SAFEGUARDING ADULTS POLICY

SAFEGUARDING ADULTS POLICY DOCUMENT CONTROL: Version: 5 Ratified by: Quality Committee Date ratified: 12 May 2016 Name of originator/author: Adult Safeguarding Lead Professional Name of responsible Safeguarding Quality Standards Forum committee/individual: Date issued: 27 May 2016 Review date: May 2019 Target Audience All Trust staff as outlined within the Policy

CONTENTS Section Page No 1. INTRODUCTION 4 1.1 Context and definitions 4 2. PURPOSE 7 2.1 The Trust Policy 7 3. SCOPE 8 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 8 4.1 Responsibilities of the Trust 8 4.2 Nominated Executive Director 8 4.3 Deputy Director of Nursing (Operational Lead) 8 4.4 Head of Safeguarding and Standards 8 4.5 Lead Professional s for Safeguarding Adults (Practice Lead) 8 4.6 Trust Quality Standards Forum 9 4.7 Trust Safeguarding Managers Clinical supervision Forum 9 4.8 Service Managers/Modern Matrons/Area clinical Managers 9 4.9 Roles undertaken by Trust staff as set out in the multiagency Safeguarding Adults procedure 4.9.1 Alerters (All Staff) 10 4.9.2 Referrers 10 4.9.3 Safeguarding Managers 10 4.9.4 Safeguarding Enquirers 11 4.9.5 Independent Chairs for Outcome Meetings 11 4.9.6 All Staff 12 4.9.7 Support for staff involved in Safeguarding Adults 12 5. PROCEDURE/IMPLEMENTATION 12 5.1 Risk assessment and risk management 12 5.2 Capacity, Consent and Decision Making 12 5.3 5.4 Referral to Independent Mental Capacity Advocate (IMCA) Service Definition of terms used within safeguarding adult procedures 5.4.1 Adult at Risk Definition according to Care Act 2014 19 5.4.2 Patterns of Abuse 19 5.4.3 Forms of Abuse 20 5.4.4 Pressure Area Care and What to Consider 23 5.4.5 Incident Reporting 24 5.4.6 Information Sharing 24 10 14 18 Page 2 of 30

Section Page No 5.4.7 Record Keeping 25 5.4.8 Whistle Blowing 25 5.4.9 Allegations against Staff 25 5.4.10 Referrals to the Disclosure and Barring Service (DBS) 25 5.4.11 Safeguarding Children 25 6. TRAINING IMPLICATIONS 25 7. MONITORING ARRANGEMENTS 27 8. EQUALITY IMPACT ASSESSMENT SCREENING 27 8.1 Privacy, Dignity and Respect 28 8.2 Mental Capacity Act 28 9. LINKS TO ANY ASSOCIATED DOCUMENTS 28 10. REFERENCES 28 11. APPENDICES 30 Page 3 of 30

1. INTRODUCTION 1.1 Context and Definitions Safeguarding means protecting adult s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adults wellbeing is promoted, including where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances. Care Act 2014 Adult Safeguarding is the process of protecting adults with care and support needs from abuse or neglect (hereafter referred to as adults ). It is an important part of what many public services do, but the key responsibility is with local authorities in partnership with the police and the NHS. The Care Act 2014 puts adult safeguarding on a legal footing and from April 2015 each local authority must: Make enquiries, or ensure others do so, 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 (specifically the local Clinical Commissioning Group/s) and the power to include other relevant bodies Arrange, where appropriate, for an independent advocate to represent and support an adult who is the 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. It also updates the scope of adult safeguarding: Where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there) Has needs for care and support (whether or not the authority is meeting any of those needs), Is experiencing, or is at risk of, abuse or neglect, And as a result of those needs is unable to protect themselves from exploitation or abuse. Page 4 of 30

It signals a major change in practice - a move away from the process-led, tick box culture to a person centred approach which achieves the outcomes that people want. Practitioners must take a flexible approach and work with the adult all the way through the enquiry and beyond where necessary. Practice must focus on what the adult wants, which accounts for the possibility that individuals can change their mind on what outcomes they want through the course of the intervention. The Care Act also recognises the key role of Carers in relation to safeguarding. For example a carer may witness or report abuse or neglect; experience intentional or unintentional harm from the adult they are trying to support or a carer may (unintentionally or intentionally) harm or neglect the adult they support. It is important procedures are in place in each of the local areas in which the Trust provides services. The procedures provide legal, policy and best practice guidance to all agencies and staff, and set out in detail the agreed local procedures to be followed where safeguarding concerns arise. Guidance for local areas: DONCASTER Details Adults at risk with a learning disability in community settings, community homes or day centres (excluding adults at risk with a learning disability in inpatient settings in that instance please see all other adults at risk) Adult at risk in private Nursing Homes All other adults at risk who are under RDaSH services ROTHERHAM Details Adult at risk over 65 under RDaSH services Adult at risk with a learning disability under RDaSH services All other adult at risk who are Telephone Contact Number/Email Referral of concern to DMBC Adult Contact Team (ACT) (01302) 737391 Referral of concern to DMBC Adult Contact Team (ACT) (01302) 737391 Referral of concern to safeguardingadults@rdash.nhs.uk Tel: 01302 796769 Telephone Contact Number/Email Direct referral of concern to RMBC Safeguarding Adults Team (01709) 822330 (out of hours 01709 364689) Direct referral to RMBC Safeguarding Adults Team (01709 822330) (out of hours 01709 364689) Referral of concern to Page 5 of 30

