January 2013 1

St Helens Multi-Agency Adult Safeguarding

ProceduresJanuary 2013 edition

   Foundation Training

January 2013 2

Introductions

January 2013 3

Housekeeping

• Fire exit• Toilets • Room temperature• Mobile phones “please turn off or silence”• Be confidential• Take care – today can be sensitive. • Respect others talking/making points• Get involved in discussions • Breaks, refreshments and light buffet are available

January 2013 4

ProgrammeARRIVAL & REFRESHMENTS9.30 Introductions

Safeguarding in St HelensKey definitionsTypes of abuseFactors associated with Adult AbuseIdentifying the signs & indicators of abuseBREAKSt Helens Safeguarding Adults ProceduresHow to make an alertKey information when reporting abuseLUNCHDisclosureSafeguarding investigationsUnderstanding who has responsibility to investigateRoles & responsibilitiesCase studiesBREAKAssessment

4.30 FINISH

January 2013 5

Learning Objectives

By the end of the day participants will:

1. understand key definitions relevant to St Helens Safeguarding Procedures

2. define the different types of abuse3. identify the signs and/or symptoms associated with

each type of abuse4. explain the actions to take, if a suspicion or allegation

of abuse occurs, following the St Helens model5. understand key information to be included when

reporting abuse6. understand the roles, responsibilities and boundaries

of the worker with regard to safeguarding vulnerable adults

January 2013 6

 

Safeguarding in St Helens

January 2013 7

Values and Beliefs

St Helens Multi-Agency Safeguarding Adults Policy 2013 has been developed in the recognition that Vulnerable

Adults can be abused and that the abuse of Vulnerable Adults constitutes a clear infringement of

their human and civil rights.

January 2013 8

All partners share the following values which underpin their work:

• Everybody within our society deserves, and is entitled to,good quality care and support to meet their needs.

• Some people have difficulty expressing their needs and require careful consideration of their individual circumstances.

• Everybody has the right to live in a safe and secure environment without fear of abuse, harassment or injury.

• Everybody has a right to live as independently as they are able.

• Everybody has a right to make choices and decisions about their lifestyle which can involve risk-taking.

• Everybody should have access to relevant services for addressing issues of abuse and neglect, including the civil and criminal justice system and victim support services.

January 2013 9

Mission Statement

The partners of St Helens Safeguarding Boardrecognise the rights of the individual to live a life

free from abuse and neglect

January 2013 10

What is Adult Safeguarding?

Discuss in groups:

• What is Adult Safeguarding?• Who is a Vulnerable Adult?• What is Abuse?

Assign someone to write and someone to give feedback

January 2013 11

 

Key Definitions

January 2013 12

Adult Safeguarding

Within St Helens Multi-Agency Procedures, AdultSafeguarding is taken to mean actions to redress

actual abuse, or provide additional security,whilst an allegation is investigated.

January 2013 13

Defining a Vulnerable Adult

The definition of a Vulnerable Adult, in terms ofthe St Helens Multi-Agency Policy 2013, is:

“An adult who is in receipt of, or may be eligible for, Community Care Services”

Association of Directors of Adult Social Services (ADASS) 2005

January 2013 14

Vulnerable Adults may be people who have:

• learning disabilities• physical disabilities• sensory impairment• mental illnesses, including Dementia• physical or mental frailty due to age or

illness

January 2013 15

Defining Abuse

The definition of abuse, used in the guidance “No Secrets”, is:

“Abuse is a violation of an individual’s human and civil rights by any other person or

persons”

January 2013 16

 

Types of Abuse

January 2013 17

Types of Abuse

• Physical• Sexual• Emotional/Psychological• Financial• Neglect• Discriminatory• Institutional

Identified by No Secrets (Department of Health, 2000)

January 2013 18

Identifying the signs and indicators of abuse

Discuss in groups the signs and indicators, youmight become aware of, for each type of abuse

January 2013 19

 

Indicators of Abuse

January 2013 20

Physical Abuse

Physical maltreatment of one person by another who maybe in a position of power over the victim. This includes:

• hitting, slapping, pinching, pushing, hair pulling

• inappropriate restraint or sanctions• necessary aids and adaptations, including

glasses and hearing aids, being withdrawn• physical intimidation• improper use of, or forcible administration of,

medication• force feeding

January 2013 21

Indicators of Physical Abuse

• Unexplained injury or injury inconsistent with explanation

• Marks, bruises, burns, scalds• Persistent pressure sores or ulcers• Being excessively withdrawn or compliant• Appearing frightened of/avoiding physical

contact• Injuries at different stages of healing• Covering up parts of the body

January 2013 22

Sexual Abuse

Involvement in sexual activities or relationships which:• individuals do not want or cannot understand and/or

have not consented to.• takes place within a family, care-giving or other power

relationship ie involves an element of coercion.• Forced Marriage

This can include harassment, inappropriate teasing orinnuendo, indecent exposure, touching, masturbation,penetration, intercourse and being forced to participate(actively or passively) in any activities which may bedeemed to be pornographic.

