1. What is a Concern?
It is the responsibility of all staff to act on any suspicion or evidence of abuse and neglect and to pass on their concerns to a responsible person or agency. This includes contacting the local authority’s adult social care service and / or the police, where necessary.
Workers (both paid and unpaid) across a wide range of agencies need to be vigilant about adult safeguarding concerns and act appropriately when dealing with such concerns.
A concern may be:
- a direct disclosure by the adult themselves;
- a concern raised by staff or volunteers, others using the service, a carer or a member of the public;
- an observation of the behaviour of the adult (including any changes in behaviour or appearance), of the behaviour of another person(s) towards the adult or of one service user towards another.
It should never be assumed that someone else will pass on information which may be critical to the safety and wellbeing of the adult. All staff have a duty of care to pass on their concerns and therefore would be failing in this duty if they did not do so.
2. Taking Immediate Action
Anyone with concerns of abuse or neglect should ensure the safety and wellbeing of the adult or others. The following should be considered:
- making an immediate evaluation of the risk and taking steps to ensure that the adult is in no immediate danger;
- where appropriate, dial 999 for an ambulance if there is need for emergency medical assistance;
- contacting the police if a crime has been or may have been committed;
- contacting adult social care if there are concerns that an adult is experiencing or at risk of abuse or neglect;
- not disturbing or moving articles that could be used in evidence, and securing the scene, for example by locking the door to a room;
- contacting children’s social care if there are concerns that a child is also at risk;
- if possible, making sure that other service users are not at risk.
All employees should be authorised to call emergency services, without referral to a manager, to ensure that there is no delay.
Although staff should do what they can to ensure the immediate safety of an adult, they must not put themselves in risky or dangerous situations.
Staff should contact their line manager, or delegated other, as soon as is practicable, to inform them of the situation and seek further advice.
3. Preserving Evidence
The police will always be responsible for the gathering and preservation of evidence to pursue criminal allegations against people causing harm, and should be contacted immediately.
The first concern is always to ensure the safety and wellbeing of the alleged victim. However, in situations where there has been or may have been a crime and the police have been called it is important that forensic and other evidence is collected and preserved. The police will attend the scene, and agencies and individuals can ensure evidence is not contaminated by:
- disturbing a ‘scene’ as little as possible, sealing off areas if possible;
- discouraging washing / bathing / eating / drinking / smoking and use of the toilet in cases of sexual assault;
- not cleaning or allowing further use by others of a toilet used by the victim since the alleged incident in cases of sexual assault;
- not handling items which may hold DNA evidence;
- putting any bedding, clothing which has been removed, or any significant items given to you (weapons etc) in a safe, dry place in bags (for example bin liners) if practical.
Staff can contribute to evidence by making a note of their observations in relation to the condition and attitude of the people involved and any actions taken.
4. Responding to Disclosures
Disclosures by the adult themselves should be listened to and recorded carefully as soon as possible, using their own words where possible. Staff should also:
- give assurances that they are taking the concerns seriously;
- listen carefully to what they are saying, staying calm, getting as clear a picture as possible, and avoid asking leading questions;
- not give promises of complete confidentiality;
- not be judgemental or jumping to conclusions.
The adult should not be questioned in detail at this stage, to avoid creating unnecessary stress through repeatedly describing events or creating a perception that they are not believed. Such questioning can also risk the contamination of evidence. This should not detract from the initial seeking of information to establish basic facts.
5. Contact with the Person Alleged to Have Caused Harm
The person alleged to have caused harm should not be contacted, unless this is part of an emergency action to safeguard the adult or others (for example, suspending a member of staff following allegations of abuse or neglect).
6. Responding to Abuse or Neglect in a Regulated Setting
It is important that all partners are clear where responsibility lies where abuse or neglect is carried out by employees or in a regulated setting, such as a care home, hospital, or college.
The first responsibility to act must be with the employing organisation as provider of the service. However, social workers or counsellors may need to be involved in order to support the adult to recover.
When an employer is aware of abuse or neglect in their organisation, they are under a duty to address this and protect the adult from harm as soon as possible.
