Responding to Safeguarding Adults Concerns
Reference: / 071 / Published: / 29 April 2014 / Status: / Active
Version: / 1.01 / Reviewed: / — / Owner: / Linda Naylor
Introduction
Legislation
Documentation
Policy & procedure
1.Identification of adult protection concerns
2.Role of the Adult Abuse Investigation Unit police (previously APU)
3.Role of the Centre of Social Care Expertise (SCCE) and MASH
4.Cases already allocated to a worker/team (including occupational therapists)
5.Patients admitted to a hospital
6.Emergency Duty Team
7.Posthumous referrals
8.Concerns raised regarding an unknown or unidentified vulnerable adult
9.CareFirst process
10.Service users who are placed in Norfolk by another local authority
11.Police-only matters
12.Police (AAIU) enquiries of CareFirst
Appendix 1:Process diagram for safeguarding adult concerns through the Social Care Centre of Expertise
Appendix 2:Guidance for care providers – when to notify police – urgent & non-urgent
Appendix 3:Decision tool
Appendix 4:MASH – checklist for initial information gathering
Introduction
This procedure outlines the process regarding receipt of concerns about the protection of vulnerable adults. It is to be read in conjunction with the NorfolkMulti-Agency Safeguarding Policy, Procedures and Legislative Guidance.
The procedure applies to all operational staff within Community Services (Adult Care), Norfolk Learning Disabilities Partnership Board, Norfolk and Suffolk NHS Foundation Trust, and Norfolk Constabulary.
Legislation
Local Authority Social Services Act 1970
National Health Service and Community Care Act 1990
Mental Health Act 1983
Mental Capacity Act 2005 (incl. Deprivation of Liberty Safeguards)
Public Interest Disclosure Act 1998
Registered Homes Act 1984
Care Standards Act 2005
Data Protection Act 1998
Local Authority Circular (LAC(93)7) – Ordinary Residence
Prioritising need in the context of putting people first: a whole system approach to eligibility for social care
Documentation
Safeguarding Adults Referral Form (in CareAssess)
Policy & procedure
- Identification of adult protection concerns
Under local Safeguarding Vulnerable Adults protocol, any worker (paid or unpaid) should identify concerns around the safety of any adult 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 him or her self, or unable or protect him or herself against significant harm or exploitation.
It is the responsibility of all staff to act on the suspicion or evidence of abuse or neglect and to record and pass on their concerns even if there is no criminal element to the safeguarding issues and police colleagues will not be involved.
Workers MUST also ensure that, where there are children in the household/environment, their safety/well-being has been fully considered in the light of any concern raised around the adult. If such concerns ARE identified, workers must contact Children’s Services in the MASH. Responsibility for identifying and alerting around safeguarding covers all children and young people as well as vulnerable adults.
- Role of the Adult Abuse Investigation Unit police (previously APU)
The role of the Adult Abuse Investigation Units is to investigate criminal allegations of abuse and/or neglect against vulnerable adults. Possible criminal evidence and investigations always take priority and should be considered with a sense of urgency.
The referral team for the Adult Abuse Investigation Unit sit in the Multi Agency Safeguarding Hub (MASH) and receive contact from officers as well as the referrals emailed to them. The MASH is staffed between 7am – 7pm Mon – Thurs, 7am – 8pm Fridays and 7am – 4pm at weekends. Norfolk Police Control Room deals with out of hours referrals. Where a strategy discussion has determined criminal investigation is required, cases are then allocated out to the operational part of the Adult Abuse Investigation Unit.
Deciding when to inform the Police of incidents can seem like a daunting task, but there are incidents that should always be reported:
- Incidents involving a death
- Sexual Offences
- Serious Assaults
At the end of this document is a flowchart that illustrates when and how the Police should be informed.
- Role of the Centre of Social Care Expertise (SCCE) and MASH
The SCCE is the principal point of contact for all safeguarding adults concerns arising in respect of vulnerable adults who are not currently allocated to a social care professional or social work team. Calls around active cases will be directly routed to the relevant worker or duty team. Where a vulnerable adult is currently admitted to a Norfolk hospital where a social work service is provided, the social work team or social worker will have the dual role of acting in lieu of the SCCE and liaising with the Adult Abuse Investigation Unit as necessary.
The SCCE will receive information about concerns and assess whether the person is deemed as a vulnerable adult, as defined by the Department Of Health’s ‘No Secrets’ documentation. Where other service needs are identified by the SCCE at the point of referral, the worker will, in addition, generate an Assessment or Review activity and reassign this to the appropriate locality team.
The definition of a vulnerable adult is a person ‘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 him or herself, or unable to protect him or herself against significant harm or exploitation. (DoH No Secrets)
People living in vulnerable situations may not meet safeguarding thresholds. It is important to discuss this with the MASH decision-maker.
