Safeguarding Adults Policy Version 4 Chief Nurse/ Deputy Chief Nurse. Date ratified: 10/04/2015

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1 Lead executive Name / title of author: Safeguarding Adults Policy Version 4 Chief Nurse/ Deputy Chief Nurse Lesley Shaw/ Lead Specialist Nurse Safeguarding Date reviewed: 20 th February 2015 Date ratified: 10/04/2015 Ratifying Committee: CSSC Target audience: Policy Summary: Equality Impact Statement: Training impact and plan summary: Organisation wide This policy provides a resource to support staff in identifying and managing allegations of abuse. UHSM practices and procedures in adult safeguarding are set out for UHSM wide application. Safeguarding adults processes are multiagency and set out in statute, this policy describes the responsibilities of individuals and of partner agencies in protecting vulnerable adults. This includes the manager s response and referrals to other agencies. The Trust recognises the need to respect individual s rights; consent to share information is explained in relation to disclosure and obligations to share information. Successful application will result in compliance with national guidelines and legal frameworks. University Hospital of South Manchester NHS Foundation Trust ( UHSM ) strives to ensure equality of opportunity for all service users, local people and the workforce. As an employer and a provider of health care, UHSM aims to ensure that none are placed at a disadvantage as a result of its policies and procedures. This document has therefore had an initial assessment, in accordance with the equality impact proforma incorporated in the Checklist for Review and Ratification of UHSM wide Documents, to ensure fairness and consistency for all those covered by it regardless of their individuality. This initial impact assessment indicated that the potential discriminatory impact is low and no further assessment was necessary There is a mandate for all staff to complete an E learning training programme in adult safeguarding every three years. Line managers will carry out a competency assessment with regards to training needs as part of the annual personal development plan and appraisal process Outline plan for dissemination: To be published on the UHSM intranet. Clinical Standards Sub Committtte Divisional Governance Meetings Professional Forum Safeguarding Sub-Committe Dissemination lead: name / title / ext n o Lesley Shaw; Lead Specialist Nurse Safeguarding Adults 2817 This version n o 4 Date published: 27/04/2015 Paper copies may not be current - refer to the intranet for the most recent version of this document 1

2 Version number Issue Date Version Control Schedule Revisions from previous issue V2.0 July 2009 Additional information paragraphs 4,5 and 9 V2.1 September 2010 V2.2 November 2010 Amendment to monitoring section to ensure policy is in line with NHSLA requirements Change of titles and information regarding clinical leadership restructure paragraphs 1,6,8,10,11,12,14, appendix B V3.0 July 2011 Full review of each section, further change in clinical leadership Date of ratification by Committee August 2009 N/A N/A August 2011 V4. February 2015 Full review and update of policy with format changes Summary of consultation process Control arrangements [Review usually every 3 years, but more frequently if required ] Associated documents to be read in association with this policy Document Control Draft policy sent to Medical Director, Chief Nurse, Divisional Medical Directors, Deputy Chief Nurse, Heads of Nursing, Head of Corporate Governance, Head of HR, Head of Patient Safety and Quality, The policy will be publicised through the following methods: Divisional Governance Meetings The Heads of Nursing Professional Forum The UHSM Safeguarding Adults Subcommittee. The Matrons Forum for dissemination on a ward by ward basis Divisional Directors/ Directorate Managers will disseminate to all professionals working within departments within their directorates, this will include medical staff The policy will be posted on the Trust intranet site All these people asked to circulate as deemed appropriate. Additionally, the draft policy is available to all Trust staff on the draft policies section of the intranet A review every three years of the policy by the Trust Lead for the Safeguarding Adult s Policy. Responsible committee- Safeguarding Adults Subcommittee Mental Capacity Act Policy Deprivation of Liberty Policy Domestic Abuse Policy Prevent Policy UHSM Recruitment and Selection policy Paper copies may not be current - refer to the intranet for the most recent version of this document 2

