Safeguarding Adults

There is a difference between safeguarding adults and adult protection, safeguarding is everybody’s responsibility, and includes actions to stop and reduce the risk of abuse happening. Protection is a vital part of safeguarding and promoting welfare, it is the process of protecting an individual who is either at risk or a risk as a result of abuse or neglect. (The broad definition of a ‘vulnerable adult’ is; a vulnerable adult is a person over the age of eighteen who is, or maybe, in need of community care services by reason of mental or other disability, age or illness. And who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation”). (REFERENCE 1). The care group policy reflects the above statement, and the partners fully recognise that the majority of the clients in their care are considered vulnerable adults by the very nature of often-complex needs.

In safeguarding a vulnerable adult you ensure all suitable procedures are in place to maximise the the safety of the person and protect them from harm. It is also your responsibility to raise the alarm if you suspect or know abuse is happening. In protecting the individual all staff members before starting a new job in a care setting are subject to a checks from the Disclosure and Barring service (DBS) and Independent Safeguarding Authority (ISA) to confirm that the staff member is not barred, by checking these registers will eliminate workers who have been deemed unsuitable to work with vulnerable people, as with all things in life this is not full proof so all persons responsible for the safety of others need to be vigilant at all times.

Within the home it is essential that we follow guidelines in place for safeguarding and follow new legislation when they arise. All staff would have been fully checked and the appropriate training given and they will receive any new updates so we all follow the same procedures. Staff should be aware of the homes policy which is kept in a file in the office, also the policy on whistle blowing. Safeguarding is a big responsibility and any signs or evidence should be reported. A range of policy developments are in place Our Health, our care, our say/ Putting People First/ No Secrets/In Safe Hands/Vetting and Barring Scheme/ Independent Safeguarding Authority/ Local Safeguarding Adults Boards. Agreed protocols may include: Boundaries- Areas of responsibility, Information sharing, Limits of authority, Decision making, Recording information.

Policy developments not only have an impact on safeguarding policies and procedures within the home they strengthen them. I think by following the next statement on the principles of safeguarding , all vulnerable adults within our setting are being treated as an individual with the support from others. The statement reads; (In practice, this means that agencies should adhere to the following guiding principles: actively work together within an inter-agency framework based, actively promote the empowerment and well-being of vulnerable adults through the services they provide, act in a way which supports the rights of the individual to lead an independent life based on self-determination and persona l choice, recognise people who are unable to take their own decisions and/or to protect themselves, their assets and bodily integrity, recognise that the right to self-determination can involve risk and ensure that such risk is recognised and understood by all concerned, and minimised whenever possible there should be an open discussion between the individual and the agencies about the risks involved to him or her.

Ensure the safety of vulnerable adult by integrating strategies, policies and services relevant to abuse within the framework of the NHS and Community Care Act 1990, the Mental Health Act 1983, the Public Interest Disclosure Act 1998 and the Registered Homes Act 1984 the provisions of which will be extended by the Care Standards Bill. Ensure that when the right to an independent lifestyle and choice is at risk the individual concerned receives appropriate help, including advice, protection and support from relevant agencies; and ensure that the law and statutory requirements are known and used appropriately so that vulnerable adults receive the protection of the law and access to the judicial process.)

There is a range of legislations in place for safeguarding the most important are; No secrets (2000) came about from media coverage of adult abuse, the aim is to create a framework for action within which all responsible agencies work together for the protection of vulnerable adults at risk of abuse. The Mental Health Act provides a legal framework for acting and making decisions for people who lack the capacity to make decisions for themselves. The Mental Health Act allows action to be taken for people with mental disorders to get the care and treatment they need for their health or the protection of others.

Safeguarding Vulnerable Groups Act 2006 aims to prevent unsuitable people from working (either paid or unpaid) with children or vulnerable adult. It does this by vetting all those who wish to do such work vulnerable groups and barring those where the information shows they pose a risk of harm. D.B.S. checks and ISA checks are done to reduce the risk of abuse by ensuring that those people who are unsuitable are not able to work with children and vulnerable adults, by checking these registers it will eliminate workers who have been deemed unsuitable to work with vulnerable people. Health and Social Care Act 2008 highlighted important measures to modernise and integrate health and social care.

