SAFEGUARDING ADULTS IN CHESHIRE WEST AND CHESTER
BREAK THE SILENCE
Safeguarding Adults Policy
Rob Butler/Karen Owen April 2015
Phone 0300 123 8 123
Document to be reviewed July 2016
Translation, Braille, audiotape and large
print are available on request
Table of Contents
Introduction ............................................................................................................................................ 2
Why do we need this policy? .................................................................................................................. 2
Who does this policy apply to? ............................................................................................................... 2
Legal Framework ..................................................................................................................................... 3
Care Act 2014 .......................................................................................................................................... 3
Mental Capacity Act 2005 ....................................................................................................................... 7
Transitions from children’s services into adults ..................................................................................... 8
The overall approach in West Cheshire .................................................................................................. 9
Monitoring and review of this Policy ...................................................................................................... 9
APPENDIX 1 Adult abuse – Flowchart ................................................................................................... 11
APPENDIX 2 Thresholds for initiating Safeguarding Procedures .......................................................... 12
APPENDIX 3 Possible indicators of abuse ............................................................................................. 12
1
Safeguarding Adults in Cheshire West and Chester
Policy
Introduction
Ensuring the continued protection of adults at risk in Cheshire West and Chester
(CWaC) is one of the most important challenges facing social care and health
services. The success of partner agencies in safeguarding vulnerable adults
requires clear policies, effective processes and partnership arrangements and
prompt and co-ordinated action to protect those most at risk from serious abuse.
This document updates the policy agreed in 2013 and brings it into line with the new
landscape created by the Care Act. It applies to ALL individuals and agencies who
have a part to play in the protection of adults at risk, across the public, private and
voluntary sectors.
Why do we need this policy?
This policy seeks to ensure that key organisations work effectively together to protect
some of the most vulnerable people in our society. It comes from a duty to offer
protection to people who find themselves in vulnerable situations and who are
unable to protect themselves without appropriate intervention from partner agencies.
Reported incidents of abuse are increasing. Whilst this demonstrates that more and
more people are being protected, it also serves to highlight the likely scale of the
problem and, therefore, the importance of this Policy and supporting Procedures.
Who does this policy apply to?
This policy does not apply to all adults; only those who the new Care Act 2015
details as needing care and support, and who are eligible for services under the Act.
Further details can be found on the Council’s website. The circumstances under
which a local authority must intervene are as follows:
Where a local authority has reasonable cause to suspect that an adult in its area
(whether or not ordinarily resident there) (a) has needs for care and support (whether or not the authority is meeting
any of those needs)
(b) is experiencing, or is at risk of, abuse or neglect, and
(c) as a result of those needs is unable to protect himself or herself against
the abuse or neglect or the risk of it
In effect, this means that regardless of whether the local authority are providing any
services, we must follow up any concerns about either actual or suspected adult
abuse, or cause others to do so.
2
Legal Framework
Care Act 2014
The Care Act establishes a clear legal framework for how local authorities and other
parts of the health and care system should protect vulnerable adults at risk of abuse
- in effect, placing Adult Safeguarding on the same statutory footing as Children’s
Safeguarding. From April 2015, each local authority must:
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make enquiries, or ensure that 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 Local Safeguarding Adults Board (LSAB) 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
co-operate with each of its relevant partners in order to protect adults
experiencing or at risk of abuse or neglect
The Local Safeguarding Adults Board will be strengthened and have more powers
than the current arrangements set up by “No Secrets” - but will also be more
transparent and subject to greater scrutiny. It must:
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Decide when a SAR is necessary, arrange for its conduct and, if it so decides,
implement the findings
Publish an annual report detailing what it has done during the year, as well as
reporting the findings of any Safeguarding Adults Reviews (SARs) and
referencing any ongoing reviews
Publish a strategic plan for each financial year that sets out how it will meet its
main objective, what each member will do to implement the strategy - and, in
developing the plan, consult its local Health watch organisation and the
community
The five priorities highlighted by our Board for 2015/16 are:
o Standard setting; what does good look like?
