1. Safeguarding Adults - Preventing Abuse and Responding to Poor Practice
Practitioner Level
9.30 welcome and introduction to course
Welcome
Practitioner safeguarding – follow on from alerter – also MCA course available – different expectations of you to alerters
Me, care worker, social worker – adults – MH, LD, OP, OPMH, Sensory, PD - safeguarding
Ensure that between people sign in and state whether or not they have completed the pre-work
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 which means that generally if people miss 35 mins or more they will not be able to stay / get a certificate.

2. Mobile Phones / Devices
Housekeeping
Fire Procedure
Smoking
Toilets
Trainer to locate toilets and tell attendees where they are
Familiarise yourself with the fire procedure and assembly point
Smoking – ensure that you are familiar with the requirements of the venue and that the attendees are encouraged to adhere to them. E-cigarettes are to be smoked during breaks only
Mobile Phones / Devices – Not to on unless an emergency / on-call. May need to labour the issue and remind people after lunch
Breaks minutes am and pm. 45 minutes lunch. Please return promptly so that the day can stay on track
Finishing time – including completion of evaluation forms etc
Breaks
Finishing Time
Mobile Phones / Devices

3. Training Transfer Getting learning into practice
“50% of learning fails to transfer to the workplace”
(Sak, 2002)
“The ultimate test of effective training is whether it benefits service users”
(Horwath and Morrison, 1999)
discuss research by ripfa/plymouth Uni/cornwall cc
Lots of research shows that learning fails to transfer to the workplace
Lectures – only 10% stays
So much going on in our lives
We need this to transfer in safeguarding

4. Training Transfer 9.36-9.40 – the factors for successful transfer
Individual Characteristics
Training Design and Delivery
Workplace Factors
– the factors for successful transfer
Individual characteristics: motivation, understanding of reason for training/benefits for service user/agency
Training Design & Delivery: designed to appeal to everyone’s needs; although everyone has different experiences, ability, skills, styles, needs, expectations and knowledge; designed to be as close as possible to real life/cases/job/task.
Workplace factors: manager/organisation should identify opportunities/time for you to practice and provide feedback/supervision
Pre and post learning has been designed to address individual motivation and workplace feedback.
Useful for CPD
Course design designed to meet individual needs
Participation - essential to learn through exploring / reflection.
Please ask questions as we go through.
Active listening – one person talking at a time. Try not to interrupt / talk over. Really listen don’t switch off
Awareness of others’ emotions – this is very difficult subject and some attending may have had recent or historical work / home situations that they may be reminded of
Value each other’s views and opinions – goes with listening but you can disagree in a professional manner that’s okay

5. Introductions Name Place and nature of work
What do you want to know by the end of today’s session?
9.35 introductions
Name, Place and nature of work / role – try and establish specifically what their role in A is
Pre-read - are there any areas that you are unsure of? Any questions? Anything you want to get out of today generally, questions, challenges and so on.
Find one thing from each person to discuss / reflect back to them etc to start to develop a confidence in contributing to group discussions

6. Outcomes By the end of the session you will:
Understand your responsibilities
Be able to recognise and respond to poor practice and know who else to involve
Recognise missed opportunities through learning from Serious Case Reviews
Have a greater awareness of the legislative framework, regulation and guidance that contribute to the prevention agenda
Identify opportunities for intervention through the assessment, care or treatment planning and review processes
Recognise the role of person-centred support in preventing abuse
Be able to consider the ongoing balance between prevention, protection and a person's right to choice
9.45

7. Ground Rules
Confidentiality within the group will be respected but may need to be broken if a disclosure of unsafe practice, abuse or neglect is made during the course – this will normally be discussed with you first.
Safeguarding is about partnership, it is not about blame. All agencies and individuals need to take responsibility, to reflect and learn to safeguard people who may be vulnerable.
ground rules
Confidentiality – individual comments are not passed on. SA issues will be highlighted – trainers responsibility to alert – will discuss with person. Recurring themes are passed on.
Respectful discussions about other disciplines / agencies – SA is not about a culture of blame. Easy to state that it’s the fault of X professional X organisation but all agencies and people take responsibility
Anything else anyone would like to add? Just ask the question.
Also check for physical as well as emotional comfort at this time

8. Underpinning message for session
Positive approach – promotion of good practice and early intervention to avoid harm
The rule of optimism - maintaining healthy scepticism and respectful uncertainty
Munro – baby P – identified too much optimism among workers about motivations of perpetrators e.g. Believing the parents too much
“It could happen here.”

