Unit 25 my work for safe guarding

POOJA SAHOTA Principles of safeguarding and protection in H &C

Unit 25

1.1 Define the following types of abuse:

Physical abuse: psychical abuse is defined as Inflicting, or threatening to inflict, physical pain or injury to a vulnerable elder. Physical abuse can also include depriving them of basic needs such as food, medicines, or giving too much medication. Physical abuse accounts for 25% of all abusecases of elder abuse. This type of abuse includes punching, pushing, shaking, pinching, burning, force feeding, and any sort of physical punishment or restraint.

Signs of abuse include physical signs as well as suddenchanges in behaviour or refusal of a caregiver to allowvisitors to see an elder alone.

Examples of Physical Abuse

Hitting;

Slapping;

Kicking;

Inappropriate restraint or sanctions;

Force feeding;

Misuse (or inappropriate withholding) of medication

Sexual abuse: Sexual abuse is non-consensual sexualcontact of any kind.Sexual abuse can be difficult to detect except for thoseinvolved in their nursing care. Signs include thephysical signs. Always investigate allegations of sexualabuse by a vulnerable adult.

Examples of Sexual Abuse

Unwanted physical and sexual contact, e.g. caresses;

Intercourse with someone who lacks the capacity toconsent;

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Rape;

Indecent exposure;

Sexual harassment (verbal or physical);

Displaying pornographic literature videos or internetsites;

Gross indecency.

Emotional/psychological abuse: Emotional, psychological abuseis defined as;Inflicting mental pain, anguish, or distress on an elderperson through verbal or nonverbal acts.Psychological abuse accounts for 36% of all cases of abuse.

Emotional abuse can be difficult to detect unless witnessed.People being abused in this way can show changes in behaviour,fear when in the presence of the abuser, agitation orwithdrawal.

Examples of Emotional/Psychological Abuse

Intimidation by word or deed;

Humiliation;

Harassment;

Enforced social isolation (including culturaldiscrimination);

Blaming, controlling, threats.

Institutional abuse: Repeated instances of poor care may be anindication of more serious problems.

Institutional Abuse is abuse (as described above) that arisesfrom an unsatisfactory regime. It occurs when the routines,systems and norms of an institution override the needs ofthose it is there to support. Such regimes compel individualsto sacrifice their own preferred life style and culturaldiversity in favour of the interests of those there to support

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them, and others. This can be the product of both ineffectualand punitive management styles, creating a climate withinwhich abuse of Adults at Risk, intentional or otherwise, isperpetrated by individual staff and others. There is a lack ofgood leadership within the institution and members of staffare not equipped to carry out the care required.

Managers and staff of such services have a responsibility toensure that the operation of the service is focused on theneeds of service users, not on those of the institution.Managers will ensure they have mechanisms in place that bothmaintain and review the appropriateness, quality and impact ofthe service for which they are responsible. These mechanismswill always take into account the views of service users,their carers and relatives.

Examples of behaviour: Inflexible routines set around theneeds of staff rather than individual service users, e.g.requiring everyone to eat together at specified times, bathinglimited to times to suit staff, no doors on toilets. These canarise through lax, uninformed or punitive management regimes.

Signs and Symptoms of Institutional Abuse:

Inappropriate or poor care;

Misuse of medication;

Inappropriate restraint Sensory deprivation, e.g. denialof use of spectacles or hearing aid;

Lack of respect shown to the Adult at Risk;

Denial of visitors or phone calls;

Restricted access to toilet or bathing facilities;

Restricted access to appropriate medical or social care;

Failure to ensure appropriate privacy or personaldignity;

Lack of flexibility and choice, e.g. mealtimes andbedtimes, choice of food;

Lack of personal clothing or possessions;

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Lack of adequate procedures, e.g. for medication,financial management;

Controlling relationships between staff and serviceusers;

Poor professional practice;

Lack of staff training.

Financial abuse: Financial Abuse is defined as "the unauthorised and improper use of funds, property or any resources belonging to an individual". Financial or exploitative abuse is defined as the illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.Financial/material exploitation accounts for 30% of all cases of abuseExploitation includes the unexplained disappearance of funds, valuable possessions, changes to wills or financial documents.

