TSA Safeguarding Vunerable Adults:
Policy & Procedures
1. Policy
The TSA is committed to safeguarding the well being of adults at risk of abuse and/or neglect who are unable to protect
themselves from harm (formerly and often colloquially referred to as vulnerable adults). Their welfare is considered paramount.
All adults at risk, without exception have the right to protection from abuse. All employees, trustees and volunteers working with
or on behalf of the TSA have a duty of care to safeguard the welfare of adults at risk and prevent their abuse.
Effective safeguarding systems are person centred. Failings in safeguarding systems are too often the result of not hearing the
views of the adult at risk, particularly where they have cognitive, mental health, and /or communication difficulties. The needs of
relatives/carers are important but should not be placed ahead of the needs of the adult at risk.
While the TSA has no statutory remit or role to investigate adult abuse, it does have a responsibility to pass on to the appropriate
statutory agency concerns in relation to the safety or welfare of the adult. All suspicions and allegations of abuse against an adult
at risk will be taken seriously and responded to swiftly and appropriately.
TSA is committed to best practice in recruiting staff and volunteers safely. All staff and volunteers engaged in “regulated activities”
will be subject to the appropriate level of screening and criminal record checks by the Disclosure and Barring Service. No person
will be formally appointed to any paid or volunteer position involving regulated activities until these checks have been
satisfactorily completed.
The TSA is committed to ensuring its staff and volunteers are equipped to recognise concerns about the safety or welfare of an
adult at risk and, to that end, will provide appropriate training and supervision. New staff will be given a mandatory induction,
which includes familiarisation with adult protection responsibilities for safeguarding. New staff will also have access to
safeguarding training within 6 months of commencing their role, and all staff will attend updated training every three years or
sooner as required.
2.
Definition of an adult at risk (vulnerable adult)
2.2
A vulnerable adult is a person who is:
2.1
It is generally accepted that the national guidance in relation to safeguarding adults is out of date and there is need for
legislation. Many authorities now use the terminology of adult at risk of harm, who is unable to protect him/her, and who
may be more vulnerable as she/he has additional needs due to illness and/or disability. Scotland did introduce legislation
in 2007 and there are proposals in the Care Bill published in May 2013 to enact similar but with some significant
differences, legislation in 2014/15. The current statutory guidance, therefore, in England and Wales remains the 2000 No
Secrets Guidance, which uses the terminology of vulnerable adult.
Aged 18 years or over;
Who is or may be in need of community care services by reason of mental or other disability, age or illness; and
Who is or may be unable to take care of him or herself or unable to protect him or herself against significant harm or
exploitation.
3.
Responsibility for safeguarding adults at risk
3.2
It is the line manager’s responsibility to clarify with the staff member or volunteer their roles and responsibilities
regarding their relationships with adults at risk with whom they may be in contact, and to identify any training needs.
Regular supervision for staff and volunteers will monitor the work and offer the opportunity to raise any issues. The CEO
and trustees will ensure that an appropriate standard of supervision is maintained, and there is a training programme in
place that is fit for purpose.
3.1
It is the responsibility of all staff and volunteers to ensure that they are familiar with the TSA’s adult at risk safeguarding
policy and procedure and to take action in line with this guidance. The responsibility for ensuring that the TSA policy and
procedures are satisfactorily followed lies jointly with the CEO and with the designated Adult Safeguarding Officer (ASO)
(currently Christine Naylor). The TSA trustees retain ultimate responsibility for safeguarding and promoting the welfare
of adults at risk.
3.3
It is the responsibility of managers, the CEO and trustees jointly to create an atmosphere in which there is respect for all
the people with whom the TSA has contact and in dealings with and between staff; makes clear that abuse in any form is
not tolerated; and ensures that staff, volunteers and the users of services are encouraged to report any concerns
regarding their treatment or that of another individual
4.
Identifying Concerns
4.1
Concerns may relate to physical abuse, sexual abuse, neglect, emotional abuse, financial abuse, and discriminatory abuse
of a vulnerable adult. Multiple types of abuse against the adult are not uncommon. Perpetrators of abuse can include
parents, carers, workers, institutions or other service users. Types of abuse include:
Physical abuse, including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate
sanctions;
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
Sexual abuse, including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or
could not consent or was pressured into consenting;
Psychological abuse, including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation,
blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or
supportive networks;
Financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or
inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits;
Neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to
appropriate health, social care or educational services, the withholding of the necessities of life, such as medication,
adequate nutrition and heating; and
4.2
4.3
4.4
Discriminatory abuse, including racist, sexist, that based on a person’s disability, and other forms of harassment, slurs
or similar treatment.
