Safeguarding Vulnerable Adults Policy & Version: 1.0 Implementation date: 19th April 2016 Author: Cheryl Mason Ratified by: Joe Kinch Review date: 19th April 2017 Record reviews and any relevant changes or amendments and reasons in the box below: Date Version Changes Made/Reason for Changes
Purpose 1.1 The overall objective of this policy is to give all staff and volunteers relevant information about the process for alerting Safeguarding concerns and to set out the responsibilities of managers/referrers. 1.2 To ensure that we make suitable arrangements so that people who use our services are safeguarded against the risk of abuse by means of: Stopping abuse or neglect wherever possible Preventing Harm and reducing the risk of abuse or neglect for adults with care and support needs Safeguarding adults in a way that supports them in making choices and having control about how they want to live 1.3 To promote a positive safeguarding culture in a safe environment which has suitably skilled and trained staff 1.4 To ensure that any any all use of restraint is appropriate, proportionate and justifiable and is done in a manner which respects people s dignity 1.5.To take any and all allegations seriously and respond to these in a timely and appropriate manner Statement Freedom Care believe that it must be the overriding concern of all staff/volunteers to provide the appropriate level of protection for adults in need of safeguarding. Safeguarding is the responsibility of everyone and there should be no assumptions made in relation to alerting or referring. All people employed by or volunteering within Freedom Care have a duty of care to take responsibility for responding to any concerns about possible abuse. Safeguarding matters will be inclusive, putting the needs and wishes of the service user at the centre of any actions taken although, it must be recognised that there may be times, for example due to the severity of the abuse/neglect or the level of risk posed to the individual and/or others is high, when referrals are made or actions are taken without the informed consent of the individual. If there are issues relating to informed consent, guidance relating to Mental Capacity should be sought and individual assessments undertaken relevant to the safeguarding matter being dealt with. Freedom Care have considered the The Care Act (2015), S42 46 which puts Adults safeguarding on a legal footing, and other chapters which incorporate safeguarding to include S47 and 68. We have also used information contained within Chapter 14 of the Care Act Statutory Guidance which replaces previous guidance issued within No Secrets. All staff should ensure when reading this Policy it is read in conjunction with the Leicester, Leicestershire and Rutland Policy & which has been reviewed following changes made in relation to the Care Act (2015) and is available to read comprehensively at www.llradultssafeguarding.co.uk. Enclosed within the Safeguarding File are further documents which have been considered when writing this policy & procedure. These documents can be accessed at any time during the day or night:: 2
Leicester, Leicestershire & Rutland Safeguarding Adults Learning Competency Framework; Minimum requirements for Safeguarding Adults Learning The Care Act Statutory Guidance (Safeguarding Adults) A copy of all of these documents is included in the Safeguarding Adults file held on site which staff have access to at any time of the day or night Adult Safeguarding and Domestic Abuse (ADASS) Female Genital Mutilation Risk & Safeguarding Guidance for professionals (DOH) Modern Slavery Briefing (Gov.co.uk) Safeguarding and The Care Act information about the changes Identifying the signs of abuse (Social Care Institute for Excellence SCIE) The Care Act (2015) The Care Act 2015 put Adult Safeguarding on a legal footing and dictated that from April 2015 Local Authorities must: Make enquiries if it believes an adult is subject to, or at risk of, abuse or neglect. An enquiry should establish whether any action needs to be taken to stop or prevent abuse or neglect, and if so, by whom Set up a Safeguarding Adults Board (SAB) with core membership from the local authority, the Police and the NHS with the power to include relevant bodies Arrange, where appropriate, for an independent advocate to represent and support an adult who is subject of a safeguarding enquiry or Safeguarding Adult Review (SAR) where the adult has substantial difficulty in being involved in the process and where there is no other appropriate adult to help them Cooperate with each of its relevant partners in order to protect adults experiencing or at risk of abuse or neglect Also, in relation to local authorities, the Care Act updates the scope of adults safeguarding meaning that regardless of whether they are providing any services they must follow up any concerns of actual or suspected abuse. As a result this should strengthen SAB s and give them more powers than the previous arrangement set up by No Secrets Statutory Guidance The Care Act (2015) The statutory guidance enshrined the six principles of safeguarding: Empowerment presumption of person led decisions and informed consent Prevention it is better to take action before harm occurs Proportionality proportionate and least intrusive response appropriate to the risk presented 3
