Principles of safeguarding and protection in health and social care

8 August 2016

Physical abuse involving contact planned to cause bodily harm, feelings of intimidation, other physical suffering or injury • Sexual abuse Sexual abuse is the forcing of undesired sexual behavior by one person upon another • Emotional/psychological abuse Emotional/psychological abuse may involve threats or actions to cause mental or physical harm; humiliation; violation • Financial abuse Financial abuse is the illegal or unauthorized use of a person’s money, property, pension book or other valuables. • Institutional abuse

Institutional abuse involves failure of an organization to provide appropriate and professional individual services to vulnerable people. It can be seen or detected in processes, attitudes and behavior that amount to discrimination through unwitting prejudice, ignorance, thoughtlessness, stereotyping and rigid systems. • Self neglect Self-neglect is a behavioral condition in which an individual neglects to attend to their basic needs, such as personal hygiene, feeding, clothing, or medical conditions they might have. • Neglect by others

Neglect is a passive form of abuse in which the wrongdoer is responsible to provide care, for someone, who is unable to care for oneself, but fails to provide adequate care to meet their needs. Neglect may include failing to provide sufficient supervision, nourishment, medical care or other needs. 1. 2 Physical Abuse Injuries that are the shape of objects Injuries in a variety of stages or injuries that have not received medical attention A person being taken to many different places to receive medical attention Skin infections

Dehydration or unexplained weight changes or medication being lost Behavior that indicates that the person is afraid or avoiding the perpetrator Change of behavior Sexual Abuse Sexually transmitted diseases or pregnancy Tears or bruises in genital/anal areas Soreness when sitting Signs that someone is trying to take control of their body image, for example, anorexia, bulimia or self-harm Sexualized behavior Inappropriately dressed

Emotional Abuse Difficulty gaining access to the adult on their own The adult not getting access to medical care or appointments with other agencies Low self-esteem or lack of confidence and anxiety Increased levels of confusion Increased urinary or fecal incontinence Sleep disturbance The person feeling/acting as if they are being watched all of the time Decreased ability to communicate Language being used that is not usual for the service user

Deference/submission to the perpetrator Financial Sudden loss of assets Unusual or inappropriate financial transactions Visitors whose visits always coincide with the day a person’s benefits are cashed Insufficient food in the house Bills not being paid A sense that the person is being tolerated in the house due to the income they bring in; sometimes with that person not included in the activities the rest of the family enjoys Institutional treating adults like children arbitrary decision making by staff group, service or organization strict, regimented or inflexible routines or schedules for daily activities such as meal times, bed / awakening times, bathing / washing, going to the toilet lack of choice or options, such as food and drink, dress, possessions, daily activities and social activities lack of privacy, dignity, choice or respect for people as individuals unsafe or unhygienic environmentlack of provision for dress, diet or religious observance in accordance with an individual’s belief or cultural background withdrawing people from individually valued community or family contact Neglect by self or others Malnutrition Rapid or continuous weight loss Not having access to necessary physical aides Inadequate or inappropriate clothing Untreated medical problems Dirty clothing/bedding Lack of personal care 1.

2- Factors may include if the individual has a mental disability such as dementia or not having mental capacity. If the individual is secluded or isolated or are vulnerable. There could also be factors for the abuser which could include the abuser having lack of training, also abusing their power. Sometimes personal issues have a part to play which could include the carer/abuser being stressed or having a history of abuse and continuing the cycle. 2.

1- If there are suspicions that an individual is being abused, or if an individual alleges that they have been abused then I would report this to my immediate line manager and use the whistle blowing technique if appropriate. Some ways to ensure that evidence is preserved can include using plastic bags to hold evidence if there is a likelihood that it may be contaminated, not entering the zone where the crime/abuse has taken place, advising the service user not to wash, gaining original copies of any CCTV tapes that may be available. 2.

2- Stay calm and listen to them, Take what you are being told seriously, Be aware that medical evidence might be needed, Offer them support to help them to stop the abuse happening, make a written note of what you have been told and contact social services or the police Depends on the age of the individual, if it is an adult call the local police if a minor call CPS If someone tells you they are a victim of abuse, take what they seriously, stay calm, and listen to them, if possible make a written or recorded account , which should be dated and signed, you should also make them aware that medical evidence might be required, offer them help and support to stop the abuse from continuing, and then contact either the police or social services. 2. 3- The most common type of evidence available to the investigator is statements made by the victim, witness(es), alleged perpetrator, and collateral(s).

Statements may be collected and documented by one or more of the following methods: * A personal face-to-face interview which is recorded in a factual summarization on the CPS-1; * An audio tape recording of the interview. The tape should be preserved and may be either transcribed or summarized on the CPS-1 and filed in the case record; * An audio-visual taped recording of the interview. The tape should be preserved and may be either transcribed and placed in the investigation section of the case record or factually summarized on the CPS-1; * A written signed statement as provided by the witness. Such statements should be filed in the investigation section of the case record. Taped and written statements are particularly important as evidence in judicial proceedings where the witness attempts to recant an earlier statement made to the investigator.

