The Care Act requires that each local authority must make enquiries, or cause other 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 who.
In Salford, this statutory duty is delegated to Salford Royal Foundation Trust who provide the Adult Social Care service, as part of the Integrated Care Organisation.
Enquiries should be carried out by Adult Social Care (on behalf of the Local Authority) under Section 42 of the Care Act where it has reasonable cause to suspect that an adult in it's area:
a) has needs for care and support (whether or not the authority is meeting any of those needs)
b) is experiencing, or is at risk of abuse or neglect, and
c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.
The decision that a formal Section 42 enquiry is required will normally be confirmed by the time of the strategy meeting, as by then, it should be clear whether the criteria set out above have been met.
For cases led by adult social care the formal enquiry process should be coordinated by a qualified worker who is trained in undertaking formal enquiries. As part of the enquiry, the enquiry officer can delegate some of the tasks (eg fact finding, information gathering and in some case the full enquiry) to other staff or agencies (eg the provider manager, or NHS staff). Where this delegation takes place, then the remit and expectations should be made clear to the requested agency
Where the police are involved then they will normally lead the initial phase of any formal enquiry where it relates to potential criminal offences.
The purpose of enquiries is to:
- Engage with the adult at risk to determine what they want to happen
- Establish the facts
- Collect evidence
- Ensure that, during the enquiry, the adult's wishes and feelings are continuously taken into account.
- be prepared to pause any enquiries if, at any point this adversely impacts on the adult at risk
- Determine whether the allegation of abuse is substantiated, not substantiated or inconclusive.
- Assess what harm has been suffered as a result of any abuse or neglect.
- Work towards achieving the desired outcomes of the adult at risk where these can be realistically achieved - where these are clearly not possible or realistic
- to explain the reasons for this to the adult at risk
- to help them gain an understanding of what might be achievable
- to work towards achievable outcomes
The first stage of the formal enquiry will normally be to interview the adult(s) at risk and any witnesses, if this has not already been done.
The strategy meeting (virtual or face to face) will have made observations about the adult at risk's mental capacity to participate in the formal enquiry process and account of this must be made before interviewing. Further information is available in the Mental Capacity section of the Adult Safeguarding Guidance.
If there are concerns about an individual's mental capacity, then an assessment will be needed at the earliest opportunity, to enable further enquiries to proceed.
Care needs to be taken to consider the specific decisions that are under consideration ie does the individual have the capacity to participate in any way in the safeguarding process, for example can they express a capacitated view?
Members of staff who already know the individual will have a view of their mental capacity based on their professional training. Other people who may be able to assist the assessment may know the individual well - parents, carer, paid staff etc. but not if they are implicated in the allegations.
Where an adult at risk lacks the mental capacity to consent to an enquiry or understand any of the protective measures being considered, an Independent Mental Capacity Advocate (IMCA) must be appointed. However this should not delay the implementation of protective measures where these are clearly necessary in the best interests of the adult at risk.
Interviews should be carried out in a way that best enables the adult at risk to relate their story. It may be where they live or in an office that is equipped for the purpose. The chosen venue should afford confidentiality to the individual and to investigators.
The adult at risk may need support in the interview. This may be provided by a friend, a carer, an advocate or member of paid staff who knows them well. This support should be documented within the strategy meeting. The support should not be provided by anyone who may also contribute to the investigation. Care should be taken to ensure the supporter is not implicated in the allegation of abuse or who may otherwise prevent a genuine discussion of the facts with the victim.
- Where possible, interviews should take place without the knowledge of the alleged perpetrator of the abuse.
- Communication support, personal assistance, interpreters and transport must be provided where needed to facilitate interviews.
- Interviews should enable the officer leading enquiries to establish what the adult at risk believes would be helpful in keeping themselves safe from abuse.
- Interviewers should inform the adult at risk about what will happen as a result of the concerns that have been raised and the information they have given.
- It is important to establish what the adult at risk would like to see happen as a result of their making their concerns known to services. This is particularly relevant to interviews led by the Police.
A small number of enquiries may require a highly specialised approach and need specialist facilities.