January 2013 23

Indicators of Sexual Abuse

• Torn, stained or disarranged clothing• Bruises, pain bleeding or unexplained discharges• Inappropriate sexual behaviour eg overly seductive• Ill-health eg discharges and infections• Vulnerable adult appears withdrawn• Pregnancy in a female who is unable to give consent

to sexual relations• Reluctance of person to be alone with an individual

known to them• Fear of staff providing help with undressing, bathing

etc

January 2013 24

Psychological/Emotional Abuse

This includes the use of threats, fear or bribes to negatethe person’s choices and independent wishes or persistent,negative or derogatory behaviour. It can include:

• Intimidation by shouting or screaming• Ignoring requests or conversation• Humiliation• Withholding of necessary assistance• Denial of requests, choices and opinions or privacy• Denial of access to friends and family• Denial of religious or cultural needs• Radicalisation/recruitment to violent extremism

January 2013 25

Indicators of Psychological/Emotional Abuse

• Alteration of psychological state eg withdrawal, depression• Cowering or fearfulness• Deliberate self-harm• Strain or broken relationships• Disturbed sleep• Weight change• Aggressive or challenging behaviour• Poor concentration• Indicators of radicalisation/recruitment to violent extremism

• Change of faith• Change of appearance• Talk about another person who seems to have a lot of influence• Associating with a limited number of people

January 2013 26

Financial and Material Abuse

The deliberate exploitation or manipulation of the person’slegal or civil rights, including misappropriation of moniesor property. This includes:• money being borrowed by staff or volunteers who

have a responsibility for providing a service to that person

• the use of money or property without the informed consent of the Vulnerable Adult

• theft• misuse of a person’s money, possessions, property or

insurance or the prevention of access to these• pressurising or deceiving a person to alter their will

January 2013 27

Indicators of Financial and Material Abuse

• Appears that a Vulnerable Adult is being exploited for personal gain• Inability to budget and pay bills that is out of character with

previous behaviour• Large or frequent withdrawals from bank account for unspecified

reasons• Reluctance to buy essential food or clothing items and/or excessive

economies on heating and lighting• Person encouraged to make financial gifts to staff paid to provide

care for them• Sudden disparity between assets and living conditions• Refusal to produce bank statements/books or to allow the holder

access to them• Recent change of deeds or title of house• An appointee using a person’s benefits for their own personal gain

January 2013 28

Neglect

Behaviour on the part of a carer which results in seriousimpairment of health or development of the cared for. Thiscan be deliberate or by default ie when the perpetrator isnot able or willing to provide the care needed or does notrecognise the need for the care to be provided. It caninclude failing to undertake a reasonable assessment ofrisk and allowing a person to harm themselves or causeharm to others. Neglect is a criminal offence (since April2007) under the Mental capacity Act (2005)

January 2013 29

Indicators of Neglect

• Poor physical state of the person – weight loss, dehydration, dirty or unkempt appearance, ignoring medical or physical needs.

• Untreated pressure sores.• Failure to provide access to appropriate health, social care or

educational services.• Marked change in relationship between the Vulnerable Adult and

others.• Marked reluctance by care-givers to co-operate with agencies.• Sole or primary carer is suffering from disabling ill-health which

renders them incapable of meeting the basic needs of the person cared for

• The withholding of the necessities of life, such as medication or adequate heating and clothing, food and drink.

• Unexplained changes in material circumstances.• Inconsistency of explanation.• A significant deterioration in the environment.

January 2013 30

Discriminatory Abuse

This includes:• Racist, ageist, homophobic or sexist abuse• Abuse based on a person’s disability• Harassment or slurs• Not making provision for disability or sensory

impairment• Denying someone the opportunity to attend a place of

worship.

January 2013 31

Indicators of Discriminatory Abuse

• Non-provision of appropriate food, clothing etc• Denial of religious/cultural needs• Acceptance of racist language or language which

denigrates someone’s disability• Lack of respect• Loss of interest, emotional withdrawal and

symptoms of depression• Self-harm• Defensiveness• Aggression or challenging behaviour• By association.

