Policy Statement

Regulation 13 – Safeguarding Service Users from Abuse and Improper Treatment.

This policy should be read in conjunction with the following policies:

• Accessible Information.
• Code of Conduct for Workers.
• Confidentiality.
• Cyber Security.
• Data Protection (UK GDPR).
• Deprivation of Liberty Safeguards.
• Disclosure and Barring Service and Disclosure and Barring Referrals.
• Duty of Candour.
• Mental Capacity Act 2005.
• Notifications.
• Position of Trust.
• Record Keeping.
• Recruitment and Selection.
• Safeguarding Children in an Adult Setting.
• Whistleblowing.

With the introduction of the Care Act, 2014 changes came into place which updated adult safeguarding in England. This adult safeguarding guidance replaced ‘No Secrets’ in its entirety. Safeguarding duties apply to an adult who:

• Needs care and support (whether or not the local authority (LA) is meeting any of those needs),
• Is experiencing, or at risk of abuse or neglect,
• As a result of those care and support needs, they are unable to protect themselves from either the risk of or the experience of abuse or neglect.

The above duties have a legal effect on organisations other than the LA e.g. The NHS or police. 

The Orchard Trust complies with Regulation 13: Safeguarding service users from abuse and improper treatment ( Health and Social Care Act 2008 (Regulations 2014) ) by implementing processes and procedures to prevent a Client from being abused by staff or other people they may have contact with when using the Service, including their visitors. This includes safeguarding a Client from suffering any form of abuse or improper treatment while receiving care and treatment (improper treatment includes discrimination or unlawful restraint, which includes inappropriate deprivation of liberty under the terms of The Mental Capacity Act 2005).

This policy should be read in conjunction with the Explanation Notes for Safeguarding located in the related documents section of this policy. These notes contain necessary information, including;

• Background Legislation.
• Health and Care Act – Reporting Requirements.
• Types of Abuse and Neglect.
• Signs of Abuse.
• Patterns of Abuse.
• Who Abuses or Neglects Adults.

This policy dovetails with the Local Authority Policy and supersedes our organisational policy with regards to local procedures and systems.

Our service works with

Socialcare.enq@gloucestershire.gov.uk

They can be accessed via

• Sitemap.
• Gloucestershire County Council homepage.

We share them with our staff by training, signage and policy updates.

When contracted with more than one authority we ensure all protocols are listed and followed.

We recognise that safer recruitment involves thoroughly assessing the skills, experience, qualifications, and values of prospective staff regarding working with the Client. As an employer, we employ a variety of safer recruitment and selection practices. Working with individuals and families who may be at risk and need support can be both rewarding and challenging. Therefore, we have a duty to ensure that those providing these essential services are suitably qualified and competent to ensure the safety of the Client.

Refer to the Recruitment and Selection Policy for details.

Access to this Policy

Access to this policy is granted to all staff, volunteers and board members online.

Other stakeholders (residents/visitors/ all other stakeholders) can request access to this policy by contacting the Registered Manager.

We provide where required other formats including an easy-read safeguarding policy.

Multi-Agency Safeguarding (Adults) Protocol

Our service works with:-

Socialcare.enq@gloucestershire.gov.uk

They can be accessed via

• Sitemap.
• Gloucestershire County Council homepage.

We share them with our staff by training, signage and policy updates.

All Local Authorities are required to produce the above Guidance. When contracted with more than one authority we ensure all protocols are listed and followed.

Legislation

Health and Social Care Act 2008 (Regulations 2014).

Regulation 13: Safeguarding service users from abuse and improper treatment.

The intention of this regulation is to safeguard people who use services from suffering any form of abuse or improper treatment while receiving care and treatment. Improper treatment includes discrimination or unlawful restraint, including inappropriate deprivation of liberty under The Mental Capacity Act 2005. To meet the requirements of this regulation, The Orchard Trust has a zero-tolerance approach to abuse, unlawful discrimination, and unlawful restraint.

Care Act 2014.

Aims of Adult Safeguarding

The Act sets out the following, which applies to all LAs and their relevant partners. Relevant partners include NHS, police, ambulance service, regulated or unregulated providers and all parties involved in the enquiry:

• 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 over how they want to live.
• Promote an approach that concentrates on improving life for the adults concerned.
• Raise public awareness so that communities, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect.
• Provide information and support in accessible ways to help people 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 or neglect.

 

The Six Principles that underpin all Adult Safeguarding.

Empowerment: People being supported and encouraged to make their own decisions, and informed consent:
“I am asked what I want from the safeguarding process, and these directly inform what happens.”

Prevention: It is better to take action before harm occurs:
“I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

Proportionality: The least intrusive response appropriate to the risk presented:
“I am sure that the professionals will work in my interest, as I see them, they will only get involved as much as needed.”

Protection: Support and representation for those in greatest need:
“I get help and support to report abuse and neglect. I get help so that I can take part in the safeguarding process to the extent to which I want.”

Partnership: Local solutions through services working with their communities have a part to play in preventing, detecting and reporting neglect and abuse:
“I know that staff treat any personal or sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.”

Accountability: Accountability and transparency in delivering safeguarding:
“I understand the role of everyone involved in my life, and so do they.”

Note: Where someone is 18 years old or over but whose services are arranged via children’ s services, any safeguarding issue is dealt with via the adult safeguarding arrangement within the Local Authority (LA) or other statutory partners, such as the NHS or police.

Health and Care Act 2022

The Act introduced measures to tackle health disparities and create safer, more joined-up services that will put the health and care system on a more sustainable footing.

This Act introduces many measures, including:

• Supporting victims of abuse and responding to recent child safeguarding tragedies by committing to looking at information sharing in relation to the safeguarding of children and requiring Integrated Care Boards to set out any proposed steps to address the particular needs of victims of abuse.
• Safeguarding women and girls by banning the harmful practices of virginity testing and hymenoplasty.
• Crackdown on the use of goods and services in the NHS tainted by modern slavery and human trafficking to ensure that the NHS is not buying or using goods or services produced by or involving slave labour.

The Mental Capacity Act 2005

The Mental Capacity Act 2005 begins with the assumption that, from the age of 16, individuals are capable of making their own decisions – including those regarding their safety and when and how services intervene in their lives. People must be presumed to have the capacity to decide and be provided with all reasonable assistance to make a particular decision before anyone considers them unable to make that decision. If an adult is found to lack the capacity to make a decision, then any action taken or decision made on their behalf must be in their best interests.

To help determine if a person lacks the capacity to make a particular decision at the time it needs to be made, the Act sets out a two-stage test of capacity.

The two-stage test is as follows:

Stage 1: Does the impairment or disturbance mean that the person is unable to make a specific decision when they need to?
For a person to lack the capacity to make a decision, the Act says their impairment or disturbance must affect their ability to make that specific decision when needed. But first, people must be given all practical and appropriate support to help them decide for themselves (Principle 2).
Stage 2 can only apply if all practical and appropriate support to help the person make the decision has failed.

Stage 2: Does the person have an impairment or a disturbance in the functioning of their mind or brain? If the person does NOT have such an impairment or disturbance, they will not lack capacity under the Act, and the assessment should stop.

Examples of impairment or disturbance include:

• Conditions associated with some forms of mental illness.
• Dementia.
• Significant learning disabilities.
• The long-term effects of brain damage.
• Physical or mental conditions that cause confusion, drowsiness or loss of consciousness.
• Delirium.
• Concussion following a head injury.
• The symptoms of alcohol or drug use.