o Communication; including with front-line staff, the community and
between Board members
o Making Safeguarding Personal; putting people at the centre of the
system
o Engagement; check, challenge and intervene in wider safeguarding
issues in the community
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o Work closely with the Local Safeguarding Children’s Board on
vulnerable groups; involving issues such as radicalisation, sexual
exploitation, street activity and transition
It is important that we do not limit our view of what constitutes abuse or neglect,
as they can take many forms and the circumstances of the individual case should
always be considered. However, the Care Act Statutory Guidance provides an
illustrative guide to the sort of behaviour which could give rise to a safeguarding
concern:
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Physical abuse
including assault, hitting, slapping, pushing, misuse of medication, restraint or
inappropriate physical sanctions
Domestic violence
including psychological, physical, sexual, financial, emotional abuse and so
called ‘honour’ based violence
Our Domestic Abuse Strategy 2015-18 can be accessed using the link below
www.cheshirewestandchester.gov.uk/domesticabuse
Sexual abuse
including rape, indecent exposure, sexual harassment, inappropriate looking
or touching, sexual teasing or innuendo, sexual photography, subjection to
pornography or witnessing sexual acts, indecent exposure and sexual assault
or sexual acts to which the adult has not consented 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, cyber bullying, isolation or unreasonable and unjustified
withdrawal of services or supportive networks
Financial or material abuse
including theft, fraud, internet scamming, coercion in relation to an adult’s
financial affairs or arrangements, including in connection with wills, property,
inheritance or financial transactions, or the misuse or misappropriation of
property, possessions or benefits
Modern slavery
which encompasses slavery, human trafficking, forced labour and domestic
servitude. Traffickers and slave masters use whatever means they have at
their disposal to coerce, deceive and force individuals into a life of abuse,
servitude and inhumane treatment
Discriminatory abuse
including forms of harassment, slurs or similar treatment; because of race,
gender and gender identity, age, disability, sexual orientation or religion
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Organisational abuse
including neglect and poor care practice within an institution or specific care
setting such as a hospital or care home, for example, or in relation tocare
provided in one’s own home. This may range from one off incidents to ongoing ill-treatment. It can be through neglect or poor professional practice as a
result of the structure, policies, processes and practices within an organisation
Neglect and acts of omission
including ignoring medical, emotional or physical care needs, failure to
provide access to appropriate health, care and support or educational
services, the withholding of the necessities of life, such as medication,
adequate nutrition and heating
Self-neglect
which covers a wide range of behaviour neglecting to care for one’s personal
hygiene, health or surroundings and includes behaviour such as hoarding
Other types of abuse may include forced marriage, in which one or both of the
parties are married without their consent, and exploitation into violent extremism by
radicalisers.
Some instances of abuse will constitute a criminal offence which may lead to criminal
proceedings, and appropriate intervention must take this into account. In all cases,
priority must be given to ensuring the safety and care of the adult(s) at risk - and, as
appropriate, action will be co-ordinated with the police and other relevant authorities.
Possible indicators relating to each of the illustrative types of abuse listed
above can be found in Appendix 3
The Care Act signals a major change in safeguarding practice. Moving away from a
process-led, tick box culture, it will enable a person-centred social work and ensure
that people achieve the outcomes they want. It will also allow for the possibility that
individuals may change their mind about what outcomes they want through the
course of the intervention.
The Care Act also recognises the key role of Carers in relation to safeguarding. A
carer may witness or report abuse or neglect, experience intentional or unintentional
harm from the adult they are trying to support; or intentionally or unintentionally harm
or neglect the adult they support. It is important, therefore, to view the situation
holistically and look at the safety and wellbeing of both. The Act makes clear
throughout the need for preventing abuse and neglect wherever possible.
It also acknowledges that local authorities cannot safeguard individuals on their own.
That can only be achieved by working together with the Police, NHS and other key
organisations, as well as awareness of the wider public. Fears of sharing
information must not stand in the way of protecting adults at risk of abuse or
neglect, and so the Care Act includes new duties for LSABs to work more closely
together and for organisations to share information with them.
5
This duty will continue to be strengthened locally by the principles of information
sharing and confidentiality agreed with our partners:
(a) Information will be shared on a need to know basis - taking account of the
best interests of the adult
(b) Confidentiality will not be confused with secrecy
(c) Informed consent should be obtained, but if this is not possible and other
adults are at risk, it may be necessary to override the requirement
(d) It is inappropriate for agencies to give absolute confidentiality in cases where
there are concerns about abuse, particularly when other people may be at risk
Any exchange or disclosure of information must be in accordance with the Data
Protection Act 1998, the Human Rights Act 1998 and the Freedom of Information Act
2000.
The advances in personalisation of social care goes hand-in-hand with the new
approach to safeguarding; empowering people to speak out, make informed choices,
with support where necessary, and encouraging communities to look out for one
another. There will be an emphasis must be on sensible risk appraisal, not risk
avoidance, which takes into account individuals' preferences, histories,
circumstances and lifestyles to achieve a proportionate tolerance of acceptable risks.
In the words of Lord Justice Munby: "What good is it making someone safer if it
merely makes them miserable?"
The Care Act enshrines the six principles of safeguarding in law:
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Empowerment
Prevention
Proportionality
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Protection
Partnerships
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Accountability
Person-led decisions and informed consent
Taking action before harm occurs
Most proportionate and least intrusive response
appropriate to the risk presented
Support and representation for those most in need
Local solutions through services working with their
communities
Accountability and transparency in delivering
safeguarding
All partners in Cheshire West and Chester are committed to working to these and, in
doing so, will adopt the following practices:
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Work actively and constructively together within this multi-agency framework
Actively promote the empowerment and wellbeing of vulnerable adults
through our services
Act appropriately to support the rights of the individual to lead an independent
life based on self-determination and personal choice, including the right to
make unwise decisions
Recognise and act promptly and effectively to protect people who are unable
to make their own decisions or are unable to protect themselves or their
possessions and assets
6
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Recognise that the right of self-determination can involve risk and ensure that
such risk is acknowledged and understood and appropriate steps taken to
minimise the risk once it has been identified
Ensure that all relevant strategies and approaches are effectively aligned and
take into account the need to safeguard adults at risk and meet all critical
legislative requirements
Ensure that when the right to an independent lifestyle and choice is at risk, the
individual concerned receives appropriate advice, assistance and protection
from all relevant agencies
Ensure that the existing legislative framework is used to optimum effect in
protecting adults at risk and where appropriate and necessary bringing
serious cases of abuse to the criminal courts
Those providing services to vulnerable people in West Cheshire are also expected to
take these principles and practices into account in developing their own internal
policies and procedures.
