The safeguarding of adults from harm and abuse are an absolute priority for AVOB, its staff, trustees and volunteers. Ignoring abuse is not an option.
This policy outlines our commitment to, and recognition of, responsibility for the protection of the people we work with through our services, who may have care and support needs.
We are committed to the principles contained in the Essex Safeguarding Adults Board ‘Safeguarding Adults Guidelines’. This policy outlines AVOB’s approach to reporting suspected abuse. The Chief Officer, Ray Harris, is responsible for safeguarding within AVOB.
What is abuse?
“Abuse is a violation of an individual’s human and social rights by any other person or persons”
“Adults with care and support needs adults” refers to any person aged 18 years and 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 himself, or herself, or unable to protect himself or herself against significant harm or serious exploitation, …”
We will endeavour to safeguard adults with care and support needs by:
▪ adopting safeguarding adults guidelines through a code of behaviour for staff and volunteers,
▪ sharing information about adult protection and good practice with clients, carers, staff and volunteers,
▪ sharing information about concerns with agencies (Social Care/Essex Police) that need to know, and involving clients and their carers as appropriate,
▪ following carefully a procedure for recruitment and selection of staff and volunteers working in those projects that may have contact with adults who may have , and
▪ providing effective management for staff and volunteers through supervision, support and training.
▪ having robust policies in place to support staff who may have concerns about safeguarding issues including whistleblowing, vehicles, code of conduct and IT.
DEFINITIONS OF ABUSE
Within this policy the following are regarded as abuse:
Discriminatory Modern Slavery
Domestic abuse including honour based abuse
However, it needs to be emphasised that abusive situations are rarely as tidy as the six categories suggest. Many situations involve combinations of abusive elements.
EXPLANATIONS AND POSSIBLE SIGNS
a) Physical abuse
▪ Physical injuries which are not explained satisfactorily
▪ Knowledge or suspicion that injury was inflicted intentionally by the violence of others
▪ Lack of care for the person by formal or informal carers or by others who have responsibility, charge, or care of the individual.
Pushing, pinching, slapping, hitting, burning, force feeding or force medication and restraint of a person might be included under this heading. The extent to which they have occurred and the circumstances in which they have taken place will need to be taken into account.
b) Sexual abuse
Sexual abuse is considered to be the involvement of adults with care and support needs in sexual activities to which they have not given or were unable to give their consent, or which violate the law.
Sexual abuse includes:
▪ Contact abuse – touch eg of breast, genitals, arms, mouth etc, masturbation of either or both persons, penetration or attempted penetration of vagina, anus, mouth with or by penis, fingers or other objects.
▪ Non-contact abuse – looking, photography, indecent exposure, harassment, serious teasing or innuendo.
Adults with care and support needs who have been or are suspected of being physically neglected by either formal or informal carers or any other person who has responsibility, charge or care for the person, to the extent that their health and/or development are significantly impaired. For example this would include an adult with care and support needs who is unable or observed to be unable to self-medicate and is not receiving their medication in an appropriate manner, or any person who has responsibility or charge for a person who fails to safeguard their living arrangements.
d) Emotional abuse
Adults with care and support needs who have been physically abused either by acts of omission or commission on the part of others resulting in humiliation or harassment, for example swearing at, ignoring and denial of their rights. This could include making the individual feel ashamed of involuntary behaviour, blaming them for actions or events beyond their control, or ridiculing them for their conduct; also included could be deprivation of normal social contact and inadequate or improper supervision. Harassment could comprise of bullying, being threatened, or intimidated, or being made to fear for their health and well being.
e) Financial/Material abuse
Adults with care and support needs who suffer material exploitation at the hands of any other person through the misuse or theft of their money, property, possessions, or by having their access to material goods restricted by another person. For example, this includes the misappropriation of benefits due to the individual or preventing access to such benefits.
f) Institutional abuse
Abuse may take place in residential care or nursing homes. The policies of all establishments should ensure that the routines do not neglect people’s ability to receive personal and individualised care and that their rights to privacy, dignity, independence, choice and fulfilment are met. Abuse may be influenced by factors wholly or partly outside the staff member’s immediate control (eg staffing levels, health and safety issues etc). Poor practice in any institutional setting is abuse, and should be challenged through the use of whistle blowing, and guidelines for allegations against staff.
