1. Safeguarding Concern
A safeguarding concern can be made by anyone and is the way of reporting abuse or neglect which are received or identified within any agency.
Safeguarding concerns maybe received from a wide range of sources, adults at risk, people receiving care and support services, members of the public, family members, staff, Statutory Agencies, Service Providers, Community and Voluntary Sector.
If you have concerns related to risk management and/or self-neglect the Local Authority will consider this under safeguarding and in conjunction with its multi-agency partners agree the appropriate action required.
Each agency should have its own clearly defined safeguarding policy which describes the internal process for raising a safeguarding concern and how to refer to the Local Authority as Safeguarding Lead Agency.
2. Contact the Local Authority
Following consideration by the person or agency when there is suspected abuse or neglect of an adult at risk by a third party, a referral should be made to Plymouth City Council who are the responsible lead agency for adult safeguarding under the Care Act 2014.
Once an adult safeguarding referral has been received by Plymouth City Council (PCC) via Customer Services, they will forward the referral to the PCC Adult Retained Function Team (RF), (the Local Authority team who undertake specific duties related to the Care Act 2014).
When a referral is received by the PCC Adult Retained Function, they will ensure:
- Immediate action is taken to safeguard the person if necessary within 24 hours of the concern been raised. The actions taken must be recorded;
- Children’s services are informed without delay if a child is thought to be at risk;
- The details of the alleged abuse are recorded, what happened, to whom, where and when, including names and contact details for any witnesses.
PCC RF where required will discuss the referral with multi-agency partners, including the police where appropriate, to determine whether the referral requires a multi-agency response. This may involve gathering additional information to clarify the level of risk and urgency.
Local authorities must cooperate with their multi-agency partners, as described in section 6(7) of the Care Act 2014, and those partners must also cooperate with the local authority, in the exercise of their functions relevant to care and support including those to protect adults (chapter 15 of the Care Act Guidance sets out general responsibilities in relation to co-operation).
Following referral and screening of the safeguarding concern, the RF will make the decision under the Care Act Section 42 to ‘undertake (or cause others to make) whatever enquiries are necessary to decide whether any action should be taken, what and by whom’.
Plymouth City Council as the Local Authority and lead agency for Safeguarding has a contractual arrangement with a local health and care provider (Livewell Southwest) to undertake where required Section 42 Safeguarding Enquiries.
Where a section 42 enquiry is required the RF will specify to the agency undertaking the enquiries to be made, the timescales and report format required.
The agency undertaking the section 42 enquiry will need to consider the views, wishes and desired outcomes (Making Safeguarding Personal) of the person. Also consider communication, language, cultural, religious and gender factors when undertaking the enquiry. Where a joint enquiry with the Police is required the agency will work in conjunction with the allocated Police Officer. The enquiring agency refers to the RF at each decision point and prior to outcome and conclusion of the safeguarding concern.
Safeguarding concerns related to services commissioned by the Clinical Commissioning Group (CCG) or NHS England, involving staff, including agency staff, or concerns regarding health care delivery to a patient in receipt of services either current or historic will immediately be shared by the Local Authority to the CCG or NHS England.
CCG and NHS England Commissioners provide advice, support and assurance to the local authority in relation to health related enquiries to ensure effective multi-agency safeguarding process.
3. Care Act - Section 42 Enquiries
The Local Authority Adult Retained Function will consider the safeguarding concerns identified in the referral and using the Care Act guidance consider whether:
The Care Act 2014 safeguarding duties apply to an adult who:
- Has needs for care and support (whether or not the local authority is meeting any of those needs);
- Is experiencing, or at risk of, abuse or neglect;
- As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
Six key Safeguarding principles together with Making Safeguarding Personal (MSP) underpin all adult safeguarding.
Where the duty applies the Local Authority can undertake (or cause others to make) whatever enquiries are necessary to decide whether any action should be taken, what and by whom, 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 whom.
