Safeguarding of Vulnerable Adults

All citizens, organisations and agencies have a responsibility to participate in the protection of adults from harm. This means that they have a duty to report any concerns to the appropriate authority.

What is Sova

The Safeguarding of Vulnerable Adults (SOVA) scheme ensures that those who have harmed or mistreated vulnerable adults in their care cannot work with vulnerable adults again.  Many care workers treat vulnerable adults with dignity. But some care workers harm or steal from the vulnerable adults in their care. When this happens, the care worker’s name has to be reported by their employer to the SOVA list. This is a legal requirement.

Making Referrals to Sova

SOVA scheme originally POVA was introduced in July 2004 to protect vulnerable adults aged 18 years and over in care settings in England and Wales  The list is operated by the Department of Health

Employers are required to check the SOVA list when recruiting workers, carers or volunteers in regular contact with vulnerable adults  Employers are also required to make a referral to the list whenever a worker, carer or volunteer is reasonably considered to be guilty of misconduct that has harmed or placed a vulnerable adult at risk of harm

Audience

Designed for people making referrals to the SOVA list such as : social care employers and providers of care in residential, domiciliary and adult placement services employment agencies and businesses that supply individuals to these care providers, it includes those providing voluntary services, and self-employed adult placement carers. local adult protection teams and staff responsible for implementing local policies for vulnerable adults staff, commissioners, carers and people who use social care services, and professionals from other organisations concerned about the well-being of vulnerable adults.

Future Demographic factors

Indicate a growth in the population of older people, particularly people of over 90 years and over and those with learning difficulties. This means that the population of potentially vulnerable people will continue to grow in the coming decades.

Rights and Value Statement (quoted from a policy document)

Every person has a basic human right to a lifestyle which maintains personal independence, safeguards privacy, offers genuine and informed choices, provides opportunities to enjoy and contribute to society and enables them to have their social, cultural and individual needs met. They also have rights to protection from harm or exploitation within the context of the law and personal civil liberties.

Values for caring

Independence - opportunities to act and think without reference to another person, including a willingness to incur a degree of calculated risk

Dignity - recognition of the intrinsic value of people regardless of their circumstances by respecting their uniqueness and their personal needs; treating people with respect

Knowledge - the right to information about services

Fulfilment - the right to personal goals, and recognition of abilities in all aspects of daily life

Privacy - the right to be left alone and free of intrusion

Equality - the right to be treated as individuals and to have services that are provided fairly

Choice – opportunity to select independently from a range of options

Consent

An act is abusive when the person -Has not consented -Cannot consent -Has been coerced to consent

Capacity to consent

An individual cannot consent unless he/she has the ‘capacity’, i.e. an understanding of the situation, the choice made and the consequences.

Acquiescence  - To agree or consent without complaint

Client with Dementia

Do you put her in a suitable chair so she cannot get out of it ?

Do you put a table with a drink in front of them all morning or afternoon ?

Do you tell them that their spouse has died every time he or she asks ?

Who is a vulnerable adult?

Any person aged 18 years or over who: ‘…is or may be in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of himself or herself, or unable to protect himself or herself against significant harm or serious exploitation.’

Main groups of people

People who have a learning disability

People who have a physical or sensory disability

People who have a mental illness, including dementia

People who are old and frail

Other groups, for example, people who have problems with alcohol and/or drugs

What is abuse?

3 National definitions

‘…a violation of an individual’s human and civil rights by another person or persons.’

  ‘Abuse may be described as physical, sexual, psychological or financial. It may be intentional, unintentional, or the result of neglect. It causes harm…either temporarily or over a period of time’

‘Abuse may consist of a single act or repeated acts. Abuse can occur in any relationships and may result in significant harm to, or exploitation of, the person subjected to it’.

The 7 categories of abuse


Physical Abuse
Sexual abuse

Financial or Material abuse

Emotional or Psychological abuse

Neglect (physical & emotional)

Discriminatory abuse

Institutional

 

Categories of harm

Sexual Harm

Neglect
Physical
Psychological/emotional
Institutional
Verbal
Finance or Material
Discriminatory
Self Harm

 

Role of the abuser

Relatives (child/spouse/in-law)          

Paid workers                                                  
Friends/neighbours                            
Other Carers (family member)                      

 

The Groups of Relatives Identified as Abusers are –

Son/Daughter            
Partner                       

Paid Staff Identified as Abusers –

Care Worker                                      
Nurse                                                 
Social Worker                                    
Hospital Doctor                                  
G.P                                                     
Housing Worker                                 
Legal services                        
Police             

Abuse can Vary With The Setting

Physical abuse & neglect are associated with care home & hospital settings

Financial & psychological abuse are associated with domiciliary settings

 

