Procedures and Guidleines

Background

KEY4LIFE recognises ABUSE as an action that makes someone upset or frightened. A person who is abusing someone has power over them and the victim does not agree to what is happening. We are aware that people who are abused are often too scared to speak out or stop what is happening.

We also understand that people may not be being abused on purpose, yet is unacceptable.

Abuse can be PHYSICAL, SEXUAL, EMOTIONAL or FINANCIAL. NEGLECT and DISCRIMINATION are both forms of abuse.

As people who misuse drugs and alcohol are defined as VULNERABLE ADULTS. Key4Life recognises that ALL our service users may present us with information to which the SVA policy will need to be applied. In our work with with unpaid/family carers of those with substance misuse problems and people with mental health needs and various disabilities we recognise the particular risks of abuse which we may encounter.

Key4Life recognises that our service has responsibility for applying the SVA policy to allegations of PEER ABUSE made by one service user about another and to concerns about DOMESTIC VIOLENCE that affect someone who is a vulnerable adult.

GUIDELINES FOR SAFEGUARDING VULNERABLE ADULTS

Standards for good practice

• Training staff and volunteers to adopt a ‘zero tolerance’ approach to abuse of vulnerable adults

• Working collaboratively to investigate allegations or suspicions of abuse and to put in place protective measures for the vulnerable adult concerned

• Identifying at assessment, service users who are unable to take their own decisions and/or protect themselves, their assets and their bodily integrity

• Promoting the empowerment and well being of vulnerable adults through all our services, supporting their right to lead an independent life based on self-determination and personal choice

• Ensuring that the risk involved in a vulnerable adult finding self-determination and personal choice is monitored and reduced

• Providing appropriate advocacy, advice and protection and involving other agencies to assist vulnerable adults to lead independent lifestyles and exercise choice

• Clarifying who can act on the behalf of vulnerable adults who do not have the capacity to consent to actions being taken by our service

• Ensuring that the policy is applied to all vulnerable adults accessing our service regardless of their age, gender, religion, language, sexuality or disability

• Ensuring that when incidents arise we follow legal and statutory requirements and support vulnerable adults to receive the protection of the law and access to the judicial process

• Identifying others who may be at risk of harm, including children and ensuring immediate referral to the appropriate authority

• Recognising our duty of care to those who perpetuate abuse and facilitating them to access services where their behaviour can be appropriately addressed (eg Everyman project, Anger management groups, other one to one counselling services etc)

• Treating seriously and responding positively to all expressions of concern about potential abuse

• Ensuring we are rigorous in our recruitment processes to deter those who actively seek vulnerable people to exploit and abuse

• Ensuring that all staff responsible for conducting investigations into incidents of abuse receive appropriate training and support

• Supporting those being abused to talk to someone they feel they can trust. This person could be a relative, friend, nurse, doctor, carer, social worker or other professional.

• Ensuring that concern over issues of confidentiality should not lead to a failure to take action to protect a vulnerable adult from abuse

• Ensuring that the need to protect the organisation does not override the need to protect a vulnerable adult

Duty to Report

All staff are expected to:

• Take allegations seriously

• Inform and remind vulnerable adults that they have the right to report abuse

• Be aware of the signs of that may indicate that someone is being or could be abused

• Report any allegations or suspicions to the manager and/or safeguarding vulnerable adults officer even if the vulnerable adult is reluctant for them to do so

• Make it clear at assessment and throughout the service user’s care planning that we are unable to keep secret any information on alleged abuse

• Wherever possible obtain signed, informed consent from the vulnerable adult before sharing information

• Share information on a ‘need to know’ basis

In cases of peer abuse:

• Be mindful not to overlook cases of abuse by one service user towards another (peer abuse) which it has been identified has sometimes been attributed to a service user’s challenging behaviour

• Report allegations of peer abuse regardless of the degree of the responsibility or intent of the person carrying out the act

• Ensure that the perpetrator is appropriately supervised to ensure that they do not intimidate or harm the vulnerable adult.

