SAFEGUARDING ADULTS IN HALTON

Transcription

1 SAFEGUARDING ADULTS IN HALTON Inter-Agency Policy, Procedures and Good Practice Guidance PART ONE: POLICY Review Date: February 2018

2 PART 1: POLICY POLICY STATEMENT Living a life that is free from harm and abuse is a fundamental right of every person. When abuse does take place, it needs to be dealt with swiftly, effectively and in ways that are proportionate to the issue. In addition, the person at risk at the centre of any safeguarding concern must stay as much in control of decision making as possible. The right of the individual to be head throughout the process is a critical element in the drive to ensuring more personalised care and support. In Halton, the main statutory agencies: the Local Authority, Police and NHS Organisations, need to work together to both promote safer communities in order to prevent harm and abuse and to deal well with suspected or actual cases. It is our belief that people at risk are best protected when procedures between statutory agencies are consistent across the whole of Halton. All staff, whatever the setting, have a key role in preventing harm or abuse occurring and in taking action when concerns arise. The Inter-Agency Policy, Procedures and Good Practice Guidance set out here, are designed to explain simply and clearly how agencies and individuals should work together to protect people at risk. The target audience for this document is therefore to protect people at risk. The target audience for this document is therefore professionals and front-line workers (including unqualified staff and volunteers). Safeguards against poor practice, abuse, neglect and exploitation need to be an integral part in the delivery of care and support, as well as commissioning and awarding contracts and monitoring arrangements. This should be achieved through partnerships between local organisations and individuals. Any person at risk of abuse, neglect or exploitation should be able to get in touch with public organisations for appropriate interventions and to know that agencies will work together as needed. Safeguarding Adults Board has a critical role to play in terms of strategic leadership and the management of safeguarding services across partners. Halton Safeguarding Adults Board leads and oversees the work of all Adult Safeguarding arrangements in Halton and is responsible for ensuring that these Policies and Procedures are developed, implemented, embedded and regularly reviewed. Page 2 of 120

3 PART 1: POLICY Contents Glossary and Acronyms INTRODUCTION PRINCIPLES AND VALUES Principles No Secrets (2000) Values Levels of Safeguarding Prevention ADULT AT RISK OF ABUSE Definition of an Adult at Risk Vulnerability Abuse Types of Abuse Harm Contexts in which abuse might take place Institutional Abuse Hate Crime Domestic Abuse Honour Based Violence Forced Marriage Prevent Agenda: Exploitation by radicalisers who promote violence Human Trafficking Carers at risk of harm Carers who cause harm Abuse of Trust Safeguarding concerns between persons at risk Personal budgets, Direct Payments and Self-Directed Care When there are concerns about children and adults at risk of abuse Transitions between Adult and Children s Services Mental Health Services Safeguarding Adults Serious Case Reviews ROLES OF SAFEGUARDING PARTNERS Adult Social Care Services in Halton Borough Council Page 3 of 120

4 PART 1: POLICY 4.2 Care Quality Commission Cheshire Police Cheshire Fire and Rescue Service Faith Communities, Voluntary and Private Sector Providers Halton Clinical Commissioning Group Halton Probation Service Healthwatch Housing Organisations NHS Funded Services Other Organisations Providing Services to Adults Responsibilities of all Organisations THE MENTAL CAPACITY ACT Capacity and Consent Deprivation of Liberty Safeguards SUPPORT FOR THOSE INVOLVED IN THE SAFEGUARDING PROCESS Supporting the Adults at Risk Involving the Adult at Risk Independent Advocacy Witness Support and Special Measures Victim Support Keeping Families and Others Concerned Informed and Supported Responsibilities to those who are alleged to have caused harm ARRANGEMENTS FOR MANAGING SAFEGUARDING ADULTS Determining the relevant Local Authority Information Sharing Whistle Blowing Guidance Complaints Process Record Keeping and Confidentiality Safeguarding Risk Assessments Involving the Adult at Risk Vital Interest Best Interest Public Interest Personal Risk Taking Page 4 of 120

5 PART 1: POLICY 8.0 PROCEDURES Stages of the Safeguarding Process Stage One Safeguarding Alert What is an alert? Who is responsible for raising an alert? How do you raise an alert? What responsibilities does the Alerter and/or their Manager have? Responsibilities of the person first aware of possible abuse Responsibilities of the Line Manager to whom an alert is made What is Disclosure and how should it be dealt with? How to manage issues around consent and confidentiality How to manage allegations against staff Stage One Alert Flowchart Stage Two Safeguarding Referral Purpose of the safeguarding adult referral Information Gathering Risk Assessment and Management Deciding the action to be taken following assessment of the alert Stage Two Referral - Flowchart Stage Three Safeguarding Strategy Discussion/Meeting The purpose of the strategy discussion or meeting The strategy discussion or meeting must: Who should participate in or attend strategy discussions/meetings? Stage Three Safeguarding Strategy Discussion/Meeting Flowchart Stage Four Safeguarding Investigation The purpose of a Safeguarding Adults Investigation The role of the nominated investigator(s) is to: The nominated investigators communication with the adult at risk When the investigation is concluded Stage Four Safeguarding Investigation - Flowchart Stage Five Case Conference Purpose of a Case Conference Roles and Responsibilities Timescales Page 5 of 120

6 PART 1: POLICY Process Safeguarding Protection Plan Closing the Investigation Stage Five Case Conference Flowchart Stage Six Safeguarding Review Purpose of the Review Who should attend? Actions required during the Review Recording Feedback Stage Six Review Flowchart APPENDIX ONE: Quick Guide for Providers of Services GOOD PRACTICE GUIDANCE Decision Making-Levels of Seriousness and Intervention Impact of the Alleged Abuse on the Person Factors to be considered Poor Practice and Abuse or Neglect Abuse of One Adult in a Care Setting by Another Decisions in Health Settings The Benefits for Patients The Benefits for the Service and their Partners Alerts which Fall Below the Threshold APPENDIX TWO: CARE CONCERNS/SAFEGUARDING THRESHOLDS APENDIX THREE: CARE CONCERN/SAFEGUARDING FLOWCHART INFORMATION SHARING GUIDANCE Key Principles of Information Sharing When can Information be Shared? Legitimate Purposes include: Public Interest includes: Information Sharing when the Person at Risk has Given Consent Information Sharing when the Person at Risk does not have the Capacity to Consent to Information Sharing SAFEGUARDING CONCERNS WITHIN NHS SERVICES Safeguarding Principles Reporting Page 6 of 120

7 PART 1: POLICY 11.3 Criteria to determine a NHS Led Intervention Decision Making Criteria Level of Response Action and Outcomes APPENDIX FOUR: NHS SAFEGUARDING PROCESS MAP THE LEGAL CONTEXT OUTCOMES AND EXPERIENCES Achieving Good Outcomes Making Safeguarding Personal APPENDIX FIVE: SAFEGUARDING ADULTS CONTACT POINTS Page 7 of 120

8 PART 1: POLICY Glossary and Acronyms Term Definition Abuse Achieving Best Evidence ADASS Adult at Risk Adult Social Care Advocacy Alert Alerter Alerting Is a violation of an individual s human and civil rights by any other person or persons. It can take many forms, including physical, sexual, emotional/psychological, financial, neglect, discriminatory and institutional abuse Vulnerable witnesses can be supported before and during a trial to help them give their best evidence in what can be a traumatic and intimidating experience. The measures available include videorecorded statements, witness intermediaries and evidence via live link Association of Directors of Adult Social Services is the national leadership association for Directors of Local Authority Adult Social Care Services Adults who need community care services because of mental or other disability, age or illness and who are, or may be unable, to take care of themselves against harm or exploitation. The term replaces vulnerable adult and alleged victim This term is often used generically but it does specifically refer to local authorities and has replaced the term social services in everyday language. The Law Commission defines adult social care as the care and support provided by local social services authorities pursuant to their responsibilities towards adults who need extra support. This includes older people, people with learning disabilities, physically disabled people, people with mental health problems, drug and alcohol misuse and carers Is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need Describes the action of reporting concerns and allegations into the multi-agency safeguarding adult contact point Is the person who alerts the multi-agency safeguarding adult contact point that an adult is being, has been, or is at risk of being abused or neglected? This could be the person themselves, a member of their family, a carer, a member of staff or any other person. Within an organisation, the Alerter will usually be the Alerting Manager Is the person within an organisation to whom any member of staff Page 8 of 120

9 PART 1: POLICY Manager Balance of probability Best Evidence Best Interests Best Interest Decision Making Carer Case Conference Discussion Clinical Commissioning Groups (or volunteer) should report their concerns? The Alerting Manager will make an alert by reporting the concerns to the multi-agency safeguarding adult contact point. Is the standard of proof required in civil law cases and many other jurisdictions for deciding outcomes. (In criminal cases, the standard is proof beyond reasonable doubt) Is also known as primary evidence, usually denotes an original writing, which is considered the most reliable proof of its existence and its contents. Best evidence is distinguishable from secondary evidence, a reproduction of an original or testimony establishing its existence, which will be admissible as proof only if the best evidence cannot be obtained and ensuring no fault of the party seeking to present it Is one of the principles of the Mental Capacity Act The Act states that if a person lacks mental capacity to make a particular decision then whoever is making that decision or taking any action on that person s behalf must do so in the person s best interests. If a person has been assessed as lacking capacity then any action taken, or decision made for or on behalf of that person, must be made in the person s best interests. The person who has to make the decision is known as the decision maker. This is normally the carer responsible for the day to day care, or a professional where decisions about treatment, care arrangements or accommodation need to be made Refers to unpaid carers, for example, relatives or friends of the adult at risk. Paid workers, including personal assistants, whose job title may be carer, are called staff within this policy and procedure Held where a case conference meeting is not required. It is held to discuss the outcome of the safeguarding investigation and to put in place a protection plan. This can be held in a number of ways, including a face to face meeting, by telephone or by Statutory NHS organisations, representing groupings of GP Practices that are responsible for designing local health services in England. They do this by commissioning (or buying) healthcare services, including elective hospital care, rehabilitation care, urgent care and emergency care, most community health services, mental health and learning disability services Page 9 of 120

10 PART 1: POLICY Clinical Governance Conflict of Interest Consent Care Programme Approach (CPA) Crown Prosecution Service (CPS) Disclosure & Barring Service (DBS) Deprivation of Liberty Safeguards (DoLS) Duty of Care Emergency Duty Officer (EDO) Emergency Duty Teams (EDT) Harm The framework through which the National Health Service (NHS) improves the quality of its services and ensures high standards of care Occurs when an individual or organisation is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other The voluntary and continuing permission of the person to the intervention based on an adequate knowledge of the purpose; nature; likely effects and risks of that intervention, including the likelihood of its success and any alternatives to it Requires health authorities, in collaboration with social services departments, to put in place specified arrangements for the care and treatment of people with mental health problems in the community The Government department responsible for prosecuting criminal cases investigated by the Police in England and Wales The Public Body set up to help prevent unsuitable people from working with children and vulnerable people. It is an amalgamation of the Criminal Records Bureau and the Independent Safeguarding Authority A legal safeguard for people who cannot make decisions about their care and treatment when they need to be cared for in a particular restrictive way. They apply to people in care homes or hospitals when they are deprived of their liberty The responsibility or the legal obligation of a person or organisation to adhere to a standard of reasonable care and avoid acts or omissions likely to cause harm to others The social worker on duty in the Emergency Duty Team (EDT) Social Services Teams that respond to out-of-hours alerts where intervention is required to protect a child or adult at risk and where it would not be safe or appropriate to delay that intervention to the next working day Defined in No Secrets (2000) as not only ill treatment (including sexual abuse and forms of ill treatment which are not physical), Page 10 of 120

11 PART 1: POLICY but also the impairment of, or an avoidable deterioration in, physical or mental health and the impairment of physical, intellectual, emotional, social or behavioural development Health and Safety Executive Independent Domestic Violence Advisers (IDVAs) Independent Mental Capacity Advocates (IMCAs) Informed Consent Investigation Multi-Agency Public Protection Arrangements (MAPPA) Multi-Agency Risk Assessment Conference (MARAC) National independent regulator that aims to reduce work-related death and serious injury across workplaces Trained support workers who provide assistance and advice to victims of domestic violence A legal safeguard for people who lack the mental capacity to make specific important decisions, including making decisions about where they live, serious medical treatment, safeguarding adults, care reviews and Deprivation of Liberty Safeguards (DoLS). IMCAs are mainly instructed to represent people where there is no one independent of services, such as a family member or friend, who is able to represent the person The voluntary agreement of a person who has mental capacity to a course of action or an adequate knowledge of the purpose, nature, likely effects and risks of that intervention, including the likelihood of its success and any alternatives to it A process of gathering evidence to determine whether abuse took place Statutory arrangements for managing sexual and violent offenders Multi-Agency forum that manages high-risk cases of domestic violence, stalking and honour -based violence Mental Capacity The ability to make a decision about a particular matter at the time the decision needs to be made National Health The country s publicly funded healthcare system Page 11 of 120

