D335. Safeguarding People Using a Care Service from Abuse or Harm in Domiciliary Care Overarching

Policy Aims

This policy shows how {{org_field_name}} protects people receiving care from abuse or harm in line with its legal requirements and best safeguarding practice guidance. It reflects in particular:

Regulation 13: Safeguarding Service Users from Abuse and Improper Treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
the CQC’s Quality Statement on safeguarding , which it will be using as a benchmark in its assessment of service provision, ie
“We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. We make sure we share concerns quickly and appropriately”
the statutory guidance for the Care Act 2014 (Chapter 14: Safeguarding), which describes the duties and responsibilities of local authorities and its partner organisations to protect adults with care and support needs from abuse, neglect and other sources of harm, and to make enquiries if they suspect or have evidence of people being abused.

More specifically, it also reflects the (local safeguarding adults’ authority) policies and procedures.

Safeguarding framework

{{org_field_name}} shares and is committed to the vision of the local safeguarding authority, which is to empower and protect adults who are at risk of abuse and neglect, as defined in legislation and statutory guidance.

{{org_field_name}} understands that local safeguarding arrangements and developments follow a government strategy based on:

empowerment – supporting people to make decisions and have a say in their care
protection – support and representation for those in greatest need
prevention – it is better to take action before harm occurs
proportionality – safeguarding must be built on proportionality and a consideration of people’s human rights
partnership – local solutions through services working with their communities
accountability – safeguarding practice and arrangements should be accountable and transparent.

Safeguarding responsibilities

In line with best practice. {{org_field_name}} has a safeguarding lead or “champion”, who provides a one-stop point of contact for addressing initially all safeguarding concerns in {{org_field_name}} and in corresponding and communicating with external agencies, particularly the local authority adult safeguarding team.

The current safeguarding lead is:

Name:	{{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Position:	Registered manager
Contact details:	{{org_field_registered_manager_phone}}

Related Policies

This policy should be read with the several other policies that relate to safeguarding of people receiving care. They include the policies on complaints, physical restraint, the management of a person’s money and financial affairs, recruitment, induction, staff development and training, staff supervision and importantly whistleblowing. The policy on mental capacity will also be relevant in some circumstances.

Our service recognises that safeguarding involves a range of responses to different forms of abuse and potential sources of harm and the different contexts in which abuse occurs. Accordingly, this policy should be read and used in association with a suite of policies all designed to make sure that users are safe from abuse and the risks of their coming to harm are kept to the minimum and well managed.

Key related policies are:

Antisocial Behaviour
Safeguarding Vulnerable People in Domiciliary Care from Financial Abuse
Safeguarding from Bullying, Harassment, Exploitation and Other Forms of Social Abuse
Safeguarding People Who Use Services from Abuse and Harm: Restraints, including Physical Controls, and Restrictive Practices in Domiciliary Care
Keeping Staff Safe: Aggression Towards Staff and Appropriate Response
Safeguarding Children and Young People from Bullying, Harassment, Exploitation and Other Forms of Social Abuse in Domiciliary Care (England) Policy
Safeguarding: Persons Missing from Their Home
Safeguarding Service Users Who Are at Significant Risk of Harm
Safeguarding Service Users from the Harmful Actions and Behaviour of Peers and Social Contacts
Whistleblowing.

Local Authority Safeguarding

{{org_field_name}} has policies and procedures for the sharing of safeguarding information amongst other forms of information that might be shared with other agencies and professionals. These are written to comply with confidentiality principles and data protection laws.

{{org_field_name}} develops its policies and procedures in line with our local Safeguarding Adults Boards (SABs) recommendations and guidance, as found on its website together with relevant documentation for, eg raising alerts and staff training.

The local multi-agency Adults Safeguarding Board/Hub to which {{org_field_name}} relate as a partner organisation is:

Title: {{org_field_local_authority_authority_name}}

Telephone numbers: {{org_field_local_authority_phone_number}}

Website: {{org_field_local_authority_information_link}}

Policy Statement

This safeguarding policy sets out the:

principles and values underlying {{org_field_name}}’s approach to the safeguarding of people receiving its care
ways in which {{org_field_name}} does this
steps taken to avoid abuse/harm taking place
actions taken to deal with abuse/harm if it occurs
how it learns from incidents of abuse to prevent reoccurrence.

{{org_field_name}} works on the principle that it is the right of vulnerable people receiving care to be kept safe from all forms of abuse/harm. Being and feeling safe will contribute a great deal to their wellbeing and quality of life. It therefore recognises that it must always protect people receiving care and identify and deal with specific instances of abuse/harm if they occur, following the required procedures and best practice guidance.