Information that gives rise to concern may come from various sources – observation, statements made by a vulnerable
adult, by another member of the family, a friend, or by a TSA worker. Equal precedence will be given regardless of the
source. The person making the disclosure/raising an alert will be informed that their concerns will be taken seriously and
our procedures will be followed, a copy of which can be provided if requested.
All concerns and allegations, whatever their origin, must be taken seriously and considered with an open mind which
does not pre-judge the situation. Remain calm and receptive. Listen without interrupting. Make it clear you take them
seriously. If it is difficult to understand what the person is saying, explain this and ask if they would mind saying it again. It
is important not to ask questions relating to the alleged abuse as this will preclude the police asking them should there be
police involvement. Do not promise confidentiality.
You need to make a careful record of what has occurred, whether it is information you have received or an incident that
you observed. It is important to do this as close to the incident as possible, and to be clear about what information has
been passed on and to whom. Use the record sheet attached to this procedure, which will form the basis of any
subsequent referral to Adult Social Care. Continue to record all subsequent events up to the time of intervention by Adult
Social Care on the TSA remote database.
5.
Taking action
5.2
If you believe there to be no immediate danger to the vulnerable adult, you should discuss your concerns on the same day
with your line manager (or with the CEO / TSA designated Vulnerable Adults Protection Officer in his/her absence).
Together you should agree whether or not your concerns / the information disclosed indicate possible abuse and if so
review and agree the action that needs to be taken as a result. The CEO / VAPO should be kept up to date with any actions
taken.
5.1
5.3
5.4
The action taken will vary with the circumstances, but must always be taken as soon as possible. You should dial 999 and
ask for the police or ambulance service if the person is in immediate danger, or needs urgent medical treatment.
Remember to have regard to your own safety. Leave the situation if it is not safe for you.
Adult Social Care has established procedures in responding to vulnerable adult protection issues. TSA personnel should
refer their concerns to the person’s local Adult Social Care Team. You will find the telephone numbers of both the Adult
Social Care Team and the Out of Hours Duty Team on the relevant local authority website. Make a note of these. When you
telephone you should make it clear you are making a Vulnerable Adult/Adult at Risk Protection Referral.
It is the responsibility of the individual who identifies concerns to ensure that the matter is referred to Adult Social Care.
Delays in contacting Adult Social Care may put a vulnerable adult in serious danger. Once a decision has been made to
refer concerns to Adult Social Care a referral should be made (by telephone in the first instance) within 24 hours.
If abuse is disclosed to you by an adult at risk / vulnerable adult you should in most circumstances seek their consent before
referring the matter to Adult Social Care. There may be exceptions to this as follows:
Where you suspect the adult is at risk and you have good reason to believe he/she lacks mental capacity to give
informed consent (giving informed consent requires the adult to be able to recognise that he/she is at risk of harm;
can make the decision to protect him/herself; and is able to carry out that decision).
There is a public interest, for example, not acting will put other adults or children at risk;
There is a duty of care to intervene, for example, a crime has been or may be committed.
You may also wish to consider discussing the circumstances (without disclosing names) with social services at an
early stage in order to take their professional advice.
Where you believe the adult at risk lacks capacity to make and carry out decisions about their own safety it is good
practice to involve family/friend carers, unless allegations have been raised against those individuals or related
family members or you believe by doing so the adult may be at greater risk.
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
If the alert/disclosure is around past abuse, with no assessed risk of that abuse recurring to the adult who is believed
not to have capacity to protect him/herself, discussions should be held with the main carer, as to whether further
action needs to be taken. However they need to be clear that the TSA may have a duty to report the matter to Adult
Social Care, for example if a crime has been committed and/or others have been/may be at risk. Details should be
recorded on the TSA database.
Should it come to your attention that a vulnerable adult is residing with or having regular contact with a registered
schedule 1 sex offender, this information must be passed on to the CEO who will seek advice from the Adult Social
Care Department.
