Suffolk Vulnerable Adult Protection Committee€¦ · Web viewSafeguarding Adults (ADSS 2005)...

Adult Safeguarding Board

Adult Safeguarding PolicyAnd

Operational Guidance

November 2008

Version 1 November 2008. Policy Author Bill Nicol. Date of Review September 2009 1

ContentsASB Policy Statement 3-4Appendix 1 Operational Guidance & Definitions 15-19Appendix 2 Abuse Types & Indicators 20-29Appendix 3 Reporting Abuse 30-37Appendix 4 The Adult Safeguarding Process 38-45Appendix 5 Interviewing 46-56Appendix 6 Communication and Alerting 57-58Appendix 7 External Providers 58-59Appendix 8 Out of County Placements 60Appendix 9 A Statement of Rights 61Appendix 10 Serious Case Reviews 62-74Appendix 11 New Developments in Safeguarding 75-80


Suffolk Adult Safeguarding BoardNovember 2008

Adult Safeguarding Policy

The Suffolk Adult Safeguarding Board (ASB) is a multi-agency partnership that promotes the development of adult safeguarding work throughout the county. The member organisations have committed themselves to implementing this policy, the good practice principles, and the adult safeguarding procedures. The ASB is tasked with providing strategic leadership, overseeing effective inter-agency collaboration and ensuring that adult safeguarding receives appropriate levels of resource.

This Policy applies to all staff and volunteers who have any responsibility for the care and protection of a vulnerable adult.

In March 2000, the Department of Health issued No Secrets which provided a framework for the inter agency collaboration on the development and implementation of procedures for the protection of adults vulnerable from abuse. In October 2005, the Association of Directors of Social Services supplemented this with Safeguarding Adults, a national framework of standards for good practice and outcomes in adult safeguarding work.

Suffolk County Council responded to No Secrets in 2001 with the production of a multi agency policy and procedures. This was fully revised in 2004 and partially revised in June 2006. This 2008 revision has been made necessary due to changes within national legislation and local practice.

STATEMENTS & KEY PRINCIPLESADULTS AT RISK OF ABUSE

Every person has the right to live a life free from abuse, exploitation and neglect


Abuse occurs in all sections of society and there should be no discrimination because of assumptions about class, gender, age, disability, sexual orientation, race, religion, culture or eligibility for service.

Some people are more vulnerable to abuse than others because they are disempowered within society. People may be additionally vulnerable because of disability, age, impairment or illness.Adults at risk of abuse must be made aware of their rights and given information, advice and support. They should be encouraged and enabled to access protection from the law and legal processes.

Every effort must be made to promote the wellbeing, security and safety of adults at risk of abuse consistent with their rights, mental capacity and personal choices.

In most cases, the adult at risk of abuse should be the person who decides on the chosen course of action, whilst being given all possible support. In a proportion of cases, an adult with mental capacity may choose to remain in an abusive environment or situation. In these cases it is still extremely important to consider what advice and support can be offered to reduce their risk from harm.

PEOPLE RAISING AN ALERT OF POSSIBLE ABUSE

Any persons making reports of allegations of abuse should be listened to and their information acted upon. Wherever possible the “Alerter” should be given information about the outcome of the investigation although due regard should always be paid to the extent of the information that can be shared. Staff should be encouraged to disclose any concern or worry that they may have in relation to the treatment and care of a vulnerable adult.

Abuse thrives on secrecy. The role of the Alerter is therefore of paramount importance in detecting abusive behaviour and practice.

ORGANISATIONS WORKING WITH VULNERABLE ADULTS

Every organisation which has a duty for the care and protection of vulnerable people should have a clear, well publicised policy of zero tolerance of abuse.

All agencies are expected to be aware of the ASB policy. All safeguarding procedures should be known and understood by customers, relatives and friends as well as staff.


All organisations must have safe recruitment practices to help reduce the risk of abusive behaviour and practice.

All staff working with vulnerable people are afforded a position of status and authority in relation to service users. Services should be provided in an environment which lessens the imbalance of power and encourages independence and self-advocacy for service users.

All working practices should minimise the risk of abuse by being sensitive to individual, gender and cultural needs.

This multi-agency policy is the foundation of the agreement made between organisations. Effective inter-agency working is critical if vulnerable people are to be protected from harm. Consistent information sharing, collaboration and communication between agencies and professionals are all key elements in abuse prevention and detection.

No single agency can act in isolation to ensure the welfare and protection of vulnerable adults.

The policy is about stopping abuse where it is happening and preventing abuse where there is a risk that it may occur.

There can be no excuses for not taking all reasonable action to protect vulnerable adults from abuse, exploitation and mistreatment.

All citizens of the United Kingdom have their rights enshrined within the Human Rights Act 1998. People who are eligible to receive health and community care services may be additionally vulnerable to the violation of these rights by reason of disability, impairment, age or illness.Abuse, and the fear of abuse, has a significant impact upon an individual’s ability to maintain and maximise their health and general well being.

All individuals and agencies that have a responsibility for the care and protection of vulnerable people will have an important role to play in abuse detection, reporting and prevention.

The accompanying guidance contains the Suffolk Multi-Agency Codes of Practice for the Safeguarding of Vulnerable Adults from Abuse. These codes set out how all agencies and individuals should collaborate to promote best practice and provide a high standard of response in adult safeguarding practice. It is addressed primarily to those who work in health and social care services, the police, voluntary


and independent sector care agencies, and others whose day-to-day work brings them into contact with vulnerable people (e.g. education, leisure and the business community)

We recognise that abuse is a symptom of social, institutional and individual discrimination. Disabling attitudes and practices allow for the belief that it is somehow acceptable to treat vulnerable people with little respect and for people not to be informed, consulted, included or empowered in order to exercise choice and take decisions which affect their lives.

Preventing discrimination is essential to abuse prevention. We are committed to work within our organisations, the services we provide, and in partnership to promote the rights of service users.

STATEMENT OF COMMITMENTThe agencies involved in drawing up these procedures recognise that, within the present legal framework there will be some occasions on which adults at risk will remain in dangerous situations. It may be that even after careful scrutiny of the legal framework, staff will conclude that they have no power to gain access to a particular vulnerable adult. Staff may find that they have no power to remove the adult from a situation of risk, investigate the adult’s financial affairs, or intervene positively because the adult refuses all help or wants to terminate contact with the authorities.In these extremely difficult circumstances, staff will be expected to continue to exercise as much vigilance as possible. However, the employer will give full support to staff over problems when handling cases of adults remaining in high-risk situations, provided that:

It is evident from case records that Adult Safeguarding Procedures have been properly followed;

Every effort has been made, on a multi-agency basis, to intervene positively to protect the vulnerable adult;

Legal advice has been obtained

The abuse of vulnerable people is a sad reality. It can be difficult to understand why anyone would want to abuse an older person, someone with a physical or learning disability, or someone who is unwell. In some instances the abuse may not have been deliberate,


malicious or premeditated. It can happen when people are trying to do their best but are unaware of what is the right thing to do.

The Suffolk Codes of Practice for the Safeguarding of Vulnerable Adults are not just about identifying abusers and punishing them, although this will happen if necessary.

Their most important aim is to:

Promote the wellbeing, security and safety of vulnerable people consistent with their rights, capacity and personal choices, and prevent abuse occurring wherever possible.

In most cases this can only happen by making sure people get the care and support that they need. It is also important that the people who care for them also get this support and recognition. Most importantly it is about listening and providing the options that permit individuals to help themselves.

It may not always be possible to provide satisfactory solutions. In a proportion of cases a vulnerable adult may choose to remain in an abusive environment or situation. At the age of 18 people are legally entitled to adult status regardless of any disability or impairment they may have. It is therefore essential that wherever possible it is the vulnerable adult who will decide on the chosen course of action. However, the people and organisations caring for, or assisting them, must do everything they can to identify and prevent abuse happening wherever possible.

Each organisation will take a role in providing safety through the development of good practice in preventing and responding to abuse.

Each organisation will designate a Lead Manager at a senior level to promote the development of this work.

Each organisation will work actively in partnership to develop adult safeguarding work at a County level and will use these multi-agency procedures to protect individuals who may be at risk

It is the responsibility of all individuals and agencies to be alert to the possibility of adult abuse and have understanding of the possible signs and indicators of abusive acts or practices.

Suspicions, allegations or concerns will arise from a wide variety of sources and for a wide variety of reasons. The responsibility to report


any such concern rests with all individuals regardless of their place within the organisation, service, or agency.

This policy is intended to assist all staff and volunteers in achieving this.

THE DOMESTIC VIOLENCE POLICY & SAFEGUARDING VULNERABLE ADULTS

Domestic Violence and Forced Marriage can also involve the abuse of a vulnerable adult. The definition of Domestic Violence is “any incident of threatening behaviour, violence or abuse between adults who are, or have been intimate partners or between family members regardless of gender, disability or sexuality.

Forced marriage is one in which one or both spouses do not consent to the marriage and some element of duress is involved, including the use of physical and emotional pressure. Forced marriage is not sanctioned within any culture, faith or religion (See Legal Appendices).

Some incidences of abuse under the Safeguarding Adults Policy could therefore also be categorised as Domestic Violence. In cases where there has been domestic violence a Safeguarding Adults Strategy meeting should take place. A referral to the Multi Agency Risk Assessment Conference (MARAC) should be made. This could lead to important information being shared and decisions being taken to safeguard the vulnerable adult from future harm.

CULTURAL AWARENESS AND ADULT SAFEGUARDING

When providing services to people from minority ethnic communities, it is important to acknowledge that any failure to recognise their cultural, religious and ethnic diversity should be interpreted as abuse, since it denies the individual their own personal history and identity. It is also important to be aware of the institutional racism and discrimination that people from minority ethnic communities may have experienced and to try and work proactively to meet the individual’s needs. People who are marginalised from society are discriminated against.

There is now arguably a greater acceptance that abuse exists within minority ethnic groups and that it can be categorised in the same way as for the indigenous population/ However racism and discrimination at the institutional, personal or societal level can make identification and


disclosure, referral and response difficult for the abused person, their family carers and social networks.

Relevant issues are:

Previous experience of racism or discrimination

Reluctance to approach public authorities about any issue, due to refugee status or self-identification as an “exile”

Anxiety about having to deal with officials in English, which may not be a preferred language

Language difficulties and lack of familiarity with local customs can lead to a heavy reliance on family members to act as intermediaries in everyday life. Disclosure about a family member may therefore be all the more difficult for that individual. Good practice would promote the use of an independent interpreter or translator. Care should be taken to ensure that the interpreter used is aware of the importance of confidentiality both within the client relationship and between the client and their community

The intricate and complex nature of extended family relationships can exacerbate the need for the vulnerable adult to have an opportunity to talk openly in private.

DIGNITY IN CARE

In 2007 the Department of Health initiated a campaign “to put dignity at the heart of care services”, whether care is given in a person’s own home or another care setting. Suffolk’s ASB, social care and health agencies are responding actively to ensure that they meet the Dignity & Respect challenge, the principles of which underpin this adult safeguarding policy.

The “Dignity Challenge” states that high quality services that respect people’s dignity should:

Have a zero tolerance to abuse

Support people with the same respect you would want for yourself or a member of your family


Treat each person as an individual by offering a personalised service

Enable people to maintain the maximum possible level of independence, choice and control

Listen and support people to express their needs and wants

Respect people’s right to privacy

Ensure people feel able to complain without fear of retribution

Engage with family members and carers as care partners

Assist people to maintain confidence and a positive self-esteem

Act to alleviate people’s loneliness and isolation

Some Multi-Agency Issues in Safeguarding Adults

The difference between confidentiality and secrecy

Confidentiality must not be confused with secrecy. An example of secrecy would be to promise an adult at risk of abuse not to tell anyone about his or her disclosure. Another example would be for one agency to keep information about abuse within the organisation rather than referring to Adult Community Services Customer First or the Police.

Confidentiality, on the other hand, means that information is shared in the best interests of the person concerned, to protect them from harm. Information is shared on a strictly “need to know” basis and wherever possible informed consent to sharing the information is obtained from


the adult at risk of abuse. Assurances about absolute confidentiality can never be given.

Sharing of Information

Sharing information is essential in protecting vulnerable adults. Suffolk ASB have a Sharing of Information Protocol to ensure that effective communication is made across all organisations. The Data Protection Act 1998 does not preclude the sharing of information to provide an effective service or protect a person from harm, danger and abuse.

