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Safeguarding Adults Level 2

What is Safeguarding Adults ? The National Framework for Safeguarding Adults is called NO SECRETS 2000 No Secrets 2000 applies to those people over 18 years old who are dependant on others for their activities of daily living or care needs and who are or may be unable to protect themselves against significant harm or serious exploitation which may be caused by actions or inactions of other people’’.

Safeguarding Adult Principles There are six key principles defined by the Department of Health (The Role of Health Services 2011) Empowerment: Presumption of person led decisions and consent Protection: Support and representation for those in greatest need Prevention: Prevention of neglect, harm and abuse is a primary objective Proportionality: Least intrusive response appropriate to the risks presented Partnership: Local solutions through services working with communities Accountability: Accountability and transparency in delivering safeguarding Consider each principal in all aspects of safeguarding adult work

Who Abuses Adults Anyone Who has POWER over others, this can be by being a Social or Health Care Professional, a paid carer or an unpaid carer. A family member or friend . Think What have you seen in practice that has made you think Abuse may have taken place? Often it can be a feeling that things are not right, that service users are not getting treatment provided in a way we would accept, or that they are being exploited by others.

Categories of Abuse Physical Abuse There are 7 different categories of abuse Think about the seven types of abuse that can take place; Physical Abuse hitting, punching, slapping, kicking, Drowning, shaking, biting restraint, medication, lap belts, locked doors These are often ones you would recognise easily as Abuse These are not so obvious but can be associated with abuse if not used properly

Sexual Abuse Direct or indirect involvement in sexual activity without consent or ability to give consent this includes rape, indecent assault, indecent exposure or exposure to explicit sexual behaviour, material or images. Possible Observed Signs and Symptoms Sexual acts the person hasn’t consented to, was pressurised into consenting to Touching inappropriately Penetration Indecent exposure Taking photographs Using inappropriate language Sexually transmitted diseases or pregnancy • New tendency of withdrawn behaviour • Tears or bruises in genital/anal areas • Soreness when sitting • Sexualised behaviour • Deliberate self harm • Incontinence and bedwetting • Excessive washing Possible observed practices Think: Preserving evidence can include supporting the victim not to wash/shower before evidence is collected.

Neglect or Acts Of Omission Failure to provide access to Health, Social or educational services, withholding daily necessities or basic care, i.e. nutrition, clothing, shelter and warmth Possible Observed Signs and Symptoms Withholding of ‘necessaries’, e.g. nutrition, medication, healthcare, education, social stimulation Withholding assistance to use toilet, keep clean, warm and comfortable Avoidable Pressure Ulcers Repeated Falls Failure to ensure privacy and dignity in living conditions Untreated physical illnesses Inconsistent or reluctant contact with health or social care agencies Lack of safety equipment being used following recommendation Clear failure to ensure the taking of medication appropriately Dehydration/ weight loss / malnutrition Possible observed practices

Psychological & Emotional Abuse Acts or behaviour affecting the emotional health causing distress or anguish to individuals including threats of harm or abandonment, isolation, humiliation, blaming, controlling or hostile behaviour Possible Observed Signs and Symptoms Shouting, swearing, name calling Bullying Insulting, humiliating, ridiculing Intimidating Controlling behaviour Control of access (family, friends, phone, post, pull cord, visitors) . Deprivation of privacy, dignity or choice • Difficulty gaining access to the adult on their own • Low self-esteem, lack of confidence and anxiety • Sharp changes in behaviour in the presence of certain persons • Self abusive behaviour-self mutilation, head banging • Loss of weight • Disturbed sleep Possible observed practices

Financial or Material Abuse Includes theft, fraud, exploitation, pressure in connection with wills or estates, misuse or appropriation of property and possessions or benefits. Possible Observed, Signs and Symptoms Exploitation of dependence for personal gain Prevention of necessary care options Misuse of funds, including lack of ‘best interest’ decisions Pressure or misappropriation of property, wills, bank accounts, benefits or assets Unexplained or sudden inability to pay bills Unexplained or sudden withdrawal of money Personal possessions of value go missing from home without explanation Someone has taken responsibility for paying bills, rent, buying food etc. but is clearly not doing so Possible observed practices . . .

