Including

Safeguarding Adults - Preventing Abuse and

Responding to Poor Practice

Practitioner Level

Including

Toilets Fire ProcedureSmoking

Mobile Phones / Devices

Finishing Time

Breaks

Housekeeping

Including

Training Transfer

Getting learning into practice

• “50% of learning fails to transfer to the workplace”

(Sak, 2002)

• “The ultimate test of effective training is whether it benefits service users”

(Horwath and Morrison, 1999)

Including

Training Transfer

Including

Introductions

• Name

• Place and nature of work

• What do you want to know by the end of today’s session?

Including

OutcomesBy the end of the session you will:• Understand your responsibilities

• Be able to recognise and respond to poor practice and know who else to involve

• Recognise missed opportunities through learning from Serious Case Reviews

• Have a greater awareness of the legislative framework, regulation and guidance that contribute to the prevention agenda

• Identify opportunities for intervention through the assessment, care or treatment planning and review processes

• Recognise the role of person-centred support in preventing abuse

• Be able to consider the ongoing balance between prevention, protection and a person's right to choice

Including

Ground RulesConfidentiality within the group will be

respected but may need to be broken if a disclosure of unsafe practice, abuse or neglect is made during the course – this will normally be discussed with you first.

Safeguarding is about partnership, it is not about blame. All agencies and individuals need to take responsibility, to reflect and learn to safeguard people who may be vulnerable.

Including

Underpinning message for session

• Positive approach – promotion of good practice and early intervention to avoid harm

• The rule of optimism - maintaining healthy scepticism and respectful uncertainty

“It could happen here.”

Including

Setting The Scene

Where does our learning about Safeguarding come from?

• Serious Case Reviews/Complaints/Near misses• Research/Surveys/Data Analysis• Practice Experience/Theory/Reflection

www.devonsafeguarding.org

www.scie.org.uk

Including

Six Safeguarding Adults Principles

• Empowerment

• Protection

• Prevention

• Proportionality

• Partnership

• Accountability

‘Adult Safeguarding: Statement of Government Policy’ 2011

Including

‘Prevention in Adult Safeguarding’

“It does not mean being over-protective or risk-averse. Prevention needs to take place

in the context of person-centred support and personalisation, with individuals

empowered to make choices and supported to manage risks.”

Report 41, SCIE, 2011

Including

Vulnerability

What does the term ‘vulnerable’ mean?

Including

The Traditional Model• Risk factors for being abused – poor

communication skills, low self esteem, challenging behaviour, cognitive difficulties, lack of education/experience, loneliness

• Risk factors for carers abusing - isolation, stress, lack of knowledge of condition, substance misuse, lack of support

• Risk factors for services – poor management, high turnover of staff, low pay, lack of staff

Including

The Social Model of Vulnerability• A way of thinking about vulnerability that is not

patronising or impairment specific because the vulnerability is outside the person

• Vulnerable groups tend to be – placed in, or left in, situations of higher risk than would be tolerated

for others– Not heard, believed or taken notice of when they make complaints– Not helped to recover or recompensed

• Because of these situations vulnerable groups risk being seen as “easy targets”

(Prof. Hilary Brown)

Including

‘Constellations of Abuse’

Exclusion from mainstream service provisionDiscrimination in health, education, housing, employment , justice and welfare Unable to access public places and spacesDenied legal advocacy and routes for challengeInvisible or stigmatised in media

breaches of professional boundaries by

arrogant grandiose and unaccountable staff

resentful, down-trodden and hard-done-by staff

Family violence,

neglect or negligence partner violence

between parent and adult child

between adult child and older parent

more distant relativesParasitic, exploitative “mate” crime

rigid de-personalised regimes

neglectful care

staff out of their depth or not available

cruel, humiliating individuals

hate crimes

predatory crimes

sexual and financial

Unethical, unjustified and/ or unauthorised practice in response to challenging needs

Targeted abuse Institutional abuseProfessional abuseDomestic abuse

Unethical practice

Systemic abuse and social exclusion

Prof. Hilary Brown, 2012

Including

PCS Analysis

Neil Thompson

Including

Opportunities for intervention

• Assessment & Planning

• Care, Support or Treatment

• Review

• Service monitoring/Complaints

What are your responsibilities?

