9.2 Provider-led enquiries The main purpose of identifying an incident of poor care is to rectify any deficiency immediately, understand why care was compromised and put in place measures to ensure that the risk of any repetition is minimised. To support this process and to ensure that there is a full enquiry and any lessons learnt, the Provider Service should complete the Provider Enquiry Report which must then be returned by email to the Safeguarding Adults Unit at within fourteen days of reporting the the Provider-led Concern. It will be the responsibility of the Provider Service to complete this document and ensure that it is forwarded to the Safeguarding Adults Unit within the timescale outlined. If there is likely to be a delay please contact the Unit to discuss this. Tel: 0151 443 4888. 9.3 Monitoring Arrangements All Provider-led enquiry reports will be subject to quality assurance and there will be arrangements to ensure that any lessons learnt are shared across providers through the Care Partnership Forum. 9.4 NHS providers Low level incidents in NHS services require a different response; Health Trusts are statutory organisations and have their own governance arrangements in relation to patient safety, dignity and respect. There is no expectation that NHS Trusts will report low level incidents through the Provider-led Concern process, they should follow their own procedures. 9.5 When to report a Safeguarding Concern (provider services) Some incidents/issues should not be investigated by the provider and should always be referred as a Safeguarding Concern for a multi-agency enquiry. These include: Physical assault Sexual assault Financial abuse Wilful neglect Any act/omission which has resulted in physical injury or harm Any allegation of harm that constitutes a criminal offence A Safeguarding Concern should be raised when are repeat low level concerns as it is recognised that in some cases it is the repetition of minor actions or omissions that collectively will amount to abuse. Determining whether or not abuse has taken place is not always a straightforward matter, particularly when the concerns relate to neglect. A judgement will be required about whether an act or an act of omission has caused a significant impact. If you are unsure whether a particular should be addressed by a Provider-led Concern or a Safeguarding Concern please contact the Knowsley Safeguarding Hub for advice. Tel: 0151 443 2600. References:
Template Action Plan Name of resident Time & Date of Fall Location of fall Witness/1st on scene Injury Received Reason for fall (Refer to Green column pathway) Action (Refer to Blue column pathway) Action Taken (Refer to Orange column pathway) Referral to Lilac column pathway) Risk Assessment Review (Date) Action Plan Review undertaken (Date) Full Name ……………………………………….. Signed .......……… Designation …………………………………….. Knowsley Care Homes only.
The following Guidance may be used to assist in distinguishing between poor practice i.e. failure to meet a service user’s care needs, which should be managed by a provider and addressed as a Provider-led concern and abuse which should trigger the reporting of a Safeguarding Concern. The following table illustrates examples of circumstances which can be managed by reporting a Provider-led Concern and those which should be reported as a Safeguarding Concern; please note this is not an exhaustive list. Area of concern Provider-led Concern Examples of poor practice which requires action by a provider organisation e.g. care home or domiciliary care manager Safeguarding Concern Examples of possible abuse which requires reporting as such, and the instigation of Safeguarding procedures 1.Failure to provide assistance with food/ drink Person does not receive necessary help to have a drink/meal. If this happens once and a reasonable explanation is given e.g. unplanned staffing problem, emergency occurring elsewhere in the home, dealt with under staff disciplinary procedures; would not be reported as a Safeguarding Concern. Person does not receive necessary help to have drink/meal and this is a recurring event, or is happening to more than one person. This constitutes neglectful practice, may be evidence of institutional abuse and would prompt a safeguarding enquiry. Harm: malnutrition, dehydration, constipation, tissue viability problems. 2.Failure to provide assistance to maintain continence Person does not receive necessary help to get to toilet to maintain continence or have appropriate assistance such as changed incontinence pads If this happens once and a reasonable explanation is given e.g. unplanned staffing problem, emergency occurring elsewhere in the home, dealt with under staff disciplinary procedures; would not be reported as a Safeguarding Concern. Person does not receive necessary help to get to toilet to maintain continence and this is a recurring event, or is happening to more than one person – neglectful practice, may be evidence of institutional abuse and would prompt reporting of a Safeguarding Concern. Harm: pain, constipation, loss of dignity, humiliation, skin problems.. 3. Failure to seek assessment re pressure area management Person known to be susceptible to pressure ulcers has not been formally assessed with respect to pressure area management Person is frail and has been admitted without appropriate risk assessment in respect of pressure area management (or plan not
lack of dignity, loss of confidence for the person. 6. Failure to provide support to maintain mobility Person not given recommended assistance to maintain mobility on one occasion. Recurring or is happening to more than one person, resulting in reduced mobility. Harm: loss of mobility, confidence and independence. 7. Failure to provide medical care An adult at risk is in pain or otherwise in need of medical care such as dental, optical, audiology assessment, foot care or therapy does not on one occasion receive required medical attention in a timely manner. An adult at risk is provided with an evidently inferior medical service or no service. Harm: pain, distress, deterioration in health 8. Inappropriate comments from staff Person is spoken to in a rude, insulting, humiliating or other inappropriate way by a member of staff. They are not distressed and this is an isolated incident. Provider takes appropriate action, to the satisfaction of the person involved. Person is frequently spoken to in a rude, insulting, humiliating or other inappropriate way or it happens to more than one person. Regime in the home doesn’t respect people’s dignity and staff frequently use derogatory terms and are abusive to residents. Regulatory breach - report as a Safeguarding Concern. Harm: demoralisation, psychological distress, loss of self-esteem. 9. Significant need not addressed in Care Plan Person does not have within their Care Plan/Service Delivery Plan/Treatment Plan a section which addresses a significant assessed need, for example: Management of behaviour to protect self or others. Failure to specify in a patient/client’s Plan how a significant need must be met. Inappropriate action or inaction related to this results in harm such as injury, choking etc. Report as a Safeguarding Concern.