In 2011 Panorama investigated Winterbourne view private hospital, where they exposed the physical and psychological abuse suffered by people with learning disabilities and challenging behaviour in their care. (The undercover footage showed staff repeatedly assaulting and harshly restraining patients under chairs. Staff gave patients cold punishment showers, left one outside in near zero temperatures, and poured mouthwash into another’s eyes. They pulled patients’ hair and forced medication into patients’ mouths. Victims were shown screaming and shaking, and one patient was seen trying to jump out of a second floor window to escape the torment, and was then mocked by staff members. Systemic failings-The national regulator, the CQC did a nationwide check on facilities owned by the same company, Castlebeck Care as a result three more institutions have been closed. The CQC reported a “systemic failure to protect people or to investigate allegations of abuse” and said that Castlebeck Care had “misled” the health watchdog.

Investigations -The CQC also inspected 132 similar institutions and a Serious Case Review was commissioned some of the roughly ten local and national enquiries were carried out to examine what went wrong, including one by NHS Southwest which was one of the first to be published and list many of the others. The head of the Care Quality Commission resigned ahead of a critical government report, a report in which Winterbourne View was cited. Mencap published a report warning that similar abuse could be going on elsewhere and calling for the closure of all large institutions far from people’s families) REFERENCE 3 As with most things in life it has to have something really go wrong before changes occur. CQC have tightened inspection in all hospitals and care homes for vulnerable groups, (CQC will share information, data and details they have about providers with the relevant Clinical commissioning groups and local authorities, from April 2013 and still ongoing provide information and data via the Joint Improvement Programme.

CQC will assess whether providers are delivering care consistent with the statement of purpose made at the time of registration. The Local Government Association and NHS Commissioning Board will establish a joint improvement programme to provide leadership and support to the transformation of services locally. CQC will take enforcement action against providers who do not operate effective processes to ensure they have sufficient numbers of properly trained staff. Responsibility for safety and quality of care depends on all parts of the system working together: Providers -have a duty of care to each individual they are responsible for, ensuring that services meet their individual needs and putting systems and processes in place to provide effective, efficient and high quality care; commissioners (NHS and local authorities)- are responsible for planning for local needs, purchasing care that meets people’s needs and building into contracts clear requirements about the quality and effectiveness of that care; workforce- including health and care professional and staff who have a duty of care to each individual they are responsible for; system and professional -regulators who are responsible for assuring the quality of care through the discharge of their duties and functions. )REFERENCE 4. All staff now are subject to stringent checks before being employed. By following all new policies and procedures set in place and being trained in safeguarding abuse will hopefully stop these incidents occurring.

The action to be taken if a member of staff suspects that a client is being abused in any way is to report it straight away to the manager; it is the responsibility of every member of staff to report instances of abuse and the responsibility and duty of every manager to instigate a thorough investigation. Any employee or person who is present and witness to an incident of abuse must intervene immediately on the client’s behalf to terminate the incident. Failure to intervene may be construed as complicity in the abuse. Any concerns regarding the abusive behavior must be reported to the registered manager as a matter of urgency. If this is not immediately possible the matter must be reported to the proprietors or the group leader. If it is not appropriate to approach the above people because they are complicit in the abuse then contact the duty officer at Social Services and inform them of your concerns.

It is the responsibility of the registered manager to then take all appropriate action. The manager should then not allow any evidence to be contaminated or tampered with in any way. Social services are to be informed for all safeguarding investigations, and the manager should be guided by their instructions and advice once they are involved. All written reports must be made available to the authorities, the matter must not be investigated wholly by the staff at the home. Medical attention may be necessary. Information must only be shared on a need to know basis. Use the companies’ disciplinary policy to act where staff are involved. Remember that your report may be required as part of any legal action or disciplinary proceedings. These reports should have date, time, and the setting of the alleged abuse or the event witnessed. Make a note of anyone else who was there. Record what was said using the exact words of the person making the disclosure. Separate factual information from any opinions expressed. Date and sign your report, initial and date any corrections. CQC will be informed of the incident.

We all take risks in life and this should be no different for the client if that’s what they want. Whilst we would promote the independence of the client we would also protect them as far as possible from danger or harm. By working with the client and making sure that they are fully aware of any risks involved, the risk assessment can be done and any dangers minimized. Risk assessments cover many things from showering themselves to going out on their own, they are done with the client looking at what they want and how it can be achieved, identifying any risks and how they can be avoided or reduced. One of our clients is very independent and uses public transport and goes to clubs on his own, at times the client is verbal and aggressive so when doing risk assessments these things need to be shown so to minimize the risk to himself and others.