4. Crime Suspected
Where there are or thought to be criminal offences everyone is entitled to the protection of the law and access to justice. Behaviour which amounts to abuse and neglect, for example physical or sexual assault or rape, psychological abuse or hate crime, wilful neglect, unlawful imprisonment, theft and fraud and certain forms of discrimination also often constitute specific criminal offences under various pieces of legislation. Although the local authority has the lead role in making enquiries, where criminal activity is suspected, only the police can investigate crime therefore early involvement of the police is required.
5. Police Referral
A safeguarding referral to the Devon & Cornwall Police-Central Safeguarding Team (CST) is undertaken by the PCC Retained Function if initially identified as required. If the necessity arises during an enquiry, the referral can be made by the agency concerned. The police are responsible for investigating crimes. Where the person is an adult at risk, the police will work together with Health or Adult Social Care Agencies. Where the police advise that there is no requirement for a criminal investigation, the appropriate agencies involved will continue with safeguarding enquiries, not related to crime.
A referral for Police involvement to undertake safeguarding enquiries is made via the Police Central Safeguarding Team; this is a Devon & Cornwall force wide team who receive referrals, triage and allocate appropriate Police Officers to undertake enquiries as a single agency or in conjunction with multi-agency partners. Dependent on the nature of the concern or crime the CST will allocate police resources accordingly e.g. Police Protection Unit, Neighbourhood Teams.
6. Enquiries
What happens as a result of an enquiry should reflect the adult‘s wishes wherever possible, as stated by them or by their representative or advocate. If they lack capacity it should be in their best interests if they are not able to make the decision, and be proportionate to the level of concern.
The adult should always be involved from the beginning of the enquiry unless there are exceptional circumstances that would increase the risk of abuse. If the adult has substantial difficulty in being involved, and where there is no one appropriate to support them, then the local authority must arrange for an independent advocate to represent them for the purpose of facilitating their involvement.
Professionals and other staff need to handle enquiries in a sensitive and skilled way to ensure distress to the adult is minimised and support provided to realise the outcomes they want and to reach a resolution or recovery.
Personal and family relationships within community settings can prove both difficult and complex to assess and intervene in. The dynamics of personal relationships can be extremely difficult to judge and re-balance. For example, an adult may make a choice to be in a relationship that causes them emotional distress which outweighs, for them, the unhappiness of not maintaining the relationship.
Family, friends and other relevant people who are not implicated in the allegation may be important in providing support to the person or managing risk. A record should be made of the decision to inform or consult or not to consult family and friends with reasons being given and noted.
Information should only be shared with family, friends or other non-professionals with the consent of the person. If there is a reasonable belief that the person lacks capacity to consent to sharing information, the information can be shared if it is in the best interest of the person. The Mental Capacity Act 2005 requires that others involved in the care of the person are consulted as part of any best interest decision being made. Consultation may take place without full disclosure of information. The level of information shared should be decided based on the circumstances of the situation and the reasons for this recorded.
Where there is a police investigation, information should not be shared by health or social care staff with any party without the explicit agreement of the police.
The Local Authority Adult Retained Function will have gathered sufficient information to consider whether a safeguarding enquiry is required in respect to the adult at risk. Where an agency is subsequently caused to make enquiries further information may be required as part of the section 42 Enquiry.
This should include:
- Details of the Adult at Risk whether the person is known to services and which other agencies are involved;
- Views and wishes of the adult;
- Is the adult aware of and did they consent to the safeguarding concerns being raised;
- Family or known advocate details;
- Information about the adults care and support needs;
- Mental Capacity to make decisions about care and safety if known;
- The adults communication needs and requirements;
- Details of the person(s) or agency alleged responsible safeguarding concerns including name, address, and date of birth (if known).
It is important to be cautious about contacting individuals involved or gathering evidence about the allegation or concern directly at this stage, but focus on gathering information which will assist in planning the enquiry. Information gathered must be recorded.
The agency leading the enquiries checks whether the adult is at immediate risk. This should include:
- Speaking to the person about how they can or wish to be safeguarded;
- Details of any injuries;
- Review current risks;
- Put in place a Safeguarding Plan where required (The Local Authority must determine what further action is necessary. Where the local authority determines that it should itself take further action, e.g. a safeguarding plan, then the authority would be under a duty to do so);
- Check if other adults are at risk.
