1. Statement

 

The Royal Star & Garter Homes believe residents have the right to live their lives with privacy, dignity, independence and choice, and to be free from all forms of abuse.  The Charity has a moral and legal responsibility to safeguard vulnerable adults through all our activities.

 

The Homes will work in collaboration with all legal, regulatory and caring agencies to uphold this right and to ensure residents are protected from harm (such as abuse or exploitation) at all times. Safeguarding is everyone’s responsibility.

 

Visiting Children

 

The Homes hosts regular visits by visiting school children between the ages of 5 – 17 years who perform in a group as a choir or in plays.  Organised visits by schools are done so with a teacher present at all times who is responsible for the wellbeing of the children as loco parentis.

 

Resident’s families are welcome and encouraged to visit, and young children are to be accompanied at all times in the Homes and are the responsibility of their parent or guardian.

 

2. Aim

 

This policy is based on The Six Principles of Safeguarding that underpin adult safeguarding and the homes procedure to be followed if abuse is suspected.

 

Empowerment – People being supported and encouraged to make their own decisions and informed consent. “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”

 

Prevention – It is better to take action before harm occurs. “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

 

Proportionality – The least intrusive response appropriate to the risk presented. “I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.”

 

Protection – Support and representation for those in greatest need. “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.”

 

Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. “I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.”

 

Accountability – Accountability and transparency in delivering safeguarding.

“I understand the role of everyone involved in my life and so do they.”

In addition to these principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised.

 

The response to safeguarding concerns must be personal to the individual.

 

3. Definitions and Information about Abuse (refer to Appendix 1)

 

People who may need safeguarding are defined under section 42 of the Care Act 2014 as adults who:

– have care and support needs;

– are experiencing, or are at risk of abuse or neglect; and

– because of their care and support needs cannot protect themselves against actual or potential abuse or neglect.

 

The Care Act (2014) sets out a clear legal framework for how local authorities and providers of adult social care should protect adults at risk of abuse or neglect.

 

The Care Act and Guidance states that safeguarding:

 

• Is ‘Person Led’
• Engages the person from the start throughout and at the end to address their needs.
• Is based upon community approach from all partners and providers

 

Local authorities:

• lead a multi-agency local adult safeguarding system that seeks to prevent abuse and neglect and stop it quickly when it happens;
• make enquiries, or request others to make them, when they think an adult with care and support needs may be at risk of abuse or neglect and they need to find out what action may be needed;
• establish Safeguarding Adults Boards, including the local authority, NHS and police, which will develop, share and implement a joint safeguarding strategy;
• carry out Safeguarding Adults Reviews when someone with care and support needs dies as a result of neglect or abuse and there is a concern that the local authority or its partners could have done more to protect them;
• Arrange for an independent advocate to represent and support a person who is the subject of a safeguarding enquiry or review, if required.

 

An adult at risk refers to a person who:

 

• Is an older adult and frail due to ill health, physical disability or cognitive impairment
• Has a learning disability
• Has a physical disability and/or sensory impairment
• Has mental health needs including dementia or a personality disorder
• Has a long-term illness/condition
• Misuses substances or alcohol
• Is a carer such as a family member/friend who provides personal assistance and care to adults and is subject to abuse
• Is unable to demonstrate the capacity to make a decision and is in need of care and support.

 

It is everybody’s right to live in a safe environment free from being threatened, intimidated or abused.  The feeling of being unsafe can occur in different ways and in different circumstances.  Most people would consider abuse as being either physical or sexual in nature, but it can also be financial or psychological, happen as a result of neglect or discrimination; it may be deliberate but it may also happen as a result of poor care practice, a lack of knowledge in how to support someone, or ignorance.  An adult at risk may be subject to abuse when they are neglected, persuaded to agree to something against their will, or be taken advantage of because they do not fully understand the consequences of their choices or actions.  It can be a single act or repeated over time.  Abuse can occur in any relationship, most frequently by people who the adult at risk knows.

 

Abuse can occur anywhere and at any time, and the nature of care ‘behind closed doors’ can lead to difficulties in detecting abuse.  Abuse can occur in any relationship.  In a care home the nursing/care staff are held in a position of trust. There is a ‘potential’ imbalance in the relationship between a member of staff and a resident in a care home.

