Safeguarding Adults P4 - Preventing Abuse and Responding to Poor Practice

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Safeguarding Adults P4 - Preventing Abuse and
Responding to Poor Practice

• Practitioner Level

www.devon.gov.uk/index/socialcarehealth/ scwd/scwd
-safeguarding-adults.htm
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Housekeeping
Fire Procedure
Smoking
Toilets
Breaks
Finishing Time
Mobile Phones / Devices
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Training Transfer

• Getting learning into practice
• 50 of learning fails to transfer to the
  workplace
• (Sak, 2002)
• The ultimate test of effective training is
  whether it benefits service users
• (Horwath and Morrison, 1999)

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Introductions

• Name
• Place and nature of work
• What do you want to know by the end of todays
  session?

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Outcomes

• By the end of the session you will
• Be able to recognise and respond to poor practice
• Recognise missed opportunities through learning
  from Serious Case Reviews
• Have a greater awareness of the legislative
  framework, regulation and guidance that
  contribute to the prevention agenda
• Identify opportunities for intervention through
  the assessment, care or treatment planning and
  review processes
• Recognise the role of person-centred support in
  preventing abuse and consider the ongoing balance
  between prevention, protection and a person's
  right to choose
• Understand your responsibilities

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Overall Outcome

• An opportunity to consider how you recognise and
  deal with poor performance and some tips and
  techniques to assist you

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Ground Rules

• Safeguarding is about partnership, it is not
  about blame. All agencies and individuals need to
  take responsibility to reflect and learn how to
  safeguard people who may be vulnerable.
• Confidentiality within the group will be
  respected but may need to be broken if a
  disclosure of unsafe practice, abuse or neglect
  is made during the course this will normally be
  discussed with you first.

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Prevention in Adult Safeguarding

• It does not mean being over-protective or
  risk-averse. Prevention needs to take place in
  the context of person-centred support and
  personalisation, with individuals empowered to
  make choices and supported to manage risks.
• Report 41, SCIE, 2011

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• What can you do to prevent abuse/harm?

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Protection
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Setting The Scene

• Where does our learning about Safeguarding come
  from?
• Serious Case Reviews/Complaints/Near misses
• Research/Surveys/Data Analysis
• Practice Experience/Theory/Reflection
• www.devonsafeguarding.org
• www.scie.org.uk

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Serious Case Reviews

• Take place where a vulnerable adult has
• died, suffered serious sexual abuse, a
  potentially life-threatening injury or serious
  and permanent impairment of health or development
  or when serious abuse takes place in an
  institution or multiple abusers are involved
• AND
• the case gives rise to concerns about the way in
  which local professionals and services work
  together to safeguard vulnerable adults
• OR
• where it is believed to be in the public interest
  to conduct such a review.

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Serious Case Reviews aim to

• Establish whether there are lessons to be learnt
  about the way in which local professionals and
  agencies work together to safeguard vulnerable
  adults
• Improve practice by acting on learning
• NB The purpose of having a serious case review
  is not to reinvestigate or to apportion blame.
  They consider individual actions as well as the
  systems and processes within which individuals
  operate.

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Devon SCRs

• A High number of deaths raised by CSCI
• Poor care standards not previously picked up by
  many and various professionals
• B 2 falls resulting in deaths raised by PALS
• Environmental risks not previously picked up by
  many and various professionals
• H Resident murdered by another on respite
• Poor transfer of risk information from hospital
  to care home

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Devon SCRs combined learning

• Duty on all health and social care professionals
  to record and act upon, any concerns about
  health, safety or wellbeing. This should include
  possible risks that are not necessarily the main
  focus of their contact.
• Ensure that a Service Provider is fully aware and
  able to safely meet someones needs. Other
  important considerations such as accessibility,
  peoples preferences, resource pressures and cost,
  should not compromise the primacy of ensuring
  safe care/support arrangements.

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Serious Case Reviews recurring national themes

• Inter-agency communication
• No lead agency
• Training needed
• Threshold issue
• Assumptions
• Jill Manthorpe and Stephen Martineau, 2009

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Common Safeguarding Challenges

• Lack of social inclusion
• Institutionalised care
• Physical abuse between residents
• Financial abuse
• www.scie.org.uk

• Maladministration of medication
• Pressure sores
• Falls
• Rough treatment, being rushed, shouted at or
  ignored
• Poor nutritional care

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Underpinning message for session

• Positive approach promotion of good practice
  and early intervention to avoid harm
• The rule of optimism - maintaining healthy
  scepticism and respectful uncertainty

It could happen here.
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Health and Social Care Act, 2008

• Single registration system acts as a licence to
  provide services
• Established Care Quality commission to
• Regulate the quality of health care and adult
  social care in many more settings
• Look after the interests of people detained under
  the Mental Health Act

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Health and Social Care Act, 2008 (Regulated
Activities) Regulations 2014
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Health and Social Care Act, 2008 (Regulated
Activities) Regulations 2014

• On 1 April 2015 new Regulations will come into
  force regarding Health and Social Care in
  England. These regulations form the basis of the
  Care Quality Commission (CQC) inspection
  regime.There are 3 legislative changes, which
  all become law on 1 April 2015. To introduce
  fundamental standards To make regulations more
  effective and improve enforcement against
  them To be outcome focused To reduce the
  burden on business.