under RDaSH services NORTH LINCOLNSHIRE Details All Adults at risk who are under RDaSH services NORTH EAST LINCOLNSHIRE Details All Adults at risk who are under RDaSH services Manchester Details All Adults at risk who are under RDaSH services safeguardingadults@rdash.nhs.uk Tel:01302 796769 Telephone Contact Number/Email Direct referral to North Lincs Council Safeguarding/Adult Social Services team (01724) 297979 Telephone Contact Number/Email Direct referral to North East Lincs Council Safeguarding/Adult Social Services team (01472) 232244 Telephone Contact Number/Email Direct referral to Manchester City Council Safeguarding/Adult Social Services team (0161) 2345001 The relevant procedures are: Doncaster and Rotherham: Safeguarding Adults: Procedures for South Yorkshire North East Lincolnshire: North East Lincolnshire Multi-agency Policy, Procedures and Practice Guidelines for the Protection of Adult at risk North Lincolnshire: The Protection of Adult at risk, Multi-agency Policy, Procedures and Practice Guidelines for the Protection of Vulnerable Adults in North Lincolnshire Manchester: Multi-agency Policy for Safeguarding Adults All staff must work to these procedures which are available on the RDaSH intranet under Adult Safeguarding. These procedures have been agreed and endorsed by the partner agencies and Safeguarding Adults Boards within each of the local areas and confirm the high priority given to safeguarding, in that partners will: Do everything within their power to ensure the Safeguarding of Adults within the context of The Care Act 2014 Page 6 of 30

Support staff and volunteers who raise concerns. Commit to providing training and development opportunities for all staff to support them in their safeguarding responsibilities. Each Council has a Safeguarding Adults Board, which oversees multiagency work aimed at protecting and safeguarding adult at risk. The Trust has senior manager representation on the Safeguarding Adults Boards in the areas in which it provides services. In addition, national standards for safeguarding adults which the Trust must meet within its own activities and in its dealings with other organisations are set out in: The Care Act 2014 National Service Frameworks NHS Litigation Authority Risk Management Standards for Mental Health and Learning Disability Trusts (2008). Care Quality Commission (2010) Essential Standards of Quality and Safety Through effective dissemination of this policy and the multi-agency Safeguarding Adults Procedures, staff support, supervision and training, this policy seeks to provide a robust system through which practice can be reviewed and challenged on an on-going basis and best practice implemented. 2. PURPOSE The purpose of this policy is to set out the arrangements for managing the risks associated with safeguarding adults. It provides a basic structure and information for the benefit of all staff and links directly with the multi-agency Safeguarding Adults Procedures listed in Section 1.1 which applies in the areas in which the Trust provides services. 2.1 The Trust Policy is: To actively promote the health and well-being of adult at risk and to prevent harm wherever possible through: the promotion of a good understanding of safeguarding adults procedures amongst all staff; effective risk assessment and risk management; routine incident reporting and review; staff training and supervision processes. Page 7 of 30

To work in partnership with other agencies through the proper and timely use of the agreed multi-agency Safeguarding Adults Procedures to refer and conduct enquiries of known or suspected cases. 3. SCOPE This policy is applicable to all Trust staff, agency staff and other staff not employed directly by the Trust such as volunteers who in the course of their duties, may come into contact directly with, or who may become party to information about, safeguarding adults issues. 4. RDaSH RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 Responsibilities of the Trust The Chief Executive and Directors of the Trust are responsible for ensuring that robust systems are in place to identify and manage the risks associated with safeguarding adult at risk and to support the effective multi-agency partnership working and responses which are required. This includes the identification and training of suitable staff to fulfil the roles set out within the multi-agency Safeguarding Adults Procedures. All staff are responsible for fulfilling their responsibilities to safeguard adult at risk. 4.2 Nominated Executive Director The Trust has a nominated Executive Director for Safeguarding Adults, who takes a professional lead in promoting best practice in safeguarding adults at Board level. In this Trust, the Nominated Executive Director for safeguarding adults is the Deputy Chief Executive. 4.3 Deputy Director of Nursing (Operational Lead) The Deputy Director of Nursing takes the operational lead role within the Trust on safeguarding adults and chairs the Trust Safeguarding Forum. 4.4 Head of Nursing and Safeguarding Has responsibility to provide advice, strategic and operational leadership for safeguarding and professional standards. To continually develop a proactive approach to safeguarding through collaboration with the local authority and other agencies. To ensure all mandatory and statutory requirements around safeguarding are met and develop support systems. 4.5 Lead Professional s for Safeguarding Adults (Practice Lead) Have responsibility to provide an expert professional leadership role in relation to Safeguarding Adults. To work at a strategic level across the health and the social care community, fostering and facilitating multi-agency working and training in respect of Safeguarding Adults. To act as an expert Page 8 of 30