Professionals and other staff must understand and consistently follow The Mental Capacity Act 2005 (MCA). They should use their professional judgement and consider multiple competing viewpoints. They will need substantial guidance and support from their employers to help adults manage risk properly and to empower them to take control of decision-making, where practical.

Regular face-to-face supervision by experienced managers is essential to help staff work confidently and competently in challenging and sensitive situations.

Mental capacity often comes up in adult safeguarding. The need to apply The Mental Capacity Act 2005 in adult safeguarding enquiries challenges many professionals and requires careful consideration, especially when it seems an adult has the capacity for certain decisions that still put them at risk of abuse or neglect.

The Mental Capacity Act 2005 established criminal offences for ill-treatment and wilful neglect concerning individuals who are unable to make decisions. These offences can be committed by anyone responsible for that adult’ s care and support, such as paid staff, family carers, and also those with legal authority to act on behalf of the adult, like persons with power of attorney or court-appointed deputies.

These offences can be punished by fines or imprisonment. Ill-treatment includes both intentional acts and reckless behaviour that cause harm. Wilful neglect involves a serious deviation from the required standards of care and typically occurs when someone deliberately fails to perform an act they knew they were obliged to do.

Abuse by an attorney or deputy: If anyone has concerns about the actions of an attorney acting under a registered enduring power of attorney (EPA) or lasting power of attorney (LPA), or a deputy appointed by the Court of Protection, they should contact the Office of the Public Guardian (OPG). The OPG can investigate the actions of a deputy or attorney and refer concerns to other relevant agencies. When making a referral, the OPG will ensure that the relevant agency remains informed of the steps taken. The OPG can also apply to the Court of Protection if it needs to take possible action against the attorney or deputy. While the OPG primarily investigates financial abuse, it must also examine concerns about the actions of an attorney acting under a health and welfare LPA or a personal welfare deputy. The OPG can investigate concerns about an attorney acting under a registered EPA or LPA, regardless of the adult’ s capacity to make decisions.

Safeguarding Vulnerable Groups Act 2006

The Safeguarding Vulnerable Groups Act 2006 was enacted to prevent harm or the risk of harm by restricting access to children and vulnerable adults for those considered unsuitable to work with them.

Refer to the Disclosure and Barring Service (DBS) and (DBS) Referral Policy for more information.

Definition of an Adult at Risk

An adult at risk of abuse or neglect is defined as someone who has needs for care and support, who is experiencing, or at risk of, abuse or neglect and, as a result of their care needs, is unable to protect themselves.

Throughout this policy, the distinction between an adult with the capacity to make decisions and adults lacking capacity is emphasised. Adults who have the capacity retain the right to make their own decisions and to direct their own lives. Adults lacking the capacity to make decisions, retain the right to be involved in decision-making as far as possible. However, decisions that have to be made on their behalf must be in their best interests. The judgement that an adult is at risk should not be confused with a decision about their capacity. They are distinct questions, although a lack of capacity will, ordinarily, contribute to an adult being at risk.

Adult Safeguarding, What it is and Why it Matters

It is a means of protecting an adult’s safety, free from abuse and neglect. It means people and organisations working together to prevent and stop such abuse and neglect, whilst making sure that the adult’s well-being is promoted, including, where appropriate, due regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

Organisations should always promote the adult’s well-being in their safeguarding arrangements. People have complex lives and being safe is only one of the things they want for themselves. Professionals should work with the adult to establish what being safe means to them and how that can best be achieved. Professionals should not be advocating safety measures that do not take account of the individual’s well-being as defined in Chapter 1 of the Care and Support Statutory Guidance issued by the Department of Health.

The Orchard Trust is committed to safeguarding every Client. We have a safeguarding lead who is responsible for safeguarding. The Orchard Trust will ensure that our safeguarding lead has received appropriate safeguarding training and possesses the necessary knowledge and skills to safeguard every Client and support other staff. Our designated safeguarding lead is, The Safeguarding lead for the Orchard Trust is Tony Lafford, Head of Support. . Training for all staff is supplied by Orchard Trust and a training matrix is in place outlining the safeguarding training requirements for people at different levels. Areas covered also include mental capacity, deprivation of liberty safeguards, consent and access to easy-read resources.

Our organisation safeguards our Service Users from abuse and harm by using the skills and experiences of our safeguarding champions.

Our safeguarding champions understand the safeguarding policy and procedure and help to ensure our procedures are followed.

They are available to support other staff, champion best practices and support reflective learning. Our organisation will ensure our safeguarding champions are supported by training and development opportunities to ensure they have the right knowledge and skills to be safeguarding champions. It is important to note that a safeguarding champion is not a replacement or alternative to the safeguarding lead.

Safeguarding is not a substitute for:

• Providers’ responsibilities to provide safe and high-quality Care and Support.
• Commissioners regularly assure themselves of the safety and effectiveness of commissioned services.
• The Care Quality Commission (CQC) ensures that regulated providers comply with the fundamental standards of care by taking enforcement action.
• The core duties of the Police are to prevent and detect crime and protect life and property.

The Care Act requires that each authority must:

• Make enquiries or cause others to do so, if it believes an adult is experiencing or is at risk of abuse or neglect. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so by whom.
• Set up a SAB.
• Arrange where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or SAR. This applies if the adult has substantial difficulty in being involved in the process and where there is no other suitable person to present and support them.
• Co-operate with each of its relevant partners to protect the adult. In their turn, each relevant partner must cooperate with the Local Authority (LA).

Staff Adult Safeguarding Training

The Orchard Trust will ensure that our safeguarding lead, The Safeguarding lead for the Orchard Trust is Tony Lafford, Head of Support. Has had suitable safeguarding training and competencies and has the right knowledge and skills to ensure the protection and safety of the Client and to support other staff.

Levels of Safeguarding Training by Role.

• Non-Care staff with no direct contact with service users – Level 1 (basic awareness).
• Carers and Support staff – Level 2.
• Clinical staff (Nursing Care Only) and Supervisors Level 3.
• Managers/Safeguarding Lead Levels 4 and 5.

All staff will be updated on legislative and regulatory changes relating to safeguarding adults and children. This will include the Multi-Agency Safeguarding Agreement from the Local Authority (LA).

Training for all staff is supplied by Orchard Trust and a training matrix is in place outlining the safeguarding training requirements for staff at different levels. Areas covered also include mental capacity, deprivation of liberty safeguards, consent and access to easy-read resources.

Our training is supported by Gloucestershire Safeguarding Board, supplying level 1, 2 and 3 training.

Our organisation safeguards our Service Users from abuse and harm by using the skills and experiences of our safeguarding champions.

Our safeguarding champions understand the safeguarding policy and procedure and help to ensure our procedures are followed.

They are available to support other staff, champion best practices and support reflective learning. Our organisation will ensure our safeguarding champions are supported by training and development opportunities to ensure they have the right knowledge and skills to be safeguarding champions. It is important to note that a safeguarding champion is not a replacement or alternative to the safeguarding lead.

The Care Act requires that each authority must:

• Make enquiries or cause others to do so, if it believes an adult is experiencing or is at risk of abuse or neglect. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so by whom.
• Set up a SAB.
• Arrange where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or SAR. This applies if the adult has substantial difficulty in being involved in the process and where there is no other suitable person to present and support them.
• Co-operate with each of its relevant partners to protect the adult. In their turn, each relevant partner must cooperate with the Local Authority (LA).

