Acknowledgement
With thanks to the Devon Care Home Collaborative who led the development of this quick guide for all providers of health and social care services to adults in Torbay and Devon. The guidance should be used in conjunction with professional judgement and is not a substitute for the policies and procedures required of organisations who provide care and support services to ensure safe care.
Who is an adult "at" risk?
An adult (somebody aged 18 or over) who:
- has care and support needs (whether or not the authority is meeting any of those needs)
- is experiencing or at risk of abuse or neglect
- their care and support needs are making them unable to protect themselves against either the risk of, or experience of, abuse or neglect
Consent to share information 1
Consent to share information (including raising a safeguarding concern) must be sought from the person at risk.
If consent is refused, consider if
•They are fearful, they are being coerced or being put under pressure
So
•Explore their concerns, and what you can do to reassure or address those issues.
•Consider if there is an overriding public interest which may determine sharing the information even though the person (with mental capacity) doesn’t give consent? For example, there are children or other adults at risk, or the level of risk is so high that not sharing the information could lead to significant harm to the person.
Consent to share information 2
And also consider
•Does the person have mental capacity to make the decision about sharing information ( as defined by Mental Capacity Act)
•If not, do you need to raise a safeguarding adult concern in their best interest?
•Do they have a suitable person to represent them or is there a need for an advocate?
What might constitute a safeguarding concern?
Examples:
1.Falls
2.Service user to service user incidents
3.Medicines management concerns
4.Nutrition/hydration concerns
5.Moving and Handling concerns
6.Pressure Care concerns
7.Concerns regarding financial matters
The following information is a guide for when you are considering if, and when, a safeguarding concern should be raised.
Example 1 - Falls
| Yes to safeguarding referral | Safeguarding referral may not be needed |
|---|---|
| Person has fallen and sustained injury Or Multiple falls Or Falling is a known risk with preventative measures in place (i.e. avoidable harm) Or Appropriate medical attention not sought |
Accidental fall And No injury And All appropriate risk assessments in place and followed |
Further details can be found in TDSAP Falls and Safeguarding – Guidance for organisations who provide care and support.
Example 2 - Service user to service user incidents
Service user to service user incidents
| Yes to safeguarding referral | Safeguarding referral may not be needed |
|---|---|
| When any person has been harmed during an incident (any sexual or physical assault must also be reported to the police)
Where there are repeat low impact incidents (incidents where no adverse effect has been caused) however the risks between persons are not being managed effectively Where the person causing the harm is also a person in need of support, agencies must ensure a reassessment of need and the care or support plan should ensure that safeguards are in place to prevent repeat incidents |
When an incident is a ‘one-off’ and no injury or distress has been caused.
It is the responsibility of the Provider or Manager to ensure that a risk assessment is in place to ensure the immediate safety of all users of the service and to review the support of the individuals involved in the incident |
Example 3 - Medicines management concerns
Medicine management concerns
| Yes to safeguarding referral | Safeguarding referral may not be needed |
|---|---|
An error causes impact which triggers requirement to notify Care Quality Commission, i.e., resulting in
Or |
Single missed or wrong dose and no harm occurs
Medication given late and the medication was not time-sensitive, and no harm occurs
Seek advice from prescribers, record incidents, address any action required with individual staff members through training/supervision and monitor to ensure errors are not repeated.
|
Further detail can be found in TDSAP Safeguarding Adults and Medicines Management – Guidance for organisations who provide care and support.
Example 4 - Nutrition/hydration concerns
Nutrition/hydration concerns
| Yes to safeguarding referral | Safeguarding referral may not be needed |
|---|---|
| Where there is a failure to provide nutrition and hydration to a person. Or Unexplained weight loss or signs of dehydration and the care plan is not in-place or has not been followed or is not up-to-date Or Where there is unexplained weight loss and failure to complete food / fluid charts that are stipulated under the care plan Or Where there is unexplained weight loss and specialist advice has not been sought in a reasonable and timely way. |
Where a person at risk loses weight or is dehydrated and the care plan has been followed and is up to date
Seek medical advice to identify cause and manage nutrition/hydration needs
|
Example 5 - Moving and handling concerns
Moving and handling concerns
| Yes to safeguarding referral | Safeguarding referral may not be needed |
|---|---|
| Where there is no care plan (or an out-of-date care plan) in place for a person who has been assessed as needing assistance with moving and handling Where there is a failure to follow a valid care plan and this is having an adverse effect on the person for example, using the wrong equipment, failure to provide equipment, sitting on slings etc or where 2 carers should provide support, but the task is only completed by 1 carer Where obsolete techniques are used, examples:
Where poor moving, and handling techniques are being used on a repeat basis |
Where poor technique is used on a one-off occasion, or there is a failure to follow care plan one-off occasion, and the Provider is aware and takes appropriate action and no adverse effect on the person
Where there is a failure to use the correct equipment on a one-off occasion, the provider is aware and there is no adverse effect on the person
|
Example 6 - Pressure care concerns
| Pressure care concerns
Failure to assess risk adequately has resulted in a person developing a pressure ulcer. A person develops a pressure ulcer and specialist advice has not been sought in a reasonable and timely way, or a care plan is not in place or has not been followed or is not up to date. A person develops a pressure ulcer, and there is a reasonable belief this is due to a lack of access to appropriate equipment and/or staff not being suitably trained to use this equipment in a timely manner. A person develops a pressure ulcer and there is failure to complete repositioning / turn charts that are stipulated under the care plan A person develops a grade 3 pressure sore there is a responsibility to notify CQC The key indicator is whether the development of a pressure ulcer was avoidable, if so a Safeguarding Adult Concern must be made.
|
A Safeguarding Adult Concern does not need to be made when a person has developed a pressure ulcer which was unavoidable and a care plan is in place and has been followed, repositioning / turning charts have been completed, necessary equipment is in place and staff are appropriately trained.
The Department of Health has issued guidance about pressure ulcers and safeguarding
The guidance includes an assessment that should be completed by a qualified health care professional before determining whether a safeguarding concern should be raised.
|
DoH guidance:
Pressure Ulcers
Example 7 - Concerns regarding financial matters
Concerns regarding financial matters
| Yes to safeguarding referral | Safeguarding referral may not be needed |
|---|---|
|
Issues at this level require further discussion/exploration to understand if there are concerns that abuse and/or neglect is taking place. |