You must follow up a telephone referral with a written referral within 48 hours. Following the referral of a vulnerable adult, the TSA
and Adult Social Care Department must be clear about who will be taking what action. Adult Social Care should acknowledge your
written referral. If you have not heard within three working days, contact Adult Social Care again. Any correspondence should be
appended to the member/contact data-base.
The TSA will endeavour whenever possible to continue to offer a support service to the adult at risk/vulnerable adult if they wish to
receive it. This may include supporting them as Adult Safeguarding protection enquiries are undertaken and through any
recommendations or decisions that are made as a result of the enquiries. If any home visits are required, a suitable buddy such as a
social worker or TSA Adviser will need to accompany that staff member and approval must be sought and given by the staff
member’s line manager for the visit.
6.
Record Keeping & Confidentiality
6.2
Clear and accurate records are essential to effective working. A clear and concise report will be completed for all
reported issues. The report will be factual and non judgemental. These will be stored securely (electronically) for a
period of six years. The electronic record should be saved as an attachment to the Harlequin database. Records will be
stored securely for a period of six years by the Head of Support Services. The database record must be copied and
pasted into a word document and a hard copy printed and filed in a secure locked cupboard, held by the Head of Support
Services.
6.1
7.
7.1
The TSA respects and understands the need for confidentiality. Adult safeguarding/protection issues will be managed in
accordance with our Confidentiality Policy, and matters should only be discussed with appropriately identified
representatives from Adult Social Care, Police and Health Services.
When abuse by a member of TSA staff or volunteer is disclosed or suspected.
Where allegations are made against a TSA worker, or there are suspicions about their behaviour, which may meet the
criteria for abuse against an adult at risk/vulnerable adult then the following procedure will take place:
The matter will be immediately referred to the CEO and the Adult Safeguarding Officer (ASO) who will then inform
the Chair of the TSA.
If the ASO is the alleged perpetrator or the suspected abuser, the concerned person should inform the Chair of the
TSA.
If the Chair of the TSA is the alleged perpetrator or suspected abuser, the concerned person should inform the Head
of Support Services, who will then inform the ASO.
7.2
If the CEO is the alleged perpetrator or suspected abuser, the concerned person should inform the ASO and the
Chair of the TSA.
In all instances, the police will be informed, as a criminal offence may have been committed. The procedures to be
followed for the protection of at risk/ vulnerable adults are those outlined above. Any alert/referral to Adult Social Care
needs to be clear that the alleged perpetrator is a member of staff/trustee or volunteer of TSA. Although there is no
statutory role in adult social care for a post equivalent to the Local Authority Designated Officer (LADO) for child
protection concerns, some authorities do have a named person, who co-ordinates and advises on alleged abuse by staff.
7.3
The TSA staff member or volunteer who is alleged to have abused or is suspected of abuse will be suspended
immediately from work on full pay. It is important to explain to the individual that such action is neutral and does not
assume that the allegations are true. This action is designed to protect the victim allegedly involved and also to protect the
alleged perpetrator from any further allegations or harassment/intimidation of the alleged victim or witnesses.
7.4
If TSA removes an individual (paid worker or unpaid volunteer including a trustee) from work such as looking after adults
who are deemed to be vulnerable (or would have, had the person not left first) because the person poses a risk of harm to
such adults, the organisation must make a referral to the Disclosure and Barring Service. This includes workers who may
have left of their own accord before a disciplinary investigation. It is an offence to fail to make a referral without good
reason. Staff who hold qualifications that require them to be registered, like nurses and social workers, would also need to
be referred to their registration bodies.
Any TSA internal investigation according to disciplinary or protection from abuse procedures will be held in abeyance
until the Police and/or Adult Social Care department(s) have indicated that they have no further involvement.
7.5
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
8.
Protection of Adults at Risk/Vulnerable Adults Code of Good Practice
8.2
Good practice will also protect the TSA through reducing the possibility of anyone using their role to gain access to adults
at risk/vulnerable adults, in order to abuse. While it is not intended that this code should restrict workers from normal
ways of working, e.g. comforting a distressed adult through providing a hug, there is much you can do to avoid situations
that may give rise to misinterpretation, which will also work to protect adults at risk/vulnerable adults.
8.1
8.3
8.4
This code has been developed to provide you with advice that not only will help to protect adults at risk/vulnerable
adults, but will also help you and your colleagues identify any practices which could be mistakenly interpreted and
perhaps lead to false allegations of abuse.
