Safeguarding and Protection of Vulnerable Adults

1. Understand the legislation, regulations and policies that underpin the protection of vulnerable adults 1.1 Analyse the difference between the concept of safeguarding and the concept of protection in relation to vulnerable adults

The concepts of safeguarding of vulnerable adults is that is about the protection from maltreatment, preventing the impairment of a person health and making sure that vulnerable adults are living in suitable environments that are consistent with the provision of safe and effective care. This ensures the safety of a person. Safeguarding is about how to keep a person safe from the above and look at how it can prevent vulnerable adults or children suffering abuse by ensuring that service providers report these incidents. The protection of adults plays an important part in the safeguarding and promotion of their health and well-being. Protection of vulnerable adults is critical and crucial as part of the wider work to safeguarding.

An emphasis of safeguarding came from the Joint Chief Inspectors Report on Arrangements to Safeguard Children (2002) and states that any agencies working with children have a duty to minimise the risks of harm to their welfare and take any action if there were any cause of concern. An emphasis was also made on about partnership working and this came in the formation of Local Safeguarding Boards (LSBs). There have been a similar emphasis on the protection of vulnerable adults as prior to 2000 local authorities did not have a legal duty to investigate any reports of abuse against an adult over the age of 18 who was deemed vulnerable in Wales. In 2000 the Welsh Government set out the In Safe Hands document that tells Local Authorities Social Services departments their duties in the protection of vulnerable adults. These duties are very similar to the safeguarding of children where they should take a partnership approach in the prevention and reporting of abuse and meet the training needs of staff who working with this client group.

1.2 Evaluate the impact of policy developments on approaches to safeguarding vulnerable adults in own service setting

Within my own setting, the impact of policy developments on approaches to safeguarding vulnerable adults can be extensive. The first is that the policies first set out what a vulnerable adult is and in my setting all the adults are classed as vulnerable because of their age, that most of them cannot make their own decisions because they do not have the mental capacity to do so and thirdly because of the mental conditions they have, such as Dementia, Alzheimer’s Disease or Learning Difficulties. Also because the adults are not in their own environment they are vulnerable because they may not feel comfortable due to being in unfamiliar surroundings to what they are used too.

Within my own setting we have to ensure that we have the relevant and comprehensive policy in place and that it is followed by all staff in terms of safeguarding and protecting vulnerable adults. The policy must also be comprehensive enough that it covers staff who may be at risk from false claims being made against them. Also there has to be a policy in place where staff can feel confident that they can report any issue anonymously to their line manager. Each of these policies must also give a comprehensive reporting procedure as well.

The impact of the policy developments make it that it is the responsibility of statutory bodies, service providers and employees to protect vulnerable adults from abuse. It also makes it a requirement that all staff who apply for a job in the Health & Social Sector are suitable to work there and complete a DBS or CRB check that is either at the cost of the employer or potential employee. Another impact the policy developments have is that all staff have to be trained in safeguarding and protecting vulnerable adults and complete this as part of their induction training as set out by the CSSIW. Within Cardiff, staff undertake the POVA Level 2 training that explores this is so that they are able to be vigilant in spotting the signs of abuse and know what happens when it is reported to the local POVA team.

One of the biggest impacts policy development has in regards to the safeguarding and protection of vulnerable adults is that staff have to be vigilant about the way they act with residents. Staff are trained to a person-centred approach and if a resident is happy being called ‘love’, this can be perceived as abuse by someone else. Staff also have to be vigilant about following the correct procedures when it comes to moving and handling and how they care for a resident as if the policies and procedures are not followed then their actions can be reported as abuse. So these policy developments make staff constantly think about their own judgements and actions constantly.

Another impact that policy development has is it the POVA policy and any other policies that assist in safeguarding vulnerable adults is reviewed on a regular basis. In my setting these policies are usually reviewed on a 6 monthly or yearly basis. This is so that any developments nationally are implemented into the reviewed policy.

1.3 Explain the legislative framework for safeguarding vulnerable adults

There are many pieces of legislation out there that talk about safeguarding vulnerable adults. Prior to 2000 there was no such piece of legislation that gave responsibility for statutory services, such as Local Authority Social Services to investigate forms of abuse, but there were pieces of legislation that supported the protection of vulnerable adults to come forward. The Crime and Disorder Act (1998) acted as first-hand support for the protection of vulnerable adults and is the basis for the formation of partnerships between the LA’s and the police. The Human Rights Act (1998) explains the rights and freedom of individuals and the Disability Act (1995) sets out the protection for adults with disabilities. All these pieces of legislation played a part in the protection of vulnerable adults.