resource on Safeguarding Adult issues, providing accessible, accurate and relevant information to staff. The Lead professionals are responsible for delivering support, advice and guidance to the safeguarding managers and investigators. The Nominated Executive Director, Deputy Director of Nursing, Head of Safeguarding and Standards and the Lead Professional s for Safeguarding Adults all have a key role in promoting best practice and are available as a source of advice/guidance and support for managers and staff involved in safeguarding adults. 4.6 Trust Quality and Standards Forum The Trust has an established Safeguarding Forum which reports to the Clinical Effectiveness Committee and is responsible for establishing and monitoring a strategic approach and plans for Safeguarding Adults within the Trust, as well as for the related work streams for Domestic Violence and Safeguarding Children. 4.7 Trust Safeguarding Managers Clinical Supervision Forum The Trust has an established Safeguarding Adults Clinical Supervision Forum where national/local policies and guidance are disseminated. All staff involved with managing safeguarding cases and enquiries are expected to attend at least one session per year. 4.8 Service Managers/Modern Matrons/ Area Clinical Managers Service Managers, Modern Matrons and Area Clinical Managers are responsible for: Advising and instructing staff on this policy and the multi-agency Safeguarding Adults Procedures via local induction arrangements and communication mechanisms. Safeguarding Adults is a core agenda item on the Trust Clinical and Management Supervision Policy for Clinical staff. Ensuring all staff have access to the relevant multi-agency SafeguardingAdults Procedures in their workplace. Maintaining compliance with the policy and multi-agency Safeguarding Adults Procedures within their services Audits of assessments and risk assessments in relation to Trust and multi-agency safeguarding issues and activities. Arranging staff attendance at training and updates in relation to safeguarding adults Provision of support for staff involved in safeguarding adults Page 9 of 30

4.9 Roles undertaken by Trust staff as set out in the multi-agency Safeguarding Adults Procedures The following roles will be undertaken by Trust staff: 4.9.1 Alerter s (All Staff) The role of the alerter applies to all staff. Anyone who has contact with adult at risk and hears disclosures or allegations, or has concerns about potential abuse or neglect has a duty to pass them on by informing their line manager/ safeguarding manager of any concerns. The Alerter also has a role in addressing any immediate safety or protection needs. 4.9.2 Referrers Referrers are identified Trust staff who are responsible for referring potential safeguarding concerns. Referrer s should always report concerns to their safeguarding manager/ line manager or Safeguarding Adults team. Where a crime may have been committed, report this to the Police. Consideration should also be given to reporting to the LCFS Local Counter fraud Service if appropriate. See 1.1 guidance for local areas for local guidance. The referrer also has a role in ensuring protection plans are in place and that immediate risks are communicated. 4.9.3 Safeguarding Managers Safeguarding Managers are identified Trust staff who have received training in multi-agency Safeguarding Adults Procedures and are responsible for: Making decisions on the need to proceed with a Section 42 Enquiry, or identify alternative responses Planning and supporting the enquiry Ensuring the Police are contacted regarding all safeguarding incidents where a crime may have been committed. Convening and chairing planning meetings, including the agreement of responsibilities, action and timescales and ensuring the agenda is met. Co-ordinating and monitoring of the enquiry Managing the convening of safeguarding outcome meetings to include the co-ordination of other enquiries/ investigations. Page 10 of 30

Ensuring referral to Independent Mental Capacity Advocate (IMCA). (See Section5.3) Ensuring referrals to Independent Care Act Advocate (ICAA) Section 68 Care Act 2014. (See section 5.3) Recommendation of referral to Disclosure and Barring Service (DBS) via Human Resources (HR) when necessary. Ensuring trust documents and records are within guidance and local authority time frames at all stages of the process. 4.9.4 Safeguarding Enquirers Enquirers are identified Trust staff who have undertaken training on conducting an enquiry of safeguarding adults concerns. They will: Co-ordinate the collection of information about the alleged abuse. This may also include the use of criminal and/or disciplinary investigations and will work under the coordination of the safeguarding manager. Make recommendations about whether abuse has taken place, and what may be an effective safeguarding plan and produce a report with clear recommendations for the safeguarding outcomes meeting this will include a risk management/protection plan. 4.9.5 Independent Chairs for Outcomes meetings Independent Chairs for Safeguarding Adults Outcomes meetings are identified Safeguarding Managers within the Trust who have undertaken training in chairing Outcome and Review Outcome meetings. Their roles and responsibilities are to: Consult with and feedback to patients at the meeting. Chair meetings, positively challenge and provide guidance, which will facilitate a consensus being reached in relation to: Whether abuse has been substantiated and what category of abuse this constitutes Develop protection plans and review risk Establish whether a Review Outcome meeting is required and the timescale Agree minutes of the meeting with the Safeguarding Manager Page 11 of 30

