Safeguarding Adults - Preventing Abuse and Responding to Poor Practice

1. Safeguarding Adults - Preventing Abuse and Responding to Poor Practice Practitioner Level

2. Housekeeping Fire Procedure Smoking Toilets Breaks Finishing Time Mobile Phones / Devices

3. Training Transfer Getting learning into practice • “50% of learning fails to transfer to the workplace” (Sak, 2002) • “The ultimate test of effective training is whether it benefits service users” (Horwath and Morrison, 1999)

4. Training Transfer

5. Introductions • Name • Place and nature of work • What do you want to know by the end of today’s session?

6. Outcomes By the end of the session you will: • Understand your responsibilities • Be able to recognise and respond to poor practice and know who else to involve • Recognise missed opportunities through learning from Serious Case Reviews • Have a greater awareness of the legislative framework, regulation and guidance that contribute to the prevention agenda • Identify opportunities for intervention through the assessment, care or treatment planning and review processes • Recognise the role of person-centred support in preventing abuse • Be able to consider the ongoing balance between prevention, protection and a person's right to choice

7. Ground Rules Confidentiality within the group will be respected but may need to be broken if a disclosure of unsafe practice, abuse or neglect is made during the course – this will normally be discussed with you first. Safeguarding is about partnership, it is not about blame. All agencies and individuals need to take responsibility, to reflect and learn to safeguard people who may be vulnerable.

8. Underpinning message for session • Positive approach – promotion of good practice and early intervention to avoid harm • The rule of optimism - maintaining healthy scepticism and respectful uncertainty “It could happen here.”

9. Setting The Scene Where does our learning about Safeguarding come from? • Serious Case Reviews/Complaints/Near misses • Research/Surveys/Data Analysis • Practice Experience/Theory/Reflection www.devonsafeguarding.org www.scie.org.uk

10. Six Safeguarding Adults Principles • Empowerment • Protection • Prevention • Proportionality • Partnership • Accountability ‘Adult Safeguarding: Statement of Government Policy’ 2011

11. ‘Prevention in Adult Safeguarding’ “It does not mean being over-protective or risk-averse. Prevention needs to take place in the context of person-centred support and personalisation, with individuals empowered to make choices and supported to manage risks.” Report 41, SCIE, 2011

12. Vulnerability What does the term ‘vulnerable’ mean?

13. The Traditional Model • Risk factors for being abused – poor communication skills, low self esteem, challenging behaviour, cognitive difficulties, lack of education/experience, loneliness • Risk factors for carers abusing - isolation, stress, lack of knowledge of condition, substance misuse, lack of support • Risk factors for services – poor management, high turnover of staff, low pay, lack of staff

14. The Social Model of Vulnerability • A way of thinking about vulnerability that is not patronising or impairment specific because the vulnerability is outside the person • Vulnerable groups tend to be • placed in, or left in, situations of higher risk than would be tolerated for others • Not heard, believed or taken notice of when they make complaints • Not helped to recover or recompensed • Because of these situations vulnerable groups risk being seen as “easy targets” (Prof. Hilary Brown)

15. ‘Constellations of Abuse’ Targeted abuse Domestic abuse Professional abuse Institutional abuse Family violence, neglect or negligence partner violence between parent and adult child between adult child and older parent more distant relatives breaches of professional boundaries by arrogant grandiose and unaccountable staff resentful, down-trodden and hard-done-by staff rigid de-personalised regimes neglectful care staff out of their depth or not available cruel, humiliating individuals hate crimes predatory crimes sexual and financial Parasitic, exploitative “mate” crime Unethical practice Unethical, unjustified and/ or unauthorised practice in response to challenging needs Systemic abuse and social exclusion Exclusion from mainstream service provision Discrimination in health, education, housing, employment , justice and welfare Unable to access public places and spaces Denied legal advocacy and routes for challenge Invisible or stigmatised in media Prof. Hilary Brown, 2012

16. PCS Analysis Neil Thompson

17. Opportunities for intervention • Assessment & Planning • Care, Support or Treatment • Review • Service monitoring/Complaints What are your responsibilities?

18. Prevention: Your Responsibilities • people being informed of the right to be free from abuse; and supported to exercise these rights, including having access to advocacy • thorough needs assessments supported by risk assessments where required to inform people’s choices • access to good universal services targeted at older and disabled people that can reduce the risk of people experiencing abuse, for example community safety services or services that increase people’s access to advice or maintain informal support networks • a well informed, competent and properly vetted workforce operating in a culture of zero tolerance of abuse • a sound framework for confidentiality and information sharing across agencies (CSCI, 2008)

19. ISA Report “Safeguarding in the Workplace: What are the lessons to be learned from cases referred to the Independent Safeguarding Authority?” March 2012 General indicators • carelessness, breaches of policy, attitudinal problems, emotional detachment and persistent non-attendance, portrayal of a close personal relationship with the victim Financial indicators • talking about money worries, seeking advances or requesting overtime, failure to complete documentation and protocols regarding the handling of money

20. Creating Safer Organisations • Recruitment - VBI • CRB/ISA Checks and References • Induction and Probation • Policies and Procedures • Setting Standards and Professional Boundaries • Training • Supervision • Performance Management

21. Serious Case Reviews Take place where a vulnerable adult has: • died, suffered serious sexual abuse, a potentially life-threatening injury or serious and permanent impairment of health or development or when serious abuse takes place in an institution or multiple abusers are involved AND • the case gives rise to concerns about the way in which local professionals and services work together to safeguard vulnerable adults OR • where it is believed to be in the public interest to conduct such a review.

