What does ill-treatment and wilful neglect mean?

Ill-treatment and wilful neglect are offences under the Criminal Justice and Courts Act 2015. The offences can apply to organisations which provide care and to individual care workers.

‘Wilful’ means that a care worker has acted deliberately or carelessly in relation to the adult they are paid to care for.

‘Ill-treatment’ is also deliberate and is when a care worker knew that they were ill-treating an adult or were being reckless in the care or support they were providing.

Ill-treatment does not have to result in physical harm. It can involve behaviour that causes, or could cause, emotional and psychological distress to an adult and their family.

It can also include a care worker failing to protect the privacy and dignity of an adult they are providing care and support to.

Who is a care worker under the Act?

Under the Act a ‘care worker’ is someone who is paid to provide health or social care to adults who need care or support. This includes all types of physical and mental health care, including learning disabilities.

A care worker who is found guilty of ill-treatment or wilful neglect could receive a prison sentence of up to five years or a fine, or both. For a less serious charge, they could receive a prison sentence of up to 12 months or a fine or both.

Unpaid family carers and friends cannot be charged with these offences but could be investigated and charged with different offences if they abuse or neglect an adult they are caring for.

If a care worker is deliberately failing to care for someone properly or is being cruel towards someone, this is likely to be considered wilful neglect or ill-treatment.

Examples of ill-treatment or wilful neglect include:

• not providing food to an adult who requires their meals to be prepared and brought to them;
• not washing an adult who regularly needs assistance with washing themselves;
• being verbally or physically abusive towards an adult.

Who is a care provider under the Act?

The term ‘care provider’ includes:

• a company or a director of a company that provides or arranges health or social care services for an adult;
• a person who provides health care or social care, or supervision or management to health and care staff, on behalf of the care provider.

A care provider commits an offence if:

• a care worker it employs ill-treats or deliberately neglects an adult;
• its management or organisation is poorly managed which results in a significant breach of a duty of care to an adult who is ill-treated or neglected as a result.

Examples of ill-treatment and deliberate neglect by an organisation include:

• failing to act where it is aware of practices which result in the serious neglect of adults using its service;
• consistently failing to make sure the health and safety of people who use their service resulting in serious risk to their life, health or wellbeing, despite concerns being raised by staff or other agencies.

What is the role of the Care Quality Commission?

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. It can prosecute registered care providers if it finds a provider has breached the required standards of care.

Criminal offences should only apply where there is evidence of the worker or organisation acting or being deliberately careless, when they knew there was some risk to the adult as a result of their actions or because they did not care about the risk.

Genuine errors or accidents by a care worker should not be dealt with under this legislation.

What should you do if you have concerns that an adult is being ill-treated or wilfully neglected?

If there is a concern that a care worker or provider has ill-treated or been deliberately neglectful to an adult or adults, it should be reported to the police to investigate. The Care Quality Commission and local authority adult social care services will also be involved in the investigation and any action required as a result.

What is the Care Quality Commission?

The Care Quality Commission, also known as the CQC, is the independent regulator of health and adult social care services in England. This means it inspects, monitors and oversees health and social care services, to make sure they provide people with safe, effective, compassionate and high-quality care.

What is the role of the CQC?

The CQC:

• registers health and adult social care providers to make sure they comply with the relevant regulations;
• monitors, inspects and rates services; and
• where necessary, takes action to protect people who use services.

What services does it oversee?

The CQC inspects, monitors and oversees local authority adult social care services, care homes, hospitals, hospices, dental services, clinics (including those providing family planning and slimming services), homecare agencies, GP services, mental health services, ambulance services and community-based health and care services.

How does it assess the quality of services?

The CQC uses a single assessment framework to assess quality and performance across all types of services. This framework uses five key questions and, under each key question, a set of quality statements. Different quality statements apply to the different types of services the CQC inspects, but all services need to demonstrate that they are:

• safe;
• effective;
• caring;
• responsive to people’s needs; and
• well-led.

