St Helens Multi-Agency Adult Safeguarding Procedures

January 2013 edition

Foundation Training

January 2013 1

Introductions

January 2013 2

Housekeeping

• Fire exit • Toilets • Room temperature • Mobile phones “please turn off or silence” • Be confidential • Take care – today can be sensitive. • Respect others talking/making points • Get involved in discussions • Breaks, refreshments and light buffet are available January 2013 3

Programme

ARRIVAL & REFRESHMENTS 9.30

Introductions Safeguarding in St Helens Key definitions Types of abuse Factors associated with Adult Abuse Identifying the signs & indicators of abuse BREAK St Helens Safeguarding Adults Procedures How to make an alert Key information when reporting abuse LUNCH Disclosure Safeguarding investigations Understanding who has responsibility to investigate Roles & responsibilities Case studies BREAK Assessment 4.30

FINISH

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Learning Objectives

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By the end of the day participants will:

understand key definitions relevant to St Helens Safeguarding Procedures define the different types of abuse identify the signs and/or symptoms associated with each type of abuse explain the actions to take, if a suspicion or allegation of abuse occurs, following the St Helens model understand key information to be included when reporting abuse understand the roles, responsibilities and boundaries of the worker with regard to safeguarding vulnerable adults January 2013 5

Safeguarding in St Helens

January 2013 6

Values and Beliefs

St Helens Multi-Agency Safeguarding Adults Policy 2013 has been developed in the recognition that Vulnerable Adults can be abused and that the abuse of Vulnerable Adults constitutes a clear infringement of their human and civil rights.

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All partners share the following values which underpin their work:

• • • • • • Everybody within our society deserves, and is entitled to,good quality care and support to meet their needs. Some people have difficulty expressing their needs and require careful consideration of their individual circumstances.

Everybody has the right to live in a safe and secure environment without fear of abuse, harassment or injury.

Everybody has a right to live as independently as they are able.

Everybody has a right to make choices and decisions about their lifestyle which can involve risk-taking.

Everybody should have access to relevant services for addressing issues of abuse and neglect, including the civil and criminal justice system and victim support services.

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Mission Statement

The partners of St Helens Safeguarding Board recognise the rights of the individual to live a life free from abuse and neglect January 2013 9

What is Adult Safeguarding?

• • • Discuss in groups: What is Adult Safeguarding?

Who is a Vulnerable Adult?

What is Abuse?

Assign someone to write and someone to give feedback January 2013 10

Key Definitions

January 2013 11

Adult Safeguarding

Within St Helens Multi-Agency Procedures, Adult Safeguarding is taken to mean actions to redress actual abuse, or provide additional security, whilst an allegation is investigated.

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Defining a Vulnerable Adult

The definition of a Vulnerable Adult, in terms of the St Helens Multi-Agency Policy 2013, is: “An adult who is in receipt of, or may be eligible for, Community Care Services” Association of Directors of Adult Social Services (ADASS) 2005 January 2013 13

Vulnerable Adults may be people who have:

• • • • • learning disabilities physical disabilities sensory impairment mental illnesses, including Dementia physical or mental frailty due to age or illness January 2013 14

Defining Abuse

The definition of abuse, used in the guidance “No Secrets”, is: “Abuse is a violation of an individual’s human and civil rights by any other person or persons” January 2013 15

Types of Abuse

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Types of Abuse

• • • • • • • Physical Sexual Emotional/Psychological Financial Neglect Discriminatory Institutional Identified by No Secrets (Department of Health, 2000) January 2013 17

Identifying the signs and indicators of abuse

Discuss in groups the signs and indicators, you might become aware of, for each type of abuse January 2013 18

Indicators of Abuse

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Physical Abuse

• • • • • • Physical maltreatment of one person by another who may be in a position of power over the victim. This includes: hitting, slapping, pinching, pushing, hair pulling inappropriate restraint or sanctions necessary aids and adaptations, including glasses and hearing aids, being withdrawn physical intimidation improper use of, or forcible administration of, medication force feeding January 2013 20

• • • • • • •

Indicators of Physical Abuse

Unexplained injury or injury inconsistent with explanation Marks, bruises, burns, scalds Persistent pressure sores or ulcers Being excessively withdrawn or compliant Appearing frightened of/avoiding physical contact Injuries at different stages of healing Covering up parts of the body January 2013 21

Sexual Abuse

Involvement in sexual activities or relationships which: • individuals do not want or cannot understand and/or have not consented to.

