanations for delays. The files did not adequately reflect analysis that had been undertaken. An example of this was seen in a case of a 15 year old girl who had been previously assaulted by a parent. She had taken an overdose and was thought to misuse substances. She had witnessed alcohol fuelled domestic violence in the home and the social worker thought that it was likely that she had learnt to resolve conflicts with violence and verbal confrontations. She had refused child and adolescent mental health services. She was in a relationship with a twenty year old male convicted of a schedule one offence. It was decided to start a core assessment on the 19th of November 2010. On the 13th of December 2010 the young persons mother phoned concerned about the situation. There was no further contact with the department until a home visit 2nd February 2011. The core assessment was ongoing at the time of the inspection in March 2011. Inspectors saw a number of difficult cases that had been allocated to student social workers. A manager explained that the practice of allocating cases to students has now stopped and cases are allocated to practice teachers with students having a secondary allocation. Students will now be more closely supervised by their practice teachers when undertaking initial assessments. Many agencies said that social services were willing to accept higher levels of risk to children than would be accepted by their agency. Agencies said that the department did not convene strategy meetings or chid protection conferences in line with their understanding and expectations. The police have highlighted significant concerns that the risks to children are not effectively managed by the Childrens Services Department. This was due to a number of reasons including; delays or refusals to abide by previously agreed decisions to take cases to case conference, a lack of robust management of cases and that care proceedings were not being considered and instigated in a timely manner. The police believe that this is the result of continued unrealistic attempts to work in partnership with parents who are not, or continually refuse to engage, whilst not appreciating the significant risks to the child. The police expressed their concerns to the Local Safeguarding Childrens Board (LSCB) Steering Group in December 2010. The police have always acknowledged the dedication and hard work and professionalism of individual social workers on Anglesey and since the report to the LSCB Steering Group in December 2010 there has been a better understanding between police and childrens services managers who have met, with additional meetings planned. Whilst there are initial signs of improvement in some areas, the police remain concerned that children are not being appropriately safeguarded.

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The concerns expressed by the police are illustrated in the 8 cases that the police report they took to the LSCB Steering Group in December 2010. One of the cases was a young infant who sustained life threatening non accidental injuries in March 2010. An interim care order was not obtained until 26 October 2010. This means that timely actions to secure the protection of the child may have been compromised by the delay. The management of risk and safeguarding issue became apparent in the councils childrens home. The recent inspection report in January 2011 identified flaws in the admissions process compounded by a demonstrable lack of risk and compatibility assessments for the admission and care of the young people. There had been clear indicators of serious concern and it was not evident that priority had been given to addressing the risks to and behaviours of one young person. Child protection action had not been taken to agree a strategy for the young persons protection and care. Following the inspection report the council now has no children placed in its home. Agencies said that when they made referrals to social services their referrals were assessed as not meeting the councils threshold. Four out of eight partner agencies said that their referrals had not been accepted. Another agency said that professionals were shocked to hear that cases were closed. A partner agency said that they seem to fail to take responsibility for cases. It was evident from the case files that there were repeat referrals subject to initial assessment that were then closed. The inspectors found that 60% of the cases they saw were repeat referrals, with many repeat referrals in short time periods. The inspectors saw a case file of a girl whose mother had mental health difficulties and was in an abusive relationship with her partner. Five referrals regarding the girl were received over a 17 month period prior to a core assessment being commenced. Inspectors saw the case file of a 23 month old child with a complex medical condition needing daily medication. There were between six and ten referrals a number of which related to domestic violence incidents where the child had been present. An initial assessment was started in February 2011. The child allegedly witnessed a further incidence of serious domestic violence at the end of February. In March 2011 the father forced his way into the home and took the child for twenty four hours without the childs medication. In response to the inspectors enquiries the council explained that a strategy meeting would now be arranged. The Local Childrens Safeguarding Board considered the operational changes within childrens social services noting that Social Services would be providing a service to children at the highest level of need. The Child Assessment Team will become a Duty/ Intake Team and the Children and Family Team will be mainly A Child in Need of Protection Team beginning October 2010. The councils performance information shows that the number of cases open to Family Assessment fell from 360 on the 31st July 2010 to 150 cases on the 31st December 2010. Childrens Services managers said that the threshold for intervention had increased. Managers said that this was a planned approach to address high social work case loads that resulted in delays. The plan was to get better information from partner agencies at the point of referral, raise the thresholds, and working with partner agencies to help them understand the thresholds for intervention. Partner agencies said that thresholds for intervention had increased, although it is unclear how this information was shared.

