Safeguarding Adults Policy and Procedure

Care Management – Rights & Abuse

Review Sheet
Last Reviewed Last Amended Next Planned Review in 12 months, or 25 Apr ’24 25 Apr ’24 sooner as required.
Business impact	Changes are important, but urgent implementation is not required, incorporate into your existing workflow. MEDIUM IMPACT
Reason for this review	Scheduled review
Were changes made?	Yes
Summary:	This policy outlines the safeguarding processes Mariama Care T/A Kangaroo Healthcare should follow to protect and support adults at risk. It has been reviewed and updated with significant changes throughout. Underpinning Knowledge and Further Reading reference links have also been checked and updated. For some customers, the policy reference number will have changed.
Relevant legislation:	• Protection of Freedoms Act 2012 (Disclosure and Barring Service Transfer of Functions) Order 2012 • Public Interest Disclosure Act 1998 • The Criminal Justice and Courts Act 2015 Section 20-25 • Anti-social Behaviour, Crime and Policing Act 2014 • The Modern Slavery Act 2015 • The Counter Terrorism and Security Act 2015 • Domestic Violence, Crime and Victims Act 2004 • Serious Crime Act 2015 Section 76 • FGM Act 2003 • Sexual Offences Act 2003 • The Care Act 2014 • Care Quality Commission (Registration) Regulations 2009 • Equality Act 2010 • The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 • Human Rights Act 1998 • Mental Capacity Act 2005 • Safeguarding Vulnerable Groups Act 2006 • Data Protection Act 2018 • UK GDPR

Underpinning knowledge – What have we used to ensure that the policy is current:

• Author: Department of Health and Social Care, (2022), NHS Prevent training and competencies framework. [Online] Available from: https://www.gov.uk/government/publications/nhs-prevent-training-and-competencies- framework/nhs-prevent-training-and-competencies-framework [Accessed: 25/4/2024]

• Author: Local Government Association, (2024), Making Safeguarding Personal. [Online] Available from: https://www.local.gov.uk/our-support/our-improvement- offer/care-and-health-improvement/making-safeguarding-personal [Accessed: 25/4/2024]

• Author: Department of Health and Social Care, (2023), Care and support statutory guidance. [Online] Available from: https://www.gov.uk/government/publications/care-act

-statutory-guidance/care-and-support-statutory-guidance [Accessed: 25/4/2024]

• Author: Nursing and Midwifery Council, (2024), Adult Safeguarding: Roles and Competencies for Health Care Staff. [Online] Available from: https://www.rcn.org.uk/Professional-Development/publications/rcn-adult-safeguarding- roles-and-competencies-for-health-care-staff-011-256 [Accessed: 5/8/2024]

• Author: CQC, (2018), Statement on CQC’s role and responsibilities for safeguarding children and adults. [Online] Available from: https://www.cqc.org.uk/sites/default/files/20190621_SC121706_CQC_statement_February_ [Accessed: 25/4/2024]

• Author: NICE, (2022), Safeguarding adults in care homes. [Online] Available from: https://cks.nice.org.uk/topics/safeguarding-adults-in-care-homes/ [Accessed: 25/4/2024]

• Author: GOV.UK, (2024), Pressure Ulcers: how to safeguard adults. [Online] Available from: https://www.gov.uk/government/publications/pressure-ulcers-how-to-safeguard- adults?utm_medium=email&utm_campaign=govuk-notifications-single- page&utm_source=73a1257f-6afc-4684-bed5- 7301bd5c711d&utm_content=immediately#full-publication-update-history [Accessed: 25/4/2024]

• Author: Social Care Institute for Excellence, (2019), Safeguarding adults: sharing information. [Online] Available from: https://www.scie.org.uk/safeguarding/adults/practice/sharing-information/ [Accessed: 25/4/2024]

• Author: scie, (2024), Safeguarding adults. [Online] Available from: https://www.scie.org.uk/safeguarding/adults/ [Accessed: 25/4/2024]

Suggested action:

• Encourage sharing the policy through the use of the QCS App

• Ensure relevant staff are aware of the content of the whole policy

Equality Impact Assessment:

QCS have undertaken an equality analysis during the review of this policy. This statement is a written record that demonstrates that we have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by equality law.

To ensure that this policy includes and refers to Enfield Council policy and procedures and details clearly who is responsible and accountable for managing safeguarding concerns within Mariama Care T/A Kangaroo Healthcare:
- Overall accountability for managing safeguarding concerns: Hannah Addo
- Hannah Addo is responsible for the governance and authorisation of this policy
- Safeguarding Lead at Mariama Care T/A Kangaroo Healthcare: Churinder
- Local Authority: Enfield Council
- Local Authority Main Contact Details: 020 83200106
To set out the key arrangements and systems that Mariama Care T/A Kangaroo Healthcare has in place for safeguarding and promoting the welfare of adults at risk and to ensure compliance with local policies and procedures. Adults are those aged 18 years and
To support Mariama Care T/A Kangaroo Healthcare in meeting the following Key Lines of Enquiry/Quality Statements (New):

(New)

Key Question Key Lines of Enquiry Quality Statements

EFFECTIVE

E2: How does the service make sure that staff have the skills, knowledge and experience to deliver effective care and support?

QSE2: Delivering evidence-based care & treatment

QSE3: How staff, teams & services work together

EFFECTIVE

E7: Is consent to care and treatment always sought in line with legislation and guidance?

QSE6: Consent to care and treatment

SAFE

S1: How do systems, processes and practices keep people safe and safeguarded from abuse?

QSS3: Safeguarding

SAFE

S2: How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?

QSS4: Involving people to manage risks

QSS5: Safe environments

To meet the legal requirements of the regulated activities that Mariama Care T/A Kangaroo Healthcare is registered to provide:
- Protection of Freedoms Act 2012 (Disclosure and Barring Service Transfer of Functions) Order 2012
- Public Interest Disclosure Act 1998
- The Criminal Justice and Courts Act 2015 Section 20-25
- Anti-social Behaviour, Crime and Policing Act 2014
- The Modern Slavery Act 2015
- The Counter Terrorism and Security Act 2015
- Domestic Violence, Crime and Victims Act 2004
- Serious Crime Act 2015 Section 76
- FGM Act 2003
- Sexual Offences Act 2003
- The Care Act 2014
- Care Quality Commission (Registration) Regulations 2009
- Equality Act 2010

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Human Rights Act 1998
Mental Capacity Act 2005
Safeguarding Vulnerable Groups Act 2006
Data Protection Act 2018
UK GDPR

The following roles may be affected by this policy:
- All staff
The following Service Users may be affected by this policy:
- Service Users
The following stakeholders may be affected by this policy:
- Family
- Advocates
- Representatives
- Commissioners
- External health professionals
- Local Authority
- NHS
- Housing Provider Partners

To ensure that the Enfield Council Safeguarding Policy and Procedure is understood by all staff

at Mariama Care T/A Kangaroo Healthcare and that the Enfield Council safeguarding procedures dovetail with the policy and procedure of Mariama Care T/A Kangaroo Healthcare.

To ensure that all staff working for, or on behalf of, Mariama Care T/A Kangaroo Healthcare, understand their responsibilities in relation to safeguarding adults at risk and know who to escalate concerns to within Mariama Care T/A Kangaroo Healthcare and externally if needed and appropriate to do so.
To protect the Service User’s right to live in safety, free from abuse and

To have a clear, well publicised policy of zero-tolerance of abuse within Mariama Care T/A Kangaroo Healthcare.

To identify lessons to be learnt from cases where Service Users have experienced abuse or

4.1 What is Safeguarding?

Mariama Care T/A Kangaroo Healthcare recognises the definition of ‘safeguarding’ as the actions taken to keep Service Users safe from harm and neglect.

The Care Act 2014 sets out that adult safeguarding duties apply to any adult who:
- Has care and support needs, and
- Is experiencing, or is at risk of, abuse and neglect, and
- 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
Safeguarding adults includes:
- Protecting their rights to live in safety, free from abuse and neglect
- People and organisations working together to prevent the risk of abuse or neglect, and to stop them from happening
- Making sure people’s wellbeing is promoted, taking their views, wishes, feelings and beliefs into account
- This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances
Mariama Care T/A Kangaroo Healthcare should always promote the Service User’s wellbeing in its safeguarding arrangements. Service Users have complex lives and being safe is only one of the things they want for themselves. Staff should work with the Service User to establish what being safe means to them and how that can be best achieved. Staff should not be advocating ‘safety’ measures that do not take account of individual

4.5 What Constitutes Abuse?

Employees at Mariama Care T/A Kangaroo Healthcare understand that the Service Users it supports can be extremely vulnerable to abuse and neglect, especially if they have care and support needs.

Abuse is a violation of an individual’s human or civil right by any other person. It is where someone does something to another person, or to themselves, which puts them at risk of harm and impacts on their health and wellbeing.

Abuse can have a damaging effect on the health and wellbeing of Service Users. These effects may be experienced in the short and long term and can sometimes be lifelong.

The signs of abuse are not always obvious, and a victim of abuse may not tell anyone what is happening to them. Sometimes they may not even be aware they are being

The robust governance processes at Mariama Care T/A Kangaroo Healthcare will make sure that staff working for, and on behalf of, Mariama Care T/A Kangaroo Healthcare, recognise and respond to the main forms of abuse which are set out in the Care Act 2014 Statutory Guidance Chapter 14.

The local authority is the lead agency for adult safeguarding and should be notified whenever abuse or neglect is suspected. It will decide whether a safeguarding enquiry is necessary, and if so, who will conduct it. The decision to conduct an enquiry depends on the criteria set out in the Care Act 2014, and not on whether a Service User is eligible for, or receiving, services funded by the local authority
Everybody has the right to live a life that is free from harm and abuse. Mariama Care T/A Kangaroo Healthcare recognises that safeguarding adults at risk of abuse or neglect is everybody’s business. Mariama Care T/A Kangaroo Healthcare aims to ensure that all adults at risk of abuse or neglect are enabled to live and work, be cared for and supported in an environment free from abuse, harassment, violence or aggression. The safeguarding policies and procedures of Mariama Care T/A Kangaroo Healthcare will dovetail with the Enfield Council multi-agency policy and procedures, which we understand take precedence over those of Mariama Care T/A Kangaroo Healthcare. Mariama Care T/A Kangaroo Healthcare will ensure that the Enfield Council policies and procedures are reflected within its

own policy and procedure, that this is shared with all staff and is accessible and available for staff to follow.

