The Care Quality and Safeguarding Risk Appraisal Framework

BRADFORD Adult Social Care Services The Care Quality and Safeguarding Risk Appraisal Framework The framework provides an accountable reference point for understanding the degree of neglect or abuse being experienced by the person or person’s (eg. multiple concerns where whole service is involved) at the centre of concern. This tool enables the measurement of the level of risk present according to the assessed degree of severity. It will usually describe exposure to risk in the person’s own home or a commissioned service, but, the tool can be used to measure risk in any environment.

The Levels of Risk with Severity Assessment Scoring 1 2 3 4 5 Non – Sec 42 Route Sec 42 Enquiry Significant Very Significant Critical Low-level concerns Critical concerns These could be addressed through agency Addressed as potential criminal matter. Police/emergency services to be internal arrangements/processes/procedures e.g. contacted. Could be addressed under MAPPA, MARAC, Hate Crime disciplinary, care management, (Section 42 Enquiry or Non-Statutory Enquiry), or Commissioning as a contractual compliance issue

Date: Name of Person/or Service subject to Safeguarding:

Address:

NB: It is essential that all categories of information are completed fully, as it could form part of court evidence in due course.  Select the category of abuse documents appropriate to the presenting circumstances.  Where more space is needed for evidence, please use the additional evidence sheets at the back of the pack. Institutional (any one or combination of the other forms of abuse) – Severity Assessment Scoring

P:\Strategic Comm & Service Improvement\Adult Protection\Our Work\AP Admin\Templates\General Templates\Care Quality & Risk Assessment Framework 2017 V2 December 2017 Page 1 CATEGORIES OF ABUSE 1 Non – Sec 42 Route  Lack of stimulation/opportunities to engage in in social and leisure activities  Service user not encouraged to participate in the running of a service 2 Sec 42 Enquiry  Denial of individuality and opportunities to make informed choices and take responsible risk  Care-planning documentation not person- centred but focussed upon what the provider thinks the service user needs 3 Significant  Rigid/inflexible routines  Service users’ dignity is undermined e.g. lack of privacy during support with intimate care needs. Discussions taking place about the service user without service user’s inclusion while the service user is present

2 CATEGORIES OF ABUSE 4 Very Significant  Bad practice not being reported, going unchecked, and not reported  Unsafe and/or unhygienic living environments.  Service users being locked in their rooms  Inadequate staffing levels to meet the service users’ required needs 5 Critical  Staff misusing position of power over service users  Over-medication and/or inappropriate restraint managing behaviour  Widespread, consistent ill treatment

3 CATEGORIES OF ABUSE Domestic Abuse - Severity Assessment Scoring

1 Non – Sec 42 Route  Single minor incident of physical violence which were short in duration  Abuser indicates genuine remorse and is willing to seek support for their abusive behaviour  Control by abuser is not intense 2 Sec 42 Enquiry  Up to three minor incidents of physical violence which were short in duration  Potential likelihood of abuse of emotional abuse family members  Intense verbal abuse 3 Significant  History of minor / moderate incidents of physical violence Evidence of intimidation /bullying behaviour – pushing /shoving / intense verbal abuse – consistent use of derogatory language

4 CATEGORIES OF ABUSE

4 Very Significant  Incidents of serious and/or persistent physical violence in the family. Increasing in severity /frequency and/or duration  Stalking / harassment. Increased risk of isolation  Abuser breaching bail conditions  Recurring or frequent requests for police intervention.  Excessive jealousy / possessiveness of abuser – domineering in relationship  Financial control maintained by abuser Forced marriage – female mutilation 5 Critical  Repeated serious and/or severe physical violence - life threatening violence. Attention to the frequency, duration and severity of violent behaviour  Use/assault with weapons  Criminal history of abuser, gangland connections, generalised aggression, history of antisocial behaviour, aggression towards previous partners/family members  Victim is very frightened of abuser - believes intent of 5 CATEGORIES OF ABUSE threats - Retaliatory violence a concern.  Victim is intensively controlled/may present as submissive - worn down by abuse.  Forced marriage – female genital mutilation  Honour Based Violence  Domestic Violence

6 CATEGORIES OF ABUSE Physical – Severity Assessment Scoring

1 Non – Sec 42 Route  Staff error causing no/little harm, e.g. skin friction mark due to ill-fitting hoist sling  Minor events that still meet criteria for incident reporting 2 Sec 42 Enquiry  Isolated incident involving service user on service user  Inexplicable very light marking found on one occasion 3 Significant  Inexplicable marking or lesions, cuts or grip marks on a number of occasions 4 Very Significant  Inappropriate restraint  Withholding of food, drinks or aids to independence  Inexplicable fractures/injuries Assault

7 CATEGORIES OF ABUSE 5 Critical  Grievous bodily harm/assault with weapon leading to irreversible damage or death  Medication, deliberate maladministration resulting in ill health or death

8 CATEGORIES OF ABUSE Neglect – Severity Assessment Scoring

1 Non – Sec 42 Route  Isolated missed home care visit – no harm occurs  Adult is not assisted with a meal/drink on one occasion and no harm occurs  Care not provided in accordance with care plan 2 Sec 42 Enquiry  Inadequacies in care provision leading to discomfort e.g. occasionally left wet  No access to aids for independence (eg, hearing aid, false teeth, spectacles) 3 Significant  Recurrent missed home care visits where risk of harm escalates, or one miss where harm occurs  Hospital discharge, no adequate planning and harm occurs.

Neglect – Severity Assessment Scoring

4 Very Significant  Ongoing lack of care to extent that health and well- being deteriorate significantly e.g. pressure wounds, dehydration, malnutrition, loss of independence/confidence 5 Critical  Failure to arrange access to life saving services or medical care  Failure to intervene in dangerous situations where the adult lacks the capacity to assess risk

10 CATEGORIES OF ABUSE Financial – Severity Assessment Scoring

1 Non – Sec 42 Route  Monies not being accounted for e.g. lack of receipts for purchases made on behalf of a vulnerable adult

2 Sec 42 Enquiry  Adult not routinely involved in decisions about how their money is spent or kept safe – capacity in this respect is not properly considered 3 Significant  Adult’s monies kept in a joint bank account – unclear arrangements for equitable sharing of interest  Adult denied access to his/her own funds or possessions Monies ‘consistently’ not being accounted for e.g. lack of receipts for purchases made on behalf of a vulnerable adult

Financial – Severity Assessment Scoring

4 Very Significant  Misuse/misappropriate-on of property, possessions or benefits by a person in a position of trust or control. To include misusing loyalty cards Personal finances removed from adult’s control 5 Critical  Fraud/exploitation relating to benefits, income, property or will  Theft

12 CATEGORIES OF ABUSE Psychological – Severity Assessment Scoring

1 Non – Sec 42 Route

 Isolated incident where adult is spoken to in a rude or inappropriate way – respect is undermined but no or little distress caused

2 Sec 42 Enquiry  Occasional taunts or verbal outbursts which cause distress  The withholding of information to dis- empower

3 Significant  Treatment that undermines dignity and damages esteem  Denying or failing to recognise an adult’s choice or opinion  Frequent verbal outbursts

4 Very Significant  Humiliation  Emotional blackmail e.g. threats of abandonment/harm  Frequent and frightening verbal outbursts  Radicalisation (prevent/counter-terrorism concern) 5 Critical  Denial of basic human rights/civil liberties, overriding advance directive, forced marriage  Prolonged intimidation Vicious/personalised verbal attacks

14 CATEGORIES OF ABUSE Sexual – Severity Assessment Scoring

1 Non – Sec 42 Route  Isolated incident of teasing or low-level unwanted sexualised attention (verbal or by gestures) directed at one adult by another whether or not capacity exists (non-contact) 2 Sec 42 Enquiry  Verbal sexualised teasing or harassment 3 Significant  Sexualised touch or masturbation without valid consent  Being subject to indecent exposure  Contact or non-contact sexualised behaviour which causes distress to the person at risk.

15 CATEGORIES OF ABUSE 4 Very Significant  Attempted penetration by any means (whether or not it occurs within a relationship) without valid consent Being made to look at pornographic material against will/where valid consent cannot be given 5 Critical  Sex in a relationship characterised by authority, inequality or exploitation, e.g. staff and service user  Sex without valid consent (rape)

16 CATEGORIES OF ABUSE Medication – Severity Assessment Scoring

1 Non – Sec 42 Route  Adult does not receive prescribed medication (missed/wrong dose) on one occasion – no harm occurs 2 Sec 42 Enquiry  Recurring missed medication or administration errors that cause no harm 3 Significant  Recurring missed medication or error that affect more than one adult and/or result in harm 4 Very Significant  Deliberate maladministration of medications Covert administration without a Best Interest meeting being undertaken with minutes produced

17 CATEGORIES OF ABUSE 5 Critical Pattern of recurring errors or an incident of deliberate maladministration that results in ill-health or death

18 CATEGORIES OF ABUSE Abuse of Professional’s status - Severity Assessment Scoring

1 Non – Sec 42 Route  groups of service users living together who have not been placed appropriately for their assessed needs

2 Sec 42 Enquiry  Poor, ill-informed or outmoded care practice no significant harm  Denying vulnerable adult access to professional support and services such as advocacy 3 Significant  Failure to whistle blow on serious issues when internal procedures to highlight issues are exhausted  Failure to refer disclosure of abuse

19 CATEGORIES OF ABUSE 4 Very Significant  Failure to support vulnerable adult to access health care, treatments  Lack of professional’s responses to challenging behaviours 5 Critical  Entering into a sexual relationship with a patient/client

Discriminatory, Hate Crime, Harassment – Severity Assessment Scoring

1 Non – Sec 42 Route  Isolated incident of taunting motivated by prejudicial attitudes towards an adult’s individual differences  Name calling/stone throwing – seemingly minor ‘low – level’ incidents that should always be reported to the appropriate agency to help to prevent escalation.

2 Sec 42 Enquiry  Isolated incident of care planning that fails to address an adult’s specific diversity associated needs for a short period  Recurring taunts  Bullying  Can increase isolation if person too afraid to leave house. Changes in victim’s routine to avoid the harassment/ self-esteem affect  Creates fear.

21 CATEGORIES OF ABUSE 3 Significant  Inequitable access to service provision as a result of diversity issue  Recurring failure to meet specific care/support needs associated with diversity  Significant harm to person and/or significant damage to property and/or personal belongings

4 Very Significant  Being refused access to essential services  Denial of civil liberties eg voting, making a complaint  Humiliation or threats on a regular basis  Failure by agencies to deal with the threat 5 Critical  Hate crime resulting in injury/emergency medical treatment/fear for life.  Hate crime resulting in serious injury/attempted murder/honour-based violence.  Serious assault/life- threatening situation.

- Modern Slavery - Severity Assessment Scoring 4/5

  Limited freedom of movement  No access to appropriate benefits  Sexual Exploitation  ALL CONCERNS ABOUT  Being forced to work for little or  Removal of passport of ID  Starvation MODERN SLAVERY ARE no payment documents  Organ harvesting DEEMED TO BE  Limited or no access to medical  Be regularly moved or trafficked  No freedom of SIGNIFICANT/CRITICAL LEVEL and dental care movement/Imprisonment  Forced Marriage

Additional Evidence – Category of Abuse/Neglect specify