Kirklees Safeguarding Adults Board

Safeguarding Adults

Managing Large Scale Investigations

The Kirklees Safeguarding Adults Board

Procedures and further guidance to assist senior managers undertake investigations,

primarily in care homes

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Contents Pages 3

Introduction

4 Flowchart of Process

5-8 The Multi Agency Procedures

9-15 Further guidance for undertaking large scale investigations

16 Appendix 1 – Ground Rules for Managing Large Scale Investigation Meeting

17-18 Appendix 2 – Large Scale Investigation Strategy Meeting – suggested agenda structure and minutes

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Appendix 3 – Checklist for First Large Scale Investigation Strategy Group Meeting

21-22 Appendix 4 – The Investigation Checklist

23 Appendix 5 – Adult Services standard letter to relatives

24-25 Appendix 6 – Adult Services standard letter to other Local Authorities

26 Appendix 7 – The Escalation Process – Strategic Investigation Management Group - Terms of reference

27-29 Appendix 8 – Managing Large Scale Investigations - Escalation Process

30 Appendix 9 – Guidance for Concluding Report for Large Scale Investigation

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Introduction

The term safeguarding adults covers everything that assists a “vulnerable” adult to live a life that is free from abuse and neglect and which enables them to retain independence, well-being, dignity and choice. It is about preventing abuse and neglect, as well as promoting good practice for responding to concerns on a multi agency basis.

A vulnerable adult is a person over 18 who “may be eligible for community care services” whose independence and wellbeing would be at risk if they do not receive appropriate health and social care support. This includes adults with physical, sensory and mental impairments and learning disabilities. It also includes carers, those family and friends who provide personal assistance and care to adults.

The responsibility for co-ordinating Safeguarding Adults’ arrangements lies with councils with social care responsibilities. However, the operation of the procedures is a collaborative responsibility and all agencies are accountable.

Effective work must be based on a multi agency approach. Decisions have to be made about the most appropriate organisation to be the lead agency in the safeguarding investigation; and who is the most appropriate person to undertake the roles within the safeguarding process.

The Kirklees Safeguarding Adults Board multi agency policy describes the procedures for carrying out a large scale investigation. This guidance is designed to further assist senior managers undertake such investigations, primarily in care homes, but also in other settings which could involve the abuse of more than one victim. It has been developed in partnership with colleagues from Health, and other partner agencies. Section 1 is taken directly from the Kirklees Safeguarding Adults Board ‘Multi-Agency Policy/ Procedures which do not reflect the recent changes in Kirklees NHS structure. Amendments will be made when the policy is reviewed. In the interim, staff involved in managing large scale investigations should ensure that they involve senior managers of Kirklees Community Health Care Services wherever this is appropriate .

For further information on the Multi-agency policy see ‘Kirklees Safeguarding Adults Board ‘Multi-Agency Policy. Procedures and guidance to safeguard vulnerable adults from abuse in Kirklees’

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Senior manager accepts recommendation

Senior manager appointed to Chair the LSI

Chair arranges and invites appropriate representatives (see section 1.5 of LSI procedures) to LSI meeting

LSI proceeds – requirements of risk and escalation process (Appendix 8 of LSI guidance) reviewed and considered at each

meeting

Risk low

Investigation proceeds and concludes Satisfactorily in line with Multi-agency procedures or Risks indicate escalation required Senior Managers within relevant Agencies informed

Medium Risk

Strategic Investigation Management (SIM) Group convened. Chaired by senior manager with senior representation from relevant partner agencies. LSI process monitored & representatives from SIM Group report to their relevant Directors/Heads of Service Risk status reviewed at each meeting.

High Risk Immediate action and decisions required from Directors/Heads of Service – this may require joint agency decision making. Multi agency Strategic Investigation Management Group convened, as required, to co-ordinate action. Risk status reviewed at each meeting

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Safeguarding adult abuse investigation/ referral or other concerns which indicate that other vulnerable adults may be at risk

Recommendation made to senior management that a large scale investigation (LSI) is required

Large Scale Investigations

THE MULTI AGENCY PROCEDURES

1. Managing large scale investigations

1.1 When to hold a large scale investigation meeting

A large scale investigation meeting is held when there are concerns about a particular service provided for vulnerable adults. It can be used for any service provider including public agencies

The most frequent use of a large scale investigation meeting follows a Safeguarding Adults Abuse Investigation, or referral, concerning one vulnerable adult where questions are then asked about the care of others in the same service.

