1. ‘Enabling people to live a life free from abuse and neglect ‘
Safeguarding Adults
Alerter level
‘Enabling people to live a life free from abuse and neglect ‘
with
Sarah Biddulph
Welcome group and introduce self
9.15 for a 9.30 start
For those arriving late they will be given the laminated ground rules card
The agreed cut off for arriving late and leaving early is 10% of the course
If people are 35 mins late or more they will not be able to stay / get a certificate if they leave early

2. Health and Safety Fire Smoking Toilets Breaks Phones Learning material
Certificates
Go through each item on list: 09.30
Handouts are not provided. They will be sent link by .
Certificates will be available to view and print at – they will remain there forever.

3. Learning Agreement Look after each other – this is a difficult subject
Listen but do not be afraid to respectfully challenge one another
Ensure examples from real cases are anonymised
If you disclose information about a person being at risk of significant harm, this information will have to be passed on to the appropriate agency
Please ask questions!!
They should participate but do not have to share personal experiences if don’t want to.
Ensure delegates are aware that if someone is at risk of harm you will have to act.
Add any other relevant rules

4. Outcomes By the end of this course you will:
Understand what safeguarding is and your role in safeguarding adults
Understand dignity and respect when working with individuals
Be able to recognise an adult potentially in need of safeguarding and take action
Have knowledge of policy, procedures and legislation that supports safeguarding adults activity.
Ask group to introduce themselves to each other and state one thing per group they want to know by the end
Go round group and write on flipchart to check back later

5. Best Practice – Preventing Abuse
In small groups list all the measures we take, procedures we use and guidance we follow that reduces the risk of individuals experiencing abuse and neglect
09.35
In small groups record on flip chart paper and prepare to feedback ideas to rest of group.

6. Prevention – Policies Procedures and Guidance
Implement Safeguarding Adults Multiagency policy and procedure
Understand Whistleblowing policy
Implement complaints procedure
Understand and apply Human Rights principles
Understand Mental Capacity Act and DoLS guidance
Person Centred Care Planning
Report accidents and incidents
Follow CQC Guidance
Use Financial Procedures/
Audits
Implement effective record keeping
Understand risk
assessments and follow
safe systems of work that
may include risk enablement
09.45
Compare chart to group lists
Ask groups to give examples, explain their answers with reasoning.
Complaints – encourage service users to know how to complain as a means of empowerment.
Safeguarding Adults Policy and Procedure – understand the role of the alerter and how this effects a member of staffs duty of care.
Whistleblowing Policies – Understand the expectation iin relation to escalating concerns when necessary – ref Terry Bryan Winterbourne View.
Human Rights Principles – complete activity and refer to post course question about chossing practice examples to identify this.
Person Centred Care Planning – reducing the risk of institutional abuse. Meeting assessed needs.
CQC Guidance – Identify Health and Social Care Act introducing CQC. Refer to Essential Standards of Quality and Safety. Make reference to outcomes 1,4,& 7
Financial Procedures – Reducing the risk of financial abuse.
Risk assessments – Duty to follow safe systems of work. Importance of monitoring and review. Encourage risk enablement where appropriate as a means of empowering individuals.
Recruitment – References, DBS check, Interview process, Probation period.
Dignity – Refer to SCIE 10 Dignity Points. Identify the activity in post course workbook asking for practice examples.
Maintain confidentiality/ share information appropriately – Security of records. Information sharing. The importance of multiagency information sharing when appropriate. Informing DBS when necessary.
Effective Record Keeping – accurate, legible, timely, factual etc. Ensure information is followed/implemented. Monitor quality. Security of information.
Accidents and Incidents – especially near miss events as a means of preventing harm, identifying the need for a risk assessment etc.
MCA & DLS – empowering people to maintain ownership of their decision making as much as possible.
Maintain confidentiality whilst
sharing
Information
appropriately
Follow guidance
on Dignity
Use robust recruitment procedures

7. Recent Law Health and Social Care Act 2008 Mental Capacity Act 2005
Essential Standards of Quality and Safety
A guide to help providers of Health and Social Care services to comply with the Health and Social Care Act 2008
Aims to ensure individuals aged 16 and over maintain ownership of their decisions. Wilful neglect or the wilful ill treatment of a person lacking capacity is a criminal offence
10.20
HSCA 2008
Registration system - applies to healthcare and adult social care
Established CQC to: Regulate the quality of health and adult social care and look after the interests of people detained under the Mental Health Act
In England if you deliver Regulated activities which are are listed in Schedule 1 of the Health and Social Care Act 2008
(Regulated Activities) Regulations 2012 you must register with CQC