{{org_field_name}} is always aiming for the very best quality of care and will not be satisfied with anything that falls short of this. It takes every possible action to prevent abuse/harm and associated risks and to deal with the issues as promptly and effectively as possible when they arise.

{{org_field_name}} seeks to work in line with local safeguarding adults’ authority policies and procedures (or, in relation to services to children and families, to work in line with local safeguarding children authority policies and procedures) and guidance from the Care Quality Commission (CQC). It recognises the importance of government and national guidance and seeks to comply in all respects with current safeguarding legislation and regulations.

{{org_field_name}} recognises that people receiving care who lack mental capacity are particularly exposed to abuse/harm and exploitation. It is accordingly mindful of the need to follow the principles and practice guidance that has accompanied the Mental Capacity Act 2005. These apply particularly to investigations of possible abuse/harm in which it is important to seek means of ascertaining the experiences and views of any victim or indeed alleged perpetrator who might lack capacity, eg through {{org_field_name}}s of independent advocates.

{{org_field_name}} recognises that anyone who might need the help of an independent advocate when engaged in safeguarding enquiries and plans is entitled to one (as legislated for by the Care Act 2014). It will always support a person to have advocacy help where required in line with its (separate) advocacy policy.

{{org_field_name}} has all required systems in place to track and monitor incidents, accidents, disciplinary action, complaints and safeguarding concerns, and to identify patterns of potential abuse/harm to people receiving care.

It will continue to exercise its safeguarding responsibilities fully in any emergency that might arise as was the situation during the Covid-19 pandemic.

Defining Abuse

{{org_field_name}} works to definitions of abuse that have been developed nationally and included in the Care Act 2014 statutory guidance and which will most likely have been adopted locally. It recognises that abuse/harm of people receiving care can take many forms including:

actual physical abuse/harm
social abuse, including bullying, cyberbullying, harassment and personal exploitation
social isolation/scapegoating/ostracism/stigmatisation
financial or material exploitation/abuse/harm
psychological or emotional abuse/harm
sexual abuse/harm/exploitation
neglect and acts of omission
discriminatory abuse/harm
self-harm, including self-neglect
inhuman or degrading treatment
inappropriate or excessive restraint and restrictions on movement and activities
organisational abuse/harm.

There are also various forms of antisocial behaviour that intentionally or unintentionally can result in being abused or harmed. These include general rowdiness, creating lots of noise, keeping people awake, interfering and invasions of people’s privacy. {{org_field_name}} might need to act in response to antisocial behaviour with the responsible authorities.

The scope of local authority statutory safeguarding responsibilities includes domestic abuse and violence, modern slavery, female genital mutilation and forced marriage all as forms of abuse that will need to be addressed by {{org_field_name}} if it has evidence that any person using {{org_field_name}} was experiencing these forms of abuse.

It is recognised that {{org_field_name}} must always protect its users and identify and deal with specific instances of abuse/harm if they occur.

(Descriptions and examples of these different forms of abuse can be found in the Safeguarding: Recognising and Reporting Signs of Abuse topic.)

Identifying Perpetrators of Abuse/Harm

{{org_field_name}} accepts that abuse/harm can be committed by a range of possible people. It therefore accepts its responsibility to protect people using its services from possible abuse from all sources. Potential perpetrators include:

the staff and management of {{org_field_name}}
volunteers working in {{org_field_name}}
visiting health and social care practitioners and other official visitors to the person’s home
relatives and friends of people receiving our care
people who have contact with those receiving care while they are temporarily outside
neighbours, people on their social network or living in the community at large
total strangers, including those who engage in random attacks on other people
people who set out to exploit and abuse a vulnerable person.

Staff Responsibilities

{{org_field_name}} insists that all its staff have a responsibility to:

provide people with the best possible care
never engage in any abusive/harmful action in relation to people receiving care
report anything they witness which is or might be abusive/harmful
co-operate in every possible way in any investigation into alleged abuse
participate in training activities relating to abuse/harm and protection from harm.