g) Discriminatory abuse
May include racist or sexist remarks or comments based on a person’s impairment, disability, age or illness, and other forms of harassment, slurs or similar treatment.
h) On-line abuse
There are safety risks associated with the Internet, in particular social media sites such as Facebook and Twitter. Risks include malicious users who may try to bully users, offensive or obscene material, identity fraud or spyware. When using the Internet to order goods or services for AVOB, staff should access reputable sites and do so only with the agreement of the Chief Officer. If you believe you are being bullied or harassed online in any way you must report it to the Chief Officer as soon as possible and cease to use the website concerned.
Indicators of Possible Abuse.
The following indicators are the main signs and symptoms which may suggest that some form of abuse might have been, or is, taking place. Caution suggests against establishing adult abuse merely due to the presence of one or more of these indicators without further detailed investigation.
a) Physical abuse
▪ History of unexplained falls or minor injuries
− in well protected areas, e.g. inside thigh, inside upper arm
− on soft parts of the body
− clustered as from repeated striking
▪ Finger marks
▪ Burns of an unusual kind or in unusual places
▪ Injuries, bruises, found at different stages of healing or those where it is difficult to suggest an accidental cause
▪ Injury shape similar to an object
▪ Injuries to head, face
▪ History of changing GP or reluctance to seek GP/services help
▪ Accounts of events which may vary with time and are inconsistent with the physical evidence
▪ Frequent attendance at hospital accident and emergency departments
▪ Malnutrition when not living alone
▪ Quiet and subdued when in the presence of carers, or flinching movements when approached
▪ Ulcers, pressure sores and being left in wet clothing
b) Sexual abuse
▪ Withdrawal, choosing to be alone, unwillingness to make eye contact
▪ Explicit or untypical sexual/language/behaviour by the
▪ Self-inflicted injury
▪ Disturbed sleep pattern
▪ Difficulty in walking or sitting
▪ Torn, stained, bloody or missing underclothes
▪ “Love” bites
▪ Bleeding, sore, torn rectal or genital area
▪ Inadequate physical care (of the individual and the environment) and inattention to the person’s basic needs, including appropriate food, clothing and shelter
▪ Medical needs of person unmet – including failure to seek medical advice for illnesses
▪ Failure to supply essential social stimulation
▪ Repeated failure to prevent (accidental) injury
d) Emotional abuse
▪ Inability to sleep
▪ Change in appetite
▪ Unusual weight gain or loss
▪ Unexplained uneasiness
▪ Low self-esteem
e) Financial abuse
▪ Unexplained or sudden inability to pay bills
▪ Unexplained or sudden withdrawal of money from accounts
▪ Unwillingness by the adult/carer/relative to consider any assistance requiring expenditure beyond natural thriftiness or privacy, and when finances are not a problem.
▪ Unusual interest by family members and other people in the individual’s assets
f) Institutional abuse
Professionals working within institutions are charged with the responsibility of ensuring that the care provided is appropriate and of a sufficient standard to meet the needs and desires of users. It may be harder for a person to complain about abuse in an institution than in the community so it is all the more vital that the appropriate care be provided. Abuse within an institution can be either personal or institutional. The personal abuse issues have already been highlighted.
Institutional abuse occurs when the rituals and routines in use force residents to sacrifice their own life style to the needs of the institution, eg getting up/going to bed. Professionals should ensure that the activities of the day are centred round the service users, and not the institution’s, needs.
Abuse can be perpetrated by an individual or by a group of staff embroiled in the accepted custom, subculture and practice. Abuse by professionals within the rituals of the setting is an abuse of an adult with care and support needs citizenship and is as serious as personal abuse. This should be treated with the same concern.