8. Human Rights Act 1998
Post WWII agreement on the need for the State to protect the rights of vulnerable groups and not to interfere in people’s lives without reasonable justification
HRA defines role of the state (police, NHS, Social Services and so on) and organisations carrying out ‘functions of a public nature’ in promoting and protecting our rights
Some rights are absolute (even finance is not an excuse for violating the right) but others may be withdrawn or limited in order to protect the rights of others .
10.15
HRA only applies to government bodies (care homes are included in this).
1948 – 1953 – any cases had to go to international court
– any cases had to go to european court
1998 onwards – cases can be heard in uk court. All uk legislation should be compatible with human rights act. This is the underpinning principles of all government intervention.
1948 United Nations Universal Declaration of Human Rights; Adopted by European Council of Human Rights in 1953; Adopted into UK law in 1998 – Human Rights Act
How individuals and private organisations treat each other is defined by other legislation e.g. sexual offences act, fraud act, health and social care act, equality act.
Complete Human Rights Activity – considering scenarios in small groups and feeding back.

9. Human Rights
Right to respect for private and family life, home and correspondence
Right to marry and found a family
Right to peaceful enjoyment of your possessions
Right to education
Right not to be discriminated against in your enjoyment of your other human rights
Right to life
Freedom from slavery and forced Labour
Freedom of thought, conscience and religion
Freedom from torture, inhuman and degrading treatment
Freedom of assembly and association
Freedom of expression
Right to Liberty and Security
10.05
Work in small groups to compare scenarios with selected HR priciples
Delegates will be asked to explore these further in post course workbook
Right to life – denial of medical treatment based on prejudice, neglect
leading to death, Decisions about resuscitation status being made for
people without capacity
Freedom from slavery and forced Labour – people with a learning
disability not receiving an equal wage/not being paid
Freedom of thought, conscience and religion – people in a
residential home not being enabled to pursue their chosen religion
Freedom from torture, inhuman and degrading treatment – lack of
privacy and dignity, overuse of restraint or punishment, physical or
psychological abuse
Freedom of assembly and association – residents of care homes
having to receive visitors in communal areas or having visitors
restricted or denied, people with disabilities being excluded from public
places or participating in society (deliberately or unintentionally
Freedom of expression – people not being listened to or enabled to
participate in decision making
Right to liberty and security – people in care homes being deprived
of their liberty without an assessment, people with a disability being
attacked in the street or being the victim of anti-social behaviour
Right to respect for private and family life, home and correspondence:
people who live in care homes having their post opened; staff not
knocking before entering rooms; information being shared between
professionals that is irrelevant, out of date, inaccurate, not based on
fact; gossip; CCTV; notes not being kept securely; access to visitors being
refused/restricted
Right to peaceful enjoyment of your possessions – people having their
money ‘pooled’ or choice relating to this taken away from them; people
having pressure put on them to change their will; people being tricked
into signing their property over to son/daughter; not having anywhere to
lock things away securely; having things stolen/hidden
Right to marry and found a family – people being prevented by staff
from having a relationship; no access to sex education; people being
‘kept apart’; people having their children taken from them
Right to education – people having to go to ‘special schools’; people not having the support they need to access education
Right not to be discriminated against in your enjoyment of your other human rights

10. Dignity Zero tolerance of all forms of abuse
Offer same respect you would want for you and your family
Treat each person as an individual
Enable people to maintain independence choice and control
Listen to and support people to express their needs and wants.
Respect the right to privacy
Ensure people feel able to complain without fear.
Engage with family members and carers
Assist people to maintain confidence and a positive self esteem.
Act to alleviate loneliness and isolation
(SCIE Dignity in Care Guide)
10.25
SCIE has developed a Dignity in Care Guide which explores this further.
The guide sets out 10 key expectations.
Delegates will be asked to focus on a number of these in the post course workbook.