9. Setting The Scene
Where does our learning about Safeguarding come from?
Serious Case Reviews/Complaints/Near misses
Research/Surveys/Data Analysis
Practice Experience/Theory/Reflection
9.50
Whole group - where does our learning come from?
We will be giving you snippets of information from these sources – a reference list will be provided at the end of the session for you to develop your understanding further.

10. Six Safeguarding Adults Principles
Empowerment
Protection
Prevention
Proportionality
Partnership
Accountability
‘Adult Safeguarding: Statement of Government Policy’ 2011
9.55
These were developed in response to no secrets review 2008/9
People said they did not want to be treated like children and wanted to be given relevant timely information so that they could make informed choices.
Empowerment - Presumption of person led decisions and informed consent.
Protection - Support and representation for those in greatest need.
Prevention - It is better to take action before harm occurs.
Proportionality – Proportionate and least intrusive response appropriate to the risk presented.
Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
Accountability - Accountability and transparency in delivering safeguarding

11. ‘Prevention in Adult Safeguarding’
“It does not mean being over-protective or risk-averse. Prevention needs to take place in the context of person-centred support and personalisation, with individuals empowered to make choices and supported to manage risks.”
Report 41, SCIE, 2011

12. What does the term ‘vulnerable’ mean?
Vulnerability
What does the term ‘vulnerable’ mean?
10.00 – small group activity 2-3 mins

13. The Traditional Model
Risk factors for being abused – poor communication skills, low self esteem, challenging behaviour, cognitive difficulties, lack of education/experience, loneliness
Risk factors for carers abusing - isolation, stress, lack of knowledge of condition, substance misuse, lack of support
Risk factors for services – poor management, high turnover of staff, low pay, lack of staff
In the traditional model we focus on risk to an individual that comes from the person’s perceived deficits. This means we focus our attention on them for change.

14. The Social Model of Vulnerability
A way of thinking about vulnerability that is not patronising or impairment specific because the vulnerability is outside the person
Vulnerable groups tend to be
placed in, or left in, situations of higher risk than would be tolerated for others
Not heard, believed or taken notice of when they make complaints
Not helped to recover or recompensed
Because of these situations vulnerable groups risk being seen as “easy targets”
(Prof. Hilary Brown)
copyright Canterbury Christ Church University UK 2012

15. ‘Constellations of Abuse’
Targeted abuse
Domestic abuse
Professional abuse
Institutional abuse
Family violence, neglect or negligence
partner violence
between parent and adult child
between adult child and older parent
more distant relatives
breaches of professional boundaries by
arrogant grandiose and unaccountable staff
resentful, down-trodden and hard-done-by staff
rigid de-personalised regimes
neglectful care
staff out of their depth or not available
cruel, humiliating individuals
hate crimes
predatory crimes
sexual and financial
Parasitic, exploitative “mate”
crime
Unethical practice
Unethical, unjustified and/ or unauthorised practice in response to challenging needs
Systemic abuse and social exclusion
copyright Canterbury Christ Church University UK 2012
10.20 – whole group – how might we intervene on a personal, cultural, structural level?
Personal: making people aware of dangers, ways of keeping safe, support to explore options
Cultural: families not accepting poor care standards/bullying or harrassment – how to report/complain - reassurance
Structural: MP
Exclusion from mainstream service provision
Discrimination in health, education, housing, employment , justice and welfare
Unable to access public places and spaces
Denied legal advocacy and routes for challenge
Invisible or stigmatised in media
Prof. Hilary Brown, 2012

16. PCS Analysis Neil Thompson
Psychological
Personal/
Cultural
Structural
This analysis reinforces the message that vulnerability comes not just from an individual’s impairments but an internalisation of the way society is unfairly structured and the way culture reinforces/normalises those structures.
S: Lack of/under investment and lack of training/support leads to
C: poor care standards; bullying and harrassment in our communities, e.g. Name calling/joke telling/derogatory language, Dehumanising language – they/the doubles/the feeds; Not taking reports seriously/not being a ‘credible witness’/not being believed leads to
P: internalisation of low self worth, Acceptance of culture as norm,
Also demonstrates how workers may view S/C and internalise leading to lack of motivation/valuing role
Neil Thompson

