Nvq 3 Safeguarding

Kasia Balicka

Safeguarding Adults

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Physical abuse includes hitting, pinching, sapping, pushing, kicking, physical restraining someone in an inappropriate way.

Signs:

• Unexplained or inappropriately explained injuries. • Unexplained cuts or scratches to mouth, lips, gums, eyes or external genitalia. • Unexplained bruising to the face, torso, arms, back, buttocks, thighs in various stages of healing; collections of bruises that form regular patterns which correspond to the shape of an object or which appear on several areas of the body. • Unexplained burns on unlikely areas of the body, e.g. soles of the feet, palms of the hands and back, immersion burns, rope burns from an electrical appliance. • Sudden and unexplained urinary and/or faecal incontinence. • Person flinches at physical contact. • Person appears frightened or subdued in the presence of particular people. • Person asks not to be hurt. • Person wears clothes that cover all parts of their body or specific parts of their body.

Sexual abuse includes any sexual act to which the vulnerable adult has no consented and may not understand.

Signs:

• Person has urinary tract infection, vaginal infections or sexually transmitted diseases that are not otherwise explained. • Person appears unusually subdued, withdrawn or has poor concentration. • Person exhibits significant changes in sexual behaviour or outlook. • Person experiences pain, itching or bleeding in the genital/anal area. • Person’s underclothing is torn, stained or bloody • A woman who lacks the mental capacity to consent to sexual intercourse becomes pregnant.

Emotional/psychological abuse includes threats of harm or abandonment, deprivation of contact, humiliation, rejection, blaming, controlling, intimidation, coercion, indifference, harassment, verbal abuse including shouting or swearing, isolation or withdrawal from services or support networks.
Signs:

• Untypical ambivalence, deference, passivity, resignation. • Person appears anxious or withdrawn, especially in the presence of the alleged abuser. • Person exhibits low self-esteem. • Untypical changes in behaviour, e.g. continence problems, sleep disturbance. • Person is not allowed visitors/phone calls. • Person is locked in a room/in their home. • Person is denied access to aids or equipment, e.g. glasses, dentures, hearing aid, crutches etc. • Person’s access to personal hygiene and toilet is restricted.
Financial abuse includes taking another’s money or possession, pressure with connection with wills, property, benefits or financial transactions.

Signs:

• Lack of money, especially after benefit day. • Inadequately explained withdrawals from accounts. • Disparity between assets/income and living conditions. • Power of Attorney obtained when the person lacks the capacity to make this decision. • Recent changes of deeds/title of house. • Recent acquaintances expressing sudden or disproportionate interest in the person and their money. • Service user not in control of their Direct Payment or Individualised Budget.

Institutional abuse often occurs in social or health care establishment when the routines, systems and norms of an institution compel individuals to sacrifice their own preferred lifestyle and cultural diversity to the needs of an institution.

Signs:

• Low staffing levels over a long period of time. • Lack of knowledge or confusion about Guidelines • Breakdown of communication between managers and the centre. • Staff factions • Staff working the hours to suit themselves. • Staff may drink heavily or abusing drugs on or off duty. • Staff ordering service users around or shouting at them. • Lack of positive communication with service users. • Lack of participatory arrangements e.g. residents meetings, social committees, participating in planning what happens. • Low staff morale • Failure of management to see a pattern of events which are often treated as individual instances in isolation. • Punitive methods adopted by staff against service users. • Insufficient staff training and staff development. • Unnecessary or inappropriate rules and regulations • Inappropriate or poor care • Lack of respect shown to vulnerable adult • Lack of privacy • Controlling relationships between staff and service users • Poor professional practice.

Self neglect Not undertaking personal hygiene, not eating healthily or taking prescribed medication, neglecting their home environment, not throwing away rubbish, hoarding items or not maintaining an adequate level of sanitation, poor household hygiene placing self or others at risk of infection or infestation etc

Neglect by others is failure to provide suitable care or attention to the point where someone’s health is affected.