The hazards and risks are he may be unpredictable at times, he may forget his home number and telephone number, and he may become agitated, whilst out resulting with some verbal outburst. Whilst these are rare occurrences they could happen so an proposed plan of action is in place, Staff are to arrange taxi’s for him telling them where he is going to and what time he is returning home, he is to carry the house number and phone numbers in his wallet in case he forgets, If he is agitated before going out staff are to assess if it’s advisable for him to go out on his own and then report any problems so they can be dealt with. This is a low risk activity and the client has signed the risk assessment agreeing to its contents, by placing this in his care plan and all staff members knowing of the procedures in place will minimise any problems arising. By following person centred planning the client gets to pursue what they want to do, and the risk assessment helps to protect them from harm or danger.

Physical abuse- signs are bruising, pressure sores or rashes from wet bedding or clothing, scratches or cuts, bruised ears. Improper use of restraints. Sexual abuse – urine infections, blood on underwear, bruises on body, refusal to undress. Emotional/Psychological abuse – being treated badly, verbal abuse bullying, intimidation, shouting at. Institutional abuse- privacy is not respected, clients not given any choice. Self-neglect – confused, clothes are dirty and smelly, unexplained weight loss. Financial abuse- unauthorized use of a client’s money, failure to use client’s money and assets by fraud resulting in harm to the client. Theft by stealing their money or possessions. Discriminatory abuse- verbal abuse, inappropriate use of language, harassment, deliberate exclusion.

Working with person centred values- by getting to know the clients likes and dislikes and the way that they usually act will hopefully pick up on any risks before they happen. Encourage active participation – by involving the client in activities and relationships and encouraging them to express their needs will probably help them confide any problems they are experiencing. Promoting choice and rights- I would encourage them to voice their own concerns, I would tell them at times that they can say NO, they also need to know their rights.

C If an alleged or suspected case of abuse arises, you should stay calm, reassure the person that they were right to report this and that you need to tell the manager, if any of the emergency services are needed call them. Record exactly what the person tells you and record the conversation, date and time this as it may be needed as evidence. The manager will call in Social Services who will tell you what they want you to do. Within the home there are policies and procedures to follow.

The policies and procedures in place are; The partners of the group consider that abuse is a direct anti-thesis of care and therefore no incidence of abuse toward a client, in any form or to any degree, will be tolerated. Any abuse of clients, as defined in this policy will constitute gross mis-conduct and will be grounds for dismissal from employment. Safeguarding Vulnerable Adults training must be made available to all staff and this must be renewed after 1 year or earlier if necessary. This training can be accessed via the group manager and will be part of the training programme for the new care staff. It is the responsibility of every member of staff to report instances of abuse and the responsibility and duty of every manager to instigate a thorough investigation. Any employee or person who is present and witness to an incident of abuse must intervene immediately on the client’s behalf to terminate the incident.

Failure to intervene may be construed as complicity in the abuse. Any concerns regarding the abusive behavior must be reported to the registered manager as a matter of urgency. The partners of the group encourage all employees to bring forward any concerns that they fear may have a detrimental effect on residents,
employees, visitors or property, without fear of recriminations, under the Public Interest Disclosure Act 1998 you have the legal right to “Whistleblow” all concerns raised will be treated in confidence and every effort will be made not to reveal your identity if this is your wish. People within our care setting will expect to be treated with respect in an environment free from any level of bullying. We also have a policy covering Mental Capacity, Decision making, Best interest for clients who may lack the capacity to act for themselves. All staff are only employed when a D.B.S. is done and received, they then go through a 6 week induction course.

Policies and procedures are in place so all staff know what to do in the case of abuse or harm. Monitoring can be done through manager’s meetings, staff discussions, updates through care standards and health workers. A review of policies and procedures are done yearly or before if needed, and any changes handed over so all personal know. All staff are monitored through DBS checks and ISA checks before being employed, new staff are trained in safeguarding in the induction period and updated after one year, all other staff have updates every two years. Staff meetings and supervisions cover any concerns that staff may have, Staff are reminded of the policies and procedures in place and know how to raise the alarm if abuse is suspected and how to proceed, the whistle blowing act will be brought to the attention of the staff.