January 2013 32

Institutional abuse

Where abuse of any type results from routines andregimes within care settings which deny people’s rights,choices and opportunities, it is called Institutional Abuse.

Abuse can be caused by weak or oppressive management,inadequate staffing (numbers, competence), inadequatesupervision or support, “closed communication”, lack ofknowledge of Whistle-blowing policies, lack of training

January 2013 33

Indicators of Institutional Abuse

In addition to other indicators, there may be:• Denial of rights• Threats of punishment, loss of personal possessions

or eviction in order to gain compliant behaviour• Denial of food, drink, adequate clothing and/or

suitable living environment• Denial of access to friends, Family, Solicitor, Doctor,

Care Manager etc• Denial of access to money, access to information

about self, information about rights and responsibilities of the management of the home/service

• A culture which does not respect personal dignity.

January 2013 34

Factors associated with Adult Abuse

The most significant factors underlying the abuse andmistreatment of Vulnerable Adults include:• Stress• Psychological or mental health problems• Lack of support• Alcohol or substance misuse• Revenge/anger• Poor understanding/lack of awareness• Premeditated self-interest and self-gratification.

January 2013 35

When is abuse or mistreatment more likely to occur?

• Long history of dysfunctional family relationships where mistreatment of family members has been the norm

• Where paid carers experience the role very negativelyIf carers:• Do not feel supported• Habitually lose their temper – linked to stress• Feel they cannot cope• Perceive the dependent adult as being deliberately awkward• Have to cope with multiple problems in the dependent adult• Habitually act angrily or aggressively• Have diminished communication.

If the Vulnerable Adult:• Hits out at the carer• Has difficulty communicating

January 2013 36

When is abuse or mistreatment more likely to occur? (Cont.)

If the Vulnerable Adult:• Disturbs the carer at night• Has odd and embarrassing behaviour• Is unhelpful or uncooperative• Is deliberately ungratefulOther factors:• Carer has other dependants• Carer is physically or mentally ill, dependant on alcohol

or misuses drugs• Violence is the norm• Poor understanding eg of behaviour or conditions• Role reversal – adult/child caring for a dependent adult• Carer is young/lacks maturity• The Vulnerable Adult has few/no social contacts.

January 2013 37

When is abuse or mistreatment more likely to occur in Residential/Nursing &

Domiciliary Care?In a residential/nursing home and domiciliary care setting,abuse/mistreatment is more likely to occur when the following applies:• Staff feel unsupported and lack confidence in management• Staff turnover is high• Staff are expected to undertake tasks outside their job description • Supervision is tokenistic• Training is minimal• Communication channels are ineffective• Support plans are not clear, complete or available• Social activity and supervision of residents is minimal• Staff feel under pressure to complete tasks quickly• Recording is not robust• Administration of medication is not audited regularly• Specialist equipment is not available• Infection control is poor• Physical hazards such as loose mats, overly hot water, unlit corridors/rooms

are not addressed

January 2013 38

 

How to make an Alert

January 2013 39

Local Context of Safeguarding Adults

St Helens Multi-agency Safeguarding Adults Policy,Procedures and Guidance

We have had 3 procedures in 9 years:-

2001 to 20082008 to 20102010 to 2012January 2013 onwards

January 2013 40

 

Safeguarding Alerts Quiz

January 2013 41

St Helens Safeguarding Adults Procedures

Follow the flowchart:

“How to make a SafeguardingAlert in St Helens”

January 2013 42

St Helens Safeguarding Adults Procedures Applies to all residents of St.Helens, regardless of setting,

i.e. community, hospital or care establishment

Deal with immediate danger (if any) – Call 999 if appropriate

Support and make the Vulnerable Adult as safe as possible

Preserve the evidence (if any, if appropriate)

Report the Abuse - Inform Line Manager/Agency’s Designated Person who must telephone St Helens Council Contact Centre within 1 hour to make a Safeguarding Alert. If Line Manager likely to be unavailable for

more than 1 hour – YOU MUST telephone the alert through yourself

BE ALERT: suspicion, allegation, observation or disclosure

Telephone

St.Helens Council Contact Centre – 01744 676600 (9.00am to 5.00pm – Monday to Friday)

OR Emergency Duty Team (EDT) – 0845 0500 148 outside of the above hours

Make a Record

January 2013 43

Be Alert

• Think about what you see and ask is it acceptable practice

• Always take seriously what you are told• Be suspicious of any signs/signals/non-verbal

communication that could indicate abuse• Create an atmosphere for someone to tell

you what is wrong

January 2013 44

Deal with immediate Danger, if any

• Call 999 for Police or an Ambulance• Danger is where there is a serious, actual

and imminent threat to health/well-being, such as:

