Adult Support and Protection Policy and Procedure

1. Purpose

  1. The protection of adults at risk of harm is not an option but a responsibility across agencies. This policy and procedure sets out what actions are required of staff working for and on behalf of Epitome Home Care Agency.

 

  1. To dovetail with local policies and procedures.

 

  1. To meet the legal requirements of the regulated activities that Epitome Home Care Agency is registered to provide:
    • Forced Marriage, etc. (Protection and Jurisdiction) (Scotland) Act 2011
    • Offences (Aggravated by Prejudice) (Scotland) Act 2009
    • Counter-Terrorism and Security Act 2015
    • Abusive Behaviour and Sexual Harm (Scotland) Act 2016
    • Human Rights Act 1998
    • Adults with Incapacity (Scotland) Act, 2000
    • Adult Support and Protection (Scotland) Act, 2007
    • Mental Health (Care & Treatment) Scotland Act, 2003
    • Social Care (Self-directed Support) (Scotland) Act 2013
    • Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016
    • Protection of Vulnerable Groups (Scotland) Act 2007
    • The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011

 

 2. Scope

  1. The following roles may be affected by this policy:

 

  • All staff
  • Volunteers
  • Agency staff

 

  1. The following people may be affected by this policy:

 

  • Service Users

 

  1. The following stakeholders may be affected by this policy:

 

  • Family
  • Advocates
  • Representatives
  • External health professionals
  • Local Authority
  • NHS

 

 3. Objectives

  1. To ensure that adults who may be at risk and who are in contact with Epitome Home Care Agency are protected effectively from abuse or harm.

 

  1. To provide a clear framework for action whenever abuse is disclosed or suspected.

 

  1. To ensure that all Epitome Home Care Agency staff and any volunteers are clear about their responsibilities.

 

  1. To ensure that Epitome Home Care Agency complies with best practice.

 

 4. Policy

  1. The support and protection of adults at risk of harm is everybody’s concern. All adults have the fundamental right to live their lives with choice and without fear of harm. All of the staff at Epitome Home Care Agency are responsible for preventing harm occurring and in taking action where concerns arise.

Epitome Home Care Agency is committed to developing services that are built around people and recognises that protection, prevention, partnership and personalisation are the cornerstones to the support and protection of adults at risk of harm.

 

Epitome Home Care Agency 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 its 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.

 

Epitome Home Care Agency will work with Service Users and others involved in their care, to ensure that 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.

 

Robust recruitment and selection, vetting, appropriate training, supervision and appraisals are an integral part of the support and protection strategy of Epitome Home Care Agency and Epitome Home Care Agency will comply with legislative and regulatory requirements to protect individuals, ensuring that these processes are subject to rigorous internal governance and scrutiny which will include audit.

  • General Principles

 

  • Any member of staff who knows or believes that harm is occurring will report it to their line manager as quickly as possible, or if they believe they are compromised they should use the whistleblowing process at Epitome Home Care Agency
  • Epitome Home Care Agency will ensure there is a named individual responsible for Adult Support and Protection. The named person/post will be a manager within Epitome Home Care Agency who has sufficient knowledge and expertise to deal with any concerns raised
  • Epitome Home Care Agency will work collaboratively with other agencies to ensure high standards of support and protection for adults at risk of harm, including liaison in relation to the investigation of allegations and will ensure that its procedures dovetail with local multi-agency procedures
  • Epitome Home Care Agency will use incident reporting, root cause analysis, lessons learnt and auditing to determine themes to improve care practice
  • Epitome Home Care Agency 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 be reported
  • Epitome Home Care Agency recognises its responsibilities in relation to confidentiality and will share information appropriately
  • Epitome Home Care Agency will have a zero-tolerance approach to harm
  • Epitome Home Care Agency 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 and the local council office that deals with Adult Support and Protection
  • Epitome Home Care Agency will ensure that any action that is taken is assessed, proportionate, and reflective of the risk presented to the people who use the services
  • Epitome Home Care Agency will report any incidents in line with its regulatory requirements stipulated by the Care Inspectorate
  • Epitome Home Care Agency will adhere to the Scottish Social Services Council Codes of Practice for Social Service Workers and Employers