• takes place within a family, care-giving or other power relationship ie involves an element of coercion.

• Forced Marriage This can include harassment, inappropriate teasing or innuendo, indecent exposure, touching, masturbation, penetration, intercourse and being forced to participate (actively or passively) in any activities which may be deemed to be pornographic.

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• • • • • • • •

Indicators of Sexual Abuse

Torn, stained or disarranged clothing Bruises, pain bleeding or unexplained discharges Inappropriate sexual behaviour eg overly seductive Ill-health eg discharges and infections Vulnerable adult appears withdrawn Pregnancy in a female who is unable to give consent to sexual relations Reluctance of person to be alone with an individual known to them Fear of staff providing help with undressing, bathing etc January 2013 23

• • • • • • • •

Psychological/Emotional Abuse

This includes the use of threats, fear or bribes to negate the person’s choices and independent wishes or persistent, negative or derogatory behaviour. It can include: Intimidation by shouting or screaming Ignoring requests or conversation Humiliation Withholding of necessary assistance Denial of requests, choices and opinions or privacy Denial of access to friends and family Denial of religious or cultural needs Radicalisation/recruitment to violent extremism January 2013 24

• • • • • • • • •

Indicators of Psychological/Emotional Abuse

Alteration of psychological state eg withdrawal, depression Cowering or fearfulness Deliberate self-harm Strain or broken relationships Disturbed sleep Weight change Aggressive or challenging behaviour Poor concentration Indicators of radicalisation/recruitment to violent extremism • • Change of faith Change of appearance • • Talk about another person who seems to have a lot of influence Associating with a limited number of people January 2013 25

Financial and Material Abuse

The deliberate exploitation or manipulation of the person’s legal or civil rights, including misappropriation of monies or property. This includes: • • • • • money being borrowed by staff or volunteers who have a responsibility for providing a service to that person the use of money or property without the informed consent of the Vulnerable Adult theft misuse of a person’s money, possessions, property or insurance or the prevention of access to these pressurising or deceiving a person to alter their will January 2013 26

• • • • • • • • •

Indicators of Financial and Material Abuse

Appears that a Vulnerable Adult is being exploited for personal gain Inability to budget and pay bills that is out of character with previous behaviour Large or frequent withdrawals from bank account for unspecified reasons Reluctance to buy essential food or clothing items and/or excessive economies on heating and lighting Person encouraged to make financial gifts to staff paid to provide care for them Sudden disparity between assets and living conditions Refusal to produce bank statements/books or to allow the holder access to them Recent change of deeds or title of house An appointee using a person’s benefits for their own personal gain January 2013 27

Neglect

Behaviour on the part of a carer which results in serious impairment of health or development of the cared for. This can be deliberate or by default ie when the perpetrator is not able or willing to provide the care needed or does not recognise the need for the care to be provided. It can include failing to undertake a reasonable assessment of risk and allowing a person to harm themselves or cause harm to others. Neglect is a criminal offence (since April 2007) under the Mental capacity Act (2005) January 2013 28

• • • • • • • • • •

Indicators of Neglect

Poor physical state of the person – weight loss, dehydration, dirty or unkempt appearance, ignoring medical or physical needs.

Untreated pressure sores.

Failure to provide access to appropriate health, social care or educational services.

Marked change in relationship between the Vulnerable Adult and others.

Marked reluctance by care-givers to co-operate with agencies.

Sole or primary carer is suffering from disabling ill-health which renders them incapable of meeting the basic needs of the person cared for The withholding of the necessities of life, such as medication or adequate heating and clothing, food and drink.

Unexplained changes in material circumstances.

Inconsistency of explanation.

A significant deterioration in the environment.

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Discriminatory Abuse

This includes: • Racist, ageist, homophobic or sexist abuse • • • • Abuse based on a person’s disability Harassment or slurs Not making provision for disability or sensory impairment Denying someone the opportunity to attend a place of worship.

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Indicators of Discriminatory Abuse

• • • • • • • • • Non-provision of appropriate food, clothing etc Denial of religious/cultural needs Acceptance of racist language or language which denigrates someone’s disability Lack of respect Loss of interest, emotional withdrawal and symptoms of depression Self-harm Defensiveness Aggression or challenging behaviour By association.