Types of Abuse and Neglect

Physical abuse: Including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

Domestic violence: Including psychological, physical, sexual, financial, and emotional abuse; so-called ‘honour-based violence. Reference to the Domestic Abuse Act 2021 can be found here in the Domestic Abuse Bill 2020 factsheet available on the Gov.UK website.

Sexual abuse: Includes rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

Sexual exploitation: The term’ sexual exploitation’ means any actual or attempted abuse of a position of vulnerability, differential power, or trust, for sexual purposes, including, but not limited to, profiting monetarily, socially or politically from the sexual exploitation of another. It may be very important in specific cases to be clear about the context in which concerns about sexual exploitation arise. Some individuals may have been groomed as children or young people, whilst others may be engaged as sex workers and are at risk because they are threatened or coerced, have drug dependencies and/or mental health needs. People with learning disabilities may be led into harm because of the perception they are being offered friendships.

Controlling Behaviour: Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, and depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive Behaviour: Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten the victim.

Forced Marriage: Although forcing someone into a marriage and/or luring someone overseas for marriage is a criminal offence, the civil route and the use of’ Forced Marriage Protection Orders’ are still available. These can be used as an alternative to entering the criminal justice system. It may be that perpetrators will automatically be prosecuted where it is overwhelmingly in the public interest to do so, however, victims should be able to choose how they want to be assisted.

Exploitation by radicalisation: The Home Office leads on the anti-terrorism PREVENT strategy, of which CHANNEL is part (refer to www.gov.uk for information). This aims to stop people from becoming terrorists or supporting extremism. All local organisations have a role to play in safeguarding people who meet the criteria. Contact should be made with the police regarding any individuals identified who present concerns regarding violent extremism.

Psychological abuse: Includes emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyberbullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.

Financial or material abuse: Including theft, fraud, internet scamming, coercion about an adult’s financial affairs or arrangements, including regarding wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

Modern slavery: Encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

Human Trafficking: The definition of human trafficking is the illegal movement of people through force, fraud or deception to exploit them, typically for forced labour or sexual exploitation. Men, women and children are forced into a situation through the use (or threat) of violence, deception or coercion. Victims may enter the UK legally, on forged documentation or secretly under forced hiding, or they may even be UK citizens living in the UK who are then trafficked within the country but should not be confused with people smuggling, where the person has the freedom of movement upon arrival in the UK. There is no’ typical’ victim of human trafficking and modern slavery. Victims can be men, women and children of all ages, ethnicities, nationalities and backgrounds. It can however be more prevalent amongst the most vulnerable members of society and within minority or socially excluded groups.

Cuckooing: Refers to the relatively recent identification of a type of controlling and coercive criminal activity. This involves gangs using adults at risk (and children and young people) to move, store and deliver drugs.

Gang exploitation: Gang members are expanding into drug markets outside their usual urban areas because they are less known to local police, face less competition from rival gangs locally, and non-metropolitan police forces generally have less experience in tackling this kind of activity. This exploitation of vulnerable people is central to county lines. Victims can be men, women, or children.

Discriminatory abuse: Including forms of harassment, slurs or similar treatment, because of race, gender, gender identity, age, disability, sexual orientation or religion.

Internet/cyberbullying: Can be defined as the use of technology, particularly mobile phones and the internet, to deliberately hurt, upset, harass or embarrass someone else. It can be an extension of face-to-face bullying, with the technology offering the bully another route for harassing their victim, or can be simple without motive. Cyberbullying can occur using practically any form of connected media, from nasty text and image messages using mobile phones to unkind blog and social networking posts, emails and instant messages, to malicious websites created solely to intimidate an individual or virtual abuse during an online multiplayer game.

Organisational abuse:

Organisational abuse (also known as institutional abuse) is distinct from other forms of abuse or neglect because it is not directly caused by individual action or inaction. Instead, it is a cumulative consequence of how services are managed, led and funded. Some aspects of organisational abuse may be hidden (closed cultures), and staff may act differently when visitors are there (disguised compliance). Organisational abuse can affect one Client or more than one Client. Therefore, it is important to consider each unique case and the impact on the Client as well as the whole care home.

Neglect and acts of omission: Include ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, and the withholding of the necessities of life, such as medication, adequate nutrition and heating.

Self-neglect: This covers a wide range of behaviour in neglecting to care for one’s hygiene, health or surroundings and includes behaviour such as hoarding.

Incidents of abuse may be one-off or multiple and affect one person or more. Professionals and others should look beyond single incidents or individuals to identify patterns of harm, just as the CQC, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems which are now described as organisational abuse. To see these patterns, it is important that information is recorded and appropriately shared.

Signs of abuse

Physical Abuse

• No explanation for injuries or inconsistency with the account of what happened.
• Injuries are inconsistent with the person’s lifestyle.
• Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps.
• Frequent injuries.
• Unexplained falls.
• Subdued or changed behaviour in the presence of a particular person.
• Signs of malnutrition.
• Failure to seek medical treatment or frequent changes of G. P.

Sexual Abuse

• Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck.
• Torn, stained or bloody underclothing.
• Bleeding, pain or itching in the genital area.
• Unusual difficulty in walking or sitting.
• Foreign bodies in genital or rectal openings.
• Infections, unexplained genital discharge, or sexually transmitted diseases.
• Pregnancy in a woman who is unable to consent to sexual intercourse.
• The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude.
• Incontinence that is not related to any medical diagnosis.
• Self-harming.
• Poor concentration, withdrawal, and sleep disturbance.
• Excessive fear/apprehension of, or withdrawal from, relationships.
• Fear of receiving help with personal care.
• Reluctance to be alone with a particular person.

Psychological Abuse

• An air of silence when a particular person is present.
• Withdrawal or change in the psychological state of the person.
• Insomnia.
• Low self-esteem.
• Uncooperative and aggressive behaviour.
• A change of appetite, weight loss/gain.
• Signs of distress: Tearfulness, anger.
• Apparent false claims, by someone involved with the person, to attract. Unnecessary treatment.

Financial Abuse

• Missing personal possessions.
• Unexplained lack of money or inability to maintain a lifestyle.
• Unexplained withdrawal of funds from accounts.
• Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity.
• Failure to register an LPA after the person has ceased to have the mental capacity to manage their finances so that it appears that they are continuing to do so.
• The person allocated to manage financial affairs is evasive or uncooperative.
• The family or others show an unusual interest in the assets of the person.
• Signs of financial hardship in cases where the person’s financial affairs are being managed by a court-appointed deputy, attorney or LPA.
• Recent changes in deeds or title to a property.
• Rent arrears and eviction notices.
• A lack of clear financial accounts held by a care home or service.
• Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person.
• The disparity between the person’s living conditions and their financial resources, e.g. Insufficient food or clothing.
• Unnecessary property repairs.

Domestic Abuse

• Appears to be afraid of a partner and/or of making choices for themselves.
• Behaves as though they deserve to be hurt or mistreated.
• May have low self-esteem or appear to be withdrawn.
• Appears unable or unwilling to leave perpetrator.
• Leaves perpetrator and then returns to them.
• Makes excuses for or condones the behaviour of the perpetrator.
• Blames abuse on themselves.
• Minimises or denies abuse or seriousness of the harm.
• The perpetrator is always with the victim and will not let the victim speak for themselves, e. g., At GP visits.
• Low self-esteem.
• Feeling that the abuse is their fault when it is not.
• Physical evidence of violence such as bruising, cuts, and broken bones.
• Verbal abuse and humiliation in front of others.
• Fear of outside intervention.
• Damage to home or property.
• Isolation – not seeing friends and family.
• Limited access to money.