3 References No Secrets 2000 The Care Act 2014 Mental Capacity Act 2005 Deprivation of Liberty Safeguards 2009 Process for monitoring Responsible individual / group/ committee Frequency of monitoring Role responsible for preparation / approval of report and action plan Committee responsible for review of results / approval of action plan Individual / group / committee that is responsible for monitoring of action plan Document Compliance Monitoring Arrangements the policy administrator, in collaboration with the author, will review this policy as a prospective audit for compliance using the completed checklist prior to publishing on website. Deputy Chief Nurse Every three years Lead Specialist Nurse Vulnerable Adults Safeguarding Adults Subcommittee Quality Assurance Committee Contents Section Page 1 Introduction and purpose 4 2 Policy statement 4 3 Scope and exclusions 5 4 Definitions 6 5 Processes to ensure that vulnerable adults are safeguarded at UHSM Procedure for responding to suspected abuse Process to follow when allegation is made Assess the situation Immediate actions by manager Referral to other agencies Formal reporting and investigation Additional Process to follow when Allegation made from the Community Multi agency safeguard process Joint investigation Documentation Consent and Capacity Managing allegations against staff 11 6 Duties related to the implementation of this policy 12 Appendices A Flowchart- procedure for dealing with suspected/alleged abuse 13 B Safeguarding body maps 14 C Criteria for referral to other agencies 15 D How to record and document abuse 17 E Mental Capacity Act- Assessing capacity Paper copies may not be current - refer to the intranet for the most recent version of this document 3

4 1. Introduction and purpose 1.1 This policy has been developed in accordance with the Department of Health Guidance No Secrets (2000) which sets out the requests for establishing multi-agency frameworks and procedures to investigate individual cases of alleged abuse. Safeguarding processes at UHSM have been developed following consultation with Local Authority and Commissioning partners. 1.2 The policy outlines procedures to be followed by all University Hospital of South Manchester Foundation Trust staff when abuse is disclosed/identified/suspected or alleged. 1.3 The document will help in:- Defining abuse Recognising abuse Highlight awareness of potential abusive situations Responding appropriately to allegations of abuse 2. Policy Statement UHSM is committed to improving the quality of health and social care, developing accountability to patients and strengthening the choice and control they have over their care. UHSM supports the Government s agreed principles for safeguarding adults that can provide a foundation for achieving good outcomes for patients. Principle 1: Empowerment Presumption of Person-Led Decisions and Consent Adults should be in control of their care and their consent is needed for decisions and actions designed to protect them. There must be clear justification where action is taken without consent such as lack of capacity or other legal or public interest justification. Where a person is not able to control the decision, they will still be included in decisions to the extent that they are able. Decisions made must respect the person s age, culture, beliefs and lifestyle. Principle 2: Protection Support and Representation for Those in Greatest Need There is a duty to support all patients to protect themselves. There is a positive obligation to take additional measures for patients who may be less able to protect themselves. Principle 3: Prevention Prevention of harm or abuse is a primary goal. Prevention involves helping the person to reduce risks of harm and abuse that are unacceptable to them. Prevention also involves reducing risks of neglect and abuse occurring within health services. Principle 4: Proportionality. Proportionality and Least Intrusive Response Appropriate to the Risk Presented Paper copies may not be current - refer to the intranet for the most recent version of this document 4