How does it assess the care and support local authorities provide to adults?

For its assessments of local authority adult social care, the CQC looks at their legal duties under the Care Act using relevant quality statements which are broken down into the following four themes:

1. working with people – how the local authority works with adults to assess their needs and support them to live healthier lives;
2. providing support – how the local authority provides support to adults and carers, which includes the provision of care and support, integration and continuity and partnerships and communities;
3. ensuring safety – how the local authority ensures safety, which includes safe systems, pathways, children moving from children’s to adults services and safeguarding adults who are at risk of or experiencing abuse and / or neglect;
4. leadership and workforce- how effective governance arrangements are – which means how it is run, management, sustainability and learning, improvement and innovation.

What are the reports and ratings it publishes?

Reports of inspections are published on the CQC website and include a rating.

Ratings are given using a four-point scale (outstanding, good, requires improvement and inadequate). If a service is assessed as requiring improvement, the CQC will tell it how it must improve. Where services are judged to be inadequate, enforcement action will be taken.

What is Modern Slavery?

Modern slavery is a serious and often hidden crime where people are exploited by criminals, usually to make money. It includes trafficking, slavery and forced labour.

In all types of modern slavery, a victim is, or is intended to be used, or exploited for someone else’s gain, with no consideration for their human rights.

Adult victims are usually forced into modern slavery through threats, force, deception or by someone abusing their position of power over them.

Modern slavery can be difficult to spot, and this means it often goes unreported.

Modern slavery is an adult safeguarding concern, and the local authority has legal duties to provide support to suspected or known victims.

Under the Modern Slavery Act 2015, criminals convicted of modern slavery crimes can receive sentences of up to life imprisonment.

What are the different types of modern slavery?

There are two main types of modern slavery: 1) human trafficking and 2) slavery and forced or compulsory labour.

Human trafficking is where a victim is forced or tricked into a situation where they are then exploited. It often involves people being moved for the purpose of exploitation, this can be between towns and cities or from another country into the UK.

Ways in which trafficking victims are exploited include:

• sexual exploitation: victims are often raped or physically assaulted. They are often tricked and given false promises of good jobs.
• forced labour: victims have to work for little or no pay, and their employers will not let them leave or find another job. Common work environments include manufacturing, food preparation and processing, farming, nail bars, the care sector and hand car washes.
• criminal exploitation: victims are forced to commit crimes such as pick pocketing, shoplifting, begging, growing cannabis, trafficking drugs (known as county lines), benefit fraud and sham marriages.
• domestic servitude: victims work in a household where they may be ill-treated, humiliated, made to work long and tiring hours and forced to work and live in very difficult conditions for little or no pay.

In cases of slavery and forced or compulsory labour, victims are not trafficked or moved from one area to the other for the purposes of exploitation but can still be victims of modern slavery. Slavery and forced labour are illegal in the UK.

What is the impact of modern slavery on victims?

Victims of modern slavery often feel very scared and helpless, as they are under the control of their exploiters and cannot go where they want. They have to live, work and behave as the exploiters say, they cannot keep any money they may earn, contact their families and friends and or make any decisions themselves. They may experience physical, psychological and sexual abuse and neglect.

The impact of these experiences can be devastating.

Acting on concerns that someone is a victim of modern slavery

If you think the person is in immediate danger, always contact the police on 999.

If they are not in immediate danger, you can contact the police on 101 or ring the Modern Slavery helpline for advice on 0800 0121 700.

You can also ask for advice from your designated safeguarding adults lead in your service, the local authority safeguarding adults team, the police public protection unit (contactable via the local Police switchboard) or visit the Modern Slavery Helpline website.

What does transition to adult care and support mean?

Under legislation a young person becomes an adult on their 18th birthday. Transition, therefore, is the term that describes the process for young people – and their families – to move from receiving support from children’s services to adult services.