12 PART 1: POLICY Service (NHS) Office of the Public Guardian (OPG) Organisation Alleged to have Caused Harm Patient Advice and Liaison Service (PALS) Person Alleged to have Caused Harm Public Interest Referral Safeguarding Adults Safeguarding Investigating Officer Safeguarding Adults Board (SAB) Serious Case Review Serious Incident/Serious Untoward Incident (SI/SUI) Supports the Public Guardian in registering enduring powers of attorney, lasting powers of attorney and supervising Court of Protection appointed deputies An organisation that is alleged to be responsible for abuse experienced by an adult at risk A NHS body created to provide advice and support to NHS patients and their relatives and carers A person who is alleged to be responsible for abuse experienced by an adult at risk. This terms replaces alleged perpetrator Determined by balancing the rights of the individual to privacy with the rights of others to protection Involves the decision to proceed to a safeguarding strategy discussion or meeting to plan an investigation, assess risk and agree interim protection arrangements Used to describe all work to help adults at risk stay safe from abuse. It replaces the term Adult Protection A member of staff from Adult Social Care (or a NHS organisation according to local arrangements) or a Service Provider Manager who leads an investigation into the allegation of abuse and produces the safeguarding investigation report Joint working arrangements comprising of statutory and nonstatutory organisations that work together within a local authority area to provide strategic leadership to safeguard adults at risk Undertaken by a Safeguarding Adults Board (SAB) when there is potential for significant multi-agency learning as to how safeguarding practice and systems can be improved A term used by the National Patient Safety Agency (NPSA). It is defined as an incident that occurred in relation to NHS-funded services resulting in serious harm or unexpected or avoidable death of one or more patients, staff, visitors or members of the public Page 12 of 120

13 PART 1: POLICY Strategy Discussion Strategy Meeting Vital Interest Wilful Neglect A multi-agency discussion between relevant organisations and parties in order to agree how to proceed with the referral. This will include reviewing the need for an investigation, planning any investigation, assessing risk and agreeing interim protection arrangements. This can be held in a number of ways, including face to face meeting, by telephone or by A multi-agency meeting with the relevant individuals involved, and with the adult at risk where appropriate, to agree how to proceed with the referral. This will include reviewing the need for an investigation, planning any investigation, assessing risk and agreeing interim protection arrangements A term used within these procedures to describe actions critical to prevent serious harm or distress or in life-threatening situations An intentional or deliberate omission or failure to carry out an act of care by someone who has care of a person who lacks capacity to care for themselves. Wilful neglect is identified as an offence under Section 44 of the Mental Capacity Act 2005 and applies to anyone caring for a person who lacks capacity, including family carers, healthcare and social care staff in care homes or hospitals and those who provide care in a person s home Page 13 of 120

14 PART 1: POLICY 1.0 INTRODUCTION The Halton Safeguarding Adults Inter-Agency Policy, Procedures and Good Practice Guidance represents the commitment of organisations in Halton to work together to safeguard adults at risk with the aim that: The human rights, needs and interests of persons who are at risk of abuse, neglect or exploitation, are respected and upheld A proportionate, timely, professional and ethical response is made to any person at risk who may be experiencing abuse, neglect or exploitation All decisions and actions are taken in line with the Mental Capacity Act 2005 Agencies work together as partners to support persons at risk to live safely in their communities A person led approach to adult safeguarding is adopted so that the adult, their families and carers are working together with agencies to find the right solutions to keep people safe and support them in making informed choices The Inter-Agency Policy, Procedures and Good Practice Guidance aims to make sure that each adult at risk maintains: Choice and control Safety Health Quality of Life Dignity and Respect and that: Support, protection and services are appropriate to the adult at risk and do not discriminate against them due to disability; age; gender; sexual orientation; race ; religion; culture or lifestyle Page 14 of 120

15 PART 1: POLICY The Inter-Agency Policy, Procedures and Good Practice Guidance document also aims to provide an overall framework for best practice and multi-agency co-operation in all work relating to safeguarding adults in Halton. These documents have been designed to be used by members of the public and all agencies and individuals involved with adults at risk where abuse is suspected and/or reported within Halton, including managers, professionals, volunteers and staff working in public, voluntary and private sector organisations. This represents the commitment of all individuals and organisations to: Work together to prevent and protect adults at risk from abuse or harm Empower and support people to make their own choices Investigate actual or suspected abuse and neglect Support and provide a service to adults at risk who are experiencing abuse, neglect and exploitation To change practice as a result of lessons learned These documents describe the systems for preventing abuse and protecting adults at risk, define abuse, the process for investigating concerns about potential abuse, the roles and responsibilities of each agency, the legal framework and the functions of Halton Safeguarding Adults Board. STRUCTURE: The Policy, Procedures and Good Practice Guidance have been divided into three parts: Part One: Policy - The policy section establishes the scope and guiding principles of the procedures, as well as the responsibilities of organisations and individuals. It includes sections relating to: Adult at risk and abuse Safeguarding principles and values Prevention Roles of safeguarding partners Specialist support services and linked agendas Responsibilities within commissioning Responsibilities in managing safeguarding arrangements Page 15 of 120

16 PART 1: POLICY Part Two: Procedures The procedures section details the actions required of individuals and organisations to respond to suspected or actual abuse of an adult at risk. Actions within the procedures should be informed by the policy. Part Three: Good Practice Guidance This section provides information and strategies relating to good practice in adult safeguarding Review These documents are an ongoing commitment to improve the response of individuals and agencies to the abuse of adults at risk. They will therefore be reviewed and revised on a regular basis in order to take into account changing policy and practice developments. Page 16 of 120

17 PART 1: POLICY 2.0 PRINCIPLES AND VALUES 2.1 Principles The Halton Safeguarding Adults Inter-Agency Policy, Procedures and Good Practice Guidance is founded on the following safeguarding principles and values that govern how the safeguarding adults procedures should be implemented. These principles and values are based upon national guidance on achieving good outcomes for adults at risk: Principle 1: Empowerment presumption of person led decisions and informed consent Principle 2: Protection support and representation for those in greatest need Principle 3: Prevention it is better to take action before harm occurs We will actively promote the empowerment, independence and wellbeing of all persons at risk and respect the right of the individual to lead an independent life based on selfdetermination and personal choice. We will involve the person at risk from the start, provide access to information, make them aware of the safeguarding procedures and provide support to assist their decision making We will ensure there is an assessment of decision making capacity where it is thought that a person at risk lacks capacity to make relevant decisions about maintaining their safety and, if required, act in their best interests in accordance with the Mental Capacity Act We will ensure that when the right to an independent lifestyle and choice is at risk, the individual concerned receives appropriate support including advice; advocacy; protection and support from relevant agencies The report on the consultation of No Secrets found that prevention should be the foundation of safeguarding services. We will ensure that our safeguarding systems are proactive, rather than reactive; we will ensure the safety of persons at risk by integrating strategies, policy systems and services within the framework of relevant legislation and promotion of human rights. We will ensure that prevention occurs in the Page 17 of 120

18 PART 1: POLICY Principle 4: Proportionality proportionate and least intrusive response appropriate to the risk presented Principle 5: Partnerships local solutions through services working with their communities Principle 6: Accountability accountability and transparency in delivering safeguarding context of person-centred support and personalisation, empowering individuals to make choices and supporting them to manage risks. This should lead to the services that people want to use, which prevent the potential crises from developing We accept that the right to selfdetermination can involve risk and will ensure that such risk is assessed, recognised and understood by all concerned. We will seek to minimise risks through open discussion between the individual and agencies. We will ensure that the law and statutory requirements are known and used appropriately so that the person at risk of experiencing crime receives the protection of the law and access to the judicial system We recognise that communities have a part to play in preventing, detecting and reporting abuse, neglect and exploitation. We will work together as partners to develop opportunities for communities to learn from the experiences of persons at risk We will work together to ensure that: The roles of all agencies are clear and that they understand to whom they are accountable Staff understand what is expected of them and others Agencies recognise their responsibilities to each other, act upon them and accept collective responsibility for safeguarding arrangements We share and receive information, consistent with the Data Protection Act 1998 Page 18 of 120

19 PART 1: POLICY 2.2 No Secrets (2000) The Department of Heath published No Secrets (March 2000) which provides national guidance on developing and implementing multi-agency procedures to protect adults at risk from abuse. This requires local agencies to work together for the protection of adults at risk with the local Social Services Authority as the lead, for co-ordinating work to safeguard adults. However, it is recognised that successful responses to adults at risk need multi-agency and multi-disciplinary working. Some instances of abuse will constitute a criminal offence. In this respect adults at risk are entitled to the protection of the law in the same way as any other member of the public. Examples of actions which may constitute criminal offences are assault, whether physical or psychological; sexual assault and rape; theft; fraud or other forms of financial exploitation and certain forms of discrimination, whether on racial or gender grounds as well as wilful neglect or ill-treatment. Alleged criminal offences differ from non-criminal forms of abuse in that the responsibility for taking action invariably rests with the state in the form of the Police and the Crown Prosecution Service. Accordingly, when concerns about alleged abuse suggest that a criminal offence may have been committed, it is imperative that reference should be made to the Police as a matter of urgency. Criminal investigation by the Police takes priority over all other lines of enquiry. 2.3 Values Halton Safeguarding Adults Inter-Agency Policy, Procedure and Good Practice Guidance has been developed in the recognition that adults at risk can be abused and that this abuse constitutes a clear infringement of their human and civil rights. All partners are expected to share the following values which underpin their work: Everybody within our society deserves, and is entitled to, good quality care and support to meet their needs Some people have difficulty expressing their needs and require careful consideration of their individual circumstances Everybody has a right to live in a safe and secure environment without fear of abuse, harassment or injury Everybody has a right to live as independently as they are able Everybody has a right to make choices and decisions about their lifestyle, which can involve risk-taking Everybody should have access to relevant services for addressing issues of abuse and neglect, including the civil and criminal justice system and victim support services Page 19 of 120

20 PART 1: POLICY 2.4 Levels of Safeguarding Safeguarding Activity There are three levels of safeguarding work: Prevention; Early Intervention and Safeguarding. Prevention and early intervention are approaches that involve a wide range of responses to individuals from across agencies that aim to prevent things escalating into the safeguarding arena. Safeguarding is carried out in direct response to individuals suffering abuse or neglect. 2.5 Prevention Whist safeguarding adults procedures focus on responding to incidents of abuse, its prevention must always be the primary objective. Prevention is associated with a broad range of responsibilities and initiatives; each associated with making safeguarding adults a core responsibility when providing services. No Secrets states that the primary aim of all agencies should be to prevent abuse of adults at risk as far as possible. In order to minimise the risk of abuse to adults in Halton, all partner agencies signed up to these procedures, will demonstrate their commitment to preventing abuse through: Ensuring all staff and volunteers within their organisation complete Safeguarding Adults Training appropriate to their roles and responsibilities Ensuring all staff and volunteers within their organisation are aware of what constitutes abuse; adults who are most at risk of abuse; the potential signs and indicators of abuse; and understand their individual responsibility for prompt action in recognising and knowing how to report potential abuse Ensuring their organisation is committed to promoting the empowerment of people who use their services, their carers and families to understand what appropriate or inappropriate behaviour is so that they know when to take action Page 20 of 120

21 PART 1: POLICY to report or stop abuse Promoting the values of independence, choice, control and integration to enable individuals to be aware of their rights and responsibilities Committing their organisation to participate in Safeguarding Adults Investigations where appropriate, whilst ensuring that the care and treatment that the adult at risk requires is still provided at an appropriate level during the investigation process Ensuring their organisation works in co-operation and collaboration with other agencies to ensure the safety and wellbeing of any person deemed to be an adult at risk Ensuring their organisation has robust Safer Staffing Recruitment processes in place so that all staff and volunteers are carefully recruited, selected and vetted Ensuring that their organisation has a clear Code of Conduct in place which sets out the standards of conduct expected of staff/volunteers when working with adults at risk, especially in relation to personal and sexual relationships Ensure that their organisation has clear policies and procedures in relation to fraud, disciplinary and health and safety arrangements Ensure that their organisation has assurances for the protection of Whistle- Blowers Ensure that their organisation has operational guidelines where appropriate in relation to the safe and appropriate management of: Challenging Behaviour Personal and Intimate Care Pressure Ulcer Guidance Physical Interventions Sexuality Medication Managing finances and property of people who use services Self-Directed Support and Direct Payments Risk assessment and management Ensuring their organisation has a system for monitoring their use of these Multi- Agency Procedures and their own safeguarding adults practice Prevention also involves the organisation assessing the effectiveness of its practice and learning from its experience: Page 21 of 120

