Multi-Agency Procedures for the Protection of Adults with Care and Support Needs in Bournemouth, Christchurch, Poole & Dorset Safeguarding Adults Procedures Bournemouth, Christchurch & Poole Safeguarding is Everybody’s Business
1 Safeguarding Adults Procedures Multi-Agency Procedures for the Protection of Adults with Care and Support Needs in Bournemouth, Christchurch, Poole & Dorset
2 Bournemouth, Christchurch and Poole and Dorset MultiAgency Safeguarding Adults Procedures Reference: BDPSAB/MAP/001 Version: V2.13 Issue date: March 2025 Review date: June 2027 Document Control Author: Dorset & Bournemouth, Christchurch & Poole Safeguarding Adults Board Policy lead: Sarah Webb and DBCP SAB Business Team Produced by: Dorset & Bournemouth, Christchurch & Poole Safeguarding Adults Board Ratified by: Dorset & Bournemouth, Christchurch & Poole Safeguarding Adults Boards Target audience: All individuals and organisations across Dorset, Bournemouth, Christchurch and Poole involved in supporting and safeguarding adults at risk of harm. Procedures should be read alongside: Guidance on Multi-agency Risk Management (MARM) (for BCP Council & Dorset Council) Adult Safeguarding Policy (for BCP Council & Dorset Council) Transitional Safeguarding Position Statement This is a controlled document: Whilst this document may be printed, the controlled copy is maintained by the Dorset and Bournemouth, Christchurch & Poole Safeguarding Adults Boards Please follow the link to www.bcpsafeguardingadultsboard.com and Dorset Safeguarding Adults Board - Dorset Council Any printed copies of this document are not controlled. It is the responsibility of all staff to ensure that they are working to the most current version of this document.
3 Table of Contents Table of Contents ........................................................................................................3 Contact Details ............................................................................................................5 Introduction.................................................................................................................. 6 ‘Wellbeing’ principle ..................................................................................................... 6 Definitions ...................................................................................................................7 Categories of Harm .....................................................................................................8 Quick guide to flow chart ...........................................................................................13 Overview Flowchart – The Adult’s Perspective .........................................................18 Raising a Concern ................................................................................................................. 19 Detailed Guidance on Progressing Safeguarding Concerns .....................................19 Raising concerns with the Police...............................................................................22 Anonymous reporting & protecting anonymity ...........................................................23 Section 42 (1) concerns and (2) enquiries.................................................................24 What is meant by care and support?.........................................................................24 Section 42 enquiry criteria not met ............................................................................24 Who is to take action .................................................................................................25 Considering other lines of enquiry .............................................................................30 Specific responsibilities of the Safeguarding Adult Practitioner (SAP) ......................31 The Nominated Enquirer ...........................................................................................31 Specific responsibilities of the Nominated Enquirer (NE) ...................................................... 32 Enquiry Planning Meeting .........................................................................................33 Enquiry Review Meeting (ERM) ................................................................................35 No further action under the Safeguarding Adults Procedures ............................................... 36 Closing the safeguarding adult enquiry ................................................................................. 37 The consent of the adult to share information should be gained, and usual information sharing rules apply. See Appendix 8 – Information Sharing. Resolution of Disagreements.. 37 References and related information ..........................................................................37 Safeguarding Adults Board Websites........................................................................37 Appendices................................................................................................................ 38 Appendix 1 - Glossary ...............................................................................................38 Appendix 2 – Self-neglect and hoarding....................................................................46 Appendix 3 – Roles and Responsibilities of other Agencies......................................54 Appendix 4 – Risk Assessment Document................................................................59 Appendix 5 – Nominated Enquirer (NE) ....................................................................62 Appendix 6 – Joint working between Safeguarding Adults Services and MARAC/HRDA ..........................................................................................................74