1.2 Who decides to hold a large scale investigation meeting?

A Manager from the investigating team can recommend to a Senior Manager that a ‘Large Scale Investigation’ Meeting Is needed. Within Adult Services, Senior Managers are defined as :

• Head of Service

• Divisional Manager

• Senior Group Manager

• Safeguarding Co-ordinator

• Group Manager

• Contracts Manager

1.3 Serious high profile cases

It is recommended that a Senior Manager chairs a large scale investigation meeting. A serious case could be:

• Very serious or multiple cases of abuse

• Media interest

• Partial suspension of contract is likely or possible closure of the service

1.4 Large scale investigation minutes The Senior Manager chairing the investigation is responsible for arranging the minuting of all meetings, and for checking the minutes before they are circulated.

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1.5 Who attends a large scale investigation meeting? The following should attend:

• An Adult Services Senior Manager responsible for managing large scale investigations

• A manager and/or a deputy team manager from the investigating team • CQC inspector (if a registered care home or domiciliary care services) • Contracts officer from the Contracts and Monitoring Unit (if a contracted service) • Primary Care Trust representative (if the lead is Kirklees Adult Services). This

representative must represent the P.C.T. at a senior level. • A social care representative (if the lead is NHS), for example with continuing care

funded beds, or beds subject to nursing funded care. • The Primary Care Trust lead officer for Safeguarding Vulnerable Adults.

The following may be involved: • the police (should always be consulted with but may not attend if no crime has

been committed) • other professionals • legal department • the service provider • human resources department.

The large scale investigations meeting should be chaired by a group manager or senior group manager. Where the chair of the meeting represents the health services, both with employer and provider responsibilities for a service about which there is serious concern, an independent chair should be sought. This can be a senior manager from a different area or the Safeguarding Co-ordinator.

1.6 When to involve the service provider It is usually necessary to meet initially without the service provider to: • share information • discuss concerns • agree a plan of action At some stage it will be necessary to meet with the Service Provider so that concerns can be addressed.

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1.7 Who should be invited from the service provider?

Depending on the size of the service provider, the nature of the allegations, and the individuals circumstances of each large scale investigation, consideration needs to be given as to whether to involve the Manager, the Owner, or the Company Director concerned.

1.8 The large scale investigation meeting

The first stage is to investigate the serious concerns to see if the concerns are substantiated. Where the concerns are about poor care of service users a number of actions may be taken including: • reviewing individual cases • interviewing service users and/or family/carers • health examinations • liaising with other professionals who have access to the service • liaising with other sponsoring authorities Most investigations involve: • Kirklees Adult Services (reviewing cases, interviewing service users and

family/carers) • The PCT (investigating / specialist health advice) • CQC (compliance with national care standards) • The police (if a crime has been committed) • Contracts and Monitoring Unit (compliance with contracting arrangements) • IMCA

Rules and responsibilities in an investigation can overlap. It is important to be clear as to who is doing what.

1.9 Serious and /or high profile cases

Where the cases are serious and/or high profile Adult Services staff must inform senior management. Where there is media interest there should be contact with the communications unit through appropriate channels. Under no circumstances should staff deal with any enquiries from the media. The complaints unit must be kept informed in case they receive complaints concerning or related to the large scale investigation.

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1.10 Recording outcomes and actions plans

If, following an investigation, the concerns are substantiated there should be records kept to show how the concerns will be addressed. The details of records will vary in content but should identify: • what is to be improved • by whom • by when (timescale with a date) • evidence of decisions made and the reasons why. Areas to be improved can include: • care plans • health plans • managerial support • staff training • closer monitoring by sponsoring authorities, Contracts and Monitoring along with

the Care Quality commission. • liaison with service users and families. Records of individual service users must be kept up to date during such an investigation for example if they are subject to a Safeguarding Plan, reassessment of needs, or move elsewhere. Best interest’s decisions must be clearly recorded. It is also important to record the outcome of the investigation into each individual allegation of abuse. Minutes of meetings and action plans should be held centrally by each agency’s Safeguarding Lead Officer.

A review date should be set within Adult Services and records should be sent to Senior Group Managers, Divisional Managers and the Safeguarding Co-ordinator to see if improvements have been made and are being maintained.

It may be necessary to suspend new placements in a residential service when investigations are taking place and/or improvements are being made.

In situations of exceptionally high risk or if the partner agencies fail to reach an agreement this must be reported to senior managers immediately.

Reports and findings of large scale investigations will be monitored by The Kirklees Safeguarding Adults Board.