Ensure the Outcome agenda is met in full Ensure that wider recommendations from the Outcome meeting are communicated to the trust operational and board staff. 4.9.6 All Staff All Trust staff should engage fully in the Safeguarding Adults Procedures by attending planning meetings, outcome meetings and provide multi-agency reports to outcome meetings when requested. All staff have a responsibility to attend any training which is provided in relation to this policy. See Learning and Development Matrix on the Trust intranet. 4.9.7 Support for staff involved in Safeguarding Adults It is acknowledged that safeguarding adults work is stressful for staff and there are various support systems available which staff can access via their line manager. These include HR support, Occupational health and access to specialist supervision when required. 5. PROCEDURE/IMPLEMENTATION Staff must always refer to the agreed, local multi-agency Safeguarding Adults Procedures for detailed procedural guidance. 5.1 Risk Assessment and Risk Management Risk assessment and risk management are essential aspects of protection of adult at risk from abuse. See Clinical Risk Assessment and Management Policy. Risks related to safeguarding adults must be considered throughout the process. Any adult who is at high risk of abuse must have an urgent risk assessment and a protection plan in place immediately. 5.2 Capacity, Consent and Decision Making Does the Adult at Risk lack specific capacity to make a decision? This should relate specifically to their capacity to engage in the safeguarding process. The decisions should relate to decisions around the safeguarding process. Is there a Best Interest Decision required? Does the adult at risk have the capacity to consent? The Mental Capacity Act 2005 (MCA 2005) its aim is to empower people to make decisions for themselves wherever possible, and protect people who lack capacity by providing a flexible framework that places individuals at the very heart of the decision-making process. Page 12 of 30

Capacity describes a person's ability to make a specific decision at a specific time. An individual is deemed to lack capacity if at the time, a decision is required, and he/she is unable to make that decision because of an impairment or disturbance in the functioning of the mind or brain. This may be temporary or permanent. The following 5 principles apply for the purposes of this Act: 1. A person must be assumed to have Capacity unless it is established that he/she lacks Capacity. 2. A person is not to be treated as unable to make a decision unless all practicable steps to help him/her to do so have been taken without success. 3. A person is not to be treated as unable to make a decision merely because he/she makes an unwise or bad decision. 4. An act done or decision made, under the Act for or on behalf of a person who lacks Capacity must be done, or made, in his/her best interests. 5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action The Functional Test of Capacity: (this is only part 2 of the test) The Two Stage test of Capacity Stage 1 The Diagnostic test In order to decide whether an individual has the mental capacity to make a particular decision you must decide whether there is an impairment of, or disturbance in, the functioning of the person s mind or brain. Stage 2 The Functional test The person will be unable to make a particular decision if after all the appropriate help and support to make the decision has been given to them; they cannot do the following things: 1. Understand the information relevant that decision 2. Retain the information 3. Use or weigh the information as part of the process or making the decision 4. Communicate their decision by any means Best Interests: If an assessment of capacity concludes that the person lacks the mental capacity to make the relevant decision, the decision maker must consider the following key factors in determining what is in the person s best interests; Page 13 of 30

1. Likelihood of regaining capacity 2. Relevant circumstances 3. Participation of the individual 4. Past and present wishes 5. Views of others 6. Beliefs and values 7. Consideration of life sustaining treatment. 8. Not making judgements based on a person s age, gender disability etc. 9. Least restrictive alternative www.justice.gov.uk/guidance/mca-code-ofpractice.html The MCA principles of supporting a person to make a decision when possible, and acting at all times in the person's best interests and in the least restrictive manner, will apply to all decision-making in operating the procedures. 5.3 Referral to the Independent Mental Capacity Advocate (IMCA) service The aim of the IMCA service is to provide independent safeguards for people who lack capacity to make certain important decisions and, at the time such decisions need to be made, have no-one else (other than paid staff) to support or represent them or be consulted. An IMCA must be instructed, and then consulted, for people lacking capacity who have no one else to support them (other than paid staff) in certain situations:- o o An NHS body is proposing to provide serious medical treatment, or An NHS body or local authority is proposing to arrange accommodation (or change of accommodation) in hospital for more than 28 days or a care home for more than eight weeks. For more detailed guidance see Practice Guidance on the Involvement of Independent Mental Capacity Advocates (IMCAs) in safeguarding adults (2009) Use of IMCAs in Safeguarding Responsible bodies have powers to instruct an IMCA to support and represent a person who lacks capacity in other situations where it is alleged that: the person is or has been abused or neglected by another person, or the person is abusing or has abused another person. The responsible bodies can only instruct an IMCA if they propose to take, or have already taken, protective measures. Page 14 of 30