Protection support and representation for those in greatest need Partnerships local solutions through services working with their communities Accountability accountability and transparency in delivering safeguarding Through use of the decision tree in the statutory guidance, this should mean that practice moves away from a process led tick box culture to one that is truly person centred. This means that we must focus on what it is that the adult wants, which accounts for the possibility that individuals change their mind on what outcomes they want through the course of any intervention. The Making Safeguarding Personal Programme (ADASS, LGA, DOH) follows the edict of no decision about me without me and means that the adult, their families and carers are all working together with agencies to find solutions to keep people safe and support them in making informed choices. The Act also recognises the key role of Carers in relation to safeguarding and leads agencies to ensure that the situation is viewed holistically to ensure the safety and wellbeing of both parties. Changes in current legislation and/or social policy may require this Policy & procedure to be reviewed. Definitions Adult Safeguarding protecting a person's right to live in safely and free from abuse & neglect. Abuse can happen anywhere, in someone's own home, a public place, in hospital, in a care home, in college. It can take place where an adult lives alone or with others (14.18 14.28 Care Act) Vulnerable Adult An adult who is 18 years or over is considered to be vulnerable if they are or may be in need of community care services by reason of disability, age or illness; and is or may be unable to take care of unable to protect him or herself against significant harm or exploitation. ( www.safeguardingmatters.co.uk ) Leading Questions this is a question which implies the answer or assumes facts, e.g. so you were touched on the leg weren t you? Disturb possible forensic evidence don t wash clothes, bedding or other items. If any sexual offence is suspected try to discourage the alleged victim from washing, drinking, cleaning teeth etc. until the Police arrive Disclosure information shared with you about alleged abuse, ensure that the vulnerable adult understands who this information will be shared with and why Categories of Abuse Abuse and neglect can take many forms; as care providers it is important we are not constrained by definitions but consider the individual circumstances of each case. Perpetrators of abuse can be anyone, this can include partners, family members, neighbors, friends, acquaintances, organised gangs, paid staff or professionals, volunteers and strangers. 4
Physical abuse hitting, pushing, pinching, shaking, misusing medication, scalding and the misuse or illegal use of restraint, inappropriate physical sanctions Psychological/Emotional abuse includes actions or behaviour that have a harmful effect on the emotional, health and/or development of an adult who is at risk, threats, deprivation of contact, shouting, ignoring, cruelty, harassment, bullying, humiliation, coercion, negating the right of the adult at risk to make choices and undermining self esteem, unreasonable withdrawal of support services/networks Sexual abuse rape, sexual assault, performing sexual acts, forcing people to watch pornography or showing them explicit photos when they do not want or have not consented, cannot understand and lack the mental capacity to be able to give consent or have been coerced into because the other person is in a position of trust, power or authority (for example a care worker) Neglect and acts of omission the failure of any person, who has responsibility for the charge, care or custody of an adult at risk, to provide the amount and type of care that a reasonable person would be expected to provide. Neglect can be intentional or unintentional and includes failure to provide for medical, social or educational needs, withholding necessities such as food, drink and warmth, and a lack of protection from hazards Financial/Material abuse Financial abuse is the use of a person's property, assets, income, funds or any resources without their informed consent or authorisation. Financial abuse is a crime. It includes theft or fraud, exploitation, undue pressure in connection with wills, property, inheritance or financial transactions, the misuse or misappropriation of property, possessions or benefits, the misuse of an enduring power of attorney or a lasting power of attorney, or appointeeship Discriminatory abuse occurs when values, beliefs or culture result in a misuse of power that denies opportunity to some groups or individuals. It can be a feature of any form of abuse of an adult at risk, but can also be motivated because of age, gender, sexuality, disability, religion, class, culture, language, and race or ethnic origin. It can result from situations that exploit a person's vulnerability by treating the person in a way that excludes them from opportunities they should have as equal citizens, for example, education, health, justice and access to services and protection Institutional abuse is the mistreatment, abuse or neglect of an adult at risk by a regime or individuals. It can take place within settings and services that adults at risk live in or use, and it violates the person's dignity, resulting in a lack of respect for their human rights. Institutional abuse occurs when the routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice. It can take the form of an organisation failing to respond to or address examples of poor practice brought to their attention. It can take place in day care, care homes, hostels, supported housing, hospitals and sheltered and supported housing. It can be difficult to identify the difference between a poor service and institutional abuse Exploitation either opportunistically or premeditated people are manipulated for profit or personal gain Radicalisation is a process by which an individual or group comes to adopt (through a process of grooming) increasingly extreme political, social, or religious ideals and aspirations that (1) reject or undermine the status quo or (2) reject and/or undermine contemporary ideas and expressions of freedom of choice 5
