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CH221-Safeguarding People at Risk of Self-Neglect and Hoarding Policy

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Safeguarding People at Risk of Self-Neglect and Hoarding Policy

1. Purpose

The purpose of this policy is to set out how {{org_field_name}} recognises, prevents, and responds to self-neglect and hoarding among the people we support. These behaviours can lead to significant risks to physical and mental health, safety, and wellbeing, and may indicate broader safeguarding concerns. This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance), Regulation 18 (Staffing), and Regulation 20 (Duty of candour), and is informed by the Care Act 2014 safeguarding framework (including self-neglect) and the Mental Capacity Act 2005. It also reflects current CQC expectations under the Single Assessment Framework (Safe: Safeguarding quality statement), including attention to mental capacity, human rights, Deprivation of Liberty Safeguards (DoLS)/Liberty Protection Safeguards (LPS), and system working with safeguarding partners.

2. Scope

This policy applies to all staff, including permanent, temporary, agency, and volunteers, working in a care or support role for individuals in their own homes. It covers identification, reporting, multi-agency collaboration, and the provision of compassionate and tailored interventions for individuals showing signs of self-neglect or hoarding behaviours. This policy applies to concerns observed in a person’s own home, including risks arising from the home environment that may affect the person, visiting professionals, neighbours, or the wider community, and it applies whether the concern is identified during assessment, scheduled visits, unplanned contacts, or via information shared by partner agencies.

3. Related Policies

4. Definitions and indicators

For the purposes of this policy:

Self-neglect describes a wide range of behaviours including neglect of personal hygiene, health needs, nutrition, hydration, medication, and/or essential living conditions, which may result in significant risks to the person’s health, safety, or wellbeing.

Hoarding refers to the accumulation of possessions (and/or animals) and difficulty discarding items such that living spaces cannot be used safely for their intended purpose, access/egress is restricted, hygiene is compromised, or fire and other hazards increase.

Staff must consider whether presentation may be influenced by factors such as physical ill-health, mental ill-health, cognitive impairment, substance misuse, trauma, bereavement, domestic abuse, exploitation, or barriers to accessing services. Indicators and risks must be documented objectively (facts and observations, not assumptions) and discussed with a manager the same working day they are identified.

5. Policy Statement and Principles

{{org_field_name}} recognises self-neglect and hoarding as serious safeguarding issues which require a sensitive, non-judgmental, and person-centred approach. Self-neglect may include neglecting personal hygiene, health, nutrition, or environmental cleanliness. Hoarding refers to the accumulation of items to an extent that it compromises safe and hygienic living. Our staff are trained to identify early signs, engage individuals with empathy, and work collaboratively with local safeguarding authorities to protect and support individuals while respecting autonomy.

5.1 Making Safeguarding Personal and a human-rights based approach

We will apply Making Safeguarding Personal (MSP) by starting with what matters to the person, agreeing desired outcomes, and working at the person’s pace wherever possible. Any intervention must be proportionate, necessary, and the least restrictive option, balancing the person’s autonomy with duties to protect life and reduce serious avoidable harm. Where the person’s choices create serious risks, we will evidence our decision-making, including the options considered, the rationale for action or inaction, and how the person was involved.

5.2 Recognising Self-Neglect and Hoarding

Self-neglect may be identified through poor personal hygiene, malnutrition, untreated medical conditions, refusal of care, or living in unsafe or unsanitary conditions. Hoarding may involve excessive clutter, difficulty discarding items, blocked access to parts of the home, or associated fire hazards. Staff must remain alert and document concerns sensitively and accurately. All observations are to be reported to the Deputy Manager {{org_field_deputy_manager_first_name}} {{org_field_deputy_manager_last_name}} and escalated through safeguarding procedures if necessary.

Immediate escalation is required if staff identify any of the following: blocked exits or unsafe egress, visible fire risk (for example, heat sources surrounded by clutter), suspected structural hazards, uncontrolled infestations, lack of water/electricity creating immediate risk, severe malnutrition or dehydration, untreated serious wounds, or where the person appears acutely unwell. In these cases staff must follow emergency procedures, including contacting 999/111 as appropriate, and inform the Registered Manager without delay.

5.3 Early Intervention and Risk Assessment

At initial assessment and during ongoing care, staff must consider indicators of self-neglect and hoarding. A risk assessment must be completed and documented within the care plan, taking into account the person’s physical and mental health, living environment, and willingness to engage. Risk levels must be reviewed regularly. Where concerns are noted, a discussion must be held with the Registered Manager {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}, and a referral to {{org_field_local_authority_authority_name}} may be required.

