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2.9 Large Scale and Whole Service Concerns

Contents

  1. Introduction
  2. Process Summary
  3. The Strategy Meeting
  4. Informing the Service of the Enquiry
  5. Access to Premises and Records
  6. Recording and Reports
  7. Suspension of Placements and Serious Default Notices
  8. Improvement and Action Planning
  9. The Role of the Local Authority Independent Chair
  10. Care Home Emergency Closures as a Consequence of Safeguarding Concerns


1. Introduction

A large-scale or whole service Safeguarding Adult Safeguarding Adult enquiries would be indicated when there has been an allegation of Organisational Abuse or a number of Adults at Risk have been allegedly abused, or patterns or trends are emerging from data that suggest serious concerns about poor quality of care in a particular resource/establishment.

Whole Service Concerns

Where there is an indication that a service, as a whole, has safety and quality concerns, not adhering to regulatory standards and a risk to the health and well-being of residents, a Whole Service Concern referral can be instigated to both prevent abuse from occurring and improve standards of care, or where abuse has occurred and actions must be taken to safeguard residents.

Indicators where a service provider meets the threshold for Whole Service concerns:

  • A pattern of individual safeguarding concerns, which seen collectively, indicate serious organisational issues;
  • A pattern of complaints made against a service provider from a variety of external agencies and or carers and relatives;
  • A serious single incident indicative of systemic and organisational abuse, such as that involving a death of a service user;
  • A large scale enquiry involving a high number of service users where abuse is suspected;
  • A report of systemic and organisational abuse;
  • Lack of contract compliance with indicates poor care and/or lack of leadership skills or commitment in complying with contractual requirements;
  • The failure of an organisation to comply with the Plymouth Multi Agency Adult Safeguarding Policy & Procedures;
  • Poor CQC compliance report identifying non-compliance with major safeguarding concerns in one or more essential outcome areas (CQC Key Lines of Enquiry - KLOE).

The above list is not exhaustive; the sharing of information between partners assists in identifying a more holistic picture of concerns about a provider.

Single safeguarding concerns alleging abuse may raise wider issues within the setting. Organisational abuse as defined by statutory guidance is ‘the mistreatment or abuse or neglect of an adult at risk by a regime or individual within setting and services that adults at risk live in or use, that violate the person’s dignity, resulting in a lack of respect for their human rights.”

While a report of abuse may be in regard to an individual act, the enquiry may find that the abuse is endemic and related to the culture or structure within the organisation.

Examples of organisational abuse include:

  • Poor management structure, or rigid and authoritarian management;
  • Poorly trained or unsupervised staff;
  • Inadequate staffing levels;
  • Inappropriate use of physical restraint;
  • Medication misadministration, record keeping and storage;
  • Failure to act on incidents of poor practice;
  • Persistent failure to meet basic health and social care needs of residents;
  • Often organisational abuse is not in isolation and is coupled with other types of abuse and neglect, including a lack of dignity and care for residents.

The Care Act guidance specifies that safeguarding is not a substitute for:

  • Service Providers’ responsibilities to ensure safe and high quality care and support;
  • Commissioners regularly assuring themselves of the safety and effectiveness of commissioned services;
  • The Care Quality Commission (CQC) ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action; and
  • The core duties of the police to prevent and detect crime and protect life and property

A Provider Service is an organisation providing care to an individual or group of people. This would include, but is not limited to:

  • Residential Care Homes;
  • Nursing Homes;
  • Domiciliary Care Providers;
  • Supported Living Services;
  • Private hospitals;
  • CCG commissioned provision;
  • NHS England commissioned provision;
  • Day Services/Opportunities;
  • Rehabilitation Units i.e. alcohol & substance use;
  • Voluntary agencies.

Where the need for a large-scale or whole service enquiry becomes apparent, senior managers in the local authority should identify a manager to take responsibility for coordinating the overall enquiry, with all other relevant organisations. If a crime is thought to have been committed, the usual principles and responsibilities for reporting to police apply.

Such enquiries may involve a wide range of organisations. It should be determined as soon as possible whether there are any service users who are in placements commissioned by health or a different local authority. Where there are concerns for the safety of these individuals, information should be shared with the relevant commissioners and care managers according to ADASS guidance (see Out-of-Area Safeguarding Adults Arrangements Procedure). The Care Quality Commission should also be informed.