• Take action to protect other vulnerable service users

In cases of domestic violence:

• Inform vulnerable adults who are victims or survivors of domestic violence that they can seek assistance under the SVA policy by referring them to the Citizen Reporting Toolkit contained within the policy

• Respect the right of people to take decisions with respect to their own safety and well-being.

• Be mindful that a person’s capacity to make decisions regarding their own safety may be affected if they are living in a situation where they are experiencing intimidation, undue pressure or fear of reprisal.

• Raise their concerns immediately with a senior member of staff

Whistleblowing

The Key4Life WHISTLEBLOWING POLICY will be applied in full to all expressions of concern about specific activities in the workplace that could put vulnerable adults at risk and also to anyone who feels unable to raise concerns with other members of staff.

Please consult this document for the full policy.

Reporting procedures

Staff are made aware of the following procedure for dealing with allegations of or concerns about abuse through regular in-house training sessions:

1. ALERT STAGE/ IMMEDIATE ACTION

Staff and volunteers should

• remain calm and listen carefully withoutinterruption

• NOT interview service users or investigate the abuses further but simply encourage the service user to say what happened through open questions

• approach the vulnerable adult with sympathy and reassure them that they are right to report abuse

• explain that the information cannot be kept secret and that they have a duty to report this to the manager

• assess if medical treatment is required and if there is an indication of assault. If so IMMEDIATELY call 999 for an ambulance and also report any signs of possible sexual or physical assault or possible theft to the police.

• take any urgent action needed to keep the vulnerable adult safe including calling the vulnerable adult’s family and friends, referring on to GP, social services or police if outside opening hours for the project.

• report all that has occurred to a manager or member of senior staff. If no senior colleagues are available this should be done by phone to the manager. Once this has been done the information should remain confidential and only be discussed with colleagues as necessary.

• tell the vulnerable adult about any action they intend to take and check that they accept the plan of action to keep them safe

• make a signed and dated written record of the allegation or concern (including dates, times, observations of any injuries and other details of the vulnerable adult’s appearance) and complete a SVA2 Referral Form and file these safely and confidentially

• refrain from giving the vulnerable adult hot drinks, a change of clothes or facilities to wash as these may all interfere with any evidence of abuse.

• NOT give any details of any allegations to the alleged perpetrator or potential witnesses as this could contaminate evidence

In addition:

• If staff are in any doubt as to whether or not an incident is genuine they are still required to report the allegation or concern

• Any evidence of abuse found on site at Key4Life or presented by a service user to be preserved by staff wherever possible, handed to senior staff and kept securely and safely.

• Written records should be clear, factual, brief and relevant and should not include the opinions of staff. As far as possible the vulnerable adult’s own words should be used to describe what happened.

• If there is any doubt about the capacity of a vulnerable adult to understand the action taken by staff or there is further risk of abuse their well-being and safety should take priority over gaining their understanding and consent. The Project Manager or SVA officer should, however, be informed of the need to assess the vulnerable adult’s mental capacity. This will happen as a matter of urgency and the specific procedure for the assessment is outlined further on in this policy.

In cases of peer abuse:

• It is the responsibilty of the Project Manager or other senior member of staff to undertake an immediate risk assessment to ensure the safety of all service users.

• This will include arrangements for the appropriate care of both the vulnerable adult concerned and the alleged abuser. It may involve contacting social services to arrange for a social worker/ care manager to be responsible for the assessment of the situation with respect to the alleged perpetrator.

• Consideration will be given as to whether the vulnerable adult making the allegation will feel safe using the same service as the alleged perpetrator. This will be balanced against the rights of the alleged perpetrator to continue accessing Key4Life.

• In most circumstances steps will be taken to encourage no further contact between the alleged perpetrator and the alleged victim at Key4Life while a safeguarding assessment investigation is taking place. Wherever possible it will be the alleged perpetrator who is asked to leave the service rather than the alleged victim.

In cases of domestic violence:

• Key4Life will act in a way that is necessary to promote the person’s well being and to prevent a deterioration in their quality of life.

• Any intervention will be as limited as possible whilst still ensuring their safety

• Any decision will take into account the known wishes of the vulnerable person and be made with due regard for the process of law

• Any concerns about the mental capacity of the person experiencing domestic violence will be passed on to the Project Manager of SVA Officer who may refer the individual for a mental capacity assessment.