Calls coming in to Norfolk County Council, where there is a concern around a vulnerable adult, will be routed into a ‘Safeguarding Skillset’ within the SCCE. An AP from this skillset will sit within the MASH each day and be the first point of contact for these calls. In every case the SCCE AP will record the information using the CareFirst form ‘Safeguarding Adults Referral Form’. They will use the Information Checklist to support the most effective gathering of information. They will then discuss the details with the Safeguarding Adults Practice Consultant or Manager in the MASH. The Practice Consultant/Manager will apply the Decision Support Tool to identify that the vulnerable adult is eligible for further safeguarding assessment/intervention. Workers will link with other agencies within the MASH to gather any further relevant information to most accurately identify ongoing safeguarding needs. The MASH B/RAG assessment tool will also be applied to consider the level of risk at this stage. The SCCE worker will finish and save the referral form on CareFirst with a clearly identified outcome, shown in the completed management overview observation. Those cases not requiring safeguarding interventions will either be signposted to more appropriate referral routes or completed with a no further action outcome. If the referral has met the threshold for safeguarding intervention, the worker will then reassign the ‘Arrange Safeguarding Assessment/Intervention’ activity to the Safeguarding desktop, APADULT. The SCCE AP will produce a copy of the Safeguarding Adults Referral Form in a Portable Document Format (pdf) and email it to the Adult Abuse Investigation Unit at Adult Abuse Investigation Unit – Secure Email. Where there are serious concerns about the immediate safety of a service user, the worker will, when in working hours, ensure that police officers as well as the Manager/Practice Consultant in the MASH are aware of the concerns and any immediate action taken. Out of hours they will telephone the police control room (101 or 999). In all cases the SCCE worker will contact the Practice Consultant in the MASH to notify them of the referral, with the manager in the MASH as back-up. In the unlikely event of the MASH PC/Manager not being available, contact can be made with the Duty Manager.
The MASH Practice Consultant/Manager will then make a decision on the complexity level of the situation, using the B/RAG, and the case will be allocated accordingly. Where the risk is standard and the safeguarding can be safely completed remotely, the MASH Practice Consultant will undertake the activity. Where there is standard to medium concerns the activity will be reassigned to the locality duty teams for allocation. Where the situation is felt to be most complex the Safeguarding Adults Practice Consultants will be allocated the activity. Referrals which do not require further safeguarding will be either signposted or referred for other assessments as required.
- Cases already allocated to a worker/team (including occupational therapists)
Where safeguarding adults issue/concern is identified in respect of a client who is already being assessed/worked-with by the department, it will remain the responsibility of the allocated worker in conjunction with their Safeguarding Adults Practice Consultant (SAPC) to respond to the concerns. It is the intention that the process will mirror the processes that apply within the MASH. They (the allocated worker) will complete the Safeguarding Adults referral form on CareFirst, using the same Information Checklist available to the MASH. The decision around agreeing that safeguarding intervention is required is made with the SAPC/another member of the Safeguarding Adults Team. The outcome of the information gathering and decision-making should again be recorded in the same way as the SCCE. The SAPC/another member of that Team will also make a decision around complexity in order to allocate the piece of safeguarding work most appropriately.
Where a complexity decision is made by another member of theSafeguarding Adults Team and not the SAPC it is the decision makers responsibility to ensure the SAPC is made aware of this decision.. The referral is then finished and saved, produced in a Portable Document Format (pdf) and emailed direct to the police AAIU Adult Abuse Investigation Unit – Secure Email by the agreed worker. They will also liaise with police colleagues regarding the strategy meeting/discussion without delay and always within 72 hours.
Allocated workers/teams will remain responsible for the social care involvement under Safeguarding Adults procedures even when the Adult Abuse Investigation Unit has advised that there is no criminal element.
- Patients admitted to a hospital
Where there are safeguarding concerns about an adult who is an inpatient at a NorfolkHospital where social work services are provided, the social work team will receive the referral and input it to CareFirst. The hospital social work team will become responsible and thereafter follow departmental procedures. This will mean liaising with the SSPC as above. This part of the process is also under review and an update will be made shortly.
- Emergency Duty Team
Where a Safeguarding issue is reported, the EDT Social Worker will fill in a Safeguarding Adults Referral Form on CareFirst and follow the CareFirst process above, including raising a strategy discussion where required. An EDT Manager must be consulted and theirdecision recorded in the Management Overview part of the form. Where further action is necessary the Safeguarding Concerns and ArrangeSafeguarding Assessment activities will begenerated and reassigned to any Active Workerand Team, or reassigned to APADULT where there is no active worker. If no emergency action is required, the EDT SW will either send a high priority EDT Incident to the Allocated Worker & Team to action the next working day or raise the referral, including the Management Overview observation evidencing the decision, and reassign to APADULT.
