Crossroads Care Safeguarding Adults Guidance for Staff

Safeguarding adults guidance for staff 1.0 SCOPE 1.1 This guidance outlines Crossroads Care’s approach to safeguarding adults aged 18 and over. Please see the separate safeguarding and child protection guidance for staff (C.01c) regarding children and young people aged 17 and under.

1.2 Its aim is to safeguard and promote the welfare of adults who are receiving a service from Crossroads Care and who may be at risk of abuse and neglect.

1.3 You also need to read guidance for staff on:  confidentiality and disclosure (D.11c)  whistleblowing (E.09a)  adults’ behaviour management (B.04c).

2.0 STAFF RESPONSIBILITY 2.1 As a Crossroads Care employee you have a responsibility to safeguard and promote the well-being of the service users you work with, by being responsible for the quality, efficiency and effectiveness of your work.

2.2 Your scheme will have appointed a senior member of staff as safeguarding officer to deal with adults’ safeguarding issues. Ask your line manager if you are not sure who it is.

2.3 Your will be given details of all the people you may need to contact if you witness or suspect that someone is being harmed, neglected or ill-treated or if you are concerned about their welfare in any way. There is a table of these people and their contact numbers in Appendix 5 at the end of this document. Make sure you can access their details quickly whenever you are at work

2.4 If you suspect that someone has been abused or is at risk of abuse or if you have any concerns about their welfare or safety, it is your responsibility to inform a senior member of staff without delay, for example:  your line manager  the safeguarding officer  the person on call.

2.5 Although ordinarily you are required to keep information about service users confidential, if you know or suspect that abuse is taking place you must speak to someone about it. Follow it up. If you cannot get hold of a senior member of staff, report it immediately to the local authority Social Care Duty Team (see Appendix 5 for contact details).

2.6 If you report a concern and are not satisfied that it has been dealt with properly, you have a responsibility to raise the matter again using the whistleblowing guidance (E.09a).

Policy/Safeguardingadults/2012/05/APb005c Last updated April 2014, to be implemented by July 2014. Review due April 2014 Carers Trust is a registered charity in England and Wales (1145181) and in Scotland (SCO42870). Registered as a company limited by guarantee in England and Wales No. 7697170. Registered office: 32-36 Loman Street, London SE1 0EH. Crossroads Care trade mark is a collective mark. © Carers Trust 2014 Crossroads Care Safeguarding adults guidance for staff

3.0 USEFUL INFORMATION 3.1 You will find useful information on the following topics at the end of this document.

Appendix 1 Definitions of:  adult at risk  abuse  harm  the abuser

Appendix 2  Factors making abuse more likely to occur

Appendix 3  The categories of abuse  The signs and symptoms of the different forms of abuse

Appendix 4  FirstAssist telephone counselling service.

4.0 WORKING WITH ADULTS AT RISK WITHIN CROSSROADS CARE 4.1 You are expected be sensitive and responsive to each person’s individual needs. This includes their cultural and religious needs, as well as physical and emotional ones, and you need to be particularly sensitive when you are dealing with any intimate care.

4.2 Intimate personal care 4.2.1 Intimate personal care is any procedure involving physical care or treatment that is an invasion of bodily privacy and that may be a potential source of exposure or embarrassment to the individual receiving the care.

4.2.2 The understanding of intimate care can vary depending on the individual concerned and their background or culture. It can include:  assistance with eating and drinking  oral care  washing  dressing / undressing  toileting  menstrual care  treatments such as enemas, suppositories, enteral feeds  administration of medication  catheter and stoma care  supervision of a person involved in intimate self-care.

4.2.3 A care planner will have discussed the arrangements regarding the provision of intimate care with the person concerned (if appropriate) and / or their carer before you begin to provide the service.

4.2.4 The care planner will put all the necessary information into the care plan, including:  details of the intimate personal care tasks you are being asked to do

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 where and how these tasks will be carried out  how the person with care needs communicates (see 4.2.7 below)  the number of staff needed to carry out the task safely  whether the staff need to be male or female.

4.2.5 The care planner will also assess whether you are able to carry out the intimate care task(s) alone or whether there needs to be two of you.

4.2.6 When you are carrying out intimate care tasks, make sure that you:  treat every service user with dignity and respect  give them as much privacy as possible  involve them as much as possible in their own intimate care  know how each individual would let you know if they were in discomfort, or were unhappy about the task or the way you are doing it  respond in a positive way to any reactions from the person receiving the care and don’t just ignore them.