• Key4Life will inform the vulnerable adult as to how they can access domestic violence services, places of refuge, the police and other support.

2. WITHIN TWO HOURS

By now the police should be informed if:

• the alleged abuse constitutes a crime

• the vulnerable adult is exposing themselves to ‘high risk’

• the alleged perpetrator may pose a risk to other vulnerable adults

The report should be made to the relevant Police Community Safety Unit (CSU)

Staff and volunteers should send a Safeguarding Vulnerable Adults Report Form to:

• Adult Social Care Team or other Community Team(s) responsible (if known)

• Social Services First Contact Tel: (dependent on which area the YO is in)

3. WITHIN 24 HOURS

A record of Initial Information Gathering will be completed (SVA3)

4. WITHIN 5 WORKING DAYS

A SVA Strategy Meeting should take place. This meeting would be organised either by the Adult Social Care Team or by the Project Manager or Safeguarding Vulnerable Adults Officer at Key4Life.

Preventative Measures

Some individuals who meet the eligibility criteria for receiving a service may have a conviction for violence (including domestic violence) or sexual offences or be known to have behaved in a violent or sexually offensive manner towards adults or children.

Any concerns about the potential for violence or sexually inappropriate behaviour will be recorded as part of our initial assessment with a clear indication of what evidence there is for this. This information will be made available to the Project Manager and other staff members at the clinical meeting in which new assessments are discussed.

Due consideration will then be given to select a service for the individual which will offer the maximum safety and enable staff to continue to monitor the risk factors. We will also explain to the individual that we may need to alert other service providers to the information and wherever possible gain the service user’s consent for us to liaise with other services about this.

Receiving a referral procedure

Key4Life recognises a referral as an allegation of abuse made by:  The vulnerable adult themselves

• The family, friends and carers of the vulnerable adult

• A member of the public

• A member of staff or volunteer from an agency

• A regulator

Key4Life recognises that a referral can also be made in the form of an expression of concern or complaint about:

• behaviour of the vulnerable adult which might indicate abuse

• the effect of one vulnerable adult’s challenging behaviour on other vulnerable adults

• someone who is not known to social services or health teams

• someone who funds their own care

In dealing with both reports of abuse and referrals decisions about how to proceed will be informed by the vulnerable adult’s right to make choices and to maintain their independence, even when this involves a degree of risk or harm. Where an individual chooses to accept this risk or harm, and asks for no further intervention this is considered with reference to their capacity to anticipate and understand the level of risk or harm and the possible consequences. If the adult is being unduly pressurised or intimidated or there are other adults or children who might be at risk staff are aware that they still have a duty of care to report the abuse.

When we do decide to intervene to reduce the risk of harm the action decided on should disrupt the person’s life as little as possible while still protecting their safety and well-being.

A decision to close a referral can be made at any stage in the process by the Safeguarding Manager, if on evaluating all the evidence they decide that the vulnerable adult is not at risk and that the possible risk to others has been, or is being, fully addressed.

1. WITHIN 24 HOURS OF RECEIVING REFERRAL

The member of staff who first receives the referral should inform Project Manager or SVA officer who will gather information WITHOUT ‘investigating’ or conducting any face-to-face contact or interviews with the parties involved.

The Project Manager or the SVA officer decides if the information warrants further action by considering:

• the reliability/ credibility of the information received

• the need for any emergency or safeguarding action

• the likely impact of the alleged abuse on the vulnerable adult

• the capacity of the vulnerable adult for self-determination

• the vulnerability of the individual(s) concerned

• the extent of abuse to this or other vulnerable adults or children

• the length of time it has been occurring

• the risk of repeated or escalating acts

• any information about the alleged perpetrator and any history of assault or violent or aggressive behaviour

• the need for further assessment or investigation

• the need to inform service user/family/carers as appropriate

• whether to instruct an Independent Mental Capacity Advocate for the vulnerable adult, when it has been established that the person lacks the capacity to make decisions regarding the process, and it is felt to be to their benefit to be represented.