In 2000, the UK government set out to look at the agenda of Protection of Vulnerable Adults and gave out guidance to all LA’s called No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. This laid out the responsibilities for LA’s to develop and organise a policy to protect vulnerable adults from abuse through a multi-agency approach, similar to the Child Protection Agenda. This guidance also gave LA’s the responsibility of setting up local multi-agency teams and set up the correct reporting procedures for any cause of concern to be reported. The guidance also set out that these local teams ensured that service providers had the relevant protection of vulnerable of adults’ policies and procedures in place and ensure that staff who work with vulnerable adults were trained to identify any signs or symptoms of abuse.

At the same time the Care Standards Act (2000) was implemented and set out the standards that all Social Care Services have to follow. It made the protection of vulnerable adults a priority and in Section 7 it stated that the provision of protecting vulnerable adults should be made. From this in 2004, the Protection of Vulnerable Adults (POVA) scheme was set up (Department of Health, 2009). Its intention was to not allow any individual work with vulnerable adults in the care sector if they have neglected, harmed or abused a vulnerable person.

The Mental Capacity Act (2005) was introduced to provide a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. Within the Act there are 5 principles and these are: 1. a presumption of capacity – every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise; 2. the right for individuals to be supported to make their own decisions – people must be given all appropriate help before anyone concludes that they cannot make their own decisions; 3. individuals must retain the right to make what might be seen as eccentric or unwise decisions; 4. best interests – anything done for or on behalf of people without capacity must be in their best interests; and 5. least restrictive intervention – anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.

Another part of this act that is about the protection of vulnerable adults is the Deprivation of Liberties Safeguard (DoLs). They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home, hospital or supported living arrangement only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. A recent court decision in March 2014 has provided a definition of what is meant by the term ‘deprivation of liberty’. A deprivation of liberty occurs when ‘the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements’. So this application for DoLs is necessary for all EMI residential care homes as residents lack capacity to leave the home and are lacking the understanding of identifying risks if left unattended.

Another major piece of legislative framework in regards to the protection of vulnerable adults was the introduction of the Criminal Record Bureau Checks now called the Disclosure and Barring Service. POVA teams needed a list of health and social care employees who have had a history of abusing vulnerable adults. These checks were implemented so that health and social care service providers were able to see if a potential employee was suitable for employment within their establishments. If employers are unable to wait for the CRB to come back then they can also use the ISA Adult First Check (previously known as the POVA list) that gives them access to a list that tells them if a potential employee is unsuitable to work with vulnerable adults.

1.4 Evaluate how serious case reviews or inquiries have influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults Case reviews or inquires have influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults because they have been used to introduce the right so that complaints procedures have to be implemented within health and social care settings. Within the National Minimum Standards (NMS) 16.1 states that: The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and timescales for the process, and that complaints are dealt with promptly and effectively And the outcome of that standard is so that the service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon.

The registered person needs to make the complaints procedure available to everyone and promote it in the service user brochure, the homes statement of purpose and is promoted throughout staff meetings, notice boards and resident meetings. It also sets out that the registered person has to respond to a complaint within 28 day (NMS 16.2). Registered managers also have to keep a written record of all complaints and copies of investigations (NMS 16.3)

Case reviews and inquiries can also influence quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults because they can be used to establish best practice to prevent/reduce the risk of a similar incident happening again. They can also be used as training materials for staff to improve their practice and implement policies and procedures within a setting.

1.5 Explain the protocols and referral procedures when harm or abuse is alleged or suspected Within the National Minimum Standards for Care Homes, Standard 18’s outcome is that Service Users are protect from abuse. This standard sets out that the registered manager or person ensures that the service users are protected and safeguarded from all forms of abuse, be it from staff members, family or strangers. It also sets out that policies regarding safeguarding vulnerable adults are in place and adhered too (NMS 18.1). Registered managers or persons also to make certain that there are measures in position to respond to the suspicion of neglect and abuse (NMS 18.2) and that they are reported immediately.

In 2005, the Safeguarding Adults Network set out a framework of standards for good practice and outcomes in adult protection work known as the Safeguarding Adults Procedures. These standards were built on from the No Secrets document that was established in 2000. Within this document standards 6, 7, 8 and 9 lay out the procedures and protocols for reporting and responding to abuse. It sets out that any safeguarding action should also be taken in consultation with the adults concerned.