11. Safeguarding Guidance
No Secrets (DoH 2000) What is Abuse? What is a Vulnerable Adult?
10.30
No secrets, 2000, published by DoH gives us definitions of abuse and neglect.
Discuss the definitions. These determine whether the safeguarding process is deemed the most appropriate method of resolving a situation and whether the safeguarding team become formally involved
Not every concern that is raised leads to a safeguarding investigation. Your concern may be relating to poor practice and your manager will deal with the situation in the most appropriate way

12. “Abuse is…..
….. a violation of an individual’s human and civil rights by any other person or persons. …. It can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it It may consist of a single act or repeated acts.
It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent.
(No Secrets, DoH, 2000)
10.45
Significant harm – “not only ill treatment (including sexual abuse and forms of ill treatment which are not physical), but also the impairment of, or an avoidable deterioration in, physical or mental health; and the impairment of physical, intellectual, emotional, social or behavioural development” (Lord Chancellor’s department, 1997).
The following factors will be taken into consideration when assessing whether harm is significant: “the vulnerability of the individual; the nature and extent of the abuse; the length of time it has been occurring; the impact on the individual; and the risk of repeated or increasingly serious acts involving this or other vulnerable adults.” (No Secrets)
Emphasise that only significant harm will be dealt with by Multiagency safeguarding processes and other less formal services may be offered/suggested if not seen as this e.g. carer assessment, care needs assessment, referral to victim support/person contacts police themselves.
Although the safeguarding team will only deal with cases where there is significant harm, alerters should be encouraged to report all instances of abuse or poor practice to their line manager. The team will give advice about other sources of support/assessment in cases of harm which is not significant.

13. Who needs safeguarding?
“A vulnerable adult is any person aged 18 years or over who is or may be in need of community care services by reason of mental or other disability, age or illness;
And
...who is or may be unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation”
No Secrets (DoH, 2000)
10.55
Anyone who does not meet this criteria will not come under safeguarding (this also means people who are able to protect themselves with their current support) – but they will be signposted.
This definition is likely to change to ‘adult at risk of harm’ so don’t get too hung up about it. Do not have to be in receipt of services, can be self funding, can be below FACS criteria. Community care services includes things like ring and ride.
Traditionally they’ve had difficulty accessing the criminal justice system. This may be because of communication difficulties, capacity, physical access, not being believed/credible/reliable, adversarial nature of courts, may not be aware being abused.
Their lives are complex and they need the input of many agencies to create a suitable response.

14. When it has gone wrong…………
13.30
They all died because of abuse or neglect and their deaths may have been prevented. These cases are the tip of the iceberg but abuse and neglect does happen in Devon – we hope to intervene in time to prevent significant harm/death
Give out ‘case notes’ to read and ask group to explain what happened or summarise the cases.
Francecca hardwick & fiona pilkington =
Peter giles =
Emma kemp =
Ask if they know any stats….
Research suggests 4% of adults are abused in any 12 month period and that only about 10% of them reach safeguarding (comic relief, AEA).
Research suggests that disability related harrassment affects % of disabled people in a 12 month period (scope, mind, mencap, ehrc)
Research suggests that if not acted on when problems are small, they escalate in either intensity or severity.
3 SCRs have just been published in devon – all related to deaths in care but have implications for staff at all levels. Look on SA webpages for more information.
Positive case of safeguarding:
N devon care home – minibus driver found guilty of several sexual assaults on v. disabled women – volunteer carer raised alert. He was jailed for 12 years. They gave evidence by blinking, nodding heads and so on. They were probably chosen for their lack of communication/capacity but excellent multi-agency work (Police, DCC, DPT, NHS and the care home) supported them throughout the investigation/trial.
Statement:
Adult and Community Services has the lead role for co-ordinating a response to suspicions of abuse
or neglect but other agencies have a responsibility to actively work together to enable people to live a
life free from abuse. Safeguarding is everyone’s responsibility.
Gemma Hayter
Hayter, who had a rare congenital disorder that caused a significant learning disability, was found dead on a disused railway embankment in August A trial in September heard she had been forced to drink urine from a beer can, beaten with a mop and stripped before being left for dead. Two men and a woman were jailed for life for her murder, with two others sentenced for manslaughter. Hayter had considered all five to be her friends.
The independent chair of the case review, Kathy McAteer, said in conclusion that better support for Hayter could have made her "less likely to fall into the company of people who presented her with serious risks". None of the agencies involved with her case knew the details of her relationship with the five killers.
There had been clear evidence that Hayter was susceptible to abuse, as it was known she had suffered "mate crime" regularly over some time, McAteer added, although none of this was carried out previously by the five.
She said: "No single agency had a full picture of what was happening in Gemma's life: there were a number of missed opportunities for initiating safeguarding procedures, assessments or other interventions and for agencies to share information.