A risk assessment must be carried out for any TSA hosted event where adults at risk/vulnerable adults are to be present.
The controls and assurances to mitigate risk must be reviewed and approved by your line manager prior to the event.
If in doubt, consider how an action or activity may be perceived as opposed to how it is intended. Wherever possible, you
should be guided by the following advice. If it is necessary to carry out practices contrary to it, you should only do so after
discussion with, and the approval of your Line Manager.
Avoid unobserved situations of one-to-one contact with an adult at risk/ vulnerable adult. If it is unavoidable, always
keep a door open and ensure you are within the hearing of other adults
Never invite an adult at risk/ vulnerable adult to your home without the knowledge and consent of your line manager
(if you know/suspect the person lacks mental capacity you also need to involve relevant family/carers).
Never offer to or take an adult at risk/ vulnerable adult alone in your own vehicle without the knowledge and consent
of your line manager and only where it is necessary in order to protect the lone adult from exposure to immediate risk
or harm.
If it is necessary to do things of a ‘personal’ nature for an adult at risk/ vulnerable adult, e.g. assisting with toileting if
they are disabled, ensure these are carried out with the full knowledge of your line manager (if you know/suspect the
person lacks mental capacity you also need to involve relevant family/carers).
Develop a culture in which workers feel comfortable enough to point out inappropriate attitudes and behaviours to
each other
Don’t join in or allow any sexually provocative games involving or observed by adults at risk/vulnerable adults,
whether based on talking or touching or images on computers/mobile phones
Never make suggestive remarks or discriminatory comments to any adult
Don’t engage in or tolerate any bullying of any adult, either by other adults who may be regarded as at
risk/vulnerable or other people
Don’t engage in or tolerate inappropriate physical activity involving any adult
Never enter a room where an adult at risk/ vulnerable adult may be changing their clothes or not be fully dressed,
without first getting their consent to enter
Respect all persons, regardless of their age, gender, ethnicity, disability or sexual identity
Avoid ‘favouritism’ and singling-out ‘troublemakers’
Never trivialise abuse
Never let allegations by an adult at risk/ vulnerable adult go unreported, including any made against you
*
**
Never “friend” a client on social media (eg Facebook).
Information to be recorded if volunteered during the contact on the phone or seen if during a face-to-face meeting
TSC Advisers are to take a copy of this form when performing any member visit
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
***
A written confirmation must be sent by the Statutory Body within 48 hours, please attach a copy of this confirmation to this
form.
Allegation or suspicion of abuse of a vulnerable adult
Date & Time of Contact
Your name and title
Type of contact made: telephone/e-mail/face-to-face
Local Authority of Vunerable Adult
Name of Vunerable Adult
Age
Gender
Ethnic Origin
Parent or Carer’s name
Home Address
Telephone Number
Vunerable Adult’s first language / non-verbal
GP
Other agencies or professionals involved
Details of any specific needs, for example, equipment /
communication aids
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
Appendix 1 – Four Nations Differences
The legal context for the safeguarding/protection of vulnerable adults is different in Scotland where there is an Act “Adult Support
and Protection (Scotland Act) 2007.
The Scottish terminology refers to adults at risk. This language has been generally adopted in England and Scotland following
Guidance from Association of Directors of Adult Social Care (ADASS) and recent pronouncements by UK Government and now
detailed in the Care Support Bill published in May 2013.
In addition the Scottish legislation includes in its definition of an adult at risk, adults who engage/may engage in behaviour that
harms them – in practice this can include self-neglect. The current and proposed position in England and Wales does not include
self-neglect or self-harm as a safeguarding issue -the key need for another person(s) who is harming (perpetrator) remains.
The Scottish legislation also gives greater to powers for relevant staff to enter premises where they believe an adult may be at risk.
This is not possible in other parts of the UK (unless Mental Health Act legislation applies) and is currently not included in the Care
Bill.
The Scottish legislation definition.
Adults at risk are adults (aged 16 or over) who –
are unable to safeguard their own well-being, property, rights or other interests
Are at risk of harm, and
Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to
being harmed than adults who are not so affected
An adult is at risk of harm if -
another person’s conduct is causing (or is likely to cause) the adult to be harmed, or
the adult is engaging (or is likely to engage) in conduct which causes (or is likely to cause) self-harm.
