1. Adult Safeguarding

2. Introductions Name and work role What does safeguarding mean to you ?
Health warning
Some of the subjects we discuss may be upsetting, if you feel the need to leave the room please do so.

3. Learning outcomes for today
To deliver a basic awareness session
To discuss safeguarding adults
Identify signs and symptoms of abuse
Take part in group activities
Understand mental capacity and decision making
How to report abuse

4. All 3 conditions must apply
Who does Safeguarding apply to?
The safeguarding duties apply to an adult who:
Has needs for care and support (Whether or not the local authority is meeting any of those needs)
and
Is experiencing, or at risk of, abuse or neglect
As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
All 3 conditions must apply
From Care and Support Statutory Guidance Nov 2014
The introduction of the Care Act was the single most biggest change to Adult Social Care in decades and puts the cared for and their carers wellbeing – broadly defined – at the heart of the Act and stresses the importance of preventing or delaying the development of care needs. In cases of safeguarding the individual should be at the centre of all activity “ Making safeguarding Personal”. No decision about me without me.

5. Definition of Care and Support
Care and support includes assessment of people’s needs, provision of services and the allocation of funds to enable a person to purchase their own care and support.
It could include care home, home care, personal assistants, day services, or the provision of aids and adaptations.

6. In the news ……..
Winterbourne View care home staff jailed for abusing residents
Six staff are jailed and five given suspended sentences after abuse of disabled patients was secretly filmed by reporter
Oxfam scandal deepens with allegations of 'sex for aid' and abuse in charity shops 
Council staff suspended over death of 81 year old woman left to starve

7. Gloria Foster: It was reported that council officials neglected to call her to make alternative care arrangements when the care company looking after her was raided and closed down by immigration officials.
Care first24, the care company responsible for visiting Mrs Foster four times a day to feed and care for her, was raided by the UK Border Agency on 15th January 2013 after allegations that the firm was employing illegal immigrants.
Care was put into place for everyone except Mrs Foster, a frail widow with dementia, who was entirely dependent on the visits from carers. A note placed in the log book after the discovery of Mrs Foster’s body stated that a call was made to her home, noting that there was no response, but police records showed that no calls were made.
Mrs Foster was discovered by a district nurse, who was making a routine visit to her home, on 24th January The review stated that the nurse found Mrs Foster in a “very poor physical state”
She was cold, lying partially off her bed, which was sodden with urine and faeces, and she appeared dehydrated with cracked lips. The ambulance crew were unable to record a blood pressure reading or find a wrist pulse, indicating that her blood pressure was extremely low.
Mrs Foster died in Epsom hospital 11 days after being admitted.
(The Guardian.com – Council staff suspended over death of 81 year old woman left to starve)
Gloria Foster 2013

8. Categories and indicators of abuse
Activity can you name them –write down as many as you can think of

9. The above pie chart shows what types of abuse are reported in Herefordshire, the %ages do not vary much month on month or year on year
Hand outs

10. This shows the location where the safeguarding concern was raised about. Nearly 50% of all concerns raised are with regard to people within their own homes
Hand out

11. Physical Abuse Indicators:
Clusters of bruising forming patterns, reflecting the shape of an article or finger marks
Burns (electrical/cigarette)
Signs of medication misuse (over or under medication)
Covering up with clothing
Examples:
Hitting, slapping, pushing, kicking, hair pulling
Misuse of medication
Restraint, or inappropriate sanctions

12. Sexual Abuse Examples: Indicators: Rape and sexual assault
Sexual harassment, inappropriate looking or touching
Subjection to pornography or witnessing sexual acts to which the adult has not consented, could not consent, or was pressured into consenting
Indicators:
Difficulty in trusting other adults or members of their peer group
Sexually transmitted infections (STIs)
Disclosure of abuse past or present
Self harm

13. Psychological Abuse Examples: Threats of harm or abandonment,
Deprivation of contact,
Humiliation, blaming, controlling, intimidation , coercion, harassment, verbal abuse,
Isolation or withdrawal from services or support networks
Indicators:
Someone who is resigned and withdrawn
Unexplained fear or defensiveness
Avoiding looking at care giver and flinching on approach
Incontinence
Weight loss/gain

14. Neglect and Acts of Omission
Examples:
Ignoring medical emotional or physical care needs
Failure to provide access to health, care or educational services
Withholding necessities or life such as food and sanitation
Indicators:
Poor physical condition of the person – unclean, soiled, being kept in nightclothes during the day
Distress resulting from unmet need such as evident thirst, hunger discomfort and despair

15. Domestic Abuse Indicators: Examples:
Previous physical assault or abuse (including of animals)
Previous sexual assault
Possessiveness, controlling or stalking behaviour
Verbal abuse
Curtailing of social interaction
Examples:
Between intimate partners or family members regardless of gender or sexuality:
physical, sexual, financial, emotional abuse
so called ‘honour’ based violence
Forced Marriage
Not just men / women, can also be in a same sex relationship. Men can also be victims
The difference between forced and arranged marriage:
An 'arranged marriage' is a marriage set up by family members. An arranged marriage is not a forced marriage if both partners are over 18 when they get married and they can choose whether or not to participate. An arranged marriage is a forced marriage if either partner is unable or unwilling to give permission.