Physical Abuse - Typical Examples

Hitting or slapping

Pushing
Hair pulling
Beating
Pinching
Punching
Dragging
Physical intimidation
Physically forcing people to do something against their will
Forced medication / under or over food
Too hot or cold an environment, including being put outside
Rough handling
Deprivation – withholding food, water, medication or bathing
Use of procedures which could cause injury
Unreasonable physical restraint
Deliberate exposure to risk or danger
Physical Abuse - Possible Indicators
Injury incompatible with its explanation
Injury which has not been cared for
Cuts, scratches, lacerations, puncture  wounds, bruises, sprains, weal marks, discoloration, bite marks, fingertip & pinch marks.
Burns, scalds, friction marks
Any fracture without satisfactory explanation of accident
Poor skin condition or hygiene
Untreated pressure sores
Dehydration/malnutrition without illness or cause, and when not living alone
Fearfulness – asks “not to be hurt”.
Flinches at physical contact
Low self esteem
Uncharacteristic behaviour
Decrease in mobility
Use of furniture to prevent movement, removal of walking aids

 

Neglect - Typical Examples

Failure to assist in personal hygiene or the provision of food, clothing or shelter
Failure to provide medical intervention for physical & mental health needs (not including refusal of treatment)
Failure to protect from health & safety hazards
A lack of personal care and/or lack of management of continence
Confining to a room on their own
Limiting or preventing social contact with friends or relatives
Unsuitable clothing for weather
Untreated medical condition
Rashes, sores, lice
Loss of weight
Malnutrition and/or dehydration
Misuse of medication
Dishevelled appearance

Neglect - Possible Indicators

Lack of necessary prosthetic devices, dentures, glasses, hearing aids etc.
Consistent lack of supervision

Emotional/Psychological Abuse -Typical Examples


Verbal assault
Humiliation
Threats
Deprivation of respect
Denial of dignity & affection
Bullying, instilling fear
Name calling
Ridiculing
Denial of access to close friends, relatives or others
Insults
Blame
Deprivation of choice
Conditional ‘love’
Denial of access to religious or cultural observances
Loss of liberty
High levels of anxiety/stress
Self-harm
Passivity
Agitation
Resignation
Fear
Signs of depression
Emotional/psychological Abuse -Possible Indicators
Sleep disturbances
Changes in appetite
Overly anxious to please or subservient
Running away
Refusing to go home
Refusing to be left with a particular carer
An air of silence when alleged abuser is present
Helplessness
Loss of interest in social contact
Cowering
Excessive craving for affection
Isolation in a room

Other Protective Measures –

Criminal Records Bureau
SOVA & PVG Scheme & List

Victim’s Characteristics

Individuals with the following conditions and characteristics are more likely to be abused:
Social isolation – fewer social contacts
A condition such as dementia, which affects intellect or memory
The victim is ‘compliant’ and may not be aware that he/she is being abused
Communication difficulties as a result of hearing, visual or speech impairments – they cannot “tell”
People who wouldn’t generally be believed if they did ‘tell’ – people with impaired mental capacity
People with behavioural problems
People who need a level of care beyond the capacity of the carer

Factors in Families/Relationships which may lead to abuse

Other responsibilities e.g. children, work
The carer feels isolated & unsupported
Mental or physical illness as a result of caring
Lack of understanding of needs of person

The carer may have a history of –

Mental illness
Substance misuse (drugs/alcohol)
Abuse (as a victim or perpetrator
The carer is dependent on the vulnerable adult
Either the carer or vulnerable adult has financial difficulties
Family history of violence, e.g. domestic violence
Difficult family relationships
Either person has had a significant recent loss or bereavement
They live in poor or inadequate living conditions
There has been a significant change in roles between the vulnerable adult & carer
Stressed or exhausted
No personal space

 

Factors in Care Establishments which may lead to Abuse –

Poor overall management
Poor communication between managers & staff teams
Low staffing levels over a long period
High staff turnover
Inappropriate attitudes
Lack of supervision & support for workers
Lack of staff training
Authoritarian atmosphere
Service users have no knowledge of complaints procedure or complaints are not recorded
Environmental issues – lack of equipment, lack of space, poor standards of cleanliness
Isolation – visitors not encouraged, service users not allowed to phone out
Breach of professional duties – inappropriate language, sexual innuendo, denying choices or inappropriate restraint of service users

Responding To Disclosure

DO -
Believe
Stay calm
Avoid showing shock or disbelief
Listen very carefully
Reassure the person
Explain about sharing the information

DO NOT -

Stop person freely recalling
Ask any questions
Press for more details
Promise to keep secrets
Contact the alleged abuser
Be judgemental
Break confidentiality e.g. tell other staff or service users