Domestic violence and abuse include any incident or pattern incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so-called ‘honour-based violence, female genital mutilation and forced marriage.

Modern Slavery and Trafficking

• Signs of physical or emotional abuse.
• Appearing to be malnourished, unkempt or withdrawn.
• Visible tattoos suggesting gang exploitation.
• Isolation from the community, seems under the control or influence of others.
• Living in dirty, cramped or overcrowded accommodation and or living and working at the same address.
• Lack of personal effects or identification documents.
• Always wearing the same clothes.
• Avoidance of eye contact, appearing frightened or hesitant to talk to strangers.
• Fear of law enforcers.

Discriminatory Abuse

• The person appears withdrawn and isolated.
• Expressions of anger, frustration, fear or anxiety.
• The support on offer does not take account of the needs of the Client in terms of a protected characteristic.

Organisational Abuse

• Incidents of abuse or neglect are not reported, or there is evidence of incidents being deliberately not reported.
• Lack of flexibility and choice for a Client.
• Inadequate staffing levels.
• People being hungry or dehydrated.
• Poor standards of care or frequent, unexplained deterioration in the health and well-being of a Client.
• Repeated cases of the Client not having access to nursing, medical or dental care.
• Lack of procedures and safeguards in place relating to the safe handling of Client money.
• A sudden increase in safeguarding concerns in which abuse or neglect has been identified.
• Repeated instances of Client, families and carers feeling victimised if they raise safeguarding concerns.
• The service fails to improve or respond to actions or recommendations in local compliance visits or audit frameworks from the local authority, clinical commissioning groups or the Care Quality Commission (CQC).
• Lack of personal clothing and possessions and communal use of personal items.
• Lack of adequate procedures.
• Poor record-keeping, missing documents or evidence of redacted, falsified, or incomplete records.
• Absence of visitors.
• Few social, recreational and educational activities.
• Public discussion of personal matters.
• Unnecessary exposure during bathing or using the toilet.
• Absence of individual care plans.
• Lack of management overview and support.

Neglect and Acts of Omission

• Poor environment – dirty or unhygienic.
• Poor physical condition and/or personal hygiene.
• Pressure sores or ulcers.
• Malnutrition or unexplained weight loss.
• Untreated injuries and medical problems.
• Inconsistent or reluctant contact with medical and social care organisations.
• Accumulation of untaken medication.
• Uncharacteristic failure to engage in social interaction.
• Inappropriate or inadequate clothing.

Self Neglect

• Very poor personal hygiene.
• Unkempt appearance.
• Lack of essential food, clothing or shelter.
• Malnutrition and/or dehydration.
• Living in squalid or unsanitary conditions.
• Neglecting household maintenance.
• Hoarding.
• Collecting a large number of animals in inappropriate conditions.
• Non-compliance with health or care services.
• Inability or unwillingness to take medication or treat illness or injury.

(Social Care Institute for Excellence. Oct 2020).

Patterns of Abuse

Serial abuse is when the person allegedly responsible seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;

Long-term abuse in the context of an ongoing family relationship such as domestic violence between spouses or generations or persistent psychological abuse; or.

Opportunistic abuse such as theft occurs because money or jewellery has been left lying around.

Who Abuses or neglects adults?

Anyone can carry out abuse or neglect, including:

• Spouses/partners.
• Other family members.
• Neighbours.
• Friends.
• Acquaintances.
• Others residing in the home.
• People who deliberately exploit adults.
• Paid staff or professionals.
• Volunteers and strangers.

While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power. Registered Manager is designated to handle concerns in relation to people in the position of trust.

Please refer to the Position of Trust Policy.

Safeguarding Children in an Adult setting

The Orchard Trust is aware of its obligations under the The Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2014 to protect and safeguard children.

Refer to the The Orchard Trust Safeguarding Children in Adult Settings policy. This policy sets out the responsibilities of staff concerning any allegation of abuse involving children that may be witnessed by staff whilst in the employ of The Orchard Trust. We are committed to working in partnership with other multi-agency partners so that the protection and safeguarding of children are consistent with current policy and guidance. We apply the Think Family principles and promote the whole family approach when working in a family situation.

Reporting and Responding to Abuse and Neglect

We recognise that our role as a service provider is key to promoting good practice (and therefore preventing harm) or allowing harm to take place. Ensuring safe recruitment practices, effective supervision, focussed training and direct observation of staff practice are all critical elements that contribute to the prevention of harm.

Refer to the The Orchard Trust Recruitment and Selection Policy for safe recruiting practices along with the Code of Conduct for Workers Policy for more details.

We also have a responsibility to work in partnership with commissioners to ensure that when things do go wrong we both report it and, if appropriate, seek help to put matters right without delay.

It is important to understand the circumstances of abuse, including the wider context such as whether others may be at risk of abuse, whether there is an emerging pattern of abuse, whether others have witnessed abuse and the role of family members and paid staff or professionals.

Concern should be raised when there is reason to believe an adult at risk may have been, is, or might be the subject of harm, abuse or neglect by any other person or persons. This may include anyone self-neglecting where there is a significant risk to their health or well-being.

Early sharing of information is the key to providing an effective response where there are emerging concerns. To ensure effective safeguarding arrangements:

• All organisations must have arrangements in place which set out the processes and the principles for sharing information between each other, with other professionals and with the SAB; this could be via an information sharing agreement to formalise the arrangements; and,
• No professional should assume that someone else will pass on information that they think may be critical to the safety and well-being of the adult. If a professional has concerns about the adult’s welfare and believes they are suffering or likely to suffer abuse or neglect, then they should share the information with the Local Authority (LA) and, or the police if they believe or suspect that a crime has been committed.

Information Sharing

Record Keeping

Good record-keeping is a crucial part of professional practice. Whenever a complaint or allegation of abuse is made, all agencies should maintain clear and accurate records, and each agency should establish procedures for incorporating all relevant documents upon receipt of a complaint or allegation, documenting all actions taken. When abuse or neglect is suspected, managers need to review past incidents, concerns, risks, and patterns. We know that, in many cases, abuse and neglect result from a series of incidents over time. For providers registered with the Care Quality Commission (CQC), records of these should be available to service commissioners and the Care Quality Commission (CQC) so they can take appropriate action.

Staff should be given clear directions as to what information should be recorded and in what format. The following questions are a guide:

• What information do staff need to know to provide a high-quality response to the adult concerned?
• What information do staff need to know to keep adults safe under the service’s duty to protect people from harm?
• What information is not necessary?
• What is the basis for any decision to share (or not) information with a third party?

Recording information about an allegation of abuse should be completed as soon as possible on the same day. If you need to refer to a safeguarding concern you should make a chronological written record of what you have seen, been told or have concerns about. Ensure that anyone else who saw or heard anything relating to the concern also makes a written record.

The written record will need to include:

• The date and time of the disclosure, or when you were told about or witnessed the incident.
• Who was involved, any other witnesses including any Client or staff.
• Exactly what happened or what you were told, in the person’s own words keeping it factual and not interpreting What you saw or were told.
• The views and wishes of the adult.
• The appearance and behaviour of the adult and/or the person making the disclosure, any injuries observed.
• Any actions and decisions taken at this point.
• Any other relevant information, e.g. Previous incidents that have caused you concern.

Records should be kept in such a way that the information can easily be collated for local use and national data collection.

