Guidance to Record Safeguarding Adult Information

Guidance to record Safeguarding Adult Information

Some organisations complete electronic forms and others input direct onto the Integrated Adult System (IAS). The format may look different on both these systems but the questions are the same.

If you are not completing directly onto the IAS system please check you are completing the most up-to-date paperwork

SAFEGUARDING ADULT CONCERN FORM

HAS THE ADULT GIVEN CONSENT TO SHARE INFORMATION WITH TASPB

Please delete as appropriate. i.e. :-

Yes = the Adult has given consent

No = the Adult has not given consent - If no please state reasons for raising concern this means why has the concern been raised without the Adults consent e.g. adult at risk does not have capacity or others at risk.

NAME:

Please complete the adult’s full name. If raising for an organisation/team/ward, please complete the name of organisation/team/ward

M/F

Please delete as appropriate. If the concern is for an organisation/team/ward this information can be omitted.

DOB

Date of Birth for the Adult.If the concern is for an organisation/team/ward this information can be omitted.

ADDRESS

Please include full address, including post code.

CONTACT DETAILS

This is the contact details for the adult. If the concern is for an organisation/team/ward this information can be omitted.

ETHNICITY

Please complete as appropriate.

If the concern is for an organisation/team/ward this information can be omitted.

DATE OF INCIDENT IF KNOWN

This is the date the incident occurred. If this took place over a period of time please indicate start date and end date

DETAILS OF THE CONCERN

PRESENTING ISSUES

Please complete brief details indicating the reason why this is a safeguarding concern. This box will expand to accommodate text. This information will inform the strategy meeting to confirm what the issues and risks are.

DATE CONCERN RAISED

This is the date the concern is raised by the SAM

CATEGORY OF PRESENTING ISSUES

Please select category as appropriate based on the presenting issues as detailed. If there is not a relevant category please select other.

LOCATION OF ALLEGED ABUSE

Please select category as appropriate

WHY IS ADULT AT RISK

Please select category as appropriate. More than one category can be selected.

FURTHER DETAILS

NAMEAND DESIGNATION OF SAFEGUARDING ADULT MANAGER RAISING CONCERN

This is the SAM who raises the concern. Please complete name of SAM and their job title.

ORGANISATION/ TEAM /WARD DEPARTMENT/ TELEHONE NUMBER/EMAIL ADDRESS

Please complete the contact details of the SAM raising the concern as appropriate.

PLEASE INDICATE NAME OF SAM, CONCERN DISCUSSED WITH, WITHIN COMMISSIONING ORGANISATIONS (IF APPLICABLE)

Where adult is in receipt of commissioned services this is the name of the SAM you discussed the concern with

DATE DISCUSSION TOOK PLACE

This is the date the SAM was contacted in the Commissioned Service to discuss this safeguarding concern

DATE OF INITIAL STRATEGY MEETING

This is the date the initial strategy meeting took place. There may be more than one strategy meeting.

TYPE OF ENQUIRY

Select option as appropriate.

Stat enquiry:-

The criteria for a section 42 individual are an adult who is believed to:

• Be experiencing, or at risk of, abuse or neglect; AND
• Have needs for care AND support (whether or not the local authority is meeting any of those needs); AND
• As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.

Non stat enquiry:-

These enquiries would relate to an adult who:

• Is believed to be experiencing, or is at risk of, abuse or neglect
• Does not have care AND support needs (but might have just support needs)

If remaining as a concern please provide details of actions taken

To be completed if not progressing to an enquiry. Please indicate what action has been taken to safeguard the adult.

If not remaining as a concern, please provide details or actions taken

Name of Safeguarding Adult Manager leading enquiry

Complete name of SAM identified at strategy to lead the enquiry.

CONTACT DETAILS

Complete contact details of SAM identified at strategy to lead the enquiry

HAS ADULT GIVEN CONSENT TO INVOKE SAFEGUARDING AULT PROCEDURES?

YES

Consent has been given

NO

Consent has not been given

IF NO PLEASE STATE REASON FOR RAISING ENQUIRY

Select option as appropriate.

SAFEGUARDING ADULT ENQUIRY FORM

NAME:

Please complete the adult’s full name.

DOB

Date of Birth for the Adult.If the concern is for an organisation/team/ward this information can be omitted.

ADDRESS

Please include full address, including post code.

CONTACT DETAILS

This is the contact details for the adult. If the concern is for an organisation/team/ward this information can be omitted.

DATE ISSUE CONFIRMED BY SAM (AS DOCUMENTED ON CONCERN FORM)

This is the date that the safeguarding issue was confirmed by the SAM raising the concern.