22 PART 1: POLICY Prevention of abuse through high quality services Prevention Responses Effective responses where abuse occurs Use learning to improve prevention, improve services and responses to abuse Learning In order for organisations to demonstrate that safeguarding measures are understood, assured and improved they will need to ensure that: Policies and procedures are kept under continual review Services strive for continual development, learning from incidents occurring and serious case reviews within the partnership Safeguarding processes are assured through governance processes, whereby incidents, patterns, trends are identified and actions taken accordingly Page 22 of 120

23 PART 1: POLICY 3.0 ADULT AT RISK OF ABUSE 3.1 Definition of an Adult at Risk In 2000, the No Secrets Guidance defined a vulnerable adult as: A person aged 18 years or over who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or maybe unable to take care of him or herself, or unable to protect himself or herself against harm or exploitation whether or not a person is vulnerable in these cases will depend upon surrounding circumstances, environment and each case must be judged on its own merits However, in March 2011 the Law Commission recommended that the term vulnerable adults be replaced by adult at risk. This is because the term vulnerable adult may wrongly imply that some of the fault for the abuse lies with the adult being abused. This document will therefore refer to adult at risk as an exact replacement for the definition of a vulnerable adult, as defined by No Secrets above. The term adult at risk is used within this policy in replacement of the term vulnerable adult. An adult at risk is defined as a person aged 18 years or over: who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against harm or exploitation (Department of Health, No Secrets, 2000) An adult at risk may therefore be a person who, for example: Is an older person who is frail due to ill health, physical disability or cognitive impairment Has a learning disability Has a physical disability and/or a sensory impairment Has mental health needs including dementia or a personality disorder Has a long-term illness/condition Misuses substances or alcohol Is a carer such as a family member/friend who provides personal assistance and care to adults and is subject to abuse Lacks the mental capacity to make particular decisions and is in need of care and support Page 23 of 120

24 PART 1: POLICY 3.2 Vulnerability The Safeguarding Vulnerable Groups Act (2006) recognises that any adult receiving any form of health care is vulnerable. Whilst there is no formal definition of vulnerability within healthcare, some people receiving health care may be at greater risk from harm than others, sometimes as a complication of their presenting condition and their individual circumstances. The risks that increase a person s vulnerability should be appropriately assessed and identified by the health care professional at the first contact and continue throughout the care pathway. Table 1: Factors which increase a person s vulnerability to abuse and exploitation Personal Characteristics of the Adult at Risk that increase vulnerability may include: Not having mental capacity to make decisions about their own safety including fluctuating mental capacity associated with mental illness Communication difficulties Physical dependency being dependent on others for personal care and activities of daily life Low self-esteem Experience of abuse Childhood experience of abuse Social/situational factors that increase the risk of abuse may include: Personal Characteristics of the Adult at Risk that decrease vulnerability may include: Having mental capacity to make decisions about their own safety Good physical and mental health Having no communication difficulties or if so, having the right equipment/support No physical dependency or if needing help, able to self-direct care Positive former life experiences Self-confidence and high self-esteem Social/situational factors that decrease the risk of abuse may include: Being cared for in a care setting that is Good family relationships more or less dependent on others Active social life and a circle of friends Not getting the right amount or the right Able to participate in the wider community kind of care that they need Good knowledge and access to the range of Isolation and social exclusion community facilities Stigma and discrimination Remaining independent and active Lack of access to information and support Access to sources of relevant information Being the focus of anti-social behaviour Page 24 of 120

25 PART 1: POLICY 3.3 Abuse For the purpose of this document, the term abuse is defined as: a violation of an individual s human and civil rights by any other person or persons which results in significant harm (Department of Health, 2000) Abuse may be: A single act or repeated acts An act of neglect or a failure to act Multiple acts, for example, an Adult at Risk may be neglected and also being financially abused Abuse is about the misuse of power and control that one person has over another. Where there is dependency, there is a possibility of abuse or neglect unless adequate safeguards are put in place. Intent is not an issue at the point of deciding whether an act or a failure to act is abuse; it is the impact of the act on the person and the risk of harm to that individual. Abuse can take place in settings such as the person s own home; day or residential centres; supported housing; educational establishments; or in nursing homes; clinics or hospitals. A number of abusive acts are crimes and informing the Police must be a key consideration. 3.4 Types of Abuse Abuse can be something that is done, or omitted from being done, to a person. It can be: Physical Abuse hitting slapping pushing kicking misuse of medication restraint or inappropriate sanctions Sexual Abuse rape and sexual assault, or sexual acts to which the person at risk did not, or could not, consent or had to consent to under pressure Page 25 of 120

26 PART 1: POLICY Psychological Abuse emotional abuse threats of harm threats of abandonment deprivation of contact humiliation blaming controlling intimidation coercion harassment verbal abuse isolation isolation of withdrawal from services or supportive networks Financial or Material Abuse theft fraud exploitation property pressure in connection with wills inheritance or financial transactions misuse or misappropriation of property, possessions or benefits Neglect and Acts of Omission Ignoring medical or physical care needs Failing to provide access to appropriate health, social care, welfare benefits or educational services Withholding the necessities of life such as medication, adequate nutrition and heating Discriminatory Abuse racism sexism or acts based on a person s disability other forms of harassment, slurs or similar treatment such as disability hate crime Page 26 of 120

27 PART 1: POLICY Self-Neglect The relationship between self-neglect and safeguarding is contested within the UK, in part because the current definition of abuse specifies harmful actions by someone other than the Adult at Risk. In the meantime, self - neglect does not come under the scope of these procedures. There may however be individual cases that warrant consideration for progressing through safeguarding, for example, if a person lacks capacity 3.5 Harm In determining what justifies intervention and what sort of intervention is required No Secrets (2000) uses the concept of significant harm. This refers to: Ill treatment (including sexual abuse and forms of ill treatment which are not physical The impairment of, or an avoidable deterioration in, physical or mental health The impairment of physical, intellectual, emotional, social or behavioural development The importance of this definition is in deciding what action to take; consideration must be given not only to the immediate impact on and risk to the person, but also to the risk of future, longer-term harm, neglect or exploitation. Seriousness of harm or the extent of the abuse is not always clear at the point of the alert or referral. All reports of suspicions or concerns should be approached with an open mind and could give rise to action under the procedures. The actual or likelihood of harm may impact upon the person in one or more areas of their life: Exercising choice and control Health and well-being, including mental and emotional as well as physical health and well-being Personal dignity and respect Quality of life Freedom from discrimination Making a positive contribution Economic well-being Freedom from harm, abuse and neglect, taking wider issues of housing and community safety into account Page 27 of 120

28 PART 1: POLICY Significant harm varies between individuals. This requires careful assessment using as much information as available before a decision is made as to how to proceed and should include consideration of the possibility of future significant harm. The seriousness or extent of the abuse, neglect or exploitation is often not clear; some incidents may not have caused immediate significant harm but if they were to happen again, could lead to significant harm to the adult, other adults or children. If there are not well managed measures in place to prevent another incident, a situation which has a high likelihood of potential serious abuse, neglect or exploitation could cross the threshold for use of safeguarding procedures. Not everyone who needs support to live their everyday lives is in need of such services; therefore, it is important to target resources on those who do. Resources must also be used proportionately i.e. some people will need the safeguarding adults procedures to be used to fully protect them, in other situations the safeguarding adults procedures can be used to enable a person to self-protect in the present, or future, circumstances. 3.6 Contexts in which abuse might take place Abuse and crimes against adults may occur in different contexts. Actual or suspected abuse of persons at risk in any of the contexts below will trigger a safeguarding response in accordance with this policy Institutional Abuse Institutional abuse occurs when the routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice which affects the whole setting and denies, restricts or curtails the dignity; privacy; choice; independence or fulfilment of adults at risk Hate Crime Hate crime is defined as any crime that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person s religion, belief, gender identity or disability. It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence Domestic Abuse Domestic violence is defined as: Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality This can encompass, but is not limited to, the following types of abuse: Page 28 of 120

29 PART 1: POLICY psychological physical sexual financial emotional Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is: an act or a pattern of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish or frighten their victim. Family members are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws or step-family; see Association of Chief Police Officers Honour Based Violence Honour based violence is a crime or incident, which has or may have been committed to protect or defend the honour of the family and/or community (Crown Prosecution Service/Association of Chief Police Officers) It is a collection of practices, which are used to control behaviour within families or other social groups to protect perceived cultural and religious beliefs and/or honour. Such violence can occur when perpetrators perceive that a relative has shamed the family and/or community by breaking their honour code Forced Marriage Forced marriage is a term used to describe a marriage in which one or both of the parties are married without their consent or against their will. A forced marriage differs from an arranged marriage, in which both parties consent to the assistance of their parents or a third party in identifying a spouse. In June 2012, the Government announced that forcing someone to marry will become a criminal offence in England and Wales in 2013/ Prevent Agenda: Exploitation by radicalisers who promote violence Individuals may be susceptible to exploitation into violent extremism by radicalisers. Violent extremists often use persuasive rationale and charismatic individuals to attract people to their cause. The aim is to attract people to their reasoning, inspire new recruits and embed their extreme views and persuade vulnerable individuals of the legitimacy of their cause. Page 29 of 120

30 PART 1: POLICY There are a number of factors that may make the individual susceptible to exploitation by violent extremists, such as identity or personal crisis, particular personal circumstances, unemployment or underemployment and criminality. None of these factors should be considered in isolation but in conjunction with the particular circumstances of the individual. The Home Office leads on the anti-terrorism strategy, CONTEST and PREVENT is part of the overall CONTEST strategy, aiming to stop people becoming terrorists or supporting violent extremism. The Police should be the initial point of contact in relation to such concerns. A safeguarding adult alert will also be required where the person is an adult at risk Human Trafficking The United Nations definition of human trafficking is: The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, or abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent or a person having control over another person, for the purpose of exploitation Carers at risk of harm There are times when carers may experience abuse from the person to whom they are offering care and support, or from the local community in which they live. Carers may also be persons at risk and those carers experiencing abuse by the person they offer care to, can expect the same response as any person at risk of abuse. Carers also have a legal right to an assessment of their needs. A carer s assessment under carer s legislation should be seen as part of the overall assessment process. In some cases both the carer and the supported person can be considered to be at risk of harm. The needs of the person at risk who is the alleged subject of abuse should be addressed separately from the needs of the person alleged to be causing them harm Carers who cause harm The vast majority of carers strive to act in the best interests of the person they support. However, on occasion carers may cause intentional or unintentional harm. Cases of unintentional harm may be due to lack of knowledge, or due to the fact that the carer s own physical or emotional needs make them unable to care adequately for the adult at risk. The carer may also be an adult at risk. In this situation the aim of any safeguarding adults work will be to support the carer to provide support and to help make changes Page 30 of 120

31 PART 1: POLICY in their behaviour in order to decrease the risk of further harm to the person they are caring for Abuse of Trust A relationship of trust is one in which one person is in a position of power or influence over the other person because of their work or the nature of their activity. There is a particular concern when abuse is caused by the actions or omissions of someone who is in a position of power or authority and who uses their position to the detriment of the health and well-being of a person at risk, who in many cases could be dependent on their care. There is always a power imbalance in a relationship of trust. A referral must also be made to professional bodies (where applicable) and the Disclosure and Barring Service if the employee or volunteer has been found to have harmed or put at risk of harm, an adult at risk and the relevant criteria has been met. If the person who is alleged to have caused the abuse is a member of a recognised professional group the organisation will need to take actions under the relevant code of conduct for the profession as well as taking action under these policy and procedures Safeguarding concerns between persons at risk Abuse can happen between persons at risk and agencies and services which provide support to adults, have a responsibility to protect them from abuse, as well as preventing them from causing harm to other adults. It is important the needs of the adult causing the harm are taken into consideration in the safeguarding responses for both parties Personal budgets, Direct Payments and Self-Directed Care People who direct their own care and support should be enabled to manage their personal budgets and direct payments in a safe way. People need to be aware of any potential for abuse or harm that may occur in the arrangements they are making. An evaluation of risk is central to any assessment: simply put, a risk assessment is a careful examination of what could cause harm to people. Risk management and risk enablement are part of the person centred support planning process. A person in receipt of direct payments must receive a comprehensive needs assessment by the Local Authority and be assessed as being able to take on the responsibilities of becoming an employer. Staff involved in assessments, support planning, monitoring, reviewing and supporting people using direct payments must ensure that all reasonable steps have been taken to minimise the risk of abuse, for people who are self-directing their own support. Support Plans should record all risks associated with identified needs and any other safeguarding issues identified in assessments. There will be specific reference to how the personal budget will be spent to meet needs and outcomes. Particular attention needs to be given to those people who may be vulnerable to Page 31 of 120