Those who financially abuse may be people who hold a positionof trust, power, and authority or has the confidence of theAdult at Risk.

Examples of Financial Abuse

Misuse and/or misappropriation of monies, benefits and/orproperty;

Forcing changes to a will or testament;

Preventing access to money, property, possessions orinheritance.

Self-neglect: Self-neglect on the part of an Adult at Riskwill not usually lead to the initiation of adult safeguardingprocedures unless the situation involves a significant act ofcommission or omission by someone else with establishedresponsibility for the adult's care. However if practitionersare concerned that an Adult at Risk is neglecting themselvesto the degree that it is putting themselves or others at

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risk, they should contact their local safeguarding lead, whowill be able to advise on local procedures

Neglect by others: Neglect is defined as failing or refusingto provide food, shelter, healthcare or protection for avulnerable elder. Neglect accounts for 49% of cases of abuse.Neglect is defined as 'the repeated deprivation of assistancethat the Adult at Risk needs for important activities of dailyliving, including a failure to intervene in behaviour which isdangerous to the Adult at Risk or to others, and poor manualhandling techniques.'

Under the Mental Capacity Act 2005 wilful neglect and illtreatment of a person lacking capacity becomes a criminaloffence.

Examples of Neglect/Deprivation

Inadequate care;

Neglect of physical and emotional needs;

Deprivation of food, clothing, medical attention, oraids;

Denial of basic right to make informed choices;

Failure to provide access to social, health oreducational services.

The physical signs of neglect are often easy to see. Dirtysurroundings, poor personal hygiene, soiled bedding, smell,untreated cuts or sores, poor dental hygiene.

1.2 Identify the signs and/or symptoms associated with eachtype of abuse

Signs and Symptoms of Physical Abuse:

The signs of Physical Abuse are often evident but can also behidden by the abuser or the victim. Any unexplained injuriesshould always be fully investigated. Evidence to look out forincludes:

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Any injury not fully explained by the history given;

Injuries inconsistent with the lifestyle of the Adult atRisk;

Bruises and/or welts on face, lips, mouth, torso, arms,back, buttocks, thighs;

Clusters of injuries forming regular patterns orreflecting the shape of an article;

Burns, especially on soles, palms or back; from immersionin hot water, friction burns, rope or electric applianceburns;

Multiple fractures;

Lacerations or abrasions to mouth, lips, gums, eyes,external genitalia;

Marks on body, including slap marks, finger marks;

Injuries at different stages of healing.

Signs and Symptoms of Psychological Abuse:

Change in appetite;

Low self-esteem, deference, passivity, and resignation;

Unexplained fear, defensiveness, ambivalence;

Emotional withdrawal;

Sleep disturbance;

Self-harming behaviour.

Signs and Symptoms of Neglect:

Physical condition of the Adult at Risk is poor, e.g.pressure ulcers, unwashed and unkempt;

Clothing in poor condition; e.g. unclean, wet, ragged;

Inadequate physical environment;

Inadequate diet;

Untreated injuries or medical problems;

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Inconsistent or reluctant contact with health or socialcare agencies;

Failure to engage in social interaction;

Malnutrition when not living alone;

Inadequate heating;

Medical condition not treated due to failure to giveprescribed medication;

Poor personal hygiene.

Signs and Symptoms of Sexual Abuse:

Significant change in sexual behaviour or attitude;

Pregnancy in a woman who is unable to consent to sexualintercourse;

Wetting or soiling;

Poor concentration;

Withdrawn, depressed, stressed appearance;

Unusual difficulty or sensitivity in walking or sitting;

Stained or bloody underclothing;

Bruises, bleeding, pain or itching in genital area;

Sexually transmitted diseases, urinary tract or vaginalinfection;

Bruising to thighs or upper arms;

Self-harming behaviour.