What is the process for transition?

Under the Care Act 2014 the local authority must assess a young person – and their carer if appropriate – before they turn 18, to see if they will be likely to have care and support needs.

Before the transition assessment, early conversations between staff and the young person give an opportunity for young people and their families, as appropriate, to reflect with staff on their strengths, needs and the outcomes they want to plan for so they can achieve their goals.

Transition assessments should take place at the right time for the young person or carer and at a point when the local authority can be reasonably confident about what the young person’s or carer’s needs for care or support will look like, after the young person turns 18. There is no set age when young people reach this point; every young person and their family is different, and therefore, transition assessments should take place when it is most appropriate for them.

The transition assessment should also provide young people and their families with information, so that they know what to expect in the future and can prepare for adulthood.

After the transition assessment has been completed, the local authority must give an indication of which needs the young person has that are likely to be ‘eligible needs’ (and which are not likely to be eligible) once they turn 18. This means whether their needs are at a level where the local authority will provide care and support. The minimum level of eligible needs is set down in law.

Who is the transition process for?

Most young people who receive transition assessments will be children in need under the Children Act 1989 and will already be known to local authorities. They may be looked after by the local authority, have disabilities or be young carers.

However, local authorities should consider how they can identify other young people who are not already receiving children’s services but who are likely to have care and support needs as an adult. For example:

• young people with medical conditions that will probably get worse over time;
• young people (for example with autism) whose needs have been met by their school, but once they leave, their needs will have to be met in another way;
• young people in young offender institutions who will move to adult prisons;
• young people and young carers receiving mental health support, even if they did not receive children’s services from the local authority.

Who is involved?

The young person, their carer and / or family or friends and professionals from different agencies who are already involved, or are likely to become involved, should all work together in a coordinated way. Everyone should be working to support the young person achieve the outcomes that are important to them.

If the young person is likely to have difficulty in understanding important information or in communicating their views, wishes and feelings, there must be someone at the transition assessment to work with them to act on their behalf. The local authority must make sure an independent advocate is working with the young person if there is nobody else appropriate, for example a family member.

What is independent advocacy?

When an adult has contacted a council for help with their care and support needs or come to the council’s attention because of a safeguarding concern, they must be actively involved in the council’s processes. This is because people’s wishes, feelings and needs must be at the heart of the assessment, care planning and review processes.

Where the council believes that a person has – what is called – ‘substantial difficulty’ in fully taking part in the processes, it must find out whether there is anyone appropriate who can support them. This might be a carer (not a professional or anyone who is paid), a family member or friend. If there is no one who is appropriate, the council must arrange for an independent advocate who will speak on their behalf; this is called independent advocacy. Under the Care Act 2014, the council must make sure that everyone who needs an independent advocate to represent them, can have one.

What does substantial difficulty mean?

The Care Act outlines four areas of substantial difficulty – a person just needs to have one. They are:

• understanding relevant information: if someone cannot understand relevant information, even though it is presented appropriately and time is taken to explain it;
• retaining information: if a person cannot remember information long enough to be able to weigh up their options and make decisions;
• using or weighing up information: if a person cannot weigh up information to be able to fully participate and choose between the different options that are available to them;
• communicating their views, wishes and feelings: if a person cannot communicate their views, wishes and feelings whether by talking, writing, signing or any other way, to help the decision process and make their priorities clear.

When a person is being considered for independent advocacy, it is their ability to communicate their views, wishes and feelings which is vital, rather than their diagnosis or specific condition.

Who can have an independent advocate?

When a person has substantial difficulty in taking part in council processes and there is no appropriate person available to support and represent their wishes, the council must arrange an independent advocate for the following:

• a needs assessment;
• a carer’s assessment;
• the preparation and review of a care and support plan or a support plan for carers;
• a child’s needs assessment;
• a child’s carer’s assessment;
• a young carer’s assessment;
• safeguarding processes.