DO

Explain what will happen next
Report to Line Manager
Record – use the person’s own words

 

Making A Written Record

As soon as possible
Date, time & setting
Any others present – the context
Use person’s own words
Stick to the facts
Avoid opinions or judgements
Record any injuries
Date & sign your report
Use a black pen
Ensure your writing is legible

Preventing Abuse

Follow codes of practice & conduct
Acknowledge that ‘it could happen here’
Be alert & report all concerns/suspicions
Training
Know your limits & ask for assistance/guidance
Be open & honest about stress
Be aware of whistleblowing policies
Empower your service users – ensure choice & avoid infringing their rights
Be aware of relationship boundaries with service users – respect, dignity & privacy
Ask questions & challenge structures which infringe people’s rights
Avoid infantilising people – remember you work with adults
Use the power you have responsibly

 

How can employers responsible for care settings prevent abuse?
Screening job applicants
Sharing information about known perpetrators of abuse
Providing training
Promoting open care environments
Protecting staff who ‘whistle blow’
Risk assessments
Regular supervision
Avoid placing staff in risky situations
Monitor occurrences of abuse
Clear, accessible & realistic policies & procedures
Promote good practice

Whistleblowing

“The disclosure to authority of the misdemeanours on the part of colleagues or employees of other organisations.”

If acting in good faith, any employee would be expected by the company to report any misdemeanour or malpractice whether a one-off or ongoing.

As an employee of …., you are protected by the Public Interest Disclosure Act 1998, so long as:   Your disclosure is carried out “in good faith”

You believe the information/allegation to be true

You are not acting for personal gain

 

Examples of misdemeanours or malpractice:

A criminal offence
Failure to comply with legal obligations
Falsifying records
Endangering someone’s health and safety
Any type of abuse

Whistleblowing Procedure

In the first instance, the issue should be raised with the branch manager
It will be treated in a fair, sensitive and confidential manner
Every effort will be made to provide regular feedback
There will be no victimisation of the discloser or anyone helping the discloser
If you have disclosed an activity/concern and no action has been taken, or your allegation concerns Management, you should report it to:

The Local Authority

Care Quality Commission

 

What Abuse in the Care Home?

Potential for Abuse in the Care Home

Amanda is a carer at Argyle Residential Care Home.  She has worked there for nine years and is quite settled and happy with her role.

The question for you is..

Are her clients happy with her role?

Mrs Walker

6.30am Amanda barges into Mrs Walker’s room without knocking and says -

 “C’mon Lorna, lets get your butt out of bed.

There’s only two of us on the early shift as Maggie is sick again so this morning we’re having to start early. You’ll need to get a move on”

 

Bert

6.45am Bert rings the buzzer and asks if he can be assisted to go to the toilet.

 “You’ll have to wait a minute, Bert, I’ve got Mrs Jones in the bath and the other carer is busy.”

“But its urgent” says Bert

 “Look, I’ll tell you what, I’ll put you on the commode and then you ring me when you’ve finished.”

 

In the Warm Kitchen

6.55am Amanda goes in to find the other care assistant, Glad putting the kettle on.

 “Make me a cup of tea will you? I’m just going for a cig.  I’ve got Bert on the commode and Mrs Jones is in the bath. 

I’ve left both doors open so they can shout if they need anything.”

 

7.15am

Amanda and Glad have finished their cups of tea.

 “Can you give me a hand with Liz?” says Glad

 “Yeah, lets get the old cow out of the way before I get that grumpy Mrs Jones dressed.”

 

7.20am Liz’s room

“Oh blimey! You’re all wet, Liz!” says Amanda “why didn’t you bloody ring the bell?”

 “C’mon, lets get her in the bath.  Grab her under her arms. I’ll wheelchair her to the upstairs bathroom.  There’s no hoist so we’ll have to grab a leg and an arm and swing her into the bath.” says Amanda

 

 

 

7.35am

Mrs Jones shouts “HELP”

Bert presses and holds his finger on his call bell.

Amanda goes into his room and takes the call alarm  bell away from him and throws it on the bed.

 “You’ll just have to wait a minute Bert, we’ve got Liz in the bath.  She’s messed herself again. I cannot be everywhere at once”

 

8.15am

Chef comes on shift to start breakfast and passes Bert’s room.

 “Amanda” shouts chef “Bert’s on the floor!”

 “He’s done that deliberately, because he knows we’re busy!” says Amanda. “Well he can stay in his room for his breakfast!”

 

QUESTIONS

How long was Bert on the commode?

What’s wrong with getting someone up at 6.30?

How long was Mrs Jones in the bath?

How was confidentiality breached?

What was wrong with the way they moved Liz?

In what ways was Bert abused?

What other signs of abuse did you notice?