All agencies should identify arrangements, consistent with principles and rules of fairness, confidentiality and data protection for making records available to those adults affected by, and subject to, an enquiry. If the alleged abuser is using Care and Support themselves, then information about their involvement in an adult safeguarding enquiry, including the outcome, should be included in their case record. If it is assessed that the individual continues to pose a threat to other people, then this should be included in any information that is passed on to service providers or other people who need to know.

To carry out their functions, SABs will need access to information that a wide number of people or other organisations may hold. Some of these may be SAB members, such as the NHS and the police. Others will not be, such as private health and care providers, housing providers/housing support providers or education providers.

In the past, there have been instances where the withholding of information has prevented organisations from being fully able to understand what ‘went wrong’ and so has hindered them from identifying to the best of their ability, the lessons to be applied to prevent or reduce the risks of such cases reoccurring. If someone knows that abuse or neglect is happening, they must act upon that knowledge, not wait to be asked for information.

A SAB may request a person to supply information to it or another person. The person who receives the request must provide the information provided to the SAB if:

• The request is made to enable or assist the SAB to do its job.
• The request is made of a person who is likely to have relevant information and then either:
  • The information requested relates to the person to whom the request is made and their functions or activities.
  • The information requested has already been supplied to another person subject to a SAB request for information.

The Service Manager should ensure that:

• All actions taken to safeguard the Client are recorded and shared with other staff as necessary.
• Safeguarding records are focused on the well-being of the individual.
• All records are clear and easily accessible for purposes such as performance management, audits, court proceedings, local authority monitoring visits, Care Quality Commission (CQC) inspections, or learning and development.
• Reviews of safeguarding records include checks of accuracy, quality and appropriateness.

Confidentiality

Agencies should draw up a common agreement relating to confidentiality and set out the principles governing the sharing of information, based on the welfare of the adult or of other potentially affected adults. Any agreement should be consistent with the principles set out in the Caldicott Review, published in 2013, ensuring that:

• Information will only be shared on a need-to-know basis when it is in the interests of the adult.
• Confidentiality must not be confused with secrecy.
• Informed consent should be obtained but, if this is not possible and other adults are at risk of abuse or neglect, it may be necessary to override the requirement; and.
• It is inappropriate for agencies to give assurances of absolute confidentiality in cases where there are concerns about abuse, particularly in those situations when other adults may be at risk.

Where an adult has refused to consent to information being disclosed for these purposes, then practitioners must consider whether there is an overriding public interest that would justify information sharing (e.g. Because there is a risk that others are at risk of serious harm) and wherever possible, the appropriate Caldicott Guardian should be involved.

Decisions about who needs to know and what needs to be known should be taken on a case-by-case basis, within agency policies and the constraints of the legal framework.

Principles of confidentiality designed to safeguard and promote the interests of an adult should not be confused with those designed to protect the management interests of an organisation. These have a legitimate role but must never be allowed to conflict with the welfare of an adult. If it appears to a staff member or person in a similar role that such confidentiality rules may be operating against the interests of the adult, then a duty arises to make full disclosure in the public interest.

In certain circumstances, it will be necessary to exchange or disclose personal information which will need to be by the law on confidentiality and data protection legislation where this applies. The Home Office and the Office of the Information Commissioner have issued general guidance on the preparation and use of information-sharing protocols to comply with the UK Data Protection Act 2018.

Front-line Staff within the Service

Operational front-line staff are responsible for identifying and responding to allegations of abuse and substandard practice. Staff at the operational level need to share a common view of what types of behaviour may be abuse or neglect and what to do as an initial response to suspicion or allegation that it is or has occurred.

It is not for front-line staff to second-guess the outcome of an enquiry in deciding whether to share their concerns. There should be effective and well-publicised ways of escalating concerns where immediate line managers do not take action in response to a concern being raised.

Concerns about abuse or neglect must be reported whatever the source of harm. Poor or neglectful care must be brought to the immediate attention of managers and responded to swiftly, including ensuring the immediate safety and well-being of the adult. Where the source of abuse or neglect is a staff member it is for the employer to take immediate action and record what they have done and why (similarly for volunteers and or students).

There should be clear arrangements in place about what each agency should contribute at this level. These will cover approaches to enquiries and subsequent courses of action. The Local Authority (LA) is responsible for ensuring effective coordination at this level.

Line Management and Supervision of Frontline Staff

The Service Manager and other staff with line manager responsibilities must:

• Promote reflective supervision to help staff understand how to identify and respond to potential abuse and neglect.
• Provide feedback (through supervision and appraisals) acknowledging how staff have learned from their experience of identifying, reporting and managing safeguarding concerns.
• Encourage staff to discuss the The Orchard Trust culture, learning and management concerning safeguarding (e.g. In exit interviews) when leaving employment.

Be aware that staff may be reluctant to challenge poor practice or raise concerns about potential abuse or neglect, particularly if they feel isolated or unsupported.

The Service Manager should also be aware of the potential for under-reporting of safeguarding concerns by staff who may be afraid of losing their job (for example staff who have their housing or work permit linked specifically to their current role.

Staff: How to Report a Safeguarding Concern

Any suspicion of a safeguarding situation must be reported as soon as possible to the Registered Manager / Service Manager or, in their absence, to the senior manager on duty at the time. It is your duty to report any such allegation and the appropriate manager will then take advice. 

If the safeguarding concern involves a member of the management team, i.e. Registered manager, nominated individual, or director, the person reporting the concern must approach the next, or other, senior management and follow the reporting procedure. To raise a concern about a member of the Management Team, contact: Head of Support 01594 861137

After a Concern is Raised.

You must report any such allegation and the appropriate manager will then take advice and follow the appropriate guidance.You must report any such allegation and the appropriate manager will then take advice and follow the appropriate guidance.

• Always believe the person who is disclosing the actual or potential abuse or neglect.
• The staff member should be supportive and listen but should not ask investigative questions.
• It is not the staff job to decide if they are telling the truth or not, but it is their responsibility to report it to the manager/person in charge.
• Even if the person asks for it not to be reported, it is the staff responsibility to report and explain the requirement to report and to whom they will report.
• It is also important to tell the person to whom the report will be made that they will need to come and talk to them about it.
• Remember it is your responsibility to report – the
  LA Safeguarding Unit.
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• Will make or arrange the enquiries and listen to the individual’s views and choices.
• In cases where the adult is in imminent danger, urgent action to protect the individual should be taken by calling the relevant emergency services. E. g., The ambulance and police service.
• Do not confront the abuser or alert them to what has been alleged, do not put yourself in danger and call for backup as soon as possible.
• Support needs to be given to the person, especially through the initial stages of the enquiries and later if an investigation takes place.
• If there is a possibility that forensic evidence can be identified, protect the person and the evidence, and do not clean up. Inform your manager.
• Relevant documents to be completed, recording what you have seen or has been disclosed must be completed as soon as possible, recording only the facts and not opinions or views.

Remember. If you suspect abuse or neglect, you must act on it. Do not assume that someone else will.

Consent

Once a person has agreed to further action, or if someone unable to give their consent has been deemed to be in their best interests to proceed, the senior staff member or Service Manager (or whoever is authorised at the time) will then notify the local Safeguarding Adult team and follow its procedures and guidance from that point onwards. This will typically involve a strategy meeting and the development of an action plan to be implemented from that meeting.

Any adult suspected of lacking the mental capacity to consent to reported abuse or harm will be assessed for their decision-making ability, and a “ best interests” decision will be made following the procedures outlined in The Mental Capacity Act 2005.