Female Genital Mutilation procedures that intentionally alter or cause injury to the female genital organs for non medical reasons. This practice is illegal in the UK. Modern Slavery This can take many forms and includes trafficking of people, forced labour, servitude or slavery Domestic Abuse Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between people aged 16 and over who are or have been intimate partners or family members regardless of gender or sexuality Self Neglect Although a complex area which needs to consider the capacity of the individual to make unwise decisions the Care Act includes self neglect in the categories of abuse where there are serious concerns and risks to the health and wellbeing on the individual Identifying Abuse Your ability to identify the signs and symptoms of abuse in any given situation is likely to depend on the nature of your relationship with the adult. If you are involved in the delivery of intimate personal care, you might notice signs or changes that may indicate abuse. If your contact is less regular, it is likely that the abuse will have to be very stark to attract your attention, you may notice various signs including: Physical signs What physical signs of abuse may be evident on the body of the adult at risk? Behavioural signs When you think about the adult's behaviour, does it add to your concerns or lessen them? Other factors associated with the abuse What do you know about the history of the adult, their family or carers? Does this information add to or detract from your concern? Please see the enclosed document Identifying the signs of abuse (Social Care Institute for Excellence SCIE) for detailed information on recognising the different types of abuse. Policy 2.1 This Policy will promote service user and carer involvement in all aspects of care and support including during any safeguarding referral and/or investigation 2.2 To ensure optimum protection for our service users we will have a robust recruitment process and an ongoing programme of training and support in place for staff (all staff will have a basic awareness of safeguarding; all senior staff and managers will be trained in MCA and DOL s requirements) 2.3 To promote a culture where service user care is truly person centred; all service users are treated with dignity and respect and staff feel comfortable sharing any concerns with senior members of the team/management 6
2.3 To enable Managers (and their deputies where relevant) to have a clear process to ensure that we fulfil our duty to report allegations of abuse or neglect to the CQC 2.4 To enable all staff and volunteers to understand what circumstances would lead to the need to report outside of our organisation to the local authority 2.5 The Policy will offer a framework to Managers in instances where abuse or neglect is perpetrated by employees 3. Staff/Volunteers all staff and volunteers will: 3.1 Receive training to ensure they are competent in 1 6 of the core competencies (for further details please see the document relating to the competency framework in the safeguarding adults file) 3.2 Alert the Registered Manager without delay regarding any concerns, suspicions or evidence of abuse they may see or hear about 3.3 Co operate with any investigation following the alert by providing all relevant information and evidence 3.4 Neither prevent nor persuade an individual or other member of staff from raising concerns or suspicions of abuse 3.5 Record all factual information accurately and clearly 3.6 Follow Leicester, Leicestershire & Rutland multi agency policy and internal procedures 4. Safeguarding Lead/Managers the safeguarding lead/manager within the care home should: 4.1 Receive training to ensure that they are competent in 1 6 and 7 11 of the core competencies (for further details please see the document relating to the competency framework in the safeguarding adults file) 4.2 Have an operational knowledge of the updated Leicester, Leicestershire & Rutland Safeguarding Adults Safeguarding Adults Policy & and the Care Act Statutory Guidance (Contained within the Safeguarding Adults file). For our care home based in Nottinghamshire there will be an operational knowledge of Nottinghamshire Safeguarding Adults Policy & 4.3 Ensure that they are aware of allegations, suspected or actual abuse which would need reporting to the local authority 4.4 Ensure that they follow Freedom Care s recruitment process (this should include DBS requirements ensuring all staff have a valid and up to date enhanced DBS and references from previous employers please see recruitment process for further information) 4.5 Liaise with the Training and Development Manager to ensure that all their staff and volunteers have appropriate support, training and supervision to carry out their role in a competent manner 7