In safeguarding adults proceedings (and no other cases), access to IMCAs is not restricted to people who have no-one else to support or represent them. People who lack capacity who have family and friends can still have an IMCA to support them in them. The Safeguarding Manager must establish the person s incapacity to agree to at least one of the proposed protective measures and consider whether the person needs to be supported by an IMCA and make a referral to the IMCA service. In cases where the Safeguarding Manager does not consider an IMCA is required. The reasons for not instructing should be made clear in the persons records. Subsequent to the IMCA instruction there may be a need to undertake further mental capacity assessments if other protective measure are being proposed and further decisions need to be made. If the person is subsequently found to have capacity with regard to all protective measures being actively considered, the IMCA instruction should be withdrawn. www.scie.org.uk/publications/guides/guide32/index.asp. The use of Independent Care Act Advocate Section 68 - Care Act 2014 - guidance The Local authority must arrange an independent advocate to facilitate the involvement of a person in their assessment, in the preparation of their care and support plan and in the review of their care plan, as well as in safeguarding enquiries and SARs if two conditions are met: That if an independent advocate were not provided then the person would have: (1) Substantial difficulty in being fully involved in these processes and second, (2) There is no appropriate individual available to support and represent the person s wishes, who is not paid or professionally engaged in providing care or treatment to the person or their carer, this will include IMCAS appointed to support the individual. The role of the independent advocate is to support and represent the person and to facilitate their involvement in the key processes and interactions with the local authority and other organisations as required for the safeguarding enquiry or SAR. The nature of safeguarding concerns is likely to mean that adults who would ordinarily be able to engage in assessments may struggle to engage with Page 15 of 30

safeguarding due to distress, embarrassment, fear etc. It is essential that assumptions are not made about adults who previously had little difficulty in engaging with assessments when receiving and responding to a safeguarding concern Human Rights Act 1998 The Human Rights Act came into effect in the UK in October 2000. The Act enables people in the UK to take cases about their human rights to a UK Court. There are 16 basic rights in the Human Rights Act, all taken from the European Convention on Human Rights. They don t only affect matters of life and death like freedom from torture and killing; they also affect people s rights in everyday life; what they can say and do, their beliefs, their right to a fair trial and many other similar basic entitlements. Article 5: Right to liberty and security Everyone has the right to liberty and security of person. No one shall be deprived of his liberty save in the following cases and in accordance with the procedures prescribe by law. Any protective measures that propose an interference with a person`s Article 5 Rights should be authorised by the appropriate legal process. Where a person is to be moved to a care home or hospital and lack capacity to consent to the arrangements the Deprivation of Liberty safeguards should be applied. Deprivation of Liberty in settings outside of care homes or hospital will need to be authorised by the Court of Protection. Article 8: Right to respect for private and family life Everyone has the right to respect for their private and family life, their home and their correspondence. This right may be restricted, provided such interference has a proper legal basis, but the interference must be necessary (not just reasonable) and it should not do more than is needed to achieve the aim desired. Balancing Article 8 is one of the Convention rights that may require a balance between a person s private rights and providing protective measures against their wishes. Any protective measures that propose an interference with a person`s Article 8 Rights should be authorised by the appropriate legal process. Where a person lacks capacity to consent to the proposed measure this will be the Court of Protection. Page 16 of 30

Deprivation of Liberty Safeguards 2007 The Deprivation of Liberty Safeguards 2007 (DOLS) became statute in April 2009, as an amendment to the Mental Capacity Act 2005 (introduced by the Mental Health Act 2007). The safeguards focus on some of the most vulnerable people in our society: those who for their own safety and in their own best interests need to be accommodated under care and treatment regimes that may have the effect of depriving them of their liberty, but who lack the capacity to consent. Depriving someone of their liberty can be a necessary requirement in order to provide effective care or treatment. By following the criteria set out in the safeguards, and explained in this Code of Practice, the decision to deprive someone of their liberty can be made lawfully and properly. DOLS is relevant in Care Home and Hospital settings however a person can be deprived of their liberty in other settings too. In those other settings and application to the Court of Protection is required to authorise the deprivation of liberty. There is a difference between deprivation of liberty (which is unlawful, unless authorised) and restrictions on an individual s freedom of movement. Restrictions of movement (if in accordance with the principles and guidance of the Mental Capacity Act, 2005) (http://www.legislation.gov.uk/ukpga/2005/9/contents) can be lawfully carried out in someone s best interest to prevent harm. This includes use of physical restraint where that is proportionate to the risk of harm to the person and in line with best practice. The difference between restriction of movement and deprivation of liberty is based on degree and intensity. Neither the Mental Capacity Act nor DOLS can be used to justify the use of restraint for the protection of members of staff or other service users or patients. Revised Test for Deprivation of Liberty The Supreme Court has clarified (P v Cheshire West and Chester Council and P&Q v Surrey County Council, March 2014) that there is a deprivation of liberty for the purposes of Article 5 of the European Convention on Human Rights where the person: Is under continuous supervision and control and Is not free to leave and Lacks Capacity to consent to these arrangements Page 17 of 30

