<p>6/2/2015 Authors Brian Gathercole and Elizabeth Walton SAFEGUARDING THRESHOLD GUIDANCE SALFORD ADULT SAFEGUARDING BOARD (SASB)</p><p>SASB has a zero tolerance policy as regards to abuse. This chart provides guidance to social work and other assessment staff in receipt of a safeguarding alert to assist in: </p><p> Determining its seriousness,  Identifying if it meets the threshold for treating as a safeguarding matter to be formally investigated  Where the case does not meet the criteria agreeing other appropriate and proportionate outcomes such as an internal investigation by the service provider</p><p>SASB believes a clear threshold and process, together with a common understanding across local partnerships and agencies will improve consistency. A number of reasons are provided to support the need for a threshold. These include:</p><p> A benchmark to assess the level of vulnerability of an individual;  A measure of consistency;  Managing the demand around alerts and referrals;  A framework to allow agencies to manage risk.</p><p>Threshold Benchmark</p><p>The contention is that without a benchmark it would be difficult to assess if any action or intervention is required, (however they are primarily a matter of professional judgment and therefore a threshold is of limited value unless used alongside other parameters for consideration).</p><p>Consistency</p><p>SASB recognises the need for a more consistent approach to safeguarding. Appropriate thresholds are seen as a good way to achieve this. Practitioners will however be required to use their professional judgment in applying the guidance to individual cases whilst taking into account all factors</p><p>1 6/2/2015 Authors Brian Gathercole and Elizabeth Walton</p><p>Managing alerts and referrals</p><p>SASB encourage the submission of adult safeguarding alerts however, evidence suggests that where a low threshold is set there is likely to be an increase in inappropriate reporting to safeguarding. A high threshold on the other hand may encourage alerts that are subsequently not processed through the safeguarding process. A balance between the two is therefore required.</p><p>Threshold continuum</p><p>The aim is to ensure everyone understands that the threshold consideration should remain constant; however the responses which follow the threshold identification may vary depending upon the likelihood and dangers associated with the risk from abuse. Within the complexity of safeguarding threshold identification forms part of a continuum, with an overall outcome to reduce risk and prevent further harm.</p><p>The Practice Tool</p><p>The practice tool (Appendix 1) has been designed to consider types of abuse, examples of abuse which sit outside of the safeguarding framework and those which sit inside the framework and require significant or critical assessment/ investigation under safeguarding procedures.</p><p>NB It is acknowledged that regular small concerns can amount to a far higher level of concern which would then require a safeguarding alert. </p><p>This is a guide to the levels and types of abuse that may occur, and should be used in conjunction with multi agency procedures</p><p>Threshold Information</p><p>Every situation is unique and needs to be determined on its merits.</p><p>Therefore if in doubt please seek advice from the adult safeguarding unit or principal managers.</p><p>2 6/2/2015 Authors Brian Gathercole and Elizabeth Walton As an example physical tier one - issues to consider </p><p> how do you know whether this is a one off incident-some teams will be in a better position to judge this than others e.g. the review team have an overview of care homes, integrated teams have an overview of their domiciliary care provider.</p><p> where a provider makes the alert themselves and has already identified the cause and possible solutions this generally will give more assurance that a service is safe whereas if the alert comes from the service user or another professional-this will generally indicate more reason for concern.</p><p>Generally where the alleged perpetrator is a paid i.e. formal carer expectations of behaviour have to be higher than where the perpetrator is another service user or informal carer and therefore should more likely be ( although not always) treated via formal safeguarding process.</p><p>NB 1 This framework is applicable to adults deemed at risk under the 2014 Care Act i.e. people with disabilities who because of that disability are less able to protect themselves. Other adults without such vulnerabilities may be referred but should be signposted to other sources of support or advice including the police if appropriate</p><p>NB 2 The framework also needs to be applied taking into account the principles behind Making Safeguarding Personal</p><p>3 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement A one off  Isolated incident  Most physical abuse  Unexplained marks on Physical event, Staff involving service that exceeds tier 2 more than one error or user on service should be run past the occasion accident user and no police as it could  Inappropriate restraint causing no/little injuries or constitute an offence. It i.e. restraint used harm but bruising may be however after illegally temporary  Unexplained very consultation with the • Inexplicable discomfort for light marking police i.e PPIU that fractures/injuries the service user found on one some cases will not go  Assault i.e. manual occasion NB not through to tier 4 /police handling to be confused led investigation and with bruising would be investigated that is healing and led by social workers/nurse NB Such incidents investigators should still be  Decisions will depend on discussed with to the facts of each the police as they individual case could still constitute assault</p><p>4 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement</p><p>Physical (Medication) Adult is not Adult is given  Recurring medication errors  Pattern of recurring given additional especially affecting more errors or an incident of prescribed medication by than one adult and/or result deliberate medication by mistake on one in harm maladministration of paid carers occasion and no  Missed medication where medication /personal harm occurs harm occurs assistants  Covert administration (missed/wrong without proper medical dose) on one authorisation occasion - no harm occurs</p><p>5 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement</p><p>Sexual One off incident One off incident of • Recurring verbal sexualised  Sex in a relationship where a service low level teasing characterised by user makes an unwanted • Use of media to take authority, inequality or inappropriate sexualised inappropriate pictures(NB exploitation, e.g. staff sexualised attention/touching pictures should not be taken and service user remark to directed at one or circulated of service users • Sex without valid another service service user to by staff without prior consent (rape) user and little another service permission irrespective of  Voyeurism or no distress is user whether or whether any sexual motive- caused. N.B. if not capacity exists whilst not necessarily abuse