Responding to a concern, triage and decision making | Salford Safeguarding Adults Board

Responding to a concern, triage and decision making



Most concerns forwarded to community or specialist teams will have been screened by the Adult Social Care Contact Team (ASCCT) for further enquiries to be made and a decision on what further action is needed.

On-call duty workers should make immediate contact with their duty Team Manager or Advanced Practitioner to agree what immediate action is required.

The worker and safeguarding chair will jointly decide;

  • Who should be contacted in addition to any parties already contacted and when including police
  • At what point to visit the adult at risk to ascertain their views (or capacity to participate). This should normally be a priority unless doing so could place the adult at greater risk for example because they live with the alleged perpetrator and there is no easy way of seeing them alone
  • Whether to proceed to a strategy meeting or whether it is appropriate to exit procedures at this point.

Some concerns (e.g where a worker in an integrated team receives a concern regarding an open case) will go direct to teams. These cases should follow the principles and processes outlined above.

Recording of safeguarding activity and decisions made in relation to a concern

It is vital that all information relevant to a concern is accurately and promptly recorded.

This should be done using the Adult Safeguarding document in CareFirst (Adult Social Care staff in SRFT) or GMMH version in PARIS.  This has been designed to support social work staff in ensuring all key aspects have been considered and recorded.

Recommended timescales

To ensure the swift protection of adults at risk there are suggested timescale standards in place for the safeguarding process. However the primary driving factor behind the actual timescales should be around the wishes of the adult at risk.

The adult at risk may need more time to think through what they want to happen and the implications of this and they should not be rushed into decision-making. Clearly however, if others are at risk, the adult will need to be made aware that action has to be taken promptly. Professional judgement may need to be exercised.

Where timescale standards have not been met, these should be documented with a brief explanation in the adult safeguarding document or SG5 (drugs and alcohol service only) especially where there has been significant delay.

Timescales

Event Timescale

Concern received by duty worker/discussed with Team Manager

As soon as possible and at least by the end of that working day. If situation is clear-cut, contact to be made with the adult at risk or their representative to ascertain their view if deemed safe to do so at this stage

Decision to enter Adult Safeguarding Procedures strategy meeting

Within 5 working days.

Strategy meeting case conference

Within 1 calendar month.

Case conference review

No later than three months (may be held sooner at the discretion of the chair).

Minutes to be produced and forwarded to chair for approval

Two working days.

Minutes to be approved, signed and returned for distribution

Five working days.

Further reviews should normally be at a minimum six monthly unless there are specific reasons not to do this. Reviews may be held more often if the chair requires it.

It is important to ensure the views and wishes of the adult at risk (or their advocate) are known , in relation to the concern being raised.  Adult Social Care officers responding to the concern should ask the referrer if the adult at risk is aware of the referral and if their views / wishes are known. 

It may be appropriate for the adult social care worker taking the referral to ask the referrer to gather more information about what has happened or to clarify the views from the adult at risk if appropriate. 

Sometimes it may be unsafe or impractical to quickly ascertain the views of the adult at risk, for example if they live with the alleged perpetrator, if they are recovering from a period of illness, or if the police are investigating the incident and need to gather evidence for their investigation.

Consideration should be given at an early stage of the best way to collect the adult's views and who is the best person to do this.

Adults at risk may need time and support to decide what they want to happen.  In some cases, they may not realise they have been abused.  In other cases, they may have unrealistic expectations about what they want to happen. 

The officer who is having this conversation with the adult at risk may need to help them understand what realistic outcomes could be.  There may be occasions where the adult is insistent on the outcome they want, even if it is unrealistic.  In this situation the preferred outcome should be recorded.

An adult may say they want the person who has abused them to be imprisoned, even if the crime would not necessarily attract a custodial sentence.  In this situation, it would be appropriate to acknowledge their anger whilst explaining that cannot happen and explaining what could happen. 

Another scenario could be where the adult says they don't want the care worker to get into trouble.  The officer would need to explain why this is not possible so they understand this.

The views of the adult should also be sought about who can be consulted with about their future protection, including family members, the GP, Police etc. 

It would be pertinent to obtain these views prior to any strategy meeting taking place.  Where this has not happened, it should be done as soon as possible afterwards.

Occasionally, it may be necessary to take emergency action to protect an individual, without full knowledge of their views and wishes.

 

If an offence may have been committed the police should be contacted to discuss the allegation and establish whether they will be involved. If there is a potential risk of abuse to others, including abuse perpetrated by anyone employed as a formal carer, then it is in the public interest to conduct an initial discussion with the police.

Deciding whether to involve the police can be a complex decision and involves consideration of a number of factors

  •  Consideration of the wishes of the adult at risk where they have capacity to make an informed decision?
  • Whether there is any evidence of coercion affecting the adults wishes?
  • The overall circumstances, level of ongoing risk and seriousness of the matter?

