Kent and Medway – Safeguarding Adults Assessment, Risk Evaluation and Care Planning form July 09
Form SA 1
Safeguarding Assessment -- Risk Evaluation -- Safeguarding Plan.
SAFEGUARDING ADULTS – ASSESSMENT
Client details as at: Completed by:
Client ID No: Name: Date of Birth: Gender: Ethnicity: Marital status of the client:
Address: Phone:
Date Assessment Started: Date Assessment Completed:
Location(s) assessment carried out (s):
1.
2.
Name of worker: Team:
Contact details(tel):
Summary of concerns and previous history e.g. previous incidents:
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Outcome of time spent with and speaking to client: Record of meeting with client / alleged victim. (Please record the questions you asked. Include the client’s views about the allegations and what they would like to happen as a result of your meeting with them. If you have not been able to spend time with or speak to the client
please explain why.
Appearance & demeanour of client:
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Mental Capacity
Is a Mental Capacity Act Assessment required? Yes
No
Give reasons including decision making issues to be assessed: Consent & information sharing Were consent issues discussed?
Yes
No
Unable to consent
If Yes, was consent given for Information to be shared as needed?
Yes
Yes, with limitations
No
N/A
Details of any limitations in sharing: Assessments of client’s strengths / needs: Factors which restrict or may restrict independence (nature & extent of disability/illness): Communication:
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Dependence/Independence (extent to which the person is able to meet their own needs: Support network (informal and formal networks of support including family and friends): Support / Care & relationship indicators: Is support / care currently available:
Is support / care needed:
Name(s) (of person(s) or agency if relevant)
Relationship to client:
Is the client happy with the support / care they receive: Are there any difficulties with support / care or the support / care relationship(s): Is a full assessment required?
Yes No
Is a carer’s assessment required?
Yes No
Environment in which risk arises Describe Environment:
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Comfort: Suitability to individuals need (especially any environmental risk factors):
Signs/indicators of harm occurring or risk of harm: For a fuller summary of the signs and indicators of harm and abuse please see: WWW.kent.gov.uk/adultprotectioncommittee policy and guidance documents
Neglect: Physical: (additional body map may be required)
Psychological/emotional: Financial:
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Sexual: Other:
Assessed Hazards i.e. types of occurrence or abuse that may cause harm/danger. If possible discuss these with the client with the aim or empowering and encouraging them to consider/decide how the hazard(s) may be reduced
Dangers i.e. possible outcomes associated with identified hazards and likelihood of occurring (high/medium/low)
Danger Likelihood
1.
2.
3.
4.
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Views of significant others Name: Relationship to service user:
Details of any limitations in sharing information: Name:
Relationship to service user:
Details of any limitations in sharing information: Name: Relationship to service user:
Details of any limitations in sharing information:
Outcome of discussion with other agencies Name: Title:
Organisation/agency:
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Name: Title
Organisation/agency:
Name: Title
Organisation/agency:
Assessor(s) Name(s):
Assessor(s) Signature(s):
Date assessment completed:
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SAFEGUARDING ADULTS – Risk Evaluation (To be completed by with the assessor(s) Designated Senior Officer on completion of the assessment)
Vulnerability (Of individual and/or other vulnerable people
who may be at risk of harm)
Low (1)
Moderate (2)
Substantial
(3)
Critical (4)
Evidence
The person is fully able to
take action to protect
themselves
The person
needs support in some
areas/has a supportive network of
family, friends etc.
The person
needs support in most areas of their life/has a
limited network of support including
family, friends etc.
The person/s is unable to take
action to protect themselves and has
no access to appropriate help or
support.
Overall Impact*
(to individual and/or other vulnerable people)
Low (1)
Moderate (2)
Substantial
(3)
Critical (4)
Evidence
No evidence of harm or abuse
occurring
Some evidence of harm
occurring or risk of harm occurring but overall impact
on individual/s low
Evidence of serious risk of harm/criminal offence may
have occurred
.
Potentially life threatening/
serious criminal offence likely to
have occurred/others
may be at serious risk
Overall Impact score* 2 + 1 (see below) = 3 *Where the vulnerability is assessed as being substantial (3) or critical (4) the overall impact grade should be increased by one (up to a maximum score of 4).
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Likelihood of Future Harm
(to individual and/or other vulnerable people)
Low (1)
Moderate (2)
Substantial
(3)
Critical (4)
Evidence
No evidence of harm or abuse occurring. No
indicators present.
Unlikely. No evidence of
serious harm some indicators
present.
Likely to occur
unless significant
changes are made.
Evidence of harm occurring and/or number of indicators suggesting
harm.
Very likely evidence of
serious harm occurring indicators
suggested high risk of
reoccurrence unless significant
changes are made
Overall Likelihood score 3 x 3 To obtain an overall risk score the overall impact score should be multiplied by the overall likelihood score of future harm score. Overall Risk Score: 9 The following is intended as a guide: For grading risk, the scores obtained from the risk matrix are assigned grades as follows:
1 – 3
Low risk
No further action required at this time. Discuss with line manager.
4 – 6
Moderate risk
Risk Assessment & Safeguarding plan required. DSO to ensure plan co-ordinated, monitored and reviewed.
7 - 9
High risk
Multi agency risk assessment & safeguarding plan required – Will be coordinated by the DSO
10 – 16
Extreme Risk
Multi agency risk assessment & safeguarding plan required –Safeguarding Lead Manager must be informed of the high risk concerns.
Designated Senior Officers Name: Designated Senior Officers Signature:
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Safeguarding Plan for the Client: (Please summarise any actions taken to empower / safeguard the client e.g. information provided, change of service/carer, change of accommodation) Action Taken/Planned/Agreed By Whom Date
Review Date and by whom
1.
2.
3.
4.
5.
Client was not deemed to have capacity to consent to the protection plan at this time.
Additional Comments
Has the client consented to this plan?
Yes
No
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Review of Safeguarding Plan for the Client: (Please summarise any actions taken to empower / safeguard the person e.g. information provided, change of service/care, change of accommodation).
Review of Actions Taken/Agreed
Any changes recommended
Date
Further Review Date and
who will be involved
1
2
3
4
5
Comments
Date ………………………………….. Kent and Medway SGVA Committee acknowledges the support of Oxfordshire CC in the development of this form
Has the client consented to the revised plan?
Yes
No
Client was not deemed to have capacity to consent to the protection plan at this time.
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