– When the person needs urgent medical attention

– When the perpetrator is making threats and is able to commit further abuse

January 2013 45

Support and make the Vulnerable Adult as safe as possible

• Take the person to a place of safety• Provide reassurance only• Offer support, where appropriate• Ensure others are able to provide support• Explain that you will inform your line

manager, unless you believe this will cause the Vulnerable Adult further distress

January 2013 46

Preserve the Evidence

• Evidence can be anything (PPP)– The person – blood, scratches, dirt etc– The place – a room, the garden, a car etc– A piece of property, cutlery, garden objects etc

• Don’t touch, remove or clean any PPP unless absolutely necessary

• Don’t interview the person

January 2013 47

Duty to Report Abuse

• Applies to all St Helens Council employees, staff and volunteers in all Agencies that are signatories to Multi-Agency Procedures or contracted by them to provide a service

• Report suspicions/ allegations/disclosure/observations of abuse to your Line Manager/Agency/Designated Person

• If the Line Manager/Agency Designated Person is likely to be unavailable for more than one hour, YOU MUST report directly to St Helens Council Contact Centre

January 2013 48

 

An Alert must have…..

An Alleged Perpetrator

An Alleged Abuse

An alleged Victim

(Who) (Did what) (To Who)

Or in the case of Neglect…

(Who) (Failed to do what) (To Who)

Line Manager/Agency’s Designated Person MUST check initial facts and consider context

January 2013 49

 

Consider Context

WHO Perpetrator Intention

WHO Victim Impact

WHAT Act or Omission Common

themes/sequence

January 2013 50

 

WHAT- is the allegation, i.e. what did alleged perpetrator do or fail to do to victim

- is the relationship between the alleged victim and alleged perpetrator?- type of alleged abuse is this, i.e. financial, sexual, physical,

emotional/psychological, discrimination, neglect or institutional?

WHERE- does the alleged victim live?

- does the alleged perpetrator live?- did the alleged abuse occur?

WHO- is the alleged victim?

- is the alleged perpetrator? 

WHEN - did the alleged abuse occur - what date / time?

 

Remember - WHO, WHAT, WHERE, WHEN 

TelephoneSt.Helens Contact Centre - 01744 676600 

(9.00am to 5.00pm - Monday to Friday) 

or Emergency Duty Team (EDT) - 0845 0500 148outside of the above hours

 

      

 

Key Information When Reporting Adult Abuse in St Helens

January 2013 51

Make a Record

• Any allegations or suspicions of abuse of a Vulnerable Adult must be recorded the same day/shift within the organisation’s/agency’s recording system that holds the Vulnerable Adult’s personal file/case file/contact records.

• Opinions should not be recorded. If necessary, opinion will be taken as a witness statement later on in the investigation by persons qualified to do so.

• The record must be signed and dated (in black ink, if possible) bearing in mind it may be required later as part of evidence in legal proceedings

January 2013 52

 

Disclosure

January 2013 53

Group Exercise

What barriers would you face in making a disclosure

about abuse from the point of view of a:

• Vulnerable Adult• Family Member• Staff Member

Assign someone to write and someone to give feedback

January 2013 54

 

Safeguarding Investigations

January 2013 55

Investigation Actions

Actions to establish facts, as far as is reasonable andproportionate to the allegation of abuse, will be taken.Initial Investigation Actions may include:• Taking legal advice• Gathering information to establish the basic factsIt may not be necessary to pursue information further wherethe Protection Actions are in place and the Vulnerable Adult issatisfied with the outcome.Formal Investigation Actions may apply in the case of seriousallegations. This includes:• Criminal Procedures• Disciplinary Procedures• Serious Incidents Requiring Investigation e.g. NHS

organisations (Trusts)

January 2013 56

Investigation Actions

Care Management & the Adult Safeguarding Unit are responsible for

Investigations

January 2013 57

 

Roles & Responsibilities

January 2013 58

The role and responsibilities of the worker

• Safeguarding individuals• Recognise potential danger, harm & abuse• Recognise actual danger, harm & abuse• Understand the roles of others• Report• Sources of support• Principles of Care• Supporting service users• Think Family

January 2013 59

Group Exercise

Case Studies

January 2013 60

Safeguarding Adults Assessment

• Please complete the test individually

• Once complete, please pass to the trainer

• Your results and certificates will be sent direct to your line manager within 2 weeks