Safeguarding Adults Preventing Abuse and
Responding to Poor Practice
Practitioner Level
Including
Housekeeping
Toilets
Fire Procedure
Breaks
Including
Mobile Phones /
Devices
Smoking
Finishing
Time
Training Transfer
Getting learning into practice
• “50% of learning fails to transfer to the
workplace”
(Sak, 2002)
Including
• “The ultimate test of effective training
is whether it benefits service users”
(Horwath and Morrison, 1999)
Training Transfer
Individual
Characteristics
Workplace
Factors
Including
Training
Design and
Delivery
Introductions
• Name
• Place and nature of work
• What do you want to know by the end of today’s
session?
Including
Outcomes
By the end of the session you will:
• Understand your responsibilities
• Be able to recognise and respond to poor practice and know
who else to involve
• Recognise missed opportunities through learning from Serious
Case Reviews
• Have a greater awareness of the legislative framework,
regulation and guidance that contribute to the prevention agenda
• Identify opportunities for intervention through the assessment,
care or treatment planning and review processes
• Recognise the role of person-centred support in preventing
abuse
• Be able to consider the ongoing balance between prevention,
protection and a person's right to choice
Including
Ground Rules
Confidentiality within the group will be
respected but may need to be broken if a
disclosure of unsafe practice, abuse or
neglect is made during the course – this
will normally be discussed with you first.
Safeguarding is about partnership, it is not
about blame. All agencies and individuals
need to take responsibility, to reflect and
learn to safeguard people who may be
vulnerable.
Including
Underpinning message for session
• Positive approach – promotion of good
practice and early intervention to avoid
harm
• The rule of optimism - maintaining healthy
scepticism and respectful uncertainty
“It could happen here.”
Including
Setting The Scene
Where does our learning about Safeguarding
come from?
• Serious Case Reviews/Complaints/Near misses
• Research/Surveys/Data Analysis
• Practice Experience/Theory/Reflection
www.devonsafeguarding.org
www.scie.org.uk
Including
Six Safeguarding Adults Principles
•
•
•
•
•
•
Empowerment
Protection
Prevention
Proportionality
Partnership
Accountability
‘Adult Safeguarding: Statement of Government Policy’ 2011
Including
‘Prevention in Adult Safeguarding’
“It does not mean being over-protective or
risk-averse. Prevention needs to take place
in the context of person-centred support
and personalisation, with individuals
empowered to make choices and supported
to manage risks.”
Including
Report 41, SCIE, 2011
Vulnerability
What does the term ‘vulnerable’ mean?
Including
The Traditional Model
• Risk factors for being abused – poor
communication skills, low self esteem,
challenging behaviour, cognitive difficulties, lack
of education/experience, loneliness
• Risk factors for carers abusing - isolation, stress,
lack of knowledge of condition, substance
misuse, lack of support
Including
• Risk factors for services – poor management,
high turnover of staff, low pay, lack of staff
The Social Model of Vulnerability
• A way of thinking about vulnerability that is not
patronising or impairment specific because the
vulnerability is outside the person
• Vulnerable groups tend to be
– placed in, or left in, situations of higher risk than would be
tolerated for others
– Not heard, believed or taken notice of when they make
complaints
– Not helped to recover or recompensed
Including
• Because of these situations vulnerable groups
risk being seen as “easy targets”
(Prof. Hilary Brown)
‘Constellations of Abuse’
Targeted abuse
hate
crimes
Domestic abuse
Family violence,
neglect or negligence
partner violence
predatory
crimes
between parent and adult
child
sexual and
financial
between adult child and
older parent
Parasitic,
exploitative
“mate”
crime
more distant relatives
Professional abuse
Institutional abuse
breaches of
professional
boundaries by
rigid depersonalised
regimes
arrogant grandiose
and unaccountable
staff
neglectful care
resentful, downtrodden and harddone-by staff
staff out of their
depth or not
available
cruel, humiliating
individuals
Unethical practice
Unethical, unjustified and/ or unauthorised practice in response to
challenging needs
Systemic abuse and social exclusion
Exclusion from mainstream service provision
Discrimination in health, education, housing, employment , justice and welfare
Unable to access public places and spaces
Denied legal advocacy and routes for challenge
Invisible or stigmatised in media
Including
Prof. Hilary Brown, 2012
PCS Analysis
Personal/
Psychological
Cultural
Structural
Neil Thompson
Including
Opportunities for intervention
• Assessment & Planning
• Care, Support or Treatment
• Review
• Service monitoring/Complaints
Including
What are your responsibilities?
