1. Updated November 20131 St Helens Multi-Agency Adult Safeguarding Procedures January 2013 edition Refresher Training

2. Updated November 20132 Programme for Today Introductions Key definitions Types and Indicators of Abuse What makes abuse more likely to occur? Tea Break How to make an alert Key Reporting information Roles and responsibilities

3. Updated November 20133 Learning Objectives By the end of the day participants will be able to: 1.understand key definitions 2.describe the different types and indicators of abuse 3.describe what makes abuse more likely to occur 4.explain how to make a Safeguarding Alert in St Helens 5. understand key information to be included when reporting abuse

4. Updated November 20134 1. Key Definitions

5. Updated November 20135 Multi Agency Adult Safeguarding in St Helens Partners agencies include Council, NHS, Police, Voluntary Sector Partners believe that; Everybody has the right to live in a safe and secure environment without fear of abuse, harassment or injury. 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.

6. Updated November 20136 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” A “Vulnerable Adult” is “An Adult who is in receipt of, or may be eligible for community care services” “No Secrets” (DoH 2000)

7. Updated November 20137 Vulnerable Adults include; 18 – 64 years Physical illness / disability Learning disability / mental illness 65 years plus as above and Frailty / Dementia

8. Updated November 20138 Social Care needs are typically met by Services such as; - Domiciliary Care - Day Care - Careline - Occupational Therapy – aids and adaptations - Supported living/ sheltered accommodation schemes - Residential Care - Residential with Nursing care - Or other arrangements such as Direct Payments / Personal Care Assistants

9. Updated November 20139 BUT Vulnerable Adults are: - more likely to experience abuse - less likely to be able to recognise and resolve abuse without specialist support Specialist support is provided via the Adult Safeguarding Procedures All Adults: - may experience abuse eg, Theft Harrassment from neighbours, Domestic violence Mainstream support is available eg, Police Community support Domestic violence services Victim

10. Updated November 201310 2. Types and Indicators of Abuse

11. Updated November 201311 Types of Abuse Physical Financial Emotional/Psychological Neglect Sexual Discriminatory Institutional Identified by No Secrets (Department of Health, 2000)

12. Updated November 201312 Identifying the Indicators (signs and/or symptoms) of abuse GROUP EXERCISE Make a table showing the types and indicators of abuse following the example below. Type of Abuse ExamplePossible Indicator of abuse PhysicalHittingBruising

13. Updated November 201313 Physical Abuse This includes: hitting, slapping, pinching, pushing, hair pulling inappropriate restraint or sanctions Removal of necessary aids and adaptations, eg.glasses and hearing aids improper use medication force feeding

14. Updated November 201314 Indicators of Physical Abuse This includes : unexplained injury or injury inconsistent with explanation marks, bruises, burns, scalds injuries at different stages of healing appearing frightened of/avoiding physical contact

15. Updated November 201315 Financial and Material Abuse This includes: Theft of money or possessions 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 pressurising or deceiving a person to alter their will

16. Updated November 201316 Indicators of Financial and Material Abuse 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 Refusal to produce bank statements/books or to allow the holder access to them Recent change of deeds or title of house Care provision seen solely in terms of expense

17. Updated November 201317 Psychological/Emotional Abuse This can occur alongside other types of abuse and includes: Use of threats,fear or bribes Intimidation by shouting, screaming or swearing 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

18. Updated November 201318 Indicators of Psychological/Emotional Abuse Significant Changes ; In behaviour – more withdrawn/more challenging In sleep pattern – more sleep/less sleep In Weight – weight gain/weight loss Indicators of radicalisation/recruitment to violent extremism include; Changes to faith Changes to appearance talk about another person who seems to have a lot of influence Associating with a limited number of people

19. Updated November 201319 Neglect Neglect is where somebody has failed to something for the Vulnerable Adult and this has caused harm The carer maybe unable or unwilling to provide the care needed or may 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)

20. Updated November 201320 Indicators of Neglect Poor environmental conditions Poor physical state of the person – weight loss, dehydration, dirty or unkempt appearance, ignoring medical or physical needs. Failure to provide access to appropriate health, social care or other relevant service Attitudes of carers lack insight and appear uncaring Carer is also a Vulnerable Adult and incapable of meeting the basic needs of the person cared for adequately

21. Updated November 201321 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 relationship of trust Forced Marriage This can include harassment, inappropriate teasing or innuendo, indecent exposure, touching, penetration and being forced to participate (actively or passively) in pornographic activity

22. Updated November 201322 Indicators of Sexual Abuse ill-health eg discharges and infections inappropriate sexual behaviour eg overly seductive Vulnerable adult appears withdrawn pregnancy in a female who is unable to give consent to sexual relations fear /reluctance of person to be alone with an individual known to them

23. Updated November 201323 Discriminatory Abuse Discriminatory abuse is a situation where a person or group of people are treated differently due to perceived differences. This includes unfair or unequal treatment on the grounds of disability, gender, race,sexual orientation,age etc Institutional abuse This is abuse of any type that results from routines and regimes within care settings which deny people’s rights, choices and opportunities

