Safeguarding adults in care homes

Care homes and care home providers must have a safeguarding policy and procedure in place, to meet the requirements of the Care Act 2014 and the Care Act 2014 statutory guidance and to follow local safeguarding arrangements (overseen by the local Safeguarding Adults Board). Providers that operate across more than one area must ensure that each care home follows the local safeguarding arrangements in their area.

Care home and care home provider safeguarding policies should:

• be clearly written and in line with Accessible Information Standard requirements to meet the communication support needs of individual residents

• be easy to find, so that all residents, staff, visitors and service providers can request and read it when they need to

• include clear and transparent arrangements for identifying, responding to and managing safeguarding concerns, and involve residents (and their families and carers) in designing and reviewing these arrangements

• explain how to respond to safeguarding concerns, and how to report suspected abuse or neglect

• be based on the principle of collaborative working, because safeguarding is everyone's responsibility.

Care homes and care home providers should have systems in place to track and monitor incidents, accidents, disciplinary action, complaints and safeguarding concerns, to identify patterns of potential harm.

Care homes should have systems in place for preserving evidence from reported safeguarding concerns, including care records, as these may be required in future, for example for local authority enquiries or police investigations.

Care homes should have a procedure for recording and sharing information (in line with data protection laws) about safeguarding concerns.

Care homes and care home providers should have a whistleblowing policy and procedure, and make sure that staff and volunteers are aware of these.

Care home providers should have a clear procedure setting out how staff and volunteers can report a whistleblowing concern. This process must specify who people can contact, and how (for example a senior contact within a care home group, and the local authority or the Care Quality Commission). For more information, see the Care Quality Commission guidance on whistleblowing.

Care home providers should consider using an external whistleblowing service. If they do, they should make sure that staff know how to contact the service.

Care homes and care home providers must ensure that whistleblowers are not victimised and do not face negative consequences for reporting or disclosing a safeguarding concern. Be aware that whistleblowers are protected by law.

Be aware that care home staff and volunteers may be afraid of the repercussions of whistleblowing, and this can prevent them from identifying and reporting abuse and neglect.

Care homes should:

• have a safeguarding lead and

• make sure everyone knows who this is, what they do, how to contact them, and who to speak to if they are unavailable.

Care homes and care home providers should make it clear who is accountable for different aspects of safeguarding within the home, in addition to the roles and responsibilities of the safeguarding lead.

Safeguarding responsibilities should be included in the job description of all care home staff, including at board level.

Care homes and care home providers should ensure that all staff understand how to meet their safeguarding responsibilities in their day‑to‑day work within the care home (see the recommendations on induction and training for more information).

Care homes 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.

Local authorities and other commissioners should ensure that all care homes they work with are fulfilling their statutory and contractual safeguarding responsibilities.

Commissioners should contribute to improving safeguarding practice in the care homes they work with, by:

• sharing key messages from Safeguarding Adults Reviews and

• helping care homes to learn from their own experience of managing safeguarding concerns.

Commissioners should:

• ensure that care homes are maintaining records about safeguarding

• make record-keeping responsibilities clear as part of contract management.

Safeguarding Adults Boards should be assured that local authorities and clinical commissioning groups have clear lines of communication in place with safeguarding leads in care homes.

Safeguarding Adults Boards should include specific objectives about safeguarding in care homes as part of their strategic planning.

Safeguarding Adults Boards should cover issues relevant to safeguarding in care homes as part of their annual report.

Safeguarding Adults Boards should share recommendations and key learning from Safeguarding Adults Reviews with key stakeholders (including care home providers, staff, residents and their families and carers).

Safeguarding Adults Boards should be assured that partner organisations are working together to support residents during safeguarding enquiries.

Safeguarding Adults Boards should ensure that their escalation procedures for resolving safeguarding disputes are applicable to care homes.