Mariama Care T/A Kangaroo Healthcare aims to provide services that will be appropriate to the adult at risk and not discriminate because of disability, age, gender, sexual orientation, race, religion, culture, or lifestyle. It will make every effort to enable Service Users to express their wishes and make their own decisions to the best of their ability, recognising that such self-determination may well involve risk. Mariama Care T/A Kangaroo Healthcare will work with Service Users and others involved in their Care to

ensure they receive the support and protection they may require, that they are listened to and treated with respect (including their property, possessions and personal information) and that they are treated with compassion and dignity.

A chaperone is always present when a Service User needs treatment, and missed healthcare appointments must be monitored to consider signs of abuse or neglect. These must be followed up with the healthcare provider and information shared in the best interests and safety of the Service User.

Mariama Care T/A Kangaroo Healthcare will follow the six principles as set out in guidance to the Care Act 2014 and this will inform practice with all Service Users:
- Empowerment – People being supported and encouraged to make their own decisions and informed consent
- Prevention – It is better to take action before harm occurs
- Proportionality – The least intrusive response appropriate to the risk presented
- Protection – Support and representation for those in greatest need
- Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse
- Accountability – Accountability and transparency in delivering safeguarding
Mariama Care T/A Kangaroo Healthcare is committed to the principles of ‘Making Safeguarding Personal’ and aims to ensure that safeguarding is person-led and focused on the outcomes that Service Users want to achieve. It will engage Service Users in a conversation about how best to respond to their safeguarding situation in a timely way that enhances involvement, choice and control as well as improving quality of life, wellbeing and
Mariama Care T/A Kangaroo Healthcare understands the importance of working collaboratively to ensure that:
- The needs and interests of adults at risk are always respected and upheld
- The human rights of adults at risk are respected and upheld
- A proportionate, timely, professional and ethical response is made to any adult at risk who may be experiencing abuse
- All decisions and actions are taken in line with the Mental Capacity Act 2005
- Each adult at risk maintains:
  - Choice and control
  - Safety
  - Health
  - Quality of life
  - Dignity and respect

4.13 Whistleblowing

Mariama Care T/A Kangaroo Healthcare has a clear Raising Concerns, Freedom to Speak Up and Whistleblowing Policy and Procedure in place which staff are frequently reminded about and with which they must be familiar. They must also understand how to escalate and report concerns.

Whistleblowing is an important aspect of the support and protection of adults at risk of harm where staff are encouraged to share genuine concerns about safety or wrongdoing within Mariama Care T/A Kangaroo Healthcare.

4.14 The Care Worker’s Responsibilities

To be able to recognise and respond to suspected abuse and substandard practice
To report concerns of harm or poor practice that may lead to harm
To remain up to date with training
To read and follow the policy and procedure
To know how and when to use the whistleblowing procedures
To understand the Mental Capacity Act and how to apply it in practice

4.15 The Hannah Addo’s Responsibilities

To establish the facts about the circumstances giving rise for concern
To identify sources and level of risk

To ensure that information is recorded and that the Enfield Council Adult Safeguarding Team is contacted to inform them of the concern or harm
If a Service User is at immediate risk of harm, the Hannah Addo will contact the The CQC will also be informed
In all cases of alleged harm, there will be early consultation between Hannah Addo, Enfield Council and the police to determine whether or not a joint investigation is required. Mariama Care T/A Kangaroo Healthcare understands that it may also be necessary to advise the relevant Power of Attorney if there is one appointed. In dealing with incidents of potential harm, people have rights which must be respected and which may need to be balanced against each other
The wishes of the person harmed will be taken into account whenever possible. This may result in no legal action
Documentation of any incidents of harm in the Service User’s file and using body maps to record any injuries
Follow Enfield Council policy guidelines where applicable
Report any incidents of abuse to the relevant parties
Work with multi-agencies
Advise and support staff
Ensure staff are trained during induction, assess knowledge annually and run refresher training if needed
Actively promote the whistleblowing policies
Ensure that agency staff working at Mariama Care T/A Kangaroo Healthcare have completed the necessary safeguarding training for their role
Participate in local Safeguarding Adults Board arrangements for sharing experiences about managing safeguarding concerns in care homes
Share relevant information from Safeguarding Adults Board meeting minutes and reports with staff

4.16 General Principles

We will have robust recruiting and safer staffing policies in place to make sure that our staff are fit to work with adults at risk and are compliant with national, safe recruitment and employment practices, including the requirements of the Disclosure and Barring Service
Safeguarding responsibilities should be included in the job description of all staff
A named safeguarding lead will be in place who is responsible for embedding safeguarding practices and improving practice in line with national and local developments. At Mariama Care T/A Kangaroo Healthcare, this person is Churinder
Any staff member who knows or believes that harm is occurring will report it to their line manager as quickly as possible, or if they feel they cannot follow the regular reporting procedure, they must use the whistleblowing process
Mariama Care T/A Kangaroo Healthcare will work collaboratively with other agencies, including liaison in relation to the investigation of allegations and will ensure its procedures dovetail with the Enfield Council multi-agency procedures
Mariama Care T/A Kangaroo Healthcare will use incident reporting, root cause analysis, lessons learned and auditing to determine themes to improve Care practice
Mariama Care T/A Kangaroo Healthcare will have a learning and development strategy which specifically addresses adult safeguarding. Mariama Care T/A Kangaroo Healthcare will provide training on the identification and reporting of harm, as well as training on the required standards in relation to procedures and processes should something need to be reported
Mariama Care T/A Kangaroo Healthcare recognises its responsibilities in relation to confidentiality and will share information appropriately
Mariama Care T/A Kangaroo Healthcare will have zero tolerance to harm
Mariama Care T/A Kangaroo Healthcare will work in partnership with other agencies to ensure that

concerns or allegations of abuse are appropriately referred for investigation to the most appropriate agency

Mariama Care T/A Kangaroo Healthcare will ensure that any action that is taken is assessed, proportionate and reflective of the risk presented to the people who use the services
Mariama Care T/A Kangaroo Healthcare will report any incidents in line with its regulatory requirements
Mariama Care T/A Kangaroo Healthcare will adhere to the Code of Conduct for Care Workers
There is a clear, well publicised Raising Concerns, Freedom to Speak Up and Whistleblowing Policy and Procedure in place that staff know how to use

4.17 Leadership, Staff and Culture

Hannah Addo is responsible for providing leadership.

Good governance in safeguarding will follow where it is seen as an integral part of Service User care and all staff take responsibility. Risks of neglect, harm and abuse will be reduced where there is strong leadership and a shared value base where:

The Service User is the primary concern
Service Users and staff are partners in their care
Quality is prioritised and measured
Staff understand the risks of neglect, harm and abuse
There is a culture of learning and improvement
There is openness and transparency, and all staff are listened to

4.18 Prevention – Providing information to support Service Users

Mariama Care T/A Kangaroo Healthcare will support Service Users by providing accessible, easy to understand information on what abuse is and what signs to look out for
A Safeguarding Leaflet can be found in the Forms section of this policy, and links to support can be found in the Further Reading section
Mariama Care T/A Kangaroo Healthcare will comply with the Accessible Information Standard
All Service Users will receive a copy of the Service User Guide, have access to the

Complaints, Suggestions and Compliments Policy and Procedure and be given information on how to escalate any concerns to the Commissioner, CQC, advocacy or Local Government and Social Care Ombudsman should they not be satisfied with the approach taken by Mariama Care T/A Kangaroo Healthcare or at any time they wish

4.19 Prevention – Raising awareness

Staff will need to be trained and understand the different patterns and behaviours of abuse as detailed in the Care Act 2014, Chapter 14 and Mariama Care T/A Kangaroo Healthcare will ensure that it is able to respond appropriately
Mariama Care T/A Kangaroo Healthcare will ensure that all staff are trained on the Raising Concerns, Freedom to Speak Up and Whistleblowing Policy and Procedure
During induction training, all employees will complete the ‘Understanding Abuse’ workbook, as part of the Care Certificate

5.1 Index

Forms of Abuse and Neglect
High Risk Groups
Who Abuses and Neglects?
Incidents of Abuse
Concerns
Staff who Consider or Suspect Abuse or Neglect
Responding to a Disclosure or Suspicion of Abuse or Neglect
Documenting a Disclosure
Response by Hannah Addo or Safeguarding Lead to Reports of Abuse or Neglect
Consent
Referral to the Enfield Council Safeguarding Adults Team
Local Authority Safeguarding Enquiry
Involve the Service User Concerned Throughout the Enquiry
After An Enquiry
If a Safeguarding Concern is Not Agreed
Informing the Relevant Inspectorate
Support and Supervision
Confidentiality and Information Sharing
Staff Alleged to be Responsible for Abuse or Neglect
Disclosure and Barring Service (DBS) Referral
Abuse by Another Adult at Risk
Management of Allegations Against People in Positions of Trust (PiPoT)
Allegations Against People who are Relatives or Friends
Pressure Ulcers
Medication Errors
Exploitation by Radicalisers who Promote Violence
Self-neglect and Refusal of Care
Abuse and Sexual Safety
Criminal Offences
Risk Assessment and Management
Training and Competence
Audit and Compliance
Forms of Abuse and Neglect

There are different types of abuse and signs and indicators for each. While indicators are not proof of abuse or neglect, they should alert staff to follow the Safeguarding Policy.

It is important that staff at Mariama Care T/A Kangaroo Healthcare are aware of the signs of abuse and what to look out for.