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2. Further guidance for carrying out a large scale investigation 2.1 Key Principles The first priority is to give attention to individuals who may have been subjected to

abuse, including the requirement to

• identify any necessary action to safeguard other vulnerable adult(s) • minimise disruption to any establishment or care

• provide vulnerable adults with access to independent advocacy • work in partnership with relevant agencies to assess what is required

2.2

Themes & Patterns of Abuse All agencies receiving safeguarding referrals need to be alert to the possibility of more than one vulnerable adult being at risk. In some cases, for example, a care home, this may be relatively obvious. In other cases, the overall picture may not be so clear. It is important that all those receiving safeguarding referrals are alert to this possibility. Information search activity (e.g. database checks, consultation with other agencies etc.) should always try to identify information of any previous investigations and allegations involving any named individuals.

2.3

The role of the ‘host’ authority The authority where the abuse happened is defined as the ‘host authority’ The ‘host’ authority: -

• Takes the initial lead on responding to the referral and co-ordinating any investigation

• Co-ordinates initial information gathering, background checks and ensuring

prompt notification to the ‘placing (funding) authority’ and other relevant agencies

• Appoints a lead person who will be responsible for the overall conduct of the investigation and ensuring that all relevant agencies are informed and involved

Within Adult Services the lead manager should be at Group Manager level and will normally be the Group Manager from the locality within which the service is based. If difficulties are experienced identifying a lead manager the case should be immediately referred to the Senior Group Manager/Divisional Manager. Within Kirklees Community Healthcare Services the lead manager should be at locality manager/service lead level.

2.4

Other placing authorities Where it is known that other authorities have clients living in the establishment it is

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important to ensure that they are informed of the concerns. The placing (funding) authority is responsible for providing support to the vulnerable adult and their authority should nominate a link person for liaison purposes during the investigation. They will be invited to attend any Strategy Meeting and/or may be required to submit a written report.

The placing (funding) authority must satisfy themselves:

• Representation has been provided at strategy meetings. • The continued placement is safe, meeting the needs of the individual and is in

their best interests. • The relatives or advocates of the individual have been kept informed of the

investigation

2.5 Partner Agencies

Primary Care Trust - NHS Kirklees must be involved in all cases where the alleged victim or perpetrator is fully funded by them (continuing care) or they are subject to funded nursing care.

Within NHS Kirklees the following should be informed at the onset: -

• Director of Risk • Director of Commissioning • Director of Patient Care and Professions • Assistant Director of Commissioning • Assistant Director for Safeguarding Children and Vulnerable Adults • Managing Director of Kirklees Community Healthcare Services

Whilst Adult Services would take the lead role in coordinating the investigation,

the PCT is expected to contribute as the commissioner of the service as they retain responsibility for those services and would be required to negotiate any changes that are required to the client's care and treatment package as a result of the investigation. Similarly they would retain responsibility for liaison with families and carers etc. and may be best placed to carry out some investigatory aspects as determined at the strategy meeting. In fully funded nursing cases, they have the expertise to evaluate evidence of a medical nature which may be pertinent to the investigation.

Kirklees Community Healthcare Services may need to be involved during the investigation as appropriate. (where for example there are those receiving care from District Nurse, Community Matrons, Intermediate Care).

If the investigation involves or affects South West Yorkshire Partnership NHS Foundation Trust (SWYPFT), The Mid Yorkshire Hospitals NHS Trust, Calderdale & Huddersfield NHS Foundation Trust the Safeguarding and Commissioning leads should be informed at the onset.

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Each agency will identify at this stage specific roles and reporting processes, along with

relationships to other procedures (eg Serious Untoward Incident Procedures, NHS Yorkshire and The Humber Procedure for the management of serious untoward incidents version 3 December 2008)

2.6 Care Home Investigations

The majority of large scale investigations deal with issues in care homes, which require careful consideration and handling.

Moving residents from a home:- The consideration of whether to move clients from a Residential or Nursing Home should be taken on the basis of an analysis of known risks and production of a risk management plan. Residents should only be moved with their agreement following careful discussion and where necessary involving relatives and IMCAs (Independent Mental Capacity Advocates).

Suspending admissions: Decisions to continue or suspend admissions should be taken on the basis of an analysis of known risks. Any decisions of this kind must be taken in close consultation with the contracts departments and legal services if necessary. If more than one agency is involved in commissioning a joint approach to suspending admissions should be discussed.

2.7 The Large Scale Investigation Strategy Meeting

The strategy group will exist for the duration of the investigation. All discussions and actions will be noted and disseminated to all relevant professionals who have been identified, by permission of the chair.