At a minimum, mandatory safeguarding training should include:

• safeguarding and legal principles under the Care Act 2014

• the 6 core principles of safeguarding and the Making Safeguarding Personal framework

• specific responsibilities and accountabilities for safeguarding in the care home

• how to recognise different forms of abuse and neglect, including organisational abuse and neglect

• how to understand the differences between poor practice and abuse and neglect

• the care homes whistleblowing policy and procedure, including what support and information is available in this situation

• how to act on and report suspected abuse or neglect

• how to deal with and preserve evidence

• how to raise safeguarding concerns within the care home and how the care home should respond

• how to escalate concerns (for example, to appropriate helplines or the local authority) if staff feel that the response taken was not appropriate or effective, or if the concern relates to the actions of the care home manager

• confidentiality and data protection

• the importance of being open and honest when things go wrong (the duty of candour)

• duties under the Public Interest Disclosure Act 1998

• other training that is needed, based on the staff member's role and their specific safeguarding responsibilities.

Mandatory safeguarding training should include reflective learning at the individual, team and organisational level, and include opportunities for problem-solving.

Mandatory safeguarding training should include an explanation of safeguarding concepts and terminology, including translations of specific terminology if needed (to ensure that training is accessible to all staff).

Further training could cover:

• how to ask about abuse and neglect in a sensitive and non-judgemental manner

• how frequently to assess and ask about abuse and neglect

• the wide range of situations and circumstances in which abuse and neglect can potentially occur

• less obvious indicators of abuse and neglect, and more complex safeguarding concerns (for example organisational abuse and neglect)

• risk assessments and their relationship to safeguarding

• the skills needed to support a resident through a safeguarding enquiry.

Provide mandatory safeguarding training face-to-face whenever possible. This can be delivered either in person or remotely. It should be live and interactive, and e-learning should only be used when face-to-face training is not possible.

Include case studies and reflective practice in training and learning at the team and organisational level (for example, at team meetings and handovers).

Use case studies and examples to teach staff how safeguarding relates to personalised care and the human rights of residents.

Incorporate recommendations and other learning from Safeguarding Adults Reviews into training as quickly as possible after they are available.

Training should be directly applicable to the responsibilities and daily practices of the person being trained, and to the care and support needs of the residents they are working with.

Tailor training to reflect the safeguarding responsibilities of each member of staff, so staff with more responsibilities receive more comprehensive training.

If using e-learning, be aware of the limitations (for example, the lack of opportunity for discussion and asking questions, and the difficulty in ensuring that people have understood the training).

If using e-learning, care home managers should assess staff literacy levels and IT skills to ensure the training is appropriate. If staff cannot use it, find an alternative e-learning programme or another way to conduct training.

Care home managers and safeguarding leads should ensure that staff are learning from training and using it to improve their practice. This could be done by:

• checking that training is completed, and that this is done within an agreed timeframe

• follow-up conversations with staff

• periodic checks that staff are adhering to safeguarding procedures.

Care home managers should evaluate changes in understanding and confidence before and after training. Assess this:

• immediately after the training

• annually

• in regular long-term evaluations (for example, as part of supervision sessions).

Line managers should encourage staff to complete and apply learning from their training, for example during staff appraisals. This could include recognising and acknowledging new skills and competences, and changes in attitudes and behaviours.

Registered managers and providers of regulated care must comply with all safeguarding requirements in regulations 12 and 13 of the Health and Social Care Act 2008 (regulated activities) Regulations 2014.

Care home managers and safeguarding leads should lead by example in maintaining up-to-date knowledge on safeguarding.

Be aware that staff may be reluctant to challenge poor practice or raise concerns about potential abuse or neglect, particularly if they feel isolated or unsupported.

Care home managers and supervisors should promote reflective supervision to help staff understand how to identify and respond to potential abuse and neglect in care homes. Consider making this independent of line management.

Line managers should provide feedback (through supervision and appraisals) acknowledging how staff have learned from their experience of identifying, reporting and managing safeguarding concerns.

Care home managers should encourage staff to discuss care home culture, learning and management in relation to safeguarding (e.g. in exit interviews) when leaving employment with the care home.

Be aware of the potential for under-reporting of safeguarding concerns by staff who may be afraid of losing their job (for example staff who have their housing or work permit linked specifically to their current role).

Care home providers (including trustees and company directors) and managers should:

• promote a culture in which safeguarding is openly discussed and abuse and neglect can be readily reported

• ensure that support is readily available for people raising concerns, for example, by appointing safeguarding champions.

Staff should be encouraged to watch out for changes in the mood and behaviour of residents, because this might indicate abuse or neglect (see indicators of individual abuse and neglect).