ALLEGED PERPETRATOR

This section refers to the perpetrator of the alleged abuse.

You must select one of the options based on classifications below:

Classification / Sub-Class
Service provider
This category refers to any individual(s) or organisation paid, contracted or commissioned to provide social care services, regardless of the funding source. This category can include:
•Services organised by the council
•Personal budget /direct payment funded services
•Self-arranged services
•Self-funded services
•Residential and nursing homes that offer social care services
This category excludes health and social care staff or organisations responsible for assessment and care management e.g. CASSRs, NHS Trusts or GPs. These groups would fall into the category of Other. / Service Provider – public sector
Service Provider – private sector
Service Provider – voluntary (voluntary /community organisations, charities etc.)
Other – Known to Individual
This category covers all other sources of risk which are not service provider. The source of risk would be classed as known to individual if the adult at risk knows their name.
Source of Risk for Self-Neglect Cases
Where the type of risk is self-neglect, please classify the source of risk as Other - Known to Individual. / Relative / family / carer
Individual – known but not related
Primary health care
Secondary health care
Community health care
Social care staff – care management and assessment
Police
Regulator
Other public sector
Other private sector
Other voluntary
Other – Unknown to Individual
This category covers all other sources of risk which are not service provider. The source of risk would be classed as unknown to the individual if the adult at risk does not know their name.
Where the source of risk has not been identified, for example if no-one knows who stole a purse, this should be categorised as Other – Unknown to Individual. / Individual – unknown / stranger
Primary health care
Secondary health care
Community health care
Social care staff – care management and assessment
Police
Regulator
Other public sector
Other private sector
Other voluntary

LOCATION OF ALLEGED ABUSE

The location of risk describes where the alleged safeguarding incident took place. Multiple locations can be recorded.

In this section you must complete the location of alleged abuse using classifications detailed below.

Classification / Notes
Care Home - Nursing / Can be used whether the person is at the care home on a permanent or temporary basis.
Care Home – Residential / Can be used whether the person is at the care home on a permanent or temporary basis.
Hospital – Acute / The individual at risk could be a patient or a visitor.
Hospital – Community / The individual at risk could be a patient or a visitor.
Hospital – Mental Health / The individual at risk could be a patient or a visitor.
Own Home / The residence where the adult at risk usually lives. Includes property owned by the individual, family or friends. Can include rented or supported accommodation.
In the community (excluding community services) / Can include places like businesses, offices, pubs and other people’s homes.
Community Service / Can include places like community centres, day care centres, leisure centres, libraries, schools, GP surgeries and dental surgeries.
Other / Includes any other setting that does not fit into one of the above categories.

TYPE OF RISK

The type of risk describes the nature of the allegations made.

In this section please select type of risk for alleged abuse.

Multiple types of risk can be recorded.

Classification / Definition
Physical / Includes hitting, slapping, pushing, kicking, misuse of medication, restraint or inappropriate sanctions.
Sexual / Includes rape and sexual assault, sexual acts to which the adult has not consented, could not consent or was pressured into consenting.
Psychological / Includes emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks.
Financial and Material / Includes 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 Omission / Includes 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 / Includes abuse based on a person’s race, sex, disability, faith, sexual orientation, or age; other forms of harassment, slurs or similar treatment or hate crime/hate incident.
Organisational / Includes poor care practice within an institution or specific care setting like a hospital or care home. This may range from isolated incidents to continuing ill-treatment.
Domestic Abuse / An incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse by someone who is or has been an intimate partner or family member regardless of gender or sexuality. It can include: psychological, physical, sexual, financial, emotional abuse; ‘honour’ based violence; Female Genital Mutilation; forced marriage.
Sexual Exploitation / Involves exploitative situations and relationships where people receive 'something' (e.g. accommodation, alcohol, affection, money) as a result of them performing, or others performing on them, sexual activities.
Modern Slavery / Encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.
Self-Neglect / Covers a wide range of behaviour; neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

CAPACITY AND CONSENT

HAS THE ADULT BEEN ASSESSED AS LACKING CAPACITY TO MAKE INFORMED CHOICES AND DECISIONS ABOUT THEIR SAFETY

This question is specific to the safeguarding concern

'Mental capacity' means a person's ability to make their own choices and decisions.

Under UK law, someone’s capacity is judged according to the specific decision to be made, so a person may have sufficient capacity to make simple decisions but not more complicated ones.