Recording

Good record keeping is essential for all agencies, at all stages of the safeguarding process records must be kept in line with agency requirements. They must always be clear, succinct, accurate and comprehensive. Staff at all levels, within all agencies must keep full and accurate records. All records are legal documents and are admissible in civil, criminal and coroner’s courts. They may also be requested by those about whom they are written. Within each agency, all recorded information should be available on the person’s case record or file.

It is essential to demonstrate how an assessment of risk, responsibility, rights, autonomy and protection was undertaken. Clear evidence of what decisions were taken and why should also be available. Records should be signed and dated and include the following:

Factual information, fir instance, dates and names of people attending meetings or taking part in discussions in relation to the allegation or disclosure

All contact, whether face to face, by telephone, e-mail or letter, with the adult concerned, family carers, other staff members and alleged abuser

All contact with other agencies

All decisions made, actions taken and the responsibility for undertaking set tasks

Any differences in opinion in relation to risk or possible harm from abuse

A chronology of actions taken


Roles and Responsibilities of Key Agencies and Organisations

Suffolk County Council Adult Community Services has the lead responsibility to co-ordinate multi-agency work to protect vulnerable people from abuse and exploitation.

The Suffolk Constabulary have the lead responsibility for carrying out an investigation of a crime. Many alleged instances of abuse may be criminal acts. The Police must always be consulted about any incident whereby a crime has been thought to have been committed.

The Commission for Social Care Inspection (CSCI) must be informed of any issues of abuse which take place in organisations or settings for which they have regulatory responsibility. The basis for the boundaries of the CSCI role is set out in the CSCI Safeguarding Adults Protocol (2007)

All agencies with a responsibility for the care, welfare and protection of vulnerable adults must:

Have a policy of zero tolerance of abuse

Be conversant with ASB guidance, policy and procedures

Have their own internal safeguarding policy consistent with the ASB document

Have safe recruitment practices

Ensure that they have sufficient staff training programmes to ensure that all staff know what to do if they have any concerns or receive a disclosure from whatever source.

Roles and Responsibilities of Individuals

The Suffolk ASB expects that all individuals who work on a paid or unpaid basis in all organisations will work together to prevent adults from being abused and to act appropriately when abuse is reported or suspected. It is only by being clear about their roles and responsibilities that this can be achieved.

Front line workers and operational staff should:


Be alert to the possibility of abuse

Respond to all concerns, worries, suspicions, disclosures and allegations

Use the ASB and internal safeguarding procedures to help them understand the process for alerting others to abusive behaviour and practice

Take advantage of opportunities for staff training in relation to this policy and other related issues

Commissioners, regulators or inspectors of services should:

Ensure that all contracts are compliant with this ASB policy

Make the links between the different public safety policy initiatives and legislation to protect adults at risk of abuse

Note that every service seeks to protect all service users from abuse and harm

Supervisors and Managers should:

Take responsibility for ensuring that any allegations or concerns of abuse are responded to within ASB guidelines

Ensure that all appropriate agencies are involved in any investigation

Ensure that staff are well supported in using the ASB guidelines

Provide an working environment where staff feel able to communicate all concerns and report bad practice

Establish and maintain clear lines of communication between themselves and other managers to ensure a quick, consistent and effective response

Senior Managers should:

Identify what needs to be done to fully implement and promote this ASB safeguarding procedure in their organisation, department or section

Monitor progress and evaluate the efficacy of the safeguarding process


Contribute to ASB Locality Committee or Board and provide information for the Annual Adult Safeguarding Report

Support the work of staff and colleagues to undertake safeguarding responsibilities

Chief Officers and Chief Executives should:

Commit to raising the profile of safeguarding work

Fully support the ASB safeguarding policy

Ensure contribution to the ASB

Respond to national safeguarding policy proposals

Local Authority Members should:

Be aware of the strategic issues in relation to safeguarding work and resources

Receive annual reports which detail safeguarding planning and achievements

Staff in Children’s Services who are monitoring a child at risk of abuse who is in the transitional period between childhood and adulthood (17-18) should make a referral to Adult Community Services Customer First for a community care assessment, with an alert raised about the need to initiate the safeguarding process. The age of the transition period is different for “looked after” children (21) but the principle remains the same.

Serious Case Reviews

The Suffolk ASB will hold a Serious Case Review in the following circumstances:

A vulnerable adult dies and abuse or neglect is considered to be a factor

A vulnerable adult sustains a life-threatening injury through abuse or neglect, or sustains permanent impairment of health and development through abuse or neglect


Serious abuse takes place within an institution or care setting and multiple abusers are involved

Serious systemic financial abuse

The purpose of a Serious Case Review is:

To establish whether there are lessons to be learned about the way in which professionals and agencies worked together to safeguard vulnerable people

To review the effectiveness of multi-agency procedures and those of individual organisations

To inform and improve local inter-agency practice

Implementing change from lessons learned.

See Appendix 10 for ASB Serious Case Review Protocol


APPENDIX ONE

OPERATIONAL GUIDANCE & DEFINITIONS

WHO IS RESPONSIBLE FOR PROTECTING VULNERABLE ADULTS FROM ABUSE?

As citizens we have a moral obligation to protect those who are most vulnerable from abusive behaviours and practices.As staff, volunteers, care providers, or representatives of our agencies, we have an absolute and unequivocal duty of care to protect our service users from harm.All people working with, or coming into direct contact with, vulnerable adults share a responsibility to be aware of issues of abuse and neglect, and to report any concerns or information that they have which indicates that an adult is, or may be, experiencing abuse.

Adult safeguarding referrals will be made in many different ways and from a wide variety of organisations.

THE REFERRER

The referrer can be anyone e.g. a neighbour, family carer, vulnerable adult, member of the public, colleague. They may wish to refer for a variety of reasons. They have received a disclosure from the person experiencing abuseThey have been contacted by a third party e.g. relative, friend or family carer, a member of the public, or an employee of another organisation

They have observed abuse occurring They are worried that abuse has occurred

Once information is received from a referral source then action must be taken.

The ALERTER, cannot keep information about abuse confidential to himself or herself. They have a formal duty of care to report abuse and therefore cannot keep secrets. They


must make it clear to anyone who shares such information with them that they will have to pass it on, in accordance with their organisation’s adult protection procedures.

The Alerter will:

Take any immediate action needed to safeguard the health or safety of the person for whom there is concern or anyone else who may be at risk.(If an adult is in immediate danger the police or other emergency service should be contacted)

Contact the police immediately when a crime is suspected, taking place, or has taken place. Start the adult safeguarding procedures within their organisation by informing their line manager at the earliest opportunity. Where there is evidence of immediate risk or threat then the line manager must be informed straight away.

If the line manager is not available then another manager or supervisor must beInformed. Details of the alert should be recorded on an adult protection referral form.

All appropriate information must be recorded clearly including dates and times when events took place. Facts and opinion should be clearly differentiated.

WHO ARE VULERABLE ADULTS?

The adults covered by this policy and procedures are all those within Suffolk who are over 18 years of age, and who are, or may be, in need of community care services. For example: People with a mental health problem or mental illness (including dementia) People with a physical disability People with drug and alcohol related problems People who have a sensory impairment. People who have a learning difficulty People who have a physical illness


People with an acquired brain injury People who are frail Family carers providing assistance for a vulnerable person(This is not an exhaustive list)

GUIDANCE BOX ONEAnyone who has been abused merits our assistance, advice and support. Safeguarding Adults (ADSS 2005) identifies a duty of care to all adults “whose independence and well-being is at risk due to abuse or neglect”.

Where a person is not vulnerable under the definition above, redirection to other services may be more appropriate, for example the criminal justice system, domestic violence services, trading standards, hate crime services etc

Safeguarding Adults (ADSS 2005) also identifies a duty of care to informal family carers who have been assessed for support services in their own right.


WHAT IS ABUSE?

Abuse will include all forms of harm and mistreatment. It is a violation of an individual’s human or civil rights by any other person or persons.It is a single or repeated act or omission, occurring within a personal or other close relationship where there is an expectation of trust, which causes harm to a vulnerable adult. Abuse concerns the misuse of power, control and/or authority and can be perpetrated by an individual, a group or an organisation. It may be intentional or unintentional.

PERPETRATORS OF ABUSE

Abuse can take place in any setting. Perpetrators might be informal carers, partners or family members, people in a position of trust, people paid to offer care services or strangers.Organisations can abuse or cause harm by the way they conduct their day to day practice.

ABUSE OF STAFF

Although abuse of staff by service users or other staff is a very serious matter which requires immediate action, the Adult Safeguarding Policy is not appropriate to address this situation. In these circumstances, the staff member should be assisted via the organisation’s internal HR procedures.

SELF NEGLECT

Some adults may be at risk from their own self-neglect. Although this is a serious issue which must be addressed, the Safeguarding Adults


procedure is not appropriate to address this matter. In this situation, a referral should be made to Adult Community Services to initiate an assessment under the Community Care Act.

DEFINITION OF SIGNIFICANT HARM

Safeguarding Adult procedures must be instigated when the concern raised indicates significant harm or exploitation to the vulnerable adult:

“harm should be taken to include not only ill-treatment (including sexual abuse and forms of ill treatment which are not physical) but also the impairment of, or avoidable deterioration in, physical or mental health; and the impairment of physical, intellectual, emotional, social or behavioural development” (Law Commission 1995)The following factors should be considered when assessing significant harm

the impact on the individual – this is best determined by the vulnerable adult and the workers involved

the individual’s wishes and feelings

the impact (actual or potential) on other vulnerable adults or family carers

evidence of physical or emotional harm

records of previous concerns or incidents

independent corroborative information

the views of other professionals involved

It is important to remember that in some cases an accumulation of events as opposed to a single act may increase the severity of the concern and the impact upon the vulnerable person.


APPENDIX TWO

ABUSE TYPES AND INDICATORSABUSE INDICATORS AND SIGNS OF ABUSE

The lists below are purely for guidance. The presence of one or more does not automatically confirm abuse. The existence of a number of the indicators may however suggest a potential for abuse and should therefore necessitate further assessment or scrutiny. If there is any concern at all about the possibility of abuse then advice should be sought.

Abuse can generally be viewed in terms of 7 main categories; Physical, Sexual, Financial, Neglect, Psychological, Discriminatory and Institutional.

PHYSICAL ABUSE, including physical assault ranging from rough, inappropriate or careless handling to direct physical violence – hitting, slapping, pushing, kicking. It can include medical mistreatment such as the misuse of medication, withholding or inappropriately altering medication or treatment regimes. It is also the misuse of restraint, forced isolation and confinement, inappropriate methods of restraint and/or inappropriate sanctions.


INDICATORS OF PHYSICAL ABUSEUnexplained bruising: some types of bruising are particularly characteristic of non-accidental injury;Hand slap marksMarks made by an implementPinch or grab marksGrip marks – this could indicate that the person has been shaken, inappropriately restrained, or forcibly movedBlack eyesBruising to buttocks, lower abdomen, thighs and genital or rectal area could be an indicator of sexual abuse. Bruising may be faint or severeThere may be a pattern to the bruising e.g. when the bruising occurs, where the bruising occurs.Person flinches at physical contactReluctance to undress or uncover part of the bodyA history of unexplained falls or minor injuriesProlonged interval between the onset of the injury or illness and subsequent presentation for medical care and attentionEvidence of improper use of medication e.g. excessive or repeat prescriptions, under-use of medicationThe general level of care is insufficient or deteriorating e.g. spectacles, dentures, hearing aid not in evidence; person is unwashed, unkempt or inappropriately dressed, clothing is dirty or soiledUnexplained ulcers or pressure soresEvidence of malnutritionEnforced social isolation

OTHER TYPES OF INJURY

Burns inside the mouth, inside arms or on genitalsBite marksCigarette burnsAny injury, bleeding or soreness in the genital or rectal area which could also be an indicator of sexual abuseA bizarre or vague explanation is offered to explain an injury to a vulnerable adult

SEXUAL ABUSE, including rape and sexual assault, or sexual acts to which the vulnerable adult has not consented, or could not consent, or was pressured into consenting. Acts of a sexual nature where one of the participants is in a position of trust, power or authority. Sexual abuse occurs when someone is forced, or coerced into taking part in


sexual activity to which they have not consented or do not fully understand.

It includes rape, buggery, incest, inappropriate touch, coercing a person into taking part in any sexual activity.

Any sexual relationship that develops between adults where one is in a position of trust, power or authority in relation to the other, for example, a member of staff, will be regarded as abusive.