Standard 6 sets out that an organisation who receives a report that an adult may be experience abuse respond to it in a positive and proactive manner. This also falls in line with NMS 18.3 that says an organisation has to have robust procedures in place to respond to reports in a prompt manner. Standard 6 says that procedures should give direction for when action has to be taken for the protection of an individual/s. Standard 6 explains that if a person does not have the mental capacity to make or agree to decisions about their protection then actions should be taken in the best interest of their protection and also take into consideration any previously expressed desires as long as it does not put them into further harm. If a person does have mental capacity then their interests should be heard by all parties and they should be signposted onto an appropriate person who can give them information about all their options available.

Standard 7 sets out the necessity of information being shared by service providers and agencies when abuse is suspected or alleged. It sets out that that a multi-agency safeguarding policy and procedure is in place and that responding to reports are done in a partnership. The standard also sets out that the multi-agency policy has to be agreed and signed at the most executive levels within organisations and that also frontline staff are consulted on with these.

Standard 8 explains that each partner agency has to have a set of internal policies and procedures in place that are consistent with the local multi-agency safeguarding policies. These policies have to also set out how individual workers operate within it. The standards explain that organisations have to incorporate the risk of abuse into their own risk assessment policies and procedures. The standard also sets out that staff within the partner agencies have to receive training and information in regards to safeguarding adults such as identify the signs of abuse and neglect and how to respond to it; to how to give information to other individuals and signpost them onto relevant agencies if they have any concerns. Standard 8.6 states that an organisation also needs to have a ‘whistle-blowing policy’ in place for staff to raise any concerns in line with the multi-agency policy. It also sets out that staff have to have the ability to record factual information in regards to safeguarding adults. Standard 9 sets out an action plan for responding to any reports of abuse or neglect and the action plan: Alert:

Report received – immediate protection needs addressed.
Referral:
Distributing information to multi-agencies as appropriate.
Decision:
Determine if procedures are sufficient for the particular case. Safeguarding assessment strategy:
Formulate plan with all agencies – access risks
Safeguarding assessments:
Collate information, carry out investigation if required.
Safeguarding plan:
Co-ordinating multi-agency response if abuse identified.
Review:
Review actions and plan for improvements.

Standard 9 sets out guidance to ensure that all policies and procedures are in effect at their best and sets out a timeframe for action on responding to a report of neglect or abuse. See below: Maximum time frame

Alert Immediate action to safeguard anyone at immediate risk Referral Within the same working day
Decision By the end of the working day following the one on which the safeguarding referral was made Safeguarding assessment strategyWithin five working days Safeguarding assessment Within four weeks of the safeguarding referral Safeguarding plan Within four weeks of the safeguarding assessment being completed Review Within six months for first review and thereafter yearly

Standard 9 also sets out that there is a need for a senior person within an organisation to be responsible for the role of a ‘safeguarding manager’ and that they have the knowledge and experience to do this through relevant
training. It also sets out the responsibility that the safeguarding manager has to keep a copy of all factual records of any multiagency process and outcomes, any meeting regarding the relevant stages set out within the timeframe above. Standard 9 also states that confidentiality is a major player within this process and that it has to be adhered to by all parties.

2 Be able to lead service provision that protects vulnerable adults
2.2 How do you provide information to others on:
– Indicators of abuse
– Measures that can be taken to avoid abuse taking place
– Steps that need to be taken in the case of suspected or alleged abuse To provide information on the above, training on the protection of vulnerable adults is to be embedded into their induction programme as set out in the Social Care Induction Framework for Wales by the Care Council for Wales within their first 12 weeks of employment. As part of this induction training staff should learn the indicators of abuse through in-house training such as DVDs or training sessions. This provides the relevant information in regards to the indicators of abuse and the measure that can be taken to avoid abuse and cover the basic information on how to report abuse. Staff can also be provided this information through their on-going supervision.

Social care staff and volunteers also have the opportunity to attend formal courses such as the P/SOVA Level 2 course that is a certificated course that they understand the indicators of abuse, measure that can take place to avoid abuse taking place. Once staff have completed a P/SOVA level 2 they can then progress onto the Level 3 that explores the steps that need to be taken in the case of suspected or alleged abuse. P/SOVA level 3 gives staff and volunteers the information in regards to the reporting procures and the multi-agency approach that safeguarding has become.

