Sexual abuse – This is unwanted sexual activity that is forced upon a person without their consent, this includes rape, making them watch pornography, pestering them by making sexual suggestions or comments, or they were pressured into consenting.
Emotional/psychological abuse – This is controlling behaviours like shouting and calling the service user names. Could be threats of harm or of being abandoned, being deprived of contact with others, being humiliated, controlled, intimidated, kept in isolation or being withdrawn from supportive networks or services.
Financial abuse – Taking control of money and bank accounts. These include theft, fraud, exploitation, property or misappropriation of property, possessions or benefits. Institutional abuse – Institutional abuse comprises of neglect, physical abuse, and sexual abuse, psychological, emotional and financial abuse. Residents are not allowed to go out, private letters opened and read, shown no respect for their privacy. Service users interests are not taken into consideration, they are given more medication than required. Complaints procedure is not made available to the resident.
Self neglect – An adult that fails to take care of their health and is likely to cause serious physical, mental or emotional harm to themselves.
Neglect by others – ignoring medical or physical needs. Fail to provide access to health, social care or educational services, withholding medication, not giving adequate nutrition and heating also clothing etc.
Signs and symptoms associated with each type of abuse
Physical abuse – these include bruising around well protected and covered areas, fractures, burn marks, fear, depression and unexplained weight loss or hair loss, flinching. Sexual abuse – Unexplained change in their behaviour, difficulty in walking, sitting. Injuries to genital area, bloodstained underwear, pregnancy and STD’s.
Emotional/psychological abuse – Withdrawal, depression, change in their sleep patterns. Agitated, feeling confused. Change in their behaviour, change with their appetite, losing or gaining weight. Low self esteem and confidence.
Financial abuse – Unpaid bills. Basic needs not being met, lack of personal possessions and clothes. Lack of money on a day to day basis. Unexlained money being taken from their bank account. Keeping the service user away from their family and friends, so that the support worker has total control.
Institutional abuse – No flexibility at meal times or bedtimes. Dirty bedding and clothing. Lack of care plans, misuse of medication, staff have no regard for the residents privacy they enter into the residents room without knocking.
Self neglect – Poor personal hygiene. Inappropriate clothing, confusion, malnourishment, incorrect medication could be over or under medicating, skin sores.
Neglect by others – Poor personal hygiene including soiled clothing, inappropriate clothing, and the resident could have bed sores, and may be constantly hungry due to lack of food. Suffer from different illnesses.
Factors that may contribute to an individual being more vulnerable to abuse The resident could be suffering from a mental disability such as dementia. The resident could be using illegal drugs or be an alcoholic. They could be isolated, suffering from depression. The resident may be suffering from low self esteem or self worth. All of these can make that person more vulnerable to abuse.
Know how to respond to suspected or alleged abuse
If a service user was showing signs of abuse, changes in their behaviour, marks or bruises on their body I would ask the service user what has happened, and tell them the changes that I have noticed. I will listen carefully; it is up to them to tell me what has happened. I will not ask them any questions, I will stay calm. I will record what the service user tells me using their own words. I will reassure the service user and explain to them that their safety is most important and it’s my duty of care to inform the manager. The report will be confidential. I will let my manger know what has happened immediately in private. I will only record and report the facts that the service user told me. Depending what is found the service user may need to be monitored, plus a care plan put into place to protect the service user that must be followed.
The actions to take if an individual alleges that they are being abused. Report the service user’s allegation to the manager in private. I would record the facts on appropriate paperwork using their words. I will listen and not judge the service user. I will establish what has happened and report any suspicions to my manager. I will reassure the service user at all times, and take the allegations seriously. I will speak clearly and precise and will avoid asking leading questions. I will date and sign the paperwork, get it signed by witnesses if there are any. Photographs will be taken of the evidence if this is possible.
Identify ways to ensure evidence of abuse is preserved
Record the facts immediately
Do not tamper with the evidence.
Leave things as they are do not touch anything. Do not clean or wash what the service user is wearing. Do not handle service users’ clothes or bedding. Keep the area safe; do not let anyone enter the area. Keep any first aid items that have been used.
