updated november 20131 st helens multi-agency adult safeguarding procedures january 2013 edition...

Updated November 2013 1

St Helens Multi-Agency Adult Safeguarding

ProceduresJanuary 2013 edition

Refresher Training


Programme for TodayIntroductionsKey definitionsTypes and Indicators of Abuse What makes abuse more likely to occur?

Tea Break

How to make an alertKey Reporting informationRoles and responsibilities


Learning Objectives

By the end of the day participants will be able to:

1. understand key definitions

2. describe the different types and indicators of abuse

3. describe what makes abuse more likely to occur

4. explain how to make a Safeguarding Alert in St Helens

5. understand key information to be included when reporting abuse


1. Key Definitions


Multi Agency Adult Safeguarding in St Helens

Partners agencies include Council, NHS, Police, Voluntary Sector

Partners believe that;

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

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.


Within St Helens Multi-Agency Procedures

• “Adult Safeguarding” is taken to mean actions to redress actual abuse or provide additional security whilst an allegation is investigated”

• A “Vulnerable Adult” is “An Adult who is in receipt of, or may be eligible for community care services”

“No Secrets” (DoH 2000)


Vulnerable Adults include;

• 18 – 64 years Physical illness / disability Learning disability / mental illness

• 65 years plus as above and Frailty / Dementia


Social Care needs are typically met by Services such as;

- Domiciliary Care- Day Care- Careline- Occupational Therapy – aids and adaptations- Supported living/ sheltered accommodation schemes- Residential Care- Residential with Nursing care- Or other arrangements such as Direct Payments / Personal Care Assistants


BUT Vulnerable Adults are:

- more likely to experience abuse

- less likely to be able to recognise and resolve abuse without specialist support

Specialist support is provided via theAdult Safeguarding Procedures

All Adults:

- may experience abuse

eg, Theft Harrassment from neighbours, Domestic violence

Mainstream support is available

eg, Police Community support Domestic violence services Victim


2. Types and Indicators of Abuse


Types of Abuse

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

Identified by No Secrets (Department of Health, 2000)


Identifying the Indicators (signs and/or symptoms) of abuse

GROUP EXERCISEMake a table showing the types and indicators of abuse following the example below.

Type of Abuse

Example Possible

Indicator of abuse

Physical Hitting Bruising


Physical Abuse

This includes:• hitting, slapping, pinching, pushing, hair pulling

• inappropriate restraint or sanctions

• Removal of necessary aids and adaptations, eg.glasses and hearing aids

• improper use medication

• force feeding


Indicators of Physical Abuse

This includes :• unexplained injury or injury

• inconsistent with explanation

• marks, bruises, burns, scalds

• injuries at different stages of healing

• appearing frightened of/avoiding physical contact


Financial and Material Abuse

This includes:• Theft of money or possessions

• 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

• pressurising or deceiving a person to alter their will


Indicators of Financial and Material Abuse

• 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

• Refusal to produce bank statements/books or to allow the holder access to them

• Recent change of deeds or title of house

• Care provision seen solely in terms of expense


Psychological/Emotional Abuse

This can occur alongside other types of abuse and includes:

• Use of threats,fear or bribes• Intimidation by shouting, screaming or swearing• 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


Indicators of Psychological/Emotional Abuse

Significant Changes ;• In behaviour – more withdrawn/more challenging• In sleep pattern – more sleep/less sleep• In Weight – weight gain/weight loss

Indicators of radicalisation/recruitment to violent extremism include;• Changes to faith• Changes to appearance• talk about another person who seems to have a lot of

influence• Associating with a limited number of people


Neglect

• Neglect is where somebody has failed to something for the Vulnerable Adult and this has caused harm

• The carer maybe unable or unwilling to provide the care needed or may not recognise the need for the care to be provided.

• It can include failing to undertake a reasonable assessment of risk and allowing a person to harm themselves or cause harm to others.

• Neglect is a criminal offence (since April 2007) under the Mental capacity Act (2005)


Indicators of Neglect

• Poor environmental conditions

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

• Failure to provide access to appropriate health, social care or other relevant service

• Attitudes of carers lack insight and appear uncaring

• Carer is also a Vulnerable Adult and incapable of meeting the basic needs of the person cared for adequately


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 relationship of trust

• Forced Marriage

This can include harassment, inappropriate teasing or innuendo,indecent exposure, touching, penetration and being forced to

participate (actively or passively) in pornographic activity


Indicators of Sexual Abuse

• ill-health eg discharges and infections

• inappropriate sexual behaviour eg overly seductive

• Vulnerable adult appears withdrawn

• pregnancy in a female who is unable to give consent to sexual relations

• fear /reluctance of person to be alone with an individual known to them


Discriminatory Abuse Discriminatory abuse is a situation where a person or

group of people are treated differently due to perceived differences.