There is an increasing understanding and respect for disabled people’s human right to a sexually active life. It is important that sexual activity per se is not assumed to be abusive. It is also important to recognise that people who have neither received information about, nor exercised their sexual rights, can be more easily exploited.

INDICATORS OF SEXUAL ABUSEDisclosure by means of hints and veiled commentsUncharacteristic sexually explicit/seductive behaviour which may include promiscuity or use of sexually explicit language.Urinary tract infections, vaginal infections or sexually transmitted diseases (STD’s) that are not otherwise explainedContinual and open masturbation or aggressive sexual activity with peers.A woman who lacks the mental capacity to consent to sexual intercourse becomes pregnantFear of pregnancy that may be exaggeratedSelf-mutilationDifficulty in walking/sitting with no apparent explanationTorn, stained or bloody underclothesBleeding, bruising, torn tissue or injury to the rectal and vaginal area

(This list is not exhaustive)

PSYCHOLOGICAL ABUSE, including verbal abuse, emotional abuse, threats, bullying, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, isolation or withdrawal from services or supportive networks, hostility, rejection, threats, oppressive language etc.

INDICATORS OF PSYCHOLOGICAL/ EMOTIONAL ABUSEThe person who is neglected or abused may display uncharacteristic behaviour that may signal distress. The behavioural signs and symptoms may range from slight to severe. Onset may be sudden or gradual. One or several signs and symptoms may be displayed.


Referred to in a disrespectful mannerHumiliated in front of othersDenied access to social activitiesDenied access to servicesDenied time alone with other peopleThe vulnerable adult is depressed, withdrawn, overly compliant or anxious to please.Appears scared, anxious or withdrawnThe vulnerable adult appears to be frightened, fearful or has both low self esteem and feelings of self worthThe vulnerable adult may be subdued in the presence of particular individualsThe vulnerable adult displays acting out, aggressive, destructive, irritable behaviour at less powerful people, animals or objectsAttempt to achieve a sense of control over their feelings through self-harm, refusing to eat, deliberate soiling, behaving in a way that elicits a predictable responseSleep disturbances that cannot be explainedEating problems. (Changes in appetite, Unusual weight gain/loss). Sudden withdrawal or absenteeism from activities or servicesA reluctance to accept medical attention

Every category of abuse will almost certainly involve elements of psychological abuse. Indicators of psychological abuse therefore could indicate that other forms of abuse are taking place.

FINANCIAL or MATERIAL ABUSE, including theft, fraud, exploitation, pressure, in connection with wills, property, pension, benefits or inheritance.

INDICATORS OF FINANCIAL ABUSE

Unexplained or sudden inability to pay billsUnexplained or sudden withdrawal of money from accounts with no known subsequent benefitsApparent lack of knowledge of income, financial resources and assetsDisparity between income/assets and satisfactory living conditionsExtraordinary interest by others in the person’s financesUnder pressure to make or alter a willUnauthorised disposal of property, possessionsLack of receptivity by a person to any necessary assistance that requires expenditure, when finances are not a problemExtortionate demands for payments for services, e.g. building or repair work


In addition there are certain factors that may increase the risk of a person being financially abused:Person has a guaranteed high benefit incomePerson is unable to administer their own money due to a lack of capacity or numeric skillsPerson is dependent on other people to administer moneyOthers become financially dependent on a person/service userPerson is isolated within their communityPerson has no independent advocate

NEGLECT or ACTS of OMISSION, including ignoring medical, physical or social care needs, failure to provide access to appropriate health, social care or educational services, the withholding of daily living needs, such as medication, shelter, heating, clothing, hygiene, personal care, food and drink, or heating.

INDICATORS OF NEGLECT

Person has inadequate heating and or lighting

Person’s physical condition/appearance is poor, for example, ulcers, pressure sores, soiled or wet clothing.

Person is malnourished, has a sudden or continuous weight loss, and is dehydrated

Person cannot access appropriate medication or medical care

Person is not afforded privacy or dignity

Person is isolated or has intermittent contact with care services

Callers, friends, visitors are not allowed access to the person

Person is exposed to unacceptable risk

Neglect of accommodation


DISCRIMINATORY ABUSE, including racist or sexist remarks or comments based upon a person’s impairment, origin, colour, disability, age, illness, sexual orientation or gender, and other forms of harassment, oppressive treatment, slurs or similar behaviours.


Discriminatory abuse can manifest itself as physical abuse/assault, sexual abuse/assault, financial abuse/theft, neglect, psychological abuse/harassment.

Abuse of this nature could also be identified as a hate crime.

INSTITUTIONAL ABUSE involves the collective failure of an organisation to provide an appropriate and professional service to vulnerable people. It can be seen or detected in processes, attitudes and behaviour that amount to discrimination through prejudice, ignorance, thoughtlessness, stereotyping, or malicious intent. It includes failure to ensure necessary safeguards are in place to protect vulnerable adults and maintain good standards of care in accordance with individual needs, including training of staff, supervision and management, record keeping and liasing with other care providers. It includes any word, action or care regime which negatively affects the dignity and respect to which every person is entitled.

Examples include;

Service users awakened too early in the morning

Lack of flexibility and choice in times of going to bed

Lack of opportunity for independently accessing drinks and snacks

Lack of choice about meals or mealtimes

Poor handling of complaints

Staff who expect routine compliance from service users

Punitive methods adopted toward service usersPoor standards of cleanliness within the care setting

Lack of knowledge from staff about care plans, policies and guidance

Lack of positive communication with service users


INDICATORS OF INSTITUTIONAL ABUSE


_Is unacceptable practice encouraged, tolerated or left unchallenged?Are people working in accordance with anti-racist, anti-sexist, anti-ageist, anti-homophobic practice, and do they promote the rights of individual service users?Are service users respected and treated with dignity?Does the organisation promote choice and an individual focus?Are staff well treated and do they enjoy their work?Do staff receive training?Is there a high staff turnover?Do staff, service users and family carers know how to make a complaint or voice a concern?Are visitors encouraged and made to feel relaxed and welcome?Does the organisation have an adult protection and whistle blowing policy?Does the organisation meet the quality standards laid down by regulatory bodies and contracting authorities?Is there a culture of continuous improvement?

SITUATIONS OF INCREASED RISK

Most recent research indicates that the profile and circumstances of the alleged abuser are more significant than the profile or degree of dependence of the adult at risk of abuse. This is likely to be the same in both formal care and domestic settings. The following factors can make abuse more likely to occur


If carers:

Abuse alcohol or drugs

Have stopped work (or have moved in with the vulnerable adult) specifically to provide care

Have a history of mental illness or distress

Have a history of abuse as a perpetrator or a victim

Are under additional stresses such as illness, financial or marital problems

Feel very lonely or isolated

Habitually lose their temper, or have previously admitted to roughly handling the vulnerable adult

Are dependent on accommodation on the person for whom they are caring

Have expressed that they cannot cope or continue to provide care for the vulnerable person

Perceive the vulnerable adult as being deliberately awkward

Feel that the person they are caring for has failed to fulfil the carer’s own needs in former years


The following factors in the vulnerable adult may lead to an increased risk from abuse:


Has a recently increased level of dependency because of behavioural difficulties such as restless wandering, confusion and incontinence, especially faecal

Disturbs the carer at night

Lacks purposeful activity

Exhibits odd or embarrassing behaviours

Is not helpful or cooperative, is rejecting or ungrateful and will accept care only from a particular person

Has a difficulty in communication; for example through visual or hearing impairment, loss of or difficulty with speech, or a difficulty with memory and concentration

REMEMBER Anyone can experience abuseAnyone may be a perpetrator of abuseAbuse may be a single or repeated actAbuse may be behaviour that deliberately or unknowingly causes harm, or endangers life or rightsAn individual, a group or an organisation may perpetrate abuse. Most often the perpetrator is someone who is known to the vulnerable person, such as a partner, a relative, a neighbour, care provider or another service user.Abuse can take place in any setting and at any time.An abused person may feel frightened, intimidated, embarrassed, isolated and have low self-esteem. To disclose abuse may therefore be traumatic and difficult. Your initial response is critical and will determine if the disclosure is made in full.


P R A C T I C E P O I N TDISCLOSURE: Disclosure occurs when the vulnerable adult says or implies that they are being, have been, or are at risk of being, abused or neglected. Disclosure may be direct, or may take the form of hints or veiled comments.A person not being treated in a dignified or respectful mannerNon-explained injuriesNot being permitted to see the person on their own

(Practice point: Always try and see the vulnerable person ontheir own for at least some of the time. It is important that theytoo have a right to confidentiality and be free to shareinformation without interference or duress).

WHAT MIGHT CAUSE CONCERN?

You might see or hear something happen that worries you.Someone being bullied or intimidatedSomeone being made to feel frightened or sad ALLEGATION: An allegation is an assertion as fact by the vulnerable adult, or others, that the vulnerable adult is or has been a victim of abuse, and usually includes a statement regarding an alleged perpetrator

CONCERN, WORRY, or SUSPICION: This is likely to be a feeling or worry that a vulnerable adult may have been, is, or might be the victim of abuse. A concern may arise as a result of a disclosure, an incident, an instinctive feeling, or other signs or indicators

INDICATORS: An indicator is a sign, symptom, or behaviour that should lead the alerter to the conclusion that a vulnerable adult may be the victim of abuse


GUIDANCE BOX TWOISSUES THAT MAY CAUSE CONCERN

A person not getting the help or care they needA person being hurt, bullied, frightened or intimidatedA person being taken advantage of, or exploited because of their age, disability or illnessPeople not being permitted to make their own choices or decisionsA person being made to do something against their willSomeone in a situation of unnecessary riskSomeone being exposed to bad practiceSomeone being addressed in a derogatory fashionThe vulnerable adult might make a disclosure (see Guidance Box 3)Someone may tell you something or say something that makes you concernedThere might be physical signs or unexplained, unusual or recurring injuries.BruisesSlap marksBleedingBurnsTorn, stained or bloodstained clothingThe person might say things or behave in a way that causes you concern or worry.The person may seem unhappy or distressedThe person may appear frightened, anxious or agitated without immediate cause, or in relation to a certain personSleeping problemsFeelings of low self worth and sadnessApathyPerson chooses to withdraw from company of others


APPENDIX THREE

REPORTING ABUSE

P R A C T I C E P O I N TYou may not understand why nor be able to give a reason for their behaviour or for your concern. It is enough that you are worried. Trust your instincts. Discuss your concerns with your supervisor/manager immediately. As an Alerter you must take the possibility of abuse very seriously, log your concerns and discuss with your manager at the first opportunity. You do not have to verify or prove that the information is true or substantiated.

GUIDANCE BOX THREEWHAT SHOULD I DO IF I SEE SOMEONE WITH AN INJURY BUT I DON’T KNOW WHAT CAUSED IT?

Don’t jump to conclusionsIt is good practice to ask the person, (or if the person is unable to tell you, their carer), for an explanation of how the injury was sustained e.g. “Can you tell me how you got the bruise?”Follow the guidance for disclosures and allegations but remain open minded, you may not always be told the truthRecord a description of any physical signs or injuries and what you have been told


Where the vulnerable adult has physical symptoms or injuries try and ensure that they are seen by a qualified medical practitioner (doctor or nurse)Discuss your findings with your supervisor or manager.It is important to find out what the explanation is, even when it is not the result of an abusive act.

GUIDANCE BOX FOURWHAT SHOULD I DO IF SOMEONE DISCLOSES TOME OR MAKES AN ALLEGATION?

How to raise an Alert.The way you respond to the vulnerable adult is crucial:Give priority to ensuring their immediate safetyDon’t panicTry and remain calmTake time to listen carefully to what is being saidQuestions which begin with WHO, WHAT, WHY, WHEN and HOW will encourage the person to tell their story freely and will ensure that your questions are non-leadingDo not interrupt. Allow them to share whatever is important to themDo not ask too many questions or press the person for more details (this may be done during any subsequent investigation, so it is important to avoid unnecessary stress and repetition for the person concerned)Accept what is being said without comment or judgementTreat the allegation seriouslyReassure the person by telling them that you are treating the information seriously, that it was not their fault and they have done the right thing by sharing the informationKeep an open-mindAsk the person what they would like to do about what has happenedDo not promise to keep the information a secret. Make explicit the fact that you will need to share what you are told, but only to people who need to know.Explain that you are required to share the information with your line manager, but not with other staff or customers.