  • Registered Manager’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 Local Authority Social Services Team is contacted to inform them of the concern or harm
  • If a Service User is at immediate risk of harm, the responsible person must contact Police Scotland and the Care Inspectorate must also be informed. The Duty of Candour should be invoked if appropriate
  • In all cases of alleged harm, there must be early consultation between the Manager, Local Authorities, and the Police to determine whether or not a joint investigation is required. It may also be necessary to advise the relevant Power of Attorney or Guardian if there is one appointed. It is noted that in most cases, the

Local Authority has the lead role in the support and protection of adults at risk of harm. 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 should be taken into account whenever possible. This may result in no legal action

  • To ensure the documentation of any incidents of harm in the Service User’s file, using body maps to record any injuries
  • To follow local policy guidelines where applicable
  • To report any incidents of abuse to the relevant parties
  • To work with multi agencies where appropriate
  • To advise and support staff
  • To ensure that staff are trained to enhance knowledge
  • To actively promote the “Whistleblowing’’ policy

  • Carer Responsibilities

 

  • To be able to recognise and report incidences of harm
  • To report concerns of harm or poor practice that may lead to harm
  • To remain up to date with training
  • To follow this policy and procedure
  • To know how and when to use the Epitome Home Care Agency Whistleblowing procedures
  • To understand the Adults with Incapacity (Scotland) Act and Mental Health (Care and Treatment) (Scotland) 2003 Act and to follow any best practice guidance from the Mental Welfare Commission for Scotland

 

 5. Procedure

  1. Staff will need to be trained and understand the following:

 

Patterns of Harm

 

Epitome Home Care Agency recognises the following as the main forms of harm which may be perpetrated as the result of deliberate intent, negligence or ignorance. Many situations will contain a combination of different kinds of abuse.

Physical Harm – May include, hitting, slapping, pushing, kicking, misuse of medication, restraint, inappropriate sanctions. Signs that physical abuse may be taking place include:

  • Injuries that are on unusual sites, e.g. cheeks, ears, neck, inside mouth
  • Injuries that are the shape of objects, e.g. a hand, teeth, cigarette
  • Presence of several injuries or scars of a variety of ages
  • Injuries that have not received medical attention
  • A person being taken to many different places to receive medical attention
  • Skin infections
  • Dehydration
  • Unexplained weight changes or medication being lost
  • Behaviour that indicates that the person is afraid of the perpetrator
  • Change of behaviour or avoiding the perpetrator
  • Burns or scalds with clear outlines or which have a uniform depth over a large area, e.g. buttocks

 

Sexual Harm – Including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, could not consent or was pressurised into consenting. Sexual harm includes:

  • ‘Non-Contact’ Harm – Looking, photography, indecent exposure, harassment, serious teasing or innuendo
  • ‘Contact’ Harm – Touch, e.g. of breasts, genitals, arms, mouth etc; masturbation of either or both persons; penetration or attempted penetration of vagina, anus, mouth by penis, fingers or by other objects

Signs that sexual harm may be taking place include:

 

  • Sexually transmitted diseases or pregnancy
  • Tears or bruises in genital/anal areas, bruises to inner thighs, breasts
  • Soreness when sitting
  • Signs that someone is trying to take control of their body image, e.g. anorexia or bulimia, self-harm
  • Sexualised behaviour or language
  • Oral infections

 

Psychological Harm – May include emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks. Staff should be aware that, while most abuse takes place when people are in physical contact, it can also take place in a virtual environment, such as an online discussion board or a chat room.

Signs that psychological abuse may be taking place include:

 

  • Difficulty gaining access to the adult on their own or the adult having difficulty gaining opportunities to contact you
  • The adult not getting access to medical care or appointments with other agencies
  • Low self-esteem
  • Lack of confidence or anxiety
  • Increased levels of confusion
  • Increased urinary or faecal incontinence
  • Sleep disturbance
  • Person feeling/acting as if they are being watched all of the time
  • Decreased ability to communicate
  • Communication that sounds like things that the perpetrator would say, language being used that is not usual for the Individual
  • Deference/submission to the perpetrator

Financial or Material Harm – Including theft, fraud, exploitation, pressure in connection with Wills, property, inheritance, financial transactions, or the misuse or misappropriation of property, possessions, or benefits. Financial harm is a crime. It is the use of a person’s property, assets, income, funds or any resources without their informed consent or authorisation.