Signs :

• Person has inadequate heating and/or lighting. • Person’s physical condition/appearance is poor, e.g. ulcers, pressure sores, soiled or wet clothing. • Person is malnourished, has sudden or continuous weight loss and/or is dehydrated. • Person cannot access appropriate medication or medical care. • Person is not afforded appropriate privacy or dignity. • Person and/or a carer have inconsistent or reluctant contact with Health and Social Services. • Callers/visitors are refused access to the person. • Person is exposed to unacceptable risk.

Correct actions to take if you suspect and individual is being abused.

• Be open and honest about your concerns. • Stay calm. • Listen very carefully. • Ensure that no one is in immediate danger. • Call for emergency services if urgent medical / police help are required. • Be aware that medical and forensic evidence might be needed. • Inform your Line Manager or Team Leader immediately.

If somebody tells you they are being abused.

• Stay Calm • Ensure that any immediate needs are addressed • Remember that this is an important conversation with someone and they will probably be more anxious than you. Keep conversation flowing by use of non-verbal prompts, verbal prompts, and echoing by repeating the last one or two words spoken • Show empathy when listening • Let them speak – do not interrupt them • Reassure the person e.g. tell them that they have done the right thing in speaking to you and that you believe them • Become an active listener -concentrate, try to comprehend what it is they are saying, sustain the conversation by verbal and non-verbal prompts and summarise • Do not promise confidentiality, as you cannot keep the information to yourself • Explain that you will need to pass this information on to your manager
Preserving evidence and recording

• Ensure written records (notes, letters, bank statements, medication records etc.) are kept in a safe place • Make a written record of messages (e.g. answer-phone) to ensure they are not lost. Include the date and time and sign them • In cases of physical or sexual assault encourage the person not to wash bathe or shower where you think they might need a medical examination • Don’t tidy up, wash clothes, bedding or other items • Try and ensure that other around do not interfere with any items that maybe important for the police

National polices that set out requirements for safeguarding individuals.

• Safeguarding Adults (2005)- National Framework of Standards was issued by the Association of Directors of Social Services (ADSS). The national framework is comprised of 11 sets of good practice standards in safeguarding adults.

• Mental Capacity Act (2005) The Mental Capacity Act 2005 provides a statutory framework to empower and protect people aged 16 and over who lack, or may lack, capacity to make certain decisions for themselves because of illness, a learning disability, or mental health problems.

• Mental Health Act (2007) amends the Mental Health Act 1983 (the 1983 Act), the Mental Capacity Act 2005 (MCA) and the Domestic Violence, Crime and Victims Act 2004. This includes changing the way the 1983 Act defines mental disorder, so that a single definition applies throughout the Act, and abolishes references to categories of disorder

• No Secrets, guidance on protection vulnerable adults from abuse- Department of Health 2000.

• Essential Standards of Quality and Safety Care Law- Ministry of Justice.

The local and organisational systems for safeguarding

All local authorities in England have multi-agency policies in place for the protection of vulnerable adults. These documents are based upon collaborative partnerships between local authorities, police and those who provide a range of services to vulnerable adults. This procedure is governed by a set of key principles and themes, so as to ensure that people who are subject to abuse, neglect and exploitation experience the process in such a way that it is sensitive to individual circumstances, is person-centred and is outcome-focused. It is vital for successful safeguarding that the procedures in this section are understood and applied consistently by all organisations. The Safeguarding Adults multi-agency procedure for the West Midlands is the result of collaboration between the following local authorities: Birmingham, Coventry, Dudley, Herefordshire, Sandwell, Shropshire, Solihull, Telford and Wrekin, Walsall, Warwickshire, Worcestershire and Wolverhampton. Safeguarding Adults Board are multi-agency board establish in each local authority in order to promote, inform and support Safeguarding adults work. They ensure that priority is given to the prevention of abuse and that safeguarding is integrated into other community initiatives and services. The local authorities should ensure coordinate the actions that relevant organisations taken in agreement with their own duties and responsibilities and key decision are made to an agreed timescale. They also ensure that an provisional and a final protection plans are put in place with adequate arrangement for reviewing and monitoring and action leading from investigation are proportionate to the level of risk and enable the individual at risk to be in control, unless there are clear recorded reasons why this should not be the case.

Safeguarding Adults Process- Multi-agency policy and procedure for the West Midlands

Stage 1 ALERT - within the same working day.

Stage 2 REFERRAL – decision within same working day.