Meetings of the strategy group should be programmed to ensure that there is a regular flow of information between the agencies involved.

The task and function of the strategy group may vary from case to case; however the purpose is to: -

• ensure that all agencies are working together effectively and that expectations of the role within the strategy group are clarified.

3. The Escalation Process

Reasons for escalation could include: -

• Where there have been series of significant incidents where the management

response within the establishment has been unsatisfactory • Where an unplanned incident poses a serious threat to the running of the

establishment and its ability to meet the needs of its residents/service users

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• Where the organisation may not have sufficient resources to meet the requirements of the clientele thus exposing them to potential risk

• Where the organisation has consistently failed to meet the national minimum

standards (for care homes as outlined in legislation.)

• Where partner agencies fail to reach an agreement over further action This list is not exhaustive. A chart – Appendix 8 (pages 27, 28 & 29) can be used to assist decision making in the escalation process. Where it is believed that there is a need to escalate the investigation response, this should be highlighted with the following for a decision:-

• Adult Services-Senior Management Team • NHS Kirklees- NHS Kirklees Senior Managers • Kirklees Community Healthcare Services (KCHS)- Senior Managers • South West Yorkshire Partnership NHS Foundation Trust • West Yorkshire Police • The Mid Yorkshire Hospitals NHS Trust • Calderdale and Huddersfield NHS Foundation Trust-

A senior manager from Adult Services will be identified and will convene a Strategic Investigation Management Group and determine membership of that group Meetings will be minuted, actions noted and shared with senior managers as agreed by the chair.

All agencies should review the investigation once it is completed. The review should highlight any policies, procedures or disciplinary processes which need changing within or between the various agencies. It is good practice to conclude all major investigations with a brief ‘overview’ report highlighting the prime activities and findings of the enquiry with recommendations for future inter-agency learning. These should be reported to the Safeguarding Adults Board via the Performance and Quality Sub Group.

In some cases a serious case review will be undertaken, for which there is a separate process (see appendix 1.9 of the multi agency procedures).

3.1 Freedom of Information:- Managers need to be aware of the existence and impact of the Freedom of Information Act and of developments in the use of this right. The advice of the relevant agencies’ legal services must be sought in respect of any requests. There needs to be an exchange of information in order to manage the risk to the public, and it is important to ensure the maximum confidentiality of such exchanges. Only relevant information should be shared in relation to alleged perpetrators and victims. Any other information relevant to protect the public from the commission of further

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offences should also be shared. 3.2 Referral of information about alleged abusers:-

It is possible that an investigation will identify individuals who are suspected abusers but against whom prosecutions are not brought. If a suspected abuser is working with vulnerable adults in a care position it is essential that due consideration is given to releasing evidence and information to support disciplinary proceedings and to enable, where appropriate, the referral of suspected abusers to the Department of Health (for inclusion on the Protection of Vulnerable Adults List/Vetting & Barring list). Any actions/ non actions, and the reasons for taking them should be recorded

4. Securing Records

One of the most difficult issues in complex abuse investigations relates to the tracing, use, management and disclosure of documentary information.

The large scale investigation strategy group should consider what information is required, where it is likely to be and take immediate steps to secure it within each agency. This will particularly be the case if an investigation is in a care environment where services are being commissioned from more than one source - for example from private and out of area placements. In these cases it will be important to gain access to records to ensure that commissioners (and possibly relatives) are made aware of the investigation and the extent to which it affects their placement.

Timelines can be used so that for any staff member relevant to the investigation, it is possible to observe the period during which it is known that an individual had contact with vulnerable adults and the names of those adults.

4.1 If the alleged perpetrator is a staff member an organisational chart may also be useful in order to illustrate the inter-relationships between staff and the relevant vulnerable adults. In this way it is possible to observe at a glance which relevant adults have known each other, and therefore the names of the vulnerable adults with which they have had contact.

Staff personnel records may need to be examined as part of the investigation.

The channelling and exchange of this information and intelligence between agencies is of vital importance. All records should be safely and securely exchanged in accordance with information sharing and data protection policies and protocols.

5. Support for Victims and Witnesses Support for victims should be considered at the first meeting of the large scale investigation strategy group. Support will be required almost from the outset of the investigation through and beyond it ending. Minimum periods for contact should be established. It is clear from experience many victims and families feel strongly that it is important to remain in contact with the same staff throughout the investigative process.