Signs and Symptoms of Financial Abuse:

Unexplained sudden inability to pay bills or maintainlifestyle;

Unusual or inappropriate bank account activity;

Lasting Power of Attorney or Enduring Power of Attorneyobtained when Adult at Risk is unable to comprehend andgive consent;

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Withholding of money;

Recent change of deeds or title of property;

Unusual interest shown by family or others in the Adultat Risk's assets;

Person managing financial affairs is evasive oruncooperative.

Signs and Symptoms of Institutional Abuse:

Inappropriate or poor care;

Misuse of medication;

Inappropriate restraint Sensory deprivation, e.g. denialof use of spectacles or hearing aid;

Lack of respect shown to the Adult at Risk;

Denial of visitors or phone calls;

Restricted access to toilet or bathing facilities;

Restricted access to appropriate medical or social care;

Failure to ensure appropriate privacy or personaldignity;

Lack of flexibility and choice, e.g. mealtimes andbedtimes, choice of food;

Lack of personal clothing or possessions;

Lack of adequate procedures, e.g. for medication,financial management;

Controlling relationships between staff and serviceusers;

Poor professional practice;

Lack of staff training.

1.3 Describe factors that may contribute to an individualbeing more vulnerable to abuse.

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One of such factors may be symptoms which occur after stoppingof taking drugs. A person begins to get depressed.

Also some types of personality disorders can contribute to abusing the person suffering from them. Low Self-esteem, low sense of self-worth, pre-exposition to abuse, substance abuse,low economic resources, homelessness, and sexual abuse as a child are just a few factors that make individuals vulnerable to abuse.

Factors related to the individual who is vulnerable to abuse:

Age (young or old ) Isolation Physical ability or illness creating dependency Mental and emotional health issues, e.g. dementia,

depression, stress Where violence is seen as normal within the environment

or relationship Culture and religion Financial factors

Factors related to the situation or care given that might cause abuse:

Prejudice or hostility towards the vulnerable individual Care given is drug or alcohol-dependent, or has physical

or mental health issues Lack of understanding about the individual’s medical or

emotional condition Lack of leadership and clear roles, responsibilities,

policies and procedures Staff shortages Lack of staff training or poor monitoring of care

provision

Complete conversation

2.1 Explain the actions to take if there are suspicions thatan individual is being abused.

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In order that inappropriate referrals are not generated,supervisors/ managers will need to assist their staff indetermining what constitutes a protection issue as opposed toa service complaint. Every professional must acknowledge and takeappropriate action if abuse is suspected. Being alert topossible abuse and informing supervisors/ management ofsuspected or actual abuse is the responsibility of all staff.Staffs have the right to form their own judgment and tochallenge other opinions, including medical statements, wherethey believe this is in the young person’s interest.

Always report your suspicious Keep an individual safe Seek advice from the Designated safeguarding officer

(DSO) Not ne persuaded by others that it is ‘unimportant’ or

‘minor’ Follow the agreed procedures of your employer

2.2expalin the actions to take if an individual alleges thatthey are being abused.

All allegations must be regarded as serious. Any suspicion,allegation or disclosure that a young person is suffering oris at risk of suffering abuse should be reported to mysupervisor/ manager who will then negotiate with otheragencies concerning whether an investigation is appropriateand how it should be conducted.

Always report your suspicious Keep an individual safe Seek advice from the Designated safeguarding officer

(DSO) Not ne persuaded by others that it is ‘unimportant’ or

‘minor’ Follow the agreed procedures of your employer

Always remember that you have a duty of care and a moralresponsibility to act.

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2.3 Identify ways to ensure that evidence of abuse ispreserved.

You must try to preserve any evidence if you think a criminaloffence may have taken place:

Things not to do:

Move or remove anything from a situation where yoususpect or observe abuse

Touch anything, unless you have to make the area orperson safe

Clean or tidy up Allow access to anyone not involved in investigating.

Things to do:

Record any visible signs of abuse, such as bruising,physical injuries or torn clothing

Avoid touching people or objects wherever possible and donot destroy fingerprints.