5 Responses to harm and abuse should reflect the nature and seriousness of the concern. Responses must be the least restrictive of the person s rights and take account of the person s age, culture, wishes, lifestyle and beliefs. Proportionality also relates to managing concerns in the most effective and efficient way. Principle 5: Partnerships. Working in a multi-disciplinary approach Safeguarding adults will be most effective where services work collaboratively to prevent, identify and respond to harm and abuse. Principle 6: Accountability. Accountability and Transparency in Delivering Safeguarding Services are accountable to patients, public and to their governing bodies. Working in partnerships also entails being open and transparent with partner agencies about how safeguarding responsibilities are being met. 3. Scope and exclusions This policy applies to all UHSM staff, including volunteers and governors. 4. Definitions 4.1 Vulnerable Adult The broad definition of a vulnerable adult is taken from The Care Act 2014 (see associated documents). A person who is over 18 years old and who is or may be in need of community care services (whether or not they are in receipt of this) 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 significant harm or exploitation. Three components within these definitions are crucial: Conditions such as frailties due to older age, mental capacity, physical/ learning disability or mental ill health. Risks possibly from the care or support delivered, from the environment or/to from others. Resilience the person may be dependent on others to protect them from significant harm due to emotional, physical, financial, psychological or clinical factors. 4.2 Abuse Abuse is a violation of an individual s human and civil rights by any other person or persons. Abuse may be perpetrated as the result of deliberate intent, negligence or ignorance. Abuse can consist of a single act or repeated acts, either to one or more people in any relationship or service context and may result in significant harm to, or exploitation of, the person subjected to it. It is important to look beyond the single incident or breach of standards to underlying dynamics and patterns of harm. Vulnerable adults are entitled to the protection of the law in the same way as any other member of the public. When complaints about alleged abuse suggest Paper copies may not be current - refer to the intranet for the most recent version of this document 5

6 that a criminal offence may have been committed, it is imperative that reference must be made to the police service as a matter of urgency. The following types of abuse are defined for this policy: Physical abuse - including hitting, slapping, pushing, kicking, misuse of medication or inappropriate sanctions or restraint. Sexual abuse - including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, could not consent or was pressured into consenting. Psychological abuse - including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation or blaming. Financial or material abuse - including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions or the misuse or misappropriation of property, possessions or benefits. Neglect and acts of omission - including ignoring medical or physical care needs, failure to provide access to appropriate health, social care, or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating. Discriminatory abuse - including abuse motivated by discriminatory and oppressive attitudes towards race, gender, cultural background, religion, physical and/or sensory impairment, sexual orientation and age. Discriminatory abuse manifests itself as physical abuse/assault, sexual abuse/assault, financial abuse/ theft and the like, neglect and psychological abuse/harassment, including verbal abuse. Institutional abuse, neglect and poor professional practice including abuse that takes the form of isolated incidents of poor or unsatisfactory professional practice at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the othe 4.3 Relevant criminal offences may include: Offences against the Person Act 1861 Section 18 - Wounding with intent to do grievous bodily harm. Section 47 - Assault occasioning actual bodily harm. Mental Health Act 1983 Section offence for any staff member of a hospital or mental nursing home or any person to ill-treat or wilfully neglect a patient or person who is subject to supervised discharge. Offence for a Guardian or other person who has the care of a mentally disordered person living in the community to ill-treat or wilfully neglect that person. Theft Act 1968 Offence of dishonest appropriation of property belonging to another, intending to deprive the owner permanently. Race Relations Act 1976 Paper copies may not be current - refer to the intranet for the most recent version of this document 6

7 Racially inspired offences. Criminal Justice Act 1988 Section 39 - offence of common assault relates to any physical contact without consent, acts or words involving threat of violence. Protection from Harassment Act 1997 Section 1 - offence of harassment. The Crime and Disorder Act Hate Crime Any crime where the perpetrator's prejudice against an identifiable group is a factor, influencing who is victimized. This includes crimes which are racially aggravated, homophobic, against faith groups, disabled people and asylum seekers. Sexual Offences Act 2003 Sections adults who are vulnerable by virtue of a mental disorder; Sections offences against people who cannot legally consent to sexual activity because their mental disorder impedes their choice; Sections people who may not be legally able to consent because they are vulnerable to threats, inducements or deceptions because of their mental disorder; Sections care workers and their involvement with people who have a mental disorder. New offences also relate to: o Touching' in a sexualised manner i.e. offences are not all about penetration. o Causing people to engage in sexual activity which does not involve touching by threats, deception etc. Police and Criminal Evidence Act 1984 Section 17 - police powers of search and entry to save life and limb or prevent serious damage to property. Section 24 - police power to arrest without warrant anyone suspected of having committed or being about to commit an offence. Section 25 - police power to arrest someone to prevent them from causing physical injury to another person or to protect others. Domestic Violence and Criminal Evidence Act 2004 The Act gives the police powers to deal with domestic violence including common assault, being an arrestable offence and enabling courts to impose restraining orders when sentencing. Section 5 - causing or allowing the death of a vulnerable adult or child in a household. It is an offence to cause the death, and to also have stood by and not taken reasonable steps to protect the victim. Paper copies may not be current - refer to the intranet for the most recent version of this document 7