Where a serious incident may have occurred and the police are already involved then the information collection will be restricted to ensuring that all relevant vulnerable adults potentially at risk are being protected from further abuse.

In addition it will only be decided that no further action is required if:

• the incident or concern is relatively minor or abuse did not occur

• the incident is not likely to be repeated

• the cause of concern is identified

• action has been taken to ensure the vulnerable adult’s safety in the future

• the situation can be dealt with under another process e.g. care management assessment, care programme approach or through a referral to health or other agencies

In such cases wherever possible, the referrer will be informed of the level of response agreed and what this will mean in practice.

We will still carry out a safeguarding assessment at this stage if:

• the vulnerable adult does not have the capacity to make informed decisions about what actions they want to take

• the alleged abuse has taken place on property owned and managed by an agency providing a service to the victim or the perpetrator of the abuse (including social services and health trusts)

• the alleged perpetrator is a paid worker or volunteer

• other service users or children may be at risk from the perpetrator

In these cases the person will be informed that the local authority has a duty to investigate and check all the facts before reaching a decision.

If no further action is to be taken a SVA form will be completed and returned

If further action is needed they will gather information in preparation for a Strategy Meeting of discussion through which the referral will be investigated.

We will then ensure that:

• urgent action is taken to ensure safety and medical treatment for the vulnerable adult and the perpetrator if they are also a vulnerable adult

• possible criminal offences (physical or sexual assault and theft) are discussed with the relevant Police Community Safety Unit and any related evidence is preserved in accordance with their guidance

• information has been gathered and risk has been assessed

• a referral has been made to the appropriate Referral and Assessment Team within Children’s Services if child protection concerns have also been raised

• the vulnerable adult and/or their family/carers have been informed and consulted about the action taken

• decisions have been recorded

• the referral is reported to the SVA business Support Officer on SVA 2

• the SVA 2 is also sent to the Police Community Safety Unit if a criminal offence has taken place

If there are possible criminal offences occurring but the vulnerable adult does not want the matter reported to the police the SVA Officer and Project Manager will assess if:

• the vulnerable adult does not have the capacity to understand

• there are wider issues such as ‘duty of care’ to a very vulnerable adult who is exposing themselves to high risk

• there are potential risks to other vulnerable adults

If at this stage no further action is needed a SVA Monitoring Ceasing Procedure form (SVA9) will be completed and sent to the local SVA Business Support Officer.

2. WITHIN 5 DAYS

We will continue to play a role in a multi-agency strategy meeting to be held if further action is needed in relation to the referral. We will also ensure we are closely involved if the business of the strategy meeting is to be carried out by telephone calls and emails/fax.

3. WITHIN 2 WEEKS

The investigation should be completed within 2 weeks.

If a SVA Conference is held as a result of the investigation the Project Manager or SVA Officer will make every effort to attend the conference and provide relevant information and support to the vulnerable adult(s) involved as appropriate.

If a member of our staff is invited to a conference but cannot attend their information will be made avilable to the meeting. This information will be discussed with the vulnerable adult beforehand. If this has not been possible it will be clearly stated in the information.

We will also encourage the vulnerable adult to attend the conference. If they are unable to attend a representative can be nominated. If the vulnerable adult does not want to be represented we will ensure that an up to date account of their views is passed on to the conference. We will also encourage any carers to attend wherever possible.

4. WITHIN 4-6 WEEKS

• We will inform the vulnerable adult and their family/carer of the conclusion of the investigation as appropriate.

• We will continue to monitor the involved parties’ need for continuing support and where appropriate provide them with that service at KEY4LIFE.

• We will offer any necessary help in accessing alternative agencies to the vulnerable adult(s) involved.

5. ONGOING ACTION

• We will continue to play a role when necessary in any further SVA reviews relating to any allegations

• In incidences where a SVA Plan is completed following an investigation we will implement any planned actions for which KEY4LIFE is responsible by offering appropriate services to vulnerable adults and modifying care plans accordingly

• As soon as any allegations of peer abuse occurring at KEY4LIFE are SUBSTANTIATED a new risk assessment with respect to the perpetrator continuing to access the service will be undertaken. This could include planned therapeutic support from KEY4LIFE to help the perpetrator address his/her abusive behaviour. Care will be taken as to how details of the SVA investigation are then recorded in an alleged perpetrator’s file, with due regard to their confidentiality.