4.6 Consult with the vulnerable adult and gain their informed consent about reporting, ensuring that the individual has a clear understanding of what this means 4.7 Work within the confines of the Mental Capacity Act all adults should be assumed to have capacity but where there are concerns that the vulnerable adult does not have capacity to make decisions about actions to be taken, a Mental Capacity Assessment should be completed (ensuring all the principles of good practice are followed) 4.8 Any decision made to report without consent will be clearly justified and where this relates to people who do not have capacity, the decision should be made in their best interests and in consultation with other people who know the vulnerable adult well (this can include family members, carers, advocates, other professionals etc) and should ensure that best practice guidance in relation to best interest decisions is followed 4.9 Take actions as required no investigations should commence without a strategy discussion/meeting between relevant agencies unless in very exceptional circumstances 4.10 Consult with Adult Social Care Service in instances of Safeguarding and complete relevant documentation to make a referral as advised 4.11 Where another process has to be operated simultaneously (e.g. grievance/disciplinary) ensure that the protection of the vulnerable adult comes first throughout and that the investigation within the care home does not jeopardise any outside agencies investigation (Social Care, Police etc.) 5. Process of Alerting staff/volunteers who suspect abuse should: 5.1 Make sure no one is in immediate danger 5.2 Call Police/Ambulance if an emergency situation 5.3 Remain Calm, do not overreact or be judgemental 5.4 Not ask the individual leading questions 5.5 If abuse is recent, do not do anything which could disturb possible forensic evidence 5.6 Record the details of what has happened as accurately as possible 5.7 Establish the views and wishes of the vulnerable adult about the safeguarding matter and the procedures that will be followed 5.8 Do not offer assurances about confidentiality, advise that concerns relating to risk of harm or where a crime has/will be committed will be shared with members of the care team and partner agencies where necessary 5.9 Be clear if the information disclosed is going to be shared regardless of their views and wishes 5.10 Report their concerns/information they have gathered to the Manager of the Home. In the event that the Manager is unavailable and there is an immediate need for a response to a serious safeguarding issue staff should follow the process for making a referral to Safeguarding Adults external from the Company 8
6. Safeguarding Lead/Manager s response to Alert 6.1 In consultation with others will collate all information and assess whether there is any immediate danger. Take any urgent measures/actions necessary to prevent any further harm and review care plans to reflect changes as necessary 6.2 If the incident is recent and the alleged victim is injured or seriously distressed ensure vulnerable adults comfort and safety 6.3 Assess whether the alert warrants Referral under the safeguarding adults multi agency policy and procedure (Screening Tool Appendix 1) gaining other professional perspectives where relevant. An initial discussion can be held with Local Adult Social Care Services if required 6.4 A ny allegation which fits the categories of abuse outlined within the multi agency policy MUST be referred. If in doubt a referral should be made 6.5 It is not always clear on initial alert the seriousness or extent of the abuse and as such all alerts should be treated seriously and with an open mind 6.6 Adult Social Care will take the responsibility for deciding whether the procedures apply subsequent to referral 6.7 When a referral has been made to Adult Social Care Services, contact CQC to notify them of a Safeguarding concern within a regulated service this can be completed on statutory notification form Regulation 18 (2) Statutory notification about abuse or alleged abuse concerning a person or persons (child or adult) who use the service 6.8 If a decision is made not to refer this should be clearly documented including how this decision was reached, who was consulted, steps taken to minimise the risk and support offered to the alleged victim 6.9 Information should be documented in Safeguarding Adults referrers Form (Appendix 2) 6.10 All Safeguarding Alerts and Referrals should be documented in daily records and the information should be retained in a separate Safeguarding Adults file located in the Manager's office 7. Referral 7.1 Referrals should go to Adult Social Care Services as identified below: Named Social Worker/Specialist Team involved make the referral to the named social worker or team within Adult Social Care services No Social Worker or Specialist Team (or they cannot be contacted promptly) make the referral to the Local Adult Social Care Team (the area you are located in) Criminal Behaviour referral should be made to both the Police and Local Adult Social Care Services 9
Out of Hours referral should be made to the Emergency Duty Team (EDT) in the locality you are based 7.2 When making a referral, the Manager should be clear that the referral is being made under the multi agency safeguarding adults policy and procedures 8. Events following referral 8.1 Strategy discussion/meeting should be held within 24 hours of the referral being received (or the following working day if the referral was out of hours) this may be via phone, e mail or a meeting dependent on individual referral 8.2 This meeting will enable agencies to get a full assessment of the risk and agree actions to minimise, confirm the responsibility of each agency, agree actions and timescales including how alleged victim, carer and others will be involved in the investigation and feedback arrangements 8.3 This will be co ordinated by the Local Adult Social Care Services who received the initial referral 9. Retraction of Allegation 9.1 If an allegation is retracted, in the majority of cases, the strategy discussion/meeting should still go ahead 9.2 This will give an opportunity to consider why the allegation was retracted (i.e. coercion, intimidation, untrue etc.) 9.4 If the allegation is found to be untrue the meeting will focus on why this was made and look at future planning for the protection of the individual making the allegation and the individual