Where a local authority has reasonable cause to suspect that an adult may be experiencing or at risk of abuse or neglect, it is under a duty to make (or cause to be made) whatever enquiries it thinks necessary to decide what if any action needs to be taken and by whom.
The local authority may well be reassured by the employer’s response so that no further action is required. However, a local authority would have to satisfy itself that an employer’s response has been sufficient to deal with the safeguarding issue and, if not, to undertake any enquiry of its own and any appropriate follow up action (for example referral to the Care Quality Commission and / or professional regulators).
The employer should investigate any concern (and provide any additional support that the adult may need) unless there is compelling reason why it is inappropriate or unsafe to do this. For example, this could be a serious conflict of interest on the part of the employer, concerns having been raised about non-effective past enquiries or serious, multiple concerns, or a matter that requires investigation by the police.
An example of a conflict of interest where it is better for an external person to be appointed to investigate may be the case of a family run business where institutional abuse is alleged, or where the manager or owner of the service is implicated. The circumstances where an external person would be required should be set out in the local multi-agency procedures. All those carrying out such enquiries should have received appropriate training.
There should be a clear understanding between partners at a local level when other agencies such as the local authority, CQC or the clinical commissioning group (CCG) need to be notified or involved and what role they have. The focus should be on promoting the wellbeing of those adults at risk (see Promoting Wellbeing). It may be that additional training or supervision will be the appropriate response, but the impact of this needs to be assessed.
Commissioners of care or other professionals should use safeguarding procedures in a way that reflects the principles above not as a means of intimidating providers or families.
Transparency, open mindedness and timeliness are important features of fair and effective safeguarding enquiries.
CQC and commissioners have alternative means of raising standards of service, including support for staff training, contract compliance and, in the case of CQC, enforcement powers.
7. Recording Concerns
See also Record Keeping.
It is vital that a written record of any incident or allegation is made as soon as possible after the information is obtained.
Written records must reflect as accurately as possible what was said and done by the people initially involved in the incident either as a victim, suspect or potential witness. The notes must be kept safe as it may be necessary to make records available as evidence and to disclose them to a court.
The record should include:
- date and time of the incident;
- exactly what the adult said, using their own words (their account), where possible, about the abuse and how it occurred or exactly what has been reported to you;
- appearance and behaviour of the adult including any changes noticed;
- any injuries observed;
- any actions taken (for example contacting police or other emergency services);
- name and signature of the person making the record.
If the member of staff witnessed the incident, they should write down exactly what they saw.
The record should be factual. However, if the record does contain opinion or an assessment, it should be clearly stated as such and be backed up by factual evidence. Information from another person should be clearly attributed to them.
If the person has physical injuries or signs of abuse or neglect, the member of staff should seek and record advice given to them from their manager or designated safeguarding manager, before taking photographs for evidential purposes on a mobile phone or tablet. This is to avoid unnecessary allegations being levelled the member of staff if their actions are misinterpreted. If the manager cannot be contacted or the advice is not to take photographs, mark the site of the injuries on a body map, along with the written record.
8. Practice Guidance
Do’s and Don’ts
Staff members should:
- stay calm;
- listen patiently;
- reassure the person they are doing the right thing by telling you;
- explain what you are going to do;
- report the situation to the relevant manager;
- write a factual account of what you have seen, immediately.
Staff members should not:
- appear shocked, horrified, disgusted or angry;
- press the individual for details (unless requested to do so);
- make comments or judgements other than to show concern;
- promise to keep secrets;
- confront the abuser, unless intervening to prevent further abuse;
risk contaminating evidence.
Discuss with the relevant manager, who will:
- ascertain whether the situation might fall within the definitions of abuse outlined in this policy;
- consider the adult’s capacity to make decisions;
- ascertain any immediate action required;
- ascertain whether an investigation is necessary in accordance with internal policies and procedures;
- where abuse is suspected conclude that a referral be made to the appropriate agency.
- ensure the Care Quality Commission (CQC) are notified of the allegation of abuse.