When a competent adult explicitly refuses any supporting intervention, this should generally be respected. Exceptions include situations where a criminal offence may have occurred or when there is a substantial risk of harm to a third party. For instance, if there is an abused adult in a position of authority over other adults at risk, it might be necessary to breach confidentiality and disclose information to an appropriate authority, such as the local safeguarding team or police, to facilitate investigation.
Where a criminal offence is suspected, the registered manager will inform the police and follow their procedures.

Ongoing support should also be provided to the adult at risk because if an adult initially refuses the offer of assistance, they should not be abandoned or feel unable to access further support later.

A Client with capacity has the right to withhold consent.

The Role of the Manager

An immediate assessment of the alleged abuse should be undertaken by Service Manager about the following:

• The health and safety and well-being of the adult.
• Their needs, preferences and wishes concerning any action to be considered.
• Their mental capacity to understand, comprehend and make decisions regarding the actions to be considered.

From this assessment, Service Manager will then take further advice from The Safeguarding lead for the Orchard Trust is Tony Lafford, Head of Support. And institute steps to ensure the protection and safeguarding of the adult; as appropriate; with immediate effect.

The Service Manager will immediately notify the local safeguarding team and the police if required.

Service Manager, in this context, is the person to whom the concern has been reported, whether during office hours or outside of hours. They will be the responsible manager until they are informed otherwise. Records and notes of all actions should be taken. This includes any advice given to the responsible manager by any triage arrangements that are in place.

Staff and Safeguarding

Supporting staff who are subject to a safeguarding enquiry

Where the source of abuse or neglect is a member of staff it is for the employer to take immediate action and record what they have done and why (similarly for volunteers and or students).

Following immediate action to safeguard Residents, and through any subsequent safeguarding enquiry, the registered manager should:

• Be aware of how safeguarding allegations can affect the way other staff and Residents view staff subject to a safeguarding enquiry.
• Take steps to protect the staff member from victimisation or discriminatory behaviour.
• Check with the local authority what information they can share with staff at each stage of the enquiry subject to the employer’s usual duties of confidentiality with its employees.
• Tell the staff member about any available Employee Assistance Programme.
• Tell the staff member about professional counselling and occupational health services (if available).
• Nominate someone to keep in touch with the staff member throughout the enquiry if they are suspended from work.
• Staff who are subject to a safeguarding enquiry should be able to request that the nominated person be replaced if they think there is a conflict of interest. The nominated person must not be directly involved with the enquiry.

If members of staff return to work after being suspended, the manager should:

• Arrange a return-to-work meeting when the enquiry is finished, to give them a chance to discuss and resolve any issues.
• Agree to a programme of guidance and support with them.

If staff are concerned about working with a Resident who has made allegations, the registered managers should:

• Provide support, additional training and supervision to address these concerns.
• Ensure that the Resident is not victimised by staff.

Complaint or Allegation About Another Member of Staff

If a staff member has concerns or receives a complaint or allegation about another staff member who has,

• Behaved in a way that has potentially harmed, or harmed the Client.
• Possibly committed a criminal offence against the Client.

They must immediately report to their line manager who will immediately make an assessment, obtain further advice, and take steps to ensure the safety and protection of every Client.

When a complaint or allegation has been made against a staff member, including people employed by the adult, they will be made aware of their rights under employment legislation and internal disciplinary procedures. This may include staff to be suspended (or transferred to other duties) pending consideration or investigation of an allegation of abuse or serious concern relating to the safety or well-being of the Client.

A disciplinary investigation, and potentially a hearing, may result in the employer taking informal or formal measures which may include dismissal and possibly referral to the Disclosure and Barring Service.

If someone is removed dismissed or redeployed to a non-regulated activity following a safeguarding incident, or a staff member leaves their role (resignation, retirement) to avoid a disciplinary hearing following a safeguarding incident and the employer/volunteer organisation feels they would have dismissed the person based on the information they hold, the regulated activity provider has a legal duty to refer to the Disclosure and Barring Service DBS and any other professional body such as the Nursing and Midwifery Council.

Residents: How to Report a Safeguarding Concern

During the information gathering process within our quality assurance systems, the Client and or their representatives need to be informed and asked about any inappropriate behaviour,  verbal or physical, that they have observed or been subject to by staff or visitors. This needs to be handled sensitively.

As part of the information given to a new Client and or their representatives our Client guide explains and details how to report a safeguarding concern.

Information on raising a safeguarding concern can also be found at the back of the Care and Support plan for the Client in The Orchard Trust and on the The Orchard Trust website.

The Client and or their representatives can inform staff on duty at any time of their concerns. Staff will then report to the designated manager.

Learning Lessons

The Orchard Trust is committed to continuous learning and driving improvement, we recognise the opportunities of learning lessons and improve our practice with safeguarding concerns, referrals and enquiries. The Orchard Trust is committed to identifying key lessons to drive improvements at:

An individual level – for example, changes to support, supervision, retraining, and performance management.
An organisational level for example through observations of practice, discussion and watching staff work across The Orchard Trust. And/or, changing practices, procedures, policy and learning, and group training (including training from other health and social care practitioners).

We also ask for feedback about safeguarding from the Client (and their families, friends and carers) and other people working in the service.

We ask them about their experience of safeguarding concerns and how these have been identified, reported, managed and resolved.

We respond to feedback and tell people about any changes made in response to their comments.

Preventing Abuse

Making Safeguarding Personal (MSP) and Risk Assessment.

This is an initiative built on the Care Quality Commission (CQC) 5 Core Domains being led by Local Authorities via the Local Government Association. We are aware of this as an ongoing resources toolkit that gathers together outstanding practices across commissioning and Care Quality Commission (CQC).

Under MSP the adult is best placed to identify risks, provide details of its impact and whether or not they find the mitigation acceptable. Working with the adult to lead and manage the level of risk that they identify as acceptable creates a culture where:

• Adults feel more in control.
• Adults are empowered and have ownership of the risk.
• There is improved effectiveness and resilience in dealing with a situation.
• There are better relationships with professionals.
• Good information sharing to manage risk, involving all the key stakeholders.
• Key elements of the person’s quality of life and well-being can be safeguarded.

Not every situation or activity will entail a risk that needs to be assessed or managed. The risk may be minimal and no greater for the adult than it would be for any other person.

• Risks can be real or potential;
• Risks can be positive or negative;
• Risks should take into account all aspects of an individual’s well-being and personal circumstances.

Sources of risk might fall into one of the four categories below:

• Private and family life: The source of risk might be someone like an intimate partner or a family member;
• Community-based risks: This includes issues like ‘mate crime, anti-social behaviour, and gang-related issues;
• Risks associated with service provision: This might be concern about poor care which could be neglect or organisational abuse, or where a person in a position of trust because of the job they do financially or sexually exploits someone;
• Self-neglect: Where the source of risk is the person themselves.

Safeguarding Adults Risk Assessment.

The primary aim of a safeguarding adults risk assessment is to assess current risks that people face and potential risks that they and other adults may face. Specific to safeguarding, risk assessments should encompass:

• The views and wishes of the adult;
• The person’s ability to protect themselves;
• Factors that contribute to the risk, for example, personal, environmental;
• The risk of future harm from the source;
• Identification of the person causing the harm and establishing if the person causing the harm is also someone who needs care and support;
• Deciding if domestic abuse is indicated.
• Identify people causing harm.
• It may increase risk where information is not shared.

