GUIDANCE TO ASSIST IN PRODUCING AN IN HOUSE POLICY ON ADULT PROTECTION
a)Guidance intended to assist care home owners in drawing up an in house policy
POLICY
The owners/managers of [Home] are committed to preventing the abuse of residents in their care. To that end, they will have regard to the ‘Adult Protection Policy’ produced jointly by Hampshire county council, Portsmouth city council and Southampton city council. And they will ensure that their staff understand the role played by that document in the in-house policy and procedure. They will report to and, as necessary, engage the support of relevant external agencies.
In order to ensure that job applicants are suitable to be employed in the workforce, they will implement stringent recruitment procedures, which, for those who are to be employed in a care position, will include checking their details against the official register of individuals who are deemed to be unsuitable to work with vulnerable people (the PoVA list) before they take up employment.
By the use of training, they will enable staff:
*to recognise and understand abuse;
*to prevent abuse;
*to respond appropriately to allegations, suspicions or incidences of abuse;
*to make necessary reports to in-house management and, where appropriate, to external agencies.
They will ensure that all workers are aware of their individual responsibilities in relation to speaking out (whistleblowing) in appropriate circumstances.
They will operate a disciplinary system which, subject to risk assessment, will enable them to make appropriate arrangements for the suspension of a worker who is accused or suspected of abuse, without prejudice to that individual, pending investigation or adjudication; and they will ensure that all workers clearly understand this system.
They will refer to the PoVA list details of all care workers who have been disciplined for misconduct which harmed or placed at risk of harm a vulnerable adult in circumstances set out in Part VII of the Care Standards Act 2000.
They will make and retain a record of all relevant decisions.
They will ensure that residents in the home understand that, should they make a report of abuse, they will be protected from reprisal and/or intimidation.
ABUSE: WHAT IS IT?
[See also Section 2 of the ‘Adult Protection Policy’]
Abuse has been defined in the following terms:
“The harming of another individual usually by someone who is in a position of power, trust or authority over that individual. The harm may be physical, psychological or emotional or it may be directed at exploiting the vulnerability of the victim in more subtle ways [for example, through denying access to people who can come to the aid of the victim, or through misuse or misappropriation of his/her financial resources]. The [unjustified] threat or use of punishment is also a form of abuse. Abuse may happen as a ‘one-off’ occurrence or it may become a regular feature of a relationship. Other people may unaware that it is happening and for this reason it may be difficult to detect. In many cases it is a criminal offence.”
Although the type of abuse which comes most readily to mind will be the infliction of physical injury — punching, hairpulling and the like — there are, in fact, many ways in which a resident can be harmed. Abuse can be carried out deliberately; it can also be the result of thoughtlessness; then again, it could result from recklessness — where the abuser does actually give some thought to what he/she is doing, but has no regard to possible adverse consequences for the resident.
Perhaps the most pervasive type of abuse to be found in a residential setting will be what has come to be known as institutional abuse: the abuse that arises from poor management and staffing procedures, where unacceptable practices, which may be long-standing, have become the norm.
A consensus has emerged identifying the following main forms of abuse:
Physical abuse
Including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions.
Sexual abuse
Including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting.
Sexual abuse might also include exposure to pornographic materials, being made to witness sexual acts and encompasses sexual harassment and non-contact abuse.
NB The Sexual Offences Act 2003 has created a number of new offences which can be committed by care workers in respect of a person with a mental disorder. Sections 38 to 41 deal with the situation where a care worker involves someone in his care, who has a mental disorder, in sexual activity.
Psychological abuse
Including emotional abuse, threats of harm, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks.
Financial or material abuse
Including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.
Neglect and acts of omission
Including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.
Discriminatory abuse
Including racist, sexist, that based on a person’s disability, and other forms of harassment, slurs or similar treatment.
A resident can be abused by:
*another resident;
*a member of staff;
*an outsider to the establishment — a relative or other visitor.
The following are just a few specific examples of abuse:
—rough treatment when delivering personal care;
—withholding a service, say a bath, as a means of securing the resident’s compliance, perhaps to take medication;
—shouting, bullying, intimidating, humiliating, threatening;
—stealing or otherwise misappropriating the resident’s money;
—sexual abuse;
—forced feeding, denial of privacy and/or dignity.
All staff at [Home] will receive training which will encourage them to be aware of abuse and enable them to recognise the various ways in which a resident can be abused.
PROCEDURE TO BE FOLLOWED BY STAFF
This procedure leans heavily on the ‘Adult Protection Policy’ produced jointly by Hampshire county council, Portsmouth city council and Southampton city council, a copy of which is kept [location].
RISK ASSESSMENT
[See also Section 6 of the ‘Adult Protection Policy’]
Where your concern is aroused, you should take the following into account when assessing what immediate action should be taken:
*the seriousness of the abuse, which in turn will involve:
—the abused person’s own view of the act
—the vulnerability of the individual
—the extent of the abuse
—the length of time it has been occurring
—the impact on the individual
—the risk of the act being repeated or getting worse
*the nature and severity of any injury;
*the risk to the abused resident;
*whether the abuse is against the law;
*the possibility of risk to yourself and to others.