4 Appendix 7- Practice Guidance – Protocol for working with adults at risk who do not wish to engage with services.....................................................................................76 Appendix 8 – Information sharing..............................................................................80 Appendix 9 – Safeguarding Adults Enquiry Summary Report ...................................85 Appendix 10 – Role of Note takers............................................................................88 Appendix 11 – Guidelines for interviews of a ‘person alleged to have caused harm’ and for determining the outcomes of Adult Safeguarding Enquiries..........................89 Appendix 12 – Large scale safeguarding enquiries – operational guidance..............92 Appendix 13 – Death of Adult sAdulAdultAdult at Risk............................................104 Appendix 14 – Independent Advocacy and “substantial difficulty”...........................105 Appendix 15 – Mental Capacity Act and Deprivation of Liberty Safeguards............106 Appendix 16 – Local pressure ulcer protocol ..........................................................109 Appendix 17 – Links with Children’s Services .........................................................111 Appendix 18 – Allegations against people in positions of trust (PiPoT) including employees, volunteers, councillors or non-executive Directors ...............................112 Appendix 19 – Practice Guidance of attendance of Solicitors at SA meetings........121 Appendix 20 – Memorandum of Understanding – Dorset Police and Partners .......122 Appendix 21 – Guidance for dealing with disputes and conflicts of opinion ............130
5 Contact Details Bournemouth, Christchurch & Poole Council In Bournemouth, Christchurch and Poole contact the Adult Social Care Contact Centre 01202 123654 asc.contactcentre@bcpcouncil.gov.uk Out of Hours - Social Services Evenings and Weekends: 0300 1239895 BCP Council website contains information regarding Safeguarding Adults Adult social care and health | BCP (bcpcouncil.gov.uk) Dorset Council: In the Dorset Council area contact Adult Access 01305 858250, email adultaccess@dorsetcouncil.gov.uk Out of Hours - Social Services Evenings and Weekends: 01305 858250 Dorset Council website contains information regarding Safeguarding Adults Care and support for adults - Dorset Council
6 These Procedures have been produced collaboratively with members of the Dorset & Bournemouth, Christchurch and Poole Safeguarding Adults Board (DBCPSAB). Dorset Council (DC) and Bournemouth, Christchurch & Poole Council (BCP) are the key statutory partners who have a duty under Section 42 of the Care Act 2014 to undertake Enquiries when certain criteria are met; however, all DBCPSAB partner agencies are committed to adhering to these procedures. A Glossary of all the Terms used in these Procedures can be found at Appendix 1. Note: consistent with Ch. 14 of the Care Act Statutory Guidance the term “adult” is to refer to the adult who is experiencing or is at risk of abuse or neglect. Where a more generic term is needed and/ or the reference is not specific to the adult the Procedures refer to a person or people. The term “professional” will be used to describe all partner agency’s staff members; specific professions may be referred to where relevant i.e. Social Worker, Nurse, Doctor, Police officer. Professionals are governed by the Safeguarding principles in the Care Act 2014, to ensure that adults who are at risk of abuse, harm, neglect and exploitation have help and support in a way that is sensitive to their individual circumstances, is person centred, and outcome focused. The key principles which will inform the ways in which professionals work with adults are as follows: • Empowerment: people being supported and encouraged to make their own decisions, presumption of person led decisions and informed consent. • Prevention: wherever possible the aim will be to act before harm occurs and ensure early engagement with all relevant people. • Proportionate: response appropriate to the risk presented; least intrusive response where possible • Protection: support and representation for those in greatest need. • Partnership: local solutions through services working with the adult’s communities. Ensure engagement with local communities to prevent, detect and report abuse. • Accountability: transparency in delivering safeguarding and of a quality that is worthy of scrutiny, i.e. the Courts or Peer Reviews The Care Act (2014) introduces a duty to promote wellbeing when carrying out any care and support functions in respect of an adult. This is sometimes referred to as “the wellbeing principle” because it is a guiding principle that puts wellbeing at the heart of care and support. The wellbeing principle applies whether carrying out care and support functions or safeguarding. It applies to adults with care and support needs and their informal carers. “Wellbeing” is a broad concept, and particularly relates to the following areas: personal dignity/ being respectful. physical and mental health and emotional wellbeing. protection from abuse and neglect. the adult’s control over day-to-day life (including care and support and the way it is provided). participation in work, education, training or recreation. Introduction ‘Wellbeing’ principle
7 social and economic well-being. domestic, family and personal relationships. suitability of living accommodation. the adult’s contribution to society. Promoting “wellbeing” means actively seeking improvements, for the adult with care and support needs (regardless of whether they have eligible needs or not) and informal carers. This approach informs planning of care, delivery of universal services and strategic planning. All professionals should assume that adults are best placed to judge their own wellbeing and be respectful of their individual views, beliefs, feelings and wishes, unless there are reasons to doubt this (see Appendix 15). If it appears the adult may lack capacity to make decisions about their care and support needs, it may be necessary to consider making a best interest decision. Promoting wellbeing should always be considered when responding to safeguarding concerns. Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect and the purpose of this document is to guide individuals and organisations to identify and respond appropriately when adults may be at risk of harm, abuse, or self-neglect. Local Authority Safeguarding services will promote wellbeing not only in these circumstances but through offering advice and guidance to organisations whose practices could lead to harm and therefore prevent it. Safeguarding is not simply concerned with responding to what has gone wrong but trying to predict risk. The member agencies of the DBCPSAB recognise this. They are keen for any professional working with an adult who appears to be at risk of harm or abuse, to bring agencies together to mitigate that risk, through the formal Multi-Agency Risk Management (MARM) process MARM Guidance which is endorsed by the SAB and is available on the SAB websites. More generally the Statutory Guidance (2020) issued under the Care Act (2014) requires a SAB to develop preventative measures to reduce the incidence of harm across their area and the DBCPSAB’s strategy encourages all agencies to take steps that will help prevent harm arising. Criteria These Procedures apply where the Local Authorities respond to safeguarding concerns and/ or make enquiries or require others to do so on their behalf if they reasonably suspect an adult meets the following criteria: 1. Has needs for care and support (whether or not the Local Authority is meeting any of these needs) and 2. Is experiencing, or at risk of, abuse or neglect; and 3. 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. The DBCPSAB support the definitions and clarity that can be found in Understanding what constitutes a safeguarding concern and how to support effective outcomes (local.gov.uk) (September 2020), which outlines how organisations should fulfil their responsibilities under Section 42 (1). if they respond to points one and two above, whilst a judgement will need to be made about the third point, this may well be an outcome of the local authority’s information gathering or statutory enquiry about the information/ allegation. In other words, it will not necessarily be possible to determine this factor at the time the concern is reported and if it is ‘reasonable to suspect’ that an adult is unable to protect themselves, an Enquiry may proceed. When determining whether an adult has care and support needs, it is important to consider needs that relate to their physical and mental health and cultural and spiritual preferences. (See Definitions
8 Appendix 1). Support needs may not be obvious, for example, an adult may have experienced trauma in their life which has an impact on how easy they will find it to trust and engage with professionals. This dynamic may also affect their ability to make decisions or carry out activities (See Appendices 1, 7, 14 & 15). These Procedures define harm as: A single act or repeated acts An act of neglect or a failure to act Multiple acts, for example, an adult may be neglected and be financially harmed Self-neglect (see also Appendix 2) This can mean: Ill-treatment (including sexual harm and forms of ill-treatment which are not physical). The impact of not providing care, providing inappropriate care or other actions which are detrimental to health, wellbeing, maintaining independence and choice The impairment of, or an avoidable deterioration in physical or mental health and/or The impairment of physical, intellectual, emotional, social or behavioural development. Allegations against people in positions of trust (see Appendix 1 and Appendix 18) Intent is not an issue at the point of deciding whether an act or a failure to act is harm; it is the impact of the act on the adult and the harm or risk of harm to that adult. Harm can take place anywhere. Harmful acts may also be crimes and informing the Police must be a priority consideration as part of any immediate actions at point of disclosure. Physical abuse including assault, hitting, slapping, pushing, misuse of medication (including covert use of medication), restraint or inappropriate physical sanctions. Domestic violence and abuse The cross-government definition of domestic violence and abuse is: any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to: Psychological physical sexual financial emotional • Controlling Behaviour Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacity for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. • Coercive Behaviour Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim. Controlling or coercive behaviour may not meet the definition of domestic abuse. It can be a type of harm present in other relationships with non-intimate contacts or professionals. For example, cuckooing or a person in a position of trust (see Appendix 1 and Appendix 18). Categories of Harm
9 Sexual abuse Including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting or does not have the mental capacity to consent. Sexual exploitation The term “sexual exploitation” means any actual or attempted abuse of a position of vulnerability, differential power, or trust, for sexual purposes, including, but not limited to, profiting monetarily, socially or politically from the sexual exploitation of another. It may be very important in specific cases to be clear about the context in which concerns about sexual exploitation arise. Some adults may have been groomed as children or young people. Others may be engaged as sex workers so are at risk because they are threatened or coerced, have drug dependencies and/or mental health needs. Adults with learning disabilities may be vulnerable/ susceptible to sexual exploitation, which may masquerade as an offer of friendship. (See BCP Safeguarding Adults Board website for detailed report from September 2016). See also Appendix 1 Glossary on Mate Crime Psychological abuse Including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks. Financial or material abuse including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with Wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits and deprivation of assets. Modern Slavery Includes human trafficking, forced labour and debt bondage, sexual exploitation, criminal exploitation, domestic servitude, descent-based slavery, child labour and slavery in supply chains. The impact on the adult needs to be considered when determining whether the Section 42(1) criteria are met, e.g. impact on their mental health. Human Trafficking The definition of human trafficking is the illegal movement of people through force, fraud or deception with the intention of exploiting them, typically for the purposes of forced labour or sexual exploitation. Men, women, and children are forced into a situation through the use (or threat) of violence, deception or coercion. Victims may enter the UK legally, on forged documentation or secretly under forced hiding, or they may even be a UK citizen living in the UK who is then trafficked within the country. It should not be confused with people smuggling, where the person has the freedom of movement upon arrival in the UK. There is no ‘typical’ victim of human trafficking and modern slavery. Victims can be men, women and children of all ages, ethnicities, nationalities, and backgrounds. It can however be more prevalent amongst the most vulnerable members of society, and within minority or socially excluded groups. Discriminatory abuse including forms of harassment, slurs or similar treatment because of race, gender and gender identity, age, disability, sexual orientation, or religion. (See Equality Act under Appendix 1). Organisational abuse Including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in an adult’s own home. This may be a one-off incident or ongoing ill-treatment. It can refer to neglect or poor professional
10 practice because of the structure, policies, processes, and practices within an organisation including corporate neglect. Neglect and acts of omission Includes ignoring medical, emotional, or physical care needs, failure to provide access to appropriate health, care and support or educational services, equipment, the withholding of the necessities of life, such as medication, adequate nutrition, and heating. Self–neglect This includes a broad spectrum of behaviour. The Care Act 2014 statutory guidance defines self-neglect as: “a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding”. Self-neglect is recognised as the failure or unwillingness by an adult to meet their own basic care needs required to maintain health. Significant hoarding may be associated with an adult having a Hoarding Disorder (See Appendix 1), either diagnosed or undiagnosed. It should be noted that neither self-neglect or hoarding may prompt a Section 42 enquiry but may need or benefit from support through case management, multidisciplinary discussion or Multi Agency Risk Management (MARM). An assessment of need and risk should be made on an individual basis. A decision on whether a response is required through a Section 42(2) Enquiry will depend on an adult’s ability to protect themselves by controlling their own behaviour. There may come a point when it is determined they are not able to do this without external support. For more information and guidance about supporting an adult who is self-neglecting or hoarding see Appendix 2 – Self-Neglect Guidance and suggested templates for screening and assessment and more detailed separate guidance produced by the SABs for organisations who could be involved in responding. Other types of harm Internet/cyberbullying Can be defined as the use of technology, and particularly mobile phones and the internet, to deliberately hurt, upset, harass, or embarrass someone else. It can be an extension of face-toface bullying, with the technology offering the bully another route for harassing their victim or can be simply without motive. Cyberbullying can occur using practically any form of connected media, from nasty text and image messages using mobile phones, to unkind blog and social networking posts, or emails and instant messages, to malicious websites created solely for the purpose of intimidating an adult or virtual abuse during an online multiplayer game. Forced Marriage: Although forcing someone into a marriage and/or luring someone overseas for the purpose of marriage is a criminal offence the civil route and the use of Forced Marriage Protection Orders is still available. These can be used as an alternative to entering the criminal justice system. It may be that perpetrators will automatically be prosecuted where it is overwhelmingly in the public interest to do so, however victims should be able to choose how they want to be assisted. Exploitation by radicalisation: The Home Office leads on the anti-terrorism PREVENT strategy, of which CHANNEL is part (refer to Prevent duty guidance - GOV.UK (www.gov.uk) for information). This aims to stop people becoming terrorists or supporting extremism. All local organisations have a role to play in safeguarding adults who meet the criteria. Contact should be made with Dorset Police regarding any adults identified who present concern regarding violent extremism. Homelessness – homelessness does not necessarily mean that the adult is at risk of harm, and it is therefore not a defined category of harm. However, circumstances such as
11 homelessness may exacerbate other conditions and impact negatively upon adult’s ability to care for their health and to protect themselves. Cuckooing – refers to the identification of a relatively new type of controlling and coercive criminal activity. This involves gangs using adults at risk (and children and young people) to move, store and deliver drugs. More details are at Appendix 1. Whilst the term cuckooing is specifically related to the County Line guidance, other types of harm or abuse can co-exist in these circumstances, such as financial, physical, psychological etc. When considering whether to act under Section 42, it is important to consider if the adult can protect themselves from the dynamics of the cuckooing.