15. How to spot things Categories of Abuse Examples and Indicators
Physical
Financial
Sexual
Psychological
Discriminatory
Institutional
Neglect
Example: slapping Indicator: red mark, learnt behaviour, fear of others etc. Example: theft of money Indicator: lack of funds leading to unkempt appearance, weight loss etc.
11.15
Discuss the 7 categories as stated in No Secrets 2000
Explain that part of the alerters role is to be able to recognise the different categories of abuse and what the common examples might be. Support the group with explanations and examples relating to each category. Identify that in order to be able to recognise that something may be wrong we need to understand that a number of indicators may be evident.

16. Time for a break
mins

17. DVD
11.25
Watch DVD.
Divide into small groups & give out worksheets – for each character discuss what you observed and attempt to explain some of the possible reasons for these circumstances. Create an overall list of possible indicators.
Man using crutches – name calling, teasing, bullying, picking on. often described as anti- social behaviour – should be reported as harrassment, hate incident/hate crime. as a one off this may not be serious but if we don’t report things like this we don’t realise whether or not this is happening all the time. police can increase patrols, respond to individual incidents, talk to schools.
Difficult to report – he may be used to it and not realise anyone will do anything about it.
Woman in park – afraid? - she can report anonymously later, by phone even. Even if she doesn’t know victim’s name. (3rd party reporting).
Man looking after wife – no abuse took place btu he is very stressed and could snap at any point. He may find difficult to report as has to admit failure to care, afraid she will go into home, may not realise, know who to contaft.
Man staying with brother – bad language, poss physical abuse (kick stool), financial abuse, putting down in supermarket. Diff to report – may not realise, worried about brother. Unlikely action would be taken against brother unless simon wanted this. they would discuss with him first. Police can prosecute in public interest but harder for them so only do it in extreme cases eg. Domestic abuse, violent crime.
Older woman in care home – no choice about TV, bed time, bath time, took call bell away, made her jump - shouting, blaming her. Diff to report – access, knowldege of process, dependence on care staff, fear of repercussions. Action would depend on previous performance. Does she need retraining or is she unsuitable for care?
Serena – touched her breast. Very quick – do your eyes believe what they see? Diff to report – access, dependence, culture?

18. Domestic Violence and Abuse
Definition
Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse: psychological, physical, sexual, financial
2 brothers could be regarded as Domestic Violence when you look at the definition
Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.
This definition includes'honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.

19. Domestic Violence and Abuse
If we have a concern about a domestic violence situation please report to your line manager or Contact Care Direct in the same way we would raise any safeguarding concern. Referrals can also be made via Devon’s Domestic Violence Support Service:
Statistics suggest that 1 in 4 women and 1 in 6 men will experience some kind of domestic abuse at some point in their lives. For women if that female is a vulnerable adult prior to the domestic violence situation, the statistic increases to 1 in 2
Perpetrators can be very manipulative and victims very afraid to report due to fear.
Local support such as women’s aid (person’s consent needed for referral) and MARAC for high risk cases (no consent needed). Risk level is ascertained by completing the CAADA DASH Risk identification checklist but essentially if the person is  a VA, the SA team could make the DV referral if required.
New single number in Devon aiming to make it as simple as possible for victims to seek help.
For more information go to

20. The Risk Factors (Person)
Mental health or personality problems
Lack of mental capacity
Cramped living conditions
Social isolation (even if not living alone)
Relationship difficulties
No money or lots of money
Substance misuse
Dependence on others
Looking different
Others being dependent
(e.g. for finance or accommodation)
Living in a deprived area
15.20
Group task divide into 2 groups looking either at risk factors for the person or the service – try to beat my list!!
Discuss selected risk factors and highlight that many factors can make the individual more likely to become a target.
Poor communication skills
Having been abused before
Lack of services
Lacking confidence or self
esteem

21. Risk factors (service)
Poor/lack/change of management
Rigid routines
Poor staffing ratios
High staff turnover
Poor supervision or lack of supervision
Limited training
Isolated/insular services
Poor staff attitudes
Perceived low status of work
Highly dependent service users or those with aggressive or challenging behaviour where this is not the norm for the service
Reducing risks:Difficult to influence as an individual worker….
Incident/accident forms
Supervision
Staff meetings
Complaints forms – encourage users of service and carers to complain
CQC – keen to receive information and will act immediately if risk dictates, otherwise issues will be picked up at next review
Consider using Care Direct/Police
Poor pay
Lack of resources
Staff burnout
Low moral