It is the collective responsibility of all organisations to share relevant information, make decisions and plan interventions with the adult. A plan to manage the identified risk and put in place safeguarding measures includes:

• What immediate action must be taken to safeguard the adult and/or others.
• Who else needs to contribute and support decisions and actions.
• What the adult sees as proportionate and acceptable.
• What options there are to address risks.
• When action needs to be taken and by whom.
• What are the strengths, resilience and resources of the adult.
• What needs to be put in place to meet the ongoing support needs of the adult.
• What the contingency arrangements are.
• How will the plan be monitored?

Positive risk management needs to be underpinned by widely shared and updated contingency planning for any anticipated adverse eventualities. This includes warning signs that indicate risks are increasing and the point at which they become unacceptable and therefore trigger a review.

Effective risk management requires exploration with the adult using a person-centred approach, asking the right questions to build up a full picture. Not all risks will be immediately apparent; therefore risk assessments need to be regularly reviewed as part of the safeguarding response.

Reviewing Risk

The individual need will determine how frequently risk assessments are reviewed and wherever possible there should be multi-agency input. These should always be in consultation with the adult.

Risk assessments will be reviewed and amended when any part of our safeguarding procedures is changed.

All Safeguarding related risk assessments are reviewed following a concern or a disclosure being raised and amended as required.

All Safeguarding risk assessments are stored following UK General Data Protection Regulation (UK GDPR) requirements and audited as part of our Safeguarding quality assurance system. Records may be disclosed in courts in criminal or civil actions. Quality recording of adult safeguarding not only safeguards adults but also protects workers by evidencing decision-making based on the information available at the time.

Statutory Notifications to CQC

Care Quality Commission (CQC) must be notified immediately about abuse or allegations of abuse concerning a Client if any of the following applies:

• The Client is affected by abuse
• They are affected by alleged abuse
• The is an Client abuser
• They are an alleged abuser

Service Manager or delegated person sends a statutory notification to Care Quality Commission (CQC) concerning any abuse or alleged abuse involving a Client. This includes where the Client is either the victim(s) or the abuser(s), or both. We acknowledged that more than one Client could be impacted.

We notify Care Quality Commission (CQC) about abuse or alleged abuse at the same time as alerting

LA Safeguarding Unit.

Socialcare.enq@gloucestershire.gov.uk

or request from:

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• Gloucestershire County Council homepage.
• Sign up for GSAB updates.

For children or adults, and the police where a crime has been or may have been committed.

The person submitting the statutory notification must use the electronic form supplied on the Care Quality Commission (CQC) website to notify both alleged and actual abuse and email the form to Care Quality Commission (CQC) at the address stated on the form.

Guidance: Statutory Notifications for non- NHS Trust Providers

The Care Quality Commission (CQC) website is regularly checked to ensure the above guidance we use is up to date.

Restrictive Interventions

We have separate robust policies to prevent abuse and improper treatment, including restraint.
The Mental Capacity Act 2005, deprivation of liberty under the terms of The Mental Capacity Act 2005 and Health and Social Care Act 2008 (Regulations 2014) Regulation 13: Safeguarding service users from abuse and improper treatment outlines the legal framework of restraint.

Restraint must only be used if assessed and deemed necessary, as a last resort, proportionate in relation to the risk of harm and within current national guidelines and good practice. There are regular and ongoing reviews of our restrictive practices.

We focus on Positive Behaviour Support. Staff are trained to use restraint responsibly and safely in a manner that respects the dignity and rights of each individual receiving care and support.

Refer to our Restraint and Intervention Policy, Positive Behaviour Policy and Mental Capacity 2005 policy for procedures.

This policy and our organisational responses to restrictive practices reflect the guidelines in the document below.

Positive and Proactive Care: Reducing the Need for Restrictive Interventions, prepared by the Department of Health, published in April 2014.

This guidance is of significance for health and social care services where individuals who are known to be at risk of being exposed to restrictive interventions are cared for. Such settings may provide services to people with mental health conditions, autistic spectrum conditions, learning disabilities, dementia and/or personality disorder, older people and a detained Client. It is more broadly applicable across general health and social care settings where the Client may on occasion present with behaviour that challenges but cannot reasonably be predicted and planned for on an individual basis.

Closed Cultures.

A closed culture is a poor culture in a health or care service that increases the risk of harm. This includes abuse and human rights breaches. The development of closed cultures can be deliberate or unintentional – either way, it can cause unacceptable harm to a person and their loved ones.

Care Home Cultures

National Institute for Health and Care Excellence (NICE) Guidance NG189 draws links between safeguarding adults from abuse and the culture of a care home and provides the following best practice advice for The Orchard Trust and Service Manager who should:

As an organisation, The Orchard Trust:

• Promote a culture in which safeguarding is openly discussed and abuse and neglect can be readily reported.
• Encourage staff to watch out for changes in the mood and behaviour of every Client, because this might indicate abuse or neglect (see indicators of individual abuse and neglect).
• Ensure staff members’ record and share relevant and important information about changes in mood or behaviour or other issues of concern in a timely manner (for example, at every shift handover or transfer of care).
• Ensure that support is readily available for people raising concerns, for example, by appointing safeguarding champions.

Service Manager must ensure there are regular opportunities (for example in team meetings or one-to-one supervision) for all staff to:

• Share best practices in safeguarding, including learning from Safeguarding Adults Reviews.
• Challenge poor practice or discuss uncertainty around practice.
• Discuss the differences between poor practice (which is not necessarily a safeguarding issue) and abuse or neglect (which are safeguarding issues).
• Make particular efforts to involve staff who work alone or who get very little direct oversight (for example night staff).

Our Service Manager asks for feedback about safeguarding from the Client (and their families, friends and carers) and other people working in care homes to:

• Ask them about their experience of safeguarding concerns and how these have been identified, reported, managed and resolved.
• Respond to feedback and tell people about any changes made in response to their comments.

This can be achieved through surveys, meetings and where appropriate, other community engagement (such as open days and visits).

Visiting the Home

Care Quality Commission (CQC) has also published guidance on visiting care homes during outbreaks of acute respiratory infections, highlighting the links between blanket visiting policies and safeguarding.

We follow a specific visiting protocol. Our open, transparent, and communicative culture, along with regular contact with residents’ families, promotes visits to our home.

Identifying and Managing a Deprivation of Liberty (DoLS)Application

Being assessed as to whether a Deprivation of Liberty has taken place is an essential right. No one should ever be restricted to an extent greater than is necessary and proportionate to the risks involved, and any deprivation must be in the individual’ s best interests.

 

To ensure the human rights of the Client are protected, the Service Manager will:

• Deciding if an authorisation may be needed, the Service Manager will consider the initial Care and Support plan and/or their prior knowledge of the Client (where appropriate, with Local Authority (LA) care managers) to determine whether there are any restrictions in place and if so, whether they may amount to a deprivation of liberty. The appropriate checklist for the Deprivation of Liberty Standards application will be completed.
• Alert any risk of a deprivation of liberty to the Local Authority (LA), Deprivation of Liberty Standards team, to ensure the rights of the Client are protected.
• Work within the principles of The Mental Capacity Act 2005, e.g. By doing everything possible to empower people to make as many decisions for themselves as they can.
• Ensure that decision-specific capacity assessments are completed where required.
• Ensure that best interest decisions are completed where a Client lacks the capacity to agree to arrangements for their care or treatment, working with the appointed representative for the Client.
• The Orchard Trust is likely to be the decision-maker for day-to-day best interests decisions, but significant decisions, including the use of restrictions, are more likely to be carried out by commissioners of care.
• Participate in best interests decisions where the decision maker is a health or social care professional.
• Ensure that restrictions on the freedom of anyone lacking capacity to consent to them are proportionate to the risk and seriousness of harm to that Client and that no less restrictive option can be identified (Useful guidance on care planning within an empowering ethos is available in The Mental Capacity Act 2005 Code of Practice).
• Liaise with commissioners of services and, as appropriate, the Deprivation of Liberty Standards as to how to ensure the protection of the human rights of adults at risk who use services.

