Risk Assessment in Safeguarding Adults

Risk Assessment in Safeguarding Adults The primary aim of the Safeguarding Risk Assessment is to assess: Individuals for the current risks that they face Potential risks they may face The secondary aim of the Safeguarding Risk Assessment is to assess: Reasonably foreseeable risks to the individual from current service activities Reasonably foreseeable risks to the individual and other service users if safeguards or improvements are not put in action to address any service failures Concept of Risk Risk to individuals result from an interaction of several factors. The resultant risk can cause harm in many ways to vulnerable individual who are dependent on others to lead a safe and independent life. Vulnerable individuals may also not be able to prevent themselves from being exploited by others to the detriment of the physical and mental wellbeing (see No Secrets for definition of vulnerable adult). Risks in safeguarding adults result from the interaction of causes: Liability and Opportunity. A hazardous event takes place when liability interacts with opportunity and allows it to cause harm to an individual or individuals. Opportunity Opportunity covers external stimuli and stressors that can pose a risk to vulnerable individuals if not avoided, managed or modified. This could be a relative, friend, stranger, or a service provided inappropriately. Liability Liability covers all the factors that make someone vulnerable and mostly intrinsic in nature. This would mean someone who is severely physically or mentally disabled, has mental health problems or learning disabilities which render him vulnerable to external stressors and unable to protect himself from harm or exploitation Liability + Opportunity = Hazardous event (causing harm) Every hazardous event has likelihood and a consequence Likelihood This is a measure of the chance that the hazardous event will occur. Example of low likelihood is where a person is mugged in the streets as he was returning from church. He is normally escorted but on this occasion he was on his own. It is a one off incident less likely to happen 1 of 9

again. An example of a high likelihood is where the carer verbally abuses the person and the interaction is daily or the carer is the relative the person lives with. Consequence This is the outcome of the hazardous event. It is assessed according to the impact the event had on the person. A broken bone and bruising would be catastrophic to the person whereas a bruised knee following a fall would be a minor consequence. Risk is therefore the combination of the likelihood of a hazardous event occurring and the consequence of that event Likelihood x Consequence = RISK Risk Assessment Tool 1) Score the likelihood of the risk occurring using Table 1 Table 1 Descriptor Description Score Almost certain Will probably occur frequently 5 Likely Will probably occur frequently but not as a 4 persistent issue Possible May occur 3 Unlikely Not expected to occur 2 Rare Would only occur in exceptional circumstances 1 2) Score the consequence of the risk using Table 2 Table 2 Level 5 Catastrophic Injury/risk of harm to Victim Unanticipated death, multiple severe injury, repeated abuse despite safeguards resulting in permanent disability, criminal offences etc 4 Major Major permanent loss of function related to acts of abuse, fractures leading to disability, theft of significant cost or from someone in Injury/ risk of harm to others Large number of people abused/neglected, assaults against staff, number of criminal offences etc. Theft from many vulnerable adults, risk of assaults and verbal abuse against staff or others, access to medical /social care denied leading to significant Cost to individual/and others Death, significant deterioration in health and wellbeing, total loss of independence etc Prolonged medical admission, change to living arrangements, total loss of independence, persistent risk of Risk/cost to organisation as public service National adverse publicity, irreparable damage to reputation, litigation etc Widespread/ sustained adverse publicity, increased public and regulator scrutiny

position of trust, sexual abuse etc, Significant selfneglect requiring hospitalisation, possible criminal offence 3 Moderate Semi-permanent harm leading to 1month-1yr of increased support and rehabilitation, some loss to independence, theft from stranger, controlling carer/relative, persistent verbal abuse/ significant psychological damage, some level of self neglect/noncompliance etc 2 Minor Short-term injury, one-off incident and low-level theft, shouted at by spouse, other relative, development of pressure sores grade 2 and above 1 insignificant Minor harm, one incident of undignified care, delays in service due to a one-off shortage of staffing health problem, possible criminal offences etc Harm/ risk of theft to vulnerable others, persistent poor quality care, resulting in people s health and well being impacted on, more than one incident of medium to low level institutional abuse, rude and abusive carers, failure to act on complaints, development of and poor management of pressure ulcers grade 3 and above, etc One-off verbal abuse with multiple victims and against staff, One-off incident of rudeness by care giver or perpetrator towards others and staff Development of grade one pressure sores with no management plan or ineffective care plan for a number of patients, one incident of undignified care due to other factors etc. assault to staff and others with risk of care withdrawal and impact on health and well-being etc Medium to low level harm, mainly psychological, anxiety, depression as a reaction requiring medical intervention, pain and discomfort, semi-permanent, loss of independence etc Anxiety and being upset which responds to reassurance, no real loss to independence or level of function Anger and frustration for victim, staff being rudely addressed Widespread or low profile adverse publicity Adverse publicity none Risk Assessment Decision Grid