8 5. Processes to ensure Vulnerable Adults are Safeguarded in UHSM 5.1 Procedure for responding to suspected abuse This may arise from an allegation, disclosure, or observation of patient arousing suspicion. In these cases, the guiding principle must be the safety, well being and independence of the person being abused. A full documentary record must be kept. 5.2 Process to follow when an Allegation is made Assessing the situation When an allegation is made an assessment of the situation must be made, taking into consideration the vulnerability of the adult, nature and extent of the abuse, and the risk of repeated abuse. A decision must be made immediately by the manager to assess if the patient is at risk of harm. Consideration must be given to ensure their health and wellbeing is protected Immediate Actions by manager Establish relevant facts Record any physical signs on a body map (See Appendix B). Contact Medical Illustrations for photographic evidence at the earliest opportunity in office hours. Arrangements should be made by police for out of hours photographs in criminal cases. Record accurate details of facts and report utilising the Trust HIRs process, please refer to the Trust Incident Reporting Policy and Procedures. Where a criminal offence is suspected the police must be informed immediately and the manager must also record date, time and whom they spoke to within the police force. If physical or sexual abuse is suspected, the patient must be treated as a crime scene, where the clinical condition allows, the victim must not wash, bathe or change their clothing until the police respond Referrals to other agencies may be necessary (see Appendix C) Police Sexual Assault Referral Centre (SARC) Child protection linkage may be required, if this is identified then contact must be made immediately with the Child Protection Nurse/Lead Social Services In very severe cases, a Court of Protection order may need to be issued to allow time for an investigation to take place. This is arranged through the Local Authority. The IMCA service can also be referred to with the aim of providing additional safeguards for patients who lack capacity and have no other close relatives, friends or any other person willing or able to protect their interests. Paper copies may not be current - refer to the intranet for the most recent version of this document 8

9 5.2.4 Formal Reporting and Investigation of Allegations / Suspicions All allegations must be treated seriously regardless of the source. Staff have a duty to report any concerns or allegations of abuse. They must report in the first instance to their direct Line Manager or (out of hours) Duty Manager or Night Manager, who will inform the Adult Safeguarding team. A HIRS must be submitted in each case. The HIRS is reviewed by the Governance and Risk team, in association with the Adult Safeguarding team, and an initial fact-finding mission, gather information and record all details. If necessary, a formal investigation at the appropriate level will be initiated in accordance with the Trust s Incident Reporting & Investigation Policy, with a nominated investigation officer to lead the enquiry. 5.3 Additional Process to follow when Allegation made from the Community The Multi Agency Adult Safeguarding Process UHSM works in partnership with Adult Social Care and other multi agency partners to adhere to the seven key stages of the Safeguarding Adults process: Stage 1: Raising an alert Stage 2: Making a referral Stage 3: Strategy discussion or meeting Stage 4: Investigation Stage 5: Case conference and Protection Plan. Stage 6: Review of the Protection plan Stage 7: Closing the safeguarding process Joint investigation will then take place The Local Authority investigating officer may arrange a strategy meeting. This will involve all key people, unless they are implicated in the allegation. The aim of the investigation is to: Establish whether or not the abuse has occurred Establish the outcome of the investigation i.e. substantiated, unsubstantiated or inconclusive Ensure all appropriate information has been gathered and relevant people have been notified of the outcome Evaluate whether the person is still at risk Professionals are experts in their own field and it is the collective combination of skills and knowledge that will produce the best evidence and outcomes. Paper copies may not be current - refer to the intranet for the most recent version of this document 9