Examples of people who may need an independent advocate could be someone with mid-stage or advanced dementia, significant learning disabilities, a brain injury or mental ill health; with Asperger’s, confusion due to an infection, or who is near the end of their life and appears to have disengaged from involvement and making decisions.

Who can be an independent advocate?

An advocate must:

• have appropriate experience: for example, working with people who may have substantial difficulty;
• appropriate training: for example, training in advocacy or working with people with learning disabilities or dementia. Independent advocates are expected to pass relevant independent advocacy qualifications;
• competency: advocacy organisations need to make sure its advocates are competent and have regular training and assessments;
• integrity and good character: this should be assessed through interview and recruitment processes, including references and DBS checks.

What is the role of the independent advocate?

Acting as an advocate for a person is a responsible position. It includes supporting the person to:

• understand assessment, care and support planning and review and safeguarding processes;
• communicate their views, wishes and feelings to staff carrying out assessments, developing a care or support plan or reviewing an existing plan, or carrying out safeguarding enquiries or reviews;
• understand how their needs can be met by the council or another organisation;
• make decisions about their care and support arrangements;
• understand their rights under the Care Act;
• challenge a decision or process made by the council, if necessary.

What is charging and financial assessment?

Under the Care Act 2014 there is a framework – or structure – for charging for care and support services. This allows the local council to decide whether or not it should charge a person for the care and support services that they need, or that a carer needs. A financial assessment is used to find out who should pay toward their care and who should receive free services. This depends on their income and financial assets, such as savings or owning a house.

The financial assessment will decide whether the council must arrange someone’s care and support free of charge, or if the person has to pay for the services they receive. This applies whether the council is delivering the care and support directly itself, or through another provider.

What are the main principles?

The main principle which guides decisions around charging and financial assessments is that people should only have to pay what they can afford.

But charging and financial assessments should also take into account a number of other principles. These include:

• being clear and transparent, so people know what they will be charged;
• promoting people’s wellbeing, social inclusion, individual choice, independence, and control;
• supporting carers to look after their own health and wellbeing and care effectively and safely;
• being person-focused and reflecting the different care options available to meet a person’s needs;
• making sure that people with similar needs are treated the same and reducing the differences between care settings;
• encouraging and enabling those who wish to stay in or take up employment, education or training to do so.

Who is involved?

The following people will be involved in a financial assessment:

• the adult who is needing care and support services;
• a family member, friend or unpaid carer, to support the person;
• a social worker or finance team officer who will carry out the assessment.

If a person does not have mental capacity to take part in the assessment and therefore does not understand the issues being discussed, the council must find out if there is:

• someone with power of attorney for the person;
• someone who has been appointed a deputy for the person by the Court of Protection; or
• any other person dealing with the person’s affairs.

What are capital limits?

When carrying out a financial assessment, there are two types of capital limit: upper limit and lower limit.

The upper capital limit is currently set at £23,250. If a person has capital below this level (in either money or assets, such as a house), the council can do a financial assessment and make a charge for services based on what they can afford to pay. If the person has above the upper capital limit, they have to pay for all the care and support services they receive.

Where a person’s cash and assets are below the ‘lower capital limit’ of £14,250 they will not need to contribute to the cost of their care and support. However, for adults receiving care and support somewhere other than in a care home (such as from a care provider in their own home) the council can set its own capital limits, within guidelines.

What are the different types of financial assessment?

There are two different types of financial assessment that the council can carry out so that it knows whether a person can afford, and will be able to continue to afford, any charges they may have to pay. These are 1) a light touch assessment and 2) a full assessment.

A light touch assessment involves gathering enough financial information for the council to show that the person or carer:

• meets the criteria (known as being eligible) to receive financial support from the council; or
• does not meet the criteria (not eligible) for full financial support from the council.

It does not involve gathering a lot of information, usually because someone’s finances are quite straightforward and only come from a few sources.