This includes unfair or unequal treatment on the grounds of disability, gender, race,sexual orientation,age etc

Institutional abuse This is abuse of any type that results from routines

and regimes within care settings which deny people’s rights, choices and opportunities


3. What makes abuse more likely to occur?


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 negatively

If the Vulnerable Adult:• Hits out at the carer• Has difficulty communicating • Disturbs the carer at night • Has odd and embarrassing behaviour• Is unhelpful or uncooperative• Is deliberately ungrateful


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

If carers:• Do not feel supported• Habitually lose their temper – linked to stress• Perceive the vulnerable adult as being deliberately

awkward• Carer is physically or mentally ill, dependant on

alcohol or misuses drugs• Role reversal – child caring for a dependent adult• Carer is young/lacks maturity• The Vulnerable Adult has few/no social contacts• Have to cope with multiple problems


RISKSERIOUSNESS

HARMCONTEXT

POOR PRACTICE POSSIBLE ABUSE

Poor Practice versus Possible Abuse

Sometimes difficult to know where to draw the line!


Poor PracticeVA not given evening meal on one occasion

Possible Abuse VA was not given evening meals over the weekend. Said it had happened before.


Poor PracticeMoving and handling procedures are not followed but VA is not harmed

Possible AbuseIdentified moving and handling equipment is not available / VA is badly bruised in transfer from chair to bed


Good PracticeVA had a fall that could not be anticipated or prevented All steps taken to provide medical attention

Possible Abuse VA has a fall on a loose step in the garden / wearing slippers that are too bigNo medical attention sought until 3 days later when hip fracture is established


Possible Abuse One additional dose of medicine administered for 9 days resulting in hospital admission

Poor PracticeOne additional dose of medicine administered in error - Pharmacy advised this would not have any impact


St Helens Safeguarding Adult Procedures


4.How to make a SafeguardingAlert in St Helens

Follow the Flow Chart !


Call 999 if appropriate

TelephoneSt.Helens Council Contact Centre - 01744 676600

(9.00am to 5.00pm - Monday to Friday)

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

Deal with immediate danger (if any)

Support and make Vulnerable Adult as safe as possible

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 is likely to be unavailable for more than 1 hour - YOU MUST telephone the Alert through yourself

BE ALERT: suspicion, allegation, observation or disclosure of abuse

Preserve the evidence (if any / appropriate)

Make a Record

How to Make a Safeguarding Alert in St Helens


Be Alert• Think about what you see and ask is it acceptable practice• Always take seriously what you are told

Deal with immediate Danger, if any• Call 999 for Police or an Ambulance

Support and make the Vulnerable Adult as safe as possible

• Explain that you will inform your line manager, unless you believe this will cause the Vulnerable Adult further distress

Preserve the Evidence• Evidence can be anything (PPP)

– Person – blood, scratches, dirt, clothing– Place – a room, the garden, a car– Property, chequebook, purse, jewellery box, medication,

documents• Don’t touch, remove or clean any PPP unless absolutely necessary• Be supportive but don’t interview the person

Report


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


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


Consider Context

WHO Perpetrator Intention

WHO Victim Impact

WHAT Act or Omission Common

themes/sequence


5. Key Information when reporting adult abuse in

ST Helens


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


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


Response to Adult Safeguarding Alerts

Actions to establish facts, as far as is reasonable andproportionate to the allegation of abuse, will be taken.• Criminal Procedures• Disciplinary Procedures• Serious Untoward Incident Reviews e.g. NHS organisations

(Trusts)

Also changes to the Care Plan maybe made toProtect the person


(Cont)

Responding to an Adult Safeguarding Alert is the responsibility of;

• “Investigating Managers”/ ”Investigating Practitioners” – these are from care management, ASCH

• Safeguarding Coordinators - these are specialist staff form the Adult Safeguarding Unit, ASCH

• Others were appropriate include the Police, Specialist nursing and health professionals, Community Safety or Domestic Violence Support

• Managers of Provider Services when employees are involved and Disciplinary Procedures are appropriate.


Initial Safeguarding Visit

Additional Strategy Discussion

Implementation and Monitoring Meeting to monitor and review:

Protection ActionsInvestigation Actions

Closure Meeting

Initial Strategy Discussion

Feedback to Vulnerable Adult and others as appropriate

Strategy Meeting to identify and agree:

Protection ActionsInvestigation Actions

Consideration of HR Procedures

Not appropriate to continue with Safeguarding process

Closure Summary

Response to a Safeguarding Alert in St Helens

updated november 20131 st helens multi-agency adult safeguarding procedures january 2013 edition...

Documents

fear of abuse

issues of abuse

actual abuse

nursing care

indicators of abuseupdated

victim support services

social care needs

investigateda vulnerable