First reported 30 Aug 2013•Latest report 18 Nov 2025
Definition
What this concern includes
Includes delayed, missing or materially inadequate assessments of a person's community care, support or treatment needs where the assessment is part of community care planning, discharge or referral.
Not included
Excludes generic staffing, communication or documentation deficiencies unless they directly constitute failure of the community care assessment.
Excludes hospital diagnostic, custody, deprivation-of-liberty and mental-capacity assessments unless the assertion explicitly concerns a community care needs assessment.
Excludes failures to provide care packages or placements after an assessment has been completed.
Reports
18
Distinct published reports
Individual concerns
20
A report can raise multiple concerns
Date range
2013–2025
First to latest report issue date
Stated actions
30
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Bolton Borough Council2
Department of Health and Social Care2
Greater Manchester Mental Health NHS Foundation Trust2
Norfolk County Council2
Brighton and Hove City Council1
Care Quality Commission1
Chesterfield Royal Hospital1
Daryel Care1
East of England Community Health and Care NHS Trust1
Essex County Council1
Essex Partnership University NHS Foundation Trust1
Herries Lodge1
Lewisham and Greenwich NHS Trust1
Lincolnshire County Council1
LNT Software1
NHS trust8
English county council4
Healthcare site3
English metropolitan district council2
English unitary authority2
London borough council2
Ministerial department2
Company1
Domiciliary care provider1
Executive non-departmental public body1
Health and social care service regulator1
Health-system partnership1
Integrated care board1
Nursing home1
Police force1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Manchester South
Concerns raised1
Placement without a clear understanding of the person's needs
This report raised 9 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.8
Action
Develop a competency framework for identifying and assessing patients with complex health, social and onward care needs.
Stated by Bolton NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 9 June 2020.
Action
Develop a Home First competency framework for recommending appropriate intermediate-care placements.
Stated by Bolton NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 9 June 2020.
Action
Review transfers to intermediate care daily through an Integrated Discharge Team nurse.
Stated by Bolton NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 9 June 2020.
Action
Require ward managers to escalate patients with complex needs to the Integrated Discharge Team for a full multidisciplinary meeting before transfer of care.
Stated by Bolton NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 9 June 2020.
Action
Provide the Integrated Discharge Team across all assessment wards and the Emergency Department, assigning a lead care coordinator from admission through discharge.
Stated by Bolton Borough Council and Bolton NHS Foundation Trust and Greater Manchester Mental Health NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 9 June 2020.
Action
Develop a skills and competency framework for Integrated Discharge Team members to identify patients with complex onward needs.
Stated by Bolton Borough Council and Bolton NHS Foundation Trust and Greater Manchester Mental Health NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 9 June 2020.
Action
Deliver additional training to existing Integrated Discharge Team staff on identifying patients with complex onward needs.
Stated by Bolton Borough Council and Bolton NHS Foundation Trust and Greater Manchester Mental Health NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 9 June 2020.
Action
Require wards to escalate patients with complex needs to the Integrated Discharge Team for a full multidisciplinary meeting before considering transfer of care.
Stated by Bolton Borough Council and Bolton NHS Foundation Trust and Greater Manchester Mental Health NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 9 June 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
The Local Authority will provide a further response on actions concerning safe placement and transfers of care.
Stated by Bolton NHS Foundation TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Local authorities, service providers and the Care Quality Commission are responsible for acting on allegations of poor care, neglect or abuse.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Failure to assess the suitability and volume of continued PEG feeding in the community
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Complete an inspection addressing the reported concerns, including end-of-life care and Mental Capacity Act arrangements.
Stated by Care Quality CommissionStated completedThe respondent said that this action was complete when they made their response on 20 December 2018.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
CQC does not prescribe how providers should improve; the provider or registered manager decides the appropriate actions.
Stated by Care Quality CommissionRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
CQC does not publish detailed standards for specific conditions because this would duplicate expert sources and be impractical to keep updated.
Stated by Care Quality CommissionUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
The Care Quality Commission, as regulator, is expected to consider and respond to concerns about the services provided in this case.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Norfolk
Concerns raised1
Failure to fully consider identified risks in assessment
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
South Lincolnshire
Concerns raised1
Lack of detailed assessment of likely functional performance in home circumstances after discharge
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Norfolk
Concerns raised1
Delays in NCC Community Services assessments
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Derby and Derbyshire
Concerns raised1
Failure to undertake post-discharge planning and assessment of follow-up care needs
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Manchester West
Concerns raised2
Failure to prioritise assessments approaching or exceeding the twenty-eight-day completion period
Lack of a system for referring overdue assessments for reallocation to another officer
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Provide six-weekly formal supervision and daily case discussions where required, supported by a systematic approach to reprioritisation or reallocation.
Stated by Bolton Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 20 December 2013.
Action
Develop electronic monitoring and trigger functions to alert staff and managers to assessment timescales requiring prioritisation or reallocation.
Stated by Bolton Borough CouncilStated in progressThe respondent said that this action was in progress when they made their response on 20 December 2013.
Action
Communicate staff and manager responsibilities for alerting case managers when assessment timescales may not be met.
Stated by Bolton Borough CouncilStated completedThe respondent said that this action was complete when they made their response on 20 December 2013.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Unavailable referral information did not identify risks requiring prioritisation, while daily welfare checks found no concerns or increasing risks.
Stated by Bolton Borough CouncilDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
South Yorkshire (Western)
Concerns raised1
Failure to obtain community care assessments
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes delayed, missing or materially inadequate assessments of a person's community care, support or treatment needs where the assessment is part of community care planning, discharge or referral.