Risk assessment must be specific, proportionate, and time-bound, recording: the hazards identified; who is at risk (including staff and others); the likelihood and impact; the person’s views; protective factors; actions agreed; and contingency plans if risk increases. Where hoarding is suspected, staff should use a structured approach (for example a clutter or room-access rating agreed locally with safeguarding partners and/or the fire service) to support consistent risk grading and review. Reviews must occur at least monthly where risks are moderate, and weekly (or more frequently) where risks are high or escalating, with escalation to safeguarding partners where progress stalls or risks increase.

5.4 Safeguarding and Multi-Agency Response

Where risks are significant, a safeguarding referral will be made to {{org_field_local_authority_authority_name}}. Self-neglect and hoarding are covered under the Care Act 2014’s safeguarding duty, even when the person refuses support. Where the Care Act 2014 section 42 criteria are met, the local authority must make (or cause to be made) enquiries to decide what action is needed and by whom; self-neglect and hoarding concerns will be considered case-by-case against these criteria, and we will cooperate fully with any safeguarding enquiries or alternative multi-agency risk management process used locally. {{org_field_name}} actively participates in safeguarding meetings and contributes to risk management planning.

Information will be shared with safeguarding partners lawfully and proportionately. Where consent is not obtained (or cannot be obtained), we may still share information to prevent serious harm, protect others, or where required for safeguarding purposes; the rationale for sharing (or not sharing) must be recorded. Staff must follow CH34 and escalate any uncertainty to the Registered Manager.

5.5 Mental Capacity, Consent and Lawful Decision-making

Capacity must be presumed unless there is evidence to the contrary. Any capacity consideration must be decision-specific and time-specific, and staff must take all practicable steps to support the person to make the decision (including accessible information, communication support, and allowing time). A person must not be treated as lacking capacity merely because they make an unwise decision.

Where there is reason to doubt capacity in relation to accepting care/support, managing health needs, allowing access, or addressing environmental risks, the Registered Manager will ensure that a formal capacity assessment is arranged and recorded.

If the person lacks capacity for the relevant decision, any action must be taken in their best interests, involving appropriate others (family/representatives where suitable), considering any Lasting Power of Attorney or Court-appointed Deputy, and choosing the least restrictive option.

If restrictions are proposed that may amount to a deprivation of liberty, the Registered Manager will seek appropriate legal authorisation and guidance (for example under DoLS, and noting that LPS is planned to replace DoLS but is not yet in force).

5.6 Person-Centred and Trauma-Informed Support

Interventions must be person-centred and non-coercive, recognising that hoarding and self-neglect may be linked to trauma, loss, or mental illness. Staff must engage with patience, build trust, and avoid judgmental language. Care plans must reflect the individual’s values, goals, and pace of change. Strategies such as motivational interviewing, regular review visits, and agreed small goals may be used to support change without overwhelming the individual.

5.7 Health and Safety Considerations

Where the environment poses a risk to the person or staff (e.g. fire hazards, infestations, blocked access routes), a health and safety risk assessment must be completed. Measures may include:

Where risks cannot be reduced to a safe level (for example, unsafe access/egress, severe infestation, exposure to hazardous waste, significant structural risk, or credible violence/aggression), staff must withdraw and seek managerial guidance immediately. Any decision to reduce or alter visits for staff safety must be risk-assessed, recorded, communicated to the person (and where appropriate their representative), and escalated to partner agencies to avoid unmanaged risk.

Staff safety must always be prioritised, and lone working procedures under CH23 must be followed.

5.8 Documentation and Confidentiality

All observations, concerns, discussions, and actions must be recorded clearly, objectively, and securely in the care record. Records must include the date, time, nature of concern, actions taken, individuals consulted, and outcomes. Records must be shared only with those who need to know and stored in line with CH34 – Confidentiality and Data Protection Policy. Records must provide a clear audit trail of decision-making, including risk/benefit analysis, mental capacity considerations, consent discussions, information-sharing decisions, escalation actions, and review outcomes.

5.9 Staff Training and Supervision

All staff receive training in safeguarding, including how to recognise and respond to self-neglect and hoarding. This includes understanding trauma, capacity, communication techniques, and multi-agency processes. Regular supervision and reflective practice sessions allow staff to raise concerns and receive support in managing complex cases. Training is refreshed annually and monitored by the Deputy Manager.

Training must include practical scenarios on respectful engagement, professional curiosity, escalation thresholds, information sharing, capacity and best interests, recording standards, and multi-agency working. The Registered Manager will ensure staff competency is monitored through supervision, spot checks, and review of safeguarding documentation, with refresher training provided where gaps are identified.

6. Policy Review

This policy will be reviewed at least annually and sooner in response to changes in legislation or regulation, CQC guidance or assessment framework updates, local safeguarding partnership procedures, learning from incidents/complaints, or Safeguarding Adult Reviews (SARs) relevant to self-neglect or hoarding. All staff will be notified of any updates and trained accordingly.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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