Physical abuse includes:

Being hit, slapped, pushed or restrained
Being denied food or water
Not being helped to go to the bathroom when you need to
Misuse of medication
Restraint
Inappropriate physical sanctions

Signs and indicators of physical abuse include:

No explanation for injuries or inconsistency with the account of what happened
Injuries are inconsistent with the person’s lifestyle
Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps
Frequent injuries
Unexplained falls

Subdued or changed behaviour in the presence of a particular person
Signs of malnutrition
Failure to seek medical treatment or frequent changes of GP Domestic violence or abuse:

This is typically an incident or pattern of incidents of controlling, coercive or threatening behaviour,

violence or abuse by someone who is, or has been, an intimate partner or family member, and can be:

Psychological
Physical
Sexual
Financial
Emotional
So called ‘honour’ based violence, female genital mutilation and forced marriage Signs and indicators of domestic violence or abuse include:
Low self-esteem
Feeling that the abuse is their fault when it is not
Physical evidence of violence such as bruising, cuts, broken bones
Verbal abuse and humiliation in front of others
Fear of outside intervention
Damage to home or property
Isolation – not seeing friends and family
Limited access to money Sexual abuse includes:
Indecent exposure
Sexual harassment
Inappropriate looking or touching
Sexual teasing or innuendo
Sexual photography
Being forced to watch pornography or sexual acts
Being forced or pressured to take part in sexual acts
Rape
Sexual assault

Signs and indicators of sexual abuse include:

Bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
Torn, stained or bloody underclothing
Bleeding, pain or itching in the genital area
Unusual difficulty in walking or sitting
Foreign bodies in genital or rectal openings
Infections, unexplained genital discharge, or sexually transmitted diseases
Pregnancy in a woman who is unable to consent to sexual intercourse
The uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
Incontinence not related to any medical diagnosis
Self-harming
Poor concentration, withdrawal, sleep disturbance
Excessive fear/apprehension of, or withdrawal from, relationships
Fear of receiving help with personal care

Reluctance to be alone with a particular person Psychological or emotional abuse include:
Threats to hurt or abandon
Deprivation of contact
Humiliating
Blaming
Controlling
Intimidation
Harassment
Verbal abuse
Cyberbullying
Isolation
Unreasonable and unjustified withdrawal of services or support networks Signs and indicators of psychological or emotional abuse include:
An air of silence when a particular person is present
Withdrawal or change in the psychological state of the person
Insomnia
Low self-esteem
Uncooperative and aggressive behaviour
A change of appetite, weight loss/gain
Signs of distress: tearfulness, anger
Apparent false claims, by someone involved with the person, to attract unnecessary treatment Financial or material abuse include:
Theft
Fraud
Internet scamming
Coercion in relation to a Service User’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions
Misuse or misappropriation of property, possessions or benefits Signs and indicators of financial abuse include:
Missing personal possessions
Unexplained lack of money or inability to maintain lifestyle
Unexplained withdrawal of funds from accounts
Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
The person allocated to manage financial affairs is evasive or uncooperative
The family or others show an unusual interest in the assets of the person
Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
Recent changes in deeds or title to property
Rent arrears and eviction notices
A lack of clear financial accounts held by a care home or service
Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person

Disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house

Modern slavery includes:

Slavery
Human trafficking
Forced labour and domestic servitude
Traffickers and slave masters using whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment

Signs and indicators of modern slavery include:

Signs of physical or emotional abuse
Appearing to be malnourished, unkempt or withdrawn
Isolation from the community, seeming under the control or influence of others
Living in dirty, cramped or overcrowded accommodation and or living and working at the same address
Lack of personal effects or identification documents
Always wearing the same clothes
Avoidance of eye contact, appearing frightened or hesitant to talk to strangers
Fear of law enforcers Discriminatory abuse includes:

Some forms of harassment, slurs or unfair treatment because of:

Race
Sex
Gender and gender identity
Age
Disability
Sexual orientation
Religion

Signs and indicators of discriminatory abuse include:

The person appears withdrawn and isolated
Expressions of anger, frustration, fear or anxiety
The support on offer does not take account of the person’s individual needs in terms of a protected characteristic

Organisational or institutional abuse:

Including neglect and poor care practice within an institution or specific care setting, or in relation to care provided in a Service User’s own home, this may range from one-off incidents to ongoing ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within Mariama Care T/A Kangaroo Healthcare:

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
Not providing adequate food and drink, or assistance with eating
Not offering choice or promoting independence

Misuse of medication
Failure to provide care with dentures, spectacles or hearing aids
Not taking account of individuals’ cultural, religious or ethnic needs
Failure to respond to abuse appropriately
Interference with personal correspondence or communication
Failure to respond to complaints

Signs and indicators of organisational abuse include:

Lack of flexibility and choice for people using the service
Inadequate staffing levels
People being hungry or dehydrated
Poor standards of care
Lack of personal clothing and possessions and communal use of personal items
Lack of adequate procedures
Poor record-keeping and missing documents
Absence of visitors
Few social, recreational and educational activities
Public discussion of personal matters
Unnecessary exposure during bathing or using the toilet
Absence of individual care plans
Lack of management overview and support Neglect or acts of omission include:
Ignoring medical emotional or physical care needs
Failure to provide access to appropriate health, care and support or educational services
Withholding of the necessities of life, such as medication, adequate nutrition and heating
Failure to administer medication as prescribed
Not taking account of individuals’ cultural, religious or ethnic needs Signs and Indicators of neglect or acts of omission include:
Poor environment – dirty or unhygienic
Poor physical condition and/or personal hygiene
Pressure ulcers
Malnutrition or unexplained weight loss
Untreated injuries and medical problems
Inconsistent or reluctant contact with medical and social care organisations
Accumulation of untaken medication
Uncharacteristic failure to engage in social interaction
Inappropriate or inadequate clothing Self-neglect includes:

A wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and

includes behaviour such as hoarding. It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case by case basis. A decision on whether a response is required under safeguarding will depend on the Service User’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.

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 Signs and indicators of self-neglect include:
Very poor personal hygiene
Unkempt appearance
Lack of essential food, clothing or shelter
Malnutrition and/or dehydration
Living in squalid or unsanitary conditions
Neglecting household maintenance
Hoarding
Collecting a large number of animals in inappropriate conditions
Non-compliance with health or care services
Inability or unwillingness to take medication or treat illness or injury

5.3 High Risk Groups

Certain groups of people may be at higher risk of abuse or neglect, including:

Those with care and support needs, such as older people or people with disabilities. They may be seen as an easy target and may be less likely to identify abuse themselves or to report it
Those with communication difficulties because they may not be able to alert others
Those with a cognitive impairment, as they may not even be aware that they are being abused

5.4 Who Abuses and Neglects?

Anyone in contact with the Service User can perpetrate abuse or neglect, including:

Volunteers
Family members
Friends
People who deliberately exploit adults they perceive as vulnerable to abuse
Staff
Professionals
Other Service Users

5.5 Incidents of Abuse

Patterns of abuse vary and include:

Serial abuse – in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse
Long-term abuse – in the context of an ongoing family relationship such as domestic violence between spouses or generations, or persistent psychological abuse
Opportunistic abuse – such as theft occurring because money or jewellery has been left lying around Abuse may be one-off or multiple and affect one Service User or

Staff should look beyond single incidents or Service Users. Mariama Care T/A Kangaroo Healthcare should

have systems in place to track and monitor incidents, accidents, disciplinary action, complaints and safeguarding concerns, to identify patterns of potential harm..

Repeated instances of poor care may be an indication of more serious problems (organisational abuse). In order to see these patterns, it is important that information is recorded and appropriately shared.

5.6 Concerns

A concern might arise from:

Something you observe (for example: bruises, a marked change in behaviour)
An allegation that is made (for example, you are told that someone has behaved inappropriately or put a Service User or colleague at risk)
A disclosure where a Service User tells you something about themselves or their circumstances that lead you to believe that they are being abused or are at risk of abuse

Staff must be able to:

Recognise: Identify that the Service User at risk may be describing abuse, even when they may not be

explicit

Respond: Stay calm, listen and show empathy
Record: Write up notes of the conversation clearly and factually as soon as possible
Report in a timely manner to the appropriate people and organisations

5.7 Staff who Consider or Suspect Abuse or Neglect

If staff observe something that causes concern, they should ask the Service User what happened, unless this would be inappropriate or cause further distress.

If the Service User does not communicate with speech, they should help them explain what has happened as far as possible.

The staff member should document what they have seen or been told and report to Hannah Addo or Churinder.

If staff are unsure if there is an indicator of abuse or neglect with a Service User, they should discuss this with Hannah Addo or Churinder at Mariama Care T/A Kangaroo Healthcare.

Hannah Addo or Churinder will decide whether to make a safeguarding referral or to seek further advice form Enfield Council.

Staff who suspect abuse or neglect must act on it; staff must not assume that someone else will do this.

If someone makes an allegation to a member of staff about them or another member of staff or volunteer, that staff member must listen carefully and explain that they will need to pass these concerns to Hannah Addo or Churinder, reassuring them that their concerns will be taken seriously. If the allegation is made by a family member or a worker from another agency, the staff member should take their name and contact details and assure them that Hannah Addo or Churinder will contact them as soon as possible. The staff member must pass the information to Hannah Addo or Churinder immediately.

5.8 Responding to a Disclosure or Suspicion of Abuse or Neglect

If a Service User discloses potential or actual abuse, staff will:

Straight away:

Remain calm and non judgemental
Try not to show shock or disbelief
Not interrupt the Service User who is freely recalling significant events, allow them to tell you whatever they want to share
- Some Service Users may simply be telling a story and not realise that they are subject to abuse. It is important to keep this in mind and be thoughtful in response
Take whatever action is required to ensure the immediate safety or medical welfare of the Service User

at risk
- Where appropriate, call 999 for the emergency services if there is a medical emergency, other danger to life or risk of imminent injury, or if a crime is in progress. Where a crime is suspected of being committed, leave things as they are wherever possible
- Call for medical assistance from the GP or NHS 111 if there is a concern about the Service User’s need for medical assistance or advice, when the situation is not life-threatening or is out of hours
  - Reassure the Service User that they are right to share this information with you; show empathy with them
  - Do not press for more detail
  - Do not make promises that cannot be kept
  - Remain sympathetic and attentive Then:
  - Listen carefully and reflect back what you are being told to ensure you have correctly grasped what is being said
  - Use simple and open questions, do not ask leading questions, (e.g. ‘So was it Peter who did that?’) or attempt to ‘investigate’ in any way
  - Explain carefully that what they have said is worrying and that you have to share that with your line manager
    - Explain the safeguarding process to the Service User and discuss the next steps

Explain that your manager may contact the Enfield Council Safeguarding Adults Team and/or the Police

Seek the Service User’s consent to share this information
As soon as you can, write down an account of your conversation, try to use the words/phrases that the Service User used. Sign and date your record
Preserve evidence (physical evidence – for example, ask the Service User to not wash or bathe)
Inform Hannah Addo or Churinder as soon as possible to inform them of the incident or concern
- Hannah Addo will be contacted on 07940952719
- Churinder will be contacted on Churinder
Do not share this information with anyone else
Do not contact the alleged abuser about the incident yourself, unless this is essential (for example, if Hannah Addo needs to immediately suspend a member of staff)
The Service User may feel frightened, so ask whether they want someone they feel comfortable with to stay with them

Staff must inform Hannah Addo or Churinder (unless they are the alleged abuser; if this is the case, then support should be sought directly from another manager, Mariama Care/T/A Kangaroo Healthcare Ltd

or Enfield Council.