The Care Worker will:

• Work within the five statutory principles of The Mental Capacity Act 2005, by doing everything possible to empower people to make as many decisions for themselves as they can.
• Presumption of Capacity: A person is assumed to have the capacity to make their own decisions unless it is proven otherwise.
• Support to Make Decisions: Individuals should be given all possible help and support to make their own decisions, before it is assumed they lack capacity.
• Unwise Decisions: A decision that may seem unwise or unconventional to others should not automatically be taken as a sign of lacking capacity.
• Best Interests: Any act or decision made on behalf of someone who lacks capacity must be done in their best interests.
• Least Restrictive Option: When acting in someone’s best interests, the chosen course of action should be the least restrictive of their rights and freedoms.
• Engage in the training provided on MCA and deprivations of liberty in community settings.
• Raise any concerns, including concerns about restrictions with the Service Manager.
• Read this policy and the separate Disclosure and Barring Service DBS in community settings policy.

Guidance on Pressure Ulcers and Safeguarding

The risk of sustaining pressure damage is often seen to be the problem of the health or social care professional; however, the Client at risk is central to successful prevention. Pressure ulcers are considered an important part of the wider Safeguarding agenda and each local Safeguarding Adults Board has guidance in place to ensure that people with pressure ulcers are referred to the safeguarding process appropriately which aligns with the NHS reporting mechanisms.

To date, the government has advised that anyone who develops category 3, category 4 or un-gradable pressure ulcers be referred to as a safeguarding risk.

Adult Safeguarding Information including this policy will be available as required, in accessible formats for the Clients, advocates. Those lawfully acting on their behalf and those close to them, as well as our staff.

Contact Info

Email: Socialcare.enq@gloucestershire.gov.uk

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The manager, in this context, is the person to whom the concern has been reported to, whether during office hours or out of hours. They will be the Responsible Manager until they are informed otherwise. Records and notes of all actions should be taken. This includes any advice given to the Responsible Manager by any triage arrangements that are in place.

The Role of the Local Authority

All local authorities have a legal duty to make enquiries or cause another agency to do so, whenever abuse or neglect are suspected in relation to an adult. The nature, scope, how long it takes and who leads it will depend on the particular circumstances presented. Everyone involved in an enquiry must focus on improving the adult’s wellbeing and work together to that shared aim. The objectives of the enquiry are to:

It is important to recognise that any member of staff involved in a safeguarding situation can find it stressful and distressing and workplace support should be available to:

• Establish fact;
• Ascertain the Adult’s views and wishes;
• Assess the needs of the adult for protection, support and wellness and how they might be met;
• Protect from abuse and neglect, in accordance with the wishes of the adult;
• Make decisions as to what follow up action should be taken with regard to the person or organisation responsible for the abuse or neglect; and
• Enable the adult to achieve resolution and recovery

 

The first priority must always be to ensure the safety and wellbeing of the adult. It is the responsibility of all staff and members of the public to act on any suspicion or evidence of concerns to a responsible person or agency.

Please note the following:

“Where a competent adult explicitly refuses any supporting intervention, this should normally be respected. Exceptions to this may be where a criminal offence may have taken place or where there may be a significant risk of harm to a third party. If for example, there may be an abusive adult in a position of authority in relation to other vulnerable adults (sic), it may be appropriate to breach confidentiality and disclose information to an appropriate authority. Where a criminal offence is suspected it may also be necessary to take further advice. Ongoing support should also be offered. Because an adult initially refuses the offer of assistance they should not therefore be lost to or abandoned by relevant services. The situation should be monitored and the individual informed that they can take up the offer of assistance at any time.

Statutory Notifications to CQC

A Statutory Notification is sent to CQC concerning any abuse or alleged abuse involving a person(s) using our service. This includes where the person(s) is either the victim(s) or the abuser(s), or both. We notify CQC about abuse or alleged abuse at the same time as alerting our local safeguarding authority for children or adults, and the police where a crime has been or may have been committed.

The person submitting the Statutory Notification must use the electronic form supplied on CQC website to notify both alleged and actual abuse and email the form to CQC at the address stated on the form. http://www.cqc.org.uk/content/notifications 

Providers Guidance -Statutory Notifications for non-NHS trust providers

The CQC website is regularly checked to ensure the above guidance we use is up to date.

Restrictive Interventions

This policy and our organisational responses to restrictive practices reflect the guidelines in the document below.

Positive and Proactive Care: reducing the need for restrictive interventions 

Prepared by the Department of Health. Published in April 2014.

Making Safeguarding Personal

This is an initiative built on the CQC 5 Core Domains being led by Local Authorities via the Local Government Association. We are aware of this as an ongoing resources toolkit which gathers together good and outstanding practice across commissioning and CQC

This guidance is of particular significance for health and social care services where individuals who are known to be at risk of being exposed to restrictive interventions are cared for. Such settings may provide services to people with mental health conditions, autistic spectrum conditions, learning disability, dementia and/or personality disorder, older people and detained patients. It is more broadly applicable across general health and social care settings where people using services may on occasion present with behaviour that challenges but which cannot reasonably be predicted and planned for on an individual basis. This may include homes where individuals employ their own support staff, and community-based primary and secondary care settings.  

Training Statement

All staff will be made aware of the changes outlined above. This will include the Multi-Agency Safeguarding Agreement from the LA, as amended. All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and when required sessions dedicated to an individual.

 

Signed:      Tony Lafford Head of Support

Issue Date: 10/7/15 Reviewed on 26/7/17 Updated 27/3/19 Updated 9/3/2020 Reviewed March 2021 Updated July 2021  reviewed Feb 2022 Updated Oct 2022

Reviewed Jan 23 Updated Feb 2023 Updated Jun 2023  Reviewed: Jan 24 Reviewed: July 2025 Updated March 2026

 

SEE CONTINUATION OF POLICY DETAILS BELOW

 

All Local Authorities are required to produce the above Guidance. We are  contracted with more than one authority please see below web links for other commissioners 

https://www.local.gov.uk/our-support/guidance-and-resources/communications-support/digital-councils/social-media/go-further/a-z-councils-online

 

Contact List

• Provider Designated Lead  – Head of Support  – 01594 861137

 

• Local Authority Safeguarding Unit

Gloucestershire Safeguarding

Use the professionals online portal     https://forms.gloucestershire.gov.uk/AdultSocialCareReferral 

• For out of hours, call the Emergency Duty Team on 01452 614194
• socialcare.enq@gloucestershire.gov.uk 

Website:http://www.gloucestershire.gov.uk/gsab/article/109960/Home-Page

 

Local Police

Gloucester Police

Tel 101

 

Whistleblowing 

The government has set up a whistleblowing helpline for NHS and Social care. This is available to both managers for advice and staff for reporting purposes. This telephone number is 08000 724 725.

www.wbhelpline.org.uk

CQC whistleblowing “Guidance for providers who are registered with CQC (issued November 2013)

To download www.cqc.org.uk/whistleblowing

• Care Quality Commission (CQC)

Citygate

Gallowgate

Newcastle Upon Tyne

NE1 4PA

03000 616161     http://www.cqc.org.uk/content/notifications