A full financial assessment involves gathering more detailed information about the person’s or carer’s capital and income. Examples of when a full assessment may be required include:

• when the person or carer is not clear about their level of income and capital;
• if the council thinks that a person is not declaring all their resources (that they may be hiding some with relatives for example);
• where the level of their capital is between the upper and lower capital limits, a full financial assessment is needed to be sure about whether a person is eligible to receive financial support from the council.

What is data protection legislation?

Data protection legislation sets out the duties and responsibilities which organisations, and all their staff, must follow when they collect, use, store and share information about people.

In the UK, the law about data protection is contained in the Data Protection Act 2018 and the UK General Data Protection Regulation (also known as the UK GDPR). Together these control how organisations – like local authorities, the NHS or care providers – can collect, use, store and share information. This includes information about:

• adults and families who are currently receiving services, including their children;
• adults and families who have received services from the organisation in the past;
• current and past staff members; and
• suppliers.

Data protection laws apply both to information which is held in paper files and digitally on computers and electronic recording systems.

Why do we have data protection legislation?

Data protection legislation helps keep people’s data safe. It does this by giving a framework to make sure that when organisations collect, use, store and share people’s information, they do it in a way that is safe and clear.

Data protection legislation also gives people rights in relation to the information organisations hold about them, including:

• the right to know what information is being collected and processed in relation to them, and – in most cases – they must clearly be asked for their consent for this;
• the right to see information held in their records;
• the right to have anything corrected in their records which is not accurate; and
• the right for data to be ‘forgotten’ when it is no longer required.

When does data protection legislation apply?

Data protection laws apply whenever personal data is being handled or processed by organisations, including being collected, stored, used, and shared.

Personal data is information about a person who is alive and who can be identified by a name, an ID number, location information or email addresses. Different rules apply to someone who has died.

The law is even stricter when processing or handling what is known as ‘sensitive personal data’. This applies to information on:

• racial or ethic origin;
• political opinions;
• religious or other beliefs;
• trade union membership;
• physical or mental health conditions;
• sexual life or sexual orientation; and
• criminal convictions and proceedings.

What does best practice look like?

To conform to the Data Protection Act and UK GDPR, the following principles should be followed whenever personal data is being processed.

• Processing or handling data should be lawful, fair and in a way which is transparent. This means people should be told what information will be collected about them and how it will be used.
• When information is collected for one purpose – for example to provide someone with a service – it must not then be used for another reason – for example to send them marketing information about another service.
• Organisations must only collect the least amount of data which is necessary for the service being provided.
• Information which is collected must be accurate and kept up to date.
• It must not be kept for any longer than is necessary.
• It must also be stored securely. This means paper files are kept secure – in a locked cabinet for example – and computers are password protected.

Organisations must make sure that everyone who manages and handles personal information as part of their job understands that they are responsible for adhering to data protection legislation.

If you need advice about data protection and collecting and sharing information, speak to your line manager or the data protection officer in your organisation.

What is Preventing, Reducing or Delaying Needs?

The term ‘prevention’ covers many different types of support or services. These can range from promoting health in the general population to interventions that are aimed at one person, a particular group of people or a carer.

There are three different levels of support or service.

• First is primary prevention. These services are aimed at people who do not currently have any particular health or care and support needs. They aim to help people avoid developing needs for care and support or help a carer avoid needing support, by keeping their independence and good health. They are usually available to everyone, for example exercise, weight and money management groups.
• Second is secondary prevention or early intervention. These are services aimed at people who already are at risk of developing care and support needs, but the provision of services or other resources may help slow down or reduce any further deterioration, or prevent other needs from developing. Providing support at an early stage can help stop someone’s life tipping into crisis, for example a few hours support to help a parent who is caring for their son or daughter with a learning disability and behaviour that challenges at home.
• Third is tertiary prevention. These are services aimed at reducing the effect of disability or deterioration for people with long term or multiple health conditions (such as dementia and heart failure for example), supporting them to regain skills and manage or reduce need where possible. Councils must provide or arrange services that support someone to be as independent as possible if they already have such needs. This may include paid home carers visiting to help with a person’s care and support needs or having equipment installed or making changes in their home to help them stay for as long as they want and is possible.