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Guidance on witness support and preparation is included in ‘Achieving Best Evidence in Criminal Proceedings: Guidance for Vulnerable or Intimidated Witness, including Children’. (Criminal Justice System – revised 2007)

5.1 Staff Support Support of the members of the investigative team is the responsibility of the large scale investigation Strategy Group. Clear arrangements should be in place from the outset for all staff. These should include debriefing for all staff on the operation. Existing difficulties in inter-agency co-operation may be inflamed by the stress associated with investigations into complex abuse. Issues such as the boundaries of confidentiality, resource scarcity and differences of professional judgement may heighten these difficulties. Careful consideration should be given to a situation when operational staff may have to investigate a colleague. The safety of the investigating team must also be given consideration. Particular caution will need to be exercised in approaching individuals who are alleged to have been perpetrators. Visits should not be made alone and protocols for staff safety and handling violence should be agreed and observed.

5.2 Alleged Abuser The protection of the vulnerable adults identified as being at risk of harm remains paramount, but the sharing of information and confidentiality issues should be treated with due consideration for the alleged abuser. Agencies should take appropriate practicable steps to minimise the potential disruption and damage to the alleged offender’s private and professional life caused by a protracted investigation. Where allegations are subsequently found to be ungrounded, or it can be proven that false or malicious allegations have been made, the needs of the alleged offender should be treated with sensitivity.

5.3 Referrer/Whistleblower Consideration should be given to how the person making the initial referral is involved in the investigation. Clearly this will vary depending on the circumstances of the case. However, in all cases the strategy group should ensure that the referrer is as far as possible, having regard for confidentiality, kept up to date with developments and informed of the final outcomes of the investigation.

5.4 Media Handling No agency should underestimate the level of media interest in complex abuse investigations. The main task of handling the media should be assigned to a senior group manager/divisional manager/safeguarding lead who should liaise with

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communications officers. A clear multi agency communications strategy should be in place, and reviewed regularly. Under no circumstances should staff deal with any enquiries from the media.

6. Records of the investigation and File Storage

The Code of Practice made under the Criminal Procedures and Investigations Act 1966 sets out the minimum requirements for record retention and defines action to be taken by the police in the context of retention and disclosure of material held by third parties.

It is considered good practice to maintain a central registry and file storage facility for all cases that come within this guidance. The holding agency should ensure that all documents and files used and/or generated in the process of an investigation are retained securely. In Adult Services these should be held by the Safeguarding Unit. In addition individual records need to be kept on the individual’s case records, with due regard to the keeping of any third party information. All records should be safely and securely stored in line with each organisation’s policies and procedures.

7. Vulnerable Adults (POVA) /Independent Safeguarding Authority The POVA scheme has been implemented for registered providers of care homes and domiciliary care agencies. It also applies to employment agencies and businesses who supply care workers to these providers. Care providers have a responsibility to refer care workers to the POVA list where such workers have harmed vulnerable adults in their care. The POVA list will be replaced by the Vetting and Barring Scheme (Safeguarding Vulnerable Groups Act 2005) in October 2009.

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Appendix 1 Ground Rules for Managing Large Scale Investigation Meeting NB: Mobile phones, pagers and bleepers must be turned off.

1. Confidentiality The content of the meeting is strictly confidential and can only be shared on a need to know basis.

2. Staying for the whole meeting It is the intention that the meeting should not last more than 1½ hours. It is important for all members to contribute to the development of the protection or action plan. Every effort should be made to stay until the end of the meeting.

3. Responsibility to speak out Everyone needs to be open and honest in their contribution to the meeting.

4. Respect for each other’s views It is everyone’s responsibility to actively listen to the views of others and not interrupt. Everyone will be given the opportunity to speak.

5. Outcomes Professionals should record any actions for themselves pending arrival of conference minutes that will be circulated as soon as possible.

6. Minutes Minutes should be sent out within 5 working days of the meeting and if sent electronically should be password protected. They will not be reproduced without the express permission of the chair.

Ensuring the accuracy of the minutes is everyone’s responsibility. Send any important omissions or corrections to the Chair of the conference within 5 working days of receipt.

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Appendix 2 Large Scale Investigation Strategy Meeting - suggested agenda structure and minutes

1. Introduction and Ground Rules – see attached.

• include roles in Safeguarding Investigations so far.

2. Purpose of meeting - Actions so far

3. Terms of reference for the investigation:-

Could include: -

• immediate or further action required to safeguard residents. • safeguarding considerations of any referrals so far. • Planning any further investigations – roles and responsibilities, • the need to undertake reassessment of needs for all residents – based on

the evidence provided.