There are legal provisions in place for decision-making for adults who lack capacity; and there are safeguards regarding
deprivation of liberty however there are differences between England/ Wales/Scotland and Northern Ireland (these provisions
should be covered as part of your safeguarding training). You should ensure that you understand and are familiar with legal
provisions as they relate to your country/countries of operation.
England and Wales: Deprivation of Liberty Safeguards (England, Wales) and The Mental Capacity Act apply.
Scotland: The current mental health legislation in Scotland is The Mental Health (Care and Treatment) (Scotland) Act
2003: which is still current, although some amendments have been made. The Adults with Incapacity (Scotland) Act
2000 provides ways to manage the financial and welfare affairs of people (aged 16 or over) who are unable to manage
them for themselves. For more information see the Scottish Executive website.
Northern Ireland: The Mental Capacity Act does not apply in Northern Ireland. Interim guidance, based on the
current legislative framework, the Mental Health (Northern Ireland) Order 1986 (the Order) and best practice,
pending the introduction of new Mental Health and Mental Capacity legislation in Northern Ireland is available from
www.dhsspsni.gov.uk
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
Appendix 2 Possible Signs of Abuse and Neglect
Possible indicators of neglect or acts of omission
Unkempt appearance
Inadequate/inappropriate clothing – in night clothes during the day –sharing of clothing with other residents
Medication withheld/not given at right time
Unexplained weight loss/excessive gain
Medical treatment not sought or advice followed
Dehydration
Poor personal hygiene
Pressure ulcers/urine sores
No/ad hoc access to necessary aids –teeth/glasses/hearing aids/mobility aids
Carers unwilling to accept support
Possible indicators of financial harm/exploitation
Unpaid bills
Unexplained inability to pay for household shopping or bills
Disparity between the adult’s assets and living conditions
The adult has insufficient food / essential items
Sudden changes in the adult’s bank account or banking practice
Unauthorised withdrawal of the adult’s funds
Unexplained disappearance of funds or valuable possessions
Signature on cheques that do not resemble the adult’s
The inclusion of additional names on the adult’s bank account
Abrupt changes to or sudden establishment of wills
The sudden appearance of previously uninvolved relatives claiming their rights to an adult’s affairs or possessions
The unexplained sudden transfer of assets from the adult to another person
Visitors whose only visits and interest in the adult always coincide with the day that the adult cashes his/her benefits
Unusual and extraordinary interest, knowledge and involvement in the adult's assets
Missing items from the adult’s home
Possible indicators of sexual harm
An allegation of harm made by an adult at risk
Denial that anything is amiss or wrong
Unexplained difficulty walking / sitting
Stained undergarments/bed linen
Changes in behaviour / mental state (e.g. fearful, anxious, withdrawn, seeking attention and/or protection from others,
sleep disturbance, nightmares, poor eye contact, anger and verbal or physical outbursts)
Bruising/injury to genital/rectal area or inner thighs etc
Infections (e.g. urinary tract infections, sexually transmitted infections)
Complaints of pain/discomfort from genital/rectal areas
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
Fearful of or retreating from any form of physical touch or contact
Sexualised behaviour / language
Inappropriate attachments (e.g. if adult is being ‘groomed’ he/she may want to spend time with perpetrator)
Attempts to avoid contact with perpetrator
Perpetrator engineering time alone with the adult
Enforced pregnancy / withdrawal of contraception
Signs of ‘Grooming’
What is grooming?
Grooming is when a perpetrator tries to ‘set up’ and ‘prepare’ another person to be the victim of harm, often sexual
abuse.
Grooming can be used by those known to the adult or by strangers.
A grooming process can last for months or even years.
It can be very subtle – those who are being groomed often do not realise that they are being manipulated, nor do their
relatives or carers.