When exploring the risks of a situation, note that the police may have key information to contribute about an alleged perpetrator, that might heighten or reduce the level of risk. Where there is not a clear responsibility for the police to lead an investigation, the police safeguarding team will normally discuss the best way forward with adult social care and partners including recording a crime, conducting checks and providing advice.

Where there is any uncertainty discussion must take place with a manager.

The contact for safeguarding enquiries should be made via;

The Bridge salfordpartnershipbridge@gmp.pnn.police.uk; or

CMT inbox Salford.CMT@GMP.police.uk.  

Officers from The Bridge will attend strategy meetings however any investigation is passed to an appropriate officer (CID or uniform) to investigate.  In cases where urgent intervention is felt to be needed or outside normal working hours contact 999 or 101.

Where the police are to be involved, email adult safeguarding document to the police with the Chair's agreement to share the information.

It is important to ensure that the appropriate safeguarding leads included in this table are notified, where concerns are identified about practice and/or whenever there is a safeguarding allegation.  Please forward a copy of the SG1 referral and/or detail of the concern being raised as set out in the table below.

CCG Safeguarding contact details:

Call: 0161 212 5657 / 0161 212 4413

Email: safeguarding.nhssalford@nhs.net

SRFT Safeguarding contact details:

Call: 0161 206 1361 / 0161 206 3803

Email: srh-tr.salfordsafeguardingteam@nhs.net

NHS Funded Care Team contact details:

Call: 0161 212 4132

Email: nhs.fundedcare@nhs.net

 

CCG Safeguarding

SRFT Safeguarding

NHS Funded Care Team

GP (excluding Salford Care Homes Practice) Yes No No
Salford Care Homes GP Practice Yes Yes No
Dentist / Optometrist / Pharmacist Yes No No
Residential Care Home Yes (involved in enquiry if there is a health related issue) Yes (If District Nurses / Podiatry / TVN or other provider service involved) Yes (If CHC funded)
Nursing Care Home Yes Yes (If District Nursing service are involved i.e. supporting end of life care)  Yes
Intermediate Care Yes Yes No

A protection plan will be needed in most cases to protect the adult form further harm.  The protection plan will need to be reviewed and is likely to change as more information becomes available.

Examples of things that might be included in a protection plan may include:

  • Specific actions to protect the victim from the perpetrator.
  • Actions taken to prevent the alleged perpetrator causing any further harm to the victim.
  • Any legal remedies to be used to make the victim safe i.e. an injunction or restraining order.
  • Access to advocacy or support services.
  • Access to services that improve self-esteem and confidence.
  • Services / support to reduce social isolation.
  • Access to counselling or other therapeutic services.
  • Referral to support service
  • DBS (Disclosure and Barring Service) listing of the perpetrator.

In some situations, it will also be necessary to ensure that any other potential victims of abuse are made safe e.g. other residents in a care home; other tenants in a supported tenancy; other people supported by a domiciliary or similar service.

The initial decision on whether the safeguarding procedures are the appropriate course of action should made by a section 42 officer in consultation with a team manager.

Sometimes they may be a more appropriate way of dealing with the referral that doesn't involve following the safeguarding process. Examples of this may include:

  • Concerns about an adult's welfare are being reported but what is being described is not abuse.
  • Advice, information, or a formal care needs assessment or other support short of assessment may be needed but further enquiry is not needed.
  • No harm or only minimal harm has been caused (see downloadable document on harm levels)
  • The adult being referred does not have any care and support needs, and is therefore not an adult at risk under the Care Act 2014. They are capable of organising their own protection and accessing help without adult social care support.
  • Signposting should be provided where appropriate. Further detail on this is available in the downloadable document on Adult safeguarding harm levels.

Where the allegations of abuse relate to care provided by a care provider, the abuse described is of a low level ie meeting tiers 1 or 2 of the harms level guidance and the manager of the service is not in any way implicated themselves in the incident, the proportionate response would be normally to ask the care provider manager to complete a provider enquiry report.

The care provider manager will normally be in the best position to both quickly make further enquiries into the incident of abuse, and speak to the adult or their representative. The manager can ensure the situation is quickly and effectively addressed in terms of ongoing protection and meeting desired outcomes.

The provider enquiry report template can be used flexibly in 2 other scenarios. The first is where further information is needed from the provider in order to determine if the situation in question does amount to abuse. The second is as a format that a provider could use as a structure for a report to a safeguarding case conference

The downloadable guidance documents below gives further detail on the appropriate use of the provider enquiry report. There is separate guidance documents for both adult social care staff and care providers. There is also a flowchart of the process.

Guidance for Care Providers

Additional Guidance for Social Workers

Provider Enquiry Form

Flowchart - Use of Provider Enquiry Reports

The term “managed outside safeguarding” is used where abuse has occurred but it has been formally decided it is disproportionate to continue to manage the situation within the traditional adult safeguarding process i.e. full formal enquiry followed by case conference.