who allegations were made against 10. Employees implicated in abuse 10.1 If the investigation relates to an employee they must be immediately suspended pending investigation (following the guidance in the Disciplinary Policy & ) 10.2 The disciplinary process regarding investigation should be followed. The Manager must ensure that their investigation does not interfere with or jeopardise any external investigation being conducted by Adult Social Care & Health and/or Police 10.3 In the event that the staff member is found to have perpetrated abuse or been implicated in neglecting a service user they will be dismissed from the company (following Disciplinary Policy & procedure guidances) and reported to the Disclosure and Barring Service with immediate effect there will be no exceptions. If the staff member has a registration with a professional body (HCPC, NMC etc they will also be reported to this organisation) 10
10. Contact Information Police 101 or 999 in an Emergency Leicester City Safeguarding Adults Phone Number: 0116 454 1004 Out of Hours: 0116 255 1606 Leicestershire County Safeguarding Adults Phone Number: 0116 305 0004 Out of Hours: 0116 2551606 Nottinghamshire County Safeguarding Adults Phone Number: 0300 456 4546 Out of Hours: 0300 500 8050 Nottingham City Safeguarding Adults Phone Number: 0115 876 5600 Out of Hours: 0300 300 3333 Templates Appendix 1 Safeguarding Adults Screening Tool Appendix 2 Safeguarding Adults Referrers Form 11
Appendix 1 Safeguarding Adults Screening Tool Vulnerable Adult Details: Name: DOB: NHS Number: 1. Alleged Abuse /Extent of Alleged Abuse (nature of risk, how and who identified the abuse, any supporting evidence available, is it actual or potential harm, what is the worst possible outcome etc.) 2. Assessment of the seriousness of Alleged Abuse (length of time the abuse has been happening, previous concerns (in a broader sense than just allegations), impact on the individual and others, the extent to which this can be monitored, are there any child protection issues) 3. Factors which mean Alleged Victim is more vulnerable to Abuse (consider mental capacity, physical disability, emotional/financial dependency, communication needs, social or cultural isolations, DOL implications) 12
4. Risk of Abuse Recurring (should be considered HIGH if reason to believe someone s life is in danger, major injury or serious ill health could occur, abuse is persistent and/or deliberate, there is a history of domestic violence, lack of awareness of the alleged victim about abuse. Also need to consider predisposing factors or triggers which make alleged victim more vulnerable, attitude of alleged perpetrator about abuse, supportive monitoring in place or can be put in place, access to the alleged victim by the alleged perpetrator) 5. Wishes of Alleged Victim (are they aware of the alleged abuse, what is their view about what happened, do they understand the risks, are they providing care for others, do their carers/family need informing, do they wish to involve Police/external agencies, do they consent to information sharing) 6. Protective Factors (any support services in place, positive relationships with family, friends or neighbours, access to social and support groups, good awareness of personal safety and how to raise concerns, awareness of what constitutes abuse) 13
7. Immediate Protection Plan (does the alleged victim need to move environments, are there others who need safeguarding in this environment, does the alleged perpetrator have support needs and are these being addressed, what monitoring and support measures can be implemented, do family/carers need to be involved, what timescales will these things happen) Signed: Completed by: Position: Date: (Adapted from No Secrets Leicester, Leicestershire and Rutland Multi Agency Safeguarding Adults Policy and ) 14
Appendix 2 Safeguarding Adults Referrers Form Vulnerable Adult Details: Name: DOB: NHS Number: 1. Details of Initial Alert (when and who raised concerns, how concerns were raised, reason for concern i.e. disclosure, marking, witness of event etc.) 2. What are the views of vulnerable adult involved (if known) (Has he/she given permission to involve other agencies? Is there a need to share information without the consent of the vulnerable adult) 3. Outline of Allegation (date, time, location of incident, professional description of the act where relevant, any evidence, witnesses, physical markings) 4. Outline of any previous related allegations 15
5. Information about person(s) alleged to be responsible for the abuse Safeguarding Vulnerable Adults Policy & (name, address, gender, relationship to victim, any future contact may have with victim or other vulnerable individuals) 6. Evaluation of Seriousness of Abuse (consider intent deliberate or non deliberate harm, risk to vulnerable adult actual or potential, risk to others actual or potential, likelihood of further abuse, opinion of professionals working with vulnerable adult, is alleged abuse one off incident or on going) 7. Actions taken prior to referral (any contact with Police or other emergency services, immediate action to reduce risk to vulnerable adult, any discussion with vulnerable adult/witnesses/other professionals) 8. Decision about referral (was this referred or not, how was this decision reached, who was involved in making this decision, if no referral made any actions taken to minimise the risk to the vulnerable adult) 16
9. Referral details (organisation referred to, contact details of referrer and the person referred to, record of conversation held with department referred to, any agreed actions and by whom, any feedback arrangements discussed) Signed: Completed by: Position: Date: 17