Special procedures for incidents of carers being abused

• If the alleged perpetrator is the cared for person any related meetings should take place without the cared for person being present

• The carer has the right to nominate any other person to be present at any discussions. It might be appropriate for Victim Support or Carers Support workers to play this role if the carer has no one else to help.

• The degree of risk and proposed actions will be determined together with the carer.

Procedure for allegations of abuse by a KEY4LIFE member of staff or volunteer

Where the alleged pepertrator is a paid member of staff or a volunteer, disciplinary proceedings will be followed and normally the alleged perpetrator will be suspended from duty.

• In incidences where a worker at KEY4LIFE is guilty of misconduct that has harmed a vulnerable adult or placed them at risk of harm the Project Manager will make a referral to the Protection of Vulnerable Adults (POVA) List. The referral will take place only when KEY4LIFE’s own disciplinary procedures have been concluded. Where the offence is very serious, a referral can be made after the worker has been suspended, in which case they may be provisionally listed until the outcome has become clear.

Complaints Procedure

• Vulnerable adults can make use of Key4Life’s complaints procedure to raise any concerns about the conduct of an investigation of an alleged abuse or a failure to investigate.

• Any complaint should be brought to the attention of the Adult Protection co-ordinator and Safeguarding Manager

Serious Cases

Key4Life recognises that the SVA committee may need to conduct a Serious Case Review when:

• A vulnerable adult dies (including death by suicide) and abuse is known or suspected to have been a factor in their death

• A potentially life threatening injury has occurred

• Serious sexual abuse had occurred

• There has a serious or permananent impairment to health or development

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

• Serious abuse takes place in an institution

• Multiple abusers are involved

Key4Life recognises that in these cases we may be requested to provide information and all relevant records. We will take action to secure all relevant records relating to the case to guard against loss or interference. We also understand that as an outcome of such a review we may be asked to undertake our own displinary proceedings.

Procedure for assessing mental capacity to consent to further action

This procedure will be followed at the earliest possible stage following an allegation.

In order to assess mental capacity the Key4Life Project Manager or SVA officer will consider seeking advice from a social care or health professional. They will:

• Pay attention to the vulnerable adult’s capacity to make the particular decision being discussed NOT their capacity to make decisions in general

• Make sure that the person is not presumed to lack capacity because of their age, behaviour, any condition they have or because they couldn’t make a decision in the past

• Ensure the person has had all the information they need to make a decision

• Explore if the information could be explained or presented in a way that is easier for the person to understand

• Schedule further discussions for particular times of day where the person’s understanding is better

• Decide if the decision can be put off until the circumstances are right for the person concerned

• Explore if there is anyone else who can support the person to make choices or express a view such as a family member, or if appropriate an independent advocate

• Encourage the person to record their wishes and preferences while they have capacity. These can cover how they would prefer things to proceed if they lose capacity so that these can be taken into account if there is a safeguarding concern.

• Consult with other staff and professionals about the extent to which the person can make decisions for themselves and take account of any formal assessments that have already been made.

Once everything has been done to support the person to make the decision a referral to a professional who can further assess the mental capacity may be required.

Once a person is assessed as lacking capacity to make a decision the act allows another person who is involved in the matter to make a “Best Interests” decision on their behalf. This involves:

• Trying to find out what is important to the person concerned and what they would want NOT what anyone else wants. This can be drawn from past and present wishes that the person might have expressed and the factors they might consider if able to do so.

• Encouraging their full involvement in anything done next

• Consulting with others about their views on the person’s best interests and any information they have about their wishes and feelings

• Seeing if the purpose of safety could be achieved in a way which is less restrictive to the person’s freedom of action

• Considering everything that is important to the person including their culture and religion

Any further assessment of capacity to consent relevant to particular allegations will be referred to the SVA Manager.

General - Procedures and guidelines