 

The recognised types of abuse are:

 

• Physical
• Psychological
• Financial
• Sexual
• Neglect & acts of omission
• Institutional
• Discriminatory
• Excessive or unlawful restraint

 

Adults at risk are sometimes abused by strangers but more often they are abused by someone that is well known to them.  A relative, partner, child, friend, neighbour, paid or voluntary worker or health and social care workers can be in a position to abuse a vulnerable person.

 

At The Royal Star & Garter Homes it is vital that all staff are aware of and know how to recognise signs of abuse and what action to take if they witness or suspect abuse may be taking place. It is the responsibility of any member of staff that suspects abuse to take action.  This involves reporting any concerns immediately to their line manager or an appropriate senior member of staff.  The Royal Star & Garter Homes has a clear policy on Whistle Blowing which can be found in the Employment Manual on StarNet.

 

The seriousness of abuse varies and can range from behaviour that is violent and criminal to passive abuse which is neglectful, unintentional and less deliberately exploitative in character.  Some instances of abuse will constitute a criminal offence, e.g. financial, physical, and sexual.

 

When complaints about alleged abuse suggest a criminal offence may have been committed, it is imperative contact should be made with the Police as a matter of urgency.  In such circumstances, evidence of abuse must be protected. The Police will take the lead in carrying out an investigation.  Criminal investigation by the Police takes priority over all other lines of enquiry.

  

4. What to do if Abuse is suspected

 

4.1       Internal Reporting

 

• Report immediately to the Home/Deputy Manager or Dementia Nurse Manager or Lead Nurse on duty where the resident resides.
• The Director on call must be informed by the senior nurse on duty at the time.

 

4.2       External Reporting

 

Solihull Home

As soon as possible following initial internal reporting of suspected abuse, the Home Manager or the senior nurse on duty must telephone Solihull Safeguarding Team on 0121 704 8007.  A duty officer will ask for details of the situation and may decide/recommend further actions for either the Home to take or which they will take.

 

• If the resident is funded by a local authority other than Solihull the resident’s social worker at that local authority must be informed.

 

• The Care Quality Commission must be notified as soon as possible during office hours by the Home Manager or by the Home Administrator:

 

CQC National CS Centre              Tel:   03000 616 161

Citygate                                              Fax:  03000 616 171

Gallowgate                                        Email: enquiries@cqc.org.uk

Newcastle upon Tyne

NE1 4PA

 

• The local Police must be contacted as soon as possible if criminal (e.g. financial, physical or sexual) abuse is suspected or has occurred
• In an emergency 999 or if it is a crime but not an emergency 101

 

Surbiton Home

At the Surbiton Home the Home Manager or the senior nurse on duty at the time must refer to and follow the Kingston-upon-Thames Local Safeguarding Adults Protocol.  A copy of this is located in the nurse’s station on each floor and on StarNet under Nursing & Care / Clinical Guidelines (latest edition is 2013). It can also be found at

http://www.kingston.gov.uk/downloads/file/37/kingston_council_safeguarding_adults_%E2%80%93_local_protocol_2011

 

Contact Kingston Adult Safeguarding and Mental Capacity Act Team:

 

Adult Safeguarding Team        Tel: 020 8547 4735

Guildhall                                              Fax: 020 8547 6142
High Street                                          Email: adult.safeguarding@rbk.kingston.gov.uk
Kingston upon Thames
KT1 1EU

Out of Hours after 5pm Monday to Friday and weekends

Tel: 0208 770 5000.

 

If criminal abuse is involved, contact the Police on 101 or in an emergency 999.

 

Surbiton Police Station            Tel: 020 8541 1212

299 Ewell Road                                  cms.met.police.uk
Surbiton
KT6 7AB

 

• If the resident is funded by a local authority the resident’s social worker at that local authority must be informed.

 

• The Care Quality Commission must be notified as soon as possible during office hours by the General Manager or the senior nurse on duty:

 

CQC National CS Centre              Tel:   03000 616 161

Citygate                                              Fax:  03000 616 171

Gallowgate                                        Email: enquiries@cqc.org.uk

Newcastle upon Tyne

NE1 4PA

 

All incidents should be reported immediately, no matter who the alleged perpetrator is or who the victim is.  Staff who report suspected abuse would be fully supported by the Home and protected under the Public Disclosure Act (Whistle Blower policy).  The Charity will not tolerate harassment of staff by other people to ‘keep quiet’.  In situations where the suspected victim asks a member of staff not to tell anyone, the staff member will advise the resident that they cannot keep that confidentiality.