Preserve clothing, footwear, bedding and similar items,and keep them safe and dry

Record injuries Preserve items in a clean paper bag or unsealed envelope Preserve liquids in clean glasses Preserve and record the state of the individual and the

alleged abuser’s clothing, and the condition andattitudes of the people involved.

3.1 identify national policies and local systems that relateto safeguarding and protection from abuse.

Safeguarding is everyone’s responsibility and all staff who,during the course of their employment have direct or indirectcontact with children and families and vulnerable adults, orwho have access to information about them, have aresponsibility to safeguard and promote the welfare ofchildren and vulnerable adults.

There is a duty on organisations to make appropriate arrangements to safeguard and promote the welfare of children

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and vulnerable adults. Also government guidance makes it clearthat it is a shared responsibility, and depends upon effectivejoint working between agencies and professionals that have different roles and expertise.

Statutory inquiry into the death of Victoria Climbié and the first joint Chief Inspectors report on safeguarding children highlighted the lack of priority status given to safeguarding.The government response to these findings included the Green Paper Every Child Matters and the provisions in the Children Act 2004. Section 11 of the Children Act 2004 places a duty onall agencies to make arrangements to safeguard and promote thewelfare of children. The Health and Social Care Act 2008 also places statutory duties on organisations and individuals.

Two key documents that relate to adults in need ofsafeguarding are:

No secrets (2000)- guidance on developing andimplementing multi-agency policies and procedures toprotect vulnerable adults from abuse

Safeguarding Adults (2009)-a national framework ofstandards for good practice and outcomes in adultprotection work.

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Legislation or nationalpolicy

Summary of key points

Legal Powers to intervene

A rage of laws enableabusers to be prosecuted,including:

Offences against theperson Act (1861) –relates to physicalabuse

Sexual offences Act(2003) – relates tosexual abuse

Protection fromharassment Act(1997) –relates topsychological abuse

Section 47 of theNational AssistanceAct (1948) - relatesto neglect

Human rights Act (1998) All individuals have theright to live free fromviolence and abuse, Rightsinclude:

Article2: The right tolife

Article 3: Freedomfrom torture(including humiliatingand degradingtreatment)

Article 8: The rightto family life.

Mental Capacity Act (2005) Outlines five keyprincipals to protectadults at risk who areunable to make their owndecisions. Also coversfinancial abuse.

Safeguarding VulnerableGroups Act (2006)

Resulted from the Bichardinquiry in 2002 into theSoham murders and led tothe creation of theindependent safeguardingAuthority (ISA) whichoversees the vetting andbarring scheme.

Health and Social care(HSC) Act (2008); HSC Act(2010); CQC Regulations(2009)

Established the CareQuality Commission (CQC) toreplace National MinimumStandards, and introducedessential standards of


3.2 Explain the roles of different agencies in safeguardingand protecting individual from abuse.

Keeping safe and protecting vulnerable adults from harm andabuse All adults should be able to live free from fear or harmand have their rights and choices respected. To help peoplewho may be being abused or suspect that abuse is happening, wehave published 'Keeping Safe and Protecting Adults' which youcan download from this page. It gives more information abouttypes of abuse and what to do if you suspect abuse. You canalso visit the York Safeguarding Adults website what is adultabuse? There are many different types of abuse, It may: bephysical or sexual involve taking money without permissioninclude bullying or humiliating include not allowing contactwith friends and family involve withholding food or medicationAbuse can be the result of a single act or may continue overmany months or years. Abuse can be accidental, or a deliberateact. An abuser may be? A relative, a partner, someone paid toprovide care and services, a volunteer, a neighbour, a friendor stranger. Abuse can happen anywhere: at home in a carehome in hospital in sheltered housing in supported livingcentres at day centres and other day services outside in apublic place How can I tell if abuse may be happening? Adultabuse is not always easy to identify as sometimes the natureof the abuse is not visible and/or often the person beingabused is afraid to speak out. However, there are some morecommon signs of abuse, see pdf attached to this page, which ifseen may suggest that abuse has occurred. Which adults arevulnerable to abuse? Some adults are less able to protectthemselves than others and some have difficulty making theirwishes and feelings known. This may make them vulnerable toabuse. They may also be vulnerable because they are in need ofcommunity care services due to mental health problems,physical or learning disability, age or illness. In York weare working together with the Police, local Councillors,Health and local independent and voluntary sector organisationto improve and develop further services to keep vulnerableadults safe.