Prevention: Your Responsibilities
Including
• people being informed of the right to be free from abuse; and
supported to exercise these rights, including having access to
advocacy
• thorough needs assessments supported by risk assessments
where required to inform people’s choices
• access to good universal services targeted at older and
disabled people that can reduce the risk of people
experiencing abuse, for example community safety services
or services that increase people’s access to advice or
maintain informal support networks
• a well informed, competent and properly vetted workforce
operating in a culture of zero tolerance of abuse
• a sound framework for confidentiality and information sharing
across agencies
(CSCI, 2008)
ISA Report
“Safeguarding in the Workplace: What are the lessons to
be learned from cases referred to the Independent
Safeguarding Authority?” March 2012
General indicators
• carelessness, breaches of policy, attitudinal problems,
emotional detachment and persistent non-attendance,
portrayal of a close personal relationship with the victim
Including
Financial indicators
• talking about money worries, seeking advances or
requesting overtime, failure to complete documentation
and protocols regarding the handling of money
Creating Safer Organisations
•
•
•
•
•
•
•
•
Including
Recruitment - VBI
CRB/ISA Checks and References
Induction and Probation
Policies and Procedures
Setting Standards and Professional Boundaries
Training
Supervision
Performance Management
Serious Case Reviews
Take place where a vulnerable adult has:
• died, suffered serious sexual abuse, a potentially lifethreatening injury or serious and permanent impairment of
health or development or when serious abuse takes place in
an institution or multiple abusers are involved
AND
• the case gives rise to concerns about the way in which local
professionals and services work together to safeguard
vulnerable adults
OR
• where it is believed to be in the public interest to conduct
such a review.
Including
Serious Case Reviews aim to:
• Establish whether there are lessons to be learnt
about the way in which local professionals and
agencies work together to safeguard vulnerable
adults
• Improve practice by acting on learning
Including
NB: The purpose of having a serious case review is not to
reinvestigate or to apportion blame. They consider
individual actions as well as the systems and processes
within which individuals operate.
Serious Case Reviews –
recurring national themes
•
•
•
•
•
Including
Inter-agency communication
No lead agency
Training needed
Threshold issue
Assumptions
Jill Manthorpe and Stephen Martineau, 2009
Devon SCRs
Including
A: High number of deaths raised by CSCI
Poor care standards not previously picked
up by many and various professionals
B: 2 falls resulting in deaths raised by PALS
Environmental risks not previously picked
up by many and various professionals
H: Resident murdered by another on respite
Poor transfer of risk information from
hospital to care home
Devon SCRs –
combined learning
• Duty on all health and social care professionals to record and
act upon, any concerns about health, safety or wellbeing.
This should include possible risks that are not necessarily
the main focus of their contact.
• Ensure that a Service Provider is fully aware and able to
safely meet someone’s needs. Other important
considerations such as accessibility, peoples preferences,
resource pressures and cost, should not compromise the
primacy of ensuring safe care/support arrangements.
Including
Common Safeguarding
Challenges (care homes)
• Maladministration of
medication
• Pressure sores
• Falls
• Rough treatment,
being rushed,
shouted at or ignored
• Poor nutritional care
Including
• Lack of social
inclusion
• Institutionalised care
• Physical abuse
between residents
• Financial abuse
www.scie.org.uk
Health and Social Care Act, 2008
• Single registration system acts
as a “licence to provide
services”
• Established Care Quality
Commission to:
 Regulate the quality of health care
and adult social care
 Look after the interests of people
detained under the Mental Health Act
Including
Health and Social Care Act 2008
• Focused on outcomes rather than policies,
systems and processes (inputs)
• CQC to monitor compliance – risk register
• New enforcement powers for CQC
Including
Snap!
Including
Behind Closed Doors
Watch the DVD
Area of
Concern /
Poor
Practice
Complete the FIRST column ONLY
Including
Behind Closed Doors
Area of
Concern/
Poor
Practice
Which
CQC
outcomes
does this
relate to?
Complete the SECOND column ONLY
Including
Behind Closed Doors
Area of
Concern /
poor
practice
Which
CQC
outcomes
does this
relate to?
