92 Large scale safeguarding adult enquiries – operational guidance 1. When this guidance applies 1.1 This guidance applies in the following circumstances – Where there are multiple safeguarding adult Enquiries which involve regulated and contracted care or support services. In this context regulated services mean care homes (with or without nursing), supported accommodation, day services, hospitals and domiciliary social care services or In cases where one person providing care is thought to have harmed or has harmed several adults using the service or in an unregulated setting. 1.2 These are both Section 42 Enquiries but need treating differently because of the scale of work required. The terms “Whole service enquiry” and “Large scale enquiry” are to some extent used interchangeably by staff in agencies. Large Scale Enquiry (LSE) is used in this document because it better describes the diverse circumstances where multiple concerns arise. 1.3 A flowchart giving a simplified account of the initial processes is attached at the end of the Appendix. Each Local Authority may have their own internal guidance in addition to this Appendix. 2. Why a large-scale enquiry might be needed? 2.1 When a safeguarding concern is received and through the course of a safeguarding adults enquiry the Enquiry Manager (EM) will need to consider if the harm being alleged or caused to one adult could indicate a risk to others. This could arise when some or all the following factors apply: Complex concerns relating to several adults using the same service. There is no specified threshold for the number of adults, as account must also be taken of the severity of harm/ allegations of harm. Types of harm being reported appear to be organisational. This means they are repeated either at one time or over time e.g. several serious medication errors or actual or potentially dangerous or neglectful actions by staff. Serious reported incidents of harm to several adults at risk. This means concerns that meet the definition for safeguarding enquiries about adults at risk. Indications that multiple criminal offences may have been committed against adults at risk. Multiple breaches of the Health and Social Care Act 2008 may have been committed e.g. regulatory breaches, inappropriate recruitment or retention (e.g. lacking references, no DBS clearance obtained). The service has an accumulation of “deficits” and problems over time which are not being addressed and are or could cause serious harm, i.e. a cluster of quality related issues that have been highlighted and discussed with the provider (e.g. lack of compliance with care plan, unwitnessed falls, poor interaction between adults where no actual harm resulted, medication errors where no harm results), but actions not taken in a timely manner to address the concerns.. 2.2 The range of concerns set out above is varied. Each incident which arises must be considered in conjunction with others, together with prior knowledge of the service, to decide if an LSE is necessary. It must be borne in mind that action in relation to any of the above circumstances is likely to mean that professionals will need to instigate reviews of the services that adults receive. This may, in turn, mean that thought will be necessary about whether the service can meet the adult’s needs. Appendix 12 – Large scale safeguarding enquiries – operational guidance
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