Staff must also take action without the immediate authority of Hannah Addo or Churinder:

If a discussion with them would involve a delay in an apparently high-risk situation
If they have raised concerns with Hannah Addo or Churinder and they have not taken appropriate action (whistleblowing)

There should be effective and well publicised ways of escalating concerns where Hannah Addo or Churinder does not take action in response to a concern being raised.

Hannah Addo or Churinder will:

Listen to any staff member if they speak up about abuse or neglect, take them seriously and act accordingly
Consider if there are other adults or children with care and support needs who are at risk of harm and take appropriate steps to protect them
Hannah Addo or Churinder will support and encourage the Service User to contact the police if a crime has been, or may have been, committed

When responding to indicators of abuse and neglect, staff must:

Follow the principles of the Making Safeguarding Personal Framework:
- Ensure that any actions are guided by the wishes and feelings of the Service User
- Be aware that Service Users experiencing abuse or neglect may be influenced, coerced or controlled by someone else
- Be aware that duties of care and public interest can override personal preference, for example, there is a risk that a perpetrator could abuse again – this needs to be addressed and prevented
Staff must also follow the principles of the Mental Capacity Act 2005 if the Service User lacks capacity

5.9 Documenting a Disclosure

Mariama Care T/A Kangaroo Healthcare must ensure that staff:

Record what the Service User actually said, using their own words and phrases
Describe the circumstance in which the disclosure came about
Note the setting and anyone else who was there at the time
When there are cuts, bruises or other marks on the skin, use a body map to indicate their location, noting the colour of any bruising
Record information that is factual
Use a pen with black ink so that the report can be photocopied
Keep writing clear
Sign and date the report, noting the time and location

Are aware that the report may be needed later as part of a legal action or disciplinary procedure Hannah Addo must ensure they preserve any evidence relating to a safeguarding concern, including care records, as these may be required in future for local authority enquiries or police

5.10 Response by Hannah Addo or Churinder to Reports of Abuse or Neglect

Hannah Addo or Churinder at Mariama Care T/A Kangaroo Healthcare should treat any report of abuse or neglect as a safeguarding concern and:

Ask the Service User at risk what they would like to happen next
Ensure that they have access to communication support
Explain that they have a responsibility to report concerns to Enfield Council, and tell the Service User who they will report to, why, and when

Decision-Making Pre-referral to the Enfield Council Safeguarding Adults Team:

Hannah Addo or Churinder will usually lead on decision-making.

When considering if a safeguarding concern needs to be completed, Hannah Addo or Churinder must consider the three duties in Section 42 (1) of the Care Act 2014:

Does the person have needs for care and support (whether or not the authority is meeting any of those needs)?
Are they experiencing, or at risk of, abuse or neglect? and
As a result of those needs, are they unable to protect themself against the abuse or neglect or the risk of it?

When using professional judgement to determine whether an incident is reported to the local authority safeguarding adults team/police, Hannah Addo or Churinder should consider the following:

The consequences to the alleged victim and the equality of the relationship between the alleged perpetrator and the alleged victim
The ability of the alleged victim to consent
The mental capacity of the alleged perpetrator to understand the consequences of their decision to act in the way that is alleged
The intent of the alleged perpetrator
The frequency of this and similar allegations regarding the alleged perpetrator
The alleged victim considers the actions against them to be abusive
The alleged victim or carer is distressed, fearful or feels intimidated by the incident
You believe that there is a deliberate attempt to cause harm or distress
Incidents are repetitive and targeted to either the Service User or others
The action resulted in a physical injury
A crime has been committed
The incident involves a member of staff
If any other people (including children) are at risk as well as the Service User you are concerned about In the decision-making process, they must evidence the following:
Why does this adult(s) need safeguarding – what are the risks?
What actions need to be taken to reduce that risk?
Do they consent to this action?
Are others potentially at risk?

Hannah Addo or Churinder will document their decision-making process.

If Hannah Addo or Churinder is not sure whether to make a safeguarding referral to Enfield

Council (because they are not sure whether they suspect abuse or neglect), they should discuss with Enfield Council.

If a Service User does not want any safeguarding actions to be taken, but abuse or neglect is suspected, a safeguarding referral must still be made.

Mariama Care T/A Kangaroo Healthcare will ensure that staff are aware of the Enfield Council reporting procedures and timescales for raising adult safeguarding concerns.

If a referral is made but the Service User at risk is reluctant to continue with an investigation, this must be

recorded and brought to the attention of the Enfield Council safeguarding adults team. This will enable a discussion on how best to support and protect the Service User at risk.

5.11 Consent

When reporting information that directly concerns the safety of an adult at risk of harm, consent from the Service User is not required. However, informing the Service User of your concerns and your referral is good practice unless it would put you or your colleagues at risk or it would put the adult at further risk.

When reporting allegations or concerns about an adult at risk of harm to the Local Authority, the Local Authority must be informed whether or not the Service User is aware of the report.

In reporting all suspected or confirmed cases of harm, an employee has a responsibility to act in the best interest of the Service User but still operate within the relevant legislation and the parameters of the codes and standards of their practice.

5.12 Referral to the Enfield Council Safeguarding Adults Team

Mariama Care T/A Kangaroo Healthcare must ensure that the Enfield Council safeguarding adult referral process is followed and must collect the following information to assist with the referral. The referral process must be clearly visible with contact numbers, including out-of-hours, where staff can access the information.

Where the CCG is the commissioner they must also be informed.

The referral information will also be required for some of the CQC notification of abuse documentation. Mariama Care T/A Kangaroo Healthcare must use any up-to-date Care Plan information where possible and have the following information available where possible:

Contact details for the adult at risk, the person who raised the concern and for any other relevant individual, and next of kin
Basic facts, focusing on whether or not the Service User has care and support needs including communication and ongoing health needs
Factual details of what the concern is about; what, when, who, where?
Immediate risks and action taken to address risk
Preferred method of communication
If reported as a crime, details of which police station/officer; crime reference number
Whether the adult at risk has any cognitive impairment which may impede their ability to protect themselves
Any information on the person alleged to have caused harm
Wishes and views of the adult at risk, in particular consent
Advocacy involvement (includes family/friends)
Information from other relevant organisations, for example, the CQC
Any recent history (if known) about previous concerns of a similar nature or concerns raised about the same person, or someone within the same household
Names of any staff involved

5.13 Local Authority Safeguarding Enquiry

Enfield Council may well be reassured by the response of Mariama Care T/A Kangaroo Healthcare so that no further action is required. However, Enfield Council would have to satisfy itself that the response of Mariama Care T/A Kangaroo Healthcare has been sufficient to deal with the safeguarding issue and, if not, to undertake any enquiry of its own. This will identify if action needs to be taken and who needs to take that action.

The enquiry:

Could be an informal conversation with the Service User at risk
Could be a more formal multi-agency discussion
Does not have to follow a formal safeguarding process The objectives of an enquiry are to:
Establish facts
Ascertain the Service User’s views and wishes
Assess the needs of the Service User for protection, support and redress and how they might be met

Protect from the abuse and neglect, in accordance with the wishes of the Service User
Make decisions as to what follow-up action should be taken with regard to the person or organisation responsible for the abuse or neglect
Enable the Service User to achieve resolution and recovery

If Enfield Council decides that Mariama Care T/A Kangaroo Healthcare should make the enquiry, then Enfield Council should be clear about timescales, the need to know the outcomes of the enquiry and what action will follow if this is not done.

What happens as a result of an enquiry should reflect the Service User’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 Service User should always be involved from the beginning of the enquiry.

Strategy Meeting/Case Conference:

Following the investigation or at any time during the process, a case conference with all relevant agencies may be called to make decisions about future action to address the needs of the Service User
Any agency involved in the case may ask for a case conference to be held but the final decision to hold a conference is with the Enfield Council Safeguarding Adults Team Manager
Mariama Care T/A Kangaroo Healthcare must ensure that it attends this meeting when invited and that all relevant information about the incident is available. A timeline of events is a useful document to prepare in complex cases

Safeguarding Adults Reviews:

Safeguarding adults reviews (SARs) are a statutory requirement for Safeguarding Adults Boards with the purpose of promoting learning and improving safeguarding practice
A safeguarding adults review must be arranged by a Safeguarding Adults Board if:
- There is reasonable cause for concern that partner agencies could have worked more effectively to protect an adult and
- Serious abuse or neglect is known or suspected and
- Certain conditions are met, in line with section 44 of the Care Act 2014 and related statutory guidance

5.14 Involve the Service User Concerned Throughout the Enquiry:

The process must be explained to the Service User in a way they will understand and their consent to proceed with the enquiry obtained, if possible
Arrangements will be made to have a relative, friend or independent advocate present if the Service User so desires. The relative, friend or independent advocate must not be a person suspected of being in any way involved or implicated in the abuse
A review of the Service User’s Care Plan and risk assessments must be undertaken to ensure individualised support following the incident
The Service User will be supported by Mariama Care T/A Kangaroo Healthcare to take part in the safeguarding process to the extent to which they wish, or are able to, having regard for their decisions and opinions. They must be kept informed of progress

Desired Outcomes Identified by the Service User:

The desired outcome by the Service User at risk must be clarified and confirmed:

To ensure that the outcome is achievable
To manage any expectations that the Service User may have
To give focus to the enquiry
Hannah Addo will support Service Users at risk to think in terms of realistic outcomes but must not restrict or unduly influence the outcome that the Service User would like. Outcomes must make a difference to risk and, at the same time, satisfy the Service User’s desire for justice and enhance their wellbeing
The Service User’s views, wishes and desired outcomes may change throughout the course of the enquiry process

There must be an ongoing dialogue and conversation with the Service User to ensure that their views and wishes are gained as the process continues and enquiries re-planned if the Service User changes their views
The Service User will be informed of the outcome of any investigation, but guidance will be sought from the Enfield Council Safeguarding Adults Team before any outcome is shared

5.15 After An Enquiry

Once an initial enquiry has been undertaken, discussions should be had with the Service User as to whether a further enquiry is needed and what further action could be taken.