We recognise that it is vital for partners to work together where the safety of adults is
concerned and will not work in isolation when incidents of abuse are identified and
reported. We believe that the protection of the individual at risk is paramount. We
do not accept that any form of abuse, under any circumstances, is acceptable; and
hold a position of zero tolerance in respect of abuse directed at adults at risk.
We will ensure that partner organisations apply the same values, principles and
processes in responding to reports of abuse to ensure consistency in approach and
the effective prevention, investigation and resolution of abuse cases. Actions will be
co-ordinated against perpetrators to promote positive outcomes, information will be
shared and appropriate planning, action and review mechanisms will continue to be
implemented to ensure that our adults at risk are protected from the earliest possible
stage.
Mental Capacity Act 2005
The Mental Capacity Act was fully implemented into statute in October 2007,
containing five guiding principles:
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A person is to be assumed to have capacity unless it is established that they
lack capacity
A person is not to be treated as unable to make a decision unless all
practicable steps to help him to do so have been taken without success
A person is not to be treated as unable to make a decision merely because he
makes an unwise decision
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 best interest
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
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All capacity assessments are to be decision specific - a person may have capacity to
make some decisions and not others, and a decision relating to capacity must not be
based on a person’s age, appearance, diagnosis or behaviour
In direct relation to the safeguarding of an adult at risk, all adults must give valid
consent to the safeguarding process
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If an adult is unable to consent to the process due to a lack of capacity to
make the decision in accordance with the Mental Capacity Act 2005, the
referrer must evidence a best interest decision to make the alert
If the person has mental capacity and withholds consent, a decision is
required to identify if the alert can be made in the greater public interest
If a person with capacity refuses consent and the risk does not warrant
referral in the public interest this decision would be recognised as a potentially
unwise decision in accordance with the Mental Capacity Act 2005
We will fully document all discussions and decisions in relation to safeguarding
concerns.
Transitions from children’s services into adults
Robust joint working arrangements between children’s and adult services need to be
put in place to ensure that the medical, psychosocial and vocational needs of
children leaving care are addressed as they move to adulthood. Young people who
have been looked after by the local authority as a child will remain the responsibility
of children’s services until they are 21. However, where someone is over 18, still
receiving children’s services and a safeguarding issue is raised, the matter should be
dealt with as a matter of course by the adult safeguarding team. The care needs of
the young person should be at the forefront of any support planning and require a
coordinated multi-agency approach. Assessments of care needs at this stage
should include issues of safeguarding and risk. Care planning needs to ensure that
the young adult’s safety is not put at risk through delays in providing the services
they need to maintain their independence and wellbeing and choice. However it must
be noted that not all children who receive a service from children’s services will be
eligible for a service from adult social care.
Good practice includes:
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Having policies and procedures which support effective transition processes
Shifting the general view of risk as a potential danger for a child to one of
potential opportunity, but acknowledging potential risks for an adult
Managing risks as a phased process with awareness of the psychological and
emotional issues
Managing family expectations (being clear about the level of support and
resources available)
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Taking time to get to know the young person and their family, especially if
they have communication difficulties
Acknowledging the rights of adults to take more responsibility for their
decisions
The overall approach in West Cheshire
As the strategic lead for adult safeguarding across the borough, the Local
Safeguarding Adults Board recognises that the most effective way to safeguard
adults at risk is for a wide range of partner organisations to work together on both
prevention and investigation activities. It needs to adapt and develop to take
account of growing national interest in adult protection - even more so following the
introduction of the Care Act - and evolving best practice.
The existing Board members have agreed to raise awareness in their respective
organisations to ensure that their own staff who have responsibility for the care and
support of adults at risk in West Cheshire work towards the early identification and
prevention of abuse, and the promotion of all working practices that seek to minimise
the risk of abuse and neglect.
All partners are committed to the principles and objectives contained within this
Policy document and recognise their responsibilities - and accountability - for
meeting legal requirements, national guidance and the adoption of best practice in
relation to safeguarding adults.
Monitoring and review of this Policy
This policy and the accompanying procedures and guidance are reviewed annually
to ensure they reflect national guidance, legislative changes and best practice.
Further, this review will involve a systematic analysis of abuse cases in order to help
in the prevention of further cases of abuse, to identify particular trends or issues that
have arisen that require more coordinated and systematic interventions and to
ensure that improvements in procedures and processes can be made on a
continuous basis
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Reporting allegations, concerns or suspicions of abuse (see appendix 1
flowchart)
If you see, hear or suspect that an adult is at risk of abuse or neglect, or you are an
adult at risk, please contact us. Information can be given in confidence:
Email:
accesswest@cheshirewestandchester.gov.uk
Telephone: Gateway Team
0300 123 7034
Emergency Duty Team (out of office hours)
01244 977277
Police (non-emergency) 999 / 101 (non-emergency)
For all other general safeguarding enquiries, please use:
Email:
SafeguardingAdults@cheshirewestandchester.gov.uk
Telephone: 0300 123 8 123
How decisions are made about whether the allegation should be dealt with under the
safeguarding procedures or other processes can be found in the thresholds
document appendix 2.
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APPENDIX 1 ADULT ABUSE – FLOWCHART
Concern, Allegation, Disclosure or Suspicion of Abuse
Alerter/first person dealing with situation
Is the person in immediate danger?