Managers’ Responsibilities

{{org_field_name}} requires its managers to take responsibility for:

developing the systems and structures within which it is possible to deliver the best possible care
encouraging a culture and ethos that is hostile to any sort of abuse/harm
producing and regularly revising the policies and procedures to prevent and deal with abuse/harm
operating personnel policies which identify, appropriately deal with and, if necessary, exclude from practice potential or actual abusers
providing training for staff in all aspects of safeguarding, abuse/harm and protection
investigating any evidence of abuse/harm speedily and sympathetically
implementing improvements to procedures if an enquiry into abuse/harm reveals deficiencies in the way in which {{org_field_name}} operates
collaborating with all other relevant agencies in combating abuse/harm and improving the safeguarding and protection of people receiving care
liaising with the relevant safeguarding adults/children authority teams and following their guidance and instructions where applicable, including the issues arising from multi-agency involvement
notifying the Care Quality Commission of all instances of abuse, alleged or suspected abuse, using CQC’s online reporting procedures.

Safe Recruitment Practices

{{org_field_name}} takes great care in the recruitment of staff, carries out all possible checks on recruits to ensure that they are of a high standard and co-operates in all initiatives regarding the sharing of information on care workers who are found to be unsuitable to work with people at risk.

{{org_field_name}} ensures that new employees employed in regulated activity have been checked against the Disclosure and Barring Service (DBS) criminal records and barred lists in line with the current requirements. (See the Safe Staff Recruitment and Selection Policy.)

Preventing Abuse

{{org_field_name}} is committed to taking all possible steps to prevent abuse or harm of people receiving care including:

setting out and making widely known the procedures for responding to suspicions or evidence of abuse/harm
operating personnel policies which ensure that all potential staff in regulated activity are rigorously checked, by the taking up of references and clearance through DBS criminal records and barred list checks, with equivalent checks for staff employed from overseas
incorporating material relevant to abuse/harm into staff training at all levels
maintaining vigilance concerning the possibility of abuse/harm of people receiving care from any source
encouraging among staff, people receiving care and all other stakeholders a climate of openness and awareness that makes it possible to pass on concerns about behaviour that might be abusive or that might lead to abuse/harm
maintaining effective procedures for regulating any contact that care workers need to have with the property, money or financial affairs of people receiving care
communicating concerns to the local Adults’ Safeguarding Board or, where applicable, Safeguarding Children Board
helping people receiving care as far as possible to avoid or control situations or relationships that would make them vulnerable to abuse/harm.

Identifying Actual or Possible Abuse

{{org_field_name}} will identify any instances of actual or possible abuse/harm of people receiving care by all possible means including:

fostering an open and trusting communication structure so that staff, people receiving care and others feel able to discuss their concerns with someone authorised to take action
ensuring that all staff and people receiving care know whom they may turn to for advice and action if they become aware or suspect that abuse/harm is occurring
encouraging staff to recognise that a commitment to the highest possible standards of care must, when necessary, overrule loyalty to colleagues individually or corporately
making it clear to staff that failing to report incidents or suspicions of abuse is itself abusive and may lead to disciplinary or criminal proceedings
operating systems of management, supervision, internal inspection and quality control that have the potential to reveal abuse/harm where it exists.

Procedures for when Abuse Has Occurred or is Alleged to Have Occurred

If abuse/harm is clearly occurring or is alleged to have occurred, {{org_field_name}} takes swift action to limit the damage to people receiving care and to deal with the abuse, as follows.

Initial procedures

A staff member who witnesses a situation in which a person receiving care is in actual or imminent danger must use their judgment as to the best way to stop what is happening without further damage to anyone involved including themselves.
It is not possible to be prescriptive about this because the circumstances might be different in each case. The staff member could act by immediately intervening personally or by summoning help from the nearest source, which could be from spectator or colleague, use of a panic alarm, phoning a line manager or police.
{{org_field_name}} will carry out risk assessments so that it has contingency plans for responding to the more likely events or when anyone is most likely to be in danger from acts of harm. Staff will be trained in emergency procedures, for example, in responding to violent behaviour.
Any staff to whom actual or suspected abuse/harm is reported — usually the manager or a senior staff member — must immediately act to protect, support or arrange additional care to a person receiving care who has been harmed.
The manager will discuss with the known or suspected abused/harmed person what actions they consider to be appropriate. In some circumstances, the person might not wish any action to be taken or agree to a referral being made on their behalf (though this would not apply to children).
In such cases, the manager will consider whether there are reasons for overriding the person’s wishes, eg because it is in the public interest and to prevent further harm or because the harmed individual is a child. This could include seeking advice from the Safeguarding Adults’ Authority or Safeguarding Children Authority.
Any adult “victim” whom it is thought might lack mental capacity to give their consent for the abuse/harm to be reported will be assessed for their capacity to decide and a “best interests” decision will be taken in line with Mental Capacity Act procedures.