Staff who are willing to progress their learning are also able to gain this information by completing the relevant QCF Health & Social Care qualifications. It is also encouraged for staff and volunteers to also further their learning through self-study and reflection. For other individuals such as service users, families or their representatives, this information can be given through the form of information booklets or posters around the setting. 2.3 Identify the policies and procedures in own work setting that contribute towards the safeguarding and the prevention of abuse Within my own setting there are many policies and procedures in place that contribute to the safeguarding and the prevention of abuse.

The main policy is the Adult Protection Policy and Procedure. In this policy it first and foremost point is that the setting is committed to preventing the abuse of residents in their care. They set to do this by ensuring all staff are fully understand this policy and procedure and if the need to respond to any allegations is reported to external agencies. The policy and procedure also sets out that the setting will employ the right individual by using stringent recruitment procedures and ensure CRB checks are done prior to taking employment. The policy also sets out to inform staff the definition of abuse, the types of abuse, the indicators of abuse and how the setting will deal with responding to any claims made. It also sets out that staff have to receive the relevant training (POVA Level 2).

Another policy in place that contributes towards the safeguarding and the prevention of abuse is the Whistleblowing policy. This policy gives employees the right to report any fraud, misconduct or wrongdoing, by employees or other agents. It give the person who has ‘whistle blown’ the confidence that they will be heard and not treated unfairly for raising any concerns.

The Complaints Procedure is also in place so that a resident or someone acting on their behalf can raise a complaint verbally or in writing at any time. This sets out way a complaint will be handled. It also sets out the timeframe for each stage of the procedure on when a person will get a response. This procedure also informs an individual that after investigation and they are unhappy with the outcome of a local resolution then a complaint can be made to the to the Person-in-Charge and follow the Formal Consideration stage and the CSSIW and relevant authority will be notified of this complaint. The Recruitment and Selection Policy can contribute to the safeguarding and prevention of abuse as it sets out how employees will be recruited and that all potential employees have to supply 2 references an complete a CRB/DBS check.

The Residents Care Plan Policy and Procedure can contribute to the safeguarding and prevention of abuse as the care plans will hold information regarding residents’ behaviour, if there is any history of violence etc. that can be a cause of concern for the prevention of abuse. The policy sets out that to build the care plan information regarding potential residents has to be acquired beforehand through the mains of Social Service Care Plans and Pre-admission assessments. It also states that each residents will have risk assessments undertaken with 48 hours of admission that can look at the following:

1. Challenging behaviour
2. Manual Handling
3. Deprivation of liberty (DOLS)
4. Sexual Behaviour etc.

3 Be able to manage interagency, joint or integrated working in order to protect vulnerable adults 3.2 Review the effectiveness of systems and procedures for working in partnership with other organisations

Within my own service setting we work in partnership with a wide-range of other organisations. We work closely with the CSSIW, Social Services, Local Health Boards, Community Mental Health Teams (CMHT), Community Psychiatrist Nurses (CPNs), District Nurses, Advocacy Agencies, GP Surgeries, and the Police. By building close working relationships with these agencies. The main partnership we have are with the CSSIW and Social Services as we report to these on the standards of care we provide to our residents. Other partnerships are bed around the care that they can provide to our residents so that they can get the full assistance to live their life fully.

The CSSIW has a robust reporting procedure in regards to reporting any wrongdoing or misconduct of a staff member. This is done through the Regulation 38 reporting procedure. This informs the CSSIW of any incident that has taken place and if it would warrant further investigation. The form has to be completed and sent to the CSSIW within 24 hours of the incident and then an inspector may call back asking for more information and take action if needed. We also need to inform them of any SA 1 applications that has also been submitted to the local DoLs team. The CSSIW is the main body we answer to with the service we provide.

The District Nurse (DN) Team in our area has an excellent working partnership with the home as if we have any concerns in regards to the health of our residents (Pressure Areas, Skin Tears etc.) they will see the resident, even if they are not booked into. The DN team are also there to support the welfare of their patients and are on call if we have any concerns and they are also quick to act. We tend to only involve GPs and other health care professionals in relation to continuing health conditions.

One of our biggest partnerships is with Local Authorities and their Social Services Departments. When the home was first opened a contract was put in place that set out the obligations that the provider have to follow and then also the obligations the Local Authority will provide. This contract is very effective but depending on the individual social worker and also the teams the effectiveness of the partnerships can vary with the way they communicate with the home. Even though at times these partnerships vary from team to team, we can communicate directly with the social worker or through their duty desk if we have any cause of concern for the protection or safety of a resident.