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Standards and Benchmarks

• The Fundamental standards must be used in
  registered environments but can also be used as a
  benchmark in non-registered environments.
• Staff should be familiar with them and they
  should be discussed in supervision, team meetings
  etc and are useful when considering poor
  practice.
• What others do you have?

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www2.hull.ac.uk
www2.hull.ac.uk/fass/care/safeguardingadults
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Behind Closed Doors DVD Clip courtesy of
Cascade. This DVD can be purchased with a
workbook programme for ongoing training call
Carol 01872 222216 for further information. Email
cascade_at_talk21.com
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Behind Closed Doors

• Read the regulation - (you only have part of it)
• Watch the DVD and consider how effectively the
  team met this regulation
• Discuss in your groups
• Be ready to feedback to the main group

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Behind Closed Doors
In your groups consider the indictors and signs
that there might be if you hadnt actually
observed the behaviours
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What might you see?

• Empty hours, bored people
• Empty and scrappy staff rotas (turnover, absences
  and not enough staff)
• Dirty rooms, Dirty linen
• No training or going through the motions
• Policy documents and care plans kept in the
  drawer
• Dirty, untidy and unlooked after clothes

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What might you see?

• Rushed staff
• Peoples behaviour may change
• They might be withdrawn
• Low in mood
• Angry
• They might be reluctant to talk with you

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What might you hear?

• Inappropriate use of language / humour
• Dehumanising they - people are lumped together
  they eat like animals, the doubles
• Sexualising theyre at it like rabbits, shes
  gagging for it
• Blaminghe knows what hes doing, shes
  manipulative, hes winding me up
• Punitive theyve got it coming, she needs to
  be taught a lesson, if he thinks he can treat
  me like that
• Discrediting he doesnt notice, they dont
  care they are zombies

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What else?

• You might smell urine, faeces, stale food, body
  odour.
• Records might be poor or incomplete including
  erratic medication charts, lack of daily records,
  no incident reports

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• What are the barriers for addressing poor
  practice?

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Barriers to addressing poor practice

• Lack of a tangible sense of what is wrong
• Lack of certainty that your concerns are
  reasonable or proportionate
• Lack of evidence to back up concerns
• Fear of immediate reprisals or long term
  detrimental consequences
• Fear that concern or complaint will not be
  handled well so that their intervention will be
  in vain

Professor Hilary Brown
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Practitioners Role
If you suspect a criminal offence, do not ask
any further questions.
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What to do about poor practice

• Discuss with the professional concerned
• Discuss with the service manager if appropriate
• Discuss in supervision or at a team or core group
  meeting
• Discuss directly with the person or their family
  - encourage people to use the complaints process
• Discuss with co-workers, your manager or
  Safeguarding Adults team Discuss with procurement
  / contracts team
• Discuss with CQC
• Record in Mr Manager if appropriate
• Record your actions - SMART

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Feelings / Emotional Responses
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Communication
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Neil Thompson
What is a problem? ....a problem is anything
that either brings about negative ...or blocks
positives or a mixture of the two. Neil
Thompson
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An Elegant Challenge

• Being constructive in challenging unacceptable
  behaviour or language
• Collusion / Elegant Aggressive
• no challenging challenge challenge
•  

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Practice

• Choose one of the scenarios from the film (or
  your own) and make an elegant challenge to your
  partner.
• Partners What did it feel like? What could be
  done differently?
• Swap over.

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Any Questions?
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Prevention is Better Than Cure

• Keep the course in context. Whilst there are
  some very worrying situations occurring everyday
  there is also good practice in all care
  environments
• Remember to vigilant and deal with things at the
  earliest opportunity.
• Whether its poor practice or abuse doing
  nothing isnt an option.

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Resources

• Dementia care mapping
• www.bradford.ac.uk
• CQC observation tools
• www.cqc.org.uk/information-our staff/observation-t
  ools
• SCRs
• www.devonsafeguarding.org

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Resources

• Social care governance audit tool
• Common Safeguarding Challenges
• Minimising the Use of Restraint
• www.scie.org.uk
• Good Ideas!
• www.kissingitbetter.co.uk/
• www.myhomelifemovement.org/