If NO, ensure person and any other
vulnerable adults are safe
If YES, Ring 999 and get
immediate medical
attention/report any
suspected crime to the police
(101)
Ring Line Manager and refer to own policy/procedures if
available
Preserve evidence (if there is any)
Record and date any information. This should be as soon as
possible and should be what you saw and heard using service
users own words, date and sign. Do not question person unless
it’s needed to assess immediate situation. (Do not discuss with
family or alleged perpetrator.)
Manager Responsibilities
Ensure all the above has been carried
out
Ring Adult Social Care – Gateway
team - 0300 123 7034
Do not fax as the person may not be
there
Out of hours – 01244 977277
Decision to suspend member of
staff?
Decision must be made by Senior
Manager
Decision to inform family?
If family may be involved NO. If the
person has capacity to consent,
check with them for consent. If
person does not have capacity a
“best interest” decision needs to be
made.
Inform CQC if regulated service
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APPENDIX 2 Thresholds for initiating Safeguarding Procedures
Protecting people from abuse, harm and exploitation in Cheshire West and Chester
is one of the Council’ and its partner’s key priorities. With an increasing number of
referrals and budgetary constraints it is important to ensure that resources are
targeted to make the most effective use of them. However, establishing whether
abuse has taken place is not always straightforward. This section in the procedures
aims to support/guide frontline managers and staff to distinguish between poor
practice and abuse. Where poor practice is felt to have occurred, it may be more
practicable for the provider to take appropriate action. Where abuse is identified, the
safeguarding procedures should be implemented.
On receiving a safeguarding alert, it is important to determine whether it is
appropriate for the concern to be dealt with under safeguarding procedures. Before
safeguarding procedures are initiated, some questions must first be considered:
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does the possible abuse relate to an adult at risk? (please see the safeguarding
policy for eligibility)
does the adult have capacity to consent to what has occurred, but if so did they
do so under duress?
is there evidence of wilful neglect?
has the adult experienced significant harm? Significant harm is defined as "…illtreatment (including sexual abuse and forms of ill treatment that are not physical);
the impairment of, or an avoidable deterioration in, physical or mental health; and
the impairment of physical, emotional, social or behavioural development". [Law
Commission 1995]
What degree of abuse justifies intervention through Safeguarding Procedures?
In determining what degree of harm justifies intervention through Safeguarding
Procedures, the factors to consider will include:
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the vulnerability of the victim
balance of power between victim and alleged perpetrator
capacity of victim and perpetrator
the nature and extent of the harm caused
the impact on the person
whether the harm caused constitutes a criminal offence
whether others (adults or children) are at risk
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It is important to note that abuse may not be deliberate or intentional. However,
where significant harm has occurred as a result of an act or omission, whether
intentional or not, then Safeguarding Procedures should be initiated.
Determining whether or not abuse of a person has taken place is not always a
straightforward matter, particularly when the concerns relate to neglect. A judgment
will be required about whether an act or an act of omission has caused significant
harm. We need to differentiate between an accident, complaint or abuse.
For example.
Mrs Jones lives in a care home, she has fallen over and broken her arm. The staff at
the home have a plan in place to minimise falls for Mrs Jones, but she has still fallen.
This will be classed as an accident; it still needs looking into but because there is no
evidence of deliberate harm/omission of care the home manager will be expected to
investigate.
It would be safeguarding if the following had happened.
Mrs Jones lives in a care home, she says that she was handled roughly by the carer, and
she slipped and fell, she is badly bruised, but no fractures. This will be classed as neglect
and will looked at under safeguarding – this will be investigated by the Local Authority.
It is very important that these arrangements (Strategy discussion and Strategy
meeting) are triggered if there is a possibility that abuse has occurred. Some very
serious abuse only comes to light because people raising the alert have drawn the
attention of social care or police to what may appear to be relatively minor concerns.
In some cases it is the repetition of minor actions or omissions that collectively will
amount to abuse. The expectation in the Cheshire West and Chester multi-agency
Safeguarding Adults Procedures of anyone suspecting abuse is if in doubt report.
However, there will be occasions when it is appropriate for provider agencies to
respond to incidents of poor practice without the need to initiate multi-agency
Safeguarding Procedures. Poor practice will always require a response because if
not challenged it can result in a further deterioration in standards leading to longerterm difficulties or even catastrophic consequences for some individuals. However,
in many instances the Provider Manager will be the appropriate person to take
appropriate action.
The following Guidance may be used to assist in distinguishing between poor
practice i.e. failure to meet a service user’s care needs, which should be managed
by a provider agency and abuse which should trigger Safeguarding Procedures. The
following table illustrates examples of circumstances in which investigations should
13
be led by providers and those which should be led by Adult social care teams;
please note this is not an exhaustive list.
Area of concern
1.Failure to provide
assistance with food/
drink
2.Failure to provide
assistance to
maintain continence
3. Failure to seek
assessment/follow
pressure area care
plan
Provider-led investigation
Poor practice which requires actions by a
provider organisation e.g. homes, ward or
domiciliary care manager
Person does not receive necessary help to
have a drink/meal.
If this happens on one or two occasions and
no significant harm occurs and a reasonable
explanation is given e.g. unplanned staffing
problem, emergency occurring elsewhere in
the home, dealt with under staff disciplinary
procedures; would not be referred under
safeguarding adult’s procedures.