24. Updated November 201324 3. What makes abuse more likely to occur?

25. Updated November 201325 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 the Vulnerable Adult: Hits out at the carer Has difficulty communicating Disturbs the carer at night Has odd and embarrassing behaviour Is unhelpful or uncooperative Is deliberately ungrateful

26. Updated November 201326 When is abuse or mistreatment more likely to occur? (Cont.) If carers: Do not feel supported Habitually lose their temper – linked to stress Perceive the vulnerable adult as being deliberately awkward Carer is physically or mentally ill, dependant on alcohol or misuses drugs Role reversal – child caring for a dependent adult Carer is young/lacks maturity The Vulnerable Adult has few/no social contacts Have to cope with multiple problems

27. Updated November 201327 RISK SERIOUSNESS HARM CONTEXT POOR PRACTICE POSSIBLE ABUSE Poor Practice versus Possible Abuse Sometimes difficult to know where to draw the line!

28. Updated November 201328 Poor Practice VA not given evening meal on one occasion Possible Abuse VA was not given evening meals over the weekend. Said it had happened before.

29. Updated November 201329 Poor Practice Moving and handling procedures are not followed but VA is not harmed Possible Abuse Identified moving and handling equipment is not available / VA is badly bruised in transfer from chair to bed

30. Updated November 201330 Good Practice VA had a fall that could not be anticipated or prevented All steps taken to provide medical attention Possible Abuse VA has a fall on a loose step in the garden / wearing slippers that are too big No medical attention sought until 3 days later when hip fracture is established

31. Updated November 201331 Possible Abuse One additional dose of medicine administered for 9 days resulting in hospital admission Poor Practice One additional dose of medicine administered in error - Pharmacy advised this would not have any impact

32. Updated November 201332 St Helens Safeguarding Adult Procedures

33. Updated November 201333 4.How to make a Safeguarding Alert in St Helens Follow the Flow Chart !

34. Updated November 201334 Call 999 if appropriate 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 Deal with immediate danger (if any) Support and make Vulnerable Adult as safe as possible 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 is likely to be unavailable for more than 1 hour - YOU MUST telephone the Alert through yourself BE ALERT: suspicion, allegation, observation or disclosure of abuse Preserve the evidence (if any / appropriate) Make a Record How to Make a Safeguarding Alert in St Helens

35. Updated November 201335 Be Alert Think about what you see and ask is it acceptable practice Always take seriously what you are told Deal with immediate Danger, if any Call 999 for Police or an Ambulance Support and make the Vulnerable Adult as safe as possible Explain that you will inform your line manager, unless you believe this will cause the Vulnerable Adult further distress Preserve the Evidence Evidence can be anything (PPP) –Person – blood, scratches, dirt, clothing –Place – a room, the garden, a car –Property, chequebook, purse, jewellery box, medication, documents Don’t touch, remove or clean any PPP unless absolutely necessary Be supportive but don’t interview the person Report

36. Updated November 201336 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

37. Updated November 201337 An Alert must have….. An Alleged Perpetrator An Alleged Abuse An alleged Victim (Who)(Did what)(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

38. Updated November 201338 Consider Context WHO Perpetrator Intention WHO VictimImpact WHAT Act or OmissionCommon themes/sequence

39. Updated November 201339 5. Key Information when reporting adult abuse in ST Helens

40. Updated November 201340 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? WHO - is the alleged victim? - is the alleged perpetrator? 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 Key Information When Reporting Adult Abuse in St Helens

41. Updated November 201341 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

42. Updated November 201342 Response to Adult Safeguarding Alerts Actions to establish facts, as far as is reasonable and proportionate to the allegation of abuse, will be taken. Criminal Procedures Disciplinary Procedures Serious Untoward Incident Reviews e.g. NHS organisations (Trusts) Also changes to the Care Plan maybe made to Protect the person

43. Updated November 201343 (Cont) Responding to an Adult Safeguarding Alert is the responsibility of; “Investigating Managers”/ ”Investigating Practitioners” – these are from care management, ASCH Safeguarding Coordinators - these are specialist staff form the Adult Safeguarding Unit, ASCH Others were appropriate include the Police, Specialist nursing and health professionals, Community Safety or Domestic Violence Support Managers of Provider Services when employees are involved and Disciplinary Procedures are appropriate.

44. Updated November 201344 Initial Safeguarding Visit Additional Strategy Discussion Implementation and Monitoring Meeting to monitor and review: Protection Actions Investigation Actions Closure Meeting Initial Strategy Discussion Feedback to Vulnerable Adult and others as appropriate Strategy Meeting to identify and agree: Protection Actions Investigation Actions Consideration of HR Procedures Closure Summary Not appropriate to continue with Safeguarding process Closure Summary Response to a Safeguarding Alert in St Helens