* The investigator will also obtain or generate a variety of documents / reports during the investigation process, which will serve as evidence to support an investigative conclusion. These statements will be used for judicial proceedings. Generated reports / documents include reports, forms, and records produced by CD staff. Obtained reports / documents include medical reports, psychological / psychiatric evaluations, police reports, written statements, etc. The investigator should take the following steps in obtaining and reviewing documents / reports that are to be used as evidence in a CA/N investigation: o Initial all pages of any original document the worker is allowed to view but not copy. This will assist the worker in identifying the document during judicial proceedings as one reviewed during the investigation 3.

1- The framework has been developed from existing practice, with contributions by adult protection lead managers throughout the country, [ and shaped in consultation and partnership with: Association of Chief Police Officers (ACPO) Commission for Social Care Inspection (CSCI) Department of Health (DoH) Public Guardianship Office (PGO) Practitioner Alliance against Abuse of Vulnerable Adults (PAVA) Ann Craft Trust (ACT) VOICE UK ] 3. 2- Care provider such as Home Care Agency. Medical professionals such as GP, A&E staff, nurses, doctors: they can examine, diagnose & treat, they can record: this can include photographic evidence. An Expert Witness: this is a specialist within a subject such as paediatric, geriatrics, and psychiatrics.

The local authority Social Services dept. would carry out an assessment of needs, this would include any unpaid carer of individual. Safeguarding Team, within Social Services dept. : investigates & ensures safety, work with other agencies such as police. A Safeguarding & Protection Officer would lead the Adult Protection Alert. Police: to investigate/prosecute, to work with other agencies, to provide support to victims, to raise awareness of crimes, crime prevention. Care Quality Commission to regulate & inspect care providers. Independent Safeguarding Authority, this includes Vetting & Barring Scheme, to safeguard & protect vulnerable people before employment commences, incl CRB 3.

3- In March 2002, a 30-year-old woman with learning disabilities was admitted to Borders General Hospital in Scotland with multiple injuries as a result of sustained physical and sexual assaults. The abuse had been carried out at home and was perpetrated by three men, one of whom was her carer. ‘The case of the vulnerable adult’ is the term that the individual involved has asked to be used. Her identity is protected under rules giving anonymity to victims of rape. The woman had made allegations against one of the perpetrators as a child but agencies decided her mother could protect her. When her mother died, he was allowed to become her carer, making her sleep on a carpet in the hall at his home.

He began taking the woman’s benefit money, deprived her of food and liquid and made her sit in the dark for long periods. Together with two friends he forced her to strip, shaved her head, sexually assaulted her and repeatedly stamped on her face and body. They also threw the woman over a fence, handcuffed her to a door and set fire to her clothing. The police, health and social services had been aware of allegations of abuse dating back to the woman’s childhood. These had been investigated and reported to the Procurator Fiscal but she was considered an unreliable witness due to her learning disability 3. 4- Policies and procedures, manager, care plans, local authority, training 4.

1- (a) Abuse is reduced by person centered values because institutional abuse often stems from things being done to people because it’s convenient for the staff. The individual’s feelings and preferences are not considered. So, for example, a person requesting pain relief is left to wait because it isn’t time for the medication to be administered or reviewed. Active participation means truly involving that person in their care so that choice, dignity and respect are addressed fully. Promoting choice and rights is also addressed by active participation and an accessible complaints procedure (which should be visible somewhere in the setting or may be included in a service user’s ‘welcome’ pack) backs up that individual’s rights.

It means that the person knows who they can go to with a complaint or concern about any aspect of their treatment or care (b) Encouraging active participation builds self-esteem, and the person will refuse to tolerate abuse and will be inclined to report it, they’re also around other people which will help to build friendships in which they can share things they may tell one of them if abuse may happen and one of them may pass it on to help. (c) Promoting choice is to help control an abusive behaviour because it gives one an option to do one thing or the other. It allows people to grow closer together over time 4. 2- Complaints are good way of considering how well the services are provided, it also helps us to identify if there are any weaknesses e. g. potential for abuse and neglect. A complaints procedure should be simple to follow because it encourages people to raise their concerns and it indicates that organization will respond to those concerns rather than ignoring them. If it’s too difficult to make a complaint the abuse is likely to continue. If it’s easy to make a complaint the abuse is likely to be dealt with sooner. On a bigger scale complaints make government to bring changes in their policies according to people demand 5. 1- poor manual handling, not keeping track if a client has taken their medication, not disposing of waste properly, every time a short cut is taken on a procedure. 5.

2- All unsafe practices need to be reported to the immediate supervisor so the person can be retrained or the condition remedied to prevent further damage 5. 3- You must go to the next superior in position. After you have reported the incident you still have a duty of care to your patient. If you feel that your patient is still at risk then speak with your line manager regarding your concerns. If you feel your line manager is not taking appropriate action, or you suspect your line manager of abusing a patient then most company policies would state that you would need to contact the regional manager. You would also need to contact an inspectorate body

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