Do not break the confidentiality agreed between the person disclosing the information, you and your line manager. Do not talk to other staff members or customers about the informationReassure the person that their wishes will be taken into account at all timesMake a note of what was said, where it was said and who was there, including any questions that you have askedReport to a supervisor/ line manager_ Complete an Adult Safeguarding Referral Form or Call Customer First on 08456023023

Always be alert to signals, signs, hints or non-verbal communication that could indicate abuse that is being denied or deliberately hidden. Respond to your hunches and concerns and create opportunities for the person to tell you what is happening to them.If you have access to the person on his or her own do not be afraid to ask a direct question such as “are you being hurt by anyone” or “do you feel frightened of anyone”

Remember:The role of Alerter is of crucial importance and your response to the vulnerable adult at this point of the investigation process is critical.

RECORDING AND PRESERVING EVIDENCE

It is the responsibility of all individuals and agencies to ensure that any concerns about the welfare or safety of a vulnerable adult are properly recorded and that any evidence is retained or preserved.

Ensure that all written records are preserved, dated, signed and kept in a safe place.

In cases of physical or sexual assault, try and dissuade the person from washing, bathing or showering until the police have seen them

When abuse has involved oral sex, encourage the person not to drink until the police or a doctor has seen them


Leave things as you find them – do not wash clothes or bedding or tidy up.

P R A C T I C E P O I N TFor many reasons people may not be able to tell you directly about the abuse they are experiencing:Perpetrators may make threats about what may happen if the victim tells other people.Perpetrators often blame victims for the abuse e.g. “You make me do it” “You deserve it.”The person may have disclosed in the past and found that they were ignored or not taken seriously.They may be frightened that any intervention will only make matters worse and place them at greater risk.They may be embarrassed or ashamedThey may feel that they are to blame because they have been unable to protect themselves.They may not trust people who are “official”, from a different culture or gender.They may not be aware that what is happening to them is abusive and wrong.

GUIDANCE BOX FIVEHOW DO I PRESERVE EVIDENCE?

In most circumstances you may not be required to do anything other than record the events that have given cause for concern on an Adult Protection Referral FormHowever, it is important to follow certain rules:Ensure any written records (notepads, letters, log books, e-mails etc.) are kept in a safe placeAll records should be dated and signedIn cases of physical or sexual assault gently encourage the person not to wash, bathe, or shower if a future medical examination is likely to be needed. Medical staff and police will respond quickly in these circumstances.Where abuse has involved oral sex encourage the person not to drink until the police or doctor has seen themDon’t tidy up, wash clothes, bedding or other items


GUIDANCE BOX SIXWHAT SHOULD STAFF RECORD AND HOW?

It is vital that you write down why you are concerned about a person as simply and clearly as you can, and as soon as you can after the event. In some cases this will mean writing in a person’s records, file or notes. In most circumstances you will need to complete an Adult Safeguarding Referral Form. Whichever course of action is deemed to be the most appropriate all notes must be retained. It is crucial that you record all relevant information including what you saw, what you heard, what you were told, what you have done so far.Try and ensure that you are recording what the person said using their own words, phrases and expressions and language. Record details of everyone else who knows that the allegation has been made. Write down what has been said to you and who said it including their relationship or role. Include any questions you may have asked. Sign and dateInclude details about what the vulnerable adult wants to be done

P R A C T I C E P O I N TPeople have the right to expect that information shared with a member of staff should be treated as confidential. However it should be made clear from the outset that where the staff member has a reason to be concerned for the welfare, or safety of a vulnerable person (or other vulnerable adults) then they have a duty to share the information disclosed with someone who is in a position to take action or responsibility. The vulnerable adult should be told whom the information is to be shared with, and reassured that their views and wishes will be taken into account. These views should be recorded and reported.


GUIDANCE BOX SEVENREPORTINGYou have a duty to report if you see, hear about or suspect abuse:Take urgent action as appropriate to protect the vulnerable adult from any immediate risk or dangerPass on the information to a relevant manager at the earliest opportunityAct in accordance with the vulnerable adult’s wishes where possibleSupport and reassure the vulnerable adult throughout

RECORDINGAccurate and detailed recording is essential:Make a note of the date, time and setting in which the allegation or disclosure was madeComplete an Adult Safeguarding Referral FormForward the form to Customer First


Remember that your referral form and notes may be required as part of any subsequent legal action or disciplinary proceduresRecord what was said using the vulnerable adult’s own wordsRecord all information as soon as possible but no later than 24 hoursKeep a copy for future referenceRequest confirmation that the referral has been received and actioned

If the alleged perpetrator is a service user then any information concerning the abuse strategy or investigation should be included in their file or records

P R A C T I C E P O I N TIn many cases, indisputable evidence of abuse may not be available. More likely is a scenario where there are a number of factors causing suspicion that abuse may be occurring.It is unlikely that there will be one single event or sign that is diagnostic. In assessing these situations, workers should be looking for a collection of factors that individually may seem insignificant, but taken together may be legitimate grounds for concern.

All concerns or suspicions should be recorded and discussed with a line manager.

GUIDANCE BOX EIGHTWHO SHOULD I TELL?

Who you will tell will depend upon your role and status within your organisation or department. In most cases you should inform your immediate supervisor/ line manager, or a designated person for adult safeguarding. However in some instances this may neither be appropriate or possible. In such an instance you should contact one of the following:Your manager’s managerAdult Community Services Customer FirstCommission for Social Care Inspection Police


Make a record of who you told, what you told them and when.Record their response to your concern and any agreed action.

GUIDANCE BOX NINEWHISTLE-BLOWING

Where concerns are raised about a vulnerable adult due to malpractice or misconduct in the workplace or due to the direct actions of an employee, those concerns should in most circumstances be raised with the organisation concerned. This provides staff with the greatest degree of protection and the employer with a chance to address the concerns. However, there may be circumstances where the alerter feels at risk of being victimised, dismissed or perceived as a troublemaker by their employer. They may believe that their employer will not be interested or prepared to take the appropriate action, i.e. having previously raised concerns with the employer which were disregarded or ignored. The provisions of the Public Interest Act 1998 may protect the alerter in raising concerns outside the workplace providing:

The disclosure is made in good faithThe disclosure is substantially trueThe disclosure is not made for personal gainThere is good reason to believe that they would be victimised, that a cover-up would occur, or that although others are aware of the matter no action has been taken

TIMESCALES

All records should be made as soon as possible after an event and stored in a safe placeAll concerns relating to a criminal offence must be reported immediatelyAll cases in which there is reason to believe that a vulnerable adult is at immediate risk, or in danger of abuse, or is a victim of criminal activity must be reported immediately


All actions taken due to concerns arising as a result of a suspicion, worry, allegation, or disclosure of abuse should be made at the earliest opportunity.

APPENDIX FOUR

THE ADULT SAFEGUARDING PROCESS


The following sections describe each part of the process which must be followed in Suffolk.

Any person, regardless of whether they are a staff member, customer, family carer, volunteer or member of the public, may raise an alert about the abuse, or risk of abuse to a vulnerable adult.

A member of staff who becomes concerned about the abuse of a vulnerable adult should discuss the situation with their line manager.

All concerns about possible or actual abuse should be passed on to Customer First, the centralised referral centre for Suffolk Adult Community Services. Any person may contact Customer First, This can be done by phoning 08456023023 or by completing and forwarding an adult safeguarding online referral form at www.suffolkas.org

Out of hours contact should be made to the Emergency Duty Service on 01473 299671

Where a criminal act has been suspected then this should be reported to Suffolk Police. If the person is at immediate risk or in danger then the emergency services should be called.

Following the receipt of the referral Customer First will then initiate a strategy discussion

STRATEGY MEETINGS –DISCUSSIONS

Strategy Meetings – Discussions

These can take place over the telephone or face-to-face.


http://www.suffolkas.org/

Their purpose is to agree a plan for how to proceed with the Alert/Referral and to identify the roles that individuals and organisations will fulfil.

WHEN SHOULD A STRATEGY MEETING/DISCUSSION TAKE PLACE?

If one of the following circumstances occurs, then a strategy meeting should be convened:_ Good practice would necessitate the need for a Strategy Meeting or Discussion whenever anAdult Safeguarding referral is received or concern raised. Individuals and organisations must not act in isolation and the strategy meeting, by its’ very nature, acts to facilitate communication and joint-working.Where the public interest issues appear to outweigh the vulnerable adult’s wishes (e.g. where other adults are at risk or where evidence is likely to be destroyed)When the situation is complex and/or seriousWhere the investigation may necessitate a joint approachWhere an investigation will involve the police because an alleged crime has been committedWhen other agencies are involved with the vulnerable adult or alleged perpetrator

WHAT IS THE PURPOSE OF A STRATEGY MEETING?Clarity about the purpose and desired outcome of the meeting is important:To ensure that steps have been taken to safeguard the vulnerable adultTo ensure effective multi-agency work by involving people from key agenciesTo reach a consensus view about the nature and degree of the alleged incidentTo establish a common understanding about the overall plan for the InvestigationTo outline and agree tasks and timings for each stage of the investigationTo plan how to carry out the investigation


P R A C T I C E P O I N TA strategy meeting will aid the promotion of best practice and effective communication. No single individual or organisation should act in isolation. A multi-agency model is most appropriate in protecting vulnerable adults from abuse. All referrals, whatever their circumstances, will merit some form of strategy discussion

CONTENT OF THE STRATEGY MEETING

The following issues will need to be considered at a Strategy MeetingWhat are the wishes, if known, of the vulnerable adult?Has the vulnerable adult given permission to involve other agencies?Is there a need to break confidentiality?Is there a need for immediate protective action?How can appropriate family carers, staff members or relatives become involved?Who should be interviewed, where and by whom?How can information best be gathered?When and how should the vulnerable adult and/or their family carers, or relatives be involved in the decision making process?Should they be present at meetings or are their other ways in which they can be consulted?What practical assistance would facilitate the vulnerable adult’s involvement and co-operation e.g. transport needs, assistance with domestic care arrangementsWhat personal support does the vulnerable adult need e.g. family carers, family members, support groups, independent advocacy groups, and carers groups?Has a key-worker for the vulnerable adult been identified to assist throughout the investigation process?What arrangements have been made to facilitate the involvement and full contribution of vulnerable adults with disabilities; e.g. access to buildings, interpreters, facilitators and specialist staff?Are there issues of race, culture, language, gender, physical disability or sensory impairment that require additional special arrangements to be made?Who is the best person, or persons, to undertake the work of the investigation?Is it possible that there are other victims?


P R A C T I C E P O I N TA full record of the details of contributors to the Strategy Meeting/Discussion, and any agreed outcomes, should always be clearly recorded

Adult Safeguarding InvestigationsTo be undertaken by Social Workers and Police Officers

WHY AND HOW THEY ARE CARRIED OUT

The purpose of any investigation is to:Protect the vulnerable adult from serious harm and offer them supportEstablish and record the facts about the circumstances giving rise to the alertEstablish evidence for formal proceedings (e.g. criminal, registration or disciplinary)Establish with the vulnerable adult whether they feel that their personal safety is at risk, whether they want professional intervention to occur and what their views are on sharing information about the incident with other staff that need to knowDecide if protective or other action is needed for the vulnerable adult or othersIdentify the sources and levels of riskDecide whether actual or suspected abuse has taken place and record the reasons for these conclusionsEnsure that appropriate action is taken in respect of any perpetratorIdentify any lessons to be learnt for the future, including recommending changes to existing practices or service delivery

The tasks that need to be undertaken will include the following:Carry out a comprehensive assessmentAssess the mental capacity of the adultDetermine the need for medical intervention relating to the physical, or mental, state of the vulnerable adult


Decide whether legal advice needs to be soughtAscertain the need for a Case ConferenceConsider the different methods of gathering and presenting evidenceConsider the communication needs of the vulnerable adult and ensure that an appropriate service is offered (this includes people with dementia, those whose first language is not English, people with sensory impairment, or people who have learning difficulties)It is important that information is shared throughout the investigation process. This will include keeping the alerter or referring agency, appropriately informed of progress and likely timescales for decisions and outcomes

PLANNING THE INVESTIGATIONConsideration of the following points is important to inform the decision-making process and the way in which the investigation should be planned.