A perpetrator of sexual abuse may use many techniques to ‘groom’ and prepare an adult for abuse, such as:
Giving an inappropriate level of attention to the adult
Telling the adult that he/she is ‘special’
Giving the adult ‘special’ treatment, favours and privileges
Offering, promising and/or giving gifts
Offering to help family/carers to gain access to the adult
Manipulating the adult through threats or coercion
Openly or ‘accidentally’ exposing the adult to nudity / sexual material
Sexualising physical contact
Having inappropriate boundaries (e.g. sharing ‘problems’)
Possible indicators of discriminatory harm
Offensive remarks/slurs/harassment/ based on the adult’s age, gender, disability, race, colour, cultural background
sexual or religious orientation
Changes to the adults mental state and behaviour ( e.g. fearful, anxious, withdrawn, angry, frustrated)
Loss of self-esteem
Bullying
Degradation
Providing unacceptable food/diet
Failure to provide for cultural needs
Lack of sensitivity, care or interest to cultural diversity
Isolation (e.g. due to barriers to communication)
Verbal abuse
‘Hate crime’
Lack of opportunities and equity
Not allowing for individual choice or difference
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
Social isolation and exclusion
The adult is refused access to services or is excluded inappropriately
Possible indicators of physical harm
An allegation of harm made by an adult at risk
Denial that anything is amiss or wrong
Changes in behaviour e.g. fearful, anxious, withdrawn, seeking attention and/or protection from others, anger and
verbal or physical outbursts
The adult’s liberty or freedom of movement is denied or restricted (e.g. being locked in a room, being tied up,
inappropriate restraint)
Unexplained, unusual or suspicious injuries (e.g. multiple bruising and/or fractures, not consistent with a fall)
Unusual or unexplained behaviour of carers (e.g. delay in seeking advice & dubious or inconsistent explanations for
injuries)
A delay between an injury and seeking medical care
Difficulty in interviewing the adult (e.g. another adult unreasonably insists on being present)
Difficulty moving (because of hidden or undisclosed physical injury)
Over-medication / Under-medication (e.g. apathy, slurring of speech, excessive sleep, lack of sleep, continual
pain/distress)
Medication is not given as prescribed or is being given against the adult’s will or without the adult knowing e.g. being
hidden in food
Possible indicators of psychological harm
Denial that anything is amiss or wrong
Changes in the adults mental state (e.g. confusion, anxiety, paranoia)
Changes in the adults behaviour (e.g. agitated, aggressive, withdrawn, fearful, challenging behaviour, anger and
verbal or physical outbursts)
Feelings of worthlessness / hopelessness
Low mood / depression
Insomnia or excessive sleep
Changes in appetite
Unusual bouts of crying / tearfulness
Resignation (the adult accepts that being ill-treated is to be expected and is part of his/her life)
Low self esteem
Poor confidence
Difficulty making decisions
Silence or restricted communication when the perpetrator is present
Subdued personality when the perpetrator is present
Lack of interest / concern / consideration for the needs of the adult
Denial of choices
The adult is not allowed to express his/her views or opinions
The adult is denied privacy
Denial of access to the adult
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB
TSA Safeguarding Vunerable Adults:
Policy & Procedures
Safeguarding Children: Action Flow Chart
You have a safeguarding concern
(a suspicion, allegatiaon, disclosure or observation of abuse).
Is there any immediate danger?
Have you sought agreement to refer where appropriate?
YES
NO
y immediate
Deal with any
danger (call 999 if
appropriate)
Leave the situation if your
personal safety is at risk
Safeguarding At Risk/Vulnerable Adults:
Action Flow Chart
Discuss your concer ns with your line
manager (or with the CEO / Chair /
ASO) on the same day. Consider
seeking advice from Social Services.
Do they agree that y
yo
our concer ns /
the infor mation disclosed indicate
possible abuse?
YES
NO
Refer your concer ns to the vulnerable adult’s local Adult
Social Care Team within 24 hours
Follow up your telephone alert/referral with a written
referral within 48 hours
Ensure that a copy of the report
for m and agreed actions is signed
by you and by the CEO/Chair/ASO
(and stored securely and
electronically)
November 2013
Further information on TSC and the work of the Tuberous Sclerosis Association can be obtained from our website at:
www.tuberous-sclerosis.org
While every effort is made to ensure that our publications are correct, please note that some information may change after the date of printing. Information in this leaflet
is not intended to be a substitute for medical advice from your own doctors, who know your individual circumstances. We strongly recommend you talk to your doctor,
and share the above information. The TSA cannot be held responsible for any actions taken as a result of using TSA information resources.
Tuberous Sclerosis Association is a Company Limited by Guarantee Registered in England and Wales No. 2900107
English Registered Charity Number. 1039549 | Scottish Registered Charity No. SC042780
Registered Office: Abertawe House, Ystrad Road, Fforestfach, Swansea, SA5 4JB