12 Steps to Safeguarding – Summary Flowchart Outcomes achieved for individual but others at risk Enquiry planning Carry out agreed actions Continue to monitor and mitigate risks for self and others Section 42(2) Enquiry – No further action Outcomes achieved Remember; to always consider mental capacity and informed consent Criteria for Section 42(1) Concern are met Who is to take actions? Raising a concern/make a referral Section 42(1) criteria not met/no statutory Enquiry required (consider other options/alternatives) Use of MARM guidance may be helpful If a child or young person is at risk refer to Children’s Services Continue to work with individuals and develop risk reduction strategy Evaluation of outcomes Enquiry Review Meeting Ongoing safeguarding plan needed Review Safeguarding Plan No further action. Cease involvement. Outstanding Actions Yes No Review Agree other actions / options Outcomes met, Section 42 (2) Enquiry ends NB: A section 42(2) Enquiry can be closed at any point where a decision is reached that risks are being managed and the adult is satisfied with the outcomes. For further information, please see Understanding what constitutes a safeguarding concern and how to support effective outcomes
13 Quick guide to flow chart Dealing with historic allegations of abuse or where the adult is no longer at risk: One of the criteria for undertaking a statutory enquiry under the Care Act Section 42(1) duty is that the adult is “experiencing, or is at risk of, abuse or neglect”. Concerns relating to historic abuse e.g. historic child abuse (historic means not previously subject to an enquiry/followed up) or neglect where the adult is no longer at risk will not be the subject of statutory enquiry under these procedures. Further action under different processes may be needed and may include criminal or other enquiry through parallel processes (e.g. complaints, inquests, regulatory, commissioning, health and safety investigations). All such historic concerns will be considered to determine whether they demonstrate a potential current risk of harm to other adults, children, or young people, where appropriate these will be referred to the Police or Children’s Services. Where an adult safeguarding concern is received for an adult who has died the same considerations will apply and an enquiry will be made where there is a clear belief that other identifiable adults are experiencing, or are at risk of, abuse or neglect. In cases where an adult has died, suffered serious abuse, neglect or harm, or the Safeguarding Adult Board (SAB) determines it appropriate to commission a SAR or other review, SAR Policy and Terms of Reference. The local Business Manager for each SAB can advise. Section 42(2) Enquiry This refers to the local authority being in receipt of information about an individual aged 18 or over who has care and support needs (whether or not these needs meet the national eligibility criteria) and is unable to protect themselves and the local authority is satisfied there are concerns the adult is experiencing or at risk of harm, abuse or neglect and therefore an enquiry is needed to help keep the adult safe. When to raise a concern A concern should be raised when there is reason to believe an adult may have been, is, or might be the subject of harm, abuse or neglect by any other person or persons. This may include anyone self-neglecting where there is a significant risk to their health or wellbeing. Urgent actions by the person raising the concern should be taken, where it is safe to do so, to safeguard anyone at risk of immediate harm if any of the following concerns are apparent: active abuse is witnessed, or an active disclosure is made by an adult or third party, or there is suspicion or fear that something is not right or there is evidence of possible abuse or neglect. In circumstances where there are serious immediate risks a response from Safeguarding Adult services, or the police should be provided the same day. Whilst reporting a concern to the local safeguarding team it is important that anyone who is aware of it must also consider if the risk or experience of immediate serious harm is so severe that the adult’s Right to Life (Human Rights Act) is at risk and urgent action is required to prevent loss of life. In this case the Police should be contacted without delay.
14 Section 42(1) concern criteria not met If not met it may be necessary to consider other options such as signposting, assessment of need and referral to other services to prevent deterioration and promote independence, health and wellbeing. This could result in actions which will engage the adult in taking steps to protect themselves from harm. If an informal carer is at risk of harm or abuse from the adult they care for, the local authority may undertake an Enquiry or consider another intervention to support the carer to stay safe. See page 23 for more details. Who is to take actions? It is important that at the earliest possible stage the relevant team consults with the adult to find out what they want to happen or ensures this is undertaken by another professional. Once the local authority decides a Section 42(2) enquiry is required, there are a range of options about who can undertake it. The local authority must decide, after consultation, who will do this. In all circumstances the local authority retains responsibility for coordinating and monitoring the enquiry in relation to achieving the adult’s desired outcomes and supporting the management of the risk. The organisation or individual that is required to undertake the enquiry should be agreed with the adult concerned where possible. The professional appointed will be known as the Nominated Enquirer/s (NE) in each case. There is no definitive list of who can be required to undertake an enquiry, but could include: • The local authority • Employer • Contract monitoring • Police • Health Care Professionals • Support workers • Other care and support providers in an adult’s life • Housing • Any other agency as deemed appropriate The local Trading Standards Services: Trading Standards in Dorset, Bournemouth, Christchurch and Poole and Dorset Police have jointly produced a Memorandum of Understanding (MoU) approved by the SAB which sets out how they will work together on safeguarding concerns. Agencies should refer to Appendix 20 which sets out when the local authority should refer to both Trading Standards and the Police. See Appendix 20. For local NHS services the local authority will contact the Safeguarding Adults lead for the provider to request that they plan for the most appropriate professional to carry out the enquiry and produce the NE report. The decision maker will indicate where possible the status of the adult’s mental capacity and their views about the issue being enquired about, the themes and specific concerns which need to be addressed and provide information about the dates or period to be considered by the professional appointed. In all Section 42(2) Enquiries the Local Authority will allocate a Safeguarding Adults Practitioner (SAP). This professional is likely to be a local authority employee and will fulfil the council’s responsibilities for monitoring and coordination of the safeguarding enquiry as necessary. This professional may also be the NE for specific actions. There may also be other NE’s.