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Agency Key ResponsibilityLocal authority adults Socialcare services

These agencies: Receive safeguarding

alerts Undertake any

intervention requiredto keep individualsafe

Liaise/coordinatebetween allindividuals andagencies involved

Remove the allegedabuser, if required

Are represented atpolice interviews

All agencies, including: thepolice, NHS, GP’s, medicalservices, councils, emergencyservices, in dependent,voluntary services andcharities, private providers,Trading Standards, CQC

These agencies: Work to agreed

safeguarding adultspolicies procedures

Ensure all staffreceive regularinformation aboutsafeguarding training,understand policiesand procedures and canrecognise signs ofabuse

Ensure all employeesare CRB checked andregistered with ISAprior to employment

Inform the ISA ofanyone who isunsuitable to workwith adults at risk.

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The following have additionalroles and responsibilities:Police The Police:

Investigateallegations of abuseif a crime issuspected

Gather evidence andpursue criminalproceedings ifappropriate

Protect people invulnerable situations.

Medical services, e.g. GP, NHSAcute Trusts

These services:Provide immediate treatmentif requiredUndertake evidentialinvestigations or medicalexaminations

3.3 Identify reports into serious failures to protectindividual form abuse.

Abuse can happen anywhere, anytime, but especially tovulnerable people, e.g. children, elderly people, people withdisabilities, and people with learning difficulties. It caneven happen in places people should be safe, e.g. hospitals,residential/nursing/care homes, schools, day-care/nurseries,centres etc. As a social worker, or health care assistant,you should understand and learn from the findings andrecommendations of inquiries into failures in safeguardingpractice.

I researched two cases reported for abuse. The winterbournecase which was nationally reported, and another abuse case ofOrme house in Lowestoft. The Winterbourne case was morephysical and emotional abuse and Orme house case was moreneglect and poor living conditions.

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The Winterbourne case was reported nationally because it wassuch a disgusting mistreatment of vulnerable people, 11members of staff were caught on cctv after visitors andpatients complaint about mistreatment. The evidence that wascaptured showed physical abuse such as, slapping, poking eyes,pulling hair, even as unbelievable as trapping them underchairs, and soaking residents in freezing cold water. It alsoshowed emotional and verbal abuse in the form of name calling.This was an inhumane and diabolic mistreatment of vulnerableindividuals unable to defend themselves. Winterbourne appearsto have made decisions based on profit and returns, over andabove decisions about the affective and humane delivery ofassessments and treatments. Where were staff who should havebeen reporting these crimes to management, if management wasnot listening then they should have been reported to theauthorities and organisations, such as social services and CQCthat is what they are there for.

3.4 Identify sources of information and advice about own rolein safeguarding and protecting individuals from abuse.

There are various different sources of information and adviceon your role in the safeguarding and protection of theindividuals you support and care for.

As well as your workplace’s policy document, you should havetraining, updates and regular supervision sessions on types,signs and symptoms of abuse. These should help to give youconfidence in your ability to perform this important part ofyour social care role.

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4.1 explains how the likelihood of abuse may be reduced by:

Working with person centred values Encouraging active participation Promoting choice and rights

Social care workers can reduce the likelihood of abuse andneglect occurring in their workplace by:

Using a person-centred approach to care Encouraging individuals to actively participate in their

care or support package Recognising and reporting unsafe practices Encouraging individuals to make use of accessible

complaints procedures Allowing individuals in the care setting to make their

own choice

Person-centred approaches: person-entered approaches areparticularly effective when supporting adults with learningdisabilities, adults with mental health problems and

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Local safegurading policy and procedures

Training

Team meeting

GSCC Codes of practice

Empoyer's policy and procedures adults

social care

services

national occupatioa

l standards

Job Descriptio

n

Supervision

CQC

Sourcesof

informat


individual with dementia. Every individual has their ownunique and different life story, needs, wishes and values. Itis important to understand these as a way of putting theperson at the centre of the care planning and deliveryprocess.