Neglect or Acts of Omission – Including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life such as medication, adequate nutrition, and heating.

 

Information Harm – For example, failure to adhere to the relevant ‘Data Protection Act’ guidance, failure to provide adequate and appropriate information about Complaints procedures, etc.

Human Rights Harm – Can include denial of an understanding of Criminal Justice processes (Article 5) or a fair hearing (Article 6).

Institutional Harm – When an institution or organisation is run for the ease and benefit of the institution and its staff, not for the benefit of the clients or patients.

 

Multiple Forms of Harm – May occur in an ongoing relationship or service setting or to more than one person at a time. This makes it important to look beyond single incidents or breaches in standards, to underlying dynamics and patterns of harm.

Any or all of these types of harm may be perpetrated, either because of deliberate targeting of adults at risk or through negligence or ignorance. In some cases, it may result from an extreme level of stress on an informal carer – which may include aggressive or violent behaviour by the vulnerable adult towards the carer. In such cases, a sensitive approach in supporting the carer has to be combined with a determination to deal with the harmful behaviour and prevent it recurring and placing the protection of the adult at risk at the forefront of intervention.

 

Hate (Mate) Crime – The Scottish Government defines Hate Crime as crime committed against a person or property that is motivated by ‘malice or ill-will towards an identifiable social group’. The Offences (Aggravation by Prejudice) (Scotland) Act 2009 identified disabled people as being one of these social groups.

 

Forced Marriage – The Forced Marriage, etc. (Protection and Jurisdiction) (Scotland) Act 2011 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. Epitome Home Care Agency will ensure that staff are reminded of the ‘one chance rule’: i.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.

Self-Harm – The adult at risk is engaging in behaviour which is causing (or likely to cause) self-harm. This is a broad term but will include people:

  • Injuring or poisoning themselves by scratching, cutting or burning skin, by hitting themselves against objects, fire-setting or taking a drug overdose, or swallowing or putting other things inside themselves

 

Less obvious forms, including taking unnecessary risks, staying in an abusive relationship, developing an eating problem (such as anorexia or bulimia), being addicted to alcohol or drugs, or someone simply not looking after their own emotional or physical needs.

 

The category of self-harm could also include instances where the conduct of others is considered to be a cause of an adult at risk self-harming.

Abuse by Another Adult at Risk – Epitome Home Care Agency recognises that it 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 adult 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.

Exploitation by Radicalisers Who Promote Violence – Individuals may be susceptible to exploitation into violent extremism by radicalisers. Violent extremists often use a persuasive rationale and charismatic individuals to attract people to their cause. The aim is to attract people to their reasoning, inspire new recruits, embed their

extreme views, and persuade vulnerable individuals of the legitimacy of their cause. There are a number of factors that may make the individual susceptible to exploitation by violent extremists. None of these factors should be considered in isolation but in conjunction with the particular circumstances of the individual: identity or personal crisis, particular personal circumstances, unemployment or underemployment and criminality.

  • Responding to Disclosure, Suspicion or Witnessing of Abuse

 

Where an adult at risk discloses or discusses potential abuse or harm, the staff member or volunteer should be able to:

 

    • Recognise: identify that the adult at risk may be describing abuse, even when they may not be explicit
    • Respond: stay calm, listen and show empathy
    • Reassure them that it will be taken seriously and explain that there is a duty to report the issues internally and what may happen next
    • Record: write up notes of the conversation clearly and factually as soon as possible

  • Report


  • 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 a 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 should take into account the following factors:

 

  • Whether the adult for whom they care has a learning disability, mental health problems or a chronic progressive disabling illness that creates caring needs which exceed the carer’s ability to meet them
  • The emotional and/or social isolation of the carer and the adult at risk
  • Minimal or no communication between the adult at risk and the carer either through choice, mental incapacity or poor relationship
  • Whether the carer is not in receipt of any practical and/or emotional support from other family members or professionals
  • Financial difficulties
  • Whether the carer has a Power of Attorney (financial or welfare) or Guardianship
  • A personal or family history of violent behaviour, alcoholism, substance misuse or mental illness
  • The physical and mental health and wellbeing of the carer

  • 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.

