Acknowledgements
With thanks to the pan-Sussex Safeguarding Adults Boards whose guidance for providers has been adopted to produce this document.
1. Introduction
1.1 This guidance is produced on the best available understanding of the issues; however, organisations that provide care and support should also refer to the latest CQC guidance, and if necessary, their own legal advice, in more complex matters.
1.2 This guidance was developed with the partners of the Torbay and Devon Safeguarding Adults Partnership and aims to support best practice principles across all partner service settings including hospital settings and in patient care settings.
1.3 Many safeguarding adult concerns raised to Torbay and South Devon NHS Foundation Trust or Devon County Council pertain to incidents between adults with care and support needs in service settings. This guidance has been produced to:
· Assist those organisations who provide care and support services to determine when they should raise a safeguarding adult concern referral to Torbay and South Devon NHS Foundation Trust or Devon County Council; and,
· Ensure that those organisations who provide care and support services are aware of when a safeguarding adult concern should be raised to the Torbay and South Devon NHS Foundation Trust and Devon County Council as well as the requirements for statutory notifications to the Care Quality Commission (CQC) for NHS and Non NHS providers (in respect of providers registered under the Health and Social Care Act 2008); and,
· Identify examples of the actions to be taken in respect of incidents between adults with care and support needs that do not require a statutory notification and how these actions will be assessed by Torbay and South Devon NHS Foundation Trust or Devon County Council.
2. Scope
2.1 Incidents between adults with care and support needs in a service setting can include any interaction involving two or more adults in any setting, involving physical, psychological/emotional, sexual, financial, or discriminatory abuse or behaviour, which results in the risk of harm, or actual harm.
2.2 The Social Care Institute for Excellence (SCIE) Resident to resident harm in care homes and other residential settings: a scoping review, published in August 2021 identified ‘‘types of resident to resident abuse: verbal (yelling, screaming), physical (hitting, kicking, pushing, throwing things), sexual (inappropriate touch, exposing themselves), violation of privacy and taking/damaging another’s belongings. Linked to this was bullying, mainly highlighted in ‘senior living facilities.’’ In some cases, resident to resident abuse may also be domestic abuse, for instance a couple or siblings who move together to live in a care home or people who have begun a relationship while living in a hostel, where one partner or family member is abusive.
2.3 Not all incidents between adults with care and support needs in a service will require a safeguarding adult concern to be raised. Agencies must use their own internal incident policy and processes to ensure that all incidents are reported using the appropriate procedures. What is important is for each incident to be considered according to the individual circumstances of the situation, and a professional judgement reached.
2.4 A degree of conflict on occasions is to be expected in all relationships. This applies equally to environments where people with care and support needs live together or spend shorter or longer periods of time together. There may be times when the actions of one adult in a service setting towards another goes beyond usual conflict and their behaviour is abusive, causing harm.
2.5 This guidance is relevant to all providers of health and social care services to adults in Torbay and Devon to enable organisations to understand when a safeguarding adult concern referral to Torbay and South Devon NHS Foundation Trust or Devon County Council is required.
2.6 This guidance is in addition to, and does not preclude all organisations from adherence to, their own specific policies and procedures relating to incidents between adults in service settings, along with any other relevant legislation, policy and guidance.
2.7 Where the incident has taken place in a hospital, if following NHS internal processes there remains doubt as to whether a safeguarding adult concern referral should be made, then guidance must always be sought from the Safeguarding Adult lead within the hospital.
2.8 The severity of the incident needs to be considered alongside the level of harm experienced by the individuals involved and should be referred to the police if there is a concern that a crime has been committed.
3. Responsibilities of care and support providers
3.1 Preventing incidents between adults with care and support needs wherever possible is always the preferred approach. Those in receipt of services should expect to be supported or cared for in a safe environment. Abuse by other adults in the service who also have care and support needs themselves is just as harmful as any other form of abuse. Provider services should ensure that interventions and support arrangements are in place to minimise the risk of abuse between adults using their service.
3.2 Where there are systemic failings in a provider’s management processes which lead to repeated incidents between adults in that service, consideration should be given as to whether a safeguarding enquiry into organisational abuse is required. There is an obligation on all services involved to identify such failings and ensure that safeguarding adult concern referrals are raised where necessary, and that issues are addressed.
4. Good Practice in the management of incidents involving adults in service settings
4.1 Having robust and comprehensive pre-admission assessment arrangements to establish an individual’s previous and current needs.
4.2 Considering the potential impact, where appropriate, on existing adults in the service prior to the placement or person starting to use the service and keeping the compatibility of all adults in that service under review.
4.3 The inclusion of anti-bullying, issues of inappropriate interactions between adults in the service and between staff and adults, being included in relevant policies and procedures.
4.4 Promoting a positive culture of mutual respect where individual rights and responsibilities are discussed with adults in the service, and the Mental Capacity Act principles of least restrictive practice are followed and confirmed in the service documentation.
4.5 Understanding how to support adults who are involved in incidents through assessment of needs and risk. Ensuring care and safety plans are reviewed to mitigate the risks to all the adults involved and linking them in with appropriate support services.
4.6 Clear and up to date care and support plans which provide staff with direction on how to promote the safety of adults in their service.
4.7 Having measures in place to positively support those with known behavioural difficulties.
4.8 Ensuring that staff have appropriate training and know how to identify, record and review incidents involving adults in the service.
