Adult Support And

Adult Support and

Protection Policy

List of Contents Page

1.Policy

1.1Introduction

1.2Code of Practice

1.3Legislation

1.4Relevant Mungo Foundation’s Policies

2.Guidance

2.1Factors which may indicate Harmful Behaviour towards and Adult at Risk

2.1.1Significant Harm

2.1.2Harm

2.1.3Who may perpetrate harm?

2.2Learning and Development

2.3Confidentiality

2.3.1General Information

3.Procedures or Reporting and Dealing with Harm

3.1You have a Duty to Report:

3.1.1Principles of Reporting and Information Sharing

3.1.2Communication

3.2Named Person

3.3Rights, Risks and Limits to Freedom

3.3.1Considering the use of Restraint

3.4Reporting Procedure

3.5Responsibilities of The Mungo Foundation’s Staff

3.6Reporting (See Appendix 2: Contact List)

3.7Recording

3.8Responsibilities of Mungo Foundation Managers/Area Managers/Named Person

3.9Dealing with Allegations/Suspicions/Disclosures of Harm

3.9.1What if it is someone within The Mungo Foundation that you are concerned about?

3.9.2Guidance for Staff Directly Observing Harm

3.9.3Dealing with Disclosure of Past or Current Harm

3.9.4Dealing with harm Suspected due to Behaviour or other Indications

3.10Frequent Complaints within The Mungo Foundation

3.11What Happens Next?

3.12Supporting the Adult at Risk of Harm

Appendix 1 Adult Protection Flowchart

Appendix 2 Important Contacts

Appendix 3

1. Policy

Purpose of the Policy

The purpose of this policy is to set out what actions and guidelines are required of staff working in The Mungo Foundation when dealing with adult protection and to ensure effective links are made into each service’s Local Authority Multi-Agency Adult Protection Procedures.

This document should be read in conjunction with your Local Authority Multi-Agency Adult Protection Procedures.

1.1 Introduction

The Mungo Foundation works to empower the people it supports to take control of their own lives, make their own choices, build capacity and reduce risk. However, it also recognises that people can be at risk of being harmed.

The protection of an at risk adult is not an option but a responsibility across agencies. The expectation for all “at risk” adults in our communities is that they are free from any preventable harm or exploitation.

It is a priority of The Mungo Foundation to support and protect any individual who uses our services. We are committed to the protection of service users and the safeguarding and promoting their interests and wellbeing is of paramount concern.

We believe that people receiving services have the right to live their lives free from any form of harm and we expect staff to know what action to take if they observe, suspect, or have reported to them possible harmful incidents; to support them in complaining about instances of harm or neglect.

Guidelines for staff action to be taken in the event that harm is suspected or witnessed can be found at Section 3.

Doing nothing is not an option.

1.2 Code of Practice

In preventing or responding to potential harm to the people we support, The

Mungo Foundation undertakes to:

• Give paramount consideration to the welfare of the people we support to keep them safe from harm;
• Ensure it will protect adults it works with from exploitative relationships. In such circumstances where it is found that an adult is at risk then we undertake to liaise with Local Authority Social Work Services to ensure that the adult continues to receive a service as agreed as appropriate;
• Ensure the interests and wishes of the at risk adult remain central to every stage of the process;
• Ensure the people we support have access to independent Advocacy Services when required;
• Act to safeguard the right of every person to be safe from harm;
• Ensure that all physical care and contact required by an individual is detailed in support plans, agreed by a Multi-Disciplinary Team and review regularly;
• Ensure each and every member of staff who suspects or has evidence that a person is suffering or likely to suffer from harm to report the matter using the guidance provided;
• Take whatever steps are necessary to protect the person, and such action will take priority over all other work, recognising that adult protection is placed above all other operating principles and supersedes the principle of confidentiality;
• Gather initial information on allegations of harm or risk of harm regardless of the source of the allegation and report these to the relevant authority;
• Act in the best interests of adults who do not have the mental capacity to make informed choices;
• Respect the autonomy, diversity and confidentiality of adults who are being harmed;
• Ensure that the person’s communication and physical needs are met so that they can participate in discussion and decision making;
• Provide training for staff on preventing, recognising and responding to harm;
• Work in conjunction with guidelines provided by the relevant Local Authority;
• The relevant legislative references are found in part 4 of this policy and details of other relevant The Mungo Foundation’s Policies and Procedures are found in part 5 of this policy.