Action: provider manager to take
appropriate action and complete ‘report
on low level incidents’ – send to Adult
safeguarding team.
Person does not receive necessary help to
get to toilet to maintain continence or have
appropriate assistance such as changed
incontinence pads
If this happens once or twice and a
reasonable explanation is given e.g.
unplanned staffing problem, emergency
occurring elsewhere in the home, dealt with
under staff disciplinary procedures; would not
be referred under safeguarding adult’s
procedures.
Action: provider manager to document
and deal with appropriately – as above.
Adult Social Care led investigation
Possible abuse which requires reporting as
such, and the instigation of Safeguarding
procedures
Person does not receive necessary help to have
drink/meal and this is a recurring event, and the
person has come to harm due to the omission.
Person known to be susceptible to pressure
ulcers has not been formally assessed with
respect to pressure area management but no
discernible harm has arisen.
Unable to demonstrate that the staff conducted the
following;
 evaluated the persons pressure ulcer risk
factors
 failure to put in place appropriate care plan
to reduce risks
 failure to act on the care plan
 failure to evaluate when risk factors change
Harm: malnutrition, dehydration, constipation, tissue
viability problems
Action: manager to make safeguarding referral
Person does not receive necessary help to get to
toilet to maintain continence and this is a recurring
event, or is happening to more than one person –
neglectful practice, may be evidence of institutional
abuse and would prompt a safeguarding
investigation
Harm: pain, constipation, loss of dignity, humiliation,
severe skin problems
Action: manager to make safeguarding referral
Harm: avoidable tissue viability damage.
4. Medication not
administered
Action: provider manager to document
and deal with appropriately – as above.
Person does not receive medication as
prescribed on one or two occasions but no
significant harm occurs.
Internal investigation should be undertaken,
possible disciplinary action depending on
severity of situation including type of
medication.
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Action: manager to make safeguarding referral
Person does not receive medication as a recurring
event, medication is missed deliberately or person
is over medicated, resulting in harm.
Neglectful practice, regulatory breach, breach of
professional code of conduct if nursing care
provided. Dependant on degree of harm, possible
criminal offence. Safeguarding procedures should
be implemented.
Area of concern
Provider-led investigation
Poor practice which requires actions by a
provider organisation e.g. homes, ward or
domiciliary care manager
Action: provider manager to document
and deal with appropriately – as above.
5.Moving and
handling procedures
not followed
Appropriate moving and handling procedures
not followed but person does not experience
harm.
Provider acknowledges departure from
procedures and inappropriate practice and
deals
with
this
appropriately
under
disciplinary procedures, to the satisfaction of
person involved.
Action: provider manager to document
and deal with appropriately – as above.
6. Failure to provide
support to maintain
mobility
Adult Social Care led investigation
Possible abuse which requires reporting as
such, and the instigation of Safeguarding
procedures
Avoidable harm occurs: avoidable symptoms due to
omissions in care.
Action: manager to make safeguarding referral
Frequent failure to follow correct moving and
handling procedures, or frequent failure to follow
moving & handling procedures make this likely to
happen.
Neglectful practice, regulatory breach, breach of
professional code of conduct if nursing care
provided. Dependant on degree of harm, possible
criminal offence. Safeguarding procedures should
be implemented
Harm: Injuries such as falls and fractures, skin
damage, lack of dignity, loss of confidence for the
person
Action: manager to make safeguarding referral
Person not given recommended assistance to
maintain mobility on one or two occasions.
Recurring event, or is happening to more than one
adult resulting in avoidable harm
Action: provider manager to document
and deal with appropriately – as above.
Harm: could include falls, pressure ulcers.
Action: manager to make safeguarding referral
7. Failure to provide
medical care
8. Inappropriate
comments from staff
Vulnerable adult in pain or otherwise in need
of medical care such as dental, optical,
audiology assessment, foot care or therapy
does not on one occasion receive required
medical attention in a timely manner.
Failure to follow care plan, deliberate missed
appointments.
Action: provider manager to document
and deal with appropriately – as above.
Harm: pain, distress, deterioration in health
Person is spoken to in a rude, insulting,
humiliating or other inappropriate way by a
member of staff. They are not distressed and
this is an isolated incident.
Provider takes appropriate action, to the
satisfaction of the person involved.
Person is frequently spoken to in a rude, insulting,
humiliating or other inappropriate way or it happens
to more than one person. Regime in a care home
doesn’t respect people’s dignity and staff frequently
use derogatory terms and are abusive to residents.
Regulatory breach - refer under safeguarding
procedures.
Harm: demoralisation, psychological distress, loss
of self-esteem
Action: manager to make safeguarding referral
Action: provider manager to document
and deal with appropriately – as above.
9.Significant need not
addressed in Care
Plan
Person does not have within their Care
Plan/Service Delivery Plan/Treatment Plan a
section which addresses a significant
15
Failure to recognise the deterioration/seek medical
opinion.
Action: manager to make safeguarding referral
Failure to specify in a patient/client’s Plan how a
significant need must be met. Inappropriate action
or inaction related to this results in harm such as
Area of concern
Provider-led investigation
Poor practice which requires actions by a
provider organisation e.g. homes, ward or
domiciliary care manager
assessed need, for example:
Adult Social Care led investigation
Possible abuse which requires reporting as
such, and the instigation of Safeguarding
procedures
injury, choking etc.

Management of behaviour to protect
self or others.