4.2.7 Always communicate in the way the person likes and understands (for example Braille, British Sign Language, using symbols or pictures), as directed in their care plan and let them communicate at their own pace.

4.2.8 When you are involved in carrying out intimate personal care tasks for a person with care needs, always be on the alert for and report any of the following:  if they get accidentally hurt or injured  any concerns you have about how other people are acting (for example colleagues, other professionals, family members)  if they appears to be unusually sore, has marks or injuries or appears to be sexually aroused by the actions of others  if they displays an extreme emotional reaction for no apparent reason.

5.0 RECOGNISING & REPORTING CONCERNS 5.1 You need to be vigilant at all times regarding the welfare of any service users your work brings you into contact with.

5.2 The service you provide is likely to be offering help to people who are having to deal with a large number of different problems and stresses. This puts you in a prime position to recognise and act early on situations that may lead to harm if they are ignored.

5.3 You will be trained to recognise the early signs of abuse. Details of the different forms of abuse and the signs and behaviour you need to be on the alert for are documented in Appendix 3 at the end of this document.

5.4 You could have concerns about a person with care needs for any of the following reasons:  seeing an actual injury or signs of abuse or neglect  comments made by him / her  comments made by another person about something they have seen or heard  observations made about the person’s emotional responses or behaviour.

5.5 Remember that carers may also be subject to abuse (for example by the person with care needs or other family members) as well as the person receiving care.

5.6 If you know or believe that abuse is taking place, you have a duty to report the matter immediately. See 2.4 – 2.6 above for details.

6.0 ACTION REQUIRED WHEN ABUSE IS EVIDENT, DISCLOSED OR SUSPECTED 6.1 If you WITNESS abuse:  contact the appropriate emergency services (for example ambulance or police) if required  immediately contact your line manager / safeguarding officer / person on call and follow their guidance  where possible establish with the adult at risk the action they wish you to take  if you think they are in danger, wait with them until an authorised person arrives to take them to hospital, or to a place of safety  if the alleged abuser is still there, try to calm the situation down but don’t put yourself in any danger by doing so  record everything in detail as soon after the incident as you can, including your concerns, who said what, details of any injuries caused and anything else you think may be relevant to the situation  do not destroy, disturb or move articles that could be used as evidence.

Please note: record any relevant marks, bruises or injuries on a body chart (for example BT.07). DO NOT UNDER ANY CIRCUMSTANCES TAKE PHOTOGRAPHS OF THEM.

6.2 If a person DISCLOSES an allegation of abuse to you:  LISTEN carefully to what the person says and pay attention to how they are behaving  explain that you cannot keep such a serious matter secret or promise not to say anything to anyone and that you have to tell a more senior person at work about it  make sure they know you are taking what they say seriously  reassure them that they will be involved in decisions about what happens next  tell them that they did the right thing by telling you  note down the time, setting and details and any witnesses to the conversation  make a record of anything you think is relevant and of what happens next  contact your line manager / safeguarding officer / person on call as soon as you can for guidance.

Do not:  stop someone from talking if they want to tell you what has happened to them  take the matter lightly or make a joke about it  change the subject because you feel uncomfortable  be judgemental or jump to conclusions  prompt or directly question the person or ask leading questions  investigate the allegation.

Write up your report of the incident as soon as you can after the even occurred and give this, along with any notes you made at the time to your line manager or the safeguarding officer as soon as possible.

6.3 If you SUSPECT abuse:

 make a note of your concerns  write down details of whether they are based on a ‘one-off’ incident or remark you have seen / heard or on things that have happened a number of times  discuss your concerns straight away with your line manager / safeguarding officer / person on call, who will decide what action to take.

7.0 ALLEGATIONS OF ABUSE AGAINST A STAFF MEMBER 7.1 If an allegation of abuse is made against you or any other member of staff, your line manager / safeguarding officer is required to notify:  the purchasing or commissioning authority  the local authority Social Care Duty Team  Care Quality Commission (CQC) or the local Care and Social Services Inspectorate Wales (CSSIW)  Crossroads Care insurance brokers (Watson Laurie)  the scheme board of trustees (details anonymised)  if a crime may have been committed.

