Safeguarding Toolkit for Adult Care Providers Standard 7

Providers are obligated to consider Duty of Candour.

Regulations under the Care Act 2004 place a duty of candour on all service providers registered with the Care Quality Commission from April 2015.

The duty aims to ensure transparency and honesty when things go wrong, ensuring the person concerned is told as soon as possible when something has gone wrong.

Assurance should be given to them, including an apology and keeping the person informed about any further enquiries and what they have done to mitigate future events. Lessons learnt should be shared to improve on  delivery of care.

The Safeguarding Enquiry Process

Surrey Safeguarding Adult Board annual report for 2021-2022 included data from concluded Section 42 enquiries. Neglect and Acts of omission were the highest category at 59.7%.

There are many types of neglect and acts of omission

• Failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care.
• Providing care in a way that the person dislikes.
• Failure to administer medication as prescribed.
• Refusal of access to visitors.
• Ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services.
• It can also involve withholding the necessities of life, such as medication, adequate nutrition and heating.
• Warning signs of neglect can include:
  • inconsistent or reluctant contact with medical and social care
  • failure to engage in social interaction.
  • inappropriate or inadequate clothing.
  • dirty or unhygienic environment.
  • poor personal hygiene or physical condition.
  • pressure sores or ulcers.
  • malnutrition or unexplained weight loss.
  • untreated injuries and medical problems.
  • health and development problems.
  • housing and family issues.
  • change in behaviour.

Under the Domestic Violence, Crime and Victims Act 2004, a domestic homicide review (DHR) must be carried out:

• when the death of a person aged 16 or over
• if the death has or appears to have resulted from violence, abuse or neglect
• if you are related to the victim or with whom he or she was or had been in an intimate personal relationship with the victim
• if you lived in the same household as a victim.

The purpose of Domestic Homicide Reviews are carried out to:

• Establish what lessons can be learned from the circumstances of the death and the way in which local professionals and organisations worked individually and together to safeguard victims 
• To identify clearly what those lessons are both within and between agencies, how and within what timescales they will be acted on, and what is expected to change as a result
• To apply these lessons to service responses that may impact on changes to policies and procedures
• Prevent homicides in domestic settings and improve service responses for all domestic violence victims and their children through improved intra- and inter-agency working. Responding effectively at the earliest opportunity.
• To highlight  and share areas of good practice

The Home Office provide a leaflet for families explaining the purpose and mechanisms of DHRs.

More information about the DHR process can be found in the Home Office Statutory Guidance for the Conduct of Domestic Homicide Reviews.

The Safeguarding Adults Review SAR

What is a SAR - A Safeguarding Adults Review (SAR) is a multi-agency process for all relevant agencies and individuals involved to explore how they could of worked differently, to have prevented abuse or neglect or a death from taking place.

Safeguarding Adult Boards (SABs) have a statutory responsibility, to arrange a Safeguarding Adult Review (SAR) when the following criteria is met under the Care Act 2014, for anyone with care and support needs (whether or not the local authority has been meeting any of those needs) if:

1. There is reasonable cause for concern about how the SAB, members of it or persons with relevant functions worked together to safeguard the adult, and
2. either of the following conditions are met:

Condition 1 is met if:

• the adult has died, and
• the SAB knows or suspects that the death resulted from abuse or neglect (whether of not it is know about or suspected there was abuse or neglect before the adult died).

Condition 2 is met if:

• the adult is still alive, and
• the SAB knows or suspects that the adult has experienced serious abuse or neglect.

A SAR for any other reason (Discretionary)

• The circumstances do not meet either Condition 1 or Condition 2 (above)
• The SAB should consider arranging for a SAR regarding an adult in Surrey with care and support needs.

Family, friends, and carer involvement in the Review

You may be asked for your comments and views as part of a SAR or supporting a family member for someone you had or are caring for.

This information may help you to understand how the views of the families, relatives and friends or your staff feed into the process.

It is acknowledged this is a very difficult time for families, relatives, friends, and carers, however they believe families, carers and the person should have the opportunity to discuss any concerns they may have and to share their thoughts, memories, and opinions.

It is important to note that a SAR is not about apportioning blame but about learning, looking a ways agencies / professionals could work differently together and learn from what happened. Also, to look at sharing good practice and continually improve practice.

You will be contacted by The Adult Safegaurding Board as soon as possible when the review is taking place to give you an opportunity to be involved. Your opinions, memories and thoughts can be shared in several ways including via a telephone discussion, email, or a face-to-face conversation with the Independent Reviewer.

To assist the Reviewer, they will ask questions to aid the discussion. The process normally last a few hours although this will depend on you, and if you feel able to participate. You can be involved as much or as little as you wish, or not at all. A SAR can take several months to complete, but we will update you regularly.

The Surrey Safeguarding Adults Board has information on Safeguarding Adults Reviews (SAR) including all published SARs.  Each Case will have supporting papers such as

• Publication Statement from the SSAB chair
• Executive Summary
• Overview Report
• Learning Briefing

Cases are in relation to many different events, such as an incident in a care home, choking incident, multi -agency working, reablement services, near miss events.

Learning from lives and deaths: People with a learning disability and autistic people (LeDeR)

The aim of the programme is to support local areas to review the deaths of people with learning disabilities (aged four years and above) and autistic people (aged 18 years old and over), identify learning from those deaths, and ensure services are developed in order to address any learning from the review.

For more information on the programme please visit the NHS England LeDeR website.

Anyone can report the death of a person with a learning disability or an autistic person to the LeDeR programme. All deaths of people with learning disabilities who are aged four years and above should be reported and deaths of autistic people (with or without a learning disability) aged 18 years old and above. Deaths can be reported online via NHS England.

Surrey Heartlands LeDeR Strategy 2021-2024 provides an overview of the number of deaths that have been reported to LeDeR for these areas and summaries the learning that has come from the completed reviews.

You can read the latest LeDeR Annual Report to get an overview of the LeDeR programme and how this has been implemented in our local area.