Staff should record and share relevant and important information about changes in mood or behaviour or other issues of concern in a timely manner (for example, at every shift handover or transfer of care). In cases of possible abuse or neglect, see the recommendations on immediate actions to take if you consider or suspect abuse or neglect.

Care home managers should make sure there are regular opportunities (for example in team meetings or one-to-one supervision) for all staff to:

• share best practice in safeguarding, including learning from Safeguarding Adults Reviews

• challenge poor practice or discuss uncertainty around practice

• discuss the differences between poor practice (which is not necessarily a safeguarding issue) and abuse or neglect (which are safeguarding issues).
  
  Care home managers should make particular efforts to involve staff who work alone or who get very little direct oversight (for example night staff).

Care home managers should ask for feedback about safeguarding from residents (and their families, friends and carers) and other people working in care homes. They should:

• ask them about their experience of safeguarding concerns and how these have been identified, reported, managed and resolved

• respond to feedback and tell people about any changes made in response to their comments.
  
  This could be done using surveys, meetings and where appropriate, other community engagement (such as open days and visits).

Care homes, local authorities, clinical commissioning groups and other local agencies should work together to establish local strategic partnership arrangements that cover safeguarding adults in care homes, and that specifically include:

• information sharing and communication protocols

• roles, responsibilities and accountability for safeguarding within each organisation

• procedures for raising and managing a safeguarding concern, the decision-making process and the procedure for enquiries

• definitions of good practice and poor practice

• the indicators of abuse and neglect that should result in safeguarding action (based on the indicators in sections 1.4 and 1.12 of this guideline).

Local health, social care and other practitioners working with care homes should use a multi-agency approach to safeguarding, bringing together a wide range of skills and expertise to keep residents safe.

Care home managers and providers should be aware that some staff may be apprehensive about external oversight, and may need time to build relationships with external agencies before effective multi-agency working and shared learning can take place.

Care home managers and providers should participate in local Safeguarding Adults Board arrangements for sharing experiences about managing safeguarding concerns in care homes.

Care home managers and providers should share relevant information from Safeguarding Adults Board meeting minutes and reports with their staff.

Care home managers should ensure that actions taken to safeguard residents are recorded, and shared with other staff as necessary.

Care home managers should ensure that all safeguarding records are focused on the wellbeing of the individual resident. Records should be clear and easily accessible for purposes such as performance management, audits, court proceedings, Care Quality Commission inspections, or learning and development.

Care home managers should regularly review safeguarding records for accuracy, quality and appropriateness.

Consider neglect when residents:

• are not supported to present themselves the way they would like (for example haircuts, makeup, fingernails and oral hygiene and care)

• are given someone else's clothes to wear

• occasionally have poor personal hygiene or are wearing dirty clothes

• are wearing clothing that is unsuitable for the temperature or the environment

• have lost or gained weight unintentionally

• do not have access to food and drink in line with their dietary needs

• have repeated urinary tract infections

• are not getting care to protect their skin integrity, potentially leading to pressure ulcers (see the NICE guideline on pressure ulcers, and the quick guide on preventing pressure ulcers in care homes)

• do not have opportunities to spend time with other people, either virtually or in person

• uncharacteristically refuse or are reluctant to engage in social interaction

• do not have opportunities to do activities that are meaningful to them

• do not have access to medical and dental care

• are occasionally denied access to communication and independence aids (such as hearing aids) contrary to their care and support plan

• have not received prescribed medication, or medication has been administered incorrectly (for example, the wrong dose, timing, method, or type of medication)

• do not have access to outdoor space, fresh air and sunlight

• are not given first aid when needed.

Suspect neglect when residents:

• do not have an agreed care and support plan

• are not receiving the care in their agreed care and support plan

• have deteriorating physical or mental health or mental capacity, and there is a lack of response to this from staff

• live in a dirty, unhygienic or smelly environment

• repeatedly have poor personal hygiene or are wearing soiled or dirty clothes

• are malnourished

• are frequently and uncharacteristically not engaging with other people, or in activities that are meaningful for them

• have only inconsistent or reluctant contact with external health and social care organisations

• have restricted access to food or drink, if this is not part of their agreed care and support plan

• are not kept safe from everyday hazards or dangerous situations

• repeatedly do not receive prescribed medication, or medication has been repeatedly administered incorrectly (for example the dose, timing, method, or type of medication)

• are denied communication or independence aids (such as hearing aids, glasses or dentures), contrary to their care and support plan.