10 5.4 Documentation Organisational documentation guidelines and best practice must be adhered to. Staff must maintain legible chronological notes, written, signed and dated, that document the events and all details, decision and actions taken with regards to the referral to social services. Full details of the concern or injury, action taken, other professionals involved any relevant history must be documented. It is important to remember that records can be used as evidence if a case is taken to court. 5.5 Consent Assessment of Capacity Any patient considered to lack capacity to consent to safeguarding investigation must have a formal capacity assessment undertaken in line with the Mental Capacity Act (see Appendix E) Consent to Share Information Wherever possible, informed consent to share information must be obtained from the vulnerable adult. However there may be situations where: consent is withheld; or the person is unable to give informed consent. In these situations, information may still be shared between professionals if there is reasonable belief (see section 3) that: o There is a high risk of serious harm to the vulnerable person; or o Consent was withheld under duress, or o Other vulnerable adults or children are at risk o When the courts have made an Order o To prevent or detect or prosecute a serious crime. If consent is withheld and the risk of harm is assessed as low at that time, then the information will not be shared at that time, but the multi-disciplinary team must consider what can be offered to the vulnerable adult to enable them to get help in the future. If the person is unable to give informed consent and is assessed as lacking capacity to consent, but information needs to be shared in order to prevent or protect them from abuse, then the best interest principle must be followed Consent to Refuse Support or Intervention Paper copies may not be current - refer to the intranet for the most recent version of this document 10

11 Some vulnerable adults may refuse intervention and support from professionals. One of the starting points is to understand whether the patient has the mental capacity to make the particular decision at that time Situations Where the Vulnerable Adult Does Have Capacity If it is decided that a person does have capacity and has taken an informed choice to live in a situation that puts them at risk, then the person, their carer, their community support and any other relevant agency or individual must be consulted in order to ensure that the person is offered all possible choices. He or she may still choose to stay in the situation and live with that risk. Staff will need to determine whether the vulnerable adult is making the decision of their own free will or whether they are being subjected to coercion or intimidation. If it is believed that the vulnerable adult is exposed to intimidation or coercion, efforts must be made to offer the adult distance from the situation in order to facilitate decision making Situations Where the Vulnerable Adult Does Not Have Capacity If it is decided that the vulnerable adult does not have capacity then staff must act in the best interests of the vulnerable adult, and do what is necessary to promote health or wellbeing or prevent deterioration. The Mental Capacity Act 2005 provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. See Appendix D for further information 5.6 Managing Allegations against Staff Recruitment and locum staff including bank A Disclosure and Barring Service (DBS) check forms one part of the wider safeguarding process. It determines whether a person is a suitable candidate for a particular role by providing information about an employee s criminal history; DBS checks are completed on all new employees and volunteers and three-year renewals are completed. A central record is kept of all staff DBS checks. There is a duty to share information between employers, social services and police so individuals who pose a threat to vulnerable groups can be identified and barred from working with these groups. Please click here for further information Recruitment and selection policy Paper copies may not be current - refer to the intranet for the most recent version of this document 11

12 6.0 Duties related to the implementation of this policy The Chief Nurse is the Trust Lead for the safeguarding of vulnerable adults and has delegated responsibility for development, implementation, operational management, evaluation of effectiveness, and timely review of this policy The Quality and Assurance Committee is responsible for the ratification and effectiveness of this policy. The Lead Specialist Nurse for safeguarding adults, as author, is responsible for reviewing progress against the implementation plan. All named roles/staff within this document, as an integral part of their role, have responsibility to develop standards of good practice in the protection of vulnerable adults within the Trust through research and monitoring current developments in practice and legal issues Each Division within the Trust must retain lines of accountability for safeguarding vulnerable adults. All information and documents relating to adult safeguarding are available on the staff intranet site link: Safeguarding Adults Intranet Site Paper copies may not be current - refer to the intranet for the most recent version of this document 12