Likelihood Consequence 5 5 10 15 20 25 4 4 8 12 16 20 3 3 6 9 12 15 2 2 4 6 8 10 1 1 2 3 4 5 1 2 3 4 5 In the case of the 5x5 matrix, the action levels are: 15-25 Unacceptable, stop activities And make immediate improvements 5-12 1-4 Unsafe without safeguards, look to Improve situation with specific timescales Safe with regular monitoring. May require minor Adjustments to existing control plans Risk Assessment Process Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Identify all the risks faced by the individuals/s-what are the opportunities and liabilities, e.g. causes of vulnerability, external stressors etc, (use risk recording sheet) Estimate the likelihood and the consequence of each of the risks Evaluate the risk against the risk assessment grid, and score the risk (see grid above) Record your findings Take appropriate actions, (immediate if protection needed whilst in hospital) starting with strategy discussion followed by strategy meeting Identify clear roles and responsibilities- if there are medical reasons, mental health involvement, relocation requirements etc identify who needs to be involved in strategy meeting/discussion

Guidance on How to Use the Risk Assessment Decision Tool The risk assessment uses a traffic light system with Green being universally used as safe to move forward. Red signifies stop and Amber being preparing to stop. In this case Red does mean a halt to hazardous activities needs to occur with immediate safeguards. Amber signifies moving forward with caution which may mean modifying the risk with some safeguards. Green means it is safe but also looking to be sure it is safe with a monitoring or review plan. Risk Management Strategies To help decide on a risk control, there s an order of hierarchy of risk control that can be used, with risk control options at the top of the hierarchy being the best measure because it is much less reliant on other variables doing something to allow the risk to persist. We can categorise risk control measures as follows: 1. Eliminating the hazard This is the most effective method of risk control as it completely eliminates the hazard, the opportunity or liability. For example, if a person is financially abusing a vulnerable adult, to eliminate the hazard would be to disallow the perpetrator to manage the vulnerable person s finances and set up a secure method of managing the person s finances. Hazard elimination may also mean that the perpetrator is reported to the police and prosecuted, removing the perpetrator completely from the situation Where a vulnerable adult is at risk of self neglect due to non-compliance with safeguards due to mental capacity issues, relocating the vulnerable person to a more supervised setting or supporting the person with a care package will eliminate the hazard of inappropriate self management 2. Reducing the hazard The next preferred option is to reduce the hazard. This would mean reducing the impact of the opportunity or liability. Where carer/relative is found to be abusive or rough with a vulnerable adult, putting in a package of care to support the carer and monitoring the situation, reduces the hazard which causes harm. This may also mean that if a vulnerable adult is subject to unacceptable control of movement at home due to the carer not coping with caring, arranging regular day centre attendances and respite for the carer, can reduce the carer stress and improve the relationship between carer and vulnerable adult 3. Creating a distance between vulnerable person and hazard This may mean distancing the perpetrator and the alleged victim. This may mean placing sanctions with contact between perpetrator and victim. For example, when in hospital, the visits to the victim by the perpetrator and others close to the perpetrator, being supervised by staff.

The same applies to the vulnerable adult being supervised during all visits in a care home. This may also mean providing separate accommodation for victim or perpetrator etc. 4. Ensuring Safe Systems at work Safe systems at work include safe procedures, the do s and don ts. Where there has been harm to a patient in hospital or a care home, it will require for policies and procedures to be reviewed. Safeguards will then be placed to ensure that this incident does not occur again or significantly reduces the likelihood of the incident happening again Another example of safe systems would be improving the process of transfer of care, i.e. documentation etc. This will also involve systems for monitoring and learning from untoward incidents through practice effective feedback loops and training. Capacity and Advocacy When identifying risks, one must take into consideration the mental capacity for decision making of person/s at risk. Capacity issues highlight the level of control the vulnerable adult may have over his current situation his ability to prevent himself being exploited One must ensure that the vulnerable person s right to advocacy is upheld. Where the vulnerable person is not represented or their family/carer may not be acting in their best interests, an IMCA must be instructed to act as the advocate for the vulnerable adult When to Use the Tool Risk assessment must be used on receipt of a referral, to obtain an initial assessment of the severity of the allegation. This will also help with allocation of resources, immediate safety of person if required, level and timing of response and who to involve in the strategy discussion/meeting Once the initial response has been undertaken and further information gathered, the risks must be reassessed in light of the new information and will help guide the investigations and the protection plan at a strategy meeting The risks will then be reassessed when the safeguarding review is undertaken * The risk assessment is not a definite science, it is a decision making support tool and the risk score can change over any period of time or with different interventions*

Safeguarding Adults Risk Assessment Recording Template Name of Service User: CareFirst User No: Identified Risk Risk score and Grading Is Risk modifiable or unmodifiable Strategies to reduce the risk or the likely harm 7 of 9