Referring incidents of abuse or of alleged abuse

Once a person has consented to further action being taken, or for someone unable to give their consent, it has been decided that it is in their best interests to do so, the senior staff member or manager (or whoever has authority at the time) will then alert the local Safeguarding Adults’ Authority or Safeguarding Children Authority and follow its procedures and guidance from that point on. This could involve a strategy meeting and a safeguarding plan to be implemented from the strategy meeting.
The specific procedures to be followed and referral forms are those available on the local SAB website.
In some instances, the registered manager/person responsible for safeguarding might need to report the matter directly to the police and take guidance from them on the measures to be taken.
The registered manager must ensure that there is no further risk of the victim being abused/harmed by the alleged or suspected perpetrator.
The registered manager must address the needs of the alleged victim of the abuse/harm for any special or additional care, support or protection or for checks on health or wellbeing as set out in the person’s safeguarding plan.
If the alleged abuser is a staff member and there is sufficient evidence that abuse/harm has or might have occurred, the manager will suspend the person from duty pending the outcome of a disciplinary investigation. The manager will receive guidance on the steps to be taken following the local safeguarding adults/children authority strategy meeting, which will be held following the reporting of the abuse or suspected abuse/harm.
If the evidence is insufficiently strong to warrant suspension, the staff member against whom the allegation has been made will be instructed not to have further unsupervised contact with any people receiving care until the matter is resolved.
However, it should be noted that in the event of a referral being made to the police because a criminal offence might have been committed the police investigation will take precedence and no action should be taken that might jeopardise its enquiries, which might contaminate the evidence it is seeking and collecting.

(See Resources for a suite of forms to help identify, report and assess suspected abuse.)

Enquiring into alleged abuse

Enquiries are based on a person-centred approach in which the wellbeing of the victim or alleged victim is the central focus of all the activities involved. In many cases, enquiries will be carried out or led by a member of an external agency in line with the action plan determined by the initial strategy meeting convened by the local SAB or Safeguarding Children Authority. If a staff member is expected to carry out an enquiry of its own, it will proceed as follows.

The person appointed to make the enquiries will usually consult the person who may have been abused/harmed to hear their account of what has occurred and their views about what actions should be taken, involving people using services’ relatives, friends or representatives if that is appropriate and in line with the wishes of the individual.

2. The enquiries should take into account:

a. the fears and sensitivity of the abused/harmed person
b. any risks of intimidation or reprisals
c. the need to protect and support witnesses
d. any confidentiality or data protection issues
e. the possible involvement of other agencies, including the police, local safeguarding team and the CQC
f. the obligation to keep the abused/harmed person and, in specific instances, the alleged perpetrator informed on the progress of the investigation.

It will be important to assure the person who may have been abused/harmed that they will be taken seriously, that their comments will as far possible be treated confidentially, that they will be protected from reprisals and intimidation, and that they will be kept informed of actions taken and of the outcome.
It is important to consider if the person needs independent help or representation, including {{org_field_name}}s of an independent advocate, in presenting their evidence. {{org_field_name}} manager will, if necessary, arrange for the appropriate help or support to be made available.
If the abused/harmed person expressly states a wish that no further action should be taken, the safeguarding enquiry will consider if:
a. a danger to others exists from not investigating further
b. in the light of that assessment it is possible to follow the person’s wishes
c. in any case precautionary measures should be taken to protect others from the possibility of abuse from the same source
d. the person will be informed of what is to happen.
Once decided that enquiries should proceed, they will look into all aspects of the situation discreetly and respecting their sensitive and confident nature.
The enquiry could include interviewing the staff involved in the incident or circumstances up to that point, hearing and assessing evidence from any others who might be in a position to supply information, exploring every other possible source of evidence, maintaining appropriate contact with any other agencies involved, and if necessary seeking expert advice on any technical aspects of the situation which are outside the knowledge or expertise available within {{org_field_name}}.
Any staff from whom evidence is taken will be assured that they will be dealt with in a fair and equitable manner and informed of their employment, legal and procedural rights.
The alleged victim of the abuse/harm, and where appropriate their relatives, friends or representatives, will at all times be kept as fully informed as possible of what is happening regarding the suspected abuse/harm.
The enquiry will be carried out within an agreed timescale.
The findings will usually be presented to the local safeguarding adults/children strategy group, which will then decide what further action to take, eg that a safeguarding plan should be developed and implemented.

(See the Safeguarding Enquiry/Investigation Form for guidance on the process and recording involved.)