7.2 The statutory agencies (for example the police) will carry out a full investigation into the allegation. In addition, the safeguarding officer may decide to carry out an internal investigation using the disciplinary policy and procedure, having first made sure that it won’t interfere with what the statutory authorities are doing.

7.3 The appropriate manager/s will consider whether to suspend the staff member concerned from their duties whilst these investigations are taking place.

7.4 When such an allegation has been made against a member of staff, it is important that the matter remains confidential. No-one is allowed to discuss either the allegation or the person concerned unless it is as part of a formal investigation. If you are found to be doing so it may result in disciplinary proceedings.

7.5 If allegations of abuse are made against you, you can get help from the FirstAssist helpline. This is an independent service, available to you free of charge and offers general counselling and support – see Appendix 4 for details. Alternatively, if you are a member of a union, they may be able to offer you help.

8.0 LEARNING AND DEVELOPMENT 8.1 You will find learning and development requirements relevant to this guidance in the learning and development guidance (E.13c).

9.0 ACCEPTANCE 9.1 You are required to sign to indicate that you have received, read and understood the content of this guidance as directed by your line manager and on completion of training it is your personal responsibility to follow it. Failure to do so may result in disciplinary proceedings.

APPENDIX 1 DEFINITIONS Adult at risk This is a person aged 18 or over who is or may be eligible for community care services. It could include a person with:  a mental health problem (including dementia)  a physical disability  drug and alcohol related problems  a sensory impairment  a learning disability  a physical illness  an acquired brain injury  frailty and / or a temporary illness  self-harming tendencies

Abuse Abuse is a violation of an individual’s human and civil rights by any other person or persons. It can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it.

Abuse may:  consist of a single act or repeated acts  be physical, verbal or psychological  be an act of neglect or omission to act  occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented or cannot consent.

Harm This includes:  ill-treatment (including sexual abuse and forms of ill-treatment that are not physical  the impairment of, or an avoidable deterioration in, physical or mental health  the impairment of physical, emotional, social or behavioural development.

The abuser This may be any of a wide range of people including for example:  relatives and family members  professional paid staff in an institutional or community setting  volunteers, including trustees  other service users  someone known to the person or a stranger.

No category of person can be excluded.

APPENDIX 2 FACTORS MAKING ABUSE MORE LIKELY TO OCCUR

Caring situations where formal carers or family / friends:  have not been given adequate knowledge, skills or equipment to provide adequate care  feel very lonely or isolated  habitually lose their temper  feel unable to cope with the vulnerable adult  experience considerable change in lifestyle  have unsupervised / uninterrupted access to the vulnerable person  have begun to regularly speak negatively to the person or speak disparagingly about the individual to others.

Unequal power relationships where one person:  can tell the other what to do  gives intimate personal care  has more status / credibility  provides material goods  has total financial control  misuses confidential information.

Situations where the vulnerable adult:  has hit out at the carer  cannot converse normally  disturbs the carer at night  has stolen from or abused the carer in the past  is or appears to be rejecting and / or ungrateful  behaves bizarrely or is experiencing personality changes.

Family situations where:  relationships have been poor over years, subject to violence  living conditions are poor  carers are not receiving practical / emotional support from other family members and / or professionals  carers have other responsibilities  role reversal has been experienced  the person cared for is inconsiderate towards other family members  the carer is being abused by the dependent person.

APPENDIX 3 CATEGORIES OF ABUSE There are multiple forms of abuse relating to adults at risk and incidents can often involve several categories. These include:  physical abuse  sexual abuse  emotional abuse  financial abuse  neglect.

ALERTING SIGNS AND SYMPTOMS Physical abuse This is defined as pain or injury which is either caused deliberately or through lack of care. Physical injury can include:  hitting  slapping  pushing  kicking  shaking  force feeding  forcible administration of medication  misuse of medication  involuntary isolation or confinement  the use of inappropriate moving and handling techniques  the use of inappropriate methods of restraint.

Signs may include, but are not limited to:  a history of unexplained falls or minor injuries  bruising o in well protected areas, such as on the inside of the upper arms or thighs, behind the ears, on face, buttocks, breasts, lower abdomen, genital or rectal area o in the shape of hand or object o resulting from pinching, gripping, biting o clustered from repeated injury (different discolouration of bruises in the same area may indicate on-going abuse).  injury o unexplained burns and / or scalds particularly to feet, back or palms of the hands o unexplained fractures or fractures of varying ages o to head, face or scalp o signs of over or under use of medication, for example over-sedation o rope or cigarette burns o pressure sores, ulcers, bed sores (which may indicate neglect) o lacerations.