Why is it important?

It is really important that the council’s care and support system actively promotes people’s wellbeing and independence and does not just wait to respond when there is a crisis. It is also vital that the council gets involved early to support people, helps them keep or regain their skills and confidence, and prevents or delays any worsening of their physical and mental health wherever possible. This is because it improves people’s quality of life and helps them stay at home for as long as possible rather than go into a care home for example. This is important for the person, their family and friends but it also benefits the wider community.

Prevention is ongoing; it is not a single activity or intervention. For example, a change in the person’s circumstances or that of their carer may mean there has to be a change to the type of prevention activity they are receiving.

Prevention is often seen as something that usually happens when a person has a diagnosis or assessment which identifies there has been a change in their condition. However, prevention services are something that should always be considered.

Who is involved?

The council’s responsibilities for preventing, reducing and delaying needs apply to all adults, including:

• those who do not have any current needs for care and support;
• adults with needs for care and support, whether their needs are already being met by the council; and
• carers, including those who do not currently have any needs for support.

How is it put into practice?

There are many ways in which the council can achieve its aims of promoting wellbeing and independence and reducing dependency for individuals, groups or the general public in its area.

The Care and Support Statutory Guidance, which accompanies the Care Act 2014, sets out how councils should carry out their responsibilities, both individually and in partnership with other local organisations, communities, and people themselves.

It should work in partnership with other agencies in relation to:

• providing prevention services and resources;
• identifying those who may benefit from such support; and
• helping them access those services.

What is information sharing?

Working with adults who have care and support needs often involves a range of agencies. Each agency will collect their own information, but to be effective and to ensure the best possible care for the adult concerned, agencies need to work together. This includes sharing information, where it is appropriate to do so.

Data protection laws state how information about people should be collected, stored and shared. This makes sure that when agencies collect and share information, they do it safely, securely and in a way which is transparent.

It is important that, as a worker, you feel confident about your responsibilities around sharing information.

Why is it important?

Sharing information between agencies is important as it helps to improve outcomes and promote wellbeing for adults, by ensuring services are joined up and by reducing duplication.

It is also vital to keep adults and their families safe from harm. Any safeguarding concerns should be shared with the council’s adult social care department as a safeguarding referral. Do not assume someone else will pass on information which may be critical to keeping a vulnerable adult or a child safe.

Who is affected by information sharing?

There are three main groups of people affected by information sharing.

• First are adults who use services. They should be helped to understand why your service needs to collect and store information about them and why it might be needed to be shared with other agencies. They should also be asked to give their consent to this.
• Second are other agencies. They are vital to make sure that the care adults receive is coordinated and any risks are managed jointly.
• Third are safeguarding professionals. In some safeguarding situations you can share information with adult social care or the police without getting the consent of the person concerned. For example, where the concerns are urgent and getting consent might cause delay or where obtaining consent is not appropriate as it could possibly increase a risk of harm to the person you are worried about. Also, if a Safeguarding Adult Board requests information from an organisation, it must be provided.

Staff should use their professional judgement in each case to decide if sharing information is appropriate. Your line managers or safeguarding lead should be contacted for advice whenever needed. All decisions about sharing information should be clearly recorded in case records. This also includes decisions not to share information.

When can I share information?

Information can be shared with other agencies when there is a clear and lawful reason for doing so. The adult will normally provide consent to their information being shared in this way (for example so providers know who are using their services). But if information needs to be shared to keep an adult, family member, child, member of the public or member of staff safe – getting the adult’s consent would not be necessary.

How can I share information safely?