Who should be interviewed?Where will the interviews take place?The sequence of interviewsWho will conduct the interviews?The purpose of the interviewsThe need for medical examinationsThe degree of risk to the vulnerable adult, including:The risk of repeated or escalating actsThe extent of the abuseThe length of time that the abuse has been occurringThe impact upon the individualThe urgency of the situation and whether immediate action is neededThe rights and wishes of the people involvedThe legal framework under which the investigation will be pursued

Consideration should be given to whether alerting the person alleged to have carried out the abuse might further jeopardise the safety of the vulnerable adult, or the collection of evidence.Collation and consideration of other sources of evidence, including written records, statements from witnesses, forensic and medical evidenceDecisions about who should be informed about the alleged abuse need to be made; in particular any agencies involved with the vulnerable adult. It will be appropriate, usually, to inform a family member should the vulnerable adult consent.The reasons for decisions being taken, or not taken, must be recordedIf the person alleged responsible for the abuse is also a vulnerable adult, then the investigation should ensure an assessment of their


needs is also undertaken. In this instance a separate Case Conference may need to be convened

INVESTIGATOR’S INTERVIEWS

The vulnerable adult should not be interviewed alone or in the presence of the person alleged to be responsible for the abuse, after the first disclosure or alert, if there is any possibility that an offence may have been committed. In such cases a joint interview is preferable at which the vulnerable adult may be accompanied by any, or several of the following:An independent advocateA family carer, member of their family, close friend, or supporter if this is deemed appropriateCare should be taken to ensure that a premature determination of abuse does not occur. No plan of action, except in emergency circumstances, should be initiated until the facts surrounding the alleged abuse have been established.

CARRYING OUT AN INTERVIEW

During the interview the Investigating Officer should ensure that:

Information about their designation and the agency represented is stated clearlyThe purpose of the interview is made clearThe nature of the allegation is identifiedHow the interview is carried out is explainedA relaxed and caring manner is adoptedAn attempt is made to establish how the alleged abuse occurredSuitable breaks are agreed and adhered too

INVESTIGATORS REPORTThe report will need to cover the following areas

Details of the initial alertOutline of the current and any previous allegationsAn assessment of the seriousness of the abusePossible causal factorsBackground information about the vulnerable adultIssues and opinions relating to consent and capacityInformation about the alleged perpetratorA description of the Investigation process (what was involved) and the level of co-operation received from those consultedPresentation and evaluation of evidenceA view about future risks


Recommendations about future action (protection planning)

ADULT SAFEGUARDING PLANThe Adult Safeguarding Plan should include information about the following:

Outcome of the case conferenceAction to be taken to ensure the future safety of the vulnerable adult, including information about who is responsible and what is entailedIf not possible to increase the safety of the vulnerable adult then the reasons for this should be clearly statedDetails of any support services, treatment, or therapy available to the vulnerable adultAny changes to service provisionHow ongoing or future risks can be managedMonitoring and review arrangements, irrespective of whether services are being provided; these should include timescales for reviewing the Adult Safeguarding Plan

ATTENTION SHOULD BE GIVEN TO ENSURE THAT THE ADULT SAFEGUARDING PLAN IS INTEGRATED WITH THE CARE PLANTHE ADULT PROTECTION PLAN SHOULD BE SENT TO ALL THOSE INDIVIDUALS PARTICIPATING IN THE CASE CONFERENCE

PRESERVING EVIDENCEThe term victim is used in place of vulnerable adult as the following section has been written from the perspective of the Police

Whilst your concern will be the immediate wellbeing of the victim, your efforts to preserve evidence may be vital.When Police involvement is required following suspected physical or sexual abuse, they are likely to be in attendance quickly. To enable the Police to investigate effectively, it is imperative that vital evidence is preserved.For that short period of time, before the Police arrive, what you do or not do can make a crucial difference.

What follows is a checklist that may help you to ensure that evidence is not destroyed. In all cases, the following apply: Obtain consent before examining the victim


Where possible, leave things as and where they are. If anything has to be handled, keep this to a minimum. Do not clean up. Do not touch what you do not have to.Leave weapons where they are unless they are handed to you. If you have to receive them, take care not to destroy fingerprints. Do not wash anything or remove fibres, blood etcKeep any items in a safe, dry place until the Police are able to collectPreserve the clothing and footwear of the victim. Handle these as little as possiblePreserve anything used to comfort or warm the victim- e.g. a blanketNote in writing the state of the alleged victim’s clothing. Note injuries, and record the conditions and attitudes of those involved in the incidentSecure the room and do not allow anyone to enter until the Police arriveIn addition, in cases of sexual abuse, the following apply:It is crucial for both the victim and alleged perpetrator to be medically examined for forensic evidence at the earliest possible opportunity. This examination will always be carried out by an appropriately trained Forensic SurgeonPhysical contact with the victim or alleged perpetrator should be avoided as cross-contamination can destroy evidencePreserve bedding where appropriateNote and preserve any bloody itemsPreserve any used condomsItems can be preserved in clean paper or plastic bags. Do not handle items unless it is necessary to move them and make them safe.These are obviously ideal solutions and may not be possible at a time of trauma. Do the best that is possible in the circumstances.

CLOSING THE INVESTIGATION

Prior to closing an investigation the Investigating Officer should ensure that: All verbal and written records have been completedThe case file contains all the necessary information and formsAgencies who are involved in the Adult Protection Plan are aware of their responsibility to re-refer the vulnerable adult should circumstances change or risks increaseAdult Safeguarding Plan has been implementedAll decisions have been recorded in writing with evidence to support the decisions clearly documentedThe reasons for closing the Investigation are fully recorded


APPENDIX FIVE

INTERVIEWINGThe interview is a key stage in the Adult Safeguarding Investigation process.

Where a criminal offence is identified or suspected then the case details must be reviewed and discussed with the police, prior to any investigative interview.Investigative interviews will be led by the Police or in certain circumstances a representative from Adult Community Services or the Commission for Social Care Inspection.Effective interviewing requires careful planning based upon good knowledge of the vulnerable person, their means of communication, physical needs etc. There will also inevitably be circumstances in which it will not be appropriate to interview a person because of the extent of their mental impairment or, because the person does not wish to be interviewed


It should also be noted that with the police are the only organisation that have the authority to detain an alleged suspect or perpetrator for an interview.

THERE ARE IN GENERAL TWO FORMS OF INTERVIEW

THE ASSESSMENT INTERVIEW

To establish, following an initial concern or alert, whether or not the vulnerable adult has something to disclose and, if they have, whether or not it amounts to a criminal offenceTo make the vulnerable adult aware of any concerns held about themTo establish the vulnerable adult’s wishes, willingness and ability to pursue the complaintTo make decisions about the format to be used for the detailed account to be given by the person i.e. video, written police statement or questions and answers and about when, where and by whom the interview is to be conductedTo inform decisions about the immediate and future needs of the vulnerable adult and promote their safety and welfare.When the vulnerable adult has already made a disclosure and indicated what they would like to happen, there would be not need to cover this again during an assessment interview. However the interview may still need to be conducted to establish communication needs, best form of recording etc.

THE INVESTIGATIVE INTERVIEW

To elicit as accurate a picture as possible from the person as to what, if anything, has happened to themTo enable the vulnerable adult to communicate in their own way what, if anything, has happened to themTo make it possible for the vulnerable adult to give as full and thorough account of what has happened to them as possible in order to:Facilitate further investigationInform further actionCareful planning of the interview strategy will avoid the need for repeated questioning.Repeated interviewing may cause distressRepeated interviewing may be regarded as “coaching”It may give the impression to the vulnerable adult that they are not believed or are under pressure to embellish


However the interview process may need to include breaks where this is in the interest of the vulnerable adult

BEFORE THE INTERVIEWNo investigative interview should be undertaken without adequate planning. A plan that includes clearly defined objectives should always be prepared before the interview.It may be useful to have in mind a checklist of questions appropriate to the particular case details. (See question phase for advice on types of questions to use)

SUPPORTING THE INDIVIDUALIt is essential that the vulnerable adult can understand the reason for the interview prior to it taking place and what will happen. Consideration should be given to the most suitable venue, how the person will get there, and who will accompany them.The vulnerable adult should be asked if they wish to be accompanied by a friend or supporterThe role of the supporter is to:Provide non-intrusive support to the vulnerable adult prior to and after the interviewThey should not be present during the interview unless the vulnerable adult is unable to continue without themIf the supporter is in the interview room during the interview, they must not play any part within the interview process and must not answer any questions or prompt the vulnerable adult in any wayIt should be made clear that the role is not to question the vulnerable adult, or comment upon, or add to what is being said. The Supporter will need to be briefed of their role prior to interview.Where the vulnerable adult has severe communication difficulties, consideration will need to be given to using an intermediary or interpreter. Guidance on the use of these should be sought from Achieving Best Evidence, a specially trained member of staff, the police or the Home Office

PLANNING THE INTERVIEW

PRACTICE GUIDANCE

Identify the purpose of the interview. Is it for example?To determine the vulnerable adult’s wishes and views of the situation (assessment)To identify the vulnerable adults support/protection needs (assessment)


To determine the best way of undertaking the investigative interview (assessment)To get to know more about the vulnerable adult (assessment)To establish in detail what the vulnerable adult alleges took place (investigative)To determine the nature and severity of the alleged abuse (investigative)To facilitate investigation by obtaining from the vulnerable adult as detailed an account as possible of what is alleged to have happened and the effect that it has had upon them (investigative)To facilitate investigation by identifying the alleged perpetrator (investigative)All ‘investigative’ interviews that involve criminal offences should be carried out by the Police, or following consultation with the Police.Identify the needs of the vulnerable adult and any aspects of their disability/cultural background that may be relevant. Eg.Do they need someone with them to help with communicating (signer, translator, intermediary, facilitator)?Do they need special equipment to help them communicate?Access and mobilityToilet breaks, refreshments etcUse of language (complex sentences, tenses etc)Identify the most appropriate person/s to carry out the interviewShould it be male or female?Are there issues of ethnicity or culture that need to be considered?What skills, knowledge or attributes are needed?Identify where the interview is to take placeThe needs of the vulnerable adult e.g. accessibilityEvidential requirements e.g. is a video interview neededResources availableIdentify how the interview is to be recordedEvidential requirementsThe views and wishes of the vulnerable adultCan the interview be recorded at the same time as the interview is being conducted, or does it need to be written immediately afterwards. (Where possible a contemporaneous method of recording should be used. Otherwise recording should take place as soon as possible following the interview)Can someone be asked to write a transcript or take detailed notes as the interview is being conducted?Should a video or audio recording of the interview be made?The Police will assist and advise and, wherever possible, should lead the investigative interview.

THE INTERVIEW


The interview should be conducted in a manner that enables the vulnerable adult to feel comfortable and relaxed and yet sufficiently formal to allow the interviewer to gather the information in a manner that meets their requirements.The interviewer needs to be flexible enough to listen to and respond to what the interviewee is saying/communicating and yet be able to gently draw the interviewee back to the reason for the interview.Never stop or interrupt an interviewee who is freely recalling significant or relevant eventsAlways proceed at the pace of the interviewee, and allow them time to respond to a questionSilence is okay, it allows you both time to reflect upon what is being said

Suffolk Police have facilities for undertaking video interviews. Recent legislation (Youth Justice & Criminal Evidence Act 1999 And Achieving Best Evidence) permits the use of video interviews with vulnerable witnesses.

THE FOUR STAGES OF THE INTERVIEWSTAGE ONE: RAPPORTAll interviews should start with a rapport stage designed to put the participants at ease, ensure that they are comfortable, and help the


vulnerable adult to get used to the question and answer nature of the interview process. In addition this stage should be used to ensure that the vulnerable adult knows and is comfortable with who is present, why they are there and, how the interview is to be recorded.Where a video recorded interview is used, this stage crosses between pre-recorded and the recorded part of rapport. Clearly no evidential issues should be discussed off-video; the rapport stage is just about getting comfortable with the witness and them feeling comfortable with the process.

STAGE TWO: FREE NARRATIVEThe purpose of the free narrative stage is to encourage the interviewee to freely recall in their own words the events that they have experienced.The transition between the rapport stage and the free narrative can be difficult and awkward. One method can be to ask the interviewee a general question in relation to the area in which the abuse took place as a lead up to a more specific but open question. You may consider asking the interviewee what they think they are there to talk about or by referring to the initial concern, e.g. “I have been told that you were worried about Bill, tell me about that”.There may be a number of difficulties for the vulnerable adult in trying to provide an account of the events.The usual inhibitions when talking about abuse apply, e.g. fear of reprisals, embarrassment, uncertainty, social pressures and perceptions.Many vulnerable adults may not have an understanding about the interview process, and communication difficulties may impose limitations upon their ability to freely recall the circumstances of the event in detail.The narrative stage should always be attempted even though the response may be very limited. Asking simple questions like, “what happened then” can often extend this stage?