32 PART 1: POLICY abuse or harm and who lack the capacity to make decisions relating to these matters and need someone to assist or make decisions on their behalf. People using self-directed support need to be given information to enable them: To recognise that abuse and harm can occur with personal budgetary arrangements To recognise that self-directed support has similar safeguarding risks as other forms of support To be aware of the processes for expressing concerns or reporting abuse or harm about the support services they engage with To understand their responsibilities, as potential employers, to inform the Disclosure and Barring service of any staff they may dismiss following an adult safeguarding investigation When there are concerns about children and adults at risk of abuse There must be a think family approach to safeguarding adults. Where it is identified through the safeguarding adults process that a child may be at risk, the concern must be referred to Children s Services. Details of the referral process for Children s Services can be found at Halton Children's Social Care Procedures. Any referral to Children s Social Care should consider the Levels of Need Framework and at Level 2 and 3, contact should be made with the Contact and Referral Team who will discuss with you the appropriate level of response. Where it is identified by Children s Services in the context of their work with children and families, that a person at risk is experiencing abuse, then the concern must be referred to Adult Services. A decision will be made as to who will lead the safeguarding process, whether it is Adult Social Care or Children s Services. Regardless of who takes the lead, there should be appropriate representation from both Adults and Children s Services within this joint process Transitions between Adult and Children s Services Robust joint working arrangements between Children s and Adult Services, need to be put into place to ensure that the medical; psychosocial; educational and vocational needs of children moving from Children s to Adult services, including children with health or disability needs, or leaving care, are addressed as they move to adulthood and there are no gaps left in assessments of needs and service provisions. The care needs of the young person should be at the forefront of any support planning and require a co-ordinated multi-agency approach. Assessments of care needs at this stage should include issues of safeguarding and risk. Care planning Page 32 of 120

33 PART 1: POLICY needs to ensure that the young adult s safety is not put at risk through delays in providing the services they need to maintain their independence, wellbeing and choice. Special Educational Needs reforms were introduced from 1 st September 2014, which included that an Education, Health and Care Plan now runs until a young person is 25 years old. For further details, please refer to Halton s Multi- Agency Transition Policy Preparing for Adulthood. Good practice includes: Having policies and procedures which support effective transition processes Shifting the general view of risk as a potential danger for a child, to one of potential opportunity for an adult, but acknowledging there are still potential risks Managing risks as a phased process with awareness of the psychological and emotional issues Managing family expectations (being clear about the level of support and resources available) Taking time to get to know the young person and their family, especially if they have communication difficulties Acknowledging the rights of adults to take more responsibility for their decisions Mental Health Services The term Care Programme Approach (CPA) is used to describe the framework that supports and co-ordinates mental health care for people with severe mental health problems and is receiving treatment from mental health services. It is called an approach rather than a system because it covers: An assessment of health and social care needs A written care plan agreed with all those involved in the delivery of an individual s care The nomination of a care co-ordinator who acts as the main point of contact overseeing the delivery of an individual s care Ongoing and regular reviews of an individual s care plan and health and social care needs Where there is a concern that someone who is known to Adult Mental Health Services has been abused or is at risk of neglect or abuse, then safeguarding procedures apply and should run alongside CPA. Page 33 of 120

34 PART 1: POLICY Safeguarding Adults Serious Case Reviews Serious Case Reviews are commissioned by Safeguarding Adults Boards, to establish whether there are any lessons to be learnt about the way in which staff and agencies work together, to safeguard adults at risk. The purpose of the serious case review is to: Establish whether there are lessons to be learnt from the case about the way in which local professionals and organisations work together to safeguard and promote the welfare of adults at risk Identify clearly what those lessons are, how they will be acted on, and what is expected to change as a result As a consequence, improve inter-agency working and better safeguard and promote the welfare of adults at risk Serious Case Reviews are not inquiries into how an adult at risk died, or who is culpable. That is a matter for Coroners and criminal courts respectively, to determine as appropriate. However, serious case reviews will take into consideration the findings of these external processes. It is acknowledged that all agencies will have their own internal/statutory review procedures to investigate serious incidents. The Serious Case Review procedure is not intended to duplicate or replace these. Agencies may also have their own mechanisms for reflective practice. Please note that when the Care Act is in place, the term Serious Case Review will be replaced with the term Safeguarding Adults Review. Criteria for Conducting a Serious Case Review The Adult Safeguarding Board should always undertake a Serious Case Review when an adult at risk dies and abuse; maltreatment or neglect is known or suspected to be a factor, in the adult at risk s death. This is irrespective of whether social care is, or has been, involved with the adult at risk or their family. The Adult Safeguarding Board should always consider whether to undertake a Serious Care Review where an adult at risk has either: Page 34 of 120

35 PART 1: POLICY Sustained a potentially life-threatening injury through abuse; maltreatment or neglect Suffered serious sexual abuse Sustained serious and permanent impairment of health or development through abuse; maltreatment or neglect Where serious abuse occurred in an institutional setting A culture of abuse was identified within the investigation Multiple abusers were involved And The case gives rise to concerns about the way in which local professionals and services work together to safeguard and promote the welfare of adults at risk Page 35 of 120

36 PART 1: POLICY 4.0 ROLES OF SAFEGUARDING PARTNERS Abuse is everybody s business, safeguarding is our responsibility From the very start, the safeguarding policy makes it clear that it is everybody s responsibility to report abuse wherever it is seen; suspected or reported and to take the necessary immediate actions to ensure the protection of any person at risk. This section provides further guidance on the responsibilities of staff and volunteers in each agency and how they can assist in the identification, reporting and prevention of abuse. 4.1 Adult Social Care Services in Halton Borough Council No Secrets requires the Local Authority to play a co-ordinating role in developing the inter-agency policy and procedures for safeguarding adults at risk. Safeguarding services in Halton Borough Council has responsibility for: Receiving safeguarding alerts Collecting initial information on the concern Determining whether a safeguarding investigation or alternative other action is required Referring alerts to care management staff for investigation Providing advice, guidance, direction and monitoring during the investigation phase Ensuring that investigations are completed within the required timeframes and to the required standards Ensuring that the objectives of the referral are achieved including effective risk assessment, protection plans and reviews Auditing of safeguarding activity Providing support to the Safeguarding Board including management reports and analysis of trends and themes, specialist advice, management and administration of its agendas and sub-groups Care management teams in the local authorities are responsible for carrying out safeguarding investigations in line with these procedures including assessment; risk management; protection planning; service commissioning; planning and review. Where criminal activity is suspected the Police will usually lead on the investigation and this will be determined and recorded in discussion with the adult safeguarding team. Page 36 of 120

37 PART 1: POLICY Care management teams are also responsible for assessment and care management of people at risk and in these roles, have responsibility for being vigilant to the potential for abuse and for opportunities for preventative actions. As commissioners of services, Adult Social Care departments must ensure that all documents such as service specifications, invitations to tender and service contracts reflect the Safeguarding Adults agenda including the prevention of abuse and compliance with the Inter-Agency Policy, Procedures and Good Practice Guidance and also specify how they expect the service provider to meet the requirements of the policy. Safeguarding adults procedures must be included in the monitoring arrangements for contracts. The Contract Manager/Officer responsible for the contract may be required to attend any strategy or planning meetings, concerning a contracted provider by the Investigating Officer and to contribute to the plans for protection and monitoring arrangements. 4.2 Care Quality Commission The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England, including those provided by the NHS; local authorities; private companies and voluntary organisations. Specifically this includes: Medical and clinical treatment given to people of all ages, including treatment given in hospitals; ambulance services and mental health services Care provided in residential and nursing homes Care provided in the community or in people s own homes Services for people whose rights are restricted under the Mental Health Act Care provided either by the NHS or by independent organisations All health and adult social care providers are required by law to be registered with CQC and must show that they are meeting the essential standards. Registration is combined with continuous monitoring of essential standards as part of a system of regulation. The CQC publication Our Safeguarding Protocol, states that they will attend safeguarding strategy meetings where: Page 37 of 120

38 PART 1: POLICY A person or people registered with CQC to provide services are directly implicated Urgent or complex regulatory action is indicated Any form of enforcement action has started, or is under consideration, in relation to the service or location involved and which relates to risk to people using the service or the quality of their care 4.3 Cheshire Police It is the responsibility of the Police to investigate criminal activity and gather and preserve evidence that may assist in criminal prosecution. Where there is a possibility of a criminal offence, the Police will act as the lead agency in the investigation. Where the Police are leading an investigation, all actions other than urgent care; medical attention and protection, require consultation with the Police prior to taking place. Police decisions will be communicated to the local authority Investigating Officer, to enable other steps in the safeguarding process to proceed. Should the Police independently take emergency action to protect an adult at risk, they will inform the relevant social services duty and adult safeguarding team, of the action as quickly as possible. The Public Protection Unit of Cheshire Police will work collaboratively with the adult safeguarding team to ensure that adults at risk are protected. The adult safeguarding teams will refer all matters to the Police where they believe there to be a possibility of criminal action or matters which may require police action. Cheshire Police will notify the adult safeguarding teams of any concerns which come to their attention, not only in the discharge of the functions of the Public Protection Unit, but also in their community safety, neighbourhood policing and general police roles. 4.4 Cheshire Fire and Rescue Service Cheshire Fire and Rescue Service visit adults at risk in various settings, including their own homes, when responding to incidents or when carrying out a fire safety visit. Where personnel have a concern about an adult at risk, they will need to inform their line manager who may need to consider undertaking a safeguarding alert. To support the fire service in protecting people from risks in their own home, staff from other agencies who visit people in their own homes should be aware and look for indications of fire risk. Anybody observing such risks should advise the local fire station, so that they may contact the occupier to arrange for a home fire safety visit. Page 38 of 120

39 PART 1: POLICY 4.5 Faith Communities, Voluntary and Private Sector Providers Faith communities, voluntary and private sector organisations will provide a diverse range of services to adults at risk. Each organisation will have an important role within these safeguarding adults procedures and provide services that will assist in both preventing and responding to abuse. Faith communities, voluntary and private sector organisations will need to work closely with statutory agencies, such as the Police, NHS and Adult Social Care, in the interests of adults at risk and to achieve the objectives of these procedures. 4.6 Halton Clinical Commissioning Group The role of the Clinical Commissioning Group is to provide strategic leadership to ensure NHS and the wider safeguarding partnership, work effectively together to both prevent and respond to issues of adult abuse and neglect. The strategic leadership role of Clinical Commissioning Group involves active contribution to safeguarding boards and ensuring the wider NHS network has established systems and processes to safeguard adults effectively. This includes promoting safeguarding adults as a core element of local clinical governance arrangements; establishing local standards; monitoring the effectiveness of local systems; promoting and embedding joint working; delivering key messages and supporting the NHS network to promote and deliver effective safeguarding systems and practice. All health service staff including doctors; nurses; occupational therapists; physiotherapists; pharmacy staff; other professionals and non-clinical staff working in the community or in hospitals need to be aware of risk factors and indicators of abuse. Specialist services may have a role in assessment and interventions. 4.7 Halton Probation Service The Probation Service protects the public by working with offenders to reduce reoffending and harm. It works jointly with other public and voluntary services to identify, assess and manage the risk in the community of offenders who have the potential to cause harm. Probation Officers use the Offender Assessment System to assess risk and identify factors that have contributed to offending. The Probation Service also has a remit to be involved with victims of serious sexual and other violent crimes. The Probation Service shares information and works in partnership with other agencies including local authorities and health services and contributes to local Multi-Agency Public Protection Arrangements (MAPPA), to help reduce the reoffending behaviour of sexual and violent offenders in order to protect the public and previous victims from serious harm. Although the focus of the Probation Service is on those who cause harm, they are also in a position to identify offenders who themselves are at risk from abuse and to Page 39 of 120