There are some key principles for good practice. These include the following:

• Being necessary and relevant – the right information needs to go to the right person to enable them to do their job effectively. It should be proportionate to the need and the level of risk.
• Being accurate and adequate – the difference between facts and opinions must be clear. When sharing information you should only share details which are necessary and relevant. You should not share all information you have on the adult with other agencies – only that which is needed for them for their role, for example the adult’s GP.
• Being timely and secure – sharing information promptly is particularly important, especially where there are safeguarding concerns. Do not delay sharing information which could help to keep a vulnerable adult or child safe. Where information is being shared with other agencies this should always be done securely, in line with your organisation’s policies and procedures.
• Being recorded, open and honest – it is important to always be open with people about information that will be shared and why it is necessary. Decisions to share information – and also not to share – should be documented in the person’s case records with the reasons why.

What is ordinary residence?

Ordinary residence describes the place that a person has chosen to live, whether in the short or long term.

A person can be considered as an ordinary resident as soon as they move into an area, whether or not they have a property in another council area.

There is no minimum time that a person has to be living in a particular area for them to be considered as ordinarily resident there. It depends on what connection they have to it, for example if they have moved to be closer to their family.

Why is ordinary residence important?

The council must meet the care and support needs of those people who are ordinarily resident in their area. So it is vital that the council knows which people they are responsible for, and that people know who they should contact when they need care and support.

When does ordinary residence apply?

Following an assessment of need the council is required to meet the eligible needs of people who are ordinarily resident in the area.

Sometimes a person’s needs can only be met by them moving to certain types of accommodation. This could be a care home, nursing home or in supported living. If this accommodation is in another council area, the council which first arranged their care is responsible for meeting their needs.

If a person chooses to move to live in a different area without the council making the arrangements, they would usually become an ordinary resident of the council where the new accommodation is situated.

Who does ordinary residence apply to?

Ordinary residence applies differently to adults and carers.

Adults eligible care and support needs will be met by the council in which they are ordinarily resident.

Carers eligible care and support needs will be met by the council in which the person that they are caring for is ordinarily resident.

If a person goes into hospital in another council area, they are ordinarily resident in the area where they were living before they went into hospital. However long someone is in hospital, the first council will still be responsible for their care and support needs.

If a person who is ordinarily resident in England goes into hospital in Scotland, Wales or Northern Ireland, their ordinary residence will still be in their council area in England.

How is ordinary residence put into practice?

In most cases it is easy to decide where a person is ordinarily resident. But when this is not clear the council meeting the needs of the adult must continue to do so while the issue is resolved.

If no council is currently meeting the person’s needs, then it is the one where the person is living or is physically present who is responsible until the dispute is resolved.

For those people who lack mental capacity to make decisions about their accommodation, councils must follow the Mental Capacity Act and its guidance.

What is a care and support plan?

Care and support planning is the process that takes place with an adult, their carers, social workers and other professionals involved. It results in a care and support plan being produced which says how the person’s needs will be met in ways that work best for them, as an individual and if they are part of a family.

There are lots of ways their needs can be met, depending on them and their particular circumstances and wishes. For instance, they might be best met in a care home or in their own home with home care services, or other types of home support such as equipment and adaptations. Care and support is often not provided directly by the council, it maybe by a local community group or going to a day centre for example.

When does it happen?

After an assessment of the person’s needs is carried out by social care staff, a care and support plan must be provided if their needs meet conditions (as set out in the Care Act) to receive care and support from the council. This is known as eligibility.

Why is it important?

Each person’s needs are unique to them and how people would like their needs to be met will depend on their particular circumstances, values, wishes, beliefs and their goals in life.

‘Meeting someone’s needs’ is more than just arranging services. The process of care and support planning makes sure everyone involved can contribute and can agree how the person’s needs identified in the assessment will be best met.