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Partners said that there has been a lack of consistency within the service. There has been a lack of consistency in decision making because of the many management changes. Partners said that different managers would make different decisions on the same case. The departmental reorganisation in October 2010 attempted to address many of the structural causes of inconsistency in the initial assessment process. There are now less managers and social workers involved in this process. The CSSIW inspectors looked at some current referrals to sample the practice. The files considered indicated a continued absence of assessment, analysis and risk management. This is illustrated in a referral received on the 6th of December 2010 alleging that a child was in a sexual relationship with an adult with a caring responsibility. The child had not been interviewed before the inspection fieldwork in March 2011. The councils performance information in the third quarter 2010-11 showed that the percentage of initial assessments completed in seven days was 44% and the percentage of core assessments completed in 35 working days was 25%. This is very limited improvement compared with the concerning performance in 2009-10 of 36% of initial assessments completed in 7 working days and 21% of core assessments completed in 35 working days. Many partner agencies reported good communication from the duty desk. Some agencies have agreed protocols for information sharing. However the communication regarding the assessment and care management of children is inconsistent and described as very poor. Partners described not having minutes for meetings. Partners reported that communication is made difficult as the social worker changes often. There is evidence that service users have not always received copies of assessment reports and of poor communication about decisions made. Inspectors saw a case where the core assessment was completed in November 2010 but the service user was not informed that the case had been closed until February 2011. There is a regular multi agency domestic violence meeting to discuss cases. This meeting was seen to contribute to delays between referral and assessment. The police did not attend the domestic violence meeting. The CSSIW inspectors field work and the view expressed by partner agencies indicate that there are serious concerns about the councils practice in the protection and support of vulnerable children.

The range of support services appropriate to the needs of children and families.
The council is developing a commissioning strategy for childrens services. To assist this work the council held a consultation day in November 2010. It has identified that it wishes to develop services for children who suffer from neglect and children who have disabilities. The council makes considerable use of Y Gorwel, a service that offers support to children and families who have experienced domestic violence. Y Gorwel is

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positively regarded by service users and staff. A mother said Y Gorwel was the only refuge service available but it was a good service and the workers had taken her and the children out on outings and given them the opportunity to speak in confidence. The council works well with some partner agencies to provide multi agency support for families. Social workers and other partner agencies describe the use of multi agency planning meetings to form plans to support children in need. Although the council say that there is a range of preventative services there was limited evidence of the use of preventative services seen in the case files. There are waiting lists for services for example 6 to 8 weeks for Y Gorwels childrens group. Barnados report a lengthy waiting list, for their services CWLWM provides a family group conference services and report referrals above their contracted level and were waiting for agreement to proceed with this work. From discussions with team managers and social workers, access to a range of support services was not always timely. A number of partner agencies reported gaps in the range of services available. During interviews a number of areas were identified where there was a need to develop services. These included parenting programmes, working with families who misuse substances, support for young people over 16 and young people who have been in care.

The supervision and management support of staff supporting children and their families.
Social Workers reported that they were supervised regularly and were appraised annually. Generally they spoke positively about the support that they received from their team leader. Social Workers said that managers had given much attention to reducing their case loads. There was less evidence that managers benefitted from regular supervision and support to manage risks and service planning. There was a lack of clarity in relation to strategic planning and its operational applications. It was evident that managers required support to manage risks associated with the service and would benefit from the corporate ownership of risk management. During the inspection we saw little evidence that risks within the service were seen as corporate risks and recorded and managed as such. The council needs to provide guidance and training regarding assessment and care management. Managers describe that there are tools available to assist in the assessment process but there was little evidence of these being used or that their application was monitored or evaluated.

The performance management and quality assurance of the services achievement of outcomes for children and families.
In the first half of 2010 the social work teams did an analysis of their teams situation identifying strengths, weaknesses, opportunities and threats.

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A difficulty faced over many years by the childrens services has been the recruitment and retention of social work staff. The quality of the service is monitored through the manager signing assessments, reviews, transfers, closures. Cases are also considered in formal meetings namely the accommodation panel, child protection conferences, and a monthly meeting looking at the ongoing court work. There is limited evidence of robust quality assurance processes within service management. A manager informed us that the council did have plans to look at the quality of practice and service provision. However, due to a lack of management capacity, little progress had been made in this regard, The expectations and standards of practice need to be explicit for managing individual and team performance. Presently the department does not accurately describe these standards and expectations. It was evident that teams and local service areas were not reviewing or evaluating their performance or the quality of service they provided. The difficulties of communication and the provision of a quality service demonstrate a lack of leadership. Three partner agencies said that leadership was not clear or lacking. The leadership has not been able to provide a pace of change to deliver the improvements in service. There will be considerable challenges and associated risks for the newly appointed management team during this transitional period. Consequently, senior managers should remain vigilant in managing these risks in order to promote the welfare and safety of children in need. Improving the quality and timeliness of assessment in childrens services has been an area for improvement for the council for many years. The absence of improvement over a significant time questions the councils ability to deliver improvement in for service users in this area.

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