That action could include disciplinary, complaints or criminal investigations or work by contracts managers and CQC to improve care standards.

Enfield Council must determine what further action is necessary. One outcome may be the formulation of agreed action or a safeguarding plan for the Service User which should be recorded in their Care Plan. This will be the responsibility of the relevant agencies to implement. This will entail joint discussion, decision taking and planning with the Service User for their future safety and wellbeing.

In relation to the Service User, this could set out:

What steps are to be taken to assure their safety in future
The provision of any support, treatment or therapy including ongoing advocacy
The need for fuller assessments by health and social care agencies
Any modifications needed in the way services are provided (for example, same gender care or placement; appointment of an OPG deputy)
How best to support the Service User through any action they take to seek justice or redress
Any ongoing risk management strategy as appropriate
Any action to be taken in relation to the person or organisation that has caused the concern

5.16 If a Safeguarding Concern is not agreed

If Enfield Council decides not to investigate, staff must ensure the continual safety of Service Users. Staff should:

Evaluate existing risk assessments and Care Plans. Ensure that there is clear, documented evidence that this has occurred
If the existing risk assessments and Care Plans do not cover the current risk(s), staff must implement new ones to ensure measures have been put in place to reduce future risk
Staff can consider other referral options (this list is not exhaustive):
- Human resources (capability/disciplinary routes)
- Health and safety
- Complaints
- Enfield Council care management, request review of current Care Plan, request for a case conference
- NHS continuing care team, request a review
- Request for a best interest meeting

5.17 Informing the Relevant Inspectorate

By law, Mariama Care T/A Kangaroo Healthcare must notify the Care Quality Commission without delay of incidents of abuse and allegations of abuse, as well as any incident which is reported to, or investigated by, the police
Mariama Care T/A Kangaroo Healthcare must notify CQC about abuse or alleged abuse involving a person(s) using the service, whether the person(s) is/are the victim(s), the abuser(s), or both
Mariama Care T/A Kangaroo Healthcare must also alert the relevant local safeguarding authority when notification is made to CQC about abuse or alleged abuse
The forms are available on CQC’s website
If a concern is received via the whistleblowing procedure, Mariama Care T/A Kangaroo Healthcare must inform the Enfield Council Safeguarding Team and CQC

5.18 Support and Supervision

Mariama Care T/A Kangaroo Healthcare will recognise that dealing with situations involving abuse and neglect can be stressful and distressing for staff and workplace support should be available.

During safeguarding enquiries, Hannah Addo should:

Be aware of how safeguarding allegations can affect the way other staff and Service Users view a Service User subject to a safeguarding enquiry
If staff are concerned about working with a Service User who has made allegations, Hannah Addo should provide support, additional training and supervision to address these concerns and ensure that the Service User is not victimised by staff
Acknowledge that enquiries are stressful and that morale may be low
Think of ways to support staff (such as one-to-one supervision and team meetings)
Provide extra support to cover absences as part of the enquiry, and to help staff continue providing consistent and high-quality care
Direct staff to sources of external support or advice if needed

Regular face-to-face supervision and reflective practice from skilled line managers is essential to support staff, and to enable staff to work confidently and competently with difficult and sensitive situations.

Hannah Addo has a central role in ensuring high standards of practice at Mariama Care T/A Kangaroo Healthcare and that staff are properly equipped and supported.

5.19 Confidentiality and Information Sharing

In seeking to share information for the purposes of protecting adults at risk, Mariama Care T/A Kangaroo Healthcare is committed to the following principles:

Personal information will be shared in a manner that is compliant with the statutory responsibilities of Mariama Care T/A Kangaroo Healthcare
Adults at risk will be fully informed about information that is recorded about them and, as a general rule, be asked for their permission before information about them is shared with colleagues or another agency. However, there may be justifications to override this principle if the adult or others are at risk
Staff will receive appropriate training on Service User confidentiality and secure data sharing
The principles of confidentiality designed to protect the management interests of Mariama Care T/A Kangaroo Healthcare must never be allowed to conflict with those designed to promote the interests of the adult at risk
Staff will follow policies at Mariama Care T/A Kangaroo Healthcare on UK GDPR, data protection, confidentiality and comply with the Caldicott principles

5.20 Staff Alleged to be Responsible for Abuse or Neglect

Mariama Care T/A Kangaroo Healthcare does not only have a duty to the Service User, but also a responsibility to take action in relation to the employee when allegations of abuse are made against them. Mariama Care T/A Kangaroo Healthcare should ensure that their disciplinary procedures are compatible with the responsibility to protect adults at risk of abuse or neglect.

When a member of staff is subject to a safeguarding enquiry, Hannah Addo should:

Tell them about any available Employee Assistance Programme
Tell them about professional counselling and occupational health services (if available)
Make them aware of their rights under employment legislation and any internal disciplinary procedures
Nominate someone to keep in touch with them throughout the enquiry (if they are suspended from work)
- They should be able to request that the nominated person be replaced, if they think there is a conflict of interest
- The nominated person should not be directly involved with the enquiry
If the police are involved, tell them who the nominated person is

For members of staff who return to work after being suspended, Hannah Addo should:

Arrange a return-to-work meeting when the enquiry is finished, to give them a chance to discuss and resolve any problems
Agree a programme of guidance and support with them

Where appropriate, Hannah Addo should report staff to the statutory and other bodies responsible for

professional regulation such as the Nursing and Midwifery Council.

If Hannah Addo is subject to a safeguarding enquiry, Mariama Care/T/A Kangaroo Healthcare Ltd should put an acting manager in their place if required.

5.21 Disclosure and Barring Service (DBS) Referral

There is a statutory requirement for providers of Care to refer workers to the DBS for inclusion on the DBS Vetting and Barring scheme list if they consider that the person is guilty of misconduct such that an adult at risk was harmed or placed at risk of harm. The legal duty to refer to the Disclosure and Barring Service also applies where a staff member leaves their role to avoid a disciplinary hearing following a safeguarding incident and Mariama Care T/A Kangaroo Healthcare feels they would have dismissed the person based on the information they hold.

Please see the DBS/Disclosure Policy and Procedure for further procedures regarding initial employment and referral.

5.22 Abuse by Another Adult at Risk

Mariama Care T/A Kangaroo Healthcare recognises that they may also have responsibilities towards the person causing the harm, and certainly will have if they are both in a care setting or have contact because they attend the same place (for example, a day centre). The person causing the harm may themselves be eligible to receive an assessment. In this situation, it is important that the needs of the Service User at risk who is the alleged victim are addressed separately from the needs of the person causing the harm. It will be necessary to reassess the adult allegedly causing the harm.

Under the Mental Capacity Act 2005, people who lack capacity and are alleged to be responsible for abuse, are entitled to the help of an Independent Mental Capacity Advocate to support and represent them in the enquiries that are taking place. This is separate from the decision whether or not to provide the victim of abuse with an independent advocate under the Care Act.

5.23 Management of Allegations Against People in Positions of Trust (PiPoT)

A relationship of trust is one in which one person is in a position of power or influence over the other person because of their work or the nature of their activity. Any allegation against a person who works with adults with care and support needs must be reported immediately to Hannah Addo.

When an allegation is made against a PiPoT, Mariama Care T/A Kangaroo Healthcare will refer this to Enfield Council as part of the safeguarding process.

Where the person alleged to have caused the harm or neglect is a volunteer or a member of a community group, Mariama Care T/A Kangaroo Healthcare must work with adult social services to support any action under this policy.

Where the person alleged to have caused the harm is a neighbour, a member of the public, a stranger or a person who deliberately targets vulnerable people, the Service User at risk should receive the services and support that they may need. In all cases, issues of consent, confidentiality and information sharing must be considered.

5.24 Allegations Against People who are Relatives or Friends

There is a clear difference between unintentional harm caused inadvertently by a relative or friend and a deliberate act of either harm or omission, in which case the same principles and responsibilities for reporting to the police apply. In cases where unintentional harm has occurred, this may be due to lack of knowledge or due to the fact that the relative’s own physical or mental needs make them unable to care adequately for the adult at risk. The relative may also be an adult at risk. In this situation, the aim is to protect the adult from harm, work to support the relative to provide support and to help make changes in their behaviour in order to decrease the risk of further harm to the person they are caring for. A carer’s assessment will take into account a number of factors and a referral to Enfield Council will be made as part of the safeguarding process.

5.25 Pressure Ulcers

Mariama Care T/A Kangaroo Healthcare must follow local safeguarding reporting requirements and the Department of Health and Social Care (DHSC) guidance ‘Pressure Ulcers: How to Safeguard Adults’ (a link can be found in the Underpinning Knowledge section of this policy) with regards to pressure ulcers.

The aim of the DHSC guidance is to provide a national framework, identifying pressure ulcers as primarily an issue for clinical investigation rather than a safeguarding enquiry led by the local authority. Indicators to help decide when a pressure ulcer case may additionally need a safeguarding enquiry are included.