22. Serious Case Reviews aim to: • Establish whether there are lessons to be learnt about the way in which local professionals and agencies work together to safeguard vulnerable adults • Improve practice by acting on learning NB: The purpose of having a serious case review is not to reinvestigate or to apportion blame. They consider individual actions as well as the systems and processes within which individuals operate.

23. Serious Case Reviews – recurring national themes • Inter-agency communication • No lead agency • Training needed • Threshold issue • Assumptions Jill Manthorpe and Stephen Martineau, 2009

24. Devon SCRs A: High number of deaths raised by CSCI • Poor care standards not previously picked up by many and various professionals B: 2 falls resulting in deaths raised by PALS • Environmental risks not previously picked up by many and various professionals H: Resident murdered by another on respite • Poor transfer of risk information from hospital to care home

25. Devon SCRs – combined learning • Duty on all health and social care professionals to record and act upon, any concerns about health, safety or wellbeing. This should include possible risks that are not necessarily the main focus of their contact. • Ensure that a Service Provider is fully aware and able to safely meet someone’s needs. Other important considerations such as accessibility, peoples preferences, resource pressures and cost, should not compromise the primacy of ensuring safe care/support arrangements.

26. Common Safeguarding Challenges (care homes) • Maladministration of medication • Pressure sores • Falls • Rough treatment, being rushed, shouted at or ignored • Poor nutritional care • Lack of social inclusion • Institutionalised care • Physical abuse between residents • Financial abuse www.scie.org.uk

27. Health and Social Care Act, 2008 • Single registration system acts as a “licence to provide services” • Established Care Quality Commission to: • Regulate the quality of health care and adult social care • Look after the interests of people detained under the Mental Health Act

28. Health and Social Care Act 2008 • Focused on outcomes rather than policies, systems and processes (inputs) • CQC to monitor compliance – risk register • New enforcement powers for CQC

29. Snap!

30. Behind Closed Doors Watch the DVD Complete the FIRST column ONLY

31. Behind Closed Doors Complete the SECOND column ONLY

32. Behind Closed Doors Consider the indictors and signs that there might be if you hadn’t actually observed the behaviours Complete the THIRD column ONLY

33. What might you see? • Empty hours, bored residents • Empty and scrappy staff rotas (turnover, absences and not enough staff) • Erratic medication charts • Dirty rooms • Dirty linen • No training or “going through the motions” • Policy documents and care plans kept in the drawer • Rushed staff • Dirty, untidy and unlooked after clothes

34. What might you smell? • Urine • Faeces • Stale food • Body Odour

35. What might you hear? • Dehumanising: “they” - people are lumped together – “they eat like animals”, “the doubles” • Sexualising:“they’re at it like rabbits”, “she’s gagging for it” • Blaming:“he knows what he’s doing,” “she’s manipulative”, “he’s winding me up” • Punitive: “they’ve got it coming”, “she needs to be taught a lesson”, “if he thinks he can treat me like that” • Discrediting: “he doesn’t notice”, “they don’t care” “they are zombies”

36. Barriers to addressing poor practice • Lack of a tangible sense of what is wrong • Lack of certainty that your concerns are reasonable or proportionate • Lack of “evidence” to back up concerns • Fear of immediate reprisals or long term detrimental consequences • Fear that concern or complaint will not be handled well so that their intervention will be in vain Professor Hilary Brown

37. How do you verbalise ‘gut instincts’? Hull University: ‘Abuse in Care?’ (http://www2.hull.ac.uk/fass/care/safeguardingadults.aspx) • A practical guide to protecting people with learning disabilities from abuse in residential services • A practical guide to protecting people with dementia from abuse in residential services

38. Service Monitoring Checklist • Leadership and Management • Staff behaviours and attitudes • Behaviours and interactions of residents • Isolation and lack of openness • Service design, delivery and make up • Environment and basics of care Adapted from ‘Abuse in Care?’

39. Practitioners’ Role If you suspect a criminal offence, do not ask any further questions.

40. Behind Closed Doors Complete column FOUR What questions might you need to ask to establish the facts of the situation? Be specific!

41. What to do with concerns about poor practice • Discuss with the professional concerned • Discuss with the service manager • Discuss with your manager immediately, in supervision or at a team meeting • Discuss directly with the person, family, organisation. Once discussed then back up in writing - SMART. • Record in Mr Manager if appropriate • Discuss with co-workers or Safeguarding Adults team • Encourage people to use the complaints process • Discuss with procurement / contracts team • Discuss with CQC

42. Feelings / Emotional Responses

43. Communication

44. Neil Thompson What is a problem? ‘....a problem is anything that either brings about negative ...or blocks positives or a mixture of the two.’ Neil Thompson

45. An Elegant Challenge Being constructive in challenging unacceptable behaviour or language Collusion / Elegant Aggressive no challenging challengechallenge

46. Practice • Choose one of the scenarios from the film (or your own) and make ‘an elegant challenge’ to your partner. • Partners – What did it feel like? What could be done differently? • Swap over.

47. Any Questions?

48. Prevention is Better Than Cure Keep the course in context. Whilst there are some very worrying situations occurring everyday there is also good practice in all care environments Remember to vigilant and deal with things at the earliest opportunity. Whether it’s poor practice or abuse doing nothing isn’t an option.

49. Resources Dementia care mapping www.bradford.ac.uk CQC observation tools www.cqc.org.uk/information-our staff/observation-tools SCRs www.devonsafeguarding.org

50. Resources Social care governance – audit tool Common Safeguarding Challenges Minimising the Use of Restraint www.scie.org.uk Good Ideas! www.kissingitbetter.co.uk/ www.myhomelifemovement.org/