4. Reports on issues raised so far

Could include:- • Safeguarding Referrals - details and investigation actions so far and any

outcome. • Information from Contracts • Information from other agencies e.g. NHS Kirklees, SWYPFT

5. Information regarding all residents in the Care Home

Could include:- • those placed and funded by KMC • those placed and funded by NHS Kirklees • out of area placements • self funded – not known

6. Decision regarding full scale investigation

• Decide on how to proceed. • Proposed timescale for investigation.

7. Action – and who is responsible for each action. And timescales for achieving

them.

Could include:- • Identification of who is to undertake investigation – resource issue

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• Clarification of NHS Kirklees staff in the investigation process • Responsibility for out of area placements and fully funded continuing care

residents. • Contact with any out of area local authorities as necessary. This could

include Social Work Teams, Contracts Teams, and Safeguarding Units. (standard letter available see appendix 6).

• Level of support available to residents and relatives. • Information to be sent to relatives (Standard letter available) see appendix 5. • Role of Contracts Unit. • Keeping Care Quality Commission (formerly CSCI) informed. • Anyone else needed to be involved in Management of the Investigation. • Any potential press/media issues. • Any legal advice required. • What type of contact is required with the Home/Manager? How this fits in

with any contact Heads of Commissioning may have/have had already. • Dates for future meetings.

8. Recording

These meetings must be clearly recorded. Minutes should be distributed with the following heading - ‘These minutes must not be photocopied or the contents shared outside the meeting without the agreement of the chair.’ and should be password protected.

Minutes should be kept in the Adult Services Safeguarding Unit; and within the relevant Safeguarding/Risk Department in partner agencies.

Recording must ensure that, in addition to the wider issues raised around the investigation, the individual safeguarding investigations and outcomes are recorded as well.

Decision making and the reasons for decisions taken must be clearly evidenced in the records. 9. Minutes

Minutes should include:-

• Those present (name of individual and agency they represent) • Chair of meeting • Date of Meeting • Purpose of Meeting • Agenda • Issues raised and any disagreements or alternative positions • Agreed decisions and Actions(with lead individual/agency) and time scale • Date and venue of next meeting • The Chair should approve and sign the minutes

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Appendix 3 Checklist for First Large Scale Investigation Strategy Group Meeting Terms of reference to include:-

• Purpose of the group • Current issues for investigation • What powers, legal and otherwise does the group and its member organisations have • How long will the group be formed for? • Frequency and length of meetings • Agree if ‘virtual’ meetings may be an option • Clarification of roles within the Strategy Group • Is legal advice necessary? • Is a media strategy required? • Is a joint communication strategy with family members and the organisation under

investigation required? Membership:-

• Is there appropriate representation from relevant agencies/organisations - are there others that should be invited to join?

• Who will be chair? • Who is responsible for note taking/minutes and disseminating information? • Will the care provider concerned be invited to join group?

The nature of the concern/abuse:-

• What is the description of the concern? • Have concerns arisen as a result of the accumulation of indicators and/or signs of

abuse? • Have concerns arisen as a result of a disclosure or allegation? • Are there witnesses? • Have clear unambiguous statements been made? • Is the organisation or abuser aware of the concerns? • Do other authorities/commissioners of care need to be informed of the concern?

The Vulnerable Adults:-

• Have the vulnerable adult(s) indicated what they would like to happen? • Are there concerns that their decision reflects an unacceptable degree of exploitation,

intimidation, or coercion? • Have other vulnerable people been, or likely to be, put at risk? • Are assessments of capacity required for the vulnerable adults? If so what

arrangements have been put in place to ensure these are completed? • Are the vulnerable adults aware of their rights? Vulnerable adults are entitled to the

same protection as any citizen in relation to the criminal law and they have the same ability to use and enforce the civil rights they have.

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• Are the vulnerable adults aware of the concerns that are held about them? If not are there plans to share this information

• What part can and should the vulnerable adults involved play in the investigation? And what support will they need (i.e. advocacy) to do so?

• Are there any cultural and/or religious factors that may need to be taken into account? • Are there any specific language/communication issues that may need to be taken into

account?

The alleged perpetrator(s):-

• What is known about the alleged perpetrator(s)? • Are there any cultural and/or religious factors that may need to be taken into account? • What is the alleged perpetrator’s relationship with the vulnerable adult? • Is the alleged perpetrator employed by this or any other organisation responsible for

the care and support of vulnerable people? • Is the alleged perpetrator also a vulnerable adult? • Is there sufficient evidence to make a provisional referral to the POVA/Vetting & Barring

list? • How will any inter-relationship between Safeguarding, disciplinary and criminal

processes be managed? Risk:-

• Are the vulnerable adults at continuing risk? • Have reviews/risk assessments been undertaken of all those at risk? • What is the extent of the risk? • Are there any secondary/potential risks that need to be considered?