‘It is the responsibility of the designated safeguarding lead in each setting to appropriately triage any safeguarding concerns and ensure that referrals to the local authority for consideration of a section 42 (2) enquiry are appropriate.’ (GOV.UK 2024)

The DHSC guidance contains the following Appendices that are used in the decision making:

Appendix 1: adult safeguarding decision guide
Appendix 2: body map
Appendix 3: adult safeguarding concern proforma regarding pressure ulceration

Safeguarding Concern Assessment Guidance:

A history of the development of the skin damage should first be obtained by a clinician, usually a nurse
Where there is concern from the clinician assessing the pressure ulcer that there has been abuse or neglect that can be directly associated with the pressure ulcer, there is a need to raise it as a safeguarding concern within Mariama Care T/A Kangaroo Healthcare
In some cases it may warrant raising a safeguarding concern with Enfield Council
If the Service User’s care has recently been transferred, this may require contact being made with former care providers for information to seek clarification about the cause and timing of the skin damage. This is the responsibility of Mariama Care T/A Kangaroo Healthcare and a concern should not be raised with Enfield Council until this has been done
If a concern is raised that a Service User has severe damage, Hannah Addo should:
- Complete the adult safeguarding decision guide
- Raise an incident immediately as per the policy of Mariama Care T/A Kangaroo Healthcare
- (Severe damage in the case of pressure ulcers may be indicated in some cases by multiple category 2 or single category 3 or 4 ulcers, but could also be indicated by the impact the pressure damage has on the Service User affected (for example, pain)

Adult Safeguarding Decision Guide:

The decision guide should be completed by a qualified member of staff who is a practising registered nurse (RN) with experience in wound management and not directly involved in the provision of care to the Service User at the time the pressure ulcer developed
The adult safeguarding decision guide should be completed immediately or within 48 hours of identifying the pressure ulcer of concern. In exceptional circumstances this timescale may be extended but the reasons for extension should be recorded
The outcome of the assessment should be documented on the adult safeguarding decision guide. If further advice or support is needed with regards to making the decision to raise a concern to Enfield Council, Churinder or Hannah Addo should be involved
Where the Service User has been transferred into the care of Mariama Care T/A Kangaroo Healthcare it may not be possible to complete the decision guide. Contact should be made with the transferring organisation to ascertain if the decision guide has been completed or any other action taken
Following this, a decision should be made whether to raise a safeguarding adults concern with Enfield Council, in line with agreed local arrangements
The decision as to whether there should be a Section 42 enquiry will be taken by the local authority, informed by a clinical view. A summary of the decision should be recorded and shared with all agencies involved
Where an internal investigation is required, this should be completed by the organisation that is or was taking care of the Service User when the pressure ulcer developed, in line with the local policies
The local authority needs to decide or agree after completion of the internal investigation if a full multi- agency meeting (virtual or face to face) needs to be convened to agree findings, decide on safeguarding outcomes and any actions
The safeguarding decision guide assessment considers 6 important questions that together indicate a safeguarding decision guide score. This score should be used to help inform decision making regarding escalation of safeguarding concerns related to the pressure ulceration. It is not a tool to risk assess for the development of pressure damage
The threshold for raising a concern is 15 or above in most instances. However, this should not replace professional judgement
Photographic evidence to support the report should be provided wherever possible. Consent for this should be sought as per local policy but great sensitivity and care must be taken to protect the identity

of the individual

A body map should be used to record skin damage and can be used as evidence, if necessary, at a later date. If 2 workers observed the skin damage, they should both sign the body map where possible
Documentation of the pressure ulcer should include as a minimum:
- Site
- Size (including its maximum length, width and depth in centimetres)
- Tissue type
- Category
Where the decision guide score is 15 or higher, or where professional judgement determines safeguarding concerns, copies of the completed decision guide and safeguarding concern proforma should then be sent to the adult safeguarding team within Enfield Council. Copies of both should also be retained in the Service User’s Care Plan
Where there is no indication that a safeguarding concern needs to be raised, the completed decision guide should be retained in the Service User’s Care Plan

5.26 Medication Errors

Mariama Care T/A Kangaroo Healthcare must follow local safeguarding reporting procedures for medication errors and ensure that notifications are made to the CQC in line with statutory requirements. Mariama Care T/A Kangaroo Healthcare will have an open and transparent approach to medication incidents, ensure that staff follow the Medication Errors and Near Misses Policy and Procedure at Mariama Care T/A Kangaroo Healthcare and understand their duty of candour responsibilities.

5.27 Exploitation by Radicalisers who Promote Violence

Individuals may be susceptible to exploitation into violent extremism by radicalisers. Staff will be expected to follow the Protecting Adults at Risk from Radicalisation Policy and Procedure in place at Mariama Care T/A Kangaroo Healthcare.

5.28 Self-neglect and Refusal of Care

Mariama Care T/A Kangaroo Healthcare must ensure that staff understand the importance of delivering care as detailed in the Care Plan. Where a Service User refuses Care, this must always be documented. Where refusal occurs repeatedly, it must be escalated by Mariama Care T/A Kangaroo Healthcare as a safeguarding concern and a request for a review of the Service User’s Care will be instigated.

5.29 Abuse and Sexual Safety

We recognise that culture, environment and processes support a Service User’s sexuality and keep them and staff safe from sexual harm. As such, Mariama Care T/A Kangaroo Healthcare will ensure that sexuality is discussed as part of the Care Plan process and is addressed positively to support people to raise concerns where necessary.

The CQC publication on sexuality and sexual safety can be referred to for further guidance in this area.

5.30 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.

Enfield Council has the lead role in making enquiries. However, where criminal activity is suspected, the early involvement of the police should take place.

5.31 Risk Assessment and Management

Achieving a balance between the right of the Service User to control their Care package and ensuring that adequate protections are in place to safeguard wellbeing is a very challenging task. The assessment of the risk of abuse, neglect and exploitation of Service Users will be integral in all assessment and planning processes. Assessment of risk is dynamic and ongoing, especially during the adult safeguarding

process, and must be reviewed throughout so that adjustments can be made in response to changes in the levels and nature of risk.

5.32 Training and Competencies

Staff, including volunteers at Mariama Care T/A Kangaroo Healthcare, are trained in recognising the symptoms of abuse or neglect, how to respond and where to go for advice and assistance.

Training should take place at all levels in Mariama Care T/A Kangaroo Healthcare and be updated regularly to reflect current best practice. To ensure that practice is consistent, no staff group should be excluded.

Mariama Care T/A Kangaroo Healthcare will ensure that staff receive training in recognising and responding to incidents, allegations or concerns of abuse or harm as part of their induction

programme. Mariama Care T/A Kangaroo Healthcare will benchmark its training and competencies within the service with the framework outlined in ‘Adult Safeguarding: Roles and Competencies for Health Care Staff”, which it recognises applies to social care staff also and does not replace any local or contractual requirements but acts as a minimum benchmark.

Mariama Care T/A Kangaroo Healthcare will also refer to the ‘NHS Prevent Training and Competencies Framework’ for more specific training requirements in relation to the Prevent strategy.

Specialist training will be provided for those who will be undertaking enquiries, Churinder and Hannah Addo at Mariama Care T/A Kangaroo Healthcare.

Churinder will cascade safeguarding information about adults at risk to appropriate staff members. Churinder will undertake and provide internal training and attend local safeguarding partnership updates, education and development sessions including regular group-based supervision.

Training needs to make a difference to the understanding, confidence and competence of staff. Assess what changes it has prompted through regular supervision sessions as well as annually during appraisals. Arrange refresher training if the annual check indicates this is needed.

5.33 Audit and Compliance

It is essential that the implementation of this policy and associated procedures is audited to ensure that Mariama Care T/A Kangaroo Healthcare is doing all it can to safeguard those receiving its services. The audit of this policy will be completed through a systematic audit of:

Recruitment procedures and disclosure and barring checks
Incident reporting, frequency and severity
Training processes, including reviews of uptake of training and evaluations

Safeguarding concerns and incidents will be reviewed by the senior management team as part of a root cause analysis with the following terms of reference:

Review incident themes
Reports from the lead responsible for safeguarding within Mariama Care T/A Kangaroo Healthcare
Look in detail at specific cases to determine learning or organisational learning
Ensure implementation of the Safeguarding Adults Policy and Procedure

Mariama Care T/A Kangaroo Healthcare should maintain and regularly audit care records (in addition to external checks, such as audits or Care Quality Commission inspections) and ensure that they are complete and available in case they are needed if a safeguarding concern is raised.

6.1 A Person with Care and Support Needs

According to the Care Act 2014: an older person, a person with a physical disability, a learning difficulty or a sensory impairment, someone with mental health needs, including dementia or a personality disorder, a person with a long-term health condition, someone who misuses substances or alcohol to the extent that it affects their ability to manage day-to-day living

6.2 Investigation

Investigation is a process that focuses on gathering ‘good evidence’ that can be used as a basis for the decision as to whether or not abuse has occurred
It must be a rigorous process and the evidence must be capable of withstanding close scrutiny as it may later be required for formal proceedings

6.3 Referral

Referral is when information regarding a possible safeguarding incident is passed on to another person for their direction. In the case of this policy, from the Provider to the Adult Social Care Team
Sometimes this may be referred to as ‘reporting’

6.4 Multi-agency

More than one agency coming together to work for a common purpose
This could include partners of the local authority such as: Integrated Care Boards (ICBs), NHS trusts and NHS foundation trusts, Department for Work and Pensions, the police, prisons, probation services, and/or other agencies such as general practitioners, dentists, pharmacists, NHS hospitals, housing, health and care providers

6.5 Caldicott Principles

The Caldicott Principles were developed in 1997 following a review of how patient information is protected and only used when it is appropriate to do so
Since then, when deciding whether they needed to use information that would identify an individual, an organisation must use the Principles as a test
The Principles were extended to adult social care records in 2000
The Principles were revised in 2013

6.6 Adults at Risk

Adults at risk means adults who need community care services because of mental or other disability, age or illness, and who are, or may be, unable to take care of themselves against significant harm or exploitation
The term replaces ‘vulnerable adult’

6.7 Making Safeguarding Personal

Making Safeguarding Personal is about person-centred and outcome-focused practice
It is how professionals are assured by adults at risk that they have made a difference to people by taking action on what matters to people and is personal and meaningful to them