17. Opportunities for intervention
Assessment & Planning
Care, Support or Treatment
Review
Service monitoring/Complaints
What are your responsibilities?
10.10

18. Prevention: Your Responsibilities
people being informed of the right to be free from abuse; and supported to exercise these rights, including having access to advocacy
thorough needs assessments supported by risk assessments where required to inform people’s choices
access to good universal services targeted at older and disabled people that can reduce the risk of people experiencing abuse, for example community safety services or services that increase people’s access to advice or maintain informal support networks
a well informed, competent and properly vetted workforce operating in a culture of zero tolerance of abuse
a sound framework for confidentiality and information sharing across agencies (CSCI, 2008)
Commission for Social Care Inspection report (2008) Safeguarding adults: A study of the effectiveness of arrangements to safeguard adults from abuse, London: CSCI

19. ISA Report
“Safeguarding in the Workplace: What are the lessons to be learned from cases referred to the Independent Safeguarding Authority?” March 2012
General indicators
carelessness, breaches of policy, attitudinal problems, emotional detachment and persistent non-attendance, portrayal of a close personal relationship with the victim
Financial indicators
talking about money worries, seeking advances or requesting overtime, failure to complete documentation and protocols regarding the handling of money
200 cases examined (1/2 adult, ½ children). Warning signs in behaviour and working practices identified.
“Safeguarding in the Workplace: What are the lessons to be learned from cases referred to the Independent Safeguarding Authority? “ March 2012
Financial Abuse referrals made more often on one off incident than other types of abuse

20. Creating Safer Organisations
Recruitment - VBI
CRB/ISA Checks and References
Induction and Probation
Policies and Procedures
Setting Standards and Professional Boundaries
Training
Supervision
Performance Management
10.40

21. Serious Case Reviews Take place where a vulnerable adult has:
died, suffered serious sexual abuse, a potentially life-threatening injury or serious and permanent impairment of health or development or when serious abuse takes place in an institution or multiple abusers are involved
AND
the case gives rise to concerns about the way in which local professionals and services work together to safeguard vulnerable adults OR
where it is believed to be in the public interest to conduct such a review.
What are SCRs, why they are undertaken?
Group discussion regarding Serious Case Reviews - requirement of pre-read
Explain that this course was partly developed in response to SCRs in Devon.
EXPLAIN there are 4 on Devon site which will be referred to throughout the day (as well as others which are on each local authority’s website).
Just run through this for information only
Death
Serious sexual abuse
Life threatening injury or serious and permanent impairment of health or development
Serious abuse in an institution
Multiple abusers
AND
Concern about professionals working together OR
Public interest

22. Serious Case Reviews aim to:
Establish whether there are lessons to be learnt about the way in which local professionals and agencies work together to safeguard vulnerable adults
Improve practice by acting on learning
NB: The purpose of having a serious case review is not to reinvestigate or to apportion blame. They consider individual actions as well as the systems and processes within which individuals operate.
Aim: to learn lessons/improve practice not to blame people
Discuss the difference with Adults / Childrens

23. Serious Case Reviews – recurring national themes
Inter-agency communication
No lead agency
Training needed
Threshold issue
Assumptions
Jill Manthorpe and Stephen Martineau, 2009
research
Serious Case Reviews in Adult Safeguarding in England: An Analysis of a Sample of Reports Jill Manthorpe and Stephen Martineau
These themes frequently recur

24. Devon SCRs A: High number of deaths raised by CSCI
Poor care standards not previously picked up by many and various professionals
B: 2 falls resulting in deaths raised by PALS
Environmental risks not previously picked up by many and various professionals
H: Resident murdered by another on respite
Poor transfer of risk information from hospital to care home
Lessons learnt regarding DCC whole homes SCRs
Whilst they are very sad reading it is important to make time to read them as they are powerful learning
These are awful cases but if the issues had been picked up earlier
Take the following SCR’s
Care home A
Care home B
Care home H
Bring it back to harm – if you don’t challenge then this could be the outcome
Learning:
not knowing standards & not challenging poor practice – training developed
not recording/cross-referencing – Mr. Manager
Also discuss any current / new SCR (use the ones most relevant to the groups roles)
e.g. JK (Cornwall), Gemma Hayter (Warwickshire), person A1 (Warwickshire)