2. Process Summary

Where there are concerns about a potential large scale enquiry or whole service safeguarding concerns, this should be referred to the Local Authority Safeguarding Team for discussion with the Adult Safeguarding Manager, Independent Chair, and the Quality Assurance and Improvement Team (QAIT) who will decide along with the responsible senior manager whether a large scale/whole service enquiry is required.

If a large scale/whole service enquiry is required, the Adult Safeguarding Manager, and relevant Health and Care Commissioners should be informed and kept up to date throughout the process. They will decide whether it is necessary to brief the Communications Officer and senior managers.

Meetings will usually be chaired by the local authority Independent Chair (see Section 9, The Role of the Local Authority Independent Chair), Adult Safeguarding Manager or a commissioning manager from health and/or social care.

Unless an urgent discussion is required with the police, planning will take the form of a Strategy Meeting rather than a Strategy Discussion due to the number of professionals likely to be involved and the need for clear and accurate minutes and records of decisions taken at the meeting.


3. The Strategy Meeting

Members of the Strategy Meeting will:

  1. Agree the scope of the enquiry (as enquiries  are to identify evidence to inform safeguarding risk assessments about service users currently receiving a service, the enquiry will focus on evidence relating to current care provision and will not routinely look at records more than three months old; unless a longer view is clearly required);
  2. Assess the risk to service users from available information and consider what steps may be necessary to manage this risk. This must include discussion of any specific individuals where there are allegations of abuse or Neglect as well as wider organisational concerns;
  3. Plan all aspects of the enquiry and clarify the respective roles and responsibilities of organisations and individual professionals;
  4. Set clear timetables for tasks agreed;
  5. Where action plans indicate further information is required to inform risk assessment and planning, the meeting will need to consider what information is required and which agency/agencies are best placed to gather the information;
  6. The plan will outline where and from whom workers will seek evidence for example visits to the service, viewing of records, contacts with service users, contacts with service users’ relatives etc.
  7. Identify any specialist staff needed to support the enquiry officers where this is required, such as sensory loss, health needs (for example tissue viability), mental health or learning disability specialist staff;
  8. Arrange for any further health and social care planning actions or reviews needed to be carried out by health or social care staff in their service;
  9. Agree a communication strategy to avoid raising unnecessary anxieties or prompting destruction or manipulation of evidence. It is important to be clear what has been communicated to whom within a service and what information is permitted to share with service managers, providers, service users etc.
  10. Agree Safeguarding Plan for affected individuals and organisational risks;
  11. Consider whether it is necessary to make a referral for involvement of Independent Mental Capacity Advocates where any residents may lack Capacity to make decisions for their care and safety. This can be the case even where the individuals have family members;
  12. Where previous safeguarding concerns have been investigated, outcome known and closed, a Whole Service meeting will not reopen discussion on these individual cases;
  13. Agree the date of any further meetings.


4. Informing the Service of the Enquiry

A worker should be identified to initiate contact with service providers / managers to request their support for and cooperation in the enquiry. In all but exceptional circumstances, this should be done prior to visiting the service, contacting service users, relatives or staff. Exceptions may arise where it is clear that to do so would compromise the conduct of the enquiry. Reasons for not doing so should be agreed at the Strategy Meeting and clearly recorded. Where this is the case, the decision not to inform the provider should be kept under review and they should be informed at the earliest appropriate opportunity.

The worker should, except where directed not to, give service providers a verbal summary of the Terms of Reference (TOR) for their enquiry and identify which service users they wish to include in the enquiry at the time they first visit the service. This should allow providers / managers the information they need to facilitate the enquiry, while minimising the possibility that evidence could be manipulated or removed. When asked, by service providers for information they do not have or are not permitted to share the worker should refer the request back to the chair of the Strategy Meeting.

Unless the enquiry is being led by the police, when health or social care workers are investigating specific actions of individual staff, they should agree their enquiries plans relating to the named staff with the employers to ensure they are in line with the employing organisation’s Human Resources policies, unless such collaboration would not be appropriate. This should be decided at the Strategy Meeting.


5. Access to Premises and Records

Plymouth City Council (PCC) does not have a statutory right of access to businesses of independent service providers and will seek Consent and cooperation from independent providers before commencing enquiries. Where such cooperation is not forthcoming the Care Quality Commission (CQC) will be informed, as the regulator responsible for care services.

Where PCC contracts with service providers, PCC staff have the right to visit and review individuals where they ‘commission’ the service. Where they do not commission the service, for example where someone has a private arrangement, PCC staff have no such right of access and we must seek the permission of the service provider and service user (or their representative) before we do so. Where it is assessed that the person lacks Capacity to give Consent to being reviewed, a Best Interest decision should be recorded regarding this.