6.8 Honour-based Violence

The terms ‘honour crime’, ‘honour-based violence’, and ‘izzat’ embrace a variety of crimes of violence (mainly but not exclusively against women), including physical abuse, sexual violence, abduction, forced marriage, imprisonment and murder where the person is being punished by their family or their community
They are punished for actually, or allegedly, ‘undermining’ what the family or community believes to be the correct code of behaviour
In transgressing this, the person shows that they have not been properly controlled to conform by their family and this is to the ‘shame’ or ‘dishonour’ of the family
‘Honour crime’ may be considered by the perpetrator(s) as justified to protect or restore the ‘honour’ of a family

6.9 Forced Marriage

The Anti-Social Behaviour, Crime and Policing Act 2014 protects people from being forced to marry

without their free and full consent as well as people who have already been forced to do so

We will ensure that staff are reminded of the one chance rule: e. our employees may only have one chance to speak to a potential victim of forced marriage and, therefore, only one chance to save a life
Forced marriage can involve physical, psychological, emotional, financial and sexual abuse including being held unlawfully captive, assaulted and raped
Law enforcement agencies will also be able to pursue perpetrators in other countries where a UK national is involved under powers defined in legislation

6.10 Independent Mental Capacity Advocate (IMCA)

An advocate appointed to act on a person’s behalf if they lack capacity to make certain decisions
Refer to the Mental Capacity Act (MCA) 2005 Policy and Procedure

6.11 Female Genital Mutilation (FGM)

Mandatory Reporting of Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM) is illegal in England and Wales under the FGM Act 2003 (‘the 2003 Act’)

Mariama Care T/A Kangaroo Healthcare has a mandatory duty to report known cases of FGM in under 18-year-olds to the police via the non-emergency number 101. ‘Known’ means that you have either visually identified that FGM has been carried out, or you have had direct verbal disclosure from the person affected
Other ways to report FGM include:
- The national FGM helpline on 0800 028 3550
- The social care team at your local council
- Crimestoppers, confidentially and anonymously

6.12 Safeguarding Adults Board

The Care Act 2014 required each local authority to set up a Safeguarding Adults Board
This includes the local authority, the NHS and the police. They should meet regularly to discuss and act upon local safeguarding issues
They develop shared plans for safeguarding, working with local people to decide how best to protect adults in vulnerable situations

6.13 Whistleblowing

The act of reporting a concern about safety, malpractice or wrongdoing within an orgnaisation to formal authorities

Professionals providing this service should be aware of the following:

Mariama Care T/A Kangaroo Healthcare is committed to supporting and protecting the wellbeing of Service Users by preventing harm and reporting and dealing with incidents of abuse through a proper process
Safeguarding is everybody’s business. Agencies have a duty to report safeguarding concerns to the local Safeguarding Adults Team
Staff of Mariama Care T/A Kangaroo Healthcare will report safeguarding concerns to the Hannah Addo or Churinder
The Hannah Addo or Churinder will refer safeguarding concerns to the Local Authority Safeguarding Adults Team
If it is suspected that a crime has taken place, the reporter of the incident must call the police immediately
Mariama Care T/A Kangaroo Healthcare will be led by the Local Authority Adult Safeguarding Team as to ‘next steps’ such as enquiries
If the alleged victim requires immediate removal from harm or medical attention, this will be done immediately
The Service User to whom the incident has happened will be consulted and supported to be involved in the safeguarding process and provided with information they understand throughout

People affected by this service should be aware of the following:

When the facts are brought together and a way forward has been decided with your input if possible, you will be talked through the findings
Mariama Care T/A Kangaroo Healthcare will have reviewed your Care Plan and worked with you to support you through the enquiry process and moving on in the future
Mariama Care T/A Kangaroo Healthcare has a duty to safeguard the people using its service
Mariama Care T/A Kangaroo Healthcare will provide information and Care Plans to help you understand safeguarding and what to look out for
If something happens that may be a safeguarding incident which involves you, Mariama Care T/A Kangaroo Healthcare will make sure that you understand your choices and the next steps, and that you are included as much as you want and can be
If you need extra support such as an advocate, one will be provided for you
Other agencies may be involved in getting to the facts of the incident
If it seems a crime has taken place, the police will be called immediately

As well as the information in the ‘underpinning knowledge’ section of the review sheet we recommend that you add to your understanding in this policy area by considering the following materials:

Please refer to the QCS Resource Centre for a full safeguarding pack as well as posters to raise awareness.

Home Office – Mandatory Reporting of Female Genital Mutilation: Procedural information:

https://assets.publishing.service.gov.uk/media/5a8086f2ed915d74e33faefc/FGM_Mandatory_Reporting_-

_procedural_information_nov16_FINAL.pdf

GOV.UK – Criminal Exploitation of Children and Vulnerable Adults: County lines: https://www.gov.uk/government/publications/criminal-exploitation-of-children-and-vulnerable-adults-county- lines

CQC – Promoting sexual safety through empowerment: https://www.cqc.org.uk/sites/default/files/20200225_sexual_safety_sexuality.pdf Prevent E-Learning: https://www.elearning.prevent.homeoffice.gov.uk/edu/screen1.html

Worcestershire Safeguarding Adults Board – Protocol for responding to allegations about people in a position of trust (PiPoT) working with adults: https://www.safeguardingworcestershire.org.uk/wp-content/uploads/2022/01/Position-of-Trust-Protocol- Final-Version-v2.1.pdf

Support and Help:

Hourglass – Resources and Forums: https://wearehourglass.org/
NHS – Social care telephone helplines and forums: https://www.nhs.uk/conditions/social-care-and- support-guide/help-from-social-services-and-charities/helplines-and-forums/
NHS – Someone to speak up for you (advocate): https://www.nhs.uk/conditions/social-care-and- support-guide/help-from-social-services-and-charities/someone-to-speak-up-for-you-advocate/
NHS – Guide to support options for abuse: https://www.mind.org.uk/information-support/guides-to- support-and-services/abuse/
Citizens Advice – Domestic Abuse: https://www.citizensadvice.org.uk/family/gender- violence/domestic-violence-and-abuse/

To be ‘ outstanding ’ in this policy area you could provide evidence that:

The wide understanding of the policy is enabled by proactive use of the QCS App
Care or support planning includes tailored information to support individual Service Users to make safe choices to promote independence and wellbeing. People report that they feel safe and well supported
Records are kept in regard to safeguarding and are extremely clear, transparent and well-ordered with all incidents reviewed and learning disseminated. Training materials are updated to reflect any learning
The same issues do not reoccur and robust measures and systems have been put in place to address the original safeguarding concern
Staff report that the service is fully aware of its responsibilities with regard to safeguarding, that they are encouraged to report incidents and are fully supported through the process
Service Users report that if they are involved in a safeguarding incident, then they are supported to be involved as much as they would like

The following forms are included as part of this policy:

Title of form

When would the form be used?

Created by

Safeguarding Incident Log – CR74

When a safeguarding concern or incident arises.

QCS

County Lines and Cuckooing – CR74

To raise awareness of different types of abuse.

QCS

Safeguarding Adults Statement – CR74

For display in the office.

QCS

Safeguarding Leaflet – CR74

On assessment, review or when concerns arise. To be used to offer guidance on who to contact. Please note an editable version can be located within the Resource Centre

QCS

Service User Name:
Name of person investigating incident/completing this form:
Name of person reporting incident (if not Service User):
Service User location:
Time and date of incident:
Precise location of incident:
Details of incident (include description of incident, as well as the names of any individuals who may have been involved. Remember to take care not to lead the Service User):

Use additional sheets if necessary

Name of witness(es):

Details of any injuries/was medical attention required?

What decision has been reached as a result of investigating the incident?

Name and designation of witness/advocate/support for Service User during discussion/report taking:

Use additional sheets if necessary

What immediate action was taken?

What lessons have been learned from this incident and investigation?

Were any outside agencies contacted? If so, who?

Use additional sheets if necessary

Hannah Addo recommendations, including Care Plan changes:

What actions will be taken to prevent further incidents?

Signature:
Print Name:
Title:
Date:
Reported to Management Meeting by:
Date:

One copy of this form to be held in the Service User’s personal file, one copy in the Safeguarding Incident file. Use additional sheets if necessary

Cuckooing and County Lines Fact Sheet

What are County Lines?

County lines is a term used to describe gangs and organised criminal networks involved in exporting illegal drugs into one or more importing areas within the UK, using dedicated mobile phone lines or other form of ‘deal line’. They are likely to exploit children and vulnerable adults to move and store the drugs and money and they will often use coercion, intimidation, violence (including sexual violence) and weapons. County lines activity and the associated violence, drug dealing and exploitation has a devastating impact on young people, vulnerable adults and local communities.

Gangs typically use children and adults at risk of harm to transport and/or deal drugs to customers. These victims are recruited using intimidation, deception, violence, debt bondage or grooming. During this process, the ‘victims’ are likely to commit criminal offences.

Who does it affect?

The term ‘vulnerable adults’ is used here in the context of ‘vulnerable to harm or abuse’. They do not need to be receiving social care or support to be vulnerable. Some vulnerabilities are outlined in this fact sheet.

County lines exploitation:

Can affect any child or young person (male or female) under the age of 18 years
Can affect any vulnerable adult over the age of 18 years
Can still be exploitation even if the activity appears consensual
Can involve force and/or enticement-based methods of compliance and is often accompanied by violence or threats of violence
Can be perpetrated by individuals or groups, males or females, and young people or adults and
Is typified by some form of power imbalance in favour of those perpetrating the Whilst age may be the most obvious, this power imbalance can also be due to a range of other factors including gender, cognitive ability, physical strength, status, and access to economic or other resources.

One of the key factors found in most cases of county lines exploitation is the presence of some form of exchange (e.g. carrying drugs in return for something). Where it is the victim who is offered, promised or given something they need or want, the exchange can include both tangible (such as money, drugs or clothes) and intangible rewards (such as status, protection or perceived friendship or affection).