By all staff following the policies and procedures and being told of any new changes i.e.; Mental Capacity Act, or DOLS will prevent abuse occurring. 2.5 In following certain procedures will protect the vulnerable person -1(People who use health and care services should be treated with dignity and respect, receive high quality, compassionate care and be safe from harm and abuse. Ensuring that this happens is the prime responsibility of those who provide and commission services and the main focus for those who regulate standards in care. Clarity on roles and responsibilities is especially important.

(It’s important to remain focused on outcomes rather than just the process of safeguarding. The outcomes should be to: To promote well-being and prevent abuse and neglect from happening in the first place, Ensure the safety and wellbeing of anyone who has been subject to abuse or neglect, Take action against those responsible for abuse or neglect taking place, Learn lessons and make changes that could prevent similar abuse or neglect happening to other people (e.g. through learning and development programmes for staff).

(Safeguarding is everybody’s business, therefore providers are required to meet essential/fundamental standards of care and people using services are safeguarded additionally through monitoring by providers and commissioners, regulation and inspection. People’s welfare should also be secured by good commissioning, contracts management and, for some people, by care management or other forms of review.) By following all of the above will set up a practice that supports the protection of vulnerable adult. In providing training and updates this will keep staff aware of what is needed if the case arises.

There are many organisations that work with each other and follow certain protocols to set up a framework to protect vulnerable adults. Social services are the main coordinators that set up policies and procedures to follow, CQC monitor and provide guidance on what health and social care providers must do to safeguard others from abuse, the safeguarding policies, procedures and systems developed are in place to prevent others from being abused. The police investigate possible crimes and share information with other agencies, to support the person suffering from abuse. Doctors, specialists and nurses give the care and treatment needed when incidents have happened, and by supporting enquiries when needed, also following up with referrals and liaising with other agencies. Care managers respond to concerns from the person involved or by family or friends, if they lack Mental Capacity best interest assessors will be involved or their advocate.

The service provider agrees to follow the protocols in place, vetting staff before employment, giving adequate training in safeguarding, adhere to follow up on incidents, complaints and whistleblowers. Take disciplinary action against staff that have abused or neglected people in their care. Other agencies who would be part of the organisation are clubs, support groups, voluntary organisations, these agencies would have policies in place for safeguarding also the service provider would have risk assessments in place for every client that uses these outlets. The Data Protection Act 1998 ensures that personal information is kept private and safe and the multi-agency approach means that where it is lawful and moral, information should be exchanged between all relevant agencies.

For systems and procedures to run well within a partnership all parties must pass over any essential information that’s relevant so all sources are working in the right way. Within our setting this is done by inspections from CQC visiting the home and handing over any policies or procedures that need changing, and if there are any discrepancies they will give you a time frame to rectify the problem. Care managers will visit the clients annually to review their needs, or if a problem arises before are contactable by phone or e-mail. Employers must give training and all staff made aware off safeguarding policy and procedures, feedback on any problems should be dealt with immediately and procedures followed and outcomes shared with all staff, this can be done at staff meetings or supervisions. As all the clients have complex needs when possible mental capacity training should be given, this will provide what options are available and how to know when outside help will be required.

All appointments with doctors and other clinicians need to be kept up to date, and any changes documented and shared if needed. An incident took place were a vulnerable client with Mental Health problems took himself of to the hospital on his own, after speaking to a nurse and being really upset and angry, she had to assume there was a problem. She phoned the care manager and was talking about an adult protection order, I (the manager) had responded to the concerns of the staff and found where the client was, through confidentiality the hospital and their staff would not disclose the whereabouts of the client.

This is where partnership working came into place as the care manager reassured the nurse that the client was not in any harm, the nurse asked the client if it was okay for myself and my line manager to speak to them, they said yes and through working with the nurse and care manager the situation was sorted out and it was nothing more than them having a bad day. As a result the client returned back to the house with me, the care manager was told what had happened and visited the next day, relevant paperwork was filled in and placed on file. By all the relevant partners following the procedures in place the client was safeguarded in all areas, this showed the effectiveness of working in partnership policies and procedures.

Vulnerable adults need to be involved in the procedures and systems of safeguarding, all services, professional people, agencies, staff and families should support vulnerable adults to protect themselves. This can be done by supporting them to make decisions that affect their life, provide them with information about abuse and protection, and ways to protect themselves from harm. They should be made given the information of how to protect themselves from abuse, also know what the risks are, who they might be at risk from, what precautions could be in place to prevent abuse happening, what to do and who to tell if abuse occurs. The vulnerable adult will be involved in care reviews with their care manager, attend appointments with aspects of their care, and health.