6. Recording and Reports

Work done with individual service users will be recorded on their CF6 electronic record and changes made to Support Plans as required. Professional colleagues from partner agencies must record in line with their own organisation’s policies.

In addition to this, investigating officers will compile reports to inform safeguarding meetings. Permission may be sought from other organisations to use their records as appendices to enquiry reports. Where more than one professional is involved in an enquiry, records must identify the contribution of each professional in relation to who they saw and the elements of care they assessed. Reports should be written with the assumption that they may be shared with service users and service providers, as well as to colleagues involved in the multi-agency Safeguarding Adults Framework.

Chairs of safeguarding meetings will ensure that the meetings consider and decide who should have access to these enquiry reports.

Investigating officers’ hand-written notes should be scanned and retained for at least three years after the safeguarding case has concluded.


7. Suspension of Placements and Serious Default Notices

Where there is evidence that the health and wellbeing of a service user/s is at immediate and significant risk, the Strategy Meeting will inform the Adult Safeguarding Manager, who in conjunction with Commissioners will consider whether placements to a particular Service Provider should be suspended with immediate effect. Where there are significant safeguarding concerns relating to the safety and wellbeing of people using a care or support service it may be appropriate, as a precautionary measure, to act to prevent further placements to that service until concerns have been examined and if proven addressed. The Chair of the meeting should raise this issue as a matter of urgency, presenting relevant evidence. If the situation is sufficiently serious to merit a placement suspension this must be applied without delay and some consideration must be given to moving residents who may be at risk. When approval to suspend placements has been given, the Contracts Team will inform the provider verbally and follow this up with a suspension letter. The Adult Safeguarding Team will also issue a Placement Suspension notification to staff across Plymouth. The responsibility for informing other authorities currently using the service will remain with the Chair of the Strategy Meeting.

Where placements with a service have been previously suspended, the appropriateness of maintaining this should be considered at regular intervals, in light of identified evidence and revised risk assessment, this should include immediately following each subsequent Strategy Review Meeting / Case Conference. The rationale for retaining or lifting the suspension should be recorded in writing and kept with the minutes of the meeting. A decision to lift suspension must also be taken by the relevant Commissioners and in conjunction with the Adult Safeguarding Manager.

Click here to access Recommendation to Suspend Placements Form.


8. Improvement and Action Planning

At the conclusion of safeguarding enquiry, information from the original Concern(s) and any subsequent enquiry and reviews will be used to formulate an action and improvement plan with the provider. All aspects of improvement planning and review of implementation are the responsibility of Quality Assurance and Improvement Team.


9. The Role of the Local Authority Independent Chair

The Independent Chair acts autonomously in all the meetings that they chair and may seek advice from the safeguarding management or senior manager in complex situations. They are required to work in accordance with legislation and policy. The role requires thought, analysis and evaluation in order to ensure effective planning to safeguard Adults at Risk and ensure Safeguarding Planning is in place.

The Independent Chair will chair complex meetings involving large scale/whole service multi agency enquiries in order to plan enquiries in accordance with the Care Act statutory guidance and these multi-agency procedures as well as provide an independent quality assurance role within Plymouth.


10. Care Home Emergency Closures as a Consequence of Safeguarding Concerns

Should a decision be needed regarding termination of contract / closure, the legal and evidence basis for such a consideration / need must be discussed within a safeguarding case conference in which the following people where appropriate should participate:

  • Independent Chair;
  • Commissioning Director or relevant Senior Manager;
  • Relevant Commissioning Managers;
  • Adult Safeguarding Manager;
  • Enquiry Leads;
  • Continuing Health Care representative if required;
  • Clinical Commissioning Group (CCG) Lead;
  • Care Quality Commission;
  • Legal Advisor;
  • Other funding authority representatives.

Any supporting evidence from other agencies such as police or CQC will be presented by representatives specific to these agencies.

Attendees at this emergency meeting will then consider the evidence base presented by the enquiry leads and others and reach an agreement on what actions are required. Any termination of contract decision must be agreed by the relevant commissioning managers in conjunction with the Commissioning Director.

In the event of a decision to remove residents on the basis of safeguarding intervention the principles as identified in Short Notice Care Home Closures: A Guide for Local Authority Commissioners, SCIE should be adopted.

End