DCS_CONFCM_009

Section 1a – Alleged victim details and concerns.

Is this an institutional concern? / Service details
Yes / No / Name
If “yes” complete service details and move to section 1b – worker details;
If “no” move to AV details / Address
Tel number
AV Name / NCC ID
Address
Telephone / Gender
DOB / Age

Section 1b – Worker details.

Worker leading SOVA investigation / Organisation & Contact address
Job role / Tel no
Date of SOVA notification
Date of strategy discussion/meeting

Section 2 – Contents of investigation report.

Section 1 / Alleged victim details and concerns
Section 1a / Worker details
Section 2 / Contents of investigation report
Section 3 / Main investigation report
-Background
-Chronology
-Method(s) of investigation
-Investigation summary
-Continuing risk factors identified
-AV’s desired outcomes
-Conclusion (including investigator decision of outcome)
Section 4 / Outcome of safeguarding investigation
Section 5 / Authorisation
Appendix of evidence
( please list attached evidence or detail where evidence is available from should it be required) / Evidence / Date obtained
Description / Available from
(e.g. photographic evidence) / (e.g. Acute hospital record, patient number: 12345 – Northampton general hospital or “attached in appendix”)

Section 3 – Main investigation report.

Background
Chronology
Method(s) of investigation
Investigation summary
Continuing risk factors identified
Alleged victims desired outcomes:
Please indicate any desired outcomes the AV hope will be achieved by the safeguarding intervention. (Please ensure these outcomes, wherever possible are SMART: Specific, Measurable, Achievable, Relevant and have a Timescale). Where the AV is able to give desired outcomes in their own words this should be indicated by quotation marks (“ “). It may be difficult to make outcomes SMART in these instances but precedence should be given to recording the AV’s views in their own words.
Conclusions(including lead investigators recommendation for outcome)
On the balance of probability the lead investigator recommends the SOVA outcome is recorded as:
Substantiated / Partially substantiated
Not determined / Not substantiated

Section 4 – Outcome of safeguarding investigation.

Please record lead investigators recommendation of actions required following SOVA investigation.
Investigation complete - Further Action required under safeguarding procedures
Is a protection plan required as a matter of urgency / Complete protection plan form SA4
Complete sec 5 of form - authorisation
Does a case conference need to be convened / Convene case conference
Complete sec 5 of form - authorisation
Police investigation / Ensure police referred to investigate
Complete sec 5 of form - authorisation
Investigation complete - No further action required under safeguarding procedures
Protection plan to be incorporated into ongoing care plan and review arrangements / Complete or amend protection plan form SA4 and ensure relevant aspects are incorporated into day-to-day care plans
NFA within safeguarding procedures (not a regulated/commissioned service) / Complete sec 5 of form - authorisation
Complete safeguarding outcome form
NFA within safeguarding procedures (regulated/commissioned service) – provider information passed to commissioning/contracts / Pass safeguarding information to commissioning / contracts
Complete sec 5 of form - authorisation Complete safeguarding outcome form
Other
Further details
Are other vulnerable adults potentially at risk either individually or as a result of institutional concerns? / Raise individual notifications
Or
Raise institutional notification
Are there any potential concerns regarding the welfare or safety of children? / Alert your line manager and refer as appropriate to the police & children’s services

Section 5 - Authorisation

Lead worker completing investigation form (name & job role) / Signature / Date
Manager authorising investigation form (name & job role) / Signature / Date

Section 6 – Information sharing

Where appropriate a copy of this form should be forwarded to the people involved in the strategy discussion/meeting and to other individuals and/or organisations that may have a safeguarding interest in this case for their records. Please give details of relevant parties provided with a copy of this form:
Name / Job role / Organisation (if applicable)

Appendix.

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