Be aware that some indicators of neglect may result from self-neglect. When deciding how to respond to self-neglect:

• think about why the resident may be refusing support

• think about whether the resident has capacity to understand the possible impact of their self-neglect on themselves and others (see the NICE guideline on decision making and mental capacity)

• if the resident is refusing support, ask them why, and ask if they would like a different kind of support

• make an assessment based on the risks and needs specific to the resident, in line with the Care Act 2014 statutory guidance.

Consider physical abuse when residents:

• have unexplained marks or injuries (for example, minor bruising, cuts, abrasions or reddened skin)

• tell you or show signs that they are in pain, and the cause is unexplained (for example, the pain is not caused by a pre-existing medical condition).

Suspect physical abuse when residents:

• have multiple or repeated marks or injuries (for example, bruising, cuts, lesions, loss of hair in clumps, bald patches, burns and scalds)

• have injuries that are very unlikely to be accidental (for example, grip marks, cigarette burns or strangulation marks)

• are being restrained without authorisation (either by direct restraint or by being confined to a particular area)

• flinch when approached, or change their behaviour (for example, acting subdued) in the presence of a particular person

• have fractures that cannot be explained

• have their activity limited by misuse of medication, or covert administration when not medically authorised.

Act immediately to safeguard residents and contact the police if you witness an assault or are told that a resident has been assaulted (see making sure people are safe).

Be aware that injuries can be caused by other residents.

Be aware that residents have the right to engage in sexual activity if they have the mental capacity to consent. For more information, see:

• the Care Quality Commission guidance on relationships and sexuality in adult social care services

• the NICE guideline on decision making and mental capacity.

Consider sexual abuse when residents:

• are spoken to or referred to using sexualised language

• experience any instances of sexualised behaviour or teasing

• show unexplained changes in their behaviour, such as:

  • resisting being touched

  • becoming aggressive or withdrawn

  • having trouble sleeping

  • using sexualised language

  • showing highly sexualised behaviours

• show changes in their relationships (for example, being afraid of or avoiding particular residents, family members or members of staff).

Suspect sexual abuse if a resident has an intimate relationship with a member of staff.

Suspect sexual abuse when residents who lack capacity to consent to intimate or sexual relationships:

• report being inappropriately touched or experience unwanted sexualised behaviours

• have unexplainable physical symptoms that may be associated with sexual activity, such as itching, bleeding or bruising to the genitals, anal area or inner thighs

• have unexplained bodily fluids on their underwear, clothing or bedding

• are involved in a sexual act with another person, including their husband, wife, partner or another resident

• have a sexually transmitted infection

• become pregnant.

Consider psychological abuse when residents:

• are addressed rudely or inappropriately on any occasion (verbally or non-verbally)

• are prevented from speaking freely

• are deliberately and systematically isolated by other residents and/or staff

• have information about their own care systematically withheld from them by the care home

• are not involved in planning their own care, or when changes are made to their care without discussion or agreement

• are denied a choice on any occasion (for example, around activities of daily living or freedom of movement)

• are denied unsupervised access to others

• show significant and otherwise unexplainable changes in their behaviour, including:

  • becoming withdrawn

  • avoiding or being afraid of particular individuals

  • being too eager to do anything they are asked

  • compulsive behaviour

  • not being able to do things they used to be able to do

  • not being able to concentrate or focus.

Suspect psychological abuse when residents:

• are repeatedly addressed rudely or inappropriately (verbally or non-verbally)

• are shouted at or verbally threatened

• are repeatedly humiliated, belittled, or have their opinions or beliefs undermined

• are getting married or entering a civil partnership, if you are concerned that they have not consented or lack capacity to consent to this.

• are denied access to independent advocacy

• are repeatedly denied choices (for example, around their activities of daily living or freedom of movement).

Be aware that not having systems to take care of residents' money and possessions is a form of organisational abuse and can lead to financial abuse.

Consider financial and material abuse when residents:

• do not have their money or possessions appropriately recorded by the care home

• lose money or possessions

• do not have access to their money, or to possessions that they want or need

• are not routinely involved in decisions about how their money is spent (for example if they do not get a personal allowance), or how their possessions are used

• appear to have bought things they do not need or invested money in things where they may lack capacity to make informed decisions

• find the person managing their financial affairs to be evasive or uncooperative

• family or others show unusual interest in their assets

• have unusual difficulty with their finances, and are uncharacteristically protective of money and things they own.