Including

Prevention: Your Responsibilities• people being informed of the right to be free from abuse; and

supported to exercise these rights, including having access to advocacy

• thorough needs assessments supported by risk assessments where required to inform people’s choices

• access to good universal services targeted at older and disabled people that can reduce the risk of people experiencing abuse, for example community safety services or services that increase people’s access to advice or maintain informal support networks

• a well informed, competent and properly vetted workforce operating in a culture of zero tolerance of abuse

• a sound framework for confidentiality and information sharing across agencies (CSCI, 2008)

Including

ISA Report“Safeguarding in the Workplace: What are the lessons to be

learned from cases referred to the Independent Safeguarding Authority?” March 2012

General indicators• carelessness, breaches of policy, attitudinal problems,

emotional detachment and persistent non-attendance, portrayal of a close personal relationship with the victim

Financial indicators• talking about money worries, seeking advances or

requesting overtime, failure to complete documentation and protocols regarding the handling of money

Including

Creating Safer Organisations• Recruitment - VBI• CRB/ISA Checks and References• Induction and Probation• Policies and Procedures• Setting Standards and Professional Boundaries• Training• Supervision• Performance Management

Including

Serious Case ReviewsTake place where a vulnerable adult has:• died, suffered serious sexual abuse, a potentially life-

threatening injury or serious and permanent impairment of health or development or when serious abuse takes place in an institution or multiple abusers are involved

AND

• the case gives rise to concerns about the way in which local professionals and services work together to safeguard vulnerable adults

OR

• where it is believed to be in the public interest to conduct such a review.

Including

Serious Case Reviews aim to:

• Establish whether there are lessons to be learnt about the way in which local professionals and agencies work together to safeguard vulnerable adults

• Improve practice by acting on learning

NB: The purpose of having a serious case review is not to reinvestigate or to apportion blame. They consider individual actions as well as the systems and processes within which individuals operate.

Including

Serious Case Reviews – recurring national themes

• Inter-agency communication• No lead agency• Training needed• Threshold issue • Assumptions

Jill Manthorpe and Stephen Martineau, 2009

Including

Devon SCRs

A: High number of deaths raised by CSCIPoor care standards not previously picked

up by many and various professionals

B: 2 falls resulting in deaths raised by PALSEnvironmental risks not previously picked

up by many and various professionals

H: Resident murdered by another on respitePoor transfer of risk information from

hospital to care home

Including

Devon SCRs – combined learning

• Duty on all health and social care professionals to record and act upon, any concerns about health, safety or wellbeing. This should include possible risks that are not necessarily the main focus of their contact.

• Ensure that a Service Provider is fully aware and able to safely meet someone’s needs. Other important considerations such as accessibility, peoples preferences, resource pressures and cost, should not compromise the primacy of ensuring safe care/support arrangements.

Including

Common Safeguarding Challenges (care homes)• Maladministration of

medication• Pressure sores• Falls• Rough treatment,

being rushed, shouted at or ignored

• Poor nutritional care

• Lack of social inclusion

• Institutionalised care• Physical abuse

between residents• Financial abuse

www.scie.org.uk

Including

Health and Social Care Act, 2008• Single registration system acts

as a “licence to provide services”

• Established Care Quality Commission to:

Regulate the quality of health care and adult social care

Look after the interests of people detained under the Mental Health Act

Including

Health and Social Care Act 2008

• Focused on outcomes rather than policies, systems and processes (inputs)

• CQC to monitor compliance – risk register

• New enforcement powers for CQC

Including

Snap!

Including

Behind Closed Doors

Area of Concern / Poor Practice

Watch the DVD

Complete the FIRST column ONLY

Including

Behind Closed Doors

Area of Concern/ Poor Practice

Which CQC outcomes does this relate to?

Complete the SECOND column ONLY

Including

Behind Closed Doors

Area of Concern / poor practice

Which CQC outcomes does this relate to?