In England and Wales the Mental Capacity Act says that a person lacks capacity to make a decision if they have an ‘impairment of or disturbance in the function of their mind or brain’ (either temporary or permanent), and as a result they cannot do one or more of the following:

Understand the information relating to this particular decision (including its benefits and risks)

Retain the information for long enough to make this decision

Weigh up the information involved in making this decision

Communicate their decision in any way (this could be by any possible means, such as talking, using sign language or even simple muscle movements like blinking an eye or squeezing a hand).

Capacity can also fluctuate during the safeguarding enquiry. If at any point during the safeguarding enquiry a Mental Capacity Act assessment is completed and the individual is found to lack capacity, please record this as ‘Yes’ for that enquiry.

Yes, the individual lacks mental capacity / Where a Mental Capacity Act assessment has taken place and found the individual to be lacking capacity
No, the individual does not lack mental capacity / Where a Mental Capacity Act assessment has taken place and found that the individual does not lack capacity
OR
Where no-one has reason to believe that the individual lacks capacity
Don’t know / Where the safeguarding officer does not know whether the individual at risk lacks capacity or not. This could be because the individual at risk died or became seriously ill before they could be spoken to.

WHERE THE ADULT IS LACKING CAPACITY, DID THEY HAVE SUPPORT OR REPRESENTATION FROM?

For every enquiry in which an individual lacks the capacity to make decisions about the safeguarding incident, practitioners should ensure that appropriate support is provided by an independent advocate. Independent advocates can include friends, family, carers and Independent Mental Health Advocates (IMCAs).

In this section please state who represented the adult. If you have stated “yes” to lacking capacity, choose from:

• An advocate ( this is an advocate who is not a paid worker used to support the adult)
• Family member
• Friend

IF NONE OF THE ABOVE PLEASE STATE REASON WHY

If the adult was lacking capacity and was not represented then the reason why must be documented in this section

MAKING SAFEGUARDING PERSONAL

MSP is about having conversations with people about how to respond in safeguarding situations in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. The Care Act advocates a person centred rather than process driven approach.

DATE PROCESS LEAFLET PROVIDED

In this section please record the date the process leaflet was provided to their individual or their advocate. The process leaflet provides the adult with information regarding the safeguarding arrangements, contacts and timescale.

The leaflet can be obtained in various accessible formats at:

IF NOT PROVIDED PLEASE STATE THE REASON WHY

If the leaflet is not provided to the adult or their advocate the reason why is to be documented in this section.

This can include reasons like: declined, more appropriate to discuss verbally etc.

WAS THE ADULT/ADVOCATE ASKED WHAT THEIR DESIRED OUTCOMES WERE?

Desired Outcomes

These are the wishes of the adult at risk or their representative which have been expressed at some point during the information gathering or enquiry phases.

In this section please select

1. Yes they were asked and outcomes were expressed (complete desired outcomes)

The individual at risk or their advocate was asked if they would like to express desired outcomes and outcomes were expressed.

1. Yes they were asked but no outcomes were expressed (not required to complete desired outcomes)

The individual at risk or their advocate was asked if they would like to express desired outcomes but no outcomes were expressed.

1. Not expressed (not required to complete desired outcomes)

The individual at risk or their advocate was not asked if they would like to express desired outcomes.

IF YES STATE WHAT THE DESIRED OUTCOMES WERE

If you have selected option A please state what the outcomes were.

Please ensure that you include all details gathered throughout the enquiry process

CATEGORY OF OUTCOME EXPRESSED BY ADULT/ADVOCATE

Please select all appropriate categories that summarise the outcomes expressed.

This section should only be completed where outcomes have been expressed.

WHERE YES, WERE THE DESIRED OUTCOMES……

•Fully achieved

All expressed outcomes have been achieved.

•Partially achieved

This could relate to when some outcomes have been achieved or partially fulfilled.

•Not achieved

None of the expressed outcomes have been achieved.

IF NOT ACHIEVED OR PARTIALLY ACHIEVED PLEASE STATE WHY

If you have selected that the desired outcomes stated have not been achieved or have been partially achieved, please document the reasons why in this section

IF NO, STATE THE REASON WHY THIS INFORMATION COULD NOT BE OBTAINED FROM THE INDIVIDUAL OR THEIR ADVOCATE

If Option C has been selected and outcomes have not been obtained please document the reasons why in this section

DID THE REQUEST FOR A DESIRED OUTCOME CHANGE DURING THE COURSE OF THE SAFEGUARDING ENQUIRY

If desired outcomes have been expressed a response to this question is required. Please select:

• Yes

If during the safeguarding enquiry the adult or their advocate changed their desired outcomes please use this option.

• No

If during the safeguarding enquiry the adult or their advocate did not change their desired outcomes please use this option.