▪ No flexibility in bed time and/or deliberate waking
▪ One commode used by a number of people; people left on commode for long periods
▪ Dirty clothing and bed linen; only changed when staff considers it necessary
▪ Lack of personal clothing and possessions
▪ Inappropriate use of tip-back chairs and excessive use of cot sides
▪ Un-homely, stark living areas
▪ Deprived environment and lack of stimulation
▪ Inappropriate nursing or medical procedures (eg enemas or catheterisation)
▪ “Batch care” – lack of individual care plans, ritualised care
▪ Inappropriate confinement or restriction
▪ Inappropriate use of power or control
g) Discriminatory abuse
▪ Withdrawal, choosing to be alone
▪ Low self-esteem
▪ Unexplained/unusual non attendance at work, social clubs, voluntary work etc
GUIDELINES FOR WORKING WITH
AVOB recognises that staff and volunteers may also be vulnerable in their work with adults with care and support needs. The following guidelines aim to provide advice and guidance to help protect both clients and staff and volunteers who may be vulnerable to suspected allegations:
▪ Meetings and interviews with potential volunteers should take place as openly as possible. If privacy is needed, other staff members should be informed of the meeting.
▪ When conducting home visits, staff should ensure the details are left with their line manager or in their office diary and they should follow the procedure as set out in the Health and Safety policy.
▪ Staff and volunteers should ensure they keep detailed case notes of home visits or contact with clients, which give an accurate reflection of the meeting, and the work that has taken place.
▪ Any member of staff who feels uncomfortable in any situation should raise this with their line manager and arrange to undertake the home visit with another member of staff.
▪ Staff and volunteers should not meet with clients outside of organised work activities /time unless it is with the knowledge and consent of the person in charge of the organisation.
▪ Any person who has found him or herself in a potentially vulnerable situation should report the circumstances to their line manager immediately.
It is expected that all staff follow the SET Safeguarding Adults Guidelines (for full set of procedures see www.essexsab.org).
1. If staff suspect an adult with care and support needs is being abused or is at risk of abuse, they are expected to report concerns to a line manager or Chief Officer (unless they suspect that the line manager or Chief Officer is implicated – in such circumstances the whistleblowing policy should be followed).
2. If at any time staff feel the person needs urgent medical assistance, they have a duty to call for an ambulance or arrange for a doctor to see the person at the earliest opportunity.
3. If at the time staff have reason to believe the individual is in immediate and serious risk of harm or that a crime has been committed the police must be called.
4. A SET SAF 1 form must be completed where there are allegations of abuse and sent immediately to the relevant Social Care area. Guidance notes are available on www.essexsab.org.uk A call can alternatively be made to Social Care Direct on 0345 603 7630. This is sometimes known as a Section 42 Enquiry. All service users need to be safe. Throughout the process the service users needs remain paramount. This process is about protecting the adult and prevention of abuse. Alleged abuser and victims who are both service users. It is important that consideration be given to a co-ordinated approach and partnership working, where it is identified that both the alleged abuser and alleged victim are service users.
Where both parties are receiving a service, staff should discuss cases and work together, however meetings with both the alleged abuser and alleged victim in attendance, are not considered appropriate.
Allegation of abuse staff member
Employees should be aware that abuse is a serious matter that can lead to a criminal conviction. Where applicable AVOB’s disciplinary policy should be implemented.
Confidentiality and information sharing.
The Care Act 2015 states that the government expects organisations to share information about individuals who may be at risk from abuse. This is also stressed by Safeguarding Adults [ADSS 2005] the framework for good practice. It is important to identify an abusive situation as early as possible so that the individual can be protected. Withholding information may lead to abuse not being dealt within a timely manner. Confidentiality must never be confused with secrecy. Staff have a duty to share information relating to suspected abuse with Social Care and Essex Police.
Consent is not required to breach confidentiality (capacity issues must be considered) and make a safeguarding referral where;
• A serious crime has been committed
• Where the alleged perpetrator may go on to abuse other adults
• Other are at risk in some way
• The adults with care and support needs adult is deemed to be in serious risk
• There is a statutory requirement e.g. Children’s Act 1989, Mental Health Act 1983 and 2007, Care Standards
• The public interest overrides the interest of the individual
• When a member of staff of a statutory service, a private or voluntary service or a volunteer is the person accused of abuse, malpractice or poor professional standards.
If a worker has any doubt about the legality of sharing information, they must in the first instance consult their manager.
In line with the Mental Capacity Act AVOB assumes that adults (16 and over) have full legal capacity to make decisions for themselves (the right to autonomy) unless it has been established that they lack capacity to make a decision for themselves at the time the decision needs to be made. AVOB will give the appropriate help and support to enable them to make their own decisions.