- Posthumous referrals
Where a safeguarding adult concern is raised regarding a deceased person (for example where the circumstances around the death are suspicious or allegations are made regarding financial abuse or the proceeds of the estate) a referral should be made as though the person were still alive.
- Concerns raised regarding an unknown or unidentified vulnerable adult
This part is under review due to CareFirst changes and likely to be revised within the next few months.
If general concerns are raised about an individual whereby it has not been possible to ascertain the person’s name, a record on CareFirst will still need to be created under Unknown Unknown in order to generate the referral.
If a concern is raised about a residential setting or other organisation but no individual is identified, then a Strategy Meeting Event should be added against the Organisation record in the Safeguarding Adults Context (Organisation Records can be found under the Resources menu in CareFirst). Associated with this Event should be added a Safeguarding Adult Concerns Activity. Both the Event and the Activity should be assigned to the team APADULT. Details of the concerns should be recorded in a linked Observation to the Event (from the Observations folder within the Event). A telephone call to the Purchasing and Quality Assurance Team, who will monitor the concerns raised and liaise with the manager of the Safeguarding Adults Team as appropriate.
- CareFirst process
There are CareFirst process maps available on the Intranet to further support the information in this document.
A flow-chart is also attached for further clarification.
- Service users who are placed in Norfolk by another local authority
For service-users who are Ordinarily Resident in another authority’s area, but for whom an incident or allegation occurs within the county, Norfolk Community Services (Adult Care) have overall responsibility for co-ordinating the safeguarding adults investigation and the authority who placed the vulnerable adult will continue to have a duty for their care management and the allocated social worker should contact the funding authority without delay to inform them of the referral.
- Police-only matters
In cases where information is received, but it is clear there is no social care role for Norfolk County Council, the referrer should be advised to contact Norfolk Police Control Room on 101 to have the information recorded on the CAD system. Police-only information should not be recorded on CareFirst.
- Police (AAIU) enquiries of CareFirst
Norfolk Police Adult Abuse Investigation Unit staff do not have access to CareFirst. They are authorised to make enquiries of CareFirst (ie whether a client is ‘allocated’ to a worker or not and the name and telephone number of that worker). These types of enquiries will be made through the MASH process using the data sharing agreed.
Appendix 1:Process diagram for safeguarding adult concerns through the Social Care Centre of Expertise
Appendix 2:Guidance for care providers – when to notify police – urgent & non-urgent
Appendix 3:Decision tool
Is this safeguarding?
This tool is to be used to determine if a safeguarding referral requires further actions and to assist in prioritising allocation and responsibility.
* Any 2 of these ‘YES’ indicates need to raise and progress investigation
All decisions to be recorded on the Safeguarding referral in Management Overview observationDate & Time decision tool applied.
YES / NO
Eligible for Community Services: in need or receipt of any community service including health provision
Unable to protect themselves from significant harm: evidence of inability to recognise or respond to identified risks/harm
*Identifiable category/categories of abuse; a crime has been perpetrated
*Evidence of serious risk of harm: actual identifiable harm to the individual has occurred or believed to be very likely
*Abusive action has occurred more than once:eg low level of harm on one occasion versus low level on several occasions/widespread poor practice from a provider.
*Intensity of Abuse: eg observed/reported impact on the individual or other vulnerable adults/children is significant
*Abuse occurred in Norfolk (If not refer to appropriate authority)
Perpetrator : Consider potential risk if provider is alleged perpetrator aswider risks are likely
Access to victim: does alleged perpetrator continue to come into contact with the individual
*Potential access to other vulnerable adults/children: wider risks must be considered
Capacity and understanding of victim (Apply MCA guidance): is the person believed to have an impairment to their capacity
Are other Agencies already involved?
Decision recorded on referral –If further safeguarding required, consider B/RAG rating:
RED = Immediate response from Locality
AMBER = Next working day response from Locality
GREEN = May be managed by locality or remotely within 3 working days
Other Outcomes:
Standard Community Care Assessment
BLUE = NFA for Safeguarding – see below
Practice Issues… / Possible abuse…
Meds management – 1 episode of missed or maladministration for one individual.. / …versus one or several for multiple users
Missed care calls – 1 incidence for one individual with no adverse effect, other protective factors in place eg family checks / …several calls missed for one or more service users, indication of adverse effect on individuals
Service user to service user events – one-off with no injury, provider response appropriate – consider if perpetrator requires a separate review of care needs / … one-off with injury incurred; repeat events which indicate provider is not protecting from or managing identified risk
Concern around care worker/provider / other professional – one-off/described as out of character, no evidence of harm caused to an individual / …incident results in significant harm to one or more vulnerable adults; practice appears recurrent or widespread indicating cultural issue
Referrals relating to practice issues may not go forward to an assessment but can still be recorded on referral form and highlighted to Quality Assurance etc, plus discussion with care provider/information shared.