22. What to do if things go wrong……
We all have a responsibility – to do nothing is NOT an option
12.00
Continue through slides

23. Concerns
If you are worried about someone and have no evidence to suggest they are being abused, it is good practice to:
Show concern for their welfare by asking how they are, how they got their bruise, etc.
Continue to monitor the situation,
recording any concerns or changes in
mood or behaviour
Discuss the situation with your line manager
15.35
Put up slide and ask them what is good practice.
Prompts recognise, respond, record, report.
Reveal answers.
If you are concerned about someone try to use commands or open questions. Closed questions should be avoided as they lead you to being leading
CLOSED QUESTIONS
Did john hit you? Did you get that bruise when you fell over?
Did?; Do?; Was?; Were?; Have?; Is?; Are?; Could?; Would?; Should?
COMMANDS
Tell me how you got your bruise. Explain how you got your bruise.
Tell me; Explain; Describe
OPEN QUESTIONS
What happened? How did you get your bruise?
What?; Where?; When?; Who?; How?; Not why? WHY NOT?
Continue through slides

24. Recognise, Respond, Record, Report
Disclosure
If a person discloses abuse to you:
Listen carefully – don’t ask questions
Ensure you and the person are safe
Remain calm and reassure person
Keep clear records – use the person’s own words where possible.
Tell your line manager
Recognise, Respond, Record, Report
Put up slide and ask them what is good practice. Prompts recognise, respond, record, report.
Reveal answers.
Remember the person may tell you without asking
Written Records
Who. when, where
Clear
Factual
Clients own words
Avoid opinions
Keep original notes
Continue through slides

25. Disclosure
Remember:
You are not being asked to prove that the information is true
Do not ask any further questions
Tell the person you are taking it seriously, you cannot keep it secret and they will be offered support to keep themselves safe
You must not contact the alleged perpetrator – however unlikely the account seems
You must tell your manager
Once someone has told you something – try to avoid asking any more questions. You don’t have to prove that it’s true. The police/social worker will take a statement from the person. They can choose a male or female officer. They can have someone to support them if they want. The interview may be video recorded.

26. Sharing information
If you identify a person is at risk of harm, you have a duty to report this to your line manager. You do not need the person’s consent to do this. Your manager will normally ask for the person’s consent before sharing information outside your organisation.
The government have produced guidance (Information Sharing a Pocket Guide)

27. Sharing information
Your manager should seek consent to share information unless doing so would:
Place a child at increased risk of significant harm
Place an adult at increased risk of serious harm
Prejudice the prevention, detection or prosecution of a serious crime
Lead to an unjustified delay in making enquiries about significant harm or serious harm

28. Escalating concerns
If your manager does not respond appropriately, you should escalate your concerns within your own agency or, if that fails, you may need to report outside. This may include contacting the regulator, Ofsted, the Care Quality Commission etc.
The Public Interest Disclosure Act (1999) provides legal protection from dismissal and harassment for whistle-blowers. Read your organisation’s whistle-blowing policy.
16.10
First port of call should be manager, then area manager, then CQC. Shouldn’t go to press unless have tried everything. Confidentiality of service user should not be broken unless necessary. Escalate if no response.
Approaching media only if no other response.
Eg nurse who filmed hospital – struck off because she didn’t follow this procedure.
Public Concern At Work – charity which is also able to offer advice
2 care workers in Plymouth home – awarded £40,000 for unfair dismissal
SCIE have produced guidance about whistleblowing

29. What happens next?
Information from others involved with the person will be gathered, as appropriate
A decision will be made about urgency & how to keep the person safe in the short term
A decision will be made about who is best placed to investigate the concern and/or support the person
The person will be supported to decide (in almost all cases) what they want to happen
16.20

30. Case examples: What should you do? What should happen next?
Extension activity if time
In groups hand out the 15 scenarios to each group and ask them to say
what they would do
what they would expect to happen next
You may want to choose 5 or 6 for each session rather than do all of them.

31. In an emergency dial 999 Contact Details Vulnerable Adults
Domestic Abuse
SPLITZ Support Service –
Children & private fostering
12.25
Evaluations and close
In an emergency dial 999