Next steps:-

• Who needs to be involved at the next step? • Is more information required before going ahead? If so what? • What would be the best way of obtaining this information? • Programming dates for future meetings • Agree specific actions required and individual responsibilities required, including

timescales for completion. Consider the need to meet with relatives and carers of vulnerable adults involved, to keep them fully informed as to the steps being taken by the relevant agencies and the support available to them.

Consider the impact of stress on front line workers from any agency and to ensure that support is offered appropriately.

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Appendix 4 - The Investigation Checklist There are some additional issues that should be borne in mind in larger scale investigations. This section aims to provide a checklist or ‘aide memoire’ that should be considered at periodic reviews while it is being conducted. Evidence of joint response and decision making: -

• Maintain a file of all policy guidance and decisions affecting / concerned with the investigation

• Consider the timing of investigative actions; is the care setting swamped with too many professionals? Are there other large scale investigations which may impact on this one?

• Is another establishment or unit involved, in which case who else needs to know? • Plans of building/accommodation – would this help establish patterns and themes?

Informing relatives of concerns – is there a continuous coordinated approach if more than one commissioning agency is involved.

Early contact with non-abusing carers: - • Support to referrers • Any funding and resourcing for the investigation required? • Use of IMCA/advocates • Implication of any ethnic/religious differences • Clarify Language & communications considerations • Help line facility • Legal advice arrangements • Liaise with press offices – who’s responsible; who to liaise with? How to ensure

confidentiality of personal details – staff and clients/patients. Is there an agreed media strategy in place? when was it reviewed?

• Consider other local and central government agencies, not normally involved • Regular briefings for strategy group. • Briefing Senior Managers from each agency involved. • Staff and welfare issues considered (counselling, debriefing) • Debriefing at conclusion of investigation • Plans for security of records • Policies and procedures that may need to be considered in relation to staff

management: Disciplinary/suspension from duty/fitness to practice/termination of employment/Professional registration/ POVA/Vetting and Barring etc. Who is responsible for doing what in relation to these?

• Does escalation process need to be used?

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Other considerations • Use of police major incident procedures • If above not used, establish what procedures are to be used to maintain an accurate

log and record of information • Joint incident centre (room) • Use available information technology facilities (e.g. police major crime computer) • Consider forensic examination • Video scene of alleged abuse

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Appendix 5

KAS Department Full Postal Address

Direct Line:

Fax:

Email:

Our Ref:

Date:

This letter should be sent out in a Senior Manager’s Name. If a joint agency approach is required and the letter is going out in both agencies’ name then advice should be taken in each agency as to which Senior Manager this should be. <Title>> <<First _Name>> <<Last_Name>> <<Address_Line_1>> <<Address _Line _2>> <<Address _Line_3>> <<Town>> <<Postcode>> Dear <<Title>> <<Last _Name>> Re: <<Name_of_Home>>, I am writing to inform you that due to a number of concerns relating to the care provided at the <<Name_of_Home>>, Kirklees Adult Services have stopped making any further placements at the home. Adult Services and the Care Quality Commission are monitoring the situation and plans are in place to assess each resident placed in the home to ensure that their individual care needs are being appropriately met. If you have any questions relating to the above or to someone who is placed at the <<Name_of_Home>>, please contact <<First_Name>> <<Last_Name>>, <<Position>>, <<Section>>, on <<Telephone>> or if the issue is contractual one <<First Name>> <<Surname>> on <<Telephone>>. Please be assured we are working hard to improve the services at <<Name_of_Home>> Yours sincerely <<First Name>> <<Last _Name>> <<Position>>

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KAS Department

Full Postal Address

Direct Line: Fax:

Email:

Our Ref:

Date:

Appendix 6

This letter should go out in the ADASS safeguarding lead’s name. <<Title>> <<First _Name>> <<Last_Name>> <<Address_Line_1>> <<Address _Line _2>> <<Address _Line_3>> <<Town>> <<Postcode>> Dear <<Title>> <<Last _Name>> Re: <<First _Name>> <<Last_Name>> We are currently undertaking a Safeguarding Investigation in relation to allegations of abuse against a number of residents placed in <<Name_of_Home>>, of which <<First _Name>> <<Last_Name>> is one. We are fulfilling our obligations in relation to Safeguarding Adults as the ‘host’ authority. Our role is defined as:

• Take the initial lead on responding to the referral • Co-ordinate initial information gathering, background checks and ensure a prompt

notification to the ‘placing authority’ and other relevant agencies • Co-ordinate any investigation

The placing authority is responsible for providing support to the vulnerable adult and planning their future care needs, either as an alleged victim or alleged perpetrator. The placing authority should nominate a link person for liaison purposes during the investigation. They will be invited to attend any Safeguarding Adults Strategy Meeting and/or may be required to submit a written report.