13 APPENDIX A INCIDENT OF ABUSE/NEGLECT/ACT OF OMISSION POTENTIALLY RESULTING IN SIGNIFICANT HARM TO AN ADULT AT RISK OF ABUSE OR A CHILD ALERT SENT TO LOCAL AUTHORITY (L.A.) CONTACT CENTRE CONTACT CENTRE REVIEWS THE INFORMATION AND INITIATES CHILDREN S SAFEGUARDING PROCESS ADULT SAFEGUARDING PROCESS SOCIAL WORKER/CARE COORDINATOR RECEIVES ALERT, GATHERS INFORMATION FROM E.G. POLICE/CQC/CCG/NHS TRUSTS/VOLUNTARY SECTOR AND DETERMINES IF SIGNIFICANT HARM HAS OCCURRED. REFER TO POLICE IF A,. IF SIGNIFICANT HARM HAS NOT OCCURRED SAFEGUARDING ENQUIRY MUST CEASE SOCIAL WORKER/CARE COORDINATOR CONSIDERS COURSES OF ACTION TO PREVENT REOCCURRENCE/ HOW TO ADDRESS WIDER NEEDS OF PERSON. IF SIGNIFICANT HARM HAS OCCURRED STRATEGY DISCUSSION WITH MANAGER/PROFESSIONALS LEVEL OF RISK AND PROPORTIONATE INTERVENTION IDENTIFIED BEGIN DISCUSSIONS WITH PERSON OR ADULT HAS CAPACITY AND DOES NOT CONSENT + NO WIDER PUBLIC INTEREST TO PURSUE CASE SAFEGUARDING ENQUIRY MUST CEASE. ALL PRACTICABLE STEPS TAKEN TO SUPPORT PERSON. ADULT HAS CAPACITY AND CONSENTS TO AN ENQUIRY OR IT IS IN PUBLIC INTEREST TO PROCEED WITHOUT RECONVENED STRATEGY MEETING IF REQUIRED ENSURE APPROPRIATE PERSONS INVITED REVIEW PERSON S OUTCOMES REVIEW ACTION PLAN CONSIDER IF ESCALATION OR MEDIA ALERT IS REQUIRED CONSIDER IF REFERRAL REQUIRED TO REGULATORY BODIES ARE RECONVENED STRATEGY MEETINGS REQUIRED OR CAN ENQUIRY OUTCOMES BE DETERMINED? IS A CASE CONFERENCE IS A FURTHER STRATEGY DISCUSSION REQUIRED? (LOW LEVEL HARM MAY REQUIRE A PLAN ONLY)OR IS A STRATEGY MEETING REQUIRED? INITIAL STRATEGY MEETING CHAIRED BY SENIOR SOCIAL WORKER / TEAM LEADER/ADULT SAFEGUARDING COORDINATOR (MCC) RELEVANT AGENCIES INVITED REVIEW INFORMATION, RISK STATUS AND SAFETY ISSUES REVIEW PERSON S DESIRED OUTCOMES CONSIDER IF REFERRALS REQUIRED TO E.G. POLICE, REGULATORY BODIES CONSIDER ANY H.R. ACTIONS REQUIRED CONSIDER IF MEDIA ALERT IS REQUIRED AGREE THE PLAN FOR THE ENQUIRY PROCESS ASSIGN ACTIONS, LEAD ROLES AND AGREE TIMESCALES ARE RECONVENED STRATEGY MEETINGS REQUIRED OR CAN ENQUIRY OUTCOMES BE DETERMINED? IS A CASE CONFERENCE REQUIRED OR CAN THE ACTIONS LISTED BELOW BE PROVIDED BY THE LEAD AGENCY? SAFEGUARDING CASE CONFERENCE (IF REQUIRED) ENSURE APPROPRIATE PERSONS INVITED REVIEW INFORMATION GATHERED, RISK STATUS AND ANY SAFETY ISSUES. REVIEW THE PERSON S SAFEGUARDING OUTCOMES AGREE HOW TO DISSEMINATE ANY KEY LESSONS 13 LEARNT INFORM RELEVANT PARTNER AGENCIES OF OUTCOME CLOSE