Suspect financial and material abuse when residents:

• have their money spent or their possessions or property used by other people, in a way that does not appear to benefit the resident (for example, their personal allowance being used to fund staff gifts, or misuse of loyalty card points)

• have treasured personal items constantly go missing

• get married or enter a civil partnership, if they are likely to lack capacity to consent to this

• change a will under duress or coercion

• sign a lasting power of attorney when they do not have the mental capacity to make this decision

• personal financial information is not kept confidential.

Consider discriminatory abuse when residents:

• are denied choices about the care and support that they receive

• are receiving care and support that does not take account of their personal or cultural needs, or other needs associated with protected characteristics under the Equality Act 2010

• show any of the indicators of psychological abuse in recommendation 1.4.18, if these are associated with protected characteristics.

Suspect discriminatory abuse when residents:

• are not treated equitably and do not have equal access to available services

• experience humiliation, violence or threatening behaviour related to protected characteristics

• are not provided with the support they need, for example, relating to their religious or cultural beliefs

• are denied access to independent advocacy

• show any of the indicators of psychological abuse in recommendation 1.4.19, if these are associated with protected characteristics.

If you suspect abuse or neglect, you must act on it. Do not assume that someone else will.

If you suspect abuse or neglect, make sure that no one is in immediate danger. If there is immediate danger, call 999 and stay with the resident at risk until help arrives.

If a crime is suspected but the situation is not an emergency, encourage and support the resident to report the matter to the police. If they cannot or do not wish to report a suspected crime (for example, because they have been coerced or lack capacity), report the situation to the police yourself.

Depending on the risks the resident is facing, and who the alleged abuser is, think about who should be immediately notified. For example:

• the care home manager

• a healthcare professional or the NHS 111 service if there is a serious medical issue

• the police or other emergency services if the resident is in immediate danger or you suspect a crime.

As soon as the resident is safe, start gathering information about the suspected abuse or neglect. Write down:

• what happened

• when it happened

• where it happened

• who was involved (the resident at risk, any other person who has told you about the abuse or neglect, and the alleged abuser).

When talking to the resident (or any other person who has told you about the abuse or neglect):

• give them the chance to speak freely about what has happened

• use simple and open questions, and ask in a non-leading way

• write down what they tell you, in their own words

• if the resident does not communicate with speech, help them explain what has happened as far as possible, and report the situation to the safeguarding lead (see recommendation 1.7.1 for safeguarding lead responsibilities in this situation).

Explain the safeguarding process to the resident (or to any other person who has told you about the abuse or neglect) and discuss the next steps.

Provide emotional support to the resident (or to any other person who has told you about the abuse or neglect).

Do not contact the alleged abuser about the incident yourself, unless this is essential (for example, if a manager needs to immediately suspend a member of staff).

Do not investigate the situation yourself, because this could cause problems for police or other investigations and enquiries. Preserve any physical evidence as far as possible (for example, ask the resident to not wash or bathe), and gather information as specified in recommendations 1.6.5 and 1.6.6.

If someone discloses abuse or neglect, tell them that you have a responsibility to report your concerns. Tell them who you will report to, why, and when.

If someone discloses abuse or neglect, do not agree to keep secrets or make promises you cannot keep.

If you suspect abuse or neglect, tell a senior member of staff and the safeguarding lead as soon as is practical (unless the alleged abuser is the only senior member of staff or the safeguarding lead). If you do not feel confident reporting within your organisation, contact:

• the local authority or

• a whistleblowing helpline, if you are a member of staff or a volunteer (for more information, see the Care Quality Commission guidance on whistleblowing).

When abuse or neglect is reported, the safeguarding lead should treat it as a safeguarding concern and:

• ask the resident at risk what they would like to happen next

• ensure that they have access to communication support

• explain that you have a responsibility to report your concerns to the local authority, and tell them who you will report to, why, and when.

When a safeguarding concern has been reported, the safeguarding lead should look at the broader context rather than assessing the concern in isolation. Take into account:

• if any other people (including children) are at risk as well as the resident you are concerned about

• if there have been repeat allegations

• if there could be a criminal offence

• if there is a current or past power imbalance in the relationship between the resident and alleged abuser.

