1. SAFEGUARDING ADULTS BASIC AWARENESS Safeguarding Adults in Bexley

2. Objectives oTo know the background to the Bexley’s Safeguarding Adults Procedures. oTo be aware of the procedures and understand the importance of making referrals. oTo raise awareness of the sign and symptoms of abuse. oTo gain an overview to the safeguarding adults process

3. No Secrets – guidance or legislation? oProduced by the Department Of Health oDefines who is at risk & in what way. oProvides framework for multi- agency work. oSets out guidance for inter- agency policy. oSafeguarding Adults Document (ADSS)

4. What is safeguarding adults? The main purpose seeks to: oprevent abuse oidentify abuse and ensure alerting of concerns oprovide multi-agency response to investigate and protect vulnerable adults from abuse oTo improve practice, service delivery and positive outcomes for individuals who have experienced abuse.

5. Who are we safeguarding from abuse? oPeople 18 or over and o‘who is or may be in need of community care services by reason of mental or other disability, age or illness; and oWho may be experiencing abuse or neglect

6. Vulnerable adults (adults at risk) o18 years plus oLearning Disability oPhysical Disability oMental Health Problem oSensory Impairment oOlder Persons

7. What do we mean by ‘abuse’? o Physical o Psychological & Emotional o Neglect & Acts of Omission o Sexual o Financial & Material o Discrimatory o Institutional

8. Types of abuse oPhysical for example……..hitting, kicking, burning, inappropriate restraint or moving and handling, misuse of medication, force feeding oPsychological & Emotional For example ……threatening, prevention of using services, denial access to friends, lack of stimulation and meaningful occupation

9. Types of abuse oNeglect & Acts of Omission For example………..a carer not meeting a person’s care needs, failure to provide food, shelter or clothing, medical care, oSexual For example.. Non-contact - photography, indecent exposure, harassment, enforced witnessing of sexual acts Contact abuse -inappropriate touching, forced masturbation of either or both persons, sexual assault, rape.

10. Types of abuse oFinancial & Material For example……theft of money or possessions, misuse of benefits, misuse of power of attorney, loans made under duress oDiscrimatory Any abuse based on discrimination for example……..not providing someone with culturally appropriate meals, inappropriate “nicknames”, unequal treatment, derogatory remarks.

11. Types of abuse oInstitutional For example…………….repeated incidents of poor practice or neglect within an organisation, services that are based on the needs of staff / managers rather than service users. ooccurs when the rituals and routines of a service result in the needs of individuals being sacrificed in favour of the needs of the institution

12. Bruising, particularly in well-protected and covered areas Fractures, sprains or dislocations, cuts or burns Drowsiness, confusion due to over- sedation Pressure sores Cowering and flinching Clusters of injuries and injuries at different stages of healing Repeated unexplained injuries Failure or unexplained delays in seeking treatment Carer, care worker or third party defensive in explanation Possible indicators of Physical abuse.

13. Notable changes in behavior, either gradual or sudden anxiety, unease or silence Fear, withdrawal and inability to communicate when the alleged perpetrator is present Depression Deterioration in ability to exercise choice Irrational fears or onset of phobias Excessive deference to carer, care worker or third party Over-protection Possible indicators of Psychological/Emotional abuse.

14. Poor hygiene - smell of urine / faeces Dehydration, weight loss or malnutrition Hypothermia - or abnormal body temperature Inappropriate clothing Failure to respond to prescribed medication Poor take up of health & social care services Infections & Pressure sores Failure to protect, Lack of stimulation Possible indicators of Neglect & Acts of Omission

15. Pregnancy or Sexually transmitted diseases Repeated urinary infections, Incontinence/bed wetting Bruising/bleeding/soreness/cuts in particular around 'private' areas Depression, unexplained behaviour changes Deliberate self-harm, self-neglect, poor self- image Excessive washing or inappropriate dressing Panic attacks, disturbed sleep patterns Overt or unusual sexual behavior or language Reluctance to be alone with an individual unknown to them Fear of staff offering help with undressing, bathing etc. Possible indicators of Sexual abuse