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Institutional abuse

Where abuse of any type results from routines and regimes within care settings which deny people’s rights, choices and opportunities, it is called Institutional Abuse.

Abuse can be caused by weak or oppressive management, inadequate staffing (numbers, competence), inadequate supervision or support, “closed communication”, lack of knowledge of Whistle-blowing policies, lack of training January 2013 32

Indicators of Institutional Abuse

In addition to other indicators, there may be: • Denial of rights • Threats of punishment, loss of personal possessions or eviction in order to gain compliant behaviour • • • • Denial of food, drink, adequate clothing and/or suitable living environment Denial of access to friends, Family, Solicitor, Doctor, Care Manager etc Denial of access to money, access to information about self, information about rights and responsibilities of the management of the home/service A culture which does not respect personal dignity.

January 2013 33

Factors associated with Adult Abuse

• • • • • The most significant factors underlying the abuse and mistreatment of Vulnerable Adults include: • Stress • Psychological or mental health problems Lack of support Alcohol or substance misuse Revenge/anger Poor understanding/lack of awareness Premeditated self-interest and self-gratification.

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When is abuse or mistreatment more likely to occur?

• • • • • • • • • Long history of dysfunctional family relationships where mistreatment of family members has been the norm Where paid carers experience the role very negatively If carers: • • Do not feel supported Habitually lose their temper – linked to stress Feel they cannot cope Perceive the dependent adult as being deliberately awkward Have to cope with multiple problems in the dependent adult Habitually act angrily or aggressively Have diminished communication.

If the Vulnerable Adult: Hits out at the carer Has difficulty communicating January 2013 35

When is abuse or mistreatment more likely to occur? (Cont.)

If the Vulnerable Adult: • • • • • • • • Disturbs the carer at night Has odd and embarrassing behaviour Is unhelpful or uncooperative • • • Is deliberately ungrateful Other factors: Carer has other dependants Carer is physically or mentally ill, dependant on alcohol or misuses drugs Violence is the norm Poor understanding eg of behaviour or conditions Role reversal – adult/child caring for a dependent adult Carer is young/lacks maturity The Vulnerable Adult has few/no social contacts.

January 2013 36

When is abuse or mistreatment more likely to occur in Residential/Nursing & Domiciliary Care?

• • • • • • • • • • • • In a residential/nursing home and domiciliary care setting, abuse/mistreatment is more likely to occur when the following applies: • Staff feel unsupported and lack confidence in management • Staff turnover is high Staff are expected to undertake tasks outside their job description Supervision is tokenistic Training is minimal Communication channels are ineffective Support plans are not clear, complete or available Social activity and supervision of residents is minimal Staff feel under pressure to complete tasks quickly Recording is not robust Administration of medication is not audited regularly Specialist equipment is not available Infection control is poor Physical hazards such as loose mats, overly hot water, unlit corridors/rooms are not addressed January 2013 37

How to make an Alert

January 2013 38

Local Context of Safeguarding Adults

St Helens Multi-agency Safeguarding Adults Policy, Procedures and Guidance We have had 3 procedures in 9 years: 2001 to 2008 2008 to 2010 2010 to 2012 January 2013 onwards January 2013 39

Safeguarding Alerts Quiz

January 2013 40

St Helens Safeguarding Adults Procedures

Follow the flowchart: “How to make a Safeguarding Alert in St Helens”

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St Helens Safeguarding Adults Procedures

Applies to all residents of St.Helens, regardless of setting, i.e. community, hospital or care establishment

BE ALERT: suspicion, allegation, observation or disclosure Deal with immediate danger (if any) – Call 999 if appropriate Support and make the Vulnerable Adult as safe as possible Preserve the evidence (if any, if appropriate) Report the Abuse - Inform Line Manager/Agency’s Designated Person who must telephone St Helens Council Contact Centre within 1 hour to make a Safeguarding Alert. If Line Manager likely to be unavailable for more than 1 hour – YOU MUST telephone the alert through yourself Telephone St.Helens Council Contact Centre – 01744 676600 (9.