Interviewers should be prepared to move from this stage and work with what little they have managed to acquire. In some cases it may be that the interviewer will move directly to the Closure stage if the previously suspected abuse is not evident.

STAGE THREE: QUESTIONINGWhere the individual said nothing relevant to the alleged offences during free narrative but there is other information documentary or otherwise, the interview may continue into the question phase by covering the issues/subjects of the evidence. E.g. by asking the interviewee about ‘Bill’ ‘His role’ ‘How she feels about him’ etc.


In planning interviews with vulnerable adults it may be decided to conduct a series of interviews rather than a one-off where this is of benefit to the interviewee.

TYPES OF QUESTIONS

OPEN ENDED QUESTIONSOpen-ended questions can be answered in a range of possible ways and do not limit the person to simple yes/no answers. Open questions start with one of the following…WHAT? WHY? WHERE? WHEN? HOW? WHO?

Good communication skills are required to respond to open ended questions. Some people with limited understanding may not be able to give long answers. Therefore the open questions may need to be specific or the interviewer may even need to revert to closed questions.An additional difficulty is that the vulnerable adult may have a desire to please. This may be particularly true of people with learning difficulties

SPECIFIC YET NON LEADING QUESTIONSA specific question asks the person to tell you about, or clarify particular details. In addition they can be used to recap, or take a person through a sequence of events e.g. what happened next?

CLOSED QUESTIONSClosed questions require a limited single yes/no response e.g. Was it? Is it? Did he?Closed questioning may be the most common form of questioning used with vulnerable adults who have severe communication difficulties. This style of questioning needs to take into account the risks of:Suggestibility – the tendency to agree with the content of any leading questionsAcquiescence – the tendency to say yes to a question automatically or to agree to the second of two optionsClosed questions tend to be leading questions

LEADING QUESTIONSA leading question is a form of closed question that leads the person towards answering in a certain wayE.g. Did that feel nice? You don’t like him do you? Did that make you feel angry?The interviewer should not ask this type of question. This is very likely to lead to evidence being omitted from court and to lead to


misinformation from the interviewee. Great care should be taken to avoid leading questions wherever possible. If leading questions are used as a last resort then the interviewer should offer more than one option e.g. “Did that touch feel nice?” and “Did it feel awful?” However people with learning difficulties are likely to acquiesce or change their answer if they believe they got it wrong the first time. Therefore similar questions should have a significant gap between them to avoid this.

Non-Verbal Communication (NVC)Attention should also be paid to the person’s non-verbal communication e.g. body language, gestures and facial expressions. Information is often available through NVCs. An interviewer should point out the NVC and ask for explanation/clarification from the interviewee.

STAGE FOUR: CLOSING THE INTERVIEWThe interviewer summarises, in the person’s own language, what they have said in the interview.Always thank the vulnerable adult for their hard work and ensure that they have a future point of contact.If timescales for subsequent decisions are known then these too can be explained to the vulnerable adult so that they have an understanding of what happens next.The interviewer should now encourage discussion of a subject, or topic, unrelated to that which is under investigation.

EVALUATING THE INTERVIEWThe interview or statement can be evaluated against the initial objectives and analysed for credibility. It may be appropriate to request an independent assessment of what has been said.


CASE CONFERENCES

The Case Conference provides a forum for the exchange of information between professionals involved with the individual deemed to be at risk, and allows for inter-agency, multi-disciplinary discussion of the circumstances of the case, the roles and responsibilities of those involved and the legal framework for intervention. The results of the discussions are recommendations to individual agencies for action and the final decisions regarding implementation rests with those agencies.

WHEN SHOULD A CASE CONFERENCE BE HELD?If the investigation demonstrates that an abuse has occurred or concerns about the safety of the vulnerable adult are unresolvedOnce relevant information and reports are available to inform those attending the case conference and the decision-making processWhere professionals have taken all appropriate measures to protect the vulnerable adult, but the abuse is on-going, case conferences including legal services should be convened to ensure that all alternatives available have been exploredIf the vulnerable adult has a significant mental health need, it may be appropriate for the case conference to take the form of an initial, or review, Care Programme approach meeting

WHAT IS THE PURPOSE OF A CASE CONFERENCE?The following issues should be considered:Ascertaining the current level of riskThe content of the Investigator’s reportAn Adult Protection Plan should be developed, and a professional nominated who has responsibility to co-ordinate, implement, and monitor the effectiveness of the planWho else should be informed on a “needs to know” basis?What arrangements are to be made for further reviews if required?Recommendations to be made about changes to the organisation and delivery of services, if appropriateProvision of a forum where the vulnerable adult and their carer or advocate can participate and express their views and concerns

FORMAT AND CONTENT OF A CASE CONFERENCEProceedings should normally cover the following


Introductions and roles of those presentOutline by chair of the purpose of the Case ConferenceRules of conductPresentation of the Investigating Officers reportCurrent position of investigation

The opportunity for representatives to contribute what they know about the situation and detail what their concerns areAssessment of current risks to the vulnerable adultFormulation of an Adult Protection Plan, including review dates and information about who will carry out the reviewSummary of discussions and conclusionsAgreed plan of action identifying specific roles and timescalesFuture meeting dates and venueCirculation list of minutes and accompanying papers to be agreed

CASE CONFERENCE REPORTCase conference reports should include the following details:AttendanceNameTitleAgency/link to adultDate/Time/Duration/VenueDetails of ChairpersonProfile of the Vulnerable AdultProfile of all relevant family carers and/or relatives or other service users as appropriateReasons for the Adult Protection Case ConferenceTasks to be addressed by the Adult Protection Case ConferenceRecord of the Adult Protection Investigation including the outcome of any medical examinationsInformation from each professionalVulnerable adult’s viewsOther concernsRecommendationsDecisionsCirculation of Case Conference reportArrangements for future meetings or reviews of the Adult Protection Plan

CONDUCT OF CASE CONFERENCESGeneral PrinciplesInvitations to participants should state the purpose of the Case Conference and all information should be presented in a format, which participants can understand


Participants should be advised that the proceedings are being conducted in strict confidenceContributors should be reminded of the importance of distinguishing between fact and opinionLanguage used should be non-discriminatory in nature having regard to the age, gender, sexuality, race, disability, religion, and role of all persons involvedThe overriding consideration should be to protect the vulnerable adult from further harmRespect for the views and wishes of the vulnerable adult, where they can be determined, will always be maintained and the need for confidentiality protectedParticipants should treat each other with respectAny decision to override the views of the vulnerable adult will always be taken in consultation with others and the reasons recordedThe contents of the notes of the meeting should not be discussed with any third party without the consent of the chairpersonShould any professional with direct knowledge of the individual or their situation not be able to attend the Case Conference then they should submit a written report giving details of their knowledge and expressing their opinion regarding possible action

INVITING THE VULNERABLE ADULT AND/OR THEIR REPRESENTATIVE/ADVOCATE

When deciding upon the venue for the Conference, the needs of the individual at risk and their representative must be considered and accommodated. Appropriate transport and care support must also be made available as appropriate.The individual felt to be at risk should be advised that a Conference is to take place, be invited to attend and given an explanation of its purpose and format. Representatives for the vulnerable adult should only attend with the consent of the individual at risk.If the individual has particular communication needs, which have to be met in order to fully enable their participation then appropriate arrangements should be made.There should be a free flow of factual information between participants. It is incumbent upon the participants to protect the confidentiality of the information that has been exchanged, insofar as that is consistent with the proper management of the case, and the legal responsibility and accountability of each agency. The deliberate withholding of information cannot be defended on the grounds of confidentiality as non-disclosure may have an influence upon the safety of the vulnerable adult.


Where a non-professional is invited to attend the Chairperson should ensure that they are properly briefed beforehand about the purpose of the Conference and the duty of confidentiality.If a professional feels unable to divulge information because of the presence of the non-professional they must communicate their concern to the Chairperson. A decision can then be made as to whether the information can be shared solely with the professionals attending.

CASE CONFERENCE MINUTESMinutes should be taken of all Conferences convened under the Adults at Risk of Abuse Procedures. They shall include:The name, address and date of birth of the individual discussed.Details of known familyA list of attendees and apologiesA description of the circumstances which caused the Conference to be convened, including the nature and evidence of abuse or risk.A summary of the Conference discussionThe recommendations of the ConferenceThe future safeguarding review date.The Chairperson shall ensure that the minutes are sent to all those invited to attend within 10 working days.The minutes should be produced in a manner that ensures that the individual is able to understand their content; language, large print, Braille, avoid jargon etc.The contents of minutes are confidential and as such must not be reproduced, divulged or copied in any way. Information obtained at a Case Conference is not to be discussed or revealed to persons not present without first obtaining written permission from the source of that information

Closing the Safeguarding Investigation

Once the investigation has been completed, there should be clarity about whether, on the balance of probabilities, abuse has taken place. Any decisions regarding case closure should be agreed and fully recorded. Cases can be closed at any stage of the investigation with the agreement of the agencies involved. The decision should detail any interventions put in place in respect of both the victim and the perpetrator.

Prior to closing an investigation the case responsible person should have regard to the following

The reason for closure must be agreed and recorded.


The case file must contain all the necessary information, minutes, forms and reports

A decision should be made on how the information is to be shared with the adult at risk of abuse

All decisions should be recorded

The vulnerable adult and their family carers (if appropriate) views of the outcome and process are recorded

The vulnerable adult is fully informed and aware of the details of the safeguarding plan and review process

Consideration must be given as to whether any staff: alerter, whistleblower, carers, need additional support

APPENDIX SIXCOMMUNICATION AND ALERTINGUnfortunately “abuse” is not something that fits into nice, neat categories and can therefore not be identified by using simple tick boxes or prescribed formulas. Concerns, worries and suspicions may come from a variety of sources; something witnessed, implied, inferred or disclosed.It is important to recognise the difference between “investigating” concerns and “alerting” others about concerns. In terms of identifying abuse or being suspicious that it may have occurred, your initial role is to gather information, inform your line manager and decide whether a referral is required. This would be an alert.In other words, you don’t need to fulfil the role of investigator. You cannot be a one-person adult safeguarding unit, but you are the person to whom information has emerged and you now need to follow good practice, policy and procedure to ensure the best response for the vulnerable adult.The role of the alerter is crucial and your actions at this stage will have a great bearing on the outcome of any subsequent investigation.If a person makes a disclosure to you try to ensure:That they can speak to you in private, or without others listening or interrupting.That they have an effective means of communicating with youThat, if necessary, you use the services of an interpreter, or translatorThat you are aware of any cultural communication issues e.g. genderThat you listen carefully to what is being said


That you remain calm and non-judgementalThat you voice regret for what has happened.That you will treat the information seriously.That the person has time and opportunity to give an account in their own words. (free narrative)That you do not ask leading questionsPay close attention to non-verbal or indirect communicationThat the person understands that you will be sharing the information with your line manager.Talk with your line manager. The decision about what should happen need not be yours alone, but is in essence the responsibility of the organisation.Record the agreed outcome of your conversation.Work in adult safeguarding requires us to communicate with our colleagues in other disciplines. Communicate with the most appropriate lead agency to further the Investigation process. (Adult Community Services, Commission for Social Care Inspection, Police)

Communication with vulnerable adults at a time when they may be frightened, embarrassed, confused, intimidated or in pain is very challenging and demanding. There are no easy answers to this. However, by utilising best practice strategies, remaining calm and focussed, seeking advice and support from your line manager, and by understanding your roles and responsibilities in relation to abuse, you will assist in the investigation process, and therefore the protection of your client.

APPENDIX SEVENEXTERNAL PROVIDERSRemember abuse is not the sole responsibility of any one single agency or individual. It is the responsibility of all who have a duty to provide care and protection to vulnerable people. The situation requires a multidisciplinary approach if an effective strategy for abuse prevention is to be implemented.Networking and communicating across agencies is of paramount importance. Maintaining positive links with other disciplines is therefore recommended.

Appropriate actionFollow the ASB Safeguarding Policy and Staff Guidance.


Discuss immediately with a line manager or designated personSpeaking to the lead agency in your area (Social Care Services, Commission for Social Care Inspection or Police)Advise and collaborate with other professionals as appropriate.