Disciplinary investigations by employers
If the alleged perpetrator is an employee of any service providing regulated activities (CQC regulated) or the NHS, it is essential that there is liaison between the SC (or delegated member of the strategy meeting) and the employer, as part of the safeguarding strategy process.
The Employment Act 2000 expects employers to investigate disciplinary matters speedily. Such investigations will normally follow police investigations and/or other investigations made under the Safeguarding Adults Policy. Meeting chairs will decide if material from the safeguarding investigation can be used as part of a disciplinary investigation. If information is shared it should be noted which safeguarding meeting it relates to.
If sharing documentation that a perpetrator would not normally be given access to it may be necessary to redact certain parts of the record where third parties are involved and also to anonymise certain participants. Legal advice may be needed.
Disciplinary action could involve the employer referring a staff member to the Disclosure and Barring Service (DBS) if the disciplinary results in a dismissal.
Information from police investigations may also be available to employers but application may have to be made to the Police Information Sharing Office at the Greater Manchester Police headquarters.
Professional bodies' investigations
These investigations include Nursing and Midwifery Council, Health and Care Professionals Council, General Medical Council etc. Such bodies may carry out investigations as part of other matters related to an individual's practice or as a direct result of a safeguarding investigation. Information may be passed to the relevant council by the individual's employer. These investigations will normally take place once the safeguarding investigation has concluded.
Investigations by the Care Quality Commission (CQC)
CQC investigations may form part of the safeguarding investigation but will ultimately be responsible to its own governing bodies. Information should be shared between the safeguarding investigation and CQC where relevant.
CQC also investigate matters of concern in services run by the NHS and private hospitals. Abuse of adults may occur in any of these settings and the CQC may need to be informed of local concerns that have been raised under the Safeguarding Adults Policy/procedures.
Investigations by commissioning authorities
These investigations could include Council commissioners or Clinical Commissioning Groups (CCG). These investigations may relate to quality of service including the safety of individuals supported by contracted services.
Where such matters are identified there should be consideration of a referral to Safeguarding Adults procedures. This will usually be carried out via liaison between a senior manager of the Commissioning Section and the Safeguarding Adults coordinator.
All such links between investigatory processes must be recorded in the minutes of the relevant safeguarding meeting. There will be times when all of these 'other' investigations may need to come together to safeguard individuals supported by services - co-ordination of such activity should be via the Safeguarding Chair.
If a police investigation comes to a halt this does not mean the end of the Adult Safeguarding procedure. A case conference or case conference review should be held to decide if there are any other matters that require further enquiry or action under the Safeguarding Adults Procedures.
In complex situations usually where a criminal investigation is taking place planning to interview the adult identified as at risk may need to be carefully carried out. This process may involve more than one meeting especially if the adult at risk is easily tired or stressed by the process. The adult at risk may need to meet the investigators before a more formal interview so they know who will interview them and be told about the process. This may involve a visit to the interview venue and the explanation of equipment used. The judicial process may need to be explained to the alleged victim if cases involve criminal activity. The adult at risk may need the support of a trained intermediary throughout the investigation and any legal proceedings that may follow. The Police will apply for this support.
Greater Manchester Police may access specialist facilities in exceptional circumstances where the police deem this necessary.
In a limited number of serious cases a medical examination may also be required.
Where there is evidence of an injury or sexual abuse a medical examination will usually be necessary. The decision to have a medical examination and the appropriate method should be made jointly between the Police and the lead investigator (social worker, nurse).
The examination can be carried out in four ways:
- By the alleged victim's GP/tissue viability team for physical injury/damage/neglect
- By hospital A&E department if the injury is serious
- By the Crime Scene Investigation unit in the case of physical or sexual assault or other criminal matter where prosecution is intended/ being considered
- St. Mary's Sexual Assault Centre
The adult at risk must give consent to having a medical examination. If their capacity to give consent is an issue, reference must be made to the discussion about capacity made in the Strategy Meeting (virtual or face to face). Photographs of physical injuries will also require consent from the individual or a best interest’s decision in the event the individual lacks capacity.