Encouraging active participation: The main result of ‘activeparticipation’ is the empowerment of the individual concerned.The individual is given independence, and is empowered to makechoices about how their personal support or assistance packageid delivered. The individual can then actively take part intheir own care, instead of just passively receiving support ina way that is convenient to the provider. Self-directedbudgets, where individual manage their own care package, arean important part of active participation.

Promoting choice and rights: you can play an active part inpromoting the choices and rights of the people you providecare or support for by spending time getting to know eachperson as an individual. If you get to know them, you can:

Understand their needs and abilities, likes and dislikes Understand how their condition affects their day-to-day

life and activities Understand hoe their past experience impact on their

views and current situation Respect their uniqueness and personal values.

4.2 Explain the importance of an accessible complaintsprocedure for reducing the likelihood of abuse.

Importance of accessible complaints procedures: Complaints area very important form of feedback. Being open to feedbackmeans that a social care organisation can review and improveits procedures for the detection of abuse. Social careorganisations must develop complaint procedures that areaccessible, easy to understand and user-friendly. Individualsand their families should feel able to make complaints withoutfear of retribution. Accessible complaints procedures should:

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Include an explanation of how to use complaintsprocedure

Include a way checking that individual understand theprocedure

Be displayed in public areas of the services Be provided by staff trained to respond positively to

complaints Confidentially inform individuals using the service

when their complaints have been dealt with and what theoutcomes are.

Use a key worker system to ensure individuals arelistened to and given the opportunity to complaintsinformally.

5.1 describe unsafe practices that may affect the well-beingof an individual.

Any practice that puts an individual or care worker at riskcould be considered unsafe. Unsafe practice includes notwearing personal protective equipment, not undertaking riskassessments and ignoring strategies to manage risk. Unsafepractice can also result from insufficient resources (lack ofequipment, lack of time or lack of staff) and operationaldifficulties (lack of training, poor leadership or lack ofstaff supervision).

Example: Unsafe practice would be more like leaving anindividual's possessions exposed and risking them being stolenrather than stealing them. It is about working in an unsafeway and putting individuals at risk.

5.2 Explain the action to take if suspected abuse or unsafepractices have been identified.

Safety is everyone’s responsibility in social care setting.In some situations unsafe practices may have become acceptedover time, but as a social worker you should not accept this

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as ‘normal’. You could lose your job if you ignore abuse ordon’t follow the correct procedure. You have a duty of careto tell your employer about any unsafe practices and to takeaction to protect yourself and others.

You should:

Make any hazardous situation safe where it is possible todo so (for example, use a hazard sign to identify anunsafe environment).

Follow up to check if the situation has been dealt witheffectively.

Report the situation verbally and in writing withoutdelay to the person in charge, completing any incident ormaintenance forms that are used in the workplace

Ensure others are aware of the potential danger-ifappropriate, remove and label broken equipment.

Remember to check local procedures, seek advice and ifnecessary, register a complaint if you have concerns aboutapparently unsafe practices. Doing nothing will only supportthe unsafe practice.

5.3 describe the action to take if suspected abuse or unsafepractices have been reported but nothing has been done inresponse.

When you raise a concern and report either suspected abuse orunsafe practices, you should always ensure that you put thisin writing. This will allow you to produce detailed, writtenevidence when your complaint is investigated.

Most complaints procedures include agreed timescales and stepsfor dealing with a complaints or incident, but the propertimescale for responding to your complaint is not followed,then you should follow your organisation’s procedures forgrievances. This grievance procedure may involve reportingthe situation to a more senior person within the organisation,to the adult Social Care Services department of your localauthority or to the care quality Commission (CQC). Dependingon the grievance, you may also want to contact your tradeunion for information and advice.

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Unit 25 my work for safe guarding

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Transcript of Unit 25 my work for safe guarding