 

5. Action to be taken in an Emergency Situation

 

If the situation is an emergency (i.e. where a resident is being or has been physically or sexually abused), ensure the individual is safe and call 999 and ask for the police if immediate help is needed.  Staff should call for assistance immediately and, if safe, intervene to protect the resident from further harm.  First aid should be given as required.

 

The incident must be recorded promptly in the resident’s notes on Caresys and an incident form completed.

 

6. Action to be taken by the Person in Charge on a report or discovery of Abuse

 

All reports of abuse should be immediately acted upon by the person in charge.  Staff should use tact and sensitivity in talking to the victim.

 

If a staff member is the alleged perpetrator they must be suspended from work with immediate effect whilst an investigation takes place.  Suspension in this situation does not indicate that the individual has committed an offence.  During their absence they will be offered support and will receive regular update communications from a support person in HR.  They are advised to seek advice and guidance from their union representative.

 

If any other person(s) (e.g. relative, visitor or volunteer) is the alleged perpetrator, they must be asked to leave the victim’s vicinity and escorted to an area where the Dementia Nurse Manager or Lead Nurse or Home Manager can talk to them regarding the incident.  Appropriate action should be taken (as in 4 above) depending on the nature of the abuse.

 

If an incident is discovered outside of office hours, it is the responsibility of the senior nurse on duty to take the appropriate action.  The Senior Nurse on duty has authority to immediately suspend a member of staff and must ensure they await instruction from the HR Department before returning to the premises.

 

Careful and sensitive management of the resident at this time is essential and they should be supported and reassured as required.

 

In consultation with external agencies it may be appropriate to arrange for an independent external advocate such as provided by Age UK on 0800 169 6565

 

6.1       Investigations

 

Social Services have the primary responsibility to undertake an external investigation of alleged abuse and will arrange this using the ‘Safeguarding Adults Protocol’ in consultation with other agencies.  They will inform the Home of what is required and whether we are permitted to undertake an internal investigation.  If the Home is requested to undertake internal investigations, a senior and neutral individual will be nominated by the Home Manager or Director of Care to undertake a comprehensive internal investigation.  Advice and input from HR will support this process.

 

Investigations may involve interviewing and taking detailed written statements from all those involved, any witnesses, the alleged perpetrator and the resident, with their consent.  The investigation should be conducted as swiftly and thoroughly as possible, contacting the relevant people, or their representatives, if they have been involved in the alleged incident.   A suspended member of staff should be managed in accordance with the HR investigatory procedures to determine if disciplinary action is required.

 

All persons involved should co-operate fully with any internal, Police or social services investigations and the Home Managers will ensure the following information is available:

 

• Personal details of the resident involved
• The referrer’s details
• The details of the allegation
• Details of the alleged abuser(s)
• Details of specific incidents or events, including dates, places, injuries, witnesses etc.
• Whether or not consent has been given to take the matter further (where appropriate).

 

7. Documentation

 

All facts, incidents, assessments and discussions related to the incident/s should be recorded clearly and accurately; personal opinion and conjecture must be avoided.  All information pertinent to the suspicions should be written in an official file and be kept locked, in accordance with the requirements of the Data Protection Act 1998.  Statements should be typed and signed wherever possible.

 

Deprivation of Liberty

 

The Deprivation of Liberty Safeguards (‘DoLS’) were introduced in 2009 and apply if a person may be deprived of their liberty as a consequence of their accommodation and care arrangements, and lacks capacity to give their consent.

 

In March 2014 the Supreme Court (P v Cheshire West and Chester Council, March 2014) clarified that a deprivation of liberty occurs whenever a person is under the continuous supervision and control of others and is not free to leave. This definition applies equally in all settings and to all people regardless of their disability or other impairment. If the person who may be being deprived of their liberty is in a registered care home or a hospital it is the responsibility of the manager of the care home or hospital to make the relevant application to the relevant local authority following the local DoLS process. The relevant local authority is the local authority funding the person who may be being deprived of their liberty, regardless of where the person is living; If a Clinical Commissioning Group (‘CCG’) are funding the person who may be being deprived of their liberty e.g. Continuing Healthcare, then the application must be made to the local authority in which the funding CCG is based, regardless of where the person is living; or If the person who may be being deprived of their liberty is funding their own care, the application must be made to the local authority of the area in which the person is living.

