ANGUS COUNCIL SOCIAL WORK AND HEALTH MANUAL OF OPERATIONAL INSTRUCTIONS OPERATIONAL INSTRUCTION NO SUBJECT: RISK ASSESSMENT AND RISK MANAGEMENT Staff responsible: Service managers Team leaders and senior social workers Care managers and social workers Occupational therapy staff Statutory basis: Human Rights Act 1998 Disability Discrimination Act 1995 Race Relations (Amendment) Act 1995 Freedom of Information (Scotland) Act 2002 Data Protection Act 1998 Purpose: To provide staff with guidance and a standardised risk assessment framework. This framework does not replace other specialist risk assessment tools already in use. 1. RISK ASSESSMENT The primary case accountable worker should complete a specific risk assessment when there are high levels of risk that cannot be managed within a service users normal care plan. Wherever possible, normal or low level risk should be managed and monitored through the care plan. Consideration should be given to completion of a specific risk assessment when known risks need a discreet management plan or where there is an increased level of risk that cannot be incorporated into the care plan. This would normally occur when consequences of failure to manage the risk present a major risk either to the individual service user or/and to the wider community. A decision to complete the risk assessment would normally be made in discussion/supervision with the line manager. This decision should be recorded, along with the reasons why the risk assessment is needed. The risk assessment should be completed using form POVA3 (Appendix 1). The completed risk assessment should be shared with the individual and with other staff as appropriate and this noted on the completed form. If the risk assessment needs to be shared more widely, the service users consent should be sought (and noted on the form). If the service user lacks capacity a decision should be made about whether an advocate or someone 1
ANGUS COUNCIL SOCIAL WORK AND HEALTH else should be involved/informed. It may be appropriate to involve relatives if the service user agrees. 2. RISK MANAGEMENT The recommendations flowing from the risk assessment should be clearly specified in section 6 and 7 of the risk assessment documentation. The risk management plan (section 7) should flow from these recommendations. This should specify what action is taken to minimise the risk and possible harm including timescales and responsibilities for implementation of the plan. 3. REVIEW A review of the risk assessment/management plan is essential and an agreed date should be arranged which must be within six months of the initial risk assessment. The risk assessment should be updated using form POVA 4 (Appendix 2). If there are increased levels of risk or changes in the circumstances of the service user, the line manager should be informed and a review arranged at the earliest opportunity, in order to make the necessary changes to the risk management plan. 4. WHEN RISKS HAVE REDUCED When the professionals involved agree that risks have reduced to a level that no longer requires a specific risk management plan, this should recorded in the appropriate place in the case records e.g. annual review, case notes, minute of meeting, POVA 4, etc. Any ongoing issues should be integrated into the service users care plan and be subject to the agreed monitoring arrangements. 5. RISK ASSESSMENT PROCESS The process is outlined in Appendix 3. 6. RECORDING The worker and the line manager should sign and date all documentation relating to the risk assessment and risk management plan. All documentation must be filed in the risk assessment section of the casefile with the most recent on top. 7. DISSENT Any dissent should be recorded. The professionals involved need to be clear how this will be managed. Attempts should be made to ensure that the views of the person(s) expressing dissent have been taken on board and understood. 2
ANGUS COUNCIL SOCIAL WORK AND HEALTH Adult Protection Risk Assessment This form should be used when a Single Shared needs assessment, or a Review, or an Adult Protection investigation or a significant incident reveals a significant level of risk of abuse or harm; or when complex needs interact to create significant risks; and when high levels of risk cannot be managed within a normal care plan. (ref to Adult protection procedures/ protocol section 5.14) CORE INFORMATION (*delete as appropriate) First Names: Surname: Also known as: Date of Birth: Gender: Address: Ethnic group: Postcode: Home Phone: Housing Status: Mobile Phone: *Own home / *Tenancy / *Temporary / *Homeless / *Roofless / *Care Home / *Supported Accommodation / *Lives alone / *With family (underline as appropriate) ID Number: (e.g.carefirst/pimms) CHI No: Legal Status (e.g. Adults with Incapacity Act Guardianship, Mental Name of Guardian or Attorney? Health Act Compulsory Order) and Date of Order Care Programme Approach? *YES/NO Risk to workers? *YES/NO (Risk Alert flag?) ASSESSING WORKER Name: Designation: Work Address: Postcode: Phone No: E-mail Address: Date of Risk Assessment: Date of SSA: 3