If the safeguarding lead suspects abuse or neglect, they should make a safeguarding referral to the local authority, in line with the Care Act 2014 and Care Act 2014 statutory guidance.

If the safeguarding lead is not sure whether to make a safeguarding referral to the local authority (because they are not sure whether they suspect abuse or neglect), they should discuss it with the local authority first.

Local authorities should ensure that there is a process for care homes to discuss safeguarding concerns with social workers or other qualified safeguarding practitioners without formally making a safeguarding referral.

Local authorities should consider providing a single point of contact for care homes, local agencies and practitioners, so they can seek expert advice on safeguarding in care homes (for example, to help decide whether a referral should be made).

Local authorities should be aware that safeguarding referrals may come from a care home's openness and awareness of the safeguarding policy, as well as being possible signs of poor care.

Local authorities and other organisations involved in assessing safeguarding referrals should use professional judgement, supported by the recommendations on indicators of individual abuse and neglect. They should not be limited in their view of what abuse or neglect is, and should always consider the circumstances of the individual case.

When a safeguarding referral is made, the local authority should decide as quickly as possible whether this meets the legal criteria for a section 42 safeguarding enquiry (as defined in the Care Act). As soon as this is done, they should tell the resident and the care home safeguarding lead what they have decided.

If a section 42 safeguarding enquiry is not needed, the local authority should:

• discuss what other support is needed with the care home and the resident

• provide advice and support to help improve outcomes for the resident (for example, by reviewing the care and support plan and risk management procedures).

If a section 42 safeguarding enquiry is needed, the local authority should decide who needs to be informed or consulted, depending on the individual context. This might include:

• the resident

• their family and carers

• anyone holding lasting power of attorney for the resident

• the care home and care home provider

• advocacy organisations

• voluntary organisations

• the police

• the organisation commissioning care

• the Office of the Public Guardian, if the safeguarding concern relates to lasting power of attorney

• the Department for Work and Pensions, if the safeguarding concern relates to an appointee for the resident's benefits

• specialist helplines or online support, for advice and information

• GPs or other healthcare professionals

• the Care Quality Commission or other regulators

• banks (for financial abuse).

The local authority should set up an initial planning discussion about the safeguarding enquiry with relevant people, and (if appropriate) involve staff from the care home or care home provider.

The local authority should appoint an enquiry lead to coordinate the work of the enquiry and act as a main point of contact.

For more information about conducting a section 42 safeguarding enquiry see Making Safeguarding Personal.

The enquiry lead should ask the resident at risk:

• if they would like to be kept up to date during the enquiry

• how much detail they want

• what format they would prefer this in

• who they would like to contact them.

If the police are involved in a safeguarding enquiry, the enquiry lead should hold early discussions with the case officer on the rules of communication and information recording.

When safeguarding enquiries finish, the enquiry lead should provide feedback for the resident (and their family and advocates) that:

• summarises the enquiry, and includes the relevant outcomes and recommendations

• gives them the information needed to decide whether they wish to take any further action (for example, informing the Care Quality Commission or making a complaint to the Local Government and Social Care Ombudsman).

For guidance on finding out how residents want to be supported in decision making, see recommendation 1.2.1 in the NICE guideline on decision making and mental capacity.

All organisations involved with safeguarding adults in care homes should:

• understand the role of advocacy in relation to safeguarding, and that the advocate is the only person who acts solely according to instructions from the resident

• think about the resident's needs and know when to refer people for advocacy

• involve an independent advocate for the resident, when this is required by the Care Act 2014 and Care Act 2014 statutory guidance or the Mental Capacity Act 2005

• ensure that anyone supporting the resident as an informal or independent advocate has been identified in line with the resident's statutory rights to advocacy under the Care Act and the Mental Capacity Act.

Care homes should tell residents:

• how advocates can help them with safeguarding enquiries

• that they may have a legal right to an advocate, and what the criteria for this are.

Practitioners involved in managing safeguarding concerns should build effective working relationships with advocates and other people supporting the resident.

Local authorities and commissioners should monitor:

• whether care homes are telling residents about advocacy and the criteria for accessing this and

• how advocates are involved in the management of safeguarding concerns.

Ask the resident at risk who they would like to support them through the enquiry (in addition to any legal rights to advocacy).