Following the enquiry

If it seems from the enquiries that on the balance of probabilities abuse/harm did indeed take place, the manager will, if the abuser is a staff member, initiate and carry through proceedings according to {{org_field_name}}’s disciplinary policy or, if the abuser is not a member of staff, take action to involve other responsible bodies.
If abuse/harm is proved against a care staff member, the manager will initiate appropriate action, which most likely will be dismissal and referral to the DBS to prevent them from being employed further in regulated activity.
Other employment sanctions could apply depending on whether there might have been mitigating or extenuating circumstances. In some cases, retraining could be appropriate.
The person using services or representatives will be informed of the outcome of the investigation and any further action and will be consulted about whether any redress or apology would be appropriate and helpful to them in line with {{org_field_name}}’s duty of candour.
The manager will take appropriate steps to inform the DBS for possible inclusion of the person on its barring lists as someone who is unsuitable to work again in regulated activity with at risk adults and/or children.
At all stages of the process, a careful record will be kept of all actions taken, paying particular attention to the sensitivity of the abused/harmed person.
Where relevant to the resolution of the situation, a plan will be drawn up to address the issues with the alleged or known perpetrator(s), particularly if they will be continuing to form part of the victim’s life, directly or indirectly. (See also the policies on: Safeguarding from Bullying, Harassment, Exploitation and Other Forms of Social Abuse, and Safeguarding Service Users from the Harmful Actions and Behaviour of Peers and Social Contacts.)

Planning further action

At the end of an incident involving possible or actual abuse/harm, managers should review what has happened with a view to assessing whether {{org_field_name}} or its management has been in any way culpable, ineffective or negligent, learning lessons for the way {{org_field_name}} should operate in the future, and passing on any appropriate information to other agencies.

If necessary, {{org_field_name}} will review and revise its policies, procedures and training arrangements in response to any material that has emerged from the incident or the investigation.

{{org_field_name}} could carry this out with advice and guidance from the local Safeguarding Adults’ Authority or Safeguarding Children Authority.

Contacts and sources of assistance

List here the names and contact details of the following:

The local Adults’ Safeguarding Authority: {{org_field_local_authority_authority_name}}, Information link: {{org_field_local_authority_information_link}}
Children’s Safeguarding where relevant to the running of the service: {{org_field_children_safeguarding_local_authority_authority_name}}, Information link: {{org_field_children_safeguarding_local_authority_information_link}}
The Care Quality Commission: 03000 616161 or
enquiries@cqc.org.uk
The police: dial 112 for life threatening emergencies, or 101 for non-emergency situation.

Record Keeping

{{org_field_name}} will record all details associated with allegations of abuse/harm clearly and accurately. The records are kept securely and {{org_field_name}}’s rules on confidentiality are carefully followed. Reports are made as required to the CQC and other safeguarding agencies involved.

Referrals to DBS Barred Lists

{{org_field_name}} will comply with its legal requirement to refer a care worker, where it has evidence that the staff member in question has been guilty of misconduct by harming or putting at risk of harm a person using services or other person at risk, during the course of their work, to the DBS barred lists following the procedures issued by the DBS.

Training

All staff receive training in recognising abuse or harm and carrying out their responsibilities under this policy as part of their induction programme and further training in line with their training needs as identified from their supervision and appraisals and policy developments and changes. The training is updated on a regular scheduled basis at least annually.

All training, including induction training, is in line with the guidance and standards produced by the relevant social and healthcare workforce development organisations and the local safeguarding authority training policies and guidance.

Examples of a Safeguarding Training Strategy (to be amended as required by individual circumstances and local requirements).

Staff new to care work must achieve Standard 10: Safeguarding Adults and Standard 11: Safeguarding Children to achieve the Care Certificate.
Other new staff will have a baseline training level, which is at least the equivalent of the Care Certificate Standards 10 and 11 from previous or current induction training.
{{org_field_name}} will check their knowledge and competencies to ensure it meets the required standard and provide additional training if needed (see the Training Factsheet).
All staff receive training to ensure that they are familiar with local Safeguarding Adults’ Boards policies and procedures.
All staff following induction are expected to proceed to at least a Foundation Level 2 award and a Multi-agency (Level 3) training in safeguarding.
Managers and staff responsible for safeguarding are required to receive Specialist Safeguarding Training (Level 4) and, where appropriate, to their roles and responsibilities, achieve the Multi-Agency Safeguarding Leaders Development Programme (Level 5).
The registered manager will include the Safeguarding unit (LMAC5C/S) in their Level 5 Diploma in Leading and Managing Adult Care Service.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

D335. Safeguarding People Using a Care Service from Abuse or Harm in Domiciliary Care Overarching