Understand the national and local context of safeguarding and protection from abuse National Policies – Safeguarding Vulnerable Groups Act 2006, the Vetting and Barring Scheme run by the independent Safeguarding Authority (ISA), Criminal Records Bureau, and Human Rights act 1998. Local Systems – Safeguarding Adult Boards, Safeguarding policies and procedures for vulnerable adults. Safeguarding Adult Boards – these bring together a number of local agencies that work with vulnerable adults to share their information and monitor their work, i.e agencies like the police, housing teams and advocacy groups. The Police – their role is to safeguard vulnerable adults, investigate reports of vulnerable adult abuse, to protect and uphold the rights of all vulnerable adults. CQC – to monitor and provide guidance on what health and social care provides must do to safeguard vulnerable adults from abuse, Safeguarding policies, procedures and systems are in place to prevent vulnerable adults from abuse.
Identify reports into serious failures to protect individuals from abuse Winterbourne Hospital had and inspection of its services after allegations of abuse. The report came after Panarama filmed patients being pinned down, slapped and doused in cold water; they were taunted and teased even though whistle blower Terry Bryan had warned of what was happening to the management and the Care Quality Control on a number of occasions. CQC inspectors found Castlebeck care failed to make sure that service users were adequately protected from risk. There was failure to protect service users or to investigate allegations of abuse. The provider also failed to notify CQC of serious accidents and times when service users went missing. Staff did not understand the needs of the service users that were in their care.
Methods of restraint would be used without any alternatives. Inspectors found that staff had been working there without any background in care service. Castlebeck failed to meet standards required by law including – They did not report major incidents to the Quality Care Commission as required’ The delivery of care did not meet the service users’ individual needs. They did not have systems to assess and monitor the quality of services. They did not identify or manage risks relating to health welfare and the safety of the service users. They did nothing regarding complaints and people about the service. Investigations into the conduct of staff were not robust and did not safeguard the service users. No reasonable steps were taken to prevent abuse before it occurred. There were ineffective recruitment procedures, not appropriate training and supervision to staff.
How to identify sources of information and advice about my own role in safeguarding and protecting individuals from abuse This can be done in a number of different ways from training and advice from training centres
Care Quality Commission
My companies’ policies and procedures on safeguarding
My manager and work colleagues
Independant Safeguarding Authority.
Understand how the likelihood of abuse may be reduced by
Working with person centred values – By working with person centred values, individuality, privacy, choice, independence dignity respect and partnership, the service user is encouraged to live as independently as possible. By promoting choice and rights for a service user then they are making their own choices, and not having them made for them. They are more independent. Complaints procedures should be in place and be accessible to them; it’s then less confusing for them to have the confidence to report any abuse.
Encouraging active participation
To encourage a service user to participate and make their own decisions, for example to ask them if they would like to have a bath or a shower. It is good practise to involve the service user with their care plan as it’s about them, this reduces the risk of abuse and also gives them confidence to speak up if there is an issue. The service user is an active partner in their own care or support, rather than a passive recipient.
Promoting choice and rights
Promoting choice and rights is all of the above; it’s about the service user taking control of their life, even if it’s in a small way by deciding what they want for breakfast. It allows them to be an individual, to have rights and wishes recognised. The importance of an accessible complaints procedure for reducing the likelihood of abuse If a complaints procedure is easily accessible abusers would be more likely challenged about their behaviour, knowing this would make them less likely to abuse. It also helps the vulnerable service users to feel protected and less likely to accept abuse.
Know how to recognise and report unsafe practices
Unsafe practices that may affect the well being of individuals.
These could be due to
Unsafe administration of medication
Inadequate toileting – dressing etc
Inappropriate physical contact
Failure to maintain professional boundaries
Unreliable systems for dealing with service user’s money and personal possessions.
Failure to ensure supervision
Inappropriate physical contact with regards to moving and handling
Inadequate service users personal care plans
Not carrying out tasks to a standard that caters to the individual’s needs and personal preferences.
Lack of staff training
Staff to tired to do their job correctly
Every time a short cut is taken on a procedure it could affect the well being and safety of others.
Actions to take if unsafe practices have been identified
Follow the organisations policies and procedures
Protect and ensure the safety of the individual
Report to the line manager
Preserve any evidence
Record and report – write a confidential report about what is suspected and why. Actions to take if suspected abuse or unsafe practices have been reported but nothing has been done in response If I have reported abuse or unsafe practices and nothing has been done by my line manager, I would contact the Care Quality Commission, social services and contact police if necessary As part of the process is to contact the local care standards inspectorate. The person that it was reported to should do this if they have not then it may be considered abuse or neglect. If I suspect that this has happened i can also blow the whistle on my employer.