 

Use of Restraint

 

The use of restraint is sometimes necessary and when used must always be appropriate, reasonable, proportionate and justifiable to that individual.  Staff must use de-escalation or restraint in a way that respects dignity and protects human rights, and where possible respects the preferences of residents (refer to Restraint Policy).

 

8. Disclosure and Barring Service

The Disclosure and Barring Service (DBS) helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups, including children. It replaces the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA).

 

When any member of staff who is being investigated for an allegation of abuse and the preliminary investigation suggests there is credible evidence to substantiate the allegation, the Disclosure and Barring Service and Care Quality Commission must be informed immediately.  If a person is dismissed due to a substantiated allegation of abuse the Disclosure and Barring Service must be informed and they will review the evidence presented and make a decision regarding the individual’s fitness to continue to work with adults at risk.  If the Service decides that the person is unfit, they will be unable to work with adults at risk.  This notification is undertaken by the Home Manager or Director of Care and Service Development or the Director of HR.  This will also apply in the case where a member of staff resigns pending disciplinary action but the evidence collected indicates that dismissal would have been the likely outcome.

 

9. Training and Support

 

Training, education and support relevant and appropriate for staff, volunteers and Governors regarding the protection of adults at risk, abuse and challenging behaviour is provided in accordance with appropriate policies and procedures which include:

 

• Staff supervision and appraisal
• Person Centred Planning
• Risk assessments
• Mandatory training for all staff
• Updates and training opportunities for volunteers
• Accurate record keeping and confidentiality policies
• The Whistle blowing policy

 

Safeguarding issues such as ‘Abuse Awareness’ must be raised on a regular basis as part of each departmental team monthly meetings.  This may include a discussion, a particular article or case that is current in the media, through the distribution of leaflets, or by making reference to the Charity’s policy and ensuring all staff are aware of their responsibilities and how to respond to and report suspected cases of abuse.

 

Protection of Vulnerable Adults at Risk training is compulsory at induction and thereafter annually for all staff and volunteers.  No individual or groups are exempt from attending training in recognising and preventing abuse.

 

10. Recruitment

 

The Homes operate rigorous recruitment practices through the use of Assessment Centres.  Every member of staff, and volunteers, are required to complete and submit a Disclosure and Barring Service (DBS) form which allows the Charity to run a check on any criminal activity of the individual.  As a care provider, we have the statutory duty to check that all workers have a satisfactory enhanced DBS clearance prior to employment and will be re-checked for a satisfactory clearance periodically throughout their employment.  Until these checks are completed a potential applicant cannot commence employment, or an opportunity to volunteer.

 

During the recruitment process any gaps in the employment history and the reason for leaving the last or current employment must be explained or employment cannot be offered.  All new staff are required to have at least two written reference checks from previous employers covering between 3-5 years, one of which will be followed up verbally.

 

11. References & Resources

 

Age UK: http://www.ageuk.org.uk/documents/en-gb/for-professionals/health-and-wellbeing/ppp_safeguarding_great_britain.pdf?dtrk=true  (Accessed 16 November 2018)

 

Care Quality Commission (QCC): http://www.cqc.org.uk/content/regulation-13-safeguarding-service-users-abuse-and-improper-treatment  (Accessed 16 November 2018)

 

Care Quality Commission (CQC): http://www.cqc.org.uk/sites/default/files/20140416_safeguarding_adults_-_roles_and_responsibilities_-_revised_draf….pdf (Accessed 16 November 2018)

 

Health & Social Care Act (2008) Regulations 2014: http://www.legislation.gov.uk/ukdsi/2014/9780111117613/regulation/13  (Accessed 16 November 2018)

 

Mental Capacity Act (2005): http://www.legislation.gov.uk/ukpga/2005/9/contents (Accessed 16 November 2018)

 

Social Care Institute of Excellence (SCIE): http://www.scie.org.uk/adults/safeguarding/policies/ (Accessed 16 November 2018)

 

The Care Act (2014): http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted/data.htm (Accessed 16 November 2018)

 

The Royal Borough of Kingston upon Thames (2013) Kingston Council safeguarding adults – Local Protocol. Available at: http://www.kingston.gov.uk/downloads/download/26/kingston_council_safeguarding_adults_%E2%80%93_local_protocol (Accessed 16 November 2018)

 

AUTHOR AND REVIEW DETAILS

 

Author: Pauline Shaw, Director of Care & Service Development

Date: March 2017

Review Date: March 2018

Published: 16 November 2018

Attachments: Appendix 1 – How to recognise signs of abuse; Appendix 2 – Identification and referral of concerns

The following are possible clues that abuse may be occurring. This is not an exhaustive list and other indicators may also raise suspicion.