16. The impact of Domestic Violence
Abuse of women and child abuse occur together in 40-60% of cases
In 90% of incidents involving domestic violence, the children are in the same or next room
Children of all ages most often take some form of passive or active support to protect the victim when witnessing domestic violence
Children may feel guilty if they are not able to come to the aid of the victim – self-blame and feeling it is their fault
Increased levels of anxiety in children

17. Financial or Material Abuse
Indicators:
Lack of belongings or services which person can afford
Insufficient food in the house and bills not being paid
Family, friends or acquaintances expressing sudden or disproportionate affection for a person with money or property
Examples:
Theft, fraud, internet scamming
Coercion in relation to financial affairs such as in connection with wills, property or inheritance
Misuse or misappropriation of property, possessions or benefits

18. Organisational Abuse Indicators: Lack of transparency and openness
Neglect and poor care practice:
in an institution such as a hospital or care home
in relation to care in one’s own home
It occurs where someone’s wishes or dignity are consistently or repeatedly compromised to ensure the “smooth running” of an institution or organisation.
Indicators:
Lack of transparency and openness
Lack of choice and control
Rigid routines
Poor record keeping
inadequate procedures

19. Modern Day Slavery Indicators
Physical appearance: Unkempt, malnourished,
Isolation
Poor living conditions
Few or no personal effects
Restricted freedom of movement
Unusual travel times
Reluctance to seek help
Encompasses slavery, human trafficking, forced labour and domestic servitude.
Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment

20. Self Neglect Examples: Personal hygiene Health Surroundings Hoarding
Indicators:
Grossly inadequate housing/homelessness
Hazardous or unsanitary living conditions
Dehydration, malnutrition, poor personal hygiene
Untreated medical conditions
Inadequate clothing, lack of necessary medical aids
KH (Gloucestershire) KH was a 56 year-old man who lived in a rented flat with his two adult sons. He had mobility difficulties as the result of a road traffic accident, and a number of other health issues. His attendance at GP and hospital appointments was sporadic; he was admitted as an inpatient for investigations into his increasing mobility difficulties, but discharged himself before these could take place. The GP referred him to ASC with concerns about his deteriorating health and living environment, and after numerous unsuccessful attempts, a social worker and OT managed to gain access to him. They found his living conditions to be poor, but not severely neglected, and arranged a reablement service for him to commence immediately. The reablement workers made several unsuccessful attempts to see KH over a number of weeks, being told by his sons over the phone that he was away from home and not expected back in the foreseeable future. The Reablement team subsequently closed the case. KH was not seen again until 6 months later, when his sons called the emergency services to report that their father had had a suspected heart attack. When Paramedics attended, they found KH sitting in a chair in the living room, covered in faeces and urine. He was found to have full depth pressure sores to his groin (the worst ever seen by the professionals who treated him), which were infested with maggots. The hoarding in the property was such that the Fire Service had to be called to remove KH from the property via a window. He was not expected to survive his very serious wounds, however he did make a full recovery and was able to participate in the review.

21. Mental Capacity Act 2005
The Mental Capacity Act provides a statutory framework for decision making for those over the age of 16 who are incapable of making certain decisions for themselves due to injury, impairment or illness.
Mental capacity issues potentially affect everyone at some time in their lives.

22. How do we decide if some one has capacity?
Are they able to understand the information relevant to the decision?
Are they able to retain that information?
Are they able to use or weigh up that information as a means of making the decision?
Are they able to communicate their decision (by whatever means)?
Somebody may be able to make a decision about one thing i.e. what to have for dinner, but not another such as ability to live alone in ones own home.
Video

23. Case study
Graham –discuss the case
Any questions

24. Why does it matter to me?
Safeguarding is everybodys responsibility This includes staff and volunteers working in health agencies, police, social care, voluntary sector and charities as well as people who might be concerned about neighbours, friends and family members.

25. We ALL have a duty to act on a concern/allegation of harm/abuse when an individual
Has needs for care and support (Whether or not the local authority is meeting any of those needs)
and
Is experiencing, or at risk of, abuse or neglect
As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
But we must consider the 6 key principles that underpin adult safeguarding

26. Before raising any safeguarding concern consent to do so should be sought from the person unless the there is a risk or harm to the wellbeing and safety of the adult or others, other adults or children could be at risk from the person causing harm, it is necessary to prevent crime or if a crime may have been committed, the person lacks capacity to consent.
Hand out

27. It is always best practice to speak to the adult involved at as early a stage as possible to get their views and wishes on the concerns.
This should help to guide what next steps should be taken and whether the concern should be reported as an adult safeguarding concern or should be dealt with by another means.

28. We ALL have a duty to act on a concern / allegation of harm or abuse
Consider the immediate safety of the adult at risk and others who may also be at risk as a result of the concerns
Where a criminal act is suspected this should be reported to the Police
Ensure immediate risks are addressed
Follow your agencies safeguarding procedure
Your agency should have a procedure that is available for you to follow. It may entail you passing details of your concern onto your manager for them to report.

29. HSAB Web Site Making a referral
Resources for professionals and guidance

30. Thank you for attending