What might you see, hear or smell?

Consider the indictors and signs that there might be if you hadn’t actually observed the behaviours

Complete the THIRD column ONLY

Including

What might you see?• Empty hours, bored residents• Empty and scrappy staff rotas (turnover, absences and

not enough staff)• Erratic medication charts• Dirty rooms• Dirty linen• No training or “going through the motions”• Policy documents and care plans kept in the drawer• Rushed staff• Dirty, untidy and unlooked after clothes

Including

What might you smell?

• Urine

• Faeces

• Stale food

• Body Odour

Including

What might you hear?• Dehumanising: “they” - people are lumped together – “they

eat like animals”, “the doubles”• Sexualising: “they’re at it like rabbits”, “she’s gagging for it”• Blaming:“he knows what he’s doing,” “she’s manipulative”,

“he’s winding me up”• Punitive: “they’ve got it coming”, “she needs to be taught a

lesson”, “if he thinks he can treat me like that”• Discrediting: “he doesn’t notice”, “they don’t care” “they

are zombies”

Including

Barriers to addressing poor practice• Lack of a tangible sense of what is wrong• Lack of certainty that your concerns are

reasonable or proportionate• Lack of “evidence” to back up concerns• Fear of immediate reprisals or long term

detrimental consequences• Fear that concern or complaint will not be

handled well so that their intervention will be in vain

Professor Hilary Brown

Including

How do you verbalise ‘gut instincts’?

Hull University: ‘Abuse in Care?’ (http://www2.hull.ac.uk/fass/care/safeguardingadults.aspx)

• A practical guide to protecting people with learning disabilities from abuse in residential services

• A practical guide to protecting people with dementia from abuse in residential services

Including

Service Monitoring Checklist 1. Leadership and Management

2. Staff behaviours and attitudes

3. Behaviours and interactions of residents

4. Isolation and lack of openness

5. Service design, delivery and make up

6. Environment and basics of care

Adapted from ‘Abuse in Care?’

Including

Practitioners’ Role

If you suspect a criminal offence, do not ask any further questions.

Including

Behind Closed Doors

Area of Concern / poor practice

If you hadn’t observed it what other indicators might there be?

What might you see, hear or smell?

What information do you need to gather? Where/ who from?

Complete column FOUR

What questions might you need to ask to establish the facts of the situation?

Be specific!

Including

What to do with concerns about poor practice

• Discuss with the professional concerned• Discuss with the service manager• Discuss with your manager immediately, in supervision

or at a team meeting• Discuss directly with the person, family, organisation.

Once discussed then back up in writing - SMART. • Record in Mr Manager if appropriate • Discuss with co-workers or Safeguarding Adults team • Encourage people to use the complaints process • Discuss with procurement / contracts team• Discuss with CQC

Including

Feelings / Emotional Responses

Including

Communication

Including

Neil Thompson

What is a problem?

‘....a problem is anything that either brings about negative ...or blocks positives or a mixture of the two.’

Neil Thompson

Including

An Elegant Challenge

Being constructive in challenging unacceptable behaviour or language

Collusion / Elegant Aggressive

no challenging challenge challenge

 

Including

Practice• Choose one of the scenarios from the film

(or your own) and make ‘an elegant challenge’ to your partner.

• Partners – What did it feel like? What could be done differently?

• Swap over.

Including

Any Questions?

Including

Prevention is Better Than Cure

Keep the course in context. Whilst there are some very worrying situations occurring everyday there is also good practice in all care environments

Remember to vigilant and deal with things at the earliest opportunity.

Whether it’s poor practice or abuse doing nothing isn’t an option.

Including

Resources

Dementia care mapping

www.bradford.ac.uk

CQC observation tools

www.cqc.org.uk/information-our staff/observation-tools

SCRs

www.devonsafeguarding.org

Including

Resources Social care governance – audit tool

Common Safeguarding Challenges

Minimising the Use of Restraint

www.scie.org.uk

Good Ideas!

www.kissingitbetter.co.uk/

www.myhomelifemovement.org/