ANGUS COUNCIL SOCIAL WORK AND HEALTH COMMUNICATION REQUIREMENTS Role Name Agency Email Tel no (inc STD) Social Worker M.H.O Community Nurse/CPN/HV G.P Consultant Police Housing/Landlord Carer/named person/ Advocate Care Commission Mental Welfare Commission Senior manager or Director (i.e does he/she need to be alerted) OT/Physio/Speech Other? Contributed to this risk assessment? Consent to share info? Informed of this R/A (date or N/A-see no 7 below) 4
RISK ASSESSMENT ANGUS COUNCIL SOCIAL WORK AND HEALTH 1. COMMUNICATION, CAPACITY, AND INVOLVEMENT First Names Surname a) Has the person being assessed any particular communication and support needs? (e.g. for interpreter, advocate, appropriate adult, Makaton, sign, speech and language therapist; or as a result of dementia, head injury etc?) b) Comment on the person s ability to make his/her own decisions about risk and to safeguard his/her own well-being? (Evidence any limitations, if possible; refer to any examples of undue pressure if relevant) c) Has there been a recent formal Assessment of Capacity? *YES/NO If yes, detail outcome in relation to identified areas of risk d) Is further assessment of capacity required? *YES/NO Has this process been initiated? *YES/NO e) Has there been a discussion with the person about information sharing *YES/NO Any comments? (See local procedures and local Information Sharing Protocols) f.) Has a carer/named person/nearest relative contributed: *YES/NO Comments 5
2. CHRONOLOGY OF SIGNIFICANT EVENTS ANGUS COUNCIL SOCIAL WORK AND HEALTH Chronology of relevant events/significant event history (Attach if available; or list significant relevant events under: date, brief detail, agencies/people involved, outcome/consequences) Date of event Brief detail of event Agencies/people involved Outcome/consequences 6
ANGUS COUNCIL SOCIAL WORK AND HEALTH 3. CURRENT RISKS OR CONCERNS Subject is considered to be at risk of serious harm from: (Tick all you consider may apply) Risk of serious harm to subject? Risk of serious harm to others? Whom? Immediate danger/ Imminent crisis? Subject agrees? Yes/No Carer agrees? Yes/No Physical injury Violence/aggressive behaviour Sexual abuse/exploitation/ Sexual ill health Pregnancy Progressive illness Harassment/exploitation/racial abuse Psychological/emotional distress Mental/cognitive impairment Mental health problem Alcohol use Drug use Suicidal intent Self harm Self neglect Reduced social functioning/isolation Financial abuse/theft Homelessness Loss of employment Abuse by omission Institutional abuse Abuse by paid carers Risk to/concerns for Children Other (specify) 7
ANGUS COUNCIL SOCIAL WORK AND HEALTH 4. ANALYSIS OF RISK (from Section 3) What behaviour, allegation, complaint, circumstances or event has prompted this risk assessment? (detail the nature of the behaviour or incidents which put the person at risk, e.g. the nature and extent of sexual/physical/financial abuse; the specific areas of self neglect (eating, medication, wandering) Who is the source of concern, and who is involved in the risk events? (subject only, other tenants, neighbours, children, immediate family.) When does this/do these circumstances occur - and how often? (Evenings/weekends/every day/mealtimes etc: rarely, frequently, occasionally, etc) Where does this/do these circumstances occur? (Daycentre, at home, on the streets, travelling) Medical assessment and/or clinical diagnosis of mental or physical illness, relevant to this risk assessment Particular triggers or risky circumstances that heighten the risks? (e.g when person is alone; if home carer is late; if relative makes contact/does not make contact; arrival of benefit; contact with specific person/staff member etc) Protective factors, or circumstances, that have protected the subject, or reduced the risk in the past? (include here any change in subject s ability to manage these risks) 8