Any protective measure proposing a care plan the results in the person being deprived of their liberty must be authorised by the appropriate legal procedure. Under Duress or Coercive Control The Adult at Risk has capacity however you suspect they are under duress or is under coercive control? Undue Influence The concept of undue influence applies where a person has capacity to conduct a financial or property transaction (usually related to gifts or wills), but they have been not just influenced but, unduly influenced by someone else. If there is evidence of coercion or undue pressure, this is known as express undue influence. Usually there is no such evidence, but there may have been presumed undue influence applied. There are three initial points in relation to undue influence: 1. The unduly influenced person has mental Capacity to take the decision in question; 2. The person is influenced to enter into a transaction concerning a gift or will, in such a way that it is not of his or her own free will; 3. There are two legal types of undue influence. One is called express undue influence that applies to both gifts and wills; the other is called presumed undue influence and applies to gifts only Consent should not therefore always be accepted at face value, since some adults may need protection from emotional manipulation and exploitation. In addition to undue influence, the courts can simply set aside gifts or wills on the grounds that the person lacked capacity at the relevant time. In Domestic Violence/ Abuse the experience of duress and coercive control can be of a similar in nature (See Section 5.4.3) 5.4 Definition of terms used within safeguarding adult procedures Alert becomes Concern Strategy meeting becomes Planning/Decision/Discussion Making Meeting Investigation is on-going or further enquiries. Case Conference becomes Outcomes meeting Final evaluation of outcomes (outcomes evaluated throughout enquiry) Review plans become on-going evaluations of outcomes & actions Page 18 of 30

Section 42 duties end when outcomes are evaluated & achieved / agreed Vulnerable Adult now Adult at risk of harm Perpetrator now Source of Harm (individual/s or organisation/s) NB: Significant harm no longer applies. Replaced as is experiencing or at risk of abuse or neglect. 5.4.1 Adult at Risk- Definition according to the Care Act 2014. Where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there) 1. has needs for care and support (whether or not the authority is meeting any of those needs) AND 2. is experiencing, or is at risk of, abuse or neglect AND 3. as a result of those needs is unable to protect themselves from exploitation or abuse It signals a major change in practice - a move away from the process-led, tick box culture to a person centred approach which achieves the outcomes that people want. Practitioners must take a flexible approach and work with the adult all the way through the enquiry and beyond where necessary. Practice must focus on what the adult wants, which accounts for the possibility that individuals can change their mind on what outcomes they want through the course of the intervention. 5.4.2 Patterns of Abuse Patterns of abuse and abusing vary and reflect very different dynamics. These include: Serial abuse in which the source of harm seeks out and grooms individuals. Sexual exploitation sometimes falls into this pattern as do some forms of financial abuse; Long-term abuse in the context of an on-going family relationship such as domestic violence between spouses or generations or persistent psychological abuse; or Opportunistic abuse such as theft occurring because money or jewellery has been left lying around. Who abuses and neglects adults? Anyone can abuse or neglect adults including: Spouses/partners. Other family members. Neighbours. Page 19 of 30

Friends. Acquaintances. Local residents. People who deliberately exploit adults they perceive as vulnerable to abuse. Paid staff or professionals and Volunteers and strangers Where does abuse take place? Abuse can happen anywhere: for example, in someone s own home, in a public place, in hospital, in a care home or in college. It can take place when an adult lives alone or lives with others. While a lot of attention is paid, for example to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power. 5.4.3 Forms of Abuse This section sets out the different types and patterns of abuse and neglect as identified within the Care Act 2014. It is not intended to be an exhaustive list but an illustrative guide as to the sorts of behaviour, which could give rise to safeguarding concerns. Other circumstances may constitute abuse or neglect and are identified in the related chapter below. RELATED LEGISLATION The Care Act 2014 http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted Physical Sexual Psychological Organisational (was institutional) Financial or Material Discriminatory Neglect and acts of omission Modern slavery (new) Domestic Abuse (new) Self- Neglect (new) Self Neglect and Safeguarding Page 20 of 30

