Safeguarding Adults Awareness Training Nottinghamshire Safeguarding Adults Board

Safeguarding Adults Awareness Training Nottinghamshire Safeguarding Adults Board www. safeguardingadultsnotts. org

Housekeeping • Fire drill & exits • Breaks and finish • Silent phones • Toilets

Ground Rules • Responsibility • Energy • Support • Punctuality • Equality • Confidentiality • Take risks

Overall Aims To enable delegates to understand: • What does Safeguarding mean? • Who does Safeguarding apply to? • What is abuse? • What are my responsibilities?

What does Safeguarding mean? “Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. ” - sec. 14. 7 The Care Act Guidance 2016

Who do Safeguarding duties apply to? According to the Care Act 2014, safeguarding duties apply to those who are: • Adults aged 18 or over who have care and support needs, whether or not those needs are met by the Local Authority and • Are experiencing, or are at risk of experiencing instance(s) of abuse or neglect and • Due to their care and support needs are unable to protect themselves againstances of abuse or neglect

The Aims of Adult Safeguarding are to: 1. stop abuse or neglect wherever possible; 2. prevent harm and reduce the risk of abuse or neglect to adults with care and support needs; 3. safeguard adults in a way that supports them in making choices and having control about how they want to live; 4. promote an approach that concentrates on improving life for the adults concerned; 5. raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect; 6. provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult; and 7. address what has caused the abuse or neglect.

6 Principles of Adult Safeguarding The Care Act 2014 describes 6 Principles of Adult Safeguarding: • Protection - Support and representation for those in greatest need. • Prevention - It is better to take action before harm occurs • Empowerment - People being supported and encouraged to make their own decisions and informed consent. • Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. • Proportionality - The least intrusive response appropriate to the risk presented. • Accountability - Accountability and transparency in delivering safeguarding.

Safeguarding Adults – the ‘I’ Statements “I understand the role of everyone involved in my life and so do they. ” “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want. ” “I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed. ” “I know that staff treat any personal and sensitive information in confidence, only sharing what is necessary. I am confident that professionals will work together and with me to get the best result for me. ” “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help. ” “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens. ”

Exercise One

Definitions of Abuse • “Any act or failure to act, which results in a significant breach of an adult at risk’s human rights, civil liberties, bodily integrity, dignity or general well-being, whether intended or inadvertent, including sexual relationships or financial transactions to which the person has not, or cannot, consent or which they are deliberately exploitative. ”

Neglect and Acts of Omission Discriminatory Financial/ Material Domestic Violence Self-Neglect Types of abuse Physical Organisational Modern Slavery Psychological Sexual

Physical Abuse Assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing Rough handling Scalding and burning Physical punishments Inappropriate or unlawful use of restraint Making someone purposefully uncomfortable (e. g. opening a window and removing blankets) • Involuntary isolation or confinement • Misuse of medication (e. g. over-sedation) • Forcible feeding or withholding food • • •

Sexual Abuse • • Rape, attempted rape or sexual assault Inappropriate touch anywhere Non- consensual masturbation of either or both persons Non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth Any sexual activity that the person lacks the capacity to consent to Inappropriate looking, sexual teasing or innuendo or sexual harassment Sexual photography or forced use of pornography or witnessing of sexual acts Indecent exposure

Psychological or Emotional Abuse • Enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends • Removing mobility or communication aids or intentionally leaving someone unattended when they need assistance • Preventing someone from meeting their religious and cultural needs • Preventing the expression of choice and opinion • Failure to respect privacy • Preventing stimulation, meaningful occupation or activities • Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse

Financial/ Material Abuse • • • Theft of money or possessions Fraud, scamming Preventing a person from accessing their own money, benefits or assets Employees taking a loan from a person using the service Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions Arranging less care than is needed to save money to maximise inheritance Denying assistance to manage/monitor financial affairs Denying assistance to access benefits Misuse of personal allowance in a care home

Neglect and Acts of Omission • Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care • Providing care in a way that the person dislikes • Failure to administer medication as prescribed • Refusal of access to visitors • Not taking account of individuals’ cultural, religious or ethnic needs • Not taking account of educational, social and recreational needs • Ignoring or isolating the person • Preventing the person from making their own decisions

Self-Neglect • • • Lack of self-care to an extent that it threatens personal health and safety Neglecting to care for one’s personal hygiene, health or surroundings Inability to avoid self-harm Failure to seek help or access services to meet health and social care needs Inability or unwillingness to manage one’s personal affairs

Modern Slavery • • • Human trafficking Forced labour Domestic servitude Sexual exploitation, such as escort work, prostitution and pornography Debt bondage – being forced to work to pay off debts that realistically they never will be able to

Domestic Abuse Domestic abuse can be characterised by any of the indicators of abuse outlined relating to: • psychological • physical • sexual • financial • emotional. • Domestic abuse includes any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been, intimate partners or family members regardless of gender or sexuality. It also includes so called 'honour’ -based violence, female genital mutilation and forced marriage.