Some of the factors that heighten a person’s vulnerability include:

Having prior experience of neglect, physical and/or sexual abuse
Lack of a safe/stable home environment, now or in the past (domestic violence or parental substance misuse, mental health issues or criminality, for example)
Social isolation or social difficulties
Economic vulnerability
Homelessness or insecure accommodation status
Connections with other people involved in gangs
Having a physical or learning disability
Having mental health or substance misuse issues
Being in care (particularly those in residential care and those with interrupted care histories)
Being excluded from mainstream education, in particular attending a Pupil Referral Unit

What happens?

Once in debt to a dealer, they will be encouraged to sell drugs to pay the debt off
The gang will ensure the debt is never fully paid off and the victim can quickly become trapped in a cycle where their only option is to commit further crime
The more crime they commit, the less likely they are to tell someone what is happening or seek help

They will be dispatched to travel to other parts of the country where they are not known to police or social services and can essentially fly under the radar
During this time away from home they are highly at risk of coming to further harm at the hands of people they are dealing to or rival local drug dealers
Older people may become exploited to also traffic drugs, weapons and cash but additionally their homes might get taken over by gangs needing somewhere to hide drugs or deal from
Adults with mental or physical disabilities, adults with addictions or adults who are particularly elderly may experience ‘cuckooing’ where a gang takes over their home
Other victims include the relatives of the exploited person who ‘lose’ their loved one to a criminal gang, and the communities where the drug dealing and associated violence is exported to

What are the signs in adults?

In adults, signs of ‘cuckooing’ can include:

A loved one or neighbour not being seen for some time
Unknown visitors and vehicles to their house at unusual times
Exchanges of cash or packages outside their home
Open drug use in the street; damage and deterioration to the appearance of their home
A change in their own personality or behaviour and appearing nervous, worried or intimidated

What should you do?

If you are worried that a person is at immediate risk of harm, you should also contact the police, your local safeguarding team or, in the case of a child, your local safeguarding partner (the group of Local Authority, ICB and police. Refer to ‘Working Together to Safeguard Children 2018’ for more information.)

References

Serious Violence Strategy April 2018:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/698009/serious- violence-strategy.pdf

Safeguarding is described as ‘protecting an adult’s right to live in safety, free from abuse and neglect’. Adult safeguarding is about preventing and responding to concerns of abuse, harm or neglect of adults. Individuals who are vulnerable may be unable to take care of themselves or protect themselves against significant harm or exploitation. This means that they may be at risk of abuse or neglect due to the actions (or lack of action) of another person. In these cases, it is vital that Mariama Care T/A Kangaroo Healthcare works together to identify people at risk and put steps in place to help prevent abuse or neglect.

Safeguarding adults is a priority for Mariama Care T/A Kangaroo Healthcare. The activities carried out by Mariama Care T/A Kangaroo Healthcare mean that there are a range of staff and people working on our behalf who may come into contact with people who are at risk of harm.

What action must you take if you have concerns?

Mariama Care T/A Kangaroo Healthcare follows Enfield Council safeguarding procedures and its own policy and procedure details the responsibilities and action required by all staff. If you have any concerns that someone is at risk of harm or abuse, is being harmed or abused, you must take action.

Ensure your own safety – leave the situation if you are at risk of harm
Where there is clear evidence of harm or an imminent danger, call the emergency services immediately
Treat all allegations of abuse seriously
Report concerns to your line manager as soon as possible

Who do you report your concerns to?

At Mariama Care T/A Kangaroo Healthcare the person responsible for safeguarding is:

Churinder

They can be contacted on Churinder or churinder.katoorah@kangaroohealthcare.co.uk Escalating Concerns

We report our concerns to Enfield Council

Enfield MASH Team 020 83200106

Raising a Concern to the CQC

You can also contact the CQC if you feel that you cannot use the Raising Concerns, Freedom to Speak Up and Whistleblowing Policy and Procedure at Mariama Care T/A Kangaroo Healthcare. The CQC can be contacted by using the following methods:

Phone: 03000 616161

Email: Enquiries@cqc.org.uk

Post: CQC National Correspondence, Citygate, Gallowgate, Newcastle upon Tyne. NE1 4PA

This statement and our full Safeguarding Adults Policy and Procedure is available online and in other languages by accessing www.qcs.co.uk

Concerned About Abuse A Guide to Keeping Safe for People who use our Services
What Can You Do?
• No one should have to live with abuse • By reporting abuse, you can help bring it to an end • You may feel completely alone but you are not • There are people who can help and it is important to get in touch with them • Abuse can be very confusing especially if you look up to the person hurting you or if they are a friend or a member of your family • You might not want to talk to someone you know and might prefer to speak to or email someone at one of the services in this factsheet • These services have people who are trained to help and support you and they will not be shocked or surprised at what you say. They will listen to you and help you decide what to do
Who Can Help?
Safeguarding Team	Police
Churinder	In an Emergency: 999
Churinder	In a non-emergency: 101
churinder.katoorah@kangaroohealthcare.co.uk
Website:
Care Quality Commission (CQC)	Silverline
Phone: 03000 61 61 61 Web: https://www.cqc.org.uk/	Confidential 24-Hour Helpline Phone: 0800 4 70 80 90 Web: https://www.thesilverline.org.uk/
Local Authority
Enfield MASH Team 020 83200106

Adult Abuse
What is Adult Abuse?	Adult Abuse is Wrong
• Adult abuse is when someone hurts or scares you on purpose • They might say, ‘Don’t tell anyone’	• Adult abuse can happen to anyone • You need to know what to do if it happens to you or to someone you know
Abuse can Happen Anywhere	Abuse can be Caused by Anyone
• At home • In a residential or care home • In hospital • In a day service, work, school • On the internet or phone • Public place/in the community	• A partner or relative • A friend or neighbour • Sometimes a person pretends to be your friend so they can abuse you. This is called ‘Mate Crime’ • A paid or volunteer carer • Other Service Users • Someone in a position of trust • A stranger
Some Examples of Abuse
Physical Abuse	Neglect
• Being hit, slapped, kicked, or hurt in another way • Being pushed • Being restrained	• This is when you do not get the help you need. It might include not getting help with your medication, or your care needs, or not giving you enough food
Sexual Abuse	Discriminatory Abuse
• This is when someone touches your private parts when you don’t want them to, or makes you touch them • It is also when someone talks to you about sex when you don’t want them to	• This is when someone treats you badly because you are different to them. This is sometimes called ‘Hate Crime’ • This could be because of your age or gender; sexuality or disability; race or religious belief
Financial or Material Abuse	Organisational Abuse
• This is when someone takes something that belongs to you without asking, or makes you give them things	• If abuse is caused by an organisation, it is often called ‘Organisational Abuse’. This is where you are not being cared for properly. It is where your own choices are ignored
Modern Slavery	Self-neglect
• This is when someone is forced to work with little or no pay, or threatened with violence if they do not work	• This is when someone might come to harm because they do not look after themselves • This might be not eating or taking their medication or looking after their personal hygiene
Domestic Violence and Abuse	Psychological Abuse
• When abuse occurs between partners or family members, it is often called ‘Domestic Violence and Abuse’	• This is when someone tries to control or hurt you emotionally with what they say or do • It could be name calling, threats, silence, humiliation, bullying

Safeguarding Adults Policy and Procedure

Care Management – Rights & Abuse

Key Question Key Lines of Enquiry Quality Statements

4.1 What is Safeguarding?

4.5 What Constitutes Abuse?

4.13 Whistleblowing

4.14 The Care Worker’s Responsibilities

4.15 The Hannah Addo’s Responsibilities

4.16 General Principles

4.17 Leadership, Staff and Culture

4.18 Prevention – Providing information to support Service Users

4.19 Prevention – Raising awareness

5.1 Index

5.3 High Risk Groups

5.4 Who Abuses and Neglects?

5.5 Incidents of Abuse

5.6 Concerns

5.7 Staff who Consider or Suspect Abuse or Neglect

5.8 Responding to a Disclosure or Suspicion of Abuse or Neglect

5.9 Documenting a Disclosure

5.10 Response by Hannah Addo or Churinder to Reports of Abuse or Neglect

Decision-Making Pre-referral to the Enfield Council Safeguarding Adults Team:

5.11 Consent

5.12 Referral to the Enfield Council Safeguarding Adults Team

5.13 Local Authority Safeguarding Enquiry

The enquiry:

Strategy Meeting/Case Conference:

Safeguarding Adults Reviews:

5.14 Involve the Service User Concerned Throughout the Enquiry:

Desired Outcomes Identified by the Service User:

5.15 After An Enquiry

5.16 If a Safeguarding Concern is not agreed

5.17 Informing the Relevant Inspectorate

5.18 Support and Supervision

5.19 Confidentiality and Information Sharing

5.20 Staff Alleged to be Responsible for Abuse or Neglect

5.21 Disclosure and Barring Service (DBS) Referral

5.22 Abuse by Another Adult at Risk

5.23 Management of Allegations Against People in Positions of Trust (PiPoT)

5.24 Allegations Against People who are Relatives or Friends

5.25 Pressure Ulcers

Safeguarding Concern Assessment Guidance:

Adult Safeguarding Decision Guide:

5.26 Medication Errors

5.27 Exploitation by Radicalisers who Promote Violence

5.28 Self-neglect and Refusal of Care

5.29 Abuse and Sexual Safety

5.30 Criminal offences

5.31 Risk Assessment and Management

5.32 Training and Competencies

5.33 Audit and Compliance

6.1 A Person with Care and Support Needs

6.2 Investigation

6.3 Referral

6.4 Multi-agency

6.5 Caldicott Principles

6.6 Adults at Risk

6.7 Making Safeguarding Personal

6.8 Honour-based Violence

6.9 Forced Marriage

6.10 Independent Mental Capacity Advocate (IMCA)

6.11 Female Genital Mutilation (FGM)

6.12 Safeguarding Adults Board

6.13 Whistleblowing

Please refer to the QCS Resource Centre for a full safeguarding pack as well as posters to raise awareness.

Support and Help:

Enfield MASH Team 020 83200106

Post: CQC National Correspondence, Citygate, Gallowgate, Newcastle upon Tyne. NE1 4PA

About Kangaroo Healthcare

Quick Links

Contact Info