IMMEDIATE ACTION
Your first priority must be to consider how to ensure the safety of the abused person. You must, therefore, consider the following courses of action:
*challenging the abuser and persuading him/her to stop;
*securing medical assistance, either via the resident’s GP or, where necessary,
by calling an ambulance via the ‘999’ system;
*calling the police via the ‘999’ system;
*removing the resident from the scene of the abuse;
*removing the abuser from the scene of the abuse.
When you are considering what action will be appropriate to the circumstances, your clear priority must always be the interests of the abused resident.
CONFIDENTIALITY
[See also Section 10.5 of the ‘Adult Protection Policy’]
We recognise that dealing with a sensitive issue like this can raise difficulties over confidentiality. However, since much wider considerations may have to be taken into account, it may not always be possible for you to maintain strict confidentiality, even where a resident has asked that what he/she has told you should ‘go no further’.
You must report at the earliest possible opportunity any concerns you may have about the abuse or suspected abuse of a resident. The fact that the concern might have arisen as a result of a confidence shared by a resident does not dilute that duty.
REPORTING
[See also Section 4 of the ‘Adult Protection Policy’]
If you witness an incidence of abuse, or suspect, or are told that abuse has occurred, you must report the matter immediately, or as soon as you possibly can, to the owner, the Manager or to the senior member of staff on duty. You can be assured that you will be taken seriously.
If you believe that either the owner or the Manager may themselves be involved, or unwilling to take necessary action, you should consider the following steps:
*speaking to another trusted member of staff who is not already involved;
*seeking advice from a professional or expert organisation: a care homes association or the Commission for Social Care Inspection;
*reporting the matter to the Commission for Social Care Inspection;
*contacting the police and asking for immediate help.
You cannot do nothing. You must be aware that you have an individual responsibility:
a)to take necessary action; and/or
b)to report the matter to others either inside or, where appropriate, outside [Home].
All those making a complaint or allegation or expressing concern, whether they be staff, service users, carers or members of the general public, should be reassured that:
*They will be taken seriously;
*Their comments will usually be treated confidentially but their concerns may be shared if they or others are at significant risk;
*If service users, they will be given immediate protection from the risk of reprisals or intimidation.
If staff, they will be given support and afforded protection if necessary:
—they will be dealt with in a fair and equitable manner; and
—they will be kept informed of action that has been taken and its outcome.
Employees who speak out (whistleblow) against their employers and/or managers in such circumstances are protected by law from being discriminated against as a result [The Public Interest Disclosure Act 1998].
INVOLVING OTHERS OUTSIDE THE HOME
[See also Section 4 of the ‘Adult Protection Policy’]
a)Police
If at any time the situation involves something which is against the law, or the resident or a witness is in danger, then the police must be contacted at the earliest opportunity. In such circumstances, you should be aware that the police will need to gather evidence.
Hampshire Constabulary has arranged for nominated officers in each Sub-Division to be available for informal consultation on whether their involvement is appropriate.
b)Social Workers/Care Managers in the local Social Services Area office
Social services is the lead agency on matters of adult protection. These people will have a key role in the investigation of abuse. You should also recognise that every resident has a right to a social work assessment and support.
c)Commission for Social Care Inspection
The owners are required by law to report to the Commission without delay the occurrence “any event in the home which adversely affects the well-being or safety of any service user”.
d)Family/close carers of the abused person
Such people should be informed of the circumstances, although the wishes of the abused person must be taken into account. This action will normally be taken by management.
RECORDING EVENTS
[See also Sections 10.8 and 10.14 of the ‘Adult Protection Policy’]
When you become aware of abuse or suspect that it is taking place, you must make a detailed personal record of what you have seen, heard or been told about the incident/allegation.
Making and retaining records is important at all stages of the process. When compiling your notes, do so in the knowledge that at some later stage they may be used as evidence in a criminal prosecution. They should, therefore, be made at the time of the event or as soon afterwards as possible. All records/notes must be retained.
You should also be aware of the need to ensure that relevant evidence is preserved.
SOURCES OF ADVICE AND SUPPORT
[See also Section 9 of the ‘Adult Protection Policy’]
Elder Abuse Response:
Telephone: 0800-88088141. All calls are treated in confidence.
Hampshire Office of the Commission for Social Care Inspection:
4th Floor Overline House, Blechynden Terrace, Southampton, SO15 1GW. Telephone: 023 8082 1300.
Hampshire Constabulary:
Contact your local station or telephone: 0845 045 4545.
Public Concern at Work:
(020) 7404 6609 [Monday - Friday, 9.00 am to 6.00 pm]. Initial enquiries can be made anonymously.
Social Services:
Contact your local social services office and ask to speak to the duty officer (details can be found in the telephone directory, listed under ‘social services’).
Voice:
Support for people with learning disabilities who have been abused. Tel: 01332 202555.
Ann Craft Trust:
Support for people with learning disabilities who have been abused. Tel: 0115 951 5400.
Saneline:
Help and advice for people with a mental illness. Tel: 0845 7678000.
Dec 04
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