If a third party is needed to make decisions on behalf of a person who lacks capacity any decisions made should be in the best interests of the individual and the person who lacks capacity should be involved in as much of the decision making as possible.
GUIDELINES FOR TRANSPORTING ADULTS WITH CARE AND SUPPORT NEEDS
Any member of staff or a volunteer who is asked to drive the minibus will receive MIDAS training before being allowed to take the vehicle on the road. In addition, drivers will undergo a DBS check at enhanced level prior to driving passengers. In circumstances where a DBS check is pending drivers and volunteers will only work in the presence of another member of staff or volunteer who has been DBS checked.
Whilst transporting adults with care and support needs in the minibus or their own vehicle drivers must never:
• Undertake tasks and extra duties for clients over and above what is required without the permission of the Chief Officer.
• Converse/sit with in the rear of the vehicle without another responsible adult in attendance.
• Allow or engage in inappropriate touching.
• Allow the use of inappropriate language to go unchallenged.
• Make sexually suggestive comments even in fun.
• Allow allegations regarding an adult with care and support needs to go unchallenged, unreported or not acted on. If an allegation is made this policy gives instructions on what steps should be taken.
• Ignore any suspicions they may have that a client is being abused in some way but should report this to the Chief Officer and follow the guidance in this policy.
MANAGEMENT AND SUPERVISION OF STAFF AND VOLUNTEERS
AVOB’s commitment to protecting adults with care and support needs from abuse includes ensuring that relevant staff and volunteers are supervised and supported in their work with service users. With this in mind:
▪ (New) staff and volunteers will be familiarised with policies, procedures and our expectations of them.
▪ Staff and volunteers’ progress will be reviewed after a three month period, and finally after a six month probationary period.
▪ Staff and volunteers will receive regular supervision.
▪ Where appropriate, staff and volunteers are provided with opportunities for training and learning.
STAFF AND VOLUNTEER DECLARATION
The following are expected to sign their acceptance and understanding of this policy prior to undertaking any work or role relating to AVOB:
▪ All staff and volunteers
The Chief Officer will be responsible for monitoring this policy. This policy will be reviewed annually.
Contact details for the Essex Safeguarding Adults Board are as follows:
Telephone number for advice – 03330 131019
Email address – email@example.com
ESAB Support Team
E3 (Zone 1)
Reviewed July 2004
Reviewed and amended October 2004
Reviewed April 2006
Reviewed August 2009
Reviewed and amended March 2011
Reviewed January 2015
Reviewed January 2016
Amended July 2016
Reviewed and amended 2018
THE INITIAL RESPONSE FLOWCHART – This flowchart is aimed at all staff
PRE STAGE ONE – THE INITIAL RESPONSE
Event / concern disclosed – Is immediate medical attention required?
* Unless manager is alleged perpetrator or implicated in concern. In these circumstances identify alternative manager or discuss directly with social services
Health Care Organisations should follow local process for reporting which integrates Clinical Governance and Safeguarding
Ensuring the safety of adults with care and support needs and any other people at risk is the primary responsibility of staff when they become aware of a serious incident
Is incident so serious that immediate police attendance is required? (E.g. rape, serious physical or sexual assault, robbery)
Provide first aid
Ensure safety of victim
Call ambulance / doctor
Ensure safety of victim
Call police (999)
Think ‘preservation of evidence’ – see guidance notes
Notify Manager *
If criminal allegation is made, contact local police station to report crime and obtain crime reference / incident number.
Notify Manager * and complete form SET SAF1 following local instructions for reporting If criminal allegation of a minor nature is made, contact Police Domestic Abuse Central Referral Unit, report crime and obtain officer in case details.
If crime requires attendance within the day contact local police station for incident number and attendance.
ALSO notify Domestic Abuse Central Referral Unit Manager to consider facts
Manager endorses incident not believed to be safeguarding adult concern. End of safeguarding process
Manager believes incident to be safeguarding adult concern – complete SET SAF 1 following guidance
STAGE ONE OF SAFEGUARDING
Does the incident involve a person or organisation with a responsibility or relationship towards the adults with care and support needs? E.g. family member, carer, close friend
YES / believed to be yes