4.9 Ensuring that staff numbers are sufficient to meet the needs of the adults in the service.
4.10 All agencies to ensure that notification procedures such as internal incident reporting and action, CQC notifications and reporting the concern to the Local Authority if it is considered a reportable concern, and commissioners of care (see grid at the end of this document for further guidance) as appropriate. This should include, where appropriate, informing the adults’ families or nominated representatives.
4.11 Ensuring that measures are in place to secure the safety of people within or visiting the service.
5. Post Incident Reviews
5.1 When an incident occurs between adults with care and support needs within a service, the details should be recorded to identify any potential patterns. As a minimum, information should be recorded, detailing the incident date and time, the adults involved, members of staff on duty, and the circumstances immediately prior to the incident and any other relevant information.
5.2 Consider whether harm occurred?
· What are the extent of any injuries?
· Was there any psychological harm?
· Was there any sexual abuse (including inappropriate touching)?
· Was there any verbal/discriminatory abuse?
· Was there any objects involved that caused injury?
· Is there any CCTV footage available to help establish the facts?
5.3 Do the adults involved have the mental capacity to understand what has happened? If so, what is their view as to what has happened. If not, is a Mental Capacity Act assessment required (including consideration of executive functioning)?
5.4 Was this an isolated incident with any of the adults involved?
· If no, have any of the adults been involved in any other previous, and or similar incidents?
· Have care/case notes and other records been examined to check this (including any background history)?
5.5 Reviews of risk assessments and care plans should always be undertaken following each incident.
5.6 Senior managers should review post incident information on a frequent basis to determine whether certain adults are regularly involved – either as the victim or the person alleged to be the cause of risk – and the staff on duty at the time.
5.7 Reviews should consider lessons learnt, whether the incident could have been prevented, and the need for changes to avoid similar incidents recurring.
5.8 The post incident findings may also trigger the need for a further review and updating of risk assessments and / or a safeguarding adult concern referral being raised. Consider direct conversation with commissioners of care for
6. Lower level incidents which may not require a safeguarding adult concern referral to be raised to the Local Authority
6.1 Non-reportable concerns are those where the threshold for a safeguarding enquiry is unlikely to be met.
6.2 Examples include (not exhaustive list):
· Isolated incident between adults using a service where no significant harm has occurred, and actions are taken to minimise the risk of reoccurrence.
· More than one incident, over a four week period where no significant harms occurs, and it can be evidenced clearly that:
· A care plan and/or risk assessment is in place, have been updated accordingly and changes implemented with adequate monitoring and review – ensuring all staff aware of amendments to appropriately manage increased needs and risks, and that this is shared in daily staff handovers.
· All necessary action is taken to minimise further risk.
· Other relevant professionals have been notified.
· There has been full discussion with the person, and/or their representative.
· No other indicators of abuse or neglect.
6.3 Where there are several low-level incidents consideration should be given as to whether to raise a safeguarding adult concern referral as the threshold may be met for a safeguarding enquiry due to increased risk.
(Please see grid at the end of this document for further guidance on non-reportable and reportable concerns).
A practitioner should always seek support from their organisational safeguarding lead if in doubt, as to whether a safeguarding adult concern should be raised to the Local Authority.
7. When should an incident between adults be raised as a safeguarding adult concern referral to Torbay and South Devon NHS Foundation Trust or Devon County Council?
7.1. A Safeguarding adult concern referral will always need to be raised where the incident triggers a notification to CQC and/or a report to the Police.
7.2. A CQC notification is required where the cause or effect of an adult/patient incident results in:
· Death
· Injury
· Abuse or an allegation of abuse
· An incident reported to or investigated by the police
7.3 In addition, Torbay and South Devon NHS Foundation Trust and Devon County Council expects a safeguarding adult concern referral to be raised where the person or persons in question came to harm and/or required a hospital admission.
In this context ‘harm’ is defined as any physical or mental change experienced by an individual that is caused by, or considered likely to have been caused by, the incident which results in a permanent increase to a person’s care and support needs and/or a high level of distress. If a safeguarding concern is raised, this must also be reported to the commissioner of care to consider a response within their well-being duty.
8. Raising a safeguarding adult concern
In the first instance the organisations’ Responsible Person or Safeguarding Lead should be consulted. Should it be determined that a safeguarding adult concern referral is required then this should be made to the relevant Safeguarding Adult Service:
We encourage Safeguarding Adult concern referrals to be raised via the Torbay and Devon Safeguarding Adults Partnership website Home – Torbay and Devon Safeguarding Adults Partnership
Alternatively, contact can be made via telephone or email as follows:
For those adults living in Torbay:
Call the Torbay Safeguarding Adults Single Point of Contact Team on 01803 219700 (Monday to Friday, 9.00 am to 5.00 pm)
Outside of the hours above or on bank holidays call the Emergency Duty Service on 0300 4564 876.
Email:
safeguarding.alertstct@nhs.net
For those adults living in Devon:
Call the Devon Safeguarding Adults Service on 0345 1551 007 (Monday to Thursday 9.00 am to 5.00 pm, Friday 9.00 am to 4.30 pm).
Outside of the hours above or on bank holidays call the Emergency Duty Service on 0345 6000 388.
Email:
adultsc.safeguardingadultservices-mailbox@devon.gov.uk