Intervention should be:Balanced – avoiding unwarranted interventionsEffective – provide practical solutionsAware – of culture, race, gender, beliefs and sexualitySensitive – to the needs and feelings of those involvedTimely – avoiding further harmMake sensitive enquiries of the vulnerable adult. Allow the person time to speak. Ascertain what the person now wants to happen. Do not ask leading questions or conduct an interrogation or investigative-type interview.It is your responsibility to report any incident or suspicion to the lead agency. This is in accordance with the VAPC protocol. Do not attempt to deal with the problem alone or in-house. Use the experience, expertise and support of others. Always involve other appropriate agencies.Initiate emergency intervention if appropriate.Monitor the situation closely, collate and record your information and observations.Keep formal detailed accurate records, including completion of the Adult Protection Referral Form. Record what is said in the persons’ own words.Never dismiss what the person says. Always take seriously even when the person appears to be confused.You may be alerted by a frightened demeanour coupled with some non-verbal indicators or other physical or environmental evidence.It is not our role to reach conclusions at this point. Be open-minded do not challenge abuse. Record what you have been told or have witnessed.

Remember_ Adults have basic rights, choice and options_ Do not jump to conclusions_ Do not make accusations_ Always try to appear calm; don’t panic_ Never show shock, astonishment or horror during disclosure_ Never keep concerns, worries, and suspicions to yourself_ Never ignore what is said or dismiss what you have been told.


PRINCIPLES AND BEST PRACTICEThe prime concern at all stages will be the interests and safety of the abused personThe aim will be to give a professional service to support and minimise distress and risk to any abused personAll vulnerable adults have the right to be protected and have their decisions respected even if that decision may place them at riskAll services will be provided in a manner that respects the rights, dignity, privacy and beliefs of all individuals concerned and does not discriminate on the basis of race, culture, religion, language, gender, disability, age or sexual orientation.Any person who has been abused needs the same care and sensitivity regardless of whoever is the alleged perpetratorVictims, witnesses, those who disclose allegations of abuse, and staff involved in the adult protection process will be treated with sensitivity, and offered appropriate support at all stages of the investigationThe importance of professionals working together and in partnership with the abused person will be recognised throughout the processThe responsibility to alert others about the abused person thought to be at risk, rests with the person who has the concernAll agencies receiving confidential information in the context of an abused adult investigation will make decisions about sharing this information in appropriate circumstances.Vulnerable adults have the right to have an independent advocate if they wish.

APPENDIX EIGHT

OUT OF COUNTY PLACEMENTSOccasionally an adult protection referral, or alert, will be made concerning a customer who is resident within the Suffolk boundary but has been placed here from another County.Even though the person is sponsored by another Local Authority, their normal place of residence, in this case Suffolk will be responsible for


completing an Adult Protection Referral Form and initiating a Strategy Meeting/Discussion.Consultation with a representative from the sponsoring Authority should begin immediately.The sponsoring or purchasing Authority should be fully advised and informed of progress made, and of decisions taken. They should be invited to attend, or contribute to any strategy discussions and meetings, and written records of the investigative process should be shared with them.When a customer is placed by Suffolk Social Care Services in an out of county establishment then the same service and response would be expected from the local authority where the customer is resident.

APPENDIX NINEA STATEMENT OF RIGHTSSuffolk’s Adult Safeguarding Board Policy is a practical expression of the commitment of organisations in Suffolk to


work together to ensure that the rights below are recognised and respected.Everyone has these rights but some people because of their age or the nature of their disability may be more at risk of exploitation and less able to defend their rights themselves.1. People have a right to be respected by their families, family carers, and those professionals and volunteers providing services for them.2. People have a right to say what they want and think and feel so long as doing so does not break the law or affect other people’s rights.3. People have a right to be involved in making decisions that affect them.4. People have a right to personal privacy, including not having personal letters opened or phone calls listened to unless the law allows this.5. People have a right to a wide range of information, especially information that would make life better for them.6. People have a right to an adequate standard of living, good food, access to health care and freedom from neglect.7. People have a right to be able to develop to their full potential.8. People have a right to be safe and receive adequate care and protection. This includes protection from all forms of violence including physical punishment, intimidation, belittling, and lack of respect, harassment, and sexual assault.9. They have the right to report violence and have their report taken seriously, including the right to have the Police called, if a crime has been committed.10. People with a disability have a right to take an active, full part in everyday life and become as independent as possible.11. People are entitled to leisure time and to spend their time as they choose including taking part in activities that include an element of risk.12. People have a right to the money and property that is legally theirs.13. People have a right not to be discriminated against because of their ethnic origin, culture or religion.14. People have the right not to be discriminated against because of their gender or sexuality.15. People have the right not to be discriminated against because of their age or disability.(Adapted from European Convention of Human Rights)


APPENDIX TEN

ADULT SAFEGUARDING BOARD-SUFFOLK

PROCEDURE FOR THE REVIEW OF SERIOUS ADULT PROTECTION CASES

Feb 2008

Author Bill Nicol, Head of Adult Safeguarding ServicesAugust 07


PROCEDURE FOR THE REVIEW OF SERIOUS ADULT PROTECTION CASES

ONE. PURPOSE OF SERIOUS CASE REVIEWS

1.1 There are three purposes to be fulfilled by serious case review:

i. To establish whether there are learning points about the way in which practitioners and agencies collaborated to safeguard vulnerable adults.

ii. To establish what those learning points are, and consider how they can be acted upon in order to change existing practice.

iii. To improve inter-agency working and ensure that systems are best utilised to promote partnership and communication.

NB. Serious Case Reviews are not inquiries into how an adult died, or suffered injury. Neither are they an exercise to discover who is culpable for a vulnerable adults’ death or serious injury.

TWO. CRITERIA FOR CONDUCTING A SERIOUS CASE REVIEW

2.1 The Suffolk Adult Safeguarding Board should undertake the lead responsibility for conducting a serious case review

2.2 The Board should always consider conducting a serious case review when a vulnerable adult dies (including death by suicide), and when abuse, or neglect, is known, or suspected, to be a factor in their death

2.3 In addition, the Board should consider whether to conduct a serious case review where a vulnerable adult has sustained

A life threatening injury through abuse or neglect


Serious sexual abuse

Serious or permanent impairment of development through abuse or neglect

Or where the operational case details give reason for concern about the way in which professionals and services worked together to safeguard vulnerable adults

2.4 In deciding whether a serious case review should be conducted in cases other than those involving a death (see criteria in para 2.3 above), the following questions should be considered.

Was there clear evidence of a risk of significant harm to a vulnerable adult that was: not recognised, or shared, by professionals or agencies?

Was the adult abused in an institutional setting?

Does one, or more, professional, or agency consider that their concerns were not taken seriously, or acted upon appropriately?

Does the case indicate that there may be operational failings in one, or more aspects of the use of the ASB adult safeguarding procedures?

Does the current adult safeguarding policy need to be amended or revised as a result of inadequacies or omissions?

Does the case appear to have implications for a range of professionals or agencies?

THREE. REFERRING OF CASES FOR SERIOUS CASE REVIEW.


3.1 Any agency, or professional may refer a case believed to conform to the criteria and guidance (as outlined in paragraphs 2.2, 2.3 and 2.4 above) using the format set out in Appendix C. Referral should be made to the Chairperson of the Suffolk ASB, or to the Head of Adult Safeguarding Services, together with a brief outline of the case and the factors that suggest that it is appropriate for serious case review. Adult Safeguarding Managers, Team Managers, or those others chairing adult safeguarding case conferences will be particularly well placed to identify those cases that warrant review

3.2 A summary of all cases that potentially meet these criteria will be submitted to ASB members for consideration

3.3 Any case that is considered appropriate for serious case review will be delegated by the Chair of the ASB to a Serious Case Review Panel. This will comprise of at least one, or more, delegate from the following areas:

Suffolk Adult Community Services

Suffolk Police

Commission for Social Care Inspection

Legal Representative

Voluntary/Customer Organisation

Health Representative

This will form the core membership of the panel.

3.4 In addition to this core group additional members may be co-opted to address particular case issues


3.5 Nominees will have appropriate levels of experience of adult safeguarding. In order to enhance the independence and objectivity of the Panel, nominees selected to contribute to specific reviews will normally be chosen from an operational area that has no direct involvement with the case in question. The selection of contributors will be the responsibility of the Serious Case Review Panel Chair.

3.6 The Serious Case Review Panel will be chaired by an independent person who, in turn, will be supported by the Head of Adult Safeguarding Services.

3.7 Before undertaking a serious case review the panel will draw up clear terms of reference for the conduct of the review and identify individuals/agencies to contribute. The terms of reference will address the following elements:

What appear to be the most important issues to consider in order to enhance points of learning from the specific case?

How can the relevant information best be obtained and analysed, including any necessity to request relevant individuals to give a direct account?

Over what time span should case details and chronology of intervention be reviewed?

What information from family, or service, history will assist the panel?

Which agencies or individuals should contribute to the review, and is there a need for other written information to be obtained from other sources?

Should the vulnerable adult, their family, or informal carers be invited to contribute to the review? If so,


which is the most appropriate method to enable their participation?

How should the review process take account of a Coroner’s inquiry, or any criminal investigation?

When should the review start and by what date should it be completed?

How will confidential information be recorded, stored, and distributed?

3.8 The Serious Case Review Panel will complete its deliberations, and make recommendations to the Chair of the ASB about what action should now be taken, within 3 months of the case being referred for review. A report outlining any recommendations will be presented to the ASB at the earliest opportunity.

FOUR. CONDUCTING A SERIOUS CASE REVIEW.

4.1 Upon confirmation from the ASB that a case is to be reviewed a representative, independent core group, and Chairperson will be identified to conduct the review. The Serious Case Review Panel will identify relevant contributory individuals and agencies.

4.2 The Chair of the Serious Case Review Panel will formally request that relevant individuals and agencies prepare and submit a management report outlining their involvement with the vulnerable adult/family. (See Appendix A for details of the content of management reports for submission to the Serious Case Review Panel)

4.3 The Chairperson for the review will, in conjunction with the Head of Adult Safeguarding Services, be responsible for ensuring administrative arrangements are completed and


that the review process is conducted according to these procedures.

4.4 The panel will complete a review of the information commissioned, and produce a short overview report of its findings, conclusions, and recommendations for the ASB. (See Appendix B for detail of contents of panel reports for presentation to the ASB)

FIVE. IMPLEMENTING THE REVIEW RECOMMENDATIONS

5.1 On completion, the overview report will:

Ensure that contributing agencies are satisfied that their information is fully, and fairly represented in the overview report.

Translate recommendations from the overview report into an action plan, which will be endorsed by each agency. The action plan will outline:

Who will be responsible for various actions.

The time-scales and targets for the completion of agreed actions.

The intended outcome and purpose of recommended actions.

The model used for evaluating, monitoring, and reviewing the necessary improvements in practice, policy, and/or systems.

Clarify to whom the report, or sections of the report, should be made available.


Disseminate the report, or key findings to interested parties and provide feedback and debriefing to staff, vulnerable adult, family, informal carers and media.

Authors. Bill Nicol. Head of Adult Safeguarding Services

APPENDIX “A”

MANAGEMENT REVIEWS AND REPORTS BY PARTNER AGENCIES FOR CONSIDERATION BY THE SERIOUS CASE REVIEW PANEL.

1. When a case conforms to the criteria for conducting a serious case review (See Section Three), the chairperson of the Serious Case Review Panel will formally request that agencies conduct a management review of their involvement with the adult, the service, and/or their family. Upon conclusion of this management review the agency should submit a report detailing their findings.

2. The request for the management review and report will be addressed to the chief officer or chief executive of the agency concerned. Although the task of completing the management review and report may be delegated to a suitably qualified senior manager within the agency, it is crucial that the final report and recommendations within are fully endorsed by the chief officer before submission.

3. On receipt of the request from the Serious Case Review Panel, it is recommended that agencies should take


action to secure all relevant records relating to the case, thus guarding against loss or interference.

4. The aim of the management review is to look openly and critically at individual and organisational practice to identify whether the case indicates that changes could, and should, be made and, if so, how these changes will be achieved.

5. The serious case review is not part of any disciplinary inquiry. However, information that emerges in the course of the review may indicate that disciplinary action should be taken under established agency procedures.

6. Where staff, or others are interviewed by those preparing management reviews then a written record of such should be made and this should be shared with the interviewee. If any individual is interviewed by the Serious Case Review Panel then a formal record will also be made.

CONTENT OF MANAGEMENT REVIEW

What was the agency’s involvement with the adult and family?

A comprehensive chronology should be compiled of involvement by the agency and its employees over the period of time specified by the Serious Case Review Panel.

Analysis of Involvement

Consider the events that occurred, the decisions made, and the actions taken. (or not taken) Where judgements were made which indicate that practice, or management could be improved then try to get an understanding not only of what occurred, but why. For example:


Were practitioners sensitive to the needs of the vulnerable adult and their family?

