2a. Purpose and scope of guidance This guidance is aimed at providing social care staff involved in front line work with a clear framework for dealing with instances where vulnerable adults do not answer the door when they normally would and where vulnerable adults with whom we are not currently working are reported as having not been seen for some time. The guidance is likely to be most used by those involved in the duty system duty social workers, duty senior practitioners and executive officers responsible for initial receipt and screening of calls. However, it could equally apply for other staff, particularly where the vulnerable adult concerned has an allocated worker. Responding to no reply and not seen recently referrals requires a broad approach, using the knowledge and resources of other services, eg housing staff, community wardens, etc. Interagency protocols are therefore being developed to cover this. This guidance will therefore be updated as necessary when those protocols have been completed. Types of referrals Adult social care teams receive referrals about vulnerable adults in the following circumstances: a. People receiving a service who do not answer the door, for example, on a day when the service is being provided or when another person (family, other professional, neighbour) calls. b. People known to adult social care in the past but not currently receiving a service, where a neighbour, for example, expresses concern that an individual has not been seen for some time. c. People who are not known to adult social services where a neighbour, for example, expresses concern that an individual has not been seen for some time. General approach to no reply and not seen recently cases Detailed procedures covering what to do in such cases are set out below. However, the general approach required is one of safety first. Thus, if attempts to establish the whereabouts of the person concerned are unsuccessful and the risk assessment does not provide clear, sustainable reasons for not doing so, the police must be asked to carry out a forced entry to the property. The approach to be taken is essentially the same for all groups above. Where people are currently receiving services there will be more sources of up to date information 1 of 1
particularly though, not exclusively, from care providers. This will help to inform the assessment of likely risk. Where vulnerable adults are known but not currently receiving services, sources of information as to their whereabouts are likely to be fewer and not so up to date. This makes it even more important to investigate thoroughly. Referrals in respect of people not previously known are likely to require more initial fact finding before any opinions can be formed regarding likely risk and the way forward. In some instances vulnerable adults may have refused services. Guidance already issued on this is repeated here for the sake of completeness. Refusal of assessment and/or services All clients have the right to refuse services. However a risk assessment should be completed to ensure that we are clear about the risks posed to the person without the provision of services. This assessment should include any issues relating to mental capacity or functioning and be documented on file. The assessment and the action plan following from it should be signed off by a senior to ensure action is timely. In situations where the person is likely to be at high risk without the provision of services, every effort should be made to provide support. If the client continues to refuse services, the risks should be clearly documented and signed by the person concerned. 2 of 2
Operational procedures Duty Desk procedure notes - must be actioned immediately 1. Notification received by phone call or fax that a person has not been seen by meals on wheels staff, home care worker, district nurses, neighbour, etc. 2. Inform duty senior practitioner immediately 3. Get details of person from CareFirst and client file. Record details on the checklist (attached). 4. Telephone the person 5. If there is no reply, inform the duty senior practitioner immediately. 6. Using the details on CareFirst and the client file, telephone the listed contacts in this order: Neighbour or key holder Warden (if living in sheltered housing) Next of kin Other agencies on care plan General Practitioner Local hospitals Housing regarding non payment of rent or vulnerability. 7. If the person is located, inform the duty senior practitioner. 8. Complete the checklist as far as possible and file a copy in the client file. Inform the next of kin Contact the person about missed services if relevant Assess whether any further action or support is necessary, including the provision of a pendant alarm to reduce further incidents of no reply 9. If the person is not located, inform the duty senior practitioner.. Complete the checklist and risk management recording guidance (attached) as far as possible and pass a copy to the duty senior practitioner and file one copy in the client file. 3 of 3