Photos should be professionally taken and timed/dated/signed by the photographer. Where the individual is in hospital these may be arranged with the Medical Illustration Department at hospital (via the relevant clinical team) or the Police (only if a criminal investigation).
The purpose of the case conference
- Bring the Section 42 enquiry process together
- Reach a conclusion to the enquiry
- Ensure that enquiries have been carried out in a timely fashion
- Secure an outcome that, as far as possible, achieves the outcomes of the adult at risk.
A conference should aim to take place within four working weeks of the strategy meeting.
If the timescale is to be longer, the reason for this should be recorded on the minutes of the strategy meeting.
The case conference will be chaired by a trained Safeguarding Chair, usually a manager or an advanced practitioner.
The case conference will review any reports relating to the case as set out in the strategy meeting.
If investigations have not been fully completed the conference meeting should:
- Focus on the desired outcomes of the adult at risk, whether these have changed or developed further since the strategy meeting
- Review the recommendations and actions from the strategy meeting
- Review the protection plan and amend if required
- Review what has happened
- Record the reason why the investigations are still outstanding
- Record how feedback to any relevant parties not present will be carried out
- Set a date for a case conference review if required.
If the Section 42 enquiry has been completed the meeting should:
- Agree to what extent the desired outcomes of the adult at risk have been met and if any further work is needed to achieve these
- Agree that the allegation has either been substantiated or not substantiated or inconclusive and record this in the minutes of the meeting.
A decision of ‘substantiated’ is based on a civil level of proof i.e. 'it is most likely that the abuse or neglect has occurred' and not necessarily proved at the level required in a court of law.
- Agree an assessment of the risk the adult at risk faces of further abuse or neglect.
- Update the protection plan if required and define how it will be reviewed if required.
- Record any outcomes for the adult at risk and for the perpetrator.
- Record how feedback to any relevant parties not present at the meeting will be carried out.
- Record detail of any police action.
- Record detail of any disciplinary processes in place.
- Record detail of any Crown Prosecution Service (CPS) or court action.
- Record if the case is to remain within the safeguarding procedures- e.g. if continued monitoring of a provider is to take place or to await the outcome of disciplinary procedures.
- Set the date for the case conference review meeting (if required).
Where the perpetrator is a care worker
Where the perpetrator is a care worker, outcomes could include disciplinary option, training, increased monitoring/supervision or any combination of these.
The focus of the safeguarding meeting should be around seeking reasonable assurance from the provider that they have taken the issues seriously and put in suitable protective measures that ensure other service users are safe from further abuse.
Referral to Disclosure and Barring Service (DBS)
Referral to the DBS applies where there is sufficient evidence to dismiss an employee for behaviours that would make them unsuitable to work with adults at risk.
Referral to the DBS is normally the responsibility of the care provider. The case conference meeting should include discussion with the provider about whether a referral should be made to the DBS and/or other professional bodies. However Safeguarding Chairs should exercise caution in making any formal recommendations to an employer about referral to the DBS as this is primarily a matter for the employer in consultation with their own human resources policy.
If a care provider is unwilling to refer and the Safeguarding Chair feels a referral should be made this can be undertaken by adult social care but senior management advice should be sought before submitting a referral.
Adult safeguarding procedure - case conference review
The first review meeting should be held within three months of the case conference meeting. Subsequent meetings must be held within six months of the last meeting. If there is a reason for exceeding this standard, it should be clearly documented.
The review meeting will address:
- The current view of the adult at risk or their representative in relation to their desired outcomes and if there has been any change in their perspective
- Any changes in the circumstances of the victim, especially if they affect the level of risk from abuse the victim faces.
- Review the protection plan.
- Review any police action.
- Review any disciplinary actions.
- Review any CPS or court actions.
- Consider any implications for DBS listing of the perpetrator.
- Decide if the case needs to remain within the Safeguarding Procedures.
- Outcome the procedure where concluded.
There may be reasons to continue some ongoing involvement with an adult at risk after all safeguarding issues have been addressed. The safeguarding process should be exited if this is the case. The personal outcome document should be completed identifying the extent to which the desired outcomes of the adult at risk have been met or not. If ongoing involvement is required for other reasons reviews can continue under care management processes
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