40 PART 1: POLICY take steps to reduce the risk to those offenders in accordance with these policy and procedures. 4.8 Healthwatch Healthwatch was created by the Health and Social Care Act 2012 and has the role of ensuring that the views and experiences of patients and service users are heard by those who manage, plan and regulate health and social care services to help shape and improve the provision of high quality health and social care services for all. Each local Healthwatch has the responsibility of being responsive to what they find out as the consumer champion of health and social care in their respective areas and reporting identified trends and themes directly to the Safeguarding Adults Board. 4.9 Housing Organisations Housing employees of the Local Authority and private/voluntary sector providers may be the first to identify possible risk situations. Staff must be aware of the indicators of abuse and to refer any concerns in accordance with this policy. Housing organisations will often have an important role within protection planning arrangements NHS Funded Services Community Health Services and Acute Hospitals Trusts have a unique role in being able to identify potential abuse situations; this includes the abuse of neglect where people who have come to harm as a result of lack of care which occurred in either the community or hospital setting. All staff within NHS Funded Services including doctors; nurses; ambulance staff; occupational therapists; physiotherapists; pharmacy staff; other professionals and non-clinical staff working in the community or in hospitals, need to be aware of risk factors and indicators of abuse. All staff have a responsibility to critically consider the causes of injuries and harm and to raise an alert if they have cause for concern about whether patients have come to harm or are at risk of coming to harm Other Organisations Providing Services to Adults Staff and volunteers in a range of organisations are in close daily contact with adults. They have a responsibility to recognise and respond to abuse. Staff and volunteers need to be aware of their agency procedures, who to alert within their organisation if they have any concerns and how to report concerns to the Local Authority. Provider agencies must have in place suitable local arrangements to prevent and respond to abuse which link with the Halton Inter-Agency Policy, Procedures and Good Practice Guidance. Page 40 of 120

41 PART 1: POLICY Providers must ensure that any allegation or complaint about abuse is brought promptly to the attention of the Adult Safeguarding Team, the Police and the Care Quality Commission Responsibilities of all Organisations An organisation that provides care and support to adults at risk has responsibilities to safeguard adults at risk within these procedures. This involves: Actively developing service provision so as to minimise the risk of abuse occurring Working with partner agencies to support adults at risk who have experienced abuse Working with partner agencies to end any abuse that is occurring All organisations that work with adults at risk must ensure that they respond to issues of abuse and neglect in accordance with these policy and procedures. This includes the responsibilities to ensure that: All staff (and volunteers) report concerns/allegations or suspicions of abuse to managers and make alerts into the safeguarding adults procedures in accordance with these procedures Appropriate senior representatives of the organisation attend and actively contribute to safeguarding strategy meetings (or discussions) Staff (and volunteers) actively contribute and participate within safeguarding investigations carried out under the Halton Safeguarding Adults Inter-Agency Policy, Procedures and Good Practice Guidance Appropriate senior representatives of the organisation attend and actively contribute to case conferences The organisation and its staff (and volunteers) work in partnership with other agencies to ensure the protection planning needs of the adult at risk are met Information is shared between agencies in accordance with information sharing policies and protocols The organisation keeps its own records in relation to safeguarding concerns, alerts and their outcome The organisation participates within serious case reviews where required by Safeguarding Adult Board Page 41 of 120

42 PART 1: POLICY The organisation supports and empowers adults at risk, to make decisions about their own lives within these procedures The staff teams (and volunteers) adhere to the Mental Capacity Act and Code of Practice where an adult at risk lacks mental capacity in relation to decisions required within these procedures The organisation supports adults at risk to end abuse and to access support that enables them to cope with the impact of what has happened Page 42 of 120

43 PART 1: POLICY 5.0 THE MENTAL CAPACITY ACT 5.1 Capacity and Consent In every situation it will be assumed that a person can make their own decisions unless it is proved that they are unable to do so. That is, there will be a presumption that people have capacity. Section 2(1) Mental Capacity Act 2005 sets out a statutory definition of capacity: 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 a matter because of an impairment of, or a disturbance in the functioning of the mind or brain. This means a person lacks capacity if: They have an impairment or disturbance (for example, a disability condition or trauma) that affects the way their mind or brain works, and The impairment or disturbance means that they are unable to make a specific decision at the time it needs to be made Issues of capacity and consent are central; both in deciding whether an act or transaction was abusive and in deciding to what extent the adult can, and should, be asked to take decisions about how best to deal with the situation. You should refer to the Mental Capacity Act 2005 Code of Practice Chapter 4 for further guidance on capacity. 5.2 Deprivation of Liberty Safeguards On 19 th March 2014, the Supreme Court handed down its judgement in the case of P v Cheshire West and Chester Council and another and P and Q v Halton County Council. The requirements for the Deprivation of Liberty Safeguards are unchanged. There are still 6 requirements which need to be met: Page 43 of 120

44 PART 1: POLICY 1. Aged 18 or over 2. Suffering from a mental disorder 3. Lacking capacity for the decision to be accommodated in the hospital or care home 4. No decision previously made to refuse treatment or care, or conflict relating to this such as LPA 5. Not ineligible for DoLS 6. The person needs to be deprived of liberty, in their best interests The Supreme Court has now confirmed that to determine whether a person is objectively deprived of their liberty, there are two questions to ask, which they describe as the acid test : Is the person subject to continuous supervision and control? (all 3 aspects are necessary) AND Is the person free to leave? (The person may not be saying this or acting on it but the issue is about how staff would react if the person did try to leave) This now means that if a person is subject both to continuous supervision and control and not free to leave they are deprived of their liberty. The following factors are no longer relevant to this: The person s compliance or lack of objection The relative normality of the placement The reason or purpose behind a particular placement The judgement is significant in determining whether arrangements made for the care and/or treatment of an individual lacking capacity to consent to those arrangements, amount to a deprivation of liberty. A deprivation of liberty for such a person must be authorised in accordance with one of the following legal regimes: a deprivation of liberty authorisation or Court of Page 44 of 120

45 PART 1: POLICY Protection order under the Deprivation of Liberty Safeguards (DoLS) in the Mental Capacity Act 2005, or (if applicable) under the Mental Health Act 1983 Deprivation of liberty in domestic settings The Supreme Court also held that a deprivation of liberty can occur in domestic settings where the State is responsible for imposing such arrangements. This will include a placement in a supported living arrangement in the community. Hence, where there is, or is likely to be, a deprivation of liberty in such placements it must be authorised by the Court of Protection. Page 45 of 120

46 PART 1: POLICY 6.0 SUPPORT FOR THOSE INVOLVED IN THE SAFEGUARDING PROCESS 6.1 Supporting the Adults at Risk The adult at risk, reflecting the principles of empowerment, should be supported to make decisions about their own lives. Decisions about how this will be achieved will be taken within the multi-agency strategy discussion/meeting, informed by what the adult is saying they need and what would be acceptable to them. 6.2 Involving the Adult at Risk Where a person has mental capacity to make decisions, the role of professionals is to support their decision making at each stage of the safeguarding adults procedures. Where a person does not have mental capacity, decisions will be required in their best interests, involving them to the full extent possible and taking their wishes, feelings, beliefs and values into account. The adult, about whom there is a concern, should be supported in a way which does not jeopardise any investigation or criminal prosecution. Decisions about this will be achieved and will be taken at the multi-agency strategy meeting informed by what the adult is saying they need and what would be acceptable to them. 6.3 Independent Advocacy The Safeguarding Co-Ordinator should consider whether an adult at risk may benefit from the support of an independent advocate. There are two distinct types of advocacy: instructed and non-instructed. Instructed Advocates take their instructions from the person they are representing. For example, they will only attend meetings or express views with the permission of that person. Non-Instructed Advocates work with people who lack mental capacity to make decisions about how the advocate should represent them. Non-Instructed Advocates independently decide how best to represent the person. Advocates will ordinarily be invited to strategy meetings and case conferences, either accompanying the adult at risk or attending on their behalf, to represent the person s views and wishes. Instructed advocates would attend only with the permission of the adult at risk. IMCAs provide a form of non-instructed advocacy. Their role was established by the Mental Capacity Act There is a legal requirement to consider instructing an IMCA in the event that an adult at risk lacks mental capacity, in relation to protective measures required within the safeguarding adults procedures. Protective measures may include, but are not limited to: Page 46 of 120

47 PART 1: POLICY. Restrictions on contact with certain people Temporary or permanent moves of accommodation Increased support or supervision An application to the Court of Protection Restrictions on accessing specific services and/or places Access to counselling or psychology with the aim of reducing the risk of further abuse The Local Authority or NHS Body may instruct an IMCA to represent the person concerned, if it is satisfied that it would be of benefit for the person to do so. In safeguarding adult s cases access to IMCAs is not restricted to people who have no one else to support or represent them. Therefore, people who lack mental capacity who have family and friends can still have an IMCA to support them through the safeguarding adult s procedures. 6.4 Witness Support and Special Measures If there is a Police investigation, the Police will ensure that interviews with a vulnerable or intimidated witness are conducted in accordance with Achieving Best Evidence in Criminal Proceedings. Special measures are those specified in the Youth Justice and Criminal Evidence Act 1999 and will be used to assist eligible witnesses. The measures can include the use of screens in court proceedings; the removal of wigs and gowns; the sharing of visually recorded evidence-in-chief; cross-examination and re-examination and the use of intermediaries and aids to communication. Intermediaries play an important role in improving access to justice for some of the most vulnerable people in society, giving them a voice within the criminal justice process. They help children and adults who have communication difficulties to understand the questions that are put to them and to have their answers understood, enabling them to achieve their best evidence for the Police and the Courts. The Witness Service provides practical and emotional support to victims and witnesses (either for the defence or for the prosecution). The support is available before, during and after a court case to enable them and their family and friends to have information about the court proceedings and could include arrangements to visit the court in advance of the trial. 6.5 Victim Support Victim Support is a national charity which provides support for victims and witnesses of crime in England and Wales. It provides free and confidential help to family, friends and anyone else affected by crime, which includes information, emotional Page 47 of 120

48 PART 1: POLICY support and practical help. Help can be accessed either directly from local branches or through the Victim Support Helpline. 6.6 Keeping Families and Others Concerned Informed and Supported If the adult at risk wishes, it is important that relatives and friends are involved within the safeguarding adults procedures. This will help them to feel fully supported when dealing with difficult or distressing issues. If the adult at risk gives consent, it will be possible to share with them concerns for their welfare or safety. It will also be possible to involve relatives/friends in meetings about how concerns or allegations are being addressed and how they are being supported to be safe in the future. If the adult at risk decides that they do not wish for a relative or friend to be informed or involved, professionals will need to respect this decision. If they do not have the mental capacity to decide this themselves, a decision will need to be made in their best interests under the Mental Capacity Act. If relatives/friends are implicated in the allegations or concerns, this will impact on the decision as to whether, when and how information is shared and/or how they are included within the safeguarding adults procedures. A record should be made of the decision to consult or not to consult family and friends with reasons given and recorded. 6.7 Responsibilities to those who are alleged to have caused harm People and organisations, whom are alleged to have caused harm to an adult at risk, have the right to be treated fairly and their confidentiality respected throughout the safeguarding adults procedures. This includes the responsibility to ensure that a person or organisation alleged to have caused harm: Knows that they are the subject of a safeguarding allegation (irrespective of any other investigation, such as disciplinary investigation or criminal proceedings) Are informed in a timely manner consistent with the needs of the investigation Are informed of the nature and content of the allegation Page 48 of 120

49 PART 1: POLICY Knows that an investigation is being undertaken under these safeguarding procedures into an incident involving their practice or conduct Has an opportunity to respond to allegations concerning their practice or conduct within the safeguarding investigation (for example, through an interview) prior to the completion of the investigation report Has an opportunity to read the investigation report and respond to the findings of the investigation. This should include the opportunity to make written comments if they so choose, so that their response can contribute to the process of reaching a case conclusion Knows if a case conference discussion or meeting is due to be held to establish, on the balance of probabilities, whether the allegation is substantiated or not Knows the case conclusion reached within a case conference discussion or meeting Only in exceptional circumstances, such as in the examples below, will it be inappropriate for a person or organisation to not be informed of allegations about themselves: The police advise otherwise It is not in an adult at risk s best interests as determined under the Mental Capacity Act Where an adult at risk with mental capacity refuses permission for them to be informed of the allegations (and there are no other persons at risk) If a person or organisation alleged to have caused harm has not been informed of allegations, it may not be possible to reach a decision as to the occurrence or not of abuse, in which case, the sole focus of the safeguarding adults procedures will be on protection planning. The strategy discussion or meeting will need to establish whether and when the person or organisation is informed, so as to not undermine the investigation process. Such decisions will need to be made on a case-by-case basis. The most appropriate way of informing the person or organisation of the allegations should be considered. A person alleged to have caused harm should be provided with appropriate support throughout the process to participate and enable their views to be recognised. If the person alleged to be causing harm is also an adult at risk, they should be provided with appropriate support. If the person alleged to be causing harm is a young person or has a mental disorder, including a learning disability and they are Page 49 of 120