The agency leading the enquiry decides how to plan and co-ordinate input to any assessment / enquiry deemed appropriate. This should include:
- Details of the person(s) or agency raising the concern and available written reports;
- Details of witness;
- Details of care visits /times, names of carers;
- Most appropriate time to visit when the person alleged responsible for concern is not present.
Any action taken by the provider organisation as part of their immediate response must not jeopardise future enquiries by the police, Care Quality Commission, or the Office of the Public Guardian.
In cases where the person alleged responsible is a person in position of trust (PIPOT), the safeguarding enquiries take precedence over Human Resources processes, i.e. disciplinary procedures.
Safeguarding referrals relating to care & nursing homes, community and voluntary services, the RF should identify an appropriate Local Authority Commissioning representative to participate in meetings. Where concerns or multiple concerns relate to potential systematic abuse, a large scale enquiry should be triggered.
7. Consider Outcome
When the enquiry is complete, all agencies/workers involved should compile a report summarising the concerns/allegations and any relevant background information about the adult at risk and the person alleged responsible for abuse, a description of the enquiry process (what was involved), an evaluation of the information gathered. The report should include the worker’s findings and conclusions, supported by relevant information and recommendations about future actions including a review if appropriate.
Workers should discuss the content of their report with their manager to enable a decision to be taken to submit the report to RF who will review and consider the outcome and decide whether any further action is needed.
The outcome of the enquiry will be communicated to the adult, their advocate or family as a priority. Consideration should be given how this is undertaken mindful of the Six Safeguarding Principles and recommendations set out in Making Safeguarding Personal.
Where following enquiry the risk is reduced or remains appropriate safeguarding plans will be considered in conjunction with the adult at risk, their advocate and other agencies involved in their care and support.
Where the enquiry has identified findings that relate to a health or care Provider i.e. a residential home, and action is required to address quality and safety concerns, a safeguarding plan is required. Findings of the enquiry are to be fed back at the earliest opportunity in order for the Provider to action recommendations, undertake Human Resource processes and to develop a safeguarding action plan to address outstanding safeguarding and quality concerns. A Case Conference process may be used effectively in these circumstances, see Safeguarding Enquiries Guidance.
8. Feedback to Referrer
Feedback on the outcome of a concern should be provided to the referrer, including where no further action is to be taken, wherever possible and appropriate. This applies to anyone raising a safeguarding concern, and should usually be the responsibility of the worker undertaking the enquiry.
In the case of a concern raised by a member of the public, feedback should be provided in a way which will respect the confidentiality of the Adult at Risk.
The person or agency alleged to be responsible for the potential abuse or neglect in the safeguarding concern will also be provided with feedback on the outcome of the enquiry. This applies whether or not action is taken or an allegation substantiated.
Exceptions to the above may apply if to do so would in any way increase or continue risk to the Adult at Risk. This decision should be taken in agreement with the appropriate line management.
9. Consider Other Actions
Where a Care Act section 42 Enquiry is not required it may be appropriate to consider other actions. Also following a safeguarding enquiry, at the outcome stage, closure to Safeguarding may be agreed with other actions required or recommended. Other actions may include:
Care Act 2014:
- Section 9 - Assessment of an adult’s needs for care and support;
- Section 10 - Assessment of a carer’s needs for support;
- Section 25 - Care and support plan, support plan;
- Section 27 - Review of care and support plan or of support plan.
Referral to other services:
- Advocacy;
- Housing;
- Trading Standards;
- Public Protection – environmental health;
- Community & Voluntary Services;
- Domestic Abuse Services;
- Probation;
- MAPPA (Multi Agency Public Protection Arrangements);
- Primary Care;
- Community Health;
- Acute Hospital.
Commissioning Actions:
- Contract monitoring and review;
- Contract compliance and default;
- Contract tendering;
- Quality Assurance and Improvement Team (QAIT);
- Medicines Optimisation Team.