  • Abuse of Trust

 

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. There is a particular concern when abuse is caused by the actions or omissions of someone who is in a position of power or authority and who uses their position to the detriment of the health and wellbeing of a person at risk, who in many cases could be dependent on their care. There is always a power imbalance in a relationship of trust. Where the person who is alleged to have caused harm is in a position of trust with the adult at risk, they may be deterred from making a complaint or taking action out of a sense of loyalty, fear, of abandonment or other repercussions. Where the person who is alleged to have caused the abuse or neglect has a relationship of trust with the adult at risk because they are a member of staff, a paid employee, a paid carer, a volunteer or a manager, Epitome Home Care Agency will invoke disciplinary procedures for employed staff as well as taking action in line with this policy. Epitome Home Care Agency will ensure that a referral is made to Disclosure Scotland if an employee is found to have caused harm to a Service

User.

 

If the person who is alleged to have caused the harm is a member of a recognised professional group, the Organisation will act under the relevant code of conduct for the profession as well as taking action under this policy. Where the person alleged to have caused the harm or neglect is a volunteer or a member of a community group, Epitome Home Care Agency will 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, in many cases the policy and procedures will be used to ensure that the adult at risk receives the services and support that they may need. In all cases regard should be had for issues of consent, confidentiality and information sharing.

  • ‘At Risk’ and the Adults with Incapacity (Scotland) Act

 

The Adults with Incapacity (Scotland) Act 2000, (AWI) allows action to be taken to intervene with regard to the property, finances and welfare of adults where the adult does not have the ability to make a decision in a particular aspect of their life. The ability to make clear decisions about property, finances and welfare is referred to as capacity. When someone is not able to make a decision, this may be because of an illness, disability or severe communication difficulty. This is referred to in the Adults with Incapacity (Scotland) Act 2000 as incapacity. It should not be assumed that all adults at risk lack mental capacity. In fact, the Act makes it clear that individuals should be treated as capable of making decisions about their care, support or treatment unless it can be clearly demonstrated that they are unable to do so.

 

However, where it has already been established that the individual is unable to make decisions for him or herself, there should be a person in place who has, under the Act, been appointed to act on the individual’s behalf. In the absence of this, the Act instructs those taking decisions on behalf of the individual to always ensure that the decisions taken are in the individual’s best interest. It is imperative that all actions and decisions taken when acting on behalf of an individual who is unable to make his or her own decisions are fully documented. As part of any initial assessment, capacity must be assessed. The person must be offered help to communicate their views.

 

It is important to recognise that any incapacity may not be permanent. Any decisions taken and agreed must be regularly reviewed to take account of possible changes in the person’s level of capacity.

  • Confidentiality

 

Where confidential information is shared or disclosed, these principles must be observed:

 

  • There must be good reason for the information to be shared, and those in receipt must be aware of their responsibilities regarding the confidentiality of the information
  • The number of recipients must be kept to a necessary minimum
  • The information disclosed must be the minimum that will achieve the purpose of the sharing
  • The sharing of the information must abide by the relevant legislation
  • Always fully document the full circumstances of the disclosure and the justification for doing so

  • Whistleblowing

 

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 a colleague’s behaviour. The behaviour may not be related to an adult at risk, but they may not be following the Code of Conduct or could be pushing boundaries beyond normal limits or conduct which is a breach of the law, conduct which compromises health and safety or conduct which falls below established standards of practice with adults at risk.

 

Epitome Home Care Agency has clear Whistleblowing polices and processes in place which staff are frequently reminded about and they must be familiar with these and understand how to escalate and report concerns.

  • 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 the concerns and referral is good practice unless it would put colleagues at risk or it would put the adult at further risk. When reporting any allegations or concerns about an adult at risk of harm to a Local Authority, the LA must be informed whether 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 Service User but still operate within the relevant legislation and the parameters of their codes and standards of their practice.