50 PART 1: POLICY interviewed at the Police Station, they are entitled to the support of an appropriate adult under the provisions of the Police and Criminal Evidence Act 1984 Code of Practice (refer to local police and Criminal Evidence Act procedures and agreements). Page 50 of 120

51 PART 1: POLICY 7.0 ARRANGEMENTS FOR MANAGING SAFEGUARDING ADULTS 7.1 Determining the relevant Local Authority The Association of Directors of Adult Social Services (ADASS), recognised the increased risk to adults at risk of harm from abuse or neglect, whose care arrangements are complicated by cross boundary considerations. These may arise where funding/commissioning responsibility for an individual lies with an authority in one area and where concerns about potential abuse and/or exploitation subsequently arise in another area. Thus the guidance in this section is taken from the ADASS Safeguarding Adults Policy Network Guidance on Out of Area Safeguarding Adults Arrangements, December 2012 The guidance clarifies strategic and operational responsibilities and actions to be taken by host authorities and placing authorities: Host Authority The Local Authority or NHS Body in the area where the abuse occurred Placing Authority The Local Authority or NHS Body that has commissioned the service for an individual involved in a safeguarding adults allegation The following principles underpin the guidance in this document: The host authority will have overall responsibility for co-ordinating the safeguarding adults investigation and for ensuring clear communication with all placing authorities and other stakeholders, especially with regards to the scheduling of meetings and the planning of the investigation The placing authority will have a continuing duty of care to the Adult at Risk of harm that they have placed The placing authority will contribute to the investigation as required and maintain overall responsibility for the individual they have placed The placing authority should ensure, through contracting arrangements and in service specifications, that the provider has arrangements in place for protecting adults at risk of harm and for managing concerns, which in turn link with local (host) authority multiagency safeguarding adults policy and procedures. This includes the requirement to inform the host authority of both individuals and placing authorities affected by the safeguarding concerns Page 51 of 120

52 PART 1: POLICY Authorities may negotiate flexible arrangements, for example, relating to another authority undertaking assessments, reviews, investigative activities or other supportive activities on behalf of a placing authority. In such cases, the placing authority would maintain overall responsibility for the person they have placed and reimbursement would be required and agreed as part of such negotiations Providers of care and support services have rights and responsibilities and may be required to undertake their own investigations. The host authority must ensure effective and timely communication with the provider of care throughout the investigation 7.2 Information Sharing Information sharing between organisations is essential to safeguard adults at risk of abuse, neglect and exploitation. In this context organisations mean not only statutory organisations but also voluntary and independent sector organisations; housing authorities; the Police; Crown Prosecution Service and organisations which provide advocacy and support. The person s wishes in respect of information sharing should always be considered, however, the following principles are also relevant: Information given to an individual member of staff belongs to the organisation and not to the individual employee. An individual employee cannot give a personal assurance of confidentiality to an adult at risk An organisation should ordinarily obtain the adult at risk s consent to share information and should routinely explain what information may be shared with other people or organisations, where appropriate It may not be possible to seek the consent of the adult at risk, due to lack of mental capacity or other reasons, and in some circumstances, it may still be necessary to share information even where consent is not given, for example, where there is risk to other people Difficulties in working within the principles of maintaining the confidentiality of an adult should not lead to a failure to take action to protect the adult from abuse or harm Page 52 of 120

53 PART 1: POLICY Confidentiality must not be confused with secrecy, that is, the need to protect the management interests of an organisation and should not override the need to protect the adult at risk Staff reporting concerns at work (whistle-blowing) are entitled to protection under the Public Interest Disclosure Act 1999 Decisions about what information is shared and with whom, will be taken on a caseby-case basis. Whether information is shared with or without the adult at risk s consent, the information shared should be: Necessary for the purpose for which it is being shared Shared only with those who have a need for it Be accurate and up to date Be shared in a timely fashion Be shared accurately Be shared securely 7.3 Whistle Blowing Guidance It is the legal duty of every employee that works with adults at risk to report potential or actual abuse. Therefore, it is the responsibility of the employer to promote openness among staff and promote this process, taking the lead in giving clear priority to the protection of Adults at Risk. Procedures which empower staff to voice concerns about the practice they encounter should be owned and promoted by the voluntary; independent; statutory or private sector agencies which employ them. These policies are often known as Codes of Conduct/Practice or Whistle-Blowing Procedures. All members of staff or volunteers, who have concerns about the way a vulnerable person is being treated in their place of work, should follow the Whistle-Blowing Procedures in their own organisation. 7.4 Complaints Process Local authorities have statutory complaints procedures. If a complaint is received that indicates an adult is at risk of abuse or neglect, they will need to consider the need to make a safeguarding alert. If a complaint is made to the local authority that leads to a safeguarding adults investigation, the local authority may decide not to commence the complaints investigation, if this would compromise a safeguarding investigation. Local guidance may apply. The complainant would need to be informed of this course of action and the reasons for this. Page 53 of 120

54 PART 1: POLICY 7.5 Record Keeping and Confidentiality Organisations will have their own recording systems for keeping comprehensive records whenever a concern is made/arises/occurs and of any work undertaken under the safeguarding adults procedures, including all alerts received and all referrals made. Organisations should refer to their internal policies and procedures for additional guidance on recording and storage of records. Throughout the safeguarding adults process, detailed factual records must be kept. This includes the date and circumstances in which conversations and interviews are held and a record of all decisions taken relating to the process. Records may be disclosed in court as part of the evidence in a criminal action/case or may be required if the regulatory CQC authority decides to take legal action against a provider. Records kept by providers of services should be available to service commissioners and to regulatory authorities. Agencies should identify arrangements, consistent with the principle of fairness, for making records available to those affected by, and subject to, investigation with due regard to confidentiality. 7.6 Safeguarding Risk Assessments Risk assessment that includes the assessment of risks of abuse, neglect and exploitation of people using services should be integral in all assessment and planning processes, including assessments for self-directed support and the setting up of personal budget arrangements. Assessment of risk is dynamic and on-going during the safeguarding adults process. It should be reviewed throughout the process so that adjustments can be made in response to changes in levels and nature of risk. The primary aim of a safeguarding adults risk assessment is to assess: Current risks that people face Potential risks they and other adults may face A safeguarding adults risk assessment will determine: What action must be taken immediately to protect the person at risk What needs to be in place to meet the need for an interim protection plan When and how quickly a strategy meeting or discussion needs to take place A proportionate response to the particular situation to manage the risk posed to the person who has been harmed and others who may be at risk from the person alleged to have caused the harm Page 54 of 120

55 PART 1: POLICY What measures need to be taken to address risks that are caused by the setting which is providing care to the person at risk What needs to be put in place to meet the ongoing support needs of the person at risk 7.7 Involving the Adult at Risk The identification of risk should usually be undertaken with the person who has been harmed, unless doing so is likely to increase the risk of harm or puts other people at risk Vital Interest If the adult at risk has the mental capacity to make informed decisions about their safety and they do not want any action to be taken, this does not preclude the sharing of information under safeguarding adults procedures, with relevant professional colleagues. This is to enable professionals to assess the risk of harm and to be confident that the adult at risk, is not being unduly influenced or intimidated and is aware of all the options. This will enable professionals to check the safety and validity of decisions made. It is good practice to inform the adult at risk that this action is being taken, unless doing so would increase the risk of harm Best Interest If an adult at risk lacks capacity to make informed decisions about maintaining their safety and they do not want any action to be taken, professionals have a duty to act in their best interests under the Mental Capacity Act This would automatically trigger a safeguarding adults alert Public Interest If the adult at risk has the mental capacity to make informed decisions about maintaining their safety and they do not want any action to be taken, practitioners have a duty to share the information with relevant professionals to prevent harm to others. This will automatically trigger a safeguarding adults alert Personal Risk Taking The adult at risk will have views about what is an acceptable level of risk to them and about balancing the risks, in order to maintain the lifestyle or contacts they wish. There may be a balance to be struck between the benefits of achieving safety and the loss of contact with someone whom they value. A person with mental capacity may choose to live in a situation which is seen as unsafe by professionals, if the alternatives they are being offered are unacceptable to them. They do not, however, have a right to make decisions about the protection other people may need, where they may also be at risk from the same person; service or setting. Adults at risk need to be able to make informed choices from the information they are given. In order to do this, they may need support in a variety of ways such as Page 55 of 120

56 PART 1: POLICY the help of a family member or friend (as long as they are not the person alleged to have caused the harm); an advocate or IMCA (if the person lacks capacity); a language interpreter or other communication assistance or aid. Page 56 of 120

57 SAFEGUARDING ADULTS IN HALTON Inter-Agency Policy, Procedures and Good Practice Guidance PART TWO: PROCEDURES

58 PART 2: PROCEDURES 8.0 PROCEDURES 8.1 Stages of the Safeguarding Process STAGE ONE: ALERT Alert describes the action of reporting concerns and allegations into the multi-agency safeguarding adults contact point in Halton. Anyone can make an alert via any route Target timescales: Same day that concerns are identified STAGE TWO: REFERRAL Having received the alert the Adult Services will decide whether to refer the alert for investigation under the inter-agency safeguarding adult s procedures Target timescales: Within 24 hours of the Alert STAGE THREE: STRATEGY DISCUSSION/MEETING The responsible team will hold a discussion or meeting to assess risk, establish the outcome desired by the adult at risk, agree a plan to keep the person safe and plan an investigation Target timescales: Within 5 working days of the Referral stage STAGE FOUR: INVESTIGATION Safeguarding activities are undertaken in line with the agreed plan. The risk assessment and protection plan are kept under review throughout Target timescales: Report completed 7 working days before Case Conference STAGE FIVE: CASE CONFERENCE The responsible team chairs a case conference discussion or meeting to review the investigation report, agree the conclusion, assess risk, agree a protection plan if required, and agree whether a review is required Target timescales: Within 4 weeks of Referral decision STAGE SIX: REVIEW The responsible team holds a review to check the protection plan is working effectively Target timescales: Within 3 months of Case Conference or as agreed at Case Conference Page 58 of 120

59 PART 2: PROCEDURES 8.2 Stage One Safeguarding Alert What is an alert? An alert is the raising of a concern, suspicion or allegation of potential abuse with an appropriate person. A concern, suspicion or allegation of abuse may have arisen from: A direct disclosure by an adult at risk A complaint or expression of concern by someone else An observation of abusive behaviour or an observation of the indicators of possible abuse Who is responsible for raising an alert? Absolutely anyone can make an alert. Anyone who is concerned about the possibility of abuse of an adult at risk should raise a concern with an appropriate person. All staff have a duty to report any allegations, suspicions or concerns of abuse How do you raise an alert? A member of the public can report a concern of abuse directly to the emergency services (if there is immediate danger), or directly to Halton Borough Council Adult Social Care Services on A member of staff or individual acting on behalf of an organisation should report any concerns following their organisation s internal procedures. All organisations should have procedures for their staff to raise an alert. These will instruct you to talk urgently to your line manager or supervisor about your concerns unless: you are in a position of authority that authorises you to act alone or; the person you would normally report to may be implicated in your concerns or has failed to act in response What responsibilities does the Alerter and/or their Manager have? At the alert stage, there are two people who have responsibilities: The person who is first made aware of the possible abuse and (if within an organisation or service), their line manager Responsibilities of the person first aware of possible abuse The first person aware of possible abuse needs to consider the following issues: Page 59 of 120

60 PART 2: PROCEDURES Make Safe Take reasonable steps to ensure the adult is in no immediate danger Seek emergency help (first aid; medical treatment; police involvement) if there are immediate risks to health or safety DO NOT confront the person alleged to have caused harm DO NOT destroy or disturb articles that could be used in evidence Inform A Line Manager or other Senior Manager immediately The Police, if a crime has been committed Record Details of the disclosure, concern or suspicion The actions taken so far and the reasons for any decisions Follow your own organisational record keeping procedures Responsibilities of the Line Manager to whom an alert is made If the referral is made within an organisation, the manager to whom an alert is made needs to consider the following: Immediate Needs Ensure the adult at risk is safe Ensure that any necessary emergency medical treatment is arranged Ensure no forensic evidence is lost If the person alleged to have caused harm is another vulnerable adult, ensure their needs are attended to and that they and others are not put at risk Page 60 of 120