00am to 5.00pm – Monday to Friday) OR Emergency Duty Team (EDT) – 0845 0500 148 outside of the above hours Make a Record

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Be Alert

• • • • Think about what you see and ask is it acceptable practice Always take seriously what you are told Be suspicious of any signs/signals/non verbal communication that could indicate abuse Create an atmosphere for someone to tell you what is wrong January 2013 43

Deal with immediate Danger, if any

• • Call 999 for Police or an Ambulance Danger is where there is a serious, actual and imminent threat to health/well-being, such as: – When the person needs urgent medical attention – When the perpetrator is making threats and is able to commit further abuse January 2013 44

Support and make the Vulnerable Adult as safe as possible

• • • • • Take the person to a place of safety Provide reassurance only Offer support, where appropriate Ensure others are able to provide support Explain that you will inform your line manager, unless you believe this will cause the Vulnerable Adult further distress January 2013 45

Preserve the Evidence

• – Evidence can be anything (PPP) The person – blood, scratches, dirt etc – The place – a room, the garden, a car etc – A piece of property, cutlery, garden objects etc • • Don’t touch, remove or clean any PPP unless absolutely necessary Don’t interview the person January 2013 46

Duty to Report Abuse

• • • Applies to all St Helens Council employees, staff and volunteers in all Agencies that are signatories to Multi-Agency Procedures or contracted by them to provide a service Report suspicions/ allegations/disclosure/observations of abuse to your Line Manager/Agency/Designated Person If the Line Manager/Agency Designated Person is likely to be unavailable for more than one hour, YOU MUST report directly to St Helens Council Contact Centre January 2013 47

An Alert must have…..

An Alleged Perpetrator

(Who)

An Alleged Abuse

(Did what)

An alleged Victim

(To Who) Or in the case of Neglect… (Who) (Failed to do what) (To Who) Line Manager/Agency’s Designated Person MUST check initial facts and consider context

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Consider Context

WHO WHO WHAT

Perpetrator Victim Act or Omission Intention Impact Common themes/sequence January 2013 49

Key Information When Reporting Adult Abuse in St Helens WHO

- is the alleged victim?

- is the alleged perpetrator?

WHAT

- is the allegation, i.e. what did alleged perpetrator do or fail to do to victim - is the relationship between the alleged victim and alleged perpetrator?

- type of alleged abuse is this, i.e. financial, sexual, physical, emotional/psychological, discrimination, neglect or institutional?

WHERE

- does the alleged victim live?

- does the alleged perpetrator live?

- did the alleged abuse occur?

WHEN

- did the alleged abuse occur - what date / time?

Remember - WHO, WHAT, WHERE, WHEN Telephone St.Helens Contact Centre - 01744 676600

(9.00am to 5.00pm - Monday to Friday)

or Emergency Duty Team (EDT) - 0845 0500 148

outside of the above hours January 2013 50

• • •

Make a Record

Any allegations or suspicions of abuse of a Vulnerable Adult must be recorded the same day/shift within the organisation’s/agency’s recording system that holds the Vulnerable Adult’s personal file/case file/contact records.

Opinions should not be recorded. If necessary, opinion will be taken as a witness statement later on in the investigation by persons qualified to do so.

The record must be signed and dated (in black ink, if possible) bearing in mind it may be required later as part of evidence in legal proceedings January 2013 51

Disclosure

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Group Exercise

• • • What barriers would you face in making a disclosure about abuse from the point of view of a: Vulnerable Adult Family Member Staff Member Assign someone to write and someone to give feedback January 2013 53

Safeguarding Investigations

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Investigation Actions

Actions to establish facts, as far as is reasonable and proportionate to the allegation of abuse, will be taken.

Initial Investigation Actions may include: • Taking legal advice • Gathering information to establish the basic facts It may not be necessary to pursue information further where the Protection Actions are in place and the Vulnerable Adult is satisfied with the outcome.

• • Formal Investigation Actions may apply in the case of serious allegations. This includes: • Criminal Procedures Disciplinary Procedures Serious Incidents Requiring Investigation e.g. NHS organisations (Trusts) January 2013 55

Investigation Actions

Care Management & the Adult Safeguarding Unit are responsible for Investigations

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Roles & Responsibilities

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The role and responsibilities of the worker

• • • • • • • • • Safeguarding individuals Recognise potential danger, harm & abuse Recognise actual danger, harm & abuse Understand the roles of others Report Sources of support Principles of Care Supporting service users Think Family January 2013 58

Group Exercise

Case Studies

January 2013 59

Safeguarding Adults Assessment

• Please complete the test individually • Once complete, please pass to the trainer • Your results and certificates will be sent direct to your line manager within 2 weeks January 2013 60