 Liquid diet because of swallowing
difficulty.
 Bed rails to prevent falls and injuries
but no harm occurs.
Action: manager to make safeguarding referral
Action: provider manager to document
and deal with appropriately – as above
10.Care/support Plan
not followed
Person’s needs are specified in Treatment or
Care/Support Plan. Plan not followed, need
not met as specified but no harm occurs.
Action: provider manager to document
and deal with appropriately – as above.
11. Failure to respond
to person’s mental
health needs
Vulnerable adult known to mental health
services is identified as being at risk.
Previous risk assessment identifies same day
response is required. Response is not made
that day but no harm occurs.
Action: provider manager to document
and deal with appropriately – as above.
12. Person deprived
of liberty without
referral for
Deprivation of Liberty
Safeguards
Failure to address a need specified in adult’s plan
results in harm. This is especially serious if it is a
recurring event or is happening to more than one
adult.
Action: manager to make safeguarding referral
Patient is known to be high risk, a timely response
is not made and harm occurs.
Harm: physical injury, emotional distress, death
Action: manager to make safeguarding
referral/may need to refer to CWAC serious case
review policy.
Person has been formally assessed under the
Mental Capacity Act and lacks capacity to
recognise danger e.g. from traffic. Steps
taken to protect them are not ‘least
restrictive’. Steps need to be reviewed and
referral for Deprivation of Liberty Safeguards
may be required.
Restraint/possible deprivation of liberty is occurring
or has occurred (e.g. bed rails, locked doors,
medication) and vulnerable adult has not been
referred for a Deprivation of Liberty Safeguards
assessment although this had been recommended.
Best interest has been ignored or presumed.
Unlawful DoL has occurred).
Action: provider manager to document
and deal with appropriately – as above.
Harm: Loss of liberty and freedom of movement,
emotional distress
Action: manager to make safeguarding
referral/contact mental capacity co-ordinator
13. Inappropriate
discharge from
hospital
Vulnerable patient is discharged from
hospital without adequate discharge planning
involving assessment for care/therapeutic
services, procedures not followed but no
harm occurs.
Vulnerable patient is discharged without adequate
discharge planning, procedures not followed and
experiences harm as a consequence.
Action; provider manager to document
Action: manager to make safeguarding referral
16
Avoidable Harm: care not provided resulting in risks
and/or deterioration in health and confidence;
avoidable re-admission
Area of concern
Provider-led investigation
Poor practice which requires actions by a
provider organisation e.g. homes, ward or
domiciliary care manager
and deal with appropriately – as above.
Adult Social Care led investigation
Possible abuse which requires reporting as
such, and the instigation of Safeguarding
procedures
14. Domiciliary care
visit missed
Person does not receive a scheduled
domiciliary care visit and no other contact is
made to check on their well-being, but no
harm occurs.
Provider deals with this appropriately through
internal investigation, to the satisfaction of
person involved.
Person does not receive scheduled domiciliary care
visit(s) and is unable to call for assistance/help, no
other contact is made to check on their well-being
resulting in serious harm.
Action: provider manager to document
and deal with appropriately – as above.
Action: manager to make safeguarding referral
One vulnerable adult verbally abuses
‘taps’ or slaps another vulnerable adult
has left no mark or bruise, victim is
intimidated and significant harm has
occurred.
Predictable and preventable (by staff) incident
between two vulnerable adults where an injury
requiring medical attention is required.
15. Abuse of a service
user by another
service user
16. A vulnerable adult
with unstable mental
health makes
allegations against
staff or fellow
residents/patients
that appear
unrealistic/false.
or
but
not
not
Harm: physical injury, psychological distress
Action: provider manager to document
and deal with appropriately – as above.
Action: manager to make safeguarding referral
Person is unwell and makes allegations that
appear false e.g. staff are trying to poison me
with medication. Or person X has assaulted
me - they were not on duty at that time.
There is no clear evidence docum3ented or
otherwise of a mental health presentation that
supports the view that the allegation is false.
That there is clear and documented evidence
supported by assessment that the allegations
are due to the person’s mental health
symptoms and no harm has occurred.
Or the person makes an historical allegation when
they are well.
That a doctor and another qualified member
of staff responsible for the person’s care are
able to confirm this. Any plans to support this
are clear and reviewed regularly.
Action: provider manager to document
and deal with appropriately – as above.
Action: provider manager/hospital staff make a
safeguarding referral.
Missed visits that don’t have serious impact to health and wellbeing still need to be
addressed. It is the responsibility of the provider manager to take the necessary
action, which should be to the satisfaction of the service user/and their
families/carers. If they are dissatisfied, then they may want to follow the complaints
procedure.
17
What should I do if I am unsure?
If after considering the threshold document you are still unsure as to whether you
need to instigate the safeguarding process, then you can discuss it with your
manager or contact the Gateway team (0300 123 8 7034) for clarification. Always
remember that if in doubt initiate Safeguarding Procedures.
If it is not Safeguarding is there anything else I should do?
The importance of recording and monitoring concerns you become aware of needs
to be highlighted here. If you have concerns which do not come under safeguarding
procedures you can contact:



Contract Team if the concern is with a domiciliary care agency or care home
Complaints department
Commissioning Team if the concern relates to the conduct of a commissioned
service
It is also important to record your concerns within your own notes and to discuss
these concerns in supervision with your line manager. This is essential as some very
serious issues have been brought to light because we have been notified of the
repetition of minor actions or omissions that collectively amounted to significant
abuse. If you do not instigate a safeguarding referral, please complete the electronic
template which has been sent out (if you do not have access to this, please call 0300
123 7034 and ask for a copy to be emailed to you).