61 PART 2: PROCEDURES Clarify The facts as stated by the member of staff. DO NOT discuss with the person alleged to have caused harm or the adult at risk, unless it is necessary in order to keep person(s) safe Whether the situation meets the criteria for a safeguarding response: o Is the individual concerned an adult at risk? o Could harm have occurred/be likely to occur? Refer To the Police, if a crime may have been committed To Halton Borough Council Adult Social Care Services To CQC, if incident involves a regulated service What is Disclosure and how should it be dealt with? A disclosure is when an adult at risk tells another person of abuse what has happened to them. If someone discloses abuse it is important to respond in the correct way. Do Listen patiently and calmly to what the person is saying even if it does not make sense Observe the adult at risk and what is happening to them Stay calm Respect confidentiality as far as you are able Tell the adult at risk what you are going to do next Report straight to your manager and record exactly what you have heard Do Not Do not ask questions. It is not your job to investigate Do not dismiss what someone is telling you, even if it appears unlikely Do not appear shocked or disgusted Do not promise to keep secrets Do not keep information to yourself Do not confront the person alleged to have caused harm Page 61 of 120

62 PART 2: PROCEDURES How to manage issues around consent and confidentiality Wherever possible, actions following an alert or disclosure should comply with the expressed wishes of the adult at risk. However, consideration should be given to circumstances where an adult at risk s wishes may be overridden. If a crime may have been committed, or other vulnerable adults may be at risk, it could be necessary to override a person s expressed wishes. If it is established that an adult lacks capacity to make a specific decision, then any decisions made should be done so, following the best interest principles in accordance with the Mental Capacity Act How to manage allegations against staff All agencies should have mechanisms for raising practice concerns with managers. All provider services should have in place a Whistle-Blowing policy and ensure that all staff are aware of this and how to access and use it. When it comes to raising concerns of adult abuse, no distinction should be made between staff and other persons. The adult at risk s wellbeing is paramount. If at any point in the process, a member of staff feels that correct action is not being taken, they should report directly to Halton Borough Council Adult Social Care Services and follow their organisation s Whistle-Blowing procedures. If an allegation is made against a member of staff, their manager will need to clarify, when making a referral, what action he/she intends to take under the appropriate personnel procedures. It is important to ensure that any action: Protects the rights and wishes of the adult at risk Protects the rights of the member of staff concerned Enables managers to take appropriate action either on behalf of the adult at risk or against the staff member where appropriate Does not compromise any criminal investigation To achieve these outcomes it will be necessary for managers to coordinate their disciplinary responsibilities with those of the investigating team, who will be working within these procedures. APPENDIX ONE: Quick Guide for Providers of Services provides a short reference guide for all staff within provider services. It is important to note that not all alerts will become referrals, for example, where there is no abuse, or the person requires signposting to another service or a review of their current care. Page 62 of 120

63 PART 2: PROCEDURES Stage One Alert Flowchart Alert of Abuse (Disclosure, Concern or Suspicion) Make Safe Take reasonable steps to ensure no immediate danger Contact Emergency Services if required Protect forensic evidence Inform Police If it is suspected that a crime has been committed Manager Or more Senior Manager if Line Manager is implicated Is Safeguarding Adults Referral Required? Record decision making Make referral to HBC Go to Stage Two Referral Page 63 of 120 Record decision making Monitor and make referral if necessary No further action required under safeguarding procedures Provide feedback to relevant persons

64 PART 2: PROCEDURES 8.3 Stage Two Safeguarding Referral Purpose of the safeguarding adult referral Once an alert has been received by Halton Borough Council, the responsible team needs to consider whether the concerns identified in the alert should be investigated under the safeguarding adult procedures. The decision should consider an outcome which supports or offers the opportunity to develop, or maintain, a private life which includes those people with whom the adult at risk wishes to establish, develop or continue a relationship. The referral stage involves: Establishing the wishes and best interests of the person at risk Gathering information about the allegations/concerns Ensuring the person at risk is protected from further harm Deciding whether the concern/allegation requires an investigation for which a strategy discussion/meeting would be required Information Gathering Information gathering is not an investigation, but a process of collecting enough information to enable a decision on whether a safeguarding referral (or an alternative process/action) is required. This may involve consulting other agencies or departments. The Alerter should always be contacted in relation to their alert in order to: Acknowledge receipt of their alert Acknowledge the Alerter s concerns Clarify and/or gather more information about the allegation/concern As part of this information gathering process, the following issues will be considered: Is the person an adult at risk by the definition? What is the perceived type of abuse? The Alerter s view as to what is known of the wishes of the adult at risk in relation to the safeguarding issue The perceived level of risk Where there have been multiple low level concerns, their cumulative effect should be considered How the concern came to light? The impact on the person(s) concerned The setting and geographical location of where the alleged abuse took place Page 64 of 120

65 PART 2: PROCEDURES The person alleged to have caused harm s name and relationship to the adult at risk The involvement of any witnesses Any action that has already been taken to safeguard the adult at risk The health and social care support needs of the adult at risk and whether this support is provided by the person alleged to have caused harm Has the adult at risk s needs been assessed (under a self-supported plan, Community Care Assessment/Care Programme Approach)? Is the adult at risk known to any other agencies or multi-agency processes e.g. MAPPA, MARAC (see Part One: Policy document Section 6 for further information)? To establish where possible the adult at risk s mental capacity (decision/specific/competence) Are there any children at risk who should be referred to Halton Children s Services Risk Assessment and Management A risk assessment must be undertaken when an alert is raised. This should clarify the degree of risk to the adult at risk and/or children. Risk should be constantly reevaluated throughout the process to ensure adults at risk and all others involved are appropriately protected. Risk assessment will seek to determine: What the actual risks are the harm that has been caused, the level of severity of the harm and the views and wishes of the adult at risk The person s ability to protect themselves Who or what is causing the harm Factors that contribute to the risk, for example: personal; environmental; relationships resulting in an increase or decrease to the risk The risk of future harm from the same source A formal risk assessment can take place at any point. However, the most likely point at which a formal assessment will take place is after the strategy discussion or meeting Deciding the action to be taken following assessment of the alert Once the information has been gathered and assessed by Adult Social Care there are four possible courses of action that can be taken: Page 65 of 120

66 PART 2: PROCEDURES Where it is clear that a criminal offence may have taken place, the Police will take the lead in the investigation Where it is suspected that abuse, that does not constitute a criminal offence, has taken place Adult Social Care Teams will co-ordinate the investigation Following further discussion and assessment it may not be necessary to pursue a Safeguarding Adults Investigation and no further action may be required OR It may be necessary to consider alternative actions such as reviewing the person s health or social care support plan needs to be reviewed or making a referral to another appropriate agency A decision on how to proceed will be made by the responsible person within the relevant Adult Social Care Teams in partnership with other agencies or person involved. Page 66 of 120

67 PART 2: PROCEDURES Stage Two Referral - Flowchart From Stage One Alert Safeguarding alert received by Adult Social Care Teams Initial information gathering e.g. background information, what is known to other agencies) Is the alleged victim an adult at Risk? Is there the possibility of harm occurring or likely to occur? YES NO Go to Stage Three Strategy Discussion/Meeting Close safeguarding referral Record decision making Take alternative action where required Provide feedback to relevant persons Page 67 of 120

68 PART 2: PROCEDURES 8.4 Stage Three Safeguarding Strategy Discussion/Meeting Where the decision has been made that the concerns meet the threshold for intervention under safeguarding procedures, the responsible team will ensure that a strategy discussion or meeting takes place. The strategy discussion or meeting enables the responsible team to share the nature of the risk and identify options for safeguarding and that a safeguarding response is planned with the person and key agencies with duties or powers to act. A safeguarding adults strategy discussion or strategy meeting will take place depending upon the assessed level of seriousness and level of intervention. In some instances a number of strategy discussions may be required and sometimes these will need to take place on the same day, to ensure that a risk management plan is in place. If a strategy meeting is required, then this should be held within 5 working days of the threshold decision. Any variations in timescales should be recorded. An assessment and investigation should not be delayed, whilst waiting for a safeguarding adults strategy discussion to be convened. Any interim action taken must be agreed by the responsible person within the appropriate adult social care team. Information at the meeting, where relevant to a service provider, must be considered within the context of any other alerts or referrals raised, which relate to this provider. In addition to individual safeguarding processes, an overarching meeting focused on the provider may need to be put in place The purpose of the strategy discussion or meeting The strategy discussion or meeting aims to: Agree a multi-agency plan to investigate the allegations and assess the risk to the person at risk who is being harmed or to the person at risk who is harming others, to assess any immediate risks and address any immediate needs Co-ordinate the collection of information about the abuse, neglect or exploitation through a clear plan of action Involve the adult at risk and/or their representative in decision making The strategy meeting will be chaired by an appropriate Responsible Manager, who will act in an impartial and objective way in conducting the meetings and will facilitate the meeting to reach decisions and recommendations with the person at risk, wherever possible. Page 68 of 120

69 PART 2: PROCEDURES The strategy discussion or meeting must: Consider the wishes of the person at risk in relation to the desired outcome for the process Consider any special needs of the adult Consider the need for advocacy Consider the mental capacity of the adult to be able to support and protect themselves from harm Consider support for the person at risk who may have caused the harm Agree an interim risk management plan Consider the health and social care needs of the adult Consider the need for legal intervention Identify who should be the key worker to support and liaise with the adult Share judgements about the risks and agree how the adult will be supported and the risks managed Consider the safety and wellbeing of other adults/children at risk and whether the concerns meet the thresholds for a safeguarding adult/child intervention o If the person at risk is aged under 18 years old, a referral must be made to Children s Services safeguarding process o If the person implicated in the safeguarding investigation works with children or young people under 18, a referral must be made to the Local Authority Designated Officer (LADO), a statutory role put in place under Working Together to Safeguard Children, 2013 Consider action under any parallel proceedings (e.g. regulatory action; health and safety issues; serious incidents requiring investigation; disciplinary processes etc.) Agree what kind of assessments/investigations will need to take place and if so, how they should be conducted; by whom and within what timescales Agree who needs to be interviewed, when and by whom Who should participate in or attend strategy discussions/meetings? Those who should be involved in the strategy discussion/meeting should be limited to those who need to know and who have a lead responsibility to ensure that an assessment and investigation is undertaken and contribute to the decision making process. Page 69 of 120

70 PART 2: PROCEDURES The views of the person at risk or their representative, should be presented and recorded as part of the meeting discussion, having been sought during the information gathering stage. Those attending from partner agencies/organisations should be of sufficient seniority to make decisions as part of the strategy discussion/meeting concerning their organisation s role and resources. They may also contribute to the assessment/investigation and to the agreed Safeguarding Plan. Page 70 of 120

71 PART 2: PROCEDURES Stage Three Safeguarding Strategy Discussion/Meeting Flowchart From Stage Two Referral Decision by Adult Social Care Team to hold strategy discussion/meeting Strategy discussion or meeting takes place Interim protection plan is reviewed or created Risk Assess What outcome does the adult at risk want? Consider mental capacity Decision made if investigation is required YES NO Go to Stage Four Investigation Close safeguarding referral Record decision making Take alternative approach where required Provide feedback to relevant persons Page 71 of 120

72 PART 2: PROCEDURES 8.5 Stage Four Safeguarding Investigation The purpose of a Safeguarding Adults Investigation The purpose of a Safeguarding Adults Investigation is to establish: Whether abuse/crime occurred and the surrounding circumstances The ongoing risks to the adult at risk or others identified to be at risk Any immediate action to prevent further abuse The level of understanding of the risk by the adult at risk Whether disciplinary action may be required on the part of the employer Where the adult at risk is the person who is alleged to have caused the abuse, the investigation will also need to consider the following: The assessment of risk to other adults at risk or children Whether the abusive behaviour is part of a pattern that may have developed Whether the abuse is an indication of illness (mental/physical) and of their need for care, treatment, specialist assessment/referrals Whether the person alleged to have caused harm (who is an adult at risk) might have been, or might continue to be, the subject of abuse him/herself The role of the nominated investigator(s) is to: Gather and preserve evidence Establish what the alleged incident was and where it occurred Establish when the alleged incident occurred (this may be particularly significant when considering the collection of forensic evidence) Assemble other background information Identify and liaise with other relevant agencies Interview the adult at risk where appropriate Establish the perception of the adult at risk where possible Consider the Mental Capacity of the adult at risk i.e. the understanding of the adult at risk in relation to specific decisions, informing the adult at risk about the process and what will happen next Carry out a risk assessment to assess present and future levels of risk and the adult at risk s ability to understand risk To reach a decision based on their investigation as to whether abuse has/has not occurred Provide feedback to adult at risk and appropriate persons about the outcome or the progress of the investigation Page 72 of 120