16. Possible indicators of Financial & Material abuse Unexplained loss of funds/sudden large withdrawals from bank accounts Inability to pay bills, evidence of recent loans Marked change in lifestyle/standard of living Basic needs not being met Theft/loss of property, recent changes of deeds/title of house Misuse of benefits Evidence of unnecessary building work or repairs to property Preventing the sale of capital assets to provide appropriate care

17. Denial of religious or cultural needs/differences Failure to meet religious or cultural needs, e.g. religious worship or appropriate diet Failure to provide appropriately sensitive services, e.g. interpretation and translation services Lack of respect for same sex relationships Prevention of appropriate non-abusive relationships/sexual relationships Not being given appropriate treatment due to age or mental capacity Possible indicators of Discrimatory abuse

18. No flexibility in bed time and/or deliberate waking to fit in with routine One commode/toilet used by a number of people; people left on commode/toilet for long periods Excessive/inappropriate use of safety rails or bed rails Deprived environment and lack of stimulation Failure to access key health services Inappropriate confinement or restriction No choice regarding meal times and opportunity for drinks and snacks at other times Lack of privacy in personal care, such as toileting, bathing, dressing, editing mail, restricting visits Subject to derogatory remarks or public discussion of matters private to residents Breaches of residents' confidentiality Possible indicators of Institutional abuse

19. Who might be the abuser? o Social care staff o Medical staff o Partners, husbands, wives o Friends o Doctors o Neighbours o Family members o People who use services o Anyone!

20. Where may abuse occur? o At home o Care homes o Day centres o College o Public transport o Hospital o Out in the community o Anywhere!

21. Assessing the Alert - exercise oLook at presenting referrals: oIs this abuse? oDo you have enough info? oWhat further info may you need? oWhat if the person is not a Bexley resident?

22. Types of disclosure oFull Disclosure – Victim tells a person directly about the abuse. oPartial Disclosure – Victim hints to that they are being abused. oIndirect Disclosure – Victim talks about abuse in a general sense.

23. Barriers to disclosure Often people do not disclose because: oPerception that nothing can change oFear of the abuser oCommunication / Cultural barriers oFear of not being believed oFeeling of guilt oConfusion oShame

24. Your responsibilities as Alerters oAbuse suspected or discovered oEnsure vulnerable adult in no immediate danger/arrange medical if needed oDo not go into detail/preserve evidence oInform = report to line manager oExplain = you must tell & see oRecord = make accurate record

25. What should you do if you suspect abuse? oMake the immediate situation safe oReport disclosure / allegation to your manager without delay. oRecord details and preserve evidence. oIf someone discloses something – listen, be sympathetic, but do not be judgemental or make any promises that you might not be able to keep.

26. What should you not do if you suspect abuse? Don’t oPromise to keep secrets oChallenge the alleged abuser oTry to investigate oDisturb any evidence oDiscourage anyone else from reporting concerns oLeave details of concern on an answer phone

27. What if the person does not want it reported? oExplain to the person that you must pass concern on to your manager. oThere is a difference between confidentiality and secrecy. oOther people may also be at risk. oYou should not have to carry the responsibility alone. oThere may be other issues that you are not aware of.

28. Making a referral Referrals of allegations or suspicions should be made to one or more of the following: oCare Central (Bexley Council) 0208 303 7777 oMental Health Service01322 356101 oEmergency duty - out of hours 0208 303 7777 oPolice 999 or 101 oCare Quality Commission 03000 616161

29. o Safeguarding Alert (Immediate referral) o Details taken by Contact Worker o Entered onto CF21 with relationship to SA Team o Outcome by appropriate Manager o Allocated to ASC Team for investigation Safeguarding adults process.

30. oReferral allocated to team for preliminary enquiries & Initial Investigation (within 24 hours) oStrategy Meeting (5 Days) oInvestigation (28 Days) oCase Conference oSafeguarding Protection Plan oMonitoring and Review (4-6 weeks)