Discriminatory Abuse This abuse is motivated by discriminatory and oppressive attitudes towards a person due to their race, gender, cultural background, religion, physical and/or sensory impairment, sexual orientation and age. Discriminatory abuse manifests itself as any of the other categories of abuse. Possible Observed, Signs and Symptoms Direct or indirect discrimination based on race, gender, culture, disability, sexuality, religion, belief or values Harassment Incitement of others to commit abusive acts or make abusive comments Omitting services or activities based on preconceived ideas about someone’s age or condition Cultural or religious needs are not being met Possible observed practices . . .

that is not addressed by the institution. Institutional Abuse Abuse by an organisation imposing rigid and insensitive routines; unskilled, intrusive or invasive interventions; or an environment allowing inadequate privacy or physical comfort. Possible Observed, Signs and Symptoms Possible observed practices . . . Poor care planning Inflexible routines Little opportunity for outside activities Lack of privacy Poor staff morale, high turnover, high sickness rate Few visitors and/or staff insistent on notification before visits Inadequate staffing or insufficient knowledge base within the service. The routine/ practice or management that is not responsive to or respectful to the individuals served Often described as “thoughtless” practice or “we always do it this way” or “this is how we do it here” Bad practice, that is not addressed by the institution.

Physical and Financial Abuse Continue One of your patients / service users tells you they are fed up with their grandchildren hitting them and demanding money. What type of abuse is this? Physical Abuse Financial Abuse Emotional Abuse Physical and Financial Abuse

Physical and Financial Abuse Continue One of your patients / service users tells you that they were hit by another patient on more than one occasion. What type of abuse is this? Physical and Financial Abuse Physical Abuse Emotional Abuse Financial Abuse

What to do if you suspect abuse or someone discloses that abuse has happened If there is a disclosure or you witness abuse, ensure you record factual information, what the service user said, what questions you ask and what they replied. Consider the mental capacity of the person with regard the disclosure and actions they want you to take. If you are not sure what you have seen, then talk to your manager, someone senior or safeguarding team immediately. Team work is essential in supporting each other to recognise and report situations that could be abusive.

Protection of Evidence Record all actions accurately. If there are items you think may be used as evidence do not handle them unless you have to. Any written evidence can be copied to preserve this. Ask for assistance as soon as possible if you think a criminal investigation may be required. The police will advise on preservation of evidence in each circumstance

What to do if someone discloses abuse or is at risk of abuse Ensure any immediate protection needs are addressed. Inform your manager immediately. Complete the Safeguarding Alert Form. Ensure that the Safeguarding Alert Form has been sent to the appropriate people. Contact the Safeguarding Team if you need further help or advice The service users immediate safety needs must be met. This may include use of emergency services or out of hours teams. Remember Complete a DATIX form and attach the Safeguarding alert form You must make sure you know who needs to be informed about the potential abuse. See the SEPT Safeguarding Intranet page for details.

Confidentiality and Consent No adult can be offered a confidential service. Whilst every effort should be made to ensure confidentiality is preserved, the disclosure of information which may assist in the prevention or detection of abuse is permissible. This applies both to information about third parties, e.g. adults who may pose a risk of harm to children or about those who may be the subject of abuse. Staff should consult the Trust Safeguarding Policies or the Trust policy on Confidentiality CPG9.  If you are uncertain about when to share confidential information, always seek advice from the Trust Safeguarding Team or your line manager

Safeguarding & Mental Capacity Mental Capacity is the ability to: Understand the information relevant to a specific decision Retain that information Use or weigh up that information Communicate the decision (by talking, sign language or any other method)   Unless a person can achieve all four elements they lack capacity to make that particular decision Think about how the mental capacity of the victim will impact on the safeguarding process. Important to note A capacity assessment must be undertaken where there are concerns that a person has not got capacity to make a specific decision Best interests – anything done for or on behalf of people without capacity must be in their best interests. Least restrictive intervention – anything done for or on behalf of people without capacity should be the least restrictive.

Deprivation of Liberty The Government has added further provisions to the Mental Capacity Act 2005 called the Deprivation of Liberty (DOL) Safeguards. The DOL process is a legal requirement where the deprivation of a person’s liberty to prevent them leaving a hospital ward or regulated care home is required in order to provide care or treatment needed. This only applies to those who lack capacity to consent to treatment or services being offered and who are not detained under the Mental Health Act.