Care and support planning must also identify any areas of risk or if the person is experiencing abuse or neglect. If the risk of abuse or neglect is identified, a safeguarding enquiry should be carried out. Any actions put in place to safeguard the person and to minimise risk should be included in the care and support plan.

Who is involved?

The person should be at the centre of the plan – known as person centred care – and must be able to participate as much as they can, and want to, in developing it. They must be given all support they need in order to do that, using speech and language therapists or other specialists such as interpreters for example.

It should also include the person’s carers, independent advocates, friends, staff from other agencies or community groups and any other person the person would like to be involved in the process.

For people who have a lot of difficulty in taking part in care and support planning and have no friends or relatives to help them, an independent advocate must be involved.

The Mental Capacity Act says that staff must think that people have the capacity to make decisions for themselves, unless this is shown to be otherwise. So every person has the right to make their own decisions in the care and support planning process. The principles of the Mental Capacity Act should be followed for people who do not have mental capacity.

Some people will need a little help to be involved, others will need much more. Social workers or other relevant professionals should first have a discussion with the person to know what is important to them and what support they feel they need to be involved.

How is it put into practice?

It is important that enough time is taken to make sure the plan is right to meet the person’s identified needs and is agreed by them, their carers and advocates.

The plan must be person centred, so it is important that people are given every opportunity to take part in planning it. This means the council involves them in regular planning meetings. These may be face to face, on the telephone or by video.

The care and support plan should also record which needs are being met by their carer.

When developing the plan, there are some things which must always be included. These are:

• the person’s needs that were identified in the assessment;
• whether those needs are eligible for council support;
• what needs the council is going to meet, and how it will do that;
• the outcomes that the person wants to achieve, their wishes and preferences;
• the outcomes the carer wants to achieve, their wishes about providing care alongside their work, education and recreation and where support could be useful to them;
• if the person’s needs change, the plan should show how this will be responded to; and
• plans should include dealing with any sudden change or an emergency, such as a carer becoming ill.

The role of social care staff is to produce the plan and sign it off with those involved, making sure that it meets the person’s needs and minimises any risk to them.

When developing it, the council must inform the person which, if any, of their needs may be met by a direct payment.

Sometimes it can be difficult to reach a plan that is agreed with the person. If so, the council should give the reasons for this and the steps which will be taken to ensure their safety and wellbeing.

If this does not settle the disagreement and the council feels that it has done everything it can to address the situation, it should suggest the person makes a complaint, using the council’s complaints procedure which will hopefully resolve it.

What is the Care Act?

The Care Act 2014 came into effect in 2015. It aims to put adults in control of the help they receive from local authorities and other agencies. It also ensures that:

• people are supported to keep safe, and as well as possible;
• that people get the services they need to stop their care needs from becoming more serious;
• that people can get the information, advice and guidance they need so that they can make decisions about their own care; and
• that they have a good range of services to choose from.

What are the key principles of the Care Act?

There are a number of key principles which include the following.

• It sets out the criteria for when local authorities have to provide care and support to people, and it aims to make sure there is a fair, national system which reaches those most in need.
• It set out how local authorities must complete assessments with adults in need of care and support. People should be encouraged to think about what outcomes they want to achieve in their lives – big or small – which will enable them to improve their physical and / or emotional wellbeing.
• It gives rights to carers which puts them on the same footing as the people they care for. All carers are be entitled to an assessment. If the local authority assesses that a carer is eligible for support for their particular needs, they have a legal right to receive support, just like the people they care for.
• There is an emphasis on protecting the most vulnerable adults from abuse and neglect.
• There is also an emphasis on prevention. Local authorities and other care and support providers should encourage and assist people to lead healthy lives, which should reduce the chances of them needing more care and support in the future.
• It lays down that local authorities must provide clear information and advice which helps members of the public make informed choices about their care and support arrangements and enable them to stay in control of their lives.
• Personal budgets existed before the Care Act came into force, but the legislation brought a greater emphasis on