  • Quality and Compliance

 

It is essential that the implementation of this policy and associated procedures is audited to ensure that Epitome Home Care Agency is doing all that it can to safeguard those people receiving its services. The audit of this policy will be completed through a systematic audit of:

 

  • Recruitment procedures and Protection of Vulnerable Group (PVG) Checks
  • Incident reporting, frequency and severity
  • Training processes, including reviews of uptake of training and evaluations

 

Support and Protection of Adult at Risk of Harm issues 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 Adult Support and Protection within Epitome Home Care Agency
  • Look in detail at specific cases to determine learning or organisational learning
  • Ensure implementation of the Support and Protection of Adults at Risk of Harm Policy

  • Training

 

Epitome Home Care Agency will ensure that staff are trained according to their roles and responsibilities and will comply with the requirements in the National Adult Protection Training Framework and the Scottish Social Services Council requirements.

 

 6. Definitions

  • Adult at Risk

 

  • Defined by the Adult Support and Protection (Scotland) Act 2007 as an adult aged 16 or over:

 

  • Who is unable to protect themselves from someone harming them, or from exploitation and neglect or safeguard their own wellbeing, property, rights or other interests
  • Is at risk of harm
  • And because they are affected by disability, mental disorder, illness or physical or mental infirmity, is more vulnerable to being harmed than adults who are not so affected

 

All three of these criteria must be met.

  • Harm

 

  • There is a legal definition of harm in the Adult Support and Protection (Scotland) Act, 2007, section 53(1): ‘Harm’ includes all harmful conduct and in particular includes:

 

  • Conduct which causes physical harm
  • Conduct which causes psychological harm (for example, by causing fear, alarm or distress)
  • Unlawful conduct which appropriately or adversely affects property, rights or interests (for example, theft, fraud, embezzlement or extortion)
  • Conduct which causes self-harm

  • Random Harm

 

  • Caused, for example, by physical or sexual violence, fraud or theft, against an adult at risk by a stranger (i.e. a person with whom the adult has had no previous or likely future contact) may require the instigation of Adult Protection procedures, but will usually be dealt with by other services (notably the Police)

  • Domestic Abuse

 

  • Domestic abuse is defined by the Crown Office Procurator Fiscal Service as: Any form of physical, sexual or mental and emotional abuse which might amount to criminal conduct and which takes place within the context of a relationship. The relationship will be between partners (married, co-habiting, civil partnership or otherwise) or ex-partners. The abuse can be committed in the home or elsewhere

 

  • It includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group. It has been widely understood for some time that coercive control is a core part of domestic violence. This abuse also relates to the perpetrator allowing or causing a child to witness, or be at risk of witnessing, domestic abuse. Domestic abuse essentially involves the misuse of power and exercise of control by one person over another with whom there is or has been a close relationship

  • Patterns of Harm

 

  • The types of harm

  • Whistleblowing

 

  • A person who raises a concern about a wrongdoing in their workplace or within the NHS or social care setting. If a person wishes to raise their concerns they should obtain a copy of their Organisation’s Whistleblowing Policy and seek advice. The wrongdoing should be about:

 

  • Concerns about actual or perceived breaches of civil, criminal, regulatory or administrative law
  • Miscarriages of justice
  • Threats to an individual’s health and safety
  • Dangers to health, safety and the environment
  • The cover up of any such malpractice

 

Professionals providing this service should be aware of the following:

 

  • The support and protection of adults at risk of harm is everybody’s concern
  • Epitome Home Care Agency should ensure that local Adult Support and Protection policies and procedures are appended to this policy and that staff have access to and an awareness of local reporting requirements
  • If a member of your staff is involved in conduct that harms a vulnerable adult and they are in a role that is eligible for the Vulnerable Groups Scheme, you may have to make a referral to Disclosure Scotland and refer to the Scottish Social Services Council if appropriate

 

Key Facts – People Affected by The Service

 

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

 

  • Each adult has a right to be protected from all forms of harm, including abuse, neglect and exploitation
  • You should be able to live in a home-like atmosphere without fear and be free from abuse by your caregivers or fellow Service Users
  • You should be empowered, with support if necessary, to make choices about your life

 

Further Reading

 

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:

 

Excellent Practice

 

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

 

  • Any concerns or incidents are reported appropriately and reviewed with a root cause analysis and lessons learnt undertaken. The findings are shared with staff to promote continuous learning
  • Service Users are involved, as far as possible, with decisions about their care, support and treatment and this includes any concerns for their wellbeing
  • Staff understand the Adults with Incapacity (Scotland) Act and can apply it in relation to Adult Support and Protection
  • The wide understanding of the policy is enabled by proactive use of the QCS App