Please note: natural ageing processes can make it more difficult to recognise abuse or neglect in some older people. For example, skin bruising can occur very easily due to blood vessels becoming very fragile: fractures may result from osteoporosis.

Sexual abuse This may include involvement of the individual in sexual activities:  that they may not fully understand  to which they have not or could not given consent or were pressured into consenting  from which they wish to withdraw  which violate social taboos of family roles  which are against the law.

Sexual abuse may be:  non-contact abuse, for example o looking o photography o indecent exposure o innuendo o exposure to inappropriate or offensive language o involvement in the making or showing of pornography o sexual harassment.  contact abuse, such as o rape o touching or fondling o masturbation o penetration or attempted penetration.

Signs may include, but are not limited to:  a change in usual behaviour  torn, stained or bloody underclothing  bleeding abrasion or pain in the genital / rectal area  disturbed sleep pattern  overt sexual behaviour / language  sexually transmitted diseases.

Emotional abuse This is defined as acts or behaviour that can cause emotional distress or anguish. These can include:  systematic intimidation  blaming  controlling and denial of choice  verbal abuse  threats of harm, abandonment or isolation  harassment or humiliation (bullying)  unreasonable demands  deliberate ignoring  emotional blackmail  deliberate continuous isolation from social contact  failure to meet cultural requirements.

Signs may include, but are not limited to:  changes to normal sleep patterns, for example insomnia  change in appetite  unusual weight gain / loss  tearfulness  appearing withdrawn, agitated or anxious  appearing fearful of making choices or expressing their wishes  unexplained paranoia.

Financial abuse This can include:  unauthorised withdrawal of money from an account  exploitation or misuse of a person’s money or goods  theft  fraud  pressure in connection with wills, property or inheritance  misuse or misappropriation of property, possessions or benefits.

Signs may include, but are not limited to:  unexplained / sudden inability to pay bills  unexplained withdrawal from bank or building society accounts  unexplained disappearance of financial documents  disparity between assets and living conditions.

Neglect This can include:  deliberate refusal to meet basic needs including withholding food and fluids, heating or medication  ignoring medical or physical care needs  deprivation of nutrition resulting in impairment of health or bodily functions  failing to provide access to appropriate health, social or educational services.

Signs may include, but are not limited to:  hunger  poor physical condition including weight loss and malnutrition  soreness / chafing due to lack of assistance with personal hygiene  pressure sores, ulcers, bed sores  clothing in poor condition or wet  wet bedding.

APPENDIX 4 FIRSTASSIST TELEPHONE COUNSELLING SERVICE

FirstAssist provides a confidential British Association for Counselling and Psychotherapy (BACP) accredited service and is the UK’s leading provider of telephone counselling services. Each telephone counsellor is a direct employee of FirstAssist and is trained to diploma of counselling (or equivalent) as a minimum qualification. All FirstAssist counsellors have at least two years post-qualifying, clinically supervised, counselling experience.

By employing the right quality and quantity of telephone counsellors, FirstAssist provides a powerful and effective counselling service via the telephone.

Each telephone counselling session can last for up to 50 minutes and the caller can continue to work with their counsellor on an ongoing basis; scheduling convenient appointments for each session.

Research has shown that telephone counselling can be at least as effective as that delivered face to face. In addition, this proven method offers callers the combination of convenience and, where desired, anonymity.

FirstAssist counsellors can work with a wide range of issues, including (but not limited to):  relationship difficulties  bereavement  stress  anxiety  emotional problems  work related issues  family difficulties  debt

All telephone counsellors are subject to formal monthly clinical supervision as well as having 24 hour access to a clinical supervisor for times of particular need. All supervision is provided by a team of FirstAssist clinical supervisors.

The contact details for this service are:

Telephone number 01455 251 500 Quoting scheme number 71422

APPENDIX 5

CONTACT NUMBERS FOR USE WHEN REPORTING SAFEGUARDING CONCERNS

Person to contact Contact number (to be completed by schemes) Crossroads Care Blankshire safeguarding officer

Crossroads Care Blankshire appropriate care manager/s

Crossroads Care Blankshire out of hours contact

Social Care Duty Team:  office hours  out of hours