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I am writing to suggest that you satisfy yourself that:

• Representation has been provided at strategy meetings. • The continued placement is safe, meetings the needs of the individual and is in their

best interests. • The relatives or advocates of the individual have been kept informed of the

investigation and the process your staff have put in place to inform them of the outcome.

The ongoing placement for <<First _Name>> <<Last_Name>> is a matter for your Commissioning Manager to decide and not something we as the ‘host’ authority can decide or advise upon. I hope you find this letter helpful in clarifying the current position. Yours sincerely <<First Name>> <<Last _Name>> <<Position>>

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Appendix 7 - The Escalation Process Strategic Investigation Management Group Terms of reference: -

1. To risk manage the investigation at a strategic level and to provide clear recommendations to Senior Management Team (Adult Services), Executive Management Team (SWYPFT) and Senior Management Group (NHS Kirklees) - or other agencies as identified

2. To ensure the safeguarding strategy in relation to each individual

agency is well coordinated and delivers its action plan

3. To receive reports and information, monitor progress, identify further areas for improvement and develop action plans as appropriate

4. To act as a conduit of communications to SMT/EMT/SMG

5. To ensure resources, knowledge and expertise are available to deliver the safeguarding improvement strategy

6. To ensure ad hoc representation to this meeting as required

Appendix 8

Kirklees Safeguarding Adults Board Managing Large Scale Investigations – Escalation Process

This should be used to determine what action needs to be taken in relation to serious concerns and should be signed by the Chair of whichever meeting takes the decision to escalate action. This would usually be the chair of large scale investigation meeting or of the strategic investigation management group). NAME OF HOME/CARE PROVIDER………………………………………….

ACTION REQUIRED

1 2 3 Monitor and

record situation via large scale investigation

meeting

Highlight to Senior Managers* and monitor regularly by convening

multi agency Strategic Investigation Management (SIM)

Group who should report to relevant senior managers in each

agency

Inform Senior Managers* in relevant organisations if

Immediate action/decision required .This may require

joint agency decision making. Multi agency Strategic

Investigation Management (SIM) group may need to be convened to coordinate any

action required

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Adult Services Senior Managers :- Heads of Service, Divisional Managers, Senior Group Managers

NHS Kirklees Senior Managers and Kirklees Community Healthcare Services Senior Managers (KCHS): SYMHT Senior Managers: General Managers , Assistant Director

Escalation triggers

Risk (Green, Amber, Red)

Impact – provide details

Action Required (1, 2 or 3)

Action undertaken

Example – Sudden closure of care home

Red All Service Users need to be removed from the home

3 Service Users’ needs assessed and new care homes found

Sudden closure of care home Serious incident causing serious harm or death

Home not managing safeguarding incidents appropriately

CQC take action to begin closure process

No sustained evidence of training having a impact

Continued failure to respond to defaults

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Continued failure to respond to regulatory notices from CCQ

Home without a manager at short notice

Negative media coverage Current management arrangements not delivering

Evidence of lack of financial viability at the care home

New placements suspended at the care home

Large Scale complaints received

Home has not sufficient resources to meet the requirements of the clientele

An unplanned incident poses a series threat to the running of the home and its ability to meet the needs of its residents/service users

Partner agencies fail to reach an agreement over action to take

Other SIGNED ………………………………………..CHAIR DATE…………………………………

Appendix 9

Guidance for Concluding Report for Large Scale Investigation The report should include:-

• Date of incident • Agencies involved • Outline of concerns • Outcome of the allegations for each individual (initials only). The

outcomes and any actions taken should also be recorded on each individual’s case file.

• Summary of outcomes of investigation. This concluding report should be sent to the Senior Group Manager/Divisional Manager and the Safeguarding Co-ordinator who will submit this information to The Safeguarding Adults Board performance and quality sub group.

If a Serious Case Review is to be requested as a result of the large scale investigation this has to be made in writing by a board member to the chair of the safeguarding board

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