14 APPENDIX B 14

15 APPENDIX C Criteria for Referrals to Other Agencies The Police will need to be informed when there is an allegation or suspicion that one of the following criminal offences has been committed against a vulnerable adult A sexual offence, in such instances SARC must be contacted for expert advice. Physical abuse or ill treatment amounting to a criminal offence Financial abuse involving a criminal offence for example theft or fraud Abuse which involves a criminal offence for example blackmail Sexual Assault Referral Centre SARC SARC can provide: Crisis support Forensic medical examination and evidence reports Access to emergency contraception Access to Independent Sexual Violence Advisor The St Mary s SARC is based in St Mary s Hospital. Opening hours are Monday to Friday 9am 5pm. There is a 24hour phone line at stmarys.sarc@cmft.nhs.uk (Please note that this address is monitored during office hours only) Fax on St. Mary s Sexual Assault Referral Centre The Old St Mary s Hospital York Place Oxford Road Manchester M13 9WL Tel: Manchester referrals Allegations, concerns or disclosure of harm due to exploitation, neglect or abuse with Manchester patients must be referred to Manchester Social Services using a Manchester Social Services Part 2 referral form and fax to Tel In every case of alleged abuse you must make a referral within 24 hours. The duty to act applies equally to referrals made anonymously. 15

16 If you are unsure what to do and need advice you can contact the Safeguarding Adults team on extension 2817 or air call via switchboard. Trafford referrals Allegations, concerns or disclosure of harm due to exploitation, neglect or abuse with Trafford patients must be referred to the Trafford Community Screening Team using the referral form for Professional staff, this can be found here: Trafford safeguard referrals to or fax to during office hours. Out of hours to or contact EDT on

17 Appendix D How to record and document alleged abuse Has a person been harmed, abused or neglected? 0r is at risk of being harmed, abused or neglected. This could be: A direct disclosure by the adult at risk A concern raised by staff or volunteers, others using the service, a carer or a member of the public An observation of the behaviour of the adult at risk; or another person s behaviour towards an adult at risk; or of one service user towards another. Written records of any incident or allegation must be made as soon as possible after the information is obtained. Written records must reflect as accurately as possible what was said and done in the incident either as a victim, suspect or potential witness. The notes must be kept safe as it may be necessary to make records available as evidence and to disclose them to a court. Include: Date and time of the incident; Exactly what the adult at risk said, using their own words (their account) about the abuse and how it occurred or exactly what has been reported to you; Appearance and behaviour of the adult at risk; Any injuries observed (complete body map); Name and signature of the person making the record; If you witnessed the incident, write down exactly what you saw. The Record must be factual, information from others must be attributed to them 17

18 APPENDIX E Mental Capacity Act The MCA is underpinned by five key principles: 1. A presumption of capacity - every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise. 2. The right for individuals to be supported to make their own decisions - people must be given all appropriate help before anyone concludes that they cannot make their own decisions. 3. Individuals must retain the right to make what might be seen as eccentric or unwise decisions. 4. Best interests anything done for or on behalf of people without capacity must be in their best interests. 5. Least restrictive intervention - anything done for or on behalf of people without capacity must be the least restrictive of their basic rights and freedoms. The Act sets out a single clear test for assessing whether a person lacks capacity to take a particular decision at a particular time. It is a decision specific test. No one can be labelled incapable as a result of a particular medical condition or diagnosis. The Act makes it clear that a lack of capacity cannot be established merely by reference to a person s age, appearance, or any other condition or aspect of a person s behaviour which might lead others to make unjustified assumptions about capacity. A person lacks capacity in relation to a specific matter if he/she is unable to: Make a decision for him/herself in relation to the matter because of impairment or a disturbance in the functioning of the mind or brain [Mental Capacity Act 2005]. Understand the information relevant to make the decision. Retain the information. Use or weigh that information as part of the process of making the decision. Communicate their decision, whether by talking, using sign language or any other means [Mental Capacity Act 2005]. For further information please refer to the UHSM Mental Capacity Act Policy.. A template to help with the Mental Capacity Assessment process can be found on the UHSM Intranet site. Link to: Safeguarding Adults Intranet Site 18