What
might you
see, hear
or smell?
Consider the indictors and signs that there might be if you
hadn’t actually observed the behaviours
Including
Complete the THIRD column ONLY
What might you see?
• Empty hours, bored residents
• Empty and scrappy staff rotas (turnover, absences and
not enough staff)
• Erratic medication charts
• Dirty rooms
• Dirty linen
• No training or “going through the motions”
• Policy documents and care plans kept in the drawer
• Rushed staff
• Dirty, untidy and unlooked after clothes
Including
What might you smell?
•
•
•
•
Including
Urine
Faeces
Stale food
Body Odour
What might you hear?
• Dehumanising: “they” - people are lumped together – “they
eat like animals”, “the doubles”
• Sexualising: “they’re at it like rabbits”, “she’s gagging for it”
• Blaming:“he knows what he’s doing,” “she’s manipulative”,
“he’s winding me up”
• Punitive: “they’ve got it coming”, “she needs to be taught a
lesson”, “if he thinks he can treat me like that”
• Discrediting: “he doesn’t notice”, “they don’t care” “they
are zombies”
Including
Barriers to addressing poor practice
• Lack of a tangible sense of what is wrong
• Lack of certainty that your concerns are
reasonable or proportionate
• Lack of “evidence” to back up concerns
• Fear of immediate reprisals or long term
detrimental consequences
• Fear that concern or complaint will not be
handled well so that their intervention will be in
vain
Including
Professor Hilary Brown
How do you verbalise ‘gut instincts’?
Hull University: ‘Abuse in Care?’
(http://www2.hull.ac.uk/fass/care/safeguardingadults.aspx)
• A practical guide to protecting people with
learning disabilities from abuse in residential
services
• A practical guide to protecting people with
dementia from abuse in residential services
Including
Service Monitoring Checklist
1.
2.
3.
4.
5.
6.
Leadership and Management
Staff behaviours and attitudes
Behaviours and interactions of residents
Isolation and lack of openness
Service design, delivery and make up
Environment and basics of care
Adapted from ‘Abuse in Care?’
Including
Practitioners’ Role
Information
received about
or poor
practice
observed
Poor practice?
Gather
Information
Safeguarding?
If you suspect a criminal offence,
do not ask any further questions.
Including
Behind Closed Doors
Complete column FOUR
Area of Concern /
poor practice
If you hadn’t
observed it what
other indicators
might there be?
What might you
see, hear or
smell?
What
information do
you need to
gather? Where/
who from?
What questions might you need to ask to establish
the facts of the situation?
Including
Be specific!
What to do with concerns about poor
practice
• Discuss with the professional concerned
• Discuss with the service manager
• Discuss with your manager immediately, in supervision
or at a team meeting
• Discuss directly with the person, family, organisation.
Once discussed then back up in writing - SMART.
• Record in Mr Manager if appropriate
• Discuss with co-workers or Safeguarding Adults team
• Encourage people to use the complaints process
• Discuss with procurement / contracts team
• Discuss with CQC
Including
Feelings / Emotional Responses
Including
Communication
Verbal
Tone
Body Language
Including
Neil Thompson
What is a problem?
‘....a problem is anything
that either brings about
negative ...or blocks
positives or a mixture of
the two.’
Neil Thompson
Including
An Elegant Challenge
Being constructive in challenging
unacceptable behaviour or language
Collusion /
no challenging
Including
Elegant
challenge
Aggressive
challenge
Practice
• Choose one of the scenarios from the film
(or your own) and make ‘an elegant
challenge’ to your partner.
• Partners – What did it feel like? What
could be done differently?
• Swap over.
Including
Any Questions?
Including
Prevention is Better Than Cure
Keep the course in context. Whilst there are
some very worrying situations occurring
everyday there is also good practice in all care
environments
Remember to vigilant and deal with things at the
earliest opportunity.
Including
Whether it’s poor practice or abuse doing
nothing isn’t an option.
Resources
Dementia care mapping
www.bradford.ac.uk
CQC observation tools
www.cqc.org.uk/information-our staff/observationtools
SCRs
www.devonsafeguarding.org
Including
Resources
Social care governance – audit tool
Common Safeguarding Challenges
Minimising the Use of Restraint
www.scie.org.uk
Good Ideas!
www.kissingitbetter.co.uk/
www.myhomelifemovement.org/
Including