25. Devon SCRs – combined learning
Duty on all health and social care professionals to record and act upon, any concerns about health, safety or wellbeing. This should include possible risks that are not necessarily the main focus of their contact.
Ensure that a Service Provider is fully aware and able to safely meet someone’s needs. Other important considerations such as accessibility, peoples preferences, resource pressures and cost, should not compromise the primacy of ensuring safe care/support arrangements.
The care needs and vulnerability of people are increasingly acute and complex.

26. Common Safeguarding Challenges (care homes)
Lack of social inclusion
Institutionalised care
Physical abuse between residents
Financial abuse
Maladministration of medication
Pressure sores
Falls
Rough treatment, being rushed, shouted at or ignored
Poor nutritional care
commissioning care homes: common safeguarding challenges (guide 46)
Includes a prevention checklist and resources for each category
Also looks at underlying causes each of which has a prevention checklist and resources:
Recruitment
Staffing levels
Adherence to policy and procedures
Training
Choice of service
Record keeping
dehumanisation

27. Health and Social Care Act, 2008
Single registration system acts as a “licence to provide services”
Established Care Quality Commission to:
Regulate the quality of health care and adult social care
Look after the interests of people detained under the Mental Health Act
11.15 background to the Act and the standards
Apply to a wide variety of services that provide regulated activities (care, support and treatment) across Health and Social care.
This includes residential, domiciliary and day care, GPs, dentists, hospitals and so on.
Depends on what services you provide not what type of service you are.
Excludes independent personal assistants
EXAMPLES of regulated activity are:
• Personal care
• Accommodation for person who require nursing or personal care
• Accommodation for persons who require treatment for substance misuse
• Accommodation and nursing or personal care in the further education sector
• Treatment of disease, disorder or injury
• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Termination (do NOT use the term abortion please) of pregnancies
• Services in slimming clinics
• Nursing care
Dental treatment
• Family planning services
If you carry on any of these activities in England, you must register.

28. Health and Social Care Act 2008
Focused on outcomes rather than policies, systems and processes (inputs)
CQC to monitor compliance – risk register
New enforcement powers for CQC
overview of the Act/Essential Standards
Clear guidance about the outcomes we expect people to experience if the provider is compliant with the new regulations. (Outcomes are what people get rather than what we give). Not as prescriptive as before - shift from service focus to person focus. E.g. keeping clean – bath, shower, strip wash
There are prompts for each outcome for providers to consider. There are references to other legislation e.g. Medicines Acts, Health and Safety at Work Act, COSHH, MCA and so on
Each provider to demonstrate that they have achieved the outcome and is compliant with the regulation – CQC compile a risk register with information received.
28 outcomes, we will focus on the 16 that apply to all types of provider - they relate directly to the quality and safety of care. Other 12 regulations may apply differently to different types of provider. (Providers who are not required to register may use them as their benchmark.)
Really helpful to have common standards and language in health and social care
ASK GROUP how many of them feel confident that they understand the outcomes. If lots of commissioners ask them if they can name any!?

29. Snap!
11.20
Look at just 16 standards – once completed discuss See Tutor Notes and then give out handout

30. Behind Closed Doors Watch the DVD Area of Concern / Poor Practice
11.30 watch DVD and complete column one – give specific examples, not general issues
Example: the manager made a joke about dementia – not the manager is disrespectful
Everything in the DVD actually happened but not all in the same care home at the same time.
If all this was happening then it would definitely be Safeguarding but we are thinking about what we would do if we saw/heard about one or two of these poor practice issues in isolation.
Complete the FIRST column ONLY

31. Behind Closed Doors Area of Concern/ Poor Practice
Which CQC outcomes does this relate to?
11.40
Complete the SECOND column ONLY

32. Behind Closed Doors Area of Concern / poor practice
Which CQC outcomes does this relate to?
What might you see, hear or smell?
Consider the indictors and signs that there might be if you hadn’t actually observed the behaviours
Complete the THIRD column ONLY
11.45 Small group
Assume that the person can’t tell you OR is unwilling
What will you actually see/hear/smell OR be informed of by provider OR ‘sense’ (if its sense, try to unpick what you saw/heard/smelt)
In the small groups ask them to pick ONE example from each person in the group