Stage 3 STRATEGY MEETING OR DISCUSSION- within five working days.

Stage 4: INVESTIGATION/ ASSESSMENT – completed within four weeks from the date of referral.

Stage 5: CASE CONFERENCE- completed within four weeks from completion of the investigation.

Stage 6: REVIEW – completed within maximum six months after case conference

Stage 7: CLOSURE – at any stage.

The roles of different agencies and professionals that are involved in safeguarding individuals

• West Midlands Police – Each Local Policing Unit has a Public Protection Unit which includes Vulnerable Persons Officers. They investigate abuse and can advise as to whether a crime may have been committed and they advise the Vulnerable Adult about the legal options available to them, including possible sanction against the abuser, to make themselves safe and support them in making decision about how to proceed.

• General Practitioners have a significant role in Safeguarding Adults. They can raising an alert to Safeguarding Adults contact when they suspect or know of abuse and they play an active role in strategy discussions, meetings, case conferences and protection planning.

• Ambulance Service - There are a number of ways in which ambulance staff may receive information or make observations which suggest that an adult at risk has been abused or is at risk of harm. Ambulance staff will often be the first professionals on the scene and their actions and recording of information may be crucial to subsequent enquiries.

• Care Quality Commission regulates and inspects health and social care services including domiciliary services. It has a role in identifying situations that give rise to concern that a person using a regulated service is or has been at risk of harm, or may receive an allegation or complaint about a service that could indicate potential risk of harm to an individual or individuals. The CQC should make a safeguarding alert when appropriate to the safeguarding contact point.

• Independent Safeguarding Authority is a public body set up to help prevent unsuitable people from working with children and vulnerable adults.

• The Supporting People Programme is a housing organisation which can identify tenants who are vulnerable and at risk of abuse, neglect and exploitation.

Sources of advice, support and information to help you understand your own role in safeguarding:

• Your manager

• Your team leader

• Websites, e.g. http://www.worcestershire.gov.uk/cms/safeguarding-adults/policies-and-procedures.aspx, www.bsab.org, www.birmingham.gov.uk/safeguardingadults, www.worcestershire.gov.uk/safeguardingadultswww.worcestershire.gov.uk/safeguardingadultswww.worcestershire.gov.uk/safeguardingadults

Task B Research and Account

I identified two reports on serous failures to protect individuals from abuse. First was the a report of a random inspection in Dormers Wells Lodge Care Home in Novemeber 2010. Inspection was carried out following a safeguarding alert received by the Care Quality Commission from Ealing Safeguarding team. Several serious shortfalls were identified by inspectors. They found shortfalls in the promotion of privacy and dignity, for example, on the dementia unit staff did not always close the door when assisting people in the toilet. Residents choices and rights were not always respected and accommodated. Staff communication was lacking when staff were carrying out care tasks for residents. Staff did not speak or explain to the residents what care activities they were carrying out and some staff members were speaking over the individuals who were assisting. They also found evidence of inappropriate restraint where some residents were locked in their bedrooms for periods of time as a behaviour management. Care staff did not always have the strategies in place to manage behaviour throughout the day.

There was lack of availability of appropriate activities for residents with dementia and they often spend long time doing nothing. In addition, not all staff members received training in dementia and managing challenging behaviour. Some residents did not received medical attention on time and medication were administering at not correct time. There were also some shortfalls with some areas of the environment, these included the dead bolts lock mechanism that was on every bedroom doors, wedging of the fire doors, odours on the dementia unit lounge, radiators covers coming away from the wall and shower door that did not close easily. On the dementia unit ground floor lounge inspectors found that that a chest of drawers contained various items which could be potentially harmful (e.g. nail polish remover, finishing spray, nail chippers, bubble bath, nail polish and disposable razor with no security cover. The door to this lounge was wedged open with paper towels.

Second report which I chose to described concerns Bromford Lane Care Centre in Birmingham. Report was completed in January 2011. Inspectors who visited the care service identified concerns about some aspects of the care being provided. There we particular concerns about food and drinks including the fact that residents’ individual food and drink needs were not always planned for. Residents and their relatives were not happy with the quality and portion sizes of food provided. Residents were not monitored to ensure they eating and drinking enough and their weight was not checked regularly. Inspectors also reported lack of organisation during lunch time. Care staff was not sure what time meals should be served. Individuals who needed encouragement to eat were not adequate supported by staff or given good alternative meals. Any cultural diets had not been taken into consideration and there was no choice of pudding available.