Follow up action where the person is not located must be actioned immediately 11. Where initial checks by telephone do not confirm that the person is safe and well: the duty social worker must visit on the day the referral is received to try to establish the person s whereabouts and take the following action: 12. Ensure that the address is correct and that you are at the right address Look through the letter box Look through the windows Knock on a neighbour's door and ask if the person has been seen or where they might be The need for other checks may become apparent on the visit. 13. if the visit confirms that the person is safe and well, assess whether any further action or support is necessary, including the provision of a pendant alarm to reduce further incidents of no reply, and consult the duty senior practitioner. 14. If a person refuses a planned service or the carer is denied access, you should try and find out the reason for this. On return to the office, this information must be included in the written report that is signed off by the team manager. 15. If the visit does not confirm that the older person is safe and well, consult the senior practitioner. 16. Forced entry In circumstances where it cannot be confirmed that the person is not safe and well, the expectation is that the police are contacted to carry out a forced entry. In contacting the police, fully explain why the client is vulnerable, the reason for the call and why access is required. (Where the senior practitioner decides that a forced entry is not appropriate see paragraph 24 for required action.) 17. Wait until access is gained to the property. 18. Stay at the property until the emergency services determine what action is required. 19. Call an ambulance or other medical services if the person is unwell. 20. If the person concerned does not need to go to hospital, you should ensure 4 of 4
that the person is safe before leaving (If relevant, ensure that all care plan duties have been completed.) Assess whether any further action or support is necessary, including the provision of a pendant alarm to reduce further incidents of no reply. 21. If the person has been found dead following the forced entry you must contact the duty senior practitioner or team manager for guidance 22. Among the actions that are likely to be required are ensuring that the property is secured and informing relatives. 23. On return to the office a full written report should be completed. This should be signed off by the team manager. 24. Decision not to ask police to force entry Where the senior practitioner has decided that forced entry is not appropriate, you must, on return to the office, complete a full report and risk assessment. These must be signed off by the senior practitioner and team manager and endorsed by the head of service. If the term manager and/or head of service do(es) not agree with the social worker s and senior practitioner s conclusions, they will determine the future action to be taken. 5 of 5
Checklist for initial screening CareFirst Id Address Name of person Date of birth Telephone number Mobile number Time and date referral received Name of referrer Telephone number of referrer Time and date screening received file Time and date carer should have visited Time and date carer did visit Relevant contacts made: Person Alarm Scheme Neighbour/Key holder Meals on Wheels Warden (if in sheltered housing) Home Care Agency 1 Next of kin Home Care Agency 2 General Practitioner Private Provider St Thomas Hospital Voluntary Sector Provider Guy s Hospital Day Centre King s College Hospital Community Wardens Lewisham University Hospital Housing Queen Elizabeth Hospital Woolwich Transport LCCC (SE1 SE17) Housing District Nurse Other Outcome: Referrer informed Yes No Next of kin informed Yes No Other agencies informed Yes No Any new contacts: Name Telephone number Address Relationship to person 6 of 6
Risk management recording guidance PRESENTING PROBLEM details and facts Include checking of previous assessments and history of trends If there is significant or potential risk, alert the Duty Senior Practitioner, Senior Practitioner or Team Manager ASSESSMENT AND THOUGHTS What are the risks? To whom? From what? How often? What is the evidence? What are you thinking? Note: risk is not limited to the level of care package PLANS AND ACTIONS TO MINIMISE IMMEDIATE AND FUTURE RISK What is the plan? What decisions have you made? Why? Is a visit required? Why? If so, when? Is the situation urgent? Should it be actioned today? Why? Should it be actioned tomorrow? Why? Action plan to be written by senior practitioner Action plan to be signed off by the team manager Time, date and sign all records 7 of 7
Protocol for service providers (carers) or neighbours reporting concerns If a person does not answer the door and you do not know where the person is, the service provider (carer) or neighbour should be asked to: 1. Ensure that the address is correct and the carer is at the right address 2. Ensure that the carer is visiting at the right time 3. Look through the letter box 4. Look through the windows 5. Knock on a neighbour's door and ask if the person has been seen or where they might be If the person is seen through the letter box or through the window and appears to be unstable or on the floor, the carer should call their office who will then speak to the duty senior practitioner. Call the police and inform them of the incident. Fully explain why the client is vulnerable and the reason for the call and why access is required. Ask the carer or neighbour to wait until access is gained to the property. Ask the carer or neighbour to stay with the person until the emergency services determine whether the person needs to go to hospital. If they do not need to go to hospital, they should ensure that the person is safe before leaving (Carers should ensure that all care plan duties have been completed.) On return to own office a full written report should be completed and forwarded to the relevant social services office. If a person refuses a planned service or the carer is denied access, the carer should try and find out the reason for this. The carer should then telephone their manager who will contact the duty senior practitioner immediately. On return to their office, the carer should provide a full written report to be forwarded to the relevant social services office. The duty senior practitioner will contact the person if it is believed that the person may be at risk for any reason. The duty senior practitioner will advise what further action, if any, should be taken. 8 of 8
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