15 The NE will be expected to complete an NE report detailing the findings of this part of the enquiry. This report will be shared with the appropriate SAP who has been appointed to the Enquiry. Section 42 (2) enquiry planning It is imperative to directly consult with the adult to confirm what outcomes they want to achieve and what support they may need to keep safe and to manage risks. This is the initial Safeguarding Plan and, depending on the circumstances the format for recording this will vary, i.e. professionals may use a Nominated Enquirer Report, Risk Assessment, or other suitable document. Through this discussion, the SAP/NE (as appropriate) may agree with the adult that other individuals and/or agencies need to be involved in the planning discussions and to take forward the responses. It may be possible to plan responses through a series of telephone calls or one to one discussion, but it may be necessary to convene an Enquiry Planning Meeting (EPM) to agree a clear response plan and actions. See Appendix 3 The NE’s must keep appropriate records (i.e. chronological notes) and ensure the SAP is updated. If the adult does not wish to proceed with the Enquiry or their desired outcomes have been met at this point the enquiry can be closed. If an agency thinks that others are at risk of harm or abuse, the enquiry continues. If the SAP has any doubts, they should refer the matter to their supervisor for support and guidance. It is necessary for the NE and/or the allocated SAP to periodically review the situation and interim safeguarding plan with the adult and others involved to: • ensure risks are managed as effectively as possible • ensure agreed actions are progressing • to agree further actions as necessary to make a record of the actions decided • It may be possible to achieve this through a series of telephone calls or small meetings; the need for larger multi-agency meetings is left to professional judgement. To develop strategies to reduce/manage risk whilst continuing to work with the adult Professionals should continue to work with the adult to meet their desired outcomes. It is important to emphasise that the adult may choose not to engage with services or plans even though the agencies involved think they could help keep the adult safe. Whilst it is vital to respect the adult’s views other factors may have to be considered such as whether a capacity assessment is necessary. See Appendix 15. Consider the need to convene an Enquiry Review Meeting (ERM) at which all relevant reports/accounts can be considered.
16 Evaluation of outcomes – Enquiry Review Meeting Either at or following the ERM the NE or allocated SAP must evaluate with the person the extent to which desired outcomes have been met and review if an ongoing safeguarding plan is needed. The adult must be given every opportunity to say what she/ he thinks about their experience of this enquiry. The local authority and other agencies involved in the enquiry must also be satisfied that the adult(s) are safe and that risks to others are reduced or removed. Review plan Agree with the adult when it is appropriate to review the safeguarding plan and who needs to be involved. Agree timescales including a decision to convene a further ERM. Closing a Safeguarding Section 42(2) enquiry If no further action is required regarding the specific Safeguarding enquiry, then the case should be closed. A decision to close the Section 42(2) enquiry will be made by the Local Authority or the Police. Ensure the person who raised the concern is aware of the outcome within the limits demanded by confidentiality. Outcome achieved for adult but others at risk Adult’s outcomes have been met, and they are safe. If there are other adults are at risk or outstanding actions further steps need to be taken by the local authority and Section 42(2) duty should continue. If other adults are at risk, consideration needs to be given to whether further Section 42(2) enquiries need to be made for those adults and there may need to be a Large-Scale Enquiry (see Appendix 12). Whilst the list is not exhaustive some actions that may be relevant and must be agreed with the adult and/or their representative/advocate are: • Seek consent/agreement from the adult at risk of harm, where possible. • Capacity assessment if deemed necessary • Make sure the rights of the adult are always taken into consideration. • Invoke interim safeguarding plan e.g. safe haven, person alleged to have caused harm arrested. • Joint interview with police. If further information is required on achieving best evidence in criminal proceedings refer to: https://www.gov.uk/government/publications/achieving-bestevidence-in-criminal-proceedings Consider if other procedures need action at the same time e.g. complaints process, disciplinary process, contracts monitoring, assessment/review, referral to Children’s Services Outstanding actions It may be necessary to convene an EPM to consider and evaluate further actions required, to agree who will undertake these and check the adult(s) agree. Mechanisms for reviewing and monitoring must also be agreed and documented. Other actions requiring local authority or other agency involvement may include the following: • CQC inspection • Contract monitoring • Care management • Disciplinary action • Trading standards • Multi-Agency Risk Assessment Conference (MARAC) or High-Risk Domestic Abuse HRDA referral • Multi-agency Risk Management (MARM)