1.3 Legislation

In Scotland, there are three Acts of the Scottish Parliament which relate specifically to adult protection. These are:

• Adult Support and Protection (Scotland) Act 2007: This Act imposes duties on, and assigns functions to, local authorities in respect of the making of enquiries, the conduct of investigations, the application for protective powers in respect of adults defined by the legislation to be at risk of actual or suspected harm. This Act also brought about the creation of Adult Protection Committees in every local authority area.

• Adults with Incapacity (Scotland) Act 2000: This Act imposes duties on, and assigns functions to, local authorities in relation to the making of enquiries in respect of adults who lack capacity, and the creation, application and supervision of proxy decision making powers in respect of such adults. Under the terms of Section 10 of the Adults with Incapacity (Scotland) Act 2000, the local authority must investigate “any circumstances made known to them in which the personal welfare of an adult seems to be at risk”. This means that, the local authority must investigate allegations of harm involving an adult who lacks the capacity to make or convey decisions for him or herself, whether the adult concerned agrees to the investigation or not. It is the function of the Public Guardian to investigate situations of suspected financial harm involving adults who lack capacity under Section 6 of the same Act.

• Mental Health (Care & Treatment) Scotland Act 2003: This Act imposes duties on, and assigns functions to, local authorities and health boards in respect of social and mental health wellbeing, the making of enquiries in respect of persons who appear to have a mental disorder, and (where necessary) the application of compulsory measures in relation to the assessment and treatment of persons having a mental disorder.

1.4 Relevant Mungo Foundation’s Policies

The following policies exist, to assist staff in supporting service users, the prevention of harm and reporting incidents/alleged incident and should be followed at all times:

• Bullying and harassment of Service Users
• Complaints, Suggestions and Comments
• Incident Reporting
• Intimate Care
• Management of Challenging Behaviour
• Restraint
• Code of Conduct
• Confidentiality and Data Protection
• Gifts and Gratuities
• Lone Working Policy;
• Recruitment and Selection Policy;
• Service Users Finance
• Financial Standing Instructions
• Medication Policy

It is the responsibility of adult protection agencies such as Social Work Services and the Police to make enquiries (proactive and reactive) and to carry out appropriate investigations in order to establish:

a) Whether or not an adult is at risk from harm or suspected harm; and, if so

b) Which, if any, of the protective measures available in terms of the legislation are most appropriate to an adult at risk’s individual circumstances.

It is, however, everyone’s responsibility to report concerns regarding any adult who is, or who appears to be, at risk of harm to Social Work Services. If you are concerned that a at risk adult is at risk of exposure to criminal activity such as fraud then the Police must be notified as well as Social Work.

However, in order to avoid confusion and to have clear lines of accountability, The Mungo Foundation’s staff should report concerns directly to their Line Manager/named person in the first instance. The procedure outlined at Section B sets out the reporting guidelines.

For the purpose of the Adult Support and Protection (Scotland) Act 2007, and ‘adult’ is a person aged 16 or over. However, if the adult concerned is 16 or 17 years of age, it is possible that he or she is already subject to a Supervision Order or other Order under the Children (Scotland) Act 1995, or other Social Work for childcare legislation. If staff know that such an Order is in place in respect of that person, they should include that information in their report to their Line Manager/named person. It is the responsibility of Social Work Services to carry out an investigation about anyone who may be subject to such an Order.