 

Physical Abuse

Possible signs of physical abuse may include:

• Unexplained bruises or cuts, especially where they reflect the shape of any object, a hand, or finger marks
• Loss of hair in clumps, or abrasions on the scalp from pulling
• Unexplained fractures
• Unexplained burns or scalding
• Delays in reporting injuries
• Vague, implausible, or inappropriate explanations
• Multiple injuries or a history of past injuries such as falls

 

Neglect

Possible signs of neglect may include:

• Debilitation or weakness through malnutrition or dehydration
• Unexplained weight loss
• Poor hygiene, including unkempt appearance, untidy/dirty surroundings
• Inappropriate dress
• Pressure ulcers
• Poor skin condition and poor resistance to infection and disease

 

Emotional Abuse

Possible signs of emotional abuse may include:

• Fearfulness and low self esteem
• Mood changes including depression, irritability, and unhappiness
• Changes in sleep and appetite patterns
• Withdrawn, self-isolating behaviour

 

Financial Abuse

Possible signs of financial abuse may include:

• Unexplained loss of money or inability to pay bills
• Sudden withdrawal of money
• Sudden disappearance of favourite or valuable possessions
• Loss of financial documents such as pension books, bank books

 

Sexual Abuse

Possible signs of sexual abuse may include:

• Unexplained difficulty walking
• Bleeding or bruised genitals
• Reluctance to be alone with a particular person
• Sudden behaviour change.

 

Indicators of other forms of abuse may be more difficult to identify, however, all staff should be aware of the following:

 

Psychological or Mental Abuse

This can take the form of verbal insults, shouting, swearing, blaming, ignoring, bullying, or humiliation.  It can also include the spreading of rumours or malicious gossip.  All residents should be able to live their lives with privacy, dignity, independence and choice, and all information about them should remain confidential.  The breaking of such a duty of confidence by the spreading of stories may constitute psychological abuse.

 

Other

Abuse can also occur in organisations that have strict rules and routines, resulting in generally abusive regimes.  Such regimes are characterised by a lack of concern for service users, a lack of choice, lack of privacy, lack of respect, public discussion of matters private to service users, unjustified use of restraints and unrestricted staff access to residents’ rooms without due cause.

Identification of abuse

 

It is often staff members, the police or other involved individuals such as unpaid carers, who having most contact with service users or patients, are most likely to become aware of abusive situations.  They may become aware of the possibility of suspected abuse in several ways:

 

• Specific occurrences of physical injury
• Observation of a person’s behaviour, or of changes in that behaviour, over a period of time
• Disclosure by the person or by a third party
• Separate referral from a third party of their suspicions or allegations.

 

Responses to the vulnerable adult:

• Remain calm and try not to show any shock or disbelief
• Listen very carefully to what you are being told.
• Demonstrate a sympathetic approach by acknowledging regret and concern that this has happened to the person.
• Reassure the person, telling them they have done the right thing by sharing the information, that this information be treated seriously and that the abuse is not their fault.
• Be aware of the possibility of forensic evidence if the disclosure refers to a recent incident.
• Explain that you are required to share the information with your line manager, but not with other staff or service users.
• Reassure the person that any further investigation will be conducted sensitively, and with their full involvement wherever possible.
• Reassure the person that the service will take steps to support and, where appropriate, protect them in the future.
• Report the information to your line manager at the earliest opportunity.
• Make a written record of what the person has told you.
• Do not stop someone who is freely recalling significant events but allow them to share whatever is important to them.
• Do not ask questions or press the person for more details. As this may be done during any subsequent investigation, it is important to avoid unnecessary stress and repetition for the person concerned.
• Do not promise to keep secrets.
• Do not make promises you are unable to keep.
• Do not contact the alleged abuser or alleged victim [depending on who is sharing the information with you at the time].
• Do not be judgmental.

 

Do not break the confidentiality agreed between the person disclosing the information, yourself and your line manager.  Therefore do not talk to other staff members or residents about the information shared with you.