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APPENDIX 3 Possible indicators of abuse
The list below are purely indicators
The list below provides concrete examples within each category and a range of
indicators, which may suggest abuse. The presence of one or more does not
necessarily confirm abuse, however, the existence of a number of indicators may
suggest a potential for abuse and will need further assessment.
Physical Abuse:
Is the physical ill treatment of an adult, which may or may not cause physical injury.
This includes pushing, shaking, pinching, slapping, punching and force-feeding.
Physical Abuse Possible Indicators:
1
Injuries that are not explained satisfactorily.
2
Person exhibiting untypical self-harm.
3
Unexplained bruising to the face, torso, arms, back, buttocks and thighs in
various stages of healing. Collection of bruises that form regular patterns
which correspond to the shape of an object, or which appear on several areas
of the body.
4
Unexplained burns on unlikely areas of the body, e.g. soles of the feet, palms
of the hands and back, immersion burns, rope burns, burns from an electrical
appliance.
5
Unexplained or inappropriate fractures at various stages of healing to any part
of the body.
6
Unexplained cuts or scratches to the mouth, lips, gums, eyes or external
genitalia.
7
Medical problems that go unattended.
8
Sudden unexplained urinary and faecal incontinence.
9
Evidence of over or under medication.
10
Person flinches at physical contact.
11
Person appears frightened or subdued in the presence of particular people.
12
Person asks not to be hurt.
13
Person may repeat what perpetrator has said, e.g. shut up or I’ll hit you.
14
Reluctance to undress part of the body.
15
Person wears clothes that cover all parts of their body or specific parts of their
body.
19
Sexual Abuse:
Is any form of sexual activity that the adult does not want and to which they have not
consented, or to which they cannot give informed consent.
Any sexual relationship that develops between adults where one is in a position of
trust, power or authority in relation to the other, for example, day centre worker/social
worker/residential worker/health worker etc will be regarded as sexual abuse.
Sexual abuse includes, rape, incest and situations where the perpetrator touches the
abused person’s body, (e.g. breasts, buttocks, genital area), exposes his or her
genitals (possibly encouraging the abused person to touch them), coerces the
abused person into participating in or watching pornographic videos or photographs.
Sexual Abuse Possible Indicators:
1
The person discloses either fully or partly that sexual abuse is occurring, or
has occurred in the past.
2
Person has urinary tract infections, vaginal infections or sexually transmitted
diseases that are not otherwise explained.
3
Person appears unusually subdued withdrawn or has poor concentration.
4
Person exhibits significant change in sexual behaviour or outlook.
5
Person experiences pain, itching or bleeding in genital/anal area.
6
Person’s underclothing is torn/stained or bloody.
7
A woman who lacks the mental capacity to consent to sexual intercourse
becomes pregnant.
Financial Abuse:
Is the exploitation, inappropriate use, or misappropriation of a person’s financial
resources or property.
This includes the withholding of money or unauthorised or improper use of a
person’s money or property, usually to the disadvantage of the person to whom it
belongs.
Financial Abuse Possible Indicators:
1
Lack of money especially after benefit day.
2
Inadequately explained withdrawals from accounts.
3
Inadequately explained inability to pay bills.
4
Disparity between assets, income and living conditions.
5
Power of Attorney obtained when the person lacks capacity to make this
decision.
20
6
Recent changes of deeds/title of house.
7
Recent acquaintances expressing sudden or disproportionate
interest in the person and their money.
8
Personal possessions being systematically removed from the
home
Neglect:
The deliberate withholding or unintentional failure to provide help or support which is
necessary for the adult to carry out activities of daily living.
Neglect also includes a failure to intervene in situations that are dangerous to the
person concerned or to others particularly when the person lacks the mental capacity
to assess risk.
Neglect Possible Indicators:
1
Person has inadequate heating and or lighting.
2
Person’s physical conditions/appearances poor, e.g. ulcers, pressure sores,
soiled or wet clothing.
3
Person is malnourished, has sudden or continuous weight loss, and is
dehydrated.
4
Person cannot access appropriate medication or medical care.
5
Person is not afforded appropriate privacy or dignity.
6
Person and or carer has inconsistent or reluctant contact with health and
social services.
7
Callers/visitors are refused access to the person.
8
Person is exposed to unacceptable risk.
Psychological Abuse:
This may be intentional or unintentional; it may involve the use of intimidation,
indifference, hostility, rejection, threats, humiliation, shouting, swearing or the use of
discriminatory and/or oppressive language, which results in:
(a)
Adults' choices, opinions and wishes being negated.
(b)
The adult becoming isolated or over dependent.
Psychological abuse includes the denial of a person’s human and civil rights
including choice and opinion, privacy and dignity and being able to follow one’s
spiritual and cultural beliefs or sexual orientation.
21
It includes preventing the adult from using services that would otherwise support
them and enhance their lives. Furthermore, it includes the intentional and/or
unintentional withholding of information, e.g. information not being available in
different formats/languages etc.
Psychological Abuse Possible Indicators:
1
Typical ambivalence, deference, passivity, resignation.
