Safeguarding Adults – Care Home Early Indicator Form

PLEASE NOTE: This is NOT A form to report Safeguarding Adults Concerns - Please call 01484 414933

·  The checklist to be used by Professionals when visiting care homes within Kirklees.

·  Please complete the information requested, this will be collated to form an overview of practices within care homes where this will be shared.

·  Please note issues and concerns are everyone’s business and it is expected that the issues highlighted on the checklist will be addressed and actions recorded by the Professional at the time of the visit.

Name of Care Home
Name of visiting professional dealing with concerns
Designation / Employer
Date of Visit
Name of person at care home addressing concerns
Points to consider during visit: / The section below has been left blank for the Professional to complete their summary of issues found and actions taken to address issues:
1.Managers and management issues:
Checklist / Summary of issues and actions
Is the Home Manager available during the visit?
Yes ¨ No ¨
Does the Manager have knowledge of service user needs / a good relationship with service users?
Yes ¨ No ¨
Are your concerns taken seriously by Management?
Yes ¨ No ¨
Are there barriers to meeting service users, e.g. specific times only, unable to just ‘drop in’?
Yes ¨ No ¨
2.Staff deployment and attitude issues:
Checklist / Summary of issues and actions
Do staff appear knowledgeable and up to date about care needs and service users’ needs?
Yes ¨ No ¨
Do staff appear supported and is there evidence of leadership?
Yes ¨ No ¨
Do staff respect service users privacy and dignity?
Yes ¨ No ¨
Do staff discuss personal matters in a public area?
Yes ¨ No ¨
is there a private place offered for residents to receive care and visitors?
Yes ¨ No ¨
are call bells and request for assistance acted on in a timely manner?
Yes ¨ No ¨
3. Service users issues
Checklist / Summary of issues and actions
Are service users comfortable, clean, appropriately dressed, have access to call bells
Yes ¨ No ¨
Do they speak freely about their care within the home environment
Yes ¨ No ¨
4. Environment issues to consider:
Checklist / Summary of issues and actions
Is the environment clean, odour free?
Yes ¨ No ¨
Is equipment in working order?
Yes ¨ No ¨
Is there a homely feel about the care environment?
Yes ¨ No ¨
5. Any Other General Comments
Checklist / Please summarise:
Actions agreed with care home.
Timescale
Where this information will be shared

Please Return this form to one of the following:-

Council Employees send to:

Safeguarding Partnership Team,

4th Floor Civic Centre 1,

High Street,

Huddersfield,

HD1 2N

Telephone: 01484 221000 Email:

NHS Kirklees Employees send to:

Greater Huddersfield and North Kirklees CCGs,

Clare Robinson,

Designated Safeguarding Professional (Adults),

Broad Lea House,

Bradley Business Park,

Dyson Wood Way,

Bradley,

Huddersfield,

HD2 1GZ

Telephone: 01484 464000 Email:

Locala Employees send to:

Locala Safeguarding Adult’s Team,

Locala Community Partnership,

1st Floor, Beckside Court,

Bradford Road,

Batley,

WF17 5PW

Telephone: Susan Wallace 07903752465 Ayesha Marshall 07908846011

Email:

SWYPFT Employees send to:

Catherine Smith, Team Leader – Kirklees Care Home Liaison Team

South West Yorkshire Partnership NHS Foundation Trust,

Beckside Court (2nd Floor),

286 Bradford Road,

Batley,

WF17 5PW

Telephone: 01924 284553 Fax: 01924 284552

Email: