Safeguarding Adults at Risk Policy.

Policy and Key Information

Safeguarding Adults at Risk Policy

To promote safe and effective practice in relation to safeguarding adults at risk, to meet the requirements of the Care Act 2014 and our commitments to working with statutory and non statutory agencies (as per the Department of Health statutory guidance adults documents).

Introduction

Safeguarding is everyone’s business and it is important that organisations work together to protect people who need help and support. The introduction of the Care Act 2014 created a legal framework so key organisations and individuals with responsibility for adult safeguarding can agree on how they MUST work together and what roles they MUST play to keep adults at risk safe. Co-ordinating responsibility for safeguarding adult’s at risk rests with Local Authorities and Atrium is fully signed up to each of the Local Multi-Agency procedures in all our contexts of sub-contracted in local government organizations, health services and associated clinical work. This policy sets out the overall framework for protection, but all staff must consult with the specific safeguarding advice for every contract pathway and consult with your supervisor, pathway team or contract link if you are unsure. Any safeguarding concern should be taken to your supervisor Becky Hall or Sara Ireland (Safeguarding Lead) to ensure that action is appropriate and coordinated, meets our legal and contract requirements and keeps the client safer.

This policy aims to ensure that Atrium Clinic complies with relevant legislation and guidance on safeguarding adults at risk of harm, abuse or neglect. All staff are required to act to promote the well-being of adults and where there are adult protection concerns, to act to safeguard them.

This policy also aims for each adult who is at risk to maintain:

• Choice and control
• Safety
• Good health and good quality of life to live longer and live better
• Dignity and respect

The aims of Adult Safeguarding are to:

• Stop abuse or neglect wherever possible
• Prevent harm and reduce the risk of abuse or neglect to adults with care and support needs
• Safeguard adults in a way that supports them in making choices and having control about how they want to live
• Promote an approach that concentrates on improving life for the adults concerned
• Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect
• Provide information and support in accessible ways to help adults understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult
• Address what has caused the abuse.

The Policy enforces the expectation that:

• The needs and interests of persons at risk are always respected and considered.
• Agencies work together as partners to support persons at risk to live safely in their communities, to access mainstream services and specialist services to keep themselves safe from abuse, neglect and exploitation, and to ensure access to criminal justice, victim support services and any therapeutic services needed to support the person to recover from the abuse

Who does the policy cover?

• All adults who meet the above criteria regardless of their mental capacity to make decisions about their own safety or other decisions relating to safeguarding processes and activities
• Adults who manage their own care and support through personal or health budgets
• Adults whose needs for care and support have not been assessed as eligible or which have been assessed as below the level of eligibility for support
• Adults who fund their own care and support
• Children and young people in specific circumstances (see safeguarding children’s policy)

Outside the scope of this policy ,please see forensic processes document

Definitions Adult

Adult at risk – A person aged 18 or over who is in need of care and support, regardless of whether they are receiving them, and because of those needs are unable to protect themselves against abuse or neglect.

We expect staff and practitioners to consider and identify

• Patterns of abuse namely
• Serial abusing in which the perpetrator seeks and grooms people. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse
• Long-term abuse in the context of a continuing family relationship such as domestic violence between spouses or generations, or persistent psychological abuse
• Opportunistic abuse such as theft occurring because money or jewellery has been left lying around. Abuse is very distressing and can take many forms:
• Physical abuse: hitting, slapping, pushing, kicking, squeezing, shaking, pinching, misuse of any medication, undue restraint, or force feeding.
• Emotional/ Psychological abuse: includes a range of non-physical controlling behaviour that cause emotional damage and undermine a person’s sense of wellbeing; confinement, isolation, verbal assault, humiliation, intimidation, infantilization, or any other treatment which may diminish the sense of identity, dignity, and selfworth.
• Sexual abuse sexual assault: rape or other sexual acts, the inappropriate touching of the individual’s sexual areas, or coercion into the viewing of pornographic materials. Compelling, inciting or facilitating a person, with impaired capacity for choice to engage in sexual activity without consent is an offence under the Sexual Offences Act 2003.
• Financial and material abuse: withholding of money or possessions, intentional mismanagement of the person’s finances or property, theft, fraud, exploitation and stealing person’s money.
• Neglect and acts of omission: the failure to access appropriate services for recognised needs, avoidance of required health care, ignoring physical care needs, withholding of adequate nutrition, clothing or warmth, exposing the person to unacceptable risk, lack of action to provide or ensure adequate supervision
• Discriminatory abuse: any acts that use hurtful language, cause harassment or similar treatment of the individual because of their race, sex, age, disability, faith, culture or sexual orientation. Such abuses are increasingly being recognised as hate crimes.
• Domestic abuse: Atrium adopts the Home Office (2016) definition of domestic violence and abuse, which 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. The abuse can encompass, but is not limited to, psychological, physical, sexual, financial and emotional abuse. Seven types of domestic violence and abuse:

1. Coercive control (intimate terrorist)
2. Violent resistance (resisting the intimate terrorist)
3. Situational couple violence
4. Female Genital Mutilation
5. Forced marriage
6. Elder/carer abuse
7. Young people aged under 18 years who are violent towards their parents

And Female Genital Mutilation (FGM): is a violation of the human rights of girls and women. FGM comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

• Forced Marriage: is a marriage conducted without the valid consent of one or both parties and where duress is a factor. FM is now a specific offence under s121 of the Anti-Social Behaviour, Crime and Policing Act 2014 and came into force on 16 June 2014
• Slavery, servitude and forced or compulsory labour: A person commits an offence of the Modern Slavery Act 2015 if: a) The person holds another person in slavery or servitude and the circumstances are such that the person knows or ought to know that the other person is held in slavery or servitude, Or b) The person requires another person to perform forced or compulsory labour and the circumstances are such that the person knows or ought to know that the other person is being required to perform forced or compulsory labour
• Human Trafficking: A person commits an offence of the Modern Slavery Act 2015 if the person arranges or facilitates the travel of another person (“V”) with a view V being exploited. It is irrelevant whether V consents to the travel or if V is an adult or a child. A person may in particular arrange or facilitate V’s travel by recruiting V, transporting or transferring V, harbouring or receiving V, or transferring or exchanging control over V.
• Organisation/ Institutional abuse: the use of systems, routines, practice or care that neglect individual needs and create an imbalance and control within a managed setting such as residential/nursing care or day services • Hate Crime: Usually violent, prejudice motivated crime that occurs when a perpetrator targets a victim because of his or her perceived membership in a certain social group
• Radicalisation: The UK Home Office, MI5’s parent agency, bluntly defines radicalisation as “The process by which people come to support terrorism and violent extremism and, in some cases, then join terrorist groups.” The MI5 report closes by saying that no single measure will reduce radicalisation in the UK and that the only way to combat it is by targeting at risk vulnerable groups and trying to assimilate them into society. This may include helping young people find jobs, better integrating immigrant populations into the local culture, and effectively reintegrating ex-prisoners into society
• Self-neglect: Complex and challenging issue with the need to balance autonomy and duty to protect health and wellbeing. Both perspectives can be supported by a human rights argument. The Care Act 2014 defines self-neglect a form of abuse or neglect that can be raised as a safeguarding but is usually dealt with under the Care Assessment Framework. Professionals need to establish capacity and if the adult is able or willing to care for themselves. An adult who is able to make choices may make ‘unwise’ decisions that others think of as self-neglect.
• Hoarding is considered to be a significant problem when: Ø the amount of clutter in the person’s home is increasing Ø they bring in more things each day and discard very little Ø the amount of clutter interferes with everyday living – for example, they are unable to use the kitchen or bathroom and cannot access rooms for each case, rendering a Fire risk.
• That the medium for undertaking therapeutic work is safe for the client eg. s/he will not be overheard if her relationships may be difficult or hostile
• That the environment is deemed safe to do the work eg. children not at risk when session in play
• Any safety and risk assessments in place from other agencies are known about and activated, coordinated as appropriate.

Atrium will

• Ensure that protection of adults is an agenda item included in managerial and clinical supervision, bearing in mind staff support needs in relation to this work.
• Ensure employees and practitioners read this policy on induction and undertake mandatory training at least once a year, providing evidence of training for their training log.
• Make enquiries, or request others to make them when they think an adult with care and support needs may be at risk of abuse or neglect and they need to find out what action may be needed
• Ensure there is specific safeguarding information and advice on every pathway contract identifying the lead for safeguarding and local safeguarding contacts.
• A whole-system approach is developed and expected
• Safeguarding responses are proportionate, transparent and outcome-focused
• The adult’s wishes are at the centre of a safeguarding enquiry
• There is an emphasis on prevention and early intervention
• People are supported in their involvement and recovery from abuse or neglect
• Training records are kept for induction and annual training and that new pathway guides are shared.
• This overarching policy is reviewed every 3 years unless earlier updating required.
• Any feedback, near misses, critical incidents are reported and reviewed within this framework for process and good practice updating.