17 Review It may be necessary to convene an ERM to review outcomes of actions taken. Monitoring must continue until all agreed actions are achieved. Section 42(2) enquiry ends - outcomes achieved In circumstances where the adult decides that they do not want a Section 42(2) enquiry to continue, and no other adult is at risk and the council is satisfied that no further action needs to be taken the Section 42(2) enquiry can be closed. Risks will have been addressed and specified outcomes achieved and, in addition the adult will have had the advice necessary to keep them safe. Below is a list of possible options, interventions or actions that could be considered. There may be others depending upon the individual circumstances. It is important for professionals s to use their judgement and legal literacy (or seek advice) when thinking about what is best for the adult: Advice and signposting to community-based services Assessment and care and support planning under Section 9 of the Care Act 2014 including the use of personal budgets Referral to other agencies e.g. housing, Independent Domestic Violence Advisor (IDVA), health, advocacy, etc. Mental Health Act 1983 (2007), including admission for treatment or use of Guardianship. Restriction/management of access to person alleged to have caused harm, i.e. Restraining order Referral to Multi Agency Risk Assessment Conference (MARAC). High Risk Domestic Abuse in Dorset (HRDA) in Dorset. Deprivation of Liberty Safeguards (DoLS) assessment Use of the complaint procedure for a specified agency. A safeguarding plan should be discussed, agreed (where possible) and given to the adult at risk to try to ensure they remain safe and that their wellbeing is promoted. It might be helpful if the MARM guidance is referred to as a means of formalising this planning process. The adult may choose not to accept or follow this plan. Consideration will need to be given about how the safeguarding plan can be shared by relevant agencies. Whenever possible provide feedback, even if only in outline, to the person or organisation who reports the concern in the first place. Complaints It is possible that the adult or their representative may be dissatisfied with the safeguarding process. If they complain this should be considered by the local authority that will signpost to the appropriate agency or have responsibility to deal with it themselves.
18 Overview Flowchart – The Adult’s Perspective This flowchart can be used as a reference tool and sets out a series of prompts: on the left, actions which organisations are responsible for at each stage of the safeguarding activity On the right, what the adult/s can expect Flowchart produced by West Midlands Safeguarding Adults Policy and Procedures Group.
19 Raising a Concern A concern will be raised when there is reason to believe an adult may have been, is, or might be the subject of harm, abuse or neglect by any other person or persons. Self-neglect can be reported as a Section 42(1) concern but may well not be dealt with via a Section 42(2) enquiry - see Appendix 2 and separate Guidance issued by the SABs. (Self Neglect and Hoarding Guidance for agencies) The local authority will determine if the concern requires a Section 42(2) enquiry and if not, what other actions may be taken. It is acknowledged that local authorities may receive information from many sources other than the adult at risk and may not be able to corroborate facts or seek consent to act immediately. Doing nothing with this information is not an option. All agencies have a duty of care to share information and take mitigating steps to preserve life under the Human Rights Act 1998. Actions to be taken when harm is directly observed or disclosed by the adult When harm is seen, the observer will take the steps necessary to make the adult safe and then urgent steps taken to report to the Local Authority. If a crime appears to have been committed, the Police should also be contacted. It is vital to listen carefully to what the adult is saying, reassure them they will be involved in decisions about what will happen and get as clear a picture as possible but avoid asking too many questions at this stage. In all circumstances staff must be assured the adult is safe from harm or any further harm. This may mean contacting any/ all the emergency services. Accept what the adult is saying – do not question the adult or get them to justify what they are saying – reassure the adult that you take what they have said seriously. Do not ‘interview’ the adult; just listen carefully and calmly to what they are saying. If the adult wants to give you lots of information, let them. Try to remember what the adult is saying in their own words so that you can make a written record later (see below). You can ask questions to establish the basic facts but try to avoid asking the same questions more than once or asking the adult to repeat what they have said - this can make them feel they are not being believed. Do not promise the adult or others that you will keep what they tell you confidential or “secret”. Explain that you will need to tell another person, but you will only tell people who need to know so that they can help. Reassure the adult that they will be involved in decisions about what will happen. Do not be judgemental or jump to conclusions. If the adult has specific communication needs, provide support and information in a way that is most appropriate to them. There should be an assumption that the adult has capacity, unless there are reasons to doubt at the time. It may be necessary to undertake a decision specific capacity assessment, which takes account of any issues of duress and coercion. (See Appendix 15 and seek advice if needed) Careful consideration will need to be given regarding who else needs to know about the concern. The concern should not be discussed with the person alleged to have caused harm; this will be a point considered through the Enquiry process and influenced by the adult’s wishes. Detailed Guidance on Progressing Safeguarding Concerns