Self-neglect can be a complex and challenging issue for practitioners to address, because of the need to find the right balance between respecting a person's autonomy and fulfilling their duty to protect the adult's health and wellbeing. Both perspectives can be supported by human rights arguments. The Care Act 2014 statutory guidance makes clear that self-neglect is a form of abuse or neglect, if the person concerned has care and support needs. However, although self-neglect in some circumstances may be raised as a safeguarding concern, it is usually likely to be dealt with as an intervention under the parts of the Care Act dealing with assessment, planning, information and advice, and prevention. It is vital to establish whether the person has capacity to make decisions about their own wellbeing, and whether or not they are able or willing to care for themselves. An adult who is able to make choices may make decisions that others think of as selfneglect. If the person does not want any safeguarding action to be taken, it may be reasonable not to intervene further, as long as: No-one else is at risk Their 'vital interests' are not compromised that is, there is no immediate risk of death or major harm All decisions are fully explained and recorded Other agencies have been informed and involved as necessary. Risk and capacity assessments are likely to be useful. The legislation makes clear that adult safeguarding responses should be guided by the adult themselves, to achieve the outcomes that they want to achieve. Carrying out an assessment may be difficult, if the person is reluctant. The Department of Health advises (in statutory guidance on the implementation of the Care Act 2014) adult social care departments should record all the steps they have taken to complete an assessment of the things that a person wants to achieve and the care and support that they need. Research indicates that intervening successfully depends on practitioners taking time to gain the person's trust and build a relationship, and going at the person s own pace. If it is impossible to complete the assessment, or if the person refuses to accept care and support services, you should be able to show that you have tried, and that information and advice have been made available to the person on how to access care and support and how to raise any safeguarding concerns. All your decisions, and the considerations that have led to them, should be recorded in light of the person's wishes and their particular circumstances. You should be able to show that whatever action you have taken is reasonable and proportionate. The following categories of abuse have dedicated services and processes in place to respond, however, a joint response with Safeguarding may be required: Page 21 of 30

Domestic Abuse See also: Adult Safeguarding and Domestic Abuse: A Guide to Support Practitioners and Managers (LGA and ADASS) Domestic Violence and Abuse, Home Office https://www.gov.uk/domestic-violence-and-abuse With effect from March 2013, the official Government definition of domestic violence and abuse is: 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: 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 acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim. The Serious Crime Act 2015 (the 2015 Act) received royal assent on 3 March 2015. The Act creates a new offence of controlling or coercive behaviour in intimate or familial relationships (section 76). The new offence closes a gap in the law around patterns of controlling or coercive behaviour in an on-going relationship between intimate partners or family members. The offence carries a maximum sentence of 5 years imprisonment, a fine or both. This definition includes honour based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group. The majority of domestic abuse is committed by men towards women, however it can also involve men being abused by their female partners, Page 22 of 30

abuse in same sex relationships, and by young people towards other family members, as well as the abuse of older people in families. Domestic abuse occurs irrespective of social class, racial, ethnic, cultural, religious or sexual relationships or identity 5.4.4 Pressure Area Care and what to consider Pressure ulcers illustrate well the challenge of finding out whether an issue is caused by poor care or avoidable neglect, or whether it is the unavoidable result of a person s current condition. While pressure ulcers are always a risk for people who are frail and are not able to move about easily, with good management and care they can usually be avoided. The simple fact that an adult at risk has a pressure ulcer even a serious one is not in itself a reason to suspect abuse or neglect. There are a number of factors to help you decide whether it potentially indicates neglect, or whether it indicates a need for care providers to improve their practice. These factors include: The person's physical health and existing medical conditions Any skin conditions the person may have Any other signs of neglect, such as poor personal hygiene The appropriateness of their care plan and whether it has been properly carried out. The person's own views, and the views of their family and friends, on their treatment and care. These factors should be looked at by a clinician asked by the local NHS trust or clinical commissioning group to establish whether the person's pressure ulcers are the result of poor practice that can be improved, or whether intentional or avoidable neglect is taking place. If the issue is neglect, a decision will need to be made as to whether there is a risk to other adults receiving services from the same provider. The nature and timing of this, and who leads it, will depend on the circumstances of the individual case. The conclusion may be that the problem can be resolved by the service provider, and that a disciplinary response is appropriate or it may be apparent that external clinical intervention or regulatory enforcement action is required. Even where it appears that the pressure ulcers are the result of abuse or neglect, these responses would all usually be more appropriate than a local authority/social worker-led enquiry under Section 42 of the Care Act 2014. If the pressure ulcers amount to the wilful neglect of people who lack mental capacity, a crime under Section 44 of the Mental Capacity Act 2005 may have occurred, and the police should be informed. So too should the SAB if there appear to be significant problems with the quality of local provision Page 23 of 30

Staff should consider all of the above in relation to pressure ulcers that are at grade 3 or 4 or if there are multiple ulcers at a lower grade or above more than 3 or 4 5.4.5 Incident Reporting When reporting an incident and filling out an IR1 always consider whether a safeguarding referral needs to be made at the same time and whether the incident meets the safeguarding thresholds. Ticking safeguarding on the IR1 does not constitute a safeguarding adults concern. A safeguarding referral should always have a related IR1. When considering whether to tick safeguarding consider whether this is an incident or an allegation of abuse and / or neglect rather than an incident that has occurred i.e. an assault against a staff member by a patient would not necessitate a safeguarding alert as the victim has to meet the Three Point Check: 1. has needs for care and support (whether or not the authority is meeting any of those needs) AND 2. is experiencing, or is at risk of, abuse or neglect AND 3. as a result of those needs is unable to protect themselves from exploitation or abuse 5.4.6 Information Sharing Concern about the abuse of adult at risk provides sufficient grounds to warrant sharing information on a need to know basis and/or in the public interest in accordance with established data protection principles. Unnecessary delays in sharing that information should be avoided. The principles that govern the sharing of information include the following: Information should only be shared on a need to know basis when it is in the best interests of the patient. Confidentiality must not be confused with secrecy. Informed consent to the sharing of information should be obtained from the person involved. However, if there are other Adult At Risk at risk or a crime committed it may be necessary to override this requirement. If the Adult at Risk remains at significant risk then the information may need to be shared. This decision should not be taken in isolation but discussed with the safeguarding manager/line manager, Information Governance, Safeguarding Lead Professionals and/or involved professionals. Page 24 of 30