Under the Adult Support and Protection (Scotland) Act 2007 ‘adults at risk’ are defined as adults aged 16 or over who:

• Are unable to safeguard their own wellbeing, property, rights or other interests;
• Are at risk of harm; and
• Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more at risk to being harmed than adults who are not so affected.

2. Guidance

Definitions (What is harm?) (Who is an at risk Adult?)

An at risk Adult is defined as someone who is:

• 16 years of age or over
• may be unable to take care of themselves/protect themselves
• in need of community care
• in danger of exploitation
• unable to safeguard their own wellbeing, property or to take steps to protect him or herself from significant harm.

This may include a person who:

• Is elderly and frail;
• Has a mental illness including dementia;
• Has a physical or sensory disability;
• Has a learning disability;
• Has a severe physical illness;
• Is a substance misuser;
• Is homeless.

The presence of a disability or age alone does not signify that an adult is necessarily at risk.

The term HARM is used rather than abuse because abuse would describe a deliberate act but harm is not necessarily deliberate but can have the same effect as when the act is deliberate.

2.1 Factors which may indicate Harmful Behaviour towards and Adult at Risk

These can include one or a combination of the following actions. The following indicators must, however, be used only as a guide.

Harm can be a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an adult. The harm can be multiple, involving some or all of the above.

Harm can occur in anywhere:

• when an adult lives alone or with a relative
• within nursing, residential, supported living or day care settings
• in hospitals
• public places.

Staff should be made aware of any adults using the service that might have come to the service because they have been subjected to harm:

• In their own home;
• In the community;
• Having been harmed by a relative, friend or acquaintance.

Alternatively, adults might be at risk of harm after they come to the service, for example from:

• Someone who is not a service user coming into the service from outside;
• Another individual we support;
• A member of staff.

On some occasions the perpetrator of the harm might be at risk of harm themselves; such as an individual we support who regularly becomes inebriated and puts other service users or members of staff into a state of fear. All parties involved can be considered as being potentially at risk however the person behaving in a harmful manner can also be treated as an adult at risk.

There is an expectation where the perpetrator of harm is a member of staff and that an internal investigation will not take precedence over reporting concerns to allow an investigation by Social Work Services and/or the Police. The procedure outlined at Section B sets out the reporting guidelines.

2.1.1 Significant Harm

In determining what degree of seriousness or extent of harm justifies intervention, a useful starting point is consideration of the concept of “significant harm”. This is described as including:

“Not only ill treatment (including sexual harm and forms of ill treatment which are not physical), but also the impairment of, or an avoidable deterioration in, physical or mental health and the impairment of physical, intellectual, emotional, social or behavioural development”. Ref “Who Decides?” the Lord Chancellor’s Department (1997).

The decision to intervene should be made in consultation with a Line Manager and other involved professionals.

2.1.2 Harm

Harm can consist of a single act or repeated acts and can take a number of forms:

a) Physical harm: hitting, pushing, shaking, inappropriate restraint, force-feeding, forcible administration of medication, neglect or abandonment.

Indicators: injuries inconsistent with person’s lifestyle, bruising, burns, lacerations, broken bones, marks indicating inappropriate restraint, expression of pain, discomfort, sensitivity, distress, tearfulness, changes in appetite and/or weight, anxiety/fear/agitation, reaction to particular place or person.

b) Sexual harm: involving in any sexual activity against his/her will, exposure to pornography, incest, acts of gross indecency, voyeurism and exhibitionism.

Indicators: Change in sexual behaviour or language, pregnancy in women unable to consent to intercourse, wetting or soiling, depression, difficulty walking, passing urine, physical disorders in the genital area, disclosure, hints, comments, sexually explicit art/drawings, secrecy, sudden reluctance to have contact with a particular person or place.

c) Emotional/psychological harm: intimidation, shouting, bullying, isolation of sensory deprivation, manipulation of or the prevention of access to services that would benefit the adult and denigration of culture or religion or humiliation.