33. What might you see? Empty hours, bored residents
Empty and scrappy staff rotas (turnover, absences and not enough staff)
Erratic medication charts
Dirty rooms
Dirty linen
No training or “going through the motions”
Policy documents and care plans kept in the drawer
Rushed staff
Dirty, untidy and unlooked after clothes

34. What might you smell?
Urine
Faeces
Stale food
Body Odour

35. What might you hear?
Dehumanising: “they” - people are lumped together – “they eat like animals”, “the doubles”
Sexualising: “they’re at it like rabbits”, “she’s gagging for it”
Blaming:“he knows what he’s doing,” “she’s manipulative”, “he’s winding me up”
Punitive: “they’ve got it coming”, “she needs to be taught a lesson”, “if he thinks he can treat me like that”
Discrediting: “he doesn’t notice”, “they don’t care” “they are zombies”

36. Barriers to addressing poor practice
Lack of a tangible sense of what is wrong
Lack of certainty that your concerns are reasonable or proportionate
Lack of “evidence” to back up concerns
Fear of immediate reprisals or long term detrimental consequences
Fear that concern or complaint will not be handled well so that their intervention will be in vain
barriers
Large or small group discussion
lack of time – challenge this strongly from a values, contractual and legal perspective
Lack of knowledge re: standards
Afraid, upset, angry, frustrated
Don’t know service type/client group
Lack of confidence
The particular staff member may be difficult/having a bad time
General staff resistance to change
Very close relationships between managers/staff – even all related
My age
My qualifications
If staff have shared things – can be difficult as the other member of staff will know who has ‘grassed’
If staff have complained about team leader/manager
The person may be the only other person on duty
Finding the right things to challenge/is it significant enough?
Want to avoid conflict
Especially difficult when they’ve been challenged before and no improvement has occurred
Fear of opening up a can of worms
Professor Hilary Brown

37. How do you verbalise ‘gut instincts’?
Hull University: ‘Abuse in Care?’ (
A practical guide to protecting people with learning disabilities from abuse in residential services
A practical guide to protecting people with dementia from abuse in residential services
11.55 : Early indicators of concern in 6 key areas (one for dementia and one for LD)
The guide should be read before using the checklist / tool

38. Service Monitoring Checklist
Leadership and Management
Staff behaviours and attitudes
Behaviours and interactions of residents
Isolation and lack of openness
Service design, delivery and make up
Environment and basics of care
Adapted from ‘Abuse in Care?’
Has been developed into the Devon service monitoring checklist
To provide a prompt / guide to reviewing within services

39. If you suspect a criminal offence, do not ask any further questions.
Practitioners’ Role
Information received about or poor practice observed
Gather Information
Poor practice?
Safeguarding?
practitioners – not alerters
you need to be making decisions about what to do with issues. You may have witnessed or someone has told you one thing and you will need to gather info in order to decide what to do. We will look more in depth at the threshold for safeguarding later.
EXAMPLE:
You go into someone’s garden and want to know what’s growing.
Gathering info means recording how many apples, pears etc are on the trees, picking up empty seed packets and asking the gardener. Investigating means digging up plants to see what’s underneath, asking neighbours to see if they know what’s growing, looking in the shed, going to the garden centre and asking what they’ve bought and so on.
If you suspect a criminal offence,
do not ask any further questions.

40. Behind Closed Doors Complete column FOUR
Area of Concern / poor practice
If you hadn’t observed it what other indicators might there be?
What might you see, hear or smell?
What information do you need to gather? Where/ who from?
What questions might you need to ask to establish the facts of the situation?
Be specific!
12.05
DETAIL:
What questions would you ask?, how might you challenge? Immediately, in supervision? , who would you discuss with and what exactly?