Discriminatory Abuse • unequal treatment based on age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex or sexual orientation (known as ‘protected characteristics’ under the Equality Act 2010) • verbal abuse, derogatory remarks or inappropriate use of language related to a protected characteristic • denying access to communication aids, not allowing access to an interpreter, signer or lip-reader • harassment or deliberate exclusion on the grounds of a protected characteristic

Organisational Abuse • • • discouraging visits or the involvement of relatives or friends run-down or overcrowded establishment authoritarian management or rigid regimes lack of leadership and supervision insufficient staff or high turnover resulting in poor quality care abusive and disrespectful attitudes towards people using the service inappropriate use of restraints lack of respect for dignity and privacy failure to manage residents with abusive behaviour

How to recognise when abuse is taking place • Group Exercise • Indicators of abuse

Who Might Pose a Risk? • • Professionals, volunteers and people paid to provide care services Neighbours or friends A manager Your colleagues A member of a place of worship Partners Another adult at risk

Prevention and Minimising of Abuse Your Responsibilities: • Have an awareness of the Nottingham & Nottinghamshire Safeguarding Adults Procedures and Guidance • Seek support to implement the procedure within your work environment • Attend relevant training • Provide service users & carers with the relevant information • Discuss any concerns with your line manager

While working in the office of a large purpose-built residential care home with attached day services, Elaine notices a new service user, Mark, is also sat in reception. He is twenty six years old, has severe learning disabilities and cannot communicate verbally. He is being accompanied by his care assistant to see if he likes the day centre and activities.

Whilst he is waiting for his appointment to be shown around, Mark is given a drink of water by his care assistant. Mark really hates drinking water, he will only drink Ribena.

When the care assistant keeps on only offering him water, Mark gets angry and knocks the plastic cup out of his hand. The care assistant shouts at him, “Don’t be an idiot, look at the mess you’ve made now. Why do you have to make such a fuss about a glass of water? "

What should Elaine do? • Check that Mark is ok? • Tell her manager? • Write down exactly what she has seen or been told? • Tell the person who allegedly committed the abuse that she is going to report them? • Report this to her nominated referrer?

What to do if someone discloses abuse to you There are several important things you must do if someone tells you that they have been abused: • Don't look horrified or shocked even through this might be how you are feeling. • Tell the individual they are doing the right thing telling you and that you are treating this information seriously. • Tell the person what has happened is not their fault. • Ask the adult at risk for their agreement to share the information. If they decline, seek support from your manager/ nominated referrer • Write down what was said as soon as you can and inform your manager/ nominated referrer (or another manager if they are unavailable)

A refusal of help • Sometimes an adult at risk will make a disclosure about abuse but refuse help. • This may be difficult as you have heard something that you might worry about but you are being asked not to take any action. • You will need to reassure the person, but at the same time explain that you will have to share this information with your line manager/ nominated referrer.

Guidance - Consent • 14. 2. 1 Article 8 of the Human Rights Act relates to an individual’s rights to autonomy. However, the requirement to respect the rights of individuals to make decisions for themselves is not an excuse for inaction where an adult at risk is at risk of abuse or neglect. • 14. 2. 2 The Data Protection Act 2018 allows the sharing of information when the Care Act 2014 requires you to do so without obtaining the consent from the adult or their representative. • 14. 2. 3 For the purposes of the duty of confidentiality owed by professionals to their patients and service users, the Care Act (2014) provides a legal basis for sharing information in relation to safeguarding duties. • Taken from Nottingham and Nottinghamshire Multi-Agency Procedures for Raising a Concern and Referring

Guidance - Consent This means that there is no requirement to obtain consent from the adult or their representative, when any of the following apply: • Other people, including other adults at risk and or children, could be at risk from the person causing harm • It is necessary to prevent crime or a serious crime has been committed • You believe that the adult at risk is being coerced or fearful of repercussions • If there is an overriding public interest • There is reason to believe that their health and/or well-being will be adversely affected by ongoing harm or abuse • The person posing a risk also has care and support needs and may also be at risk • Taken from Nottingham and Nottinghamshire Multi-Agency Procedures for Raising a Concern and Referring

Legal Framework • The Care Act 2014 sets out a clear legal framework for how Councils and other organisations should protect adults at risk of abuse or neglect. For example, Councils are the lead organisation in safeguarding adults. Nottinghamshire County Council is the largest partner of the Nottinghamshire safeguarding Adults Board. • It is our responsibility as a Council to look into and respond where concerns are raised with us • All referrals go to a central point, this is called the Multi-Agency Safeguarding Hub (MASH) who will make an initial enquiry and determine the right course of action, this could include requesting further work to be undertaken by a Social Worker or Occupational Therapist in a local Adult Social Care Team and possibly referral to other services e. g. Police or Health

Procedures and Pathways: • Nottingham and Nottinghamshire Multi-agency Procedures for Raising a Concern and Referring • Nottingham and Nottinghamshire Multi-agency Guidance for Raising a Concern and Referring • Nottinghamshire Referral Pathway www. safeguardingadultsnotts. org

Immediate action • Consider immediate health, safety and welfare of the adult at risk • Is this an emergency? • Does the person posing a risk have care and support needs?

Desired outcomes (or what do you want to happen? ) • Ask the adult what they want to happen • Allow to express wishes freely • No promises

Multi-Agency Safeguarding Hub (MASH) • The MASH is the county’s first point of contact for new safeguarding concerns and has significantly improved the sharing of information between agencies, helping to protect the most vulnerable children and adults from harm, neglect and abuse. • The MASH handles concerns about both children and adults at risk, taking a holistic family approach. Staff from the Police, Health, Probation Trust, Schools, Children's Social Care and Adult Safeguarding are working together in the MASH office. • MASH will not work with adults who do not have care and support needs

Recap • We are all responsible for protecting adults at risk of harm • If an adult at risk tells you they have been abused you must stay calm and write down exactly what they tell you • You must be aware of what you should not do or say if someone discloses abuse to you • If you are concerned about an adult you must report your concern to your manager or in an emergency to emergency services • You will need to give certain information to support your report of potential abuse

Session feedback/ questions • Any questions? Thank you www. safeguardingadultsnotts. org