ANGUS COUNCIL SOCIAL WORK AND HEALTH 5. RISK ASSESSMENT a) What is your assessment of the risk? How severe might the consequences/injuries/harm/damage be if no action is taken to reduce the risk, or increase protection? How probable is it that these circumstances will recur? What is your view and any agreed view about the degree of risk and urgency of action? b) Your assessment will include the contributions of other agencies/services. Indicate here if there is any disagreement: c) What is the adult s assessment of the risk? Does he/she agree with your assessment? (if not - explain) d) What is the carers assessment of the risk? (explain if not available or not appropriate,) 9
ANGUS COUNCIL SOCIAL WORK AND HEALTH 6. RECOMMENDATION/ACTIONS a.) Is an Adult Protection case conference recommended? *YES/NO b.) Detail any emergency/immediate actions that have already been taken in order to protect, or reduce the risk (include whether this situation/risk/concern been referred to another service, or agency, and if so, with what result) c.) What future action do you recommend is taken to reduce the risk, or protect the adult being assessed? (e.g. increased support; review of Care Plan; further needs assessment; change of environment/ service, legal action etc) Clearly indicate who should do what and when. d.) What advantages and disadvantages, gains or losses to the adult s quality of life, or freedom, or independence might result from these actions (e.g. in the event of increased supervision, change of home, statutory intervention) e) Risks to other people - Recommended Actions (Consider risks to other adults, carers; children, alleged abuser. Consider actions such as police and/or Care Commission investigation of allegations, Carer s Assessment, alert to Home or Centre management in respect of other service users, additional risk assessments, referral to child protection or criminal justice) f.) Is a claim for criminal injuries compensation appropriate? *YES/NO 10
ANGUS COUNCIL SOCIAL WORK AND HEALTH Any further comment from the person being assessed? Does the person consent to share information in this assessment? (*YES/NO) Any conditions or limitations? Risk Assessment discussed with Manager? Agreed immediate actions to be taken: Communication Requirements - Please ensure completion of final column of page 2 Notification Requirements Agency/Person Requirement to notify Date notified Care Commission Mental Welfare Commission Office of Public Guardian Senior Manager/Director Critical Incident Review Group 11
7. RISK MANAGEMENT PLAN ANGUS COUNCIL SOCIAL WORK AND HEALTH Action Who When Review Signature of Assessor: Signature of Line Manager: Signature of Assessed Person: (if no signature please state why) 12
ANGUS COUNCIL SOCIAL WORK AND HEALTH APPENDIX 2 POVA 4 Angus Council Social Work and Health Specific Risk Assessment Update and Review 1 NAME AND ADDRESS OF SUBJECT Name: Address: Tel no (inc std): D. O. B: Name of Assessing Worker: Signature of Worker: Signature of Team Leader: Postcode: 2 CHANGES OR DEVELOPMENTS AFFECTING RISK SINCE LAST REVIEW Detail increase/decrease of incidences of previous concerns, including any deterioration or significant lifestyle influences and level of co-operation. 3 LEVEL OF RISK In the light of above comment on any change 13
ANGUS COUNCIL SOCIAL WORK AND HEALTH Angus Council Social Work and Health APPENDIX 2 POVA 4 Specific Risk Assessment Update and Review 4 REVIEW OF MOST RECENT RISK MANAGEMENT PLAN ACTION POINT COMMENT 5 ANY OTHER SIGNIFICANT DEVELOPMENTS 14
ANGUS COUNCIL SOCIAL WORK AND HEALTH Angus Council Social Work and Health APPENDIX 2 POVA 4 Specific Risk Assessment Update and Review 6 REVISED RISK MANAGEMENT PLAN ACTION WHO WHEN/FREQUENCY 7 REVIEW DATE/TIME/VENUE (minimum 6 monthly) 15
ANGUS COUNCIL SOCIAL WORK AND HEALTH RISK ASSESSMENT PROCESS APPENDIX 3 Vulnerable Adults processes highlight risks needing further assessment/ management Generic assessment/ssa highlights specific areas of high risk. Flags up need for further specific risk assessment Generic assessment/ssa does not highlight specific areas of risk requiring a management plan no specific risk assessment required Integrate any ongoing issues into current care plan. Full specific risk assessment completed by case holder, involving all relevant service providers Risk management plan implemented Increase in risk or change in circumstances Decrease in risks or changed circumstances Review risk assessment and amend risk management plan if required. Guidance Notes Specific risk assessments should be completed by the primary case accountable worker, involving all other relevant professionals/service providers Standard risk assessments [within daycare centres or residential units for example] to manage general risks eg falls, should continue to be done onsite. This risk assessment does not replace other specialist risk assessments. 16