Managing a case outside of safeguarding does require a careful weighing up of the seriousness of the situation and should only be considered where the risk of harm is relatively low and therefor this approach is proportionate to the situation.  Normally, some safeguarding enquiry or follow up work is still required, but the process can be exited safely and/or the adults preferred outcomes met without the need to go to a case conference.  The term “managed outside safeguarding” does not mean that an abusive situation is not being addressed or indeed that the issue is not a safeguarding matter.

Below are some examples of when it might be appropriate to manage a case outside of safeguarding:

  • Where the adult at risk and the perpetrator are both service users and steps can be taken to prevent similar situations from occurring through changes to the support plan, supervision or care management;
  • Where the perpetrator is an informal carer and their actions have occurred directly as a result of the stress of their caring role and there is confidence that the provision of supportive services have / will prevent that situation from arising again.  The views of the adult at risk should be taken into account.
  • Minor cases of abuse where the adult at risk has mental capacity and they are clear that they do not want the safeguarding process to continue and everyone is satisfied that they are not making this decision under duress.

The safeguarding enquiry should be progressed under the formal procedures, until there is sufficient information to make the decision that it can be managed outside of safeguarding.

If the adult at risk will have substantial difficulty in participating without support, then the Care Act says that an “appropriate person” must be identified to support them. This might be a close relative, carer or friend, as long as they are not implicated in the abuse in any way. If there is no appropriate person, or the adult at risk does not want to be supported by the person in question, then a Care Act Advocate must be appointed to support them.

Some people who will have substantial difficulty without an advocate may still be able to make some decisions about the Safeguarding process. If however the adult at risk appears to lack the mental capacity to make decisions about the Safeguarding investigation, this should be assessed and documented on the adult safeguarding document or PARIS document. It is important to record whether any support plan is being implemented with the consent of the adult at risk, or whether it is being carried out in their best interests.

Even if the person lacks capacity to make decisions they should still be supported to participate in the Safeguarding process as much as possible if it is in their best interests. Section 42 enquiry officers should remember that capacity is decision-specific and time-specific and may need to be reviewed during the course of the investigation.

Some protective measures may have an impact on the human rights of the adult at risk, e.g. rights to liberty, and privacy and family life. If the protection plan is for the adult to be protected in a care home where they will be deprived of their liberty then an application for DOLS should  be made as soon as possible.

If the plan involves restricting contact between the adult at risk and members of their family/friends then this can only be done with the agreement of the people concerned. If the family members/friends do not agree with the proposed restrictions then the Safeguarding Chair should obtain legal advice. An application to the Court of Protection may be necessary.

Adults at risk are fully entitled to take risks and make decisions that to other people might appear unwise if they have the mental capacity to make the relevant decisions. Being safe is not the only consideration that may be important to an individual and has to be balanced against other things that make their life a happy and fulfilled one. Even if the adult at risk lacks capacity it may still be in their best interests to live in a manner that involves some degree of risk.

However caution does need to be exercised where an adult is clearly in a situation of significant risk from another party yet does not want this to change.

Work may well be needed to ensure the adult at risk is fully aware of all the alternatives and has properly thought through and weighed up their options

Time may be needed to build up a trusting relationship with the adult or there may need to be a multi-disciplinary exploration of who has the strongest relationship with the individual

There can be a delicate balance to be struck between accepting the clear wishes of the adult whilst not "abandoning" them to a very risky situation

Where different staff and agencies agree the risks are high, a multi-disciplinary meeting should be held to ensure all alternatives have been fully considered. If the adult at risk has made an 'unsafe' decision, the agencies and staff involved need to be able to evidence they took all reasonable actions in the circumstances and considered all options.

If there are concerns that the adult at risk is making unwise decisions because they are being subject to undue influence or coercion from others then this should be documented in as much detail as possible. Legal advice should be sought on whether an application should be made to the High Court to exercise its inherent jurisdiction to protect the adult at risk. 

Where the concern raised is in relation to a pressure ulcer, there is a Safeguarding adults protocol: pressure ulcers and the interface with safeguarding enquiry, that has been produced by the Department of Health and Social Care.  This should be completed by a nurse which will help identify whether there is a reasonable explanation or whether a Section 42 enquiry is required. 

If advice or assistance is needed in identifying the right nurse to complete the tool please see, who else to involve section above, which gives information and contact details for who to contact. Should the outcome of the screening be that a formal enquiry should take place, a nurse with the relevant expertise should undertake the aspects of the enquiry relating specifically to the likely cause of the pressure sore. Overall responsibility for oversight of the enquiry and organising strategy and case conferences will remain with the lead agency such as Adult Social Care or GMMH where they have the delegated responsibility. 

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