73 PART 2: PROCEDURES The nominated investigators communication with the adult at risk Where the adult at risk has the capacity to make decisions regarding their present and future circumstances, they should have the opportunity to discuss the possible options with a professional. The adult at risk s wishes should be paramount, unless a legal responsibility to intervene exists. Where there are issues around capacity and potential legal proceedings, a formal capacity assessment should be undertaken in accordance with the Mental Capacity Act An Independent Mental Capacity Advocate (IMCA) may also be considered at this stage. These actions will run alongside the investigation. Consideration should also be given at this stage to the involvement of family members or friends/others, where appropriate. If an adult at risk is deemed to lack capacity, the responsibility to make a decision on behalf of the person rests with the professional who is the decision maker. The decision maker will, following assessment and in accordance with the Mental Capacity Act, make a best interests decision. The nominated investigator needs to consider: The ability of the adult(s) at risk to communicate Their means of communication (consideration should be given to how the adult at risk communicates, i.e. their preferred language; whether they communicate through Makaton; a Communication Board; or other preferred communication styles. This will reflect on the way questions are framed/language used/how sentences are constructed/whether an interpreter is required) The degree of the adult at risk s disability Recognition of the possible continuing emotional attachment an adult at risk as a victim, may have for their abuser The same consideration needs to be taken into account when interviewing an adult at risk who is alleged to have caused harm When the investigation is concluded The nominated person will notify the responsible manager within the Adult Social Care Team following consultation with key agencies, that the investigation is concluded. The Responsible Manager, in discussion with other agencies, will make a decision whether the outcome of the investigation/assessment requires a Safeguarding Adults Conference to be convened. If it is agreed that no further action is required under the Safeguarding Adults Procedures, the Responsible Manager in Halton Borough Council must advise the Page 73 of 120

74 PART 2: PROCEDURES adult at risk where appropriate, the referrer and all relevant agencies, the outcome of the investigation. Page 74 of 120

75 PART 2: PROCEDURES Stage Four Safeguarding Investigation - Flowchart From Stage Three Safeguarding Strategy Discussion/Meeting Investigation takes place e.g. criminal investigation, disciplinary investigation, contract compliance investigation, assessment of need Decision made if Case Conference is required YES NO Safeguarding Investigation report prepared for case conference by Investigating Officer Close safeguarding referral Record decision making Take alternative action where required Provide feedback to relevant persons Go to Stage Five Case Conference Page 75 of 120

76 PART 2: PROCEDURES 8.6 Stage Five Case Conference Purpose of a Case Conference To consider the findings and outcomes of the investigation/assessment To decide whether abuse took place To assess ongoing risk To produce or revise a protection plan To ascertain whether the adult at risk is satisfied with the outcome of the investigation Roles and Responsibilities The Managing Officer ensures that a Case Conference is convened, chaired and minutes taken. In large-scale investigations a more senior/independent person may take the Chair. The Investigating Officer will submit a report summarising the findings of the investigation and will attend the Case Conference. Any reports made to date will be available to the meeting and will inform the basis of discussion Timescales The Case Conference should take place within four weeks of the referral decision Process Wherever possible, the adult at risk should be involved and assisted to participate in the Case Conference. It is essential that the adult at risk is given information about the purpose of the Conference in advance and who will be there. In some cases, in order to meet the adult at risk s access and communication needs (e.g. specialist facilities are needed), a separate protection plan meeting could be held in a different venue. Such a meeting should be held on a date as close to the Case Conference as possible. In some cases, the Case Conference will be divided into two parts (e.g. where the information being discussed may compromise a future criminal investigation; where confidential or sensitive information relating to a third party needs to be discussed; or where actions relating to the person alleged to have caused harm, need to be discussed). In such cases the first part of the meeting is attended by professionals only and the adult at risk and/or their representative, will attend the second part Safeguarding Protection Plan The protection plan should include information about the following: The outcome of the Case Conference Action to be taken to ensure the future safety of the adult at risk, including information about who is responsible and what they are expected to do Details of any support services, treatment or therapy available to the adult at risk Page 76 of 120

77 PART 2: PROCEDURES Changes to the way services will be provided How best to support the adult at risk through any action he/she takes in seeking justice or redress Monitoring and review arrangements, irrespective of whether services are being provided. These should include details and timescales for reviewing the Safeguarding Protection Plan Decisions on who should be kept informed about future action Consideration should be given to how the protection plan will be recorded and implemented, to include any concerns about person(s) who may have caused harm having access to the plan. For example, how safeguarding adults issues are recorded in documents likely to be held in a service user s own home Closing the Investigation Prior to closing an investigation, the Investigating Manager should ensure that: The investigation has been completed and a conclusion about whether or not the allegation was substantiated; partially substantiated; unsubstantiated; or inconclusive The reasons for closing the case are recorded All decisions have been recorded in writing, with evidence to support the decisions clearly documented All written reports have been completed Agencies who are involved in the protection plan are aware of their responsibility to re-refer the adult at risk, should circumstances change or risks increase significantly The adult at risk themselves, have been informed of the outcome (and their carers/family if appropriate) A record is made that the investigation has been formally signed off and noted as closed on the Local Authority database All individuals who have been involved in the investigation are notified as appropriate, of the outcomes and conclusions of the investigation If appropriate, information about organisations that assist victims of crime should be made available to the vulnerable adult If an adult at risk or a vulnerable witness wishes to seek justice or redress through the Criminal Justice system, consideration should be given to contacting the local Court Witness Service The initial referrer should receive feedback with the permission of the adult at risk and given reassurance that the concerns expressed have been thoroughly investigated Page 77 of 120

78 PART 2: PROCEDURES Stage Five Case Conference Flowchart From Stage Four Investigation Case Conference takes place Protection Plan is reviewed and updated if required Risk Assessment is reviewed and updated if required Have the adult at risk s outcomes been achieved? YES Agree actions Is a review required? NO Go to Stage Six Review Page 78 of 120 Close safeguarding referral Record decision making Take alternative action where required Provide feedback to relevant persons

79 PART 2: PROCEDURES 8.7 Stage Six Safeguarding Review Purpose of the Review Where a Case Conference meeting is held, any subsequent review meeting will be chaired by the Case Conference Chair, wherever possible. The purpose of the review is to ensure that the actions agreed in the protection plan have been implemented, the risk is being managed and to decide whether further actions are required. In some circumstances, more than one review meeting will be required within the safeguarding procedures Who should attend? The Safeguarding Coordinator will need to determine the appropriate invitees for the review. This may need to include an appropriate representative of any organisation that has a specific role in: Assessing risk Developing or carrying out the protection plan Invitations should include the adult at risk. Where the adult at risk lacks the mental capacity to decide about attendance, a decision will be required in the best interests as to whether they should be invited and should attend. The adult at risk is entitled to be supported by an appropriate person(s), such as a family member; friend; advocate or personal assistant (according to their wishes, or decided in their best interests, where they lack the mental capacity to decide for themselves). The adult at risk may also choose not to attend and have their views reported by a representative or in writing. When an IMCA has been appointed, they will be invited to attend Actions required during the Review The review will: Record the feedback of the adult at risk or their personal representative about the protection plan and/or matters of importance to them Re-evaluate the risk of harm Ensure all required actions have been or are being taken Decide in consultation with the adult at risk and/or their personal representative what changes, if any, need to be made to the protection plan to decrease the risk or to make the plan fit more closely with their wishes Make decisions about what changes/additions are needed to the care plan Decide whether to exit the safeguarding procedures Decide whether there is need for a further review and if so, set a date Page 79 of 120

80 PART 2: PROCEDURES Recording Feedback The Safeguarding Coordinator will need to ensure that: All actions are completed or are in progress All records are completed Case records contain all relevant information and completed forms The person at risk knows that the process is concluded and where/who to contact if they have any future concerns about abuse All those involved with the person know how to re-refer if there are renewed or additional concerns Where identified a referral has been made to the appropriate professional body and/or the Disclosure and Barring Service The referrer is notified of completion All relevant partner organisations are informed about the closure The necessary monitoring forms and all data monitoring systems are completed Feedback must routinely be sought from the adult at risk about their experience of the process and whether they are satisfied with the measures that have been put in place and if they feel safer. The case may remain open to care management or the care programme approach systems, in which case the situation will be reviewed and monitored through those processes. This will include monitoring and review of the protection plan as necessary. Any decisions and actions are recorded with the names of responsible individuals/organisations identified All those involved in the review and the care plan have a copy of the review notes, including the adult at risk or their personal representative, if the adult at risk has given them permission Agreement is reached about feedback arrangements in accordance with the adult at risk s wishes (or best interests, if they do not have mental capacity) and do not attend the review. This feedback should be provided as soon as possible after the review meeting. Page 80 of 120

81 PART 2: PROCEDURES Stage Six Review Flowchart From Stage Five Case Conference Review takes place Protection Plan is reviewed and updated if required Risk Assessment is reviewed and updated if required Have the adult at risk s outcomes been achieved Agree actions Close safeguarding referral Record decision making Take alternative action where required Provide feedback to relevant persons Page 81 of 120

82 PART 2: PROCEDURES APPENDIX ONE: Quick Guide for Providers of Services Disclosure or Expression of Concern of Abuse Immediate action to be taken: Ensure the safety of the person who is alleged to have been harmed or the person alleged to have caused harm; if in immediate danger, contact the relevant emergency services e.g. Police, Ambulance etc. Support and reassure the person, recording what is said and/or observed but avoid asking leading questions Log nature of alleged abuse, any information given or witnessed; actions taken; who was present at the time; dates and times of incident(s) Secure any evidence Do not question the person alleged to have caused the harm about the incident Listen to the person, ascertain their wishes and explain what will happen next Do not take photographs of any injuries (unless a Policy and Procedure on the taking of photographs is in existence, then this should be followed) Report concerns to appropriate Manager to enable the Manager to assess the risk and safety needs of the adults at risk and assess if the concerns constitute an alert Ensure all discussions and decisions are recorded Report incident to Police if criminal offence appears to have been committed Within 24 hours (the Manager should): Assess the presenting risk issues and record this risk assessment Discuss with the adult/family at risk, a management plan to minimise the risk to the person at risk and others Secure any evidence (records; reports; body maps; clothing; etc.) Consider internal disciplinary action if a member of staff is alleged to be involved Inform CQC (if in a regulated setting) Refer to Adult Social Care or Emergency Duty Team Record any actions taken Information to be given at the point of referral by the Manager or Whistle- Blower : Details of the adult alleged to have been harmed (name; contact details; DOB; gender; ethnicity and principle language; any disability; any communication issues; next of kin and key others) Name and contact details of GP Reasons for the concerns, the context of these and how they came to light Page 82 of 120

83 PART 2: PROCEDURES Details of any witnesses Any concerns or doubts about the person s mental capacity to make a decision about their protection/safety needs Whether the adult at risk is aware of and has consented to the referral Any expressed wishes of the adult at risk Action already taken to protect the adult or others at risk and actions under any other process e.g. disciplinary etc. Actions to be discussed/agreed: What interim measures need to be put in place? What reports should be sent by the provider? Contact with families as agreed with the person at risk or if the adult lacks capacity to make this decision, discuss what would be in their best interests Contact with funding agencies Contact with Regulators What will happen next and timescales Ongoing Action Ensure ongoing support and risk management to the adult(s) at risk of abuse Contribute to strategy discussions, attend strategy discussions or meetings Participate in single agency or multi-agency investigation Undertake actions as agreed as part of the strategy plan (agreed in strategy discussions or meetings) Liaise with the person at risk and families as required Participate in Case Conferences and Review meetings as required Continue internal management investigation and seek HR advice on implications of employment legislation Ensure referral to the DBS where required Ensure referrals to professional bodies where required Page 83 of 120

84 SAFEGUARDING ADULTS IN HALTON Inter-Agency Policy, Procedures and Good Practice Guidance PART THREE: GOOD PRACTICE GUIDANCE