2
Person appears anxious or withdrawn, especially in the presence of the
alleged perpetrator.
3
Person exhibits low self-esteem.
4
Person rejects his or her own cultural background or racial origin.
5
Untypical changes in behaviour, e.g. continence problems, sleep disturbance.
6
Person who is not allowed visitors/phone calls.
7
Person who is locked in a room in their home.
8
Person who is denied access to aids or equipment, e.g. glasses, hearing
aid/crutches etc.
9
Person’s access to personal hygiene and toilet is restricted.
10
Person’s movement is restricted by use of furniture or other equipment.
Be aware that every other category of abuse will almost inevitably involve elements
of psychological abuse. Signs of psychological abuse may well be indicative of other
forms of abuse taking place
Discriminatory Abuse: (including hate crime)
Discriminatory abuse exists when values, beliefs and culture result in a misuse of
power that denies opportunity to individuals or groups. It can be motivated by race,
gender, disability, religion, sexuality, culture or ethnic origin. A person may be
exploited/targeted by others whom perceive them as ‘vulnerable’ due to one or more
of the above factors.
Discriminatory Abuse Possible Indicators:
1
Lack of opportunities including access to health, social and leisure facilities
2
Lack of access to the criminal justice system
Hate crime is defined as any incident that is perceived by the victim, or any other
person to be racist, homophobic, transphobic due to the person’s religion, belief,
gender identity or disability. This can include incidents such as anti-social behaviour
which do not always constitute a criminal offence.
22
Incidents of anti-social behaviour against ‘ vulnerable’ adults need to be recognised
at an early stage and multi-agency strategies in place to prevent incidents
escalating. In CWAC the anti-social behaviour multi-agency panel meet on a regular
basis, anyone whom an agency is concerned about should be referred to the panel
through their organisational representative.
Hate Crime Possible Indicators:
1
Damage to property
2
Fear of going outside own home
3
Name calling/harassment abuse
4
Repeat calls to statutory agencies such as police, social care and health
Institutional Abuse:
This can be defined as abuse or mistreatment by a regime as well as by individuals
within any building, where care is provided.
Institutional Abuse Possible Indicators:
1
Lack of flexibility/choice
2
No opportunity for drinks or snacks
3
Lack of choice re consultation over meals
4
Pressure sores
5
Person is unkempt and smells
6
Over use of communal items and communal personal toiletries
7
Restraint
8
Lack of procedures for financial management
9
Staff member has a history of moving jobs
10
Lack of privacy, including editing of mail, restricting visits, control of phone
11
Derogatory remarks overheard
12
Public discussion of personal matters
13
Inadequate or delayed response to medical requests
14
Missing documentation
15
Entering rooms without knocking/seeking permission
16
Staff overly controlling relationships with service users
17
Service users abusive to staff and other service users.
23
Self neglect:
This covers a wide range of behaviour neglecting to care for one’s personal hygiene,
health or surroundings and includes behaviour such as hoarding.
Self neglect Possible Indicators
1
2
3
Lack of self care, including personal hygiene, nutrition, hydration and general
health
Lack of care for personal environment, including situations that may lead to
domestic squalor or elevated levels of risk in the domestic environment
Refusal of services that might alleviate these issues, including care
assessments and/or interventions which could potentially improve self care or
care of the person’s environment
Forced marriage:
Forced marriage is a term used to describe a marriage in which one or both of the
parties is married without their consent or against their will. A forced marriage differs
from an arranged marriage, in which both parties consent to the assistance of their
parents or a third party in identifying a spouse.
The guidance contained in the multi-agency practice guidelines, Handling cases of
forced marriage(Home Office, 2009),recommends that cases involving forced
marriage are best dealt with by child protection or ‘adult protection’ specialists.
In a situation where there is concern that an adult at risk is being forced into a
marriage they do not or cannot consent to, there will be an overlap between action
taken under the forced marriage provisions and the Safeguarding Adults process. In
this case action will be coordinated with the police and other relevant organisations.
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Exploitation by radicalisers who promote violence:
Individuals may be susceptible to exploitation into violent extremism by radicalisers.
Violent extremists often use a persuasive rationale and charismatic individuals to
attract people to their cause. The aim is to attract people to their reasoning, inspire
new recruits, embed their extreme views and persuade vulnerable individuals of the
legitimacy of their cause.
There are a number of factors that may make the individual susceptible to
exploitation by violent extremists. None of these factors should be considered in
isolation but in conjunction with the particular circumstances of the individual: identity
or personal crisis, particular personal circumstances, unemployment or
underemployment and criminality. All of these may contribute to alienation from UK
values and a decision to cause harm to symbols of the community or the state.
The Home Office leads on the Counter-Terrorism Strategy, CONTEST, and
PREVENT is part of the overall CONTEST Strategy, aiming to stop people becoming
terrorists or supporting violent extremism. Local safeguarding structures have a role
to play for those eligible for adult protection.
The CHANNEL project is a key element of the Prevent strategy. It is a multi-agency
approach to protect people at risk from radicalisation. Channel uses existing
collaboration between local authorities, statutory partners (such as the education and
health sectors, social services, children’s and youth services and offender
management services), the police and the local community to:
• identify individuals at risk of being drawn into terrorism;
• assess the nature and extent of that risk; and
• develop the most appropriate support plan for the individuals concerned.
25