Processes and Procedures the logistics of every pathway process may vary slightly so check always before you take action with Safeguarding Lead /and peers.

The Six Principles of Safeguarding that underpin all adult safeguarding work:

• Empowerment– Adults are encouraged to make their own decisions and are provided with support and information. Clients are consulted about the outcomes they want from the safeguarding process as far as the limits of this policy apply nd these directly inform what happens.
• Prevention Strategies-These are developed to prevent abuse and neglect and that promote resilience and self determination. Clients are provided with easily understood information about what abuse is, how to recognise the signs and what the help options are.
• Proportionate – A proportionate and least intrusive response is made balanced with the level of risk. Professionals will work in the client interest and only get involved as much as needed.
• Protection– Adults are offered ways to protect themselves, and there is a coordinated response to adult safeguarding. Clients are provided with help and support to report abuse. They are supported to take part in the safeguarding process to the extent to which they want and to which they are able. They feel part of the safeguarding process and it is not something which happens around them. They are supported to take informed risks and to mitigate for the effects.
• Partnership– Local solutions through services working together within their communities and clients are confident that information will be appropriately shared in a way that takes into account its personal and sensitive nature. Clients can be confident that Atrium will work with agencies to find the most effective responses for the client situation to the limits of its ability and influence.
• Accountable Accountability and transparency in delivering a safeguarding response. Atrium staff are clear how to access more information about the roles and responsibilities of all the KEY people involved in safeguarding in Atrium and commissioner pathways, NHS and Local Government. Atrium is always clear and shares our consent agreement before we begin the work and we seek to gain client support for any action unless it is too risky as per consent policy. Atrium always take advice from GPs as guardian of the client’s mental health and other KEY agencies, as required to work collaboratively to the right solutions to keep the person safe and to support them in making informed choices. Making risks clear and understood is crucial to empowering and safeguarding adults and in recognising people as “experts in their own lives.’’
• Atrium follows a prescribed approach for each contract with KEY commissioners where further assessment will be undertaken with reference to the values and approaches laid down for key agencies in this role . Staff should also recognise that others can help to keep people safe, and an intervention from statutory services is not always required. For example, relatives, housing staff or health professionals could all have a key role to play. Atrium staff know how to use safety planning routinely for risk and safety management.
• Who may be considered for statutory and non-statutory enquiries? This may include people with learning disabilities, mental health issues, older people, and people with a physical disability or impairment. It may also include adult victims of abusive care practices, neglect and self-neglect, domestic abuse, sexual exploitation, hate crime, female genital mutilation, forced marriage, modern slavery, human trafficking, honour-based violence, and anti-social abuse behaviour. An adult’s need for additional support to protect themselves may be increased when complicated by additional factors, such as, physical frailty or chronic illness, sensory impairment, challenging behaviour, drug or alcohol problems, social or emotional problems, or poverty or homelessness and it is important to note that vulnerability can fluctuate. Many adults may not realise that they are being abused and/or exploited, particularly where there is an abuse of power, a dependency, a relationship or a reluctance to assert themselves for fear of making the situation worse.
• What do I do if I am worried an adult is at risk?
• Speak to safeguarding lead (Sara Ireland public, community and workplace pathways) and you may be advised to consult the Local government safeguarding advice line .Discuss with supervisor and keep a record of action. If a vulnerable adult is in imminent danger, or a serious criminal act is suspected, the police should be immediately informed, through a 999 call if necessary. Staff must avoid any possible contamination of evidence, either through disturbing physical evidence or questioning witnesses including the victim beyond what is necessary to establish what has happened. Where there is immediate or continuing concern about harm to a vulnerable adult, steps must be taken to reduce or remove that harm. Wherever possible these should be discussed with managers, and be in line with local multi-agency procedures and be aware of the adult’s capacity.
• Overriding Consent Consent can be over ridden in cases where:-
• The allegation is against a paid carer
• Where there are concerns for other adults and/ or children at risk
• Where there is a clear public interest and it is alleged that a serious crime has been committed.
• For cases of Domestic Violence and Abuse (DV&A) for scores 14 or more or on professional judgement and should involve discussions with team manager / safeguarding team. Consider if a Police referral is required, which will give a clear audit trail of information shared and advice This document will be reviewed in five years or sooner in the light of organisational, legislative or other changes.
• Note All staff should review policies and undertake additional H&S, Protections trainings on induction to atrium and sign off attendance on the Induction checklist.