Were they knowledgeable about potential indicators of abuse or neglect?

Were practitioners, or was the agency, clear about its’ roles and responsibilities in protecting vulnerable adults from abuse?

Did the agency have policies and procedures for safeguarding vulnerable adults?

What were the key relevant points/opportunities for assessment and decision making in this case?

Do these assessments, or decisions, appear to have been made in and informed and professional way?

Did subsequent actions accord with any assessments or decisions made?

Were appropriate services offered or provided in light of the assessment?

Where care plans reviewed?

Were the views and feelings of the vulnerable adult, family, or referring body ascertained? Was this information recorded?

Was practice sensitive to the racial, cultural, linguistic, and religious identity of the adult, family, or family carer?

Was information shared appropriately in order to alert other managers or agencies of concerns?

Was the work in this case consistent with the agency’s and ASB’s adult safeguarding policy and wider professional standards?


What has been learned from the case?

Are there lessons from this case for the way in which this agency works to safeguard vulnerable adults and promote their welfare?

Are there examples of good practice, or ways in which practice could be improved?

Are there implications for ways of working; training (single and multi-agency); management and supervision; working in partnership with partner agencies; shortfalls in resources or service provision?

Recommendations for action

What action should be taken, by whom, and by when?

What outcomes should these actions bring about?

How will the agency review whether they have been achieved?

A report of the management review should be completed, endorsed by the agency’s chief officer and sent to the Chairperson of the Serious Case Review Panel, or the Head of Adult Safeguarding Services. Any foreseeable delays should be communicated as a matter of urgency.APPENDIX “B”.

OVERVIEW REPORT BY SERIOUS CASE REVIEW PANEL.

1. Upon receipt of management reports provided by partner agencies, The Panel membership will review the report’s content and any other information, with the aim of providing an overview report for the ASB.

2. The report will be set out in the following format:


Introduction

1. Summary of circumstances that led to the review being undertaken

2. Terms of reference of the review

3. List of contributors to the review and the nature of their contribution.

The Report Detail

4. Details of the family and care services provided

5. Integrated chronology of all relevant agency involvement with the adult, family, or family carer.

6. Summaries of information known to the agencies and professionals involved about the adult, family, family carer, or perpetrator.

Analysis

7. Examination of how, and why, events occurred, including decisions made, actions taken, or omitted. Reviewers can consider, with the benefit of hindsight, whether different decisions or actions may have resulted in an alternative course of events. This section should also highlight good practice.

Conclusion

8. A summary of the lessons that, in the opinion of the review panel, are to be drawn from the case and how these lessons should be translated into recommendations for action. These recommendations should be focussed, specific and achievable. If there are


lessons for national, as well as local, policy and practice, then these too should be highlighted.

APPENDIX “C”

REFERRAL TO ASB REQUESTING A SERIOUS CASE REVIEW

The format for requesting a serious case review must include the summary information listed below.

To be sent to;Bill Nicol,Head of Adult Safeguarding Servicesc/o Endeavour HouseIpswich

E-mail to: [email protected]

All requests will be assessed and submitted to the ASB. If the matter requires urgent attention then it will be sent directly to the Chair of the ASB. They will decide if the committee needs to be convened on special grounds.

Content of the report

1. Name of the person submitting the application for a serious case review


2. Position of applicant

3. Agency of the applicant

4. Contact details, to include address, telephone number, and E-mail

5. Brief details of the adult protection issue, to include:

The name and date of birth of the victim

Name of any service provider involved

Details of why, in your opinion, the case meets the serious case review criteria and guidelines.

APPENDIX 11New Developments relevant to Safeguarding Adults


The Mental Capacity Act (2005) is a complex piece of legislation and the following is a guide to some of the most pertinent parts. Guidance on the Act is provided in a statutory Code of Practice (see www.justice.gov.uk/guidance/mca-code-of-practice.htm).

Additionally practitioners should make reference to the Suffolk MCA website.

The consideration of capacity is crucial at all stages of the adult safeguarding process. For example, in determining the ability of a vulnerable adult to make lifestyle choices, such as choosing to remain in a situation where they are at risk of further abuse; determining whether a particular act or transaction is abusive or consensual’ or determining how much a vulnerable adult can be involved in making decisions in a given situation.

The whole Act is underpinned by a set of 5 key principles

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 proven otherwise

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

That individuals must retain the right to make what might be seen as eccentric or unwise decisions

Best interests – anything done for or on behalf of people without capacity must be in their best interests; and

Least restrictive intervention - anything done for or on behalf of people without capacity should be the least restrictive of their basic human rights and freedoms

MCA 2005 Section 2 (1), Code of Practice 4.11- 4.13

Section 2 states that a person lacks capacity in relation to a matter if at the material time s/he is unable to make a decision for himself or herself in relation to the matter because of impairment of or a disturbance in the functioning of the mind or brain.

MCA 2005 Section 3, Code of Practice 4.49 – 4.54


http://www.justice.gov.uk/guidance/mca-code-of-practice.htm

Section 3 states that a person is unable to make a decision if s/he is unable:

To understand the information relevant to the decision

To retain the information

To use or weigh that information as part of the process of making the decision

To communicate his decision by any means

Every assessment of capacity must be undertaken in accordance with the Act, the provisions of the Code of Practice and the Suffolk MCA Practice Guidance. Anybody who claims that a person lacks capacity should be able to show on the balance of probabilities that the individual lacks capacity to make a particular decision at the time that it needed to be made.

Where a decision needs to be made in respect of a person who lacks capacity, the law requires that the decision be based upon the concept of best interests. The term best interests is not actually defined in the Act. However, Section 4 of the Act explains how to work out the best interests of a person. This section sets out a checklist of common factors that must be considered by anyone who needs to decide what is in the best interests of a person who lacks capacity in any particular situation. The decision maker must work through these factors when deciding what is in the best interests of the individual.

There are 2 levels to assessing capacity:

For acts of every day care or treatment, the care worker must have a reasonable belief that the person lacks capacity to agree to the action or decision to be taken. They must have taken reasonable steps to establish that the person lacks capacity to make a decision or consent to an act at the time the decision or consent is needed. They do not usually need to follow formal processes such as involving a [professional to make an assessment

When making a complex or major decision about as person who is believed to be lacking capacity, it is advisable for a more formal assessment tio be carried out by a suitable professional e.g. psychiatrist, psychologist or social worker. It must be


demonstrated on the balance of probabilities that the individual lacks capacity to make a particular decision.

The Act deals with 2 situations where a designated decision-maker can act on behalf of someone who lacks capacity:

Lasting Powers of Attorney (LPAs)

The Act allows a person top appoint an attorney to act on their behalf if they should lose capacity in the future. This is similar to previously available Enduring Power of Attorney (EPA), but the Act also allows people to let an attorney make personal health and welfare decisions.

Financial LPA’s can be used both before and after the donor loses capacity, according to the donor’s wishes. However, personal welfare LPA’s can only be used when the donor lacks capacity to make a particular welfare decision

Court appointed duties

The Act provides for a system of court appointed deputies top replace the current system of receivership in the old Court of Protection. The new Court of Protection will include the power to make declarations, decisions and orders on financial and welfare matters affecting those who lack capacity and additionally be able to appoint a deputy to make substitute decisions about personal welfare matters as well as issues concerning the property and affairs of the person lacking capacity.

The Act creates 2 new public bodies to support the statutory framework both of which will be designed around the needs of those who lack capacity. These are:

A new Court of Protection

The new Court has jurisdiction relating to the whole Act and will be the final arbiter for capacity matters. It has its own procedures and nominated judges. In particular the Court of Protection has powers to:

Decide whether a person has capacity to make a particular decision for themselves

Make declarations, decisions or orders on financial or welfare matters affecting people who lack capacity to make decisions


Appoint deputies to make decisions for people lacking capacity to make those decisions

Decide whether a lasting Power of Attorney or Enduring Power of Attorney is valid; and

Remove deputies or attorneys who fail to carry out their duties.

The Office of the Public Guardian

The Public Guardian and his/her staff are the registering authority for LPA’s and Court Orders that appoint deputies. They also work together with other agencies to respond to any concerns raised about the way in which an attorney is operating.

The Act introduces 2 new criminal offences: ill treatment and wilful neglect of a person who lacks capacity to make relevant decisions. (Section 44) The offences Apply to:

Anyone caring for a person who lacks capacity - this includes family carers, healthcare and social care staff in hospital or care homes and those providing care in a person’s home;

An attorney appointed under an LPA or an EPA or a deputy appointed for that person by the Court

These people may be guilty of an offence if they ill-treat or wilfully neglect the person they care for or represent. Ill treatment and neglect are separate offences. For a person to be found guilty of ill treatment, they must either:

Have deliberately ill-treated the person, or

Be reckless in the way they were ill-treating the person

It does not matter whether the behaviour was likely to cause, or actually caused, harm or damage to the victim’s health.

The meaning of wilful neglect varies depending upon the circumstances, but it usually means that a person has deliberately failed to carry out an act they knew they had a duty to do.

Independent Mental Capacity Advocate (IMCA)


The purpose of the IMCA service is to help particularly vulnerable people who lack the capacity to make important decisions about serious medical treatment and changes of accommodation, and who have no family or friends that it would be appropriate to consult about those decisions. If a person who lacks capacity has nobody to represent them or no-one who is appropriate to consult, an IMCA must be instructed in prescribed circumstances. These are:

Providing, withholding or stopping serious medical treatment

Moving a person into long-term care, into hospital or into a care home, or

Moving a person into a different hospital or care home

The only exception to this can be in situations where an urgent decision is needed.

The role of the IMCA is to work with and support people who lack capacity, and represent their views to those who are working in their best interests.

The Department of Health has extended the Act through Regulations to cover circumstances where a adult abuse allegation has been made. The Regulations specify that that Local Authorities and the NHS have powers to instruct an IMCA if the following requirements are met

Where safeguarding measures are being put in place in relation to the protection of vulnerable adults from abuse; and

Where a person lacks capacity

In these circumstances the Local Authority or NHS body may instruct an IMCA to represent the person concerned, if it is satisfied that it would benefit the person to do so.

In safeguarding cases access to IMCA’s is not restricted to people who have no one else to support or represent them. People who lack capacity who have family and friends can still have an IMCA to support them through the safeguarding process.

The regulations equally apply to a person who may have been abused or neglected and a person who is alleged to be the perpetrator. Where the qualifying criteria are met, it would be unlawful for the Local Authority or the NHS not to consider the exercise of their power to instruct an IMCA for safeguarding cases.


Restraint

Section 5 permits the use of restraint if the person using it reasonable believes that it is necessary to prevent harm to the incapacitated person and if the restraint is proportionate to the likelihood and seriousness of harm. If restraint is necessary to prevent harm to the person who lacks capacity, it must be the minimum amount of force for the shortest time possible.

The Vulnerable Groups Act (2006) provides a framework for the new Independent Safeguarding Authority Scheme. The major purpose of this is to prevent those deemed unsuitable to work with vulnerable groups gaining access to them through their employment. The Act does not make any distinction between paid or unpaid work. Employers will retain their responsibilities for ensuring safe recruitment practices. The current proposal is that the Independent Authority Scheme (ISA) will be phased in over a 5 year period from Oct 2009

The Deprivation of Liberty Safeguards will be introduced in April 2009, as an amendment to the Mental Capacity Act (2005). The purpose of these safeguards is to protect people who lack mental capacity from being deprived of their liberty. The procedure and related Code of Practice will introduce criteria, a procedure for assessment, and a decision-making forum, as well as guidance for reviewing and deprivation of liberty that has been put in place.

Forced Marriage (Civil Protection) Act 2007

The Act allows Courts to make orders to prevent forced marriages and to order the behaviour or conduct of those responsible for forcing another into marriage to change or stop or impose requirements on them. It also provides recourse for those already forced into marriage. The Act gives the Courts a wide discretion to deal flexibly and sensitively with the circumstances of each individual case. It employs civil remedies that offer protection to victims without criminalising members of their family

In February the Government began work on a review of No Secrets (2000), and although this is in its early stages, it is expected to have wide ranging implications for safeguarding work.


Suffolk Vulnerable Adult Protection Committee€¦ · Web viewSafeguarding Adults (ADSS 2005)...

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Transcript of Suffolk Vulnerable Adult Protection Committee€¦ · Web viewSafeguarding Adults (ADSS 2005)...