4 Be able to monitor and evaluate the systems, processes and practice that safeguard vulnerable adults 4.1 How do you support the participation of vulnerable adults in a review of systems and procedures Modernising Social Services (1998) called for standards that “focus on the key areas that most affect the quality of life experienced by service users, as well as physical standards”. The NMS ensure that homes and providers lead to positive outcomes for, and the active involvement, of service users. Practice demands that the resident is the most central point to the development of their own care and have a vital contribution in the decision-making as to how their care will be delivered. The foremost point of participation is by making sure that the resident has all the information they need to make an informed decision if they are fit to do so. However, involving people who use services in safeguarding is patchy, and a Commission for Social Care Inspection (CSCI) report concluded that ‘most councils need to put systems in place to obtain feedback from people who have experienced abuse … in order to improve services’ (2008).

Within the Safeguarding Adults Framework, Standard 11 includes individuals as a key partner in any work that is involving them. Within my setting to support the participation in a review of system and procedures, I would first include them in the development and review of their individual care plans. This would be done by working alongside the care plans that are supplied prior to admission to find out their own personal needs, their interests and their dietary likes and dislikes as this information is not on the care plans supplied. When reviewing their care plans, we would sit down with the resident and explain any changes that we would have noted with their needs and see if they agree to this. If a resident finds it difficult to be able to express their views then this would be done with help from an advocate.

As a provider we also work with an advocacy service through a partner agency that would work with individuals to increase their participation by voicing any concerns they have and support them through any process in relation to issues that affect their lives. An advocate is a person who will work with these individuals who have difficulties representing their interests, to exercise their rights, express their views, explore and make informed choices. They do this by providing all the right information that a person needs to make an informed decision.

Another way to ensure participation from a resident is through resident surveys. This will gather information and feedback from individual residents about how they feel about living at the home, if they are happy, feeling safe etc. We would also include a section about anything they dislike and how we as a provider can improve the care and services provide for them.

Other ways to involve a resident is by them being able to have a chance to speak to any medical professionals in relation to reviewing their medication, being part of mental health and medical reviews with various health professionals.

4.2 Evaluate the effectiveness of systems and procedures to protect vulnerable adults in own service setting One system and procedure in place to protect vulnerable adults in my own service setting is Regulation 38. Regulation 38 is part of the Care Home (Wales) Regulations 2002 and it places a duty on registered managers to notify the CSSIW about a serious injury or illness of a service use within a care home, any misconduct by the registered person or any member of staff or volunteer who works within the establishment (SOVA etc.) The positive thing about this system is that any incident needs to be reported within 24 hours to the CSSIW of when the incident occurs. As it is part of the Care Home Regulations this places a legal duty on the registered person to ensure that this is submitted within the respective timeframe. It also states that consideration will have to be given if notifying the Police or Local Authority is needed in appropriate circumstances.

A Regulation 38 notification provides a clear and concise form that needs to be filled in asking what type of incident it was, how it happened, and who was informed. A negative aspect of the Regulation 38 notification is that depending on the nature of the incident not all the information can be recorded if a resident was admitted to hospital for an injury or illness and you may not know within 24 hours what the diagnosis is. Another aspect is that you do not hear if the notification is received unless you receive a phone call from the inspector in your area asking for more information regarding the incident or the outcome of your notification. Another negative aspect is that in my setting all notifications are sent via fax to which it could be time consuming and if the fax line was not working, a notification would not be received within the required timeframe.

Another system in place to protect vulnerable adults is a Deprivation of Liberties Safeguarding (DoLs). DoLs forms part of the Mental Capacity Act and is used to provide a legal framework for those people who lack Mental Capacity and are deprived of liberties, such as living in an EMI residential home that has locked doors and the residents are not able to leave due to the fact that it is in their best interest and safety to do so. A positive aspect of this system is that it has a multi-agency approach to its work and includes experienced nurses and social workers, Occupational Therapist and Psychologist who assess if a DoLs authorisation is needed.

Also the DoLs application is very comprehensive where you can apply for an Urgent Authorisation (UA1) if the provider believes that a resident is already being deprived of liberties and make it lawful or apply for a Standard Authorisation (SA1) if a resident is going to be deprived within 28 days. The forms for which the applications are applied for are comprehensive with what information they would like to know but they do not provide guidance with how to complete them, but the DoLs team within my area are always happy to answer any questions via email or phone.

4.3 How would you challenge ineffective practice in the promotion of the safeguarding of vulnerable adults There are a number of ways that as a manager you could challenge ineffective practice in the promotion of the safeguarding of vulnerable adults.