this is a staff policies on use of social member to a NB Such incidents media/staff code of conduct service user should still be and disciplinary issues apply then this should discussed with the • Being subject to indecent be reported to police as they exposure safeguarding could still  Contact or non-contact </p><p>6 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement constitute assault sexualised behaviour which causes distress to the person at risk  Being made to look at pornographic material against will/where valid consent cannot be given</p><p>Psychological/emotional Isolated Occasional  Treatment that  Denial of basic incident taunts or verbal undermines dignity and human rights/civil where adult outbursts which damages esteem liberties, over- is spoken to cause distress  Denying or failing to riding advance in a rude or NB If this is a recognise an adult’s directive, forced inappropriate staff member choice or opinion marriage way dignity take into  Frequent and  Hate Crime ( see undermined safeguarding frightening verbal also section on but no or outbursts discriminatory little distress abuse) caused  Bullying  Humiliation</p><p>7 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement  Emotional blackmail e.g. threats of abandonment/ harm etc which produce anxiety or fear Financial Money is not  Adult is not • Adult denied access to  Fraud/exploitation Wherever possible, a person recorded routinely his/her own funds or relating to lacking capacity to make a safely or involved in possessions benefits, income, decision should still be involved in recorded decisions  e.g. Adult’s monies kept property or will the decision making process. properly about how in a joint bank account –  Theft their money is unclear arrangements being spent or for equitable sharing of kept safe. interest  The person’s • Misuse/misappropriatio mental n of property, capacity to possessions or benefits manage their by a person in a position own money of trust or control. To </p><p>8 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement has not been include misuse of loyalty properly cards by staff considered.  Personal finances  illegally removed from adult’s control</p><p>Neglect/and acts of omission • Isolated  Inadequacies in • Recurrent missed home care • Failure to arrange NB Whether the neglect is intentional missed home care provision visits where risk of harm access to life saving or unintentional it does not matter, care visit - no leading to escalates, or one miss where services or medical discomfort - no the harm to the individual is the harm occurs harm occurs care • Adult is not significant harm • Hospital discharge, no adequate deciding factor when determining if • Failure to intervene assisted with e.g. left wet once planning and harm occurs abuse has occurred. Clearly if done for a short period in dangerous deliberately this will however be more a meal/drink  Deliberate deprivation of access on one  Poor hospital situations where the worrying when considering protective to aids for independence occasion and discharge adult lacks the measures and what needs to be done  Ongoing lack of care to extent no harm planning which that health and well-being capacity to assess doesn’t result in occurs deteriorate significantly e.g. risk For self neglect see guidance harm pressure wounds, dehydration, • NB It can be difficult http://www.partnersinsalford.org/asg- Pressure sores- the malnutrition, loss of to decide whether a self-neglect.htm NHS grades these 1-4 independence /confidence with 4 being most  Grade 3 or 4 pressures sores matter constitutes serious-pressure should always be referred for clinical negligence or</p><p>9 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement sores can develop consideration-advice should be abuse e.g. a doctor due to medical sought from CCG/SRFT makes a mistake and conditions but can operates on the also arise from neglect. CCG and wrong leg- if ever in SRFT should be doubt seek advice asked for advice from lead nurse where concerns adult safeguarding raised Discriminatory/hate crime One off  Isolated • Inequitable access to  Hate crime incident of incident of service provision as a resulting in injury teasing care planning result of diversity issue /emergency motivated by that fails to  Recurring failure to meet medical prejudicial address an specific care/support treatment /fear for attitudes adult’s specific needs associated with life towards an diversity diversity  Hate crime adult’s associated  Being refused access to resulting in serious individual needs for a essential services injury/attempted differences short period • Denial of civil liberties murder /honour- NB If staff  Recurring e.g. voting, making a based violence member taunts ( if staff complaint  Humiliation or </p><p>10 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement consider take to  threats on a regular safeguarding safeguarding basis</p><p>Institutional  Lack of  Care-planning • Cultures/ practice involving  Staff misusing position stimulation/ and/or rigid/inflexible routines of power over service opportunity documentation  Cultures where service users’ users for person not person- dignity and respect is  Over-medication to engage in centred undermined /not considered and/or inappropriate social and  Poor practice e.g. lack of privacy during unauthorised restraint leisure where this support with intimate care managing behaviour activities relates to an needs, e.g. shared under-  Widespread, consistent  Service User isolated incident clothing ill treatment use of not given by an individual  Poor practice which seems “punishment “ sufficient member of staff routine and does not comply voice or  NB Poor practice with established policies and involvement can be a very procedures both locally and NB Where uncertain in running of broad concept- nationally- not being whether an issue should </p><p>11 6/2/2015 Authors Brian Gathercole and Elizabeth Walton Tier 1 Tier 2 Tier 3 Tier 4</p><p>Managed Investigated within Referral to Safeguarding and Referral to TYPE OF ABUSE through other own organisation but investigated through Salford adult safeguarding/police approaches outcome/action safeguarding process Potential criminal following own plan, passed onto NB Tier 3 should always be matter/serious case review organisations Salford Adult Social discussed with the PPIU who will internal Care advise if these constitute a procedure potential criminal offence and therefore their involvement service any poor reported and going be dealt with as practice that unchecked institutional abuse please seems to be • Unsafe and unhygienic living seek advice from the standard environments adult safeguarding unit- practice should  Mismanagement of infection distinguishing what is be considered outbreaks “poor practice” and what abusive is abuse can be difficult</p><p>12 6/2/2015 Authors Brian Gathercole and Elizabeth Walton</p><p>Glossary of terms </p><p>Paid carer- a person who is paid to look after someone</p><p>Personal assistant- a paid employee of a person requiring care who is paid for and employed directly by the individual requiring care</p><p>13</p>