All residents had a care plan but their were not detailed enough to enable residents to receive personalised care. Care plans did not show how individuals were affected by their dementia and there was no individualised plans for how was to be managed. In addition, identified risks did not have appropriate plans in place to minimising them and monitoring was found to be poor. Care staff did not have the right skills and experience to response well to the needs of people with dementia and they were not sure how to deal with residents challenging behaviours.

Residents were not able to lock their bedrooms and other people could had access to their rooms. One resident had some items missing from their bedroom.

There was sometimes not sufficient number of staff on duty and residents had to wait sometimes for assistants and on some occasions care staff had to use the hoist along alone. What is more, not all care workers had completed safeguarding and NVQ level 2 training.

All providers of care services have legal responsibility to make sure they are meeting all the essential standards of quality and safety. Care Quality Commission inspectors found that providers of these two care services, Dormers Wells Lodge Ltd and Bromford Lane Care Centre failed to meet most essential standards of quality and safety.

Ci Explain what a social care worker must to do if they become aware of unsafe practice.

If I become aware of unsafe practice I must follow Maggs’ internal Safeguarding Adults procedure. There are four main priorities in responding to concerns of abuse:

1. Protection – ensuring that vulnerable person is safe and protected from any further abuse- taking any necessary emergency action to protect the person, including dialling 999 if necessary.

2. Reporting- pass on concerns as soon as possible and certainly within 12 hours of becoming aware of abuse. Allegations of assault must be reported to the police.

3. Preserving- preserving any evidence as it could be a potential crime scene.

4. Recording and referring- Recording of any observed or been told evidence.

Cii Describe what a social care worker must do if unsafe practice is reported but nothing is done to ensure it is correct.

If unsafe practice has been reported but nothing has been done it is important to seek higher authorities until they ensure the unsafe practice has been correct. I can consult/ or write a confidential report detailing all relevant information to the Adults and Communities Directorate Safeguarding Adult Team , local Social Services department or General Social Care Council.

Ciii Describe three factors that may make individuals more vulnerable to abuse than others:

• Where there is relationship and someone has influence over the person though to be at risk, whether physical, emotional or financial.

• Individual who is isolated, living along and dependent on other people to provide for their care needs.

• Financial difficulties

Civ Explain how adopting a person centred approach which offers choices and upholds rights can empower an individual and help to reduce the likelihood of abuse.

Adopting person cantered approach means treating somebody with respect, supporting individuals rights, help them to take control over their lives, make informed choices, promoting clients’ independence, respecting and promoting individual views, helping clients to comment, make complaints and maintaining confidentiality. Those practices empower clients, recognise and upholding their rights, powers and beliefs, help individuals to acquire their self-esteem what protect them being abuse and help individuals be more likely to protest about or report any safeguarding concerns.

Cv Explain how encouraging and promoting active participation can help to reduce the likelihood of abuse.

Active participation means encouraging and promoting independence, treating clients as individuals, encourage them to be assertive and make their own decisions based on informed choices, and supporting them to develop skills which increase confidence and self-esteem, giving them opportunity to speak-up and to be heard and make them feel that what they say matters. Client are active partner not passive recipients, of the support/service they receive which ensure a more equitable balance of power. Active participation builds self esteem, and individuals will refuse to tolerate abuse and will be more prone to report it.

Cvi Explain how an effective and easy to use complaints procedure can help to reduce the likelihood of abuse,

Every organisation should have simple procedure in place for raising any concerns or a complaint which encourage people to rise their worries, however small they might appear to be. All service users should know to whom they can speak to if they have any questions or need more information about the service and who they can go to for help and advice. If it is easy to access the complaints procedure, and anyone willing to complain has no difficulty in doing so, then it makes it harder for abuse to go unreported. If issues are highlighted early action can be taken quicker and abuse can be minimise or stop sooner. Complaints are very important as they often lead to an improvement in the service.