20 Making a Written Record As soon as possible on the same day, the referrer of the safeguarding concern should make a chronological written record of what you have seen, been told or have concerns about. Try to make sure anyone else who saw or heard anything relating to the concern also makes a written record. The written record will need to include: the date and time of the disclosure, or when you were told about or witnessed the incident/s, who was involved, any other witnesses’ details, exactly what happened or what you were told, in the adult’s own words, keeping it factual and not interpreting what you saw or were told, the views and wishes of the adult, the appearance and behaviour of the adult and/or the person making the disclosure, any injuries observed, any actions and decisions taken at this point, i.e. management of immediate risks any other relevant information, e.g. previous incidents that have caused you concern. Remember to: Wherever possible and practicable seek the adult’s consent to raise the concern. Where the adult raises objections and there are significant risks, or if other adults or children could be at risk, it may be necessary to override their expressed wish not to consent. include as much detail as possible, make sure the written record is legible, written or printed in black ink, and is of a quality that can be photocopied, make sure you have printed your name on the record and that it is signed and dated, keep the record factual as far as possible. However, if it contains your opinion or an assessment, it should be clearly stated as such and be backed up by factual evidence or observations. Information from another person should be clearly attributed to them. keep the record/s confidential, storing them in a safe & secure place until needed. When a Crime is suspected If a crime is suspected, it is critical that the Police are informed. Try not to disturb the scene as it may be important for the Police to collect forensic evidence. If in doubt, ask police for advice. In cases where there may be physical evidence of crimes (e.g. physical or sexual assault), contact the Police immediately. Ask their advice about what to do to preserve evidence. See Appendix 8. Professionals must contact Dorset Police Multi Agency Safeguarding Hub (MASH). Contact Children’s Social Care if child/children are also at risk. Whilst the above is necessary as an initial action, it is also vital to report the concern to the Safeguarding Adults contact point within the Council, details on page 5. Dorset Police is resolute in its commitment to tackling all forms of crime against adults at risk. Every member of the community deserves protection from exploitation and harm by those entrusted with their care and the people they should be able to rely on to keep them safe. People raising a concern must make it clear whether they are reporting a crime or suspected crime or seeking advice. Discuss with the relevant authority’s Adult Social Care safeguarding service who will advise. In an emergency call the Police on 999.
21 The Police will ask: Who is reporting the concern? What did the adult at risk say happened? Who is alleged to have caused the harm? What else is known and who else saw it or knew about What crime is suspected of being committed? Further information can sometimes be obtained in a joint visit. What is recorded in daily records if these exist? (The Police can only seize records after an arrest is made or on authority of a Court Order) Did the adult at risk give Do they have the capacity to give that consent and were they under influence or duress? What does the person want to happen? Do they want the police involved?
22 Partner agencies should contact the Multi Agency Safeguarding Hub (MASH) via secure email to AdultsAtRisk@dorset.pnn.police.ukThis office is staffed 0800 to 1800 Monday to Friday. Once the referral is sent then a telephone discussion can take place by phoning 01202 222229. The Multi Agency Safeguarding Hub (MASH) will facilitate early discussions which will decide if the referral is suitable for joint Adult Social Services and Police investigation or single agency action. A trained police officer will be responsible for arranging any forensic examination that is required. This will normally be conducted at Shores (a Sexual Assault Referral Centre). However, if this is not appropriate the officer will plan for the examination to be facilitated elsewhere. The Police will always determine whether a criminal investigation is required and decide which department will undertake the investigation. It is likely that offences against the person which are complex and serious will be investigated by the Criminal Investigation Department and lesser offences of concern will be dealt with by Neighbourhood Policing Teams (NPT). Criminal investigation by the Police will take priority over all other professionals’ enquiries. However, safeguarding the adult at risk is of prime importance throughout the investigation. Professionals must ensure the adult at risk is involved, consulted and consent gained unless any of the following apply: Other adults or children could be at risk from the person alleged to have caused harm. It is necessary to prevent crime. Where there is a high risk to the health and safety of the adult at risk. The adult lacks capacity to consent, is under duress or being coerced. If in doubt discuss this with the Local Authority or the Police. Good practice guide – when a crime is suspected Raising concerns with the Police Where possible leave things as and where they are. If anything has to be handled, keep this to an absolute minimum. Do not clean up. Do not touch anything you do not have to. Do not throw anything away which could be evidence. Do not wash anything or in any way remove fibres, blood etc. Preserve the clothing and footwear of the victim. Preserve anything used to comfort or warm the victim, e.g. a blanket. Note in writing the state of the clothing of both the victim and person alleged to have caused the harm. Note injuries in writing. As soon as possible, make full written notes on the conditions and attitudes of the people involved in the incident. Take steps to secure the room or area where the incident took place. Do not allow anyone to enter until the Police arrive. If you believe that evidence, such as patient notes will be destroyed or collected, advise the Police immediately. In addition, in cases of sexual assault: Preserve bedding and clothing where appropriate, do not wash. Try not to have any personal or physical contact with either the victim or the person alleged to have caused the harm. Offer reassurance and comfort as needed but be aware that anyone touching the victim or source of risk can cross contaminate evidence.
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