41. What to do with concerns about poor practice
Discuss with the professional concerned
Discuss with the service manager
Discuss with your manager immediately, in supervision or at a team meeting
Discuss directly with the person, family, organisation. Once discussed then back up in writing - SMART.
Record in Mr Manager if appropriate
Discuss with co-workers or Safeguarding Adults team
Encourage people to use the complaints process
Discuss with procurement / contracts team
Discuss with CQC
What you do will depend on your role
Discuss with professional concerned – NOT if SA.
May need to speak with their manager – your professional judgement Provider or commissioner
Discuss directly with the person, family, organisation. Once discussed then back up in writing. Have SMART discussions with SMART recording (as an observation ) Provider or commissioner
Record in Mr Manager – DCC or stat partners
Discuss immediately with manager OR In supervision, or at a team meeting Provider or commissioner
Discuss with co-workers or Safeguarding Adults team Provider or commissioner
Encourage people to use the complaints process Provider or commissioner – how do you get residents to do this?
Discuss with procurement / contracts team DCC or stat partners
Discuss with CQC DCC or stat partners OR providers

42. Feelings / Emotional Responses
Ask group what there emotional response is when they have to address a concern with someone?
Usually it will be some of all of these
Worried about time
Almost wish they hadn’t seen it
Fear
Upset
Apologetic etc etc
Physical feelings as well
We all have to find ways of dealing with / managing these so we can challenge effectively

43. Communication
Verbal
Tone
Body Language
We experience a wide variety of emotions and these can come through in our body language.
Research suggests that Communication is composed of
Body Language= 55%
Tone / intonation etc (delivery of words)=38%
Words =7%
Our thoughts, emotions, behaviours, physical reactions and environment all work together to effect a person’s state of mind:
Feelings / Thoughts help define the moods (positive or negative) we experience.
Feelings / Thoughts influence how we behave, what we choose to do, or not to do.
Feelings / Thoughts (and beliefs) affect our biological, physical reactions.
All of the above are surrounded by life situations and environmental changes.
To give you confidence, it may be helpful to remind yourself why you are doing this – to protect people, it’s the law and so on

44. Neil Thompson What is a problem?
‘....a problem is anything that either brings about negative ...or blocks positives or a mixture of the two.’
Neil Thompson
Highly recommended
Can get from Amazon etc
Before you discuss an issue you need to be clear that you have a shared understanding of the problem.
Example – teenager who leaves clothes on floor, dirty, cleaned, ironed etc does not why parents get so cross or upset. Need to explain impact on parent who my buy clothes, wash them and iron. Also the fact that clean and dirty get muddled so clean clothes may need washing again.
May also be useful for teenager to do the washing / ironing to understand impact
Need to have shared understanding of problem / issues / poor practice

45. An Elegant Challenge
Being constructive in challenging unacceptable behaviour or language Collusion / Elegant Aggressive no challenging challenge challenge
From his book along with may other good points / tips
Restaurant Example
Creating a small positive change in one area, will gently shift small changes in other areas.

46. Practice
Choose one of the scenarios from the film (or your own) and make ‘an elegant challenge’ to your partner.
Partners – What did it feel like? What could be done differently?
Swap over.
12.15

47. Any Questions? 12.25-12.30 Questions, Evaluation forms
Feedback, Finish

48. Prevention is Better Than Cure
Keep the course in context. Whilst there are some very worrying situations occurring everyday there is also good practice in all care environments
Remember to vigilant and deal with things at the earliest opportunity.
Whether it’s poor practice or abuse doing nothing isn’t an option.
If time ‘’What pro-active methods do we have available to us to ensure that the risk of abuse is reduced and that people aren’t placed at avoidable risk?’’. Also remind them that abuse can happen in all types of care environment but also so can good practice
Large groups to flip chart fast and punchy positive end exercise
Should come up with
Good planning of care (covered later)
Robust monitoring of care – Audit CQC / internal / care mgt etc
Response to complaints / concerns / alerts
Induction / training / ongoing
Supervisions / appraisal / communication / team meetings
Good shift patters / staff who are rested etc
Strong value based leadership
Sufficient focused resources etc etc etc
LEAST restrictive options

49. Resources
Dementia care mapping CQC observation tools staff/observation-tools SCRs
Remind them that there is a lot of information ‘out there’ which is simple to implement and can make a huge difference
Dementia care mapping based on work of Tom Kitwood – personhood essential to wellbeing – measures quality of staff/resident interactions/activity – training required to undertake this type of mapping
Could use CQC observation tools instead – available on website

50. Resources
Social care governance – audit tool Common Safeguarding Challenges Minimising the Use of Restraint Good Ideas!
Useful tools for providers and commissioners