It is not appropriate for agencies to give assurances of absolute confidentiality in cases where there are concerns about abuse, particularly in those situations when other people may be at risk. If staff are unsure about what information can be shared they should seek advice from their manager and/or the Trust Information Governance Manager. 5.4.7 Record keeping Please refer to RDaSH Lifecycle of Clinical and Corporate Records Policy and ensure that you maintain contemporaneous records of all observations actions and concerns which are timed, dated and signed as soon as possible as this could be referred to at a later point or in legal procedures. 5.4.8 Whistle Blowing Where concerns arise about an Adult At Risk regarding potential malpractice or misconduct in a workplace or by employees of the Trust or other organisation/agency, those concerns should be raised with the organisation/agency concerned and reported within the Trust to a senior manager as per the multi-agency Safeguarding Adults Procedures. See Whistleblowing (Disclosure of Health Matters) Policies. All partner organisations should have a Whistle Blowing Policy. 5.4.9 Allegations against Staff Where abuse is alleged against a Trust employee, this must be reported immediately to the Trust Human Resources Department, the local manager, Director of the relevant service and the Safeguarding Adults Lead. Consideration should be given to whether a crime has been committed and the duty to report to the Police. Consideration should also be given to whether a referral to the LCFS is appropriate. 5.4.10 Referrals to the Disclosure and Barring Service (DBS) The Safeguarding Manager may make recommendations to the Trust Human Resources Dept. that a referral to the DBS should be made. The decision to make a referral to the DBS will rest with the HR department following consideration of the safeguarding investigation. 5.4.11 Safeguarding Children During the safeguarding adults process always consider the risk to the child and any safeguarding children issues and refer to social services or safeguarding children named nurses if there is any risk to the child. If the child is an alleged perpetrator of abuse against a vulnerable adult then a referral to children s service should also be made. See Safeguarding Children Policy Page 25 of 30

6. TRAINING IMPLICATIONS Safeguarding Adults Training Staff groups requiring training How often should this be undertaken Length of training Delivery method Training delivered by whom Where are the records of attendance held? All staff Every 3 years Level 1 Safeguarding Adults 30mins-1 hr ELearning Leaflets ELearning Electronic Staff Record System (ESR) All staff with patient contact providing clinical care and support Every 3 years Level 2 Safeguarding Adults Basic Awareness Training ½ day or full day Face to face ELearning Via E learning/training via Local Authority Electronic Staff Record System (ESR) All staff who are referrers Every 3 years Level 3 Safeguarding Adults Alerter/Referre rs Training Doncaster -1/2 day Rotherham / NLincs - 1 day Face to face via Local Authority Electronic Staff Record System (ESR) Staff required to undertake role of investigator within adult safeguarding Every 3 years Level 4 Enquirer Training 2 days Face to face via Local Authority Electronic Staff Record System (ESR) Staff required to undertake role of safeguarding manager within adult safeguarding Every 3 years Level 4 Safeguarding Managers Training 1 day Face to face via Local Authority Electronic Staff Record System (ESR) Staff required to undertake role of Case Conference Chair within safeguarding Every 3 years Level 4 Chairing Safeguarding Adults Outcomes Meeting 1 day Face to face Via local authority Electronic Staff Record System (ESR) Page 26 of 30

Safeguarding Adults Training Staff groups requiring training Staff responsible for ensuring appropriate systems and resources are in place to support safeguarding adults work in an inter and intra agency context How often should this be undertaken Every 3 years Level 4 Length of training Various dependent upon topic Delivery method Blended learning approach Training delivered by whom Inter and intra agency commissioned by RDaSH as required Where are the records of attendance held? Electronic Staff Record System ESR Please refer to the Learning and Development matrix on the Trust Intranet 7. MONITORING ARRANGEMENTS Area for monitoring How Who by Reported to Frequency Adherence to policy and process Training, supervision, monitoring process/ quality assurance Safeguarding Team and Safeguarding Managers Safeguarding Quality and Standards Group Bi monthly Safeguarding referrals and outcomes Audit On-going monitoring / quality assurance and database Safeguarding Team and Clinical Audit Department Safeguarding Team Safeguarding Adult Board Safeguarding Quality and Standards group Annual Bi monthly 8. EQUALITY IMPACT ASSESSMENT SCREENING - The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website Page 27 of 30