Provide practical and emotional support to the resident at risk:

• while the enquiry is taking place

• when the enquiry has finished, to help deliver the outcomes the person wishes to achieve

• as needed after the enquiry (for example, by updating the care and support plan or protection plan, conducting risk assessments, or through future reviews).

Consider referring the resident for other specialist support (such as psychological support) after the enquiry.

Provide information and support to informal advocates chosen by the resident at risk (for example, family and friends).

Everyone involved with a safeguarding enquiry should remember that the resident is entitled to and may benefit from support (regardless of their mental capacity).

Ensure that the same level of support is offered to residents who self-fund their care and to residents whose care is publicly funded.

Be aware that when the alleged abuser is another resident, they may also need support (including advocacy). Manage the risks between residents while any enquiry takes place and work with relevant commissioners.

Care home providers and managers should:

• be aware of how safeguarding allegations can affect the way other staff and residents view a person subject to a safeguarding enquiry

• take steps to protect the person from victimisation or discriminatory behaviour.

When a member of staff is subject to a safeguarding enquiry, care home providers and managers should:

• tell them about any available Employee Assistance Programme

• tell them about professional counselling and occupational health services (if available)

• nominate someone to keep in touch with them throughout the enquiry (if they are suspended from work).

Staff who are subject to a safeguarding enquiry 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, care home providers and managers should tell them who the nominated person is.

For members of staff who return to work after being suspended, care home providers and managers 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.

Unless they are subject to the safeguarding enquiry themselves, care home managers should:

• find out from the local authority what they can share with staff at each stage of the enquiry

• communicate as much as possible with all staff about the enquiry, and be open to answering questions.

During safeguarding enquiries, care home managers should:

• 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.

If a care home manager is subject to a safeguarding enquiry, the care home or care home provider should put an acting manager in their place.

If staff are concerned about working with a resident who has made allegations, care home managers should:

• provide support, additional training and supervision to address these concerns

• ensure that the resident is not victimised by staff.

Care home managers should direct staff to sources of external support or advice if needed.

For indicators starting with 'consider'

• raise the matter with the care home manager, in writing if possible

  • if the care home manager is believed to be part of the problem, go to the group manager, regional manager, owner or board of trustees

  • if the care home manager is the sole owner, follow the actions to take if you suspect abuse or neglect

• explain the impact on residents, or the likely impact if the situation continues

• ask for a response within a specified period of time (for example 2 weeks)

• if the manager agrees to make changes, make sure these happen

• after taking these steps, if the situation does not improve, raise your level of concern to 'suspect'.

Suspect organisational abuse when:

• incidents of abuse or neglect are not reported, or there is evidence of incidents being deliberately not reported

• there is evidence of redacted, falsified, missing or incomplete records

• there have been multiple hospital admissions of residents, resulting in safeguarding enquiries

• there are repeated cases of residents not having access to nursing, medical or dental care

• there is frequent, unexplained deterioration in residents' health and wellbeing

• residents' money is being misused by the care home (for example, to purchase gifts for staff or other residents without permission)

• there is a sudden increase in safeguarding concerns in which abuse or neglect has been identified

• residents are repeatedly evicted or threatened with eviction after making complaints

• repeated instances of residents, families and carers feeling victimised if they raise safeguarding concerns

• the care home fails to improve or respond to actions or recommendations in local inspections or audit frameworks from clinical commissioning groups or the local authority, or reviews and inspections by the Care Quality Commission or Healthwatch, and deteriorates over time.

If you 'suspect' abuse or neglect:

• Contact your local authority and tell them that you want to make an adult safeguarding referral.

• When local authorities receive adult safeguarding referrals:

  • they should gather information, under section 4 of the Care Act

  • they must decide if there is reasonable cause to suspect that an adult with care and support needs is experiencing abuse or neglect and is unable to protect themselves from harm

  • if this criteria is met, they must conduct a section 42 enquiry.

• If many residents of a care home are affected, local authorities may conduct a large-scale enquiry, following their own local procedures.

• If you are not satisfied with the response from your local authority, you can make a complaint to the Local Government and Social Care Ombudsman and give feedback to the Care Quality Commission.

When organisational abuse or neglect is identified, plan what individual or collective support is needed for residents, staff, and other people who might be affected.