Indicators: Change in appetite, low self-esteem, unexplained fear, emotional withdrawal, and change in behaviour, agitation, distress/tearfulness, confusion, and comfort/obsessive/ritualistic behaviour.

d) Financial/Material harm: theft or exerting improper pressure to sign over money from pensions or savings etc.

Indicators: Unexplained sudden inability to pay bills, person lacks belongings, recent friendships that become controlling, unusual bank account activity, e.g. sudden, unexplained withdrawals from accounts, power of attorney obtained when person is unable to give consent.

e) Neglect or Acts of Omission: E.g. being left in wet or soiled clothing, or malnutrition.

Indicators: Inadequate heating/lighting, wearing the same clothes day and night, unclean clothing, poor diet, untreated medical problems, poor personal hygiene, bed sores, and sensory deprivation e.g. not allowed to have glasses or hearing aid.

f) Discriminatory harm: E.g. racial, sexual or religious harassment.

Indicators: Failure to respect cultural/religious needs, exclusion from public services, lack of respect shown, failure to respect dietary needs.

g) Institutional harm: E.g. mistreatment or harm of a at risk adult by a regime or individual by regime, failure to provide a choice of meals or failure to ensure privacy or dignity.

Indicators: Poor care, misuse of medication, inappropriate restraint, lack of recording in client files, denial of visitors, lack of respect, failure to ensure privacy, lack of flexibility around mealtimes, food and bedtimes, lack of response to complaints, restricted access to medical care, bathing and toileting facilities.

h) The similarity between the above acts of harm in relation to adult protection is recognised. However, the key factor in relation to activating adult protection procedures in such situations is that the victim (or suspected victim) must be an adult at risk of harm as defined in the Act.

Any or all of these categories of harm may be perpetrated as a result of deliberate intent, negligence or ignorance.

2.1.3 Who may perpetrate harm?

• A member of staff;
• A member of a recognised professional group;
• A volunteer or member of a community group such as a place or worship or a social club;
• A person we support;
• A relative or friend;
• A carer;
• A neighbour;
• A member of the public who specifically targets an individual

Harm can occur at any time and may result in significant harm to the person subjected to it. It can sometimes be difficult to decide whether a particular act or omission is harmful. Incidents of harm may be, and often are, multiple. They can be either to one person or to more than one person. It is important to look beyond the single incident or breach in standards to the underlying dynamics and patterns of harm.

2.2 Learning and Development

As an allegation of harm can come to the notice of any member of staff at any time, all staff members will receive training in Adult Support and Protection, during an initial orientation, and then as part of an ongoing learning and development programme.

Employees/volunteers will be made aware of the existence of the Adult Protection Policy and their responsibilities in relation to this.

2.3 Confidentiality

There is a clear requirement across agencies to co-operate in relation to the protection of adults seen to be at risk of harm. The Mungo Foundation will ensure appropriate mechanisms are in place for staff to report any concerns to Social Work Services and/or the Police, as may be appropriate in the circumstances. The Mungo Foundation will also ensure that appropriate mechanisms are in to ensure effective risk management and continuing support to the service user.

The interests and welfare of the at risk adult are paramount. To trust a professional worker with private and personal information about you is a significant matter. An adult has the right to believe that such information given in confidence will not be released to others without their consent. As a general principle, the worker must obtain the consent of the individual to the sharing of information.

Where the individual is not able to give informed consent, then the way in which this judgement was made and the evidence for it, must be clearly noted, and the implications considered.

There is a responsibility for all workers to share information on a “need to know” basis where they judge that the best interests of an individual are likely to be served. All workers, therefore, have a clear duty to report suspected harm and concerns if someone is thought to be at risk of harm to their Line Manager. The deliberate withholding of information cannot be defended on the grounds of confidentiality as non-disclosure may impact on the future safety and security of the individual and others.