Attend resident meetings and be able to put across any concerns that they may have. Vulnerable adults who fall under the Mental Capacity Act 2005 and are deemed unable to make a decision for themselves, could be supported by an IMCA (INDEPENDENT MENTAL CAPACITY ADVOCATE), have a Best Interest meeting, this would involve the manager of home, family members, doctor, district nurse, care manager, the vulnerable adult would participate in the meetings and be advised by the above of how to put their views across, but have systems in place if they are unable to make any decisions for themselves, for their advocates to proceed on their behalf.

The effectiveness of protecting vulnerable adults through systems and procedures start when you start employment, D.B.S. and I.S.A. checks are done before you can start work. All staff are given safeguarding training, and shown all policies on safeguarding in their induction period, by everybody knowing about the procedures in place makes them aware of what signs to look for if a vulnerable adult is in danger of abuse or harm. Staff meetings are where any concerns can be talked about, supervisions are also used for discussions especially if they have concerns about someone and want to talk on their own. The home has a whistle-blowing policy and staff are made aware of this and are assured that their concerns will be looked at.

All clients and their families are made aware of the complaints policy and what actions to take if needed, this procedure is placed in their room. Within our home several clients cannot speak, these clients are the most vulnerable as they cannot communicate what is happening, care plans are in place and are individualised, they contain their needs and risk assessments are in place to allow them to participate in activities with the risk being looked at and any actions being put in place, to minimise the potential of harm or abuse. The policies show what signs to look for in abuse and by knowing how the client is normally you will be able to know if they have a problem or concern by there changes in behaviour. As manager I am aware of what procedures to take if a case of suspected abuse or harm is brought to my attention.

At times in the position of manager problems arise and they have to be dealt with, these problems may be classed as minor to severe but all problems need to be looked at and resolved. Harm to a vulnerable adult may result from a carer being stressed out from working too many hours, they might not realise that they are acting differently to the vulnerable adult but being tired makes you snappy and this could come across as abuse, staffing levels need to be in place to allow for a smooth running of the home, and the manager should make sure staff have days of to recoup and rest, at times through illness and holidays this may change, in this case the manager should ensure adequate rest time is had during the day, to lower the risk of any harm and promote good care. People seen as whistle-blowers can sometimes feel as if they are the abuser as other staff members or people treat them differently for speaking out about a practice that is not right, to make sure this does not happen managers or employers need to emphasise that all wrong doings need to be reported to prevent abuse or harm, otherwise it could carry on and escalate into something far worse.

Our policy is that all information will be regarded as confidential and under the Public Interest Disclosure Act 1998 1. An employee is entitled not to be subjected to any detriment by virtue of having made a protected disclosure, 2. The dismissal of any employee directly due to the individual having made such a disclosure will automatically be unfair. People should be able to protect people from harm and not felt as if it is wrong not to say anything. We need to challenge our practices and find ways to improve them, and make them more effective. Looking at different ways and changing how things are done, by involving all parties and changing policies and procedures when necessary will lower the risk of potential abuse or harm.

Since I have become a manager after several years working within the home, paperwork seems to rule your day-to-day running of the home. But with this in mind it has also brought to light that the people who write the policies and procedures for the running of the homes don’t always write it so all aspects are covered. Our policy states that abuse will not be tolerated, and goes on to tell what types of abuse there are and some of the signs and symptoms that may occur, it then tells us what to do if we suspect a client is being abused, then tells us what to do and what not to do, managers are then given guidance on how to proceed, and lastly report writing.

We have separate policies on complaints, bullying, whistle-blowing and mental health act but as safeguarding adults incorporates all of these policies I think there should be some reference to these policies put into the safeguarding policy, this way staff reading it will be aware of all the different aspects that need to be looked at. I would also like to see a section on how to reduce the risk of harm and abuse so all staff and other people can implement changes and prevent abuse or harm from occurring. A flow chart could be put in place so all involved know what steps to take from the beginning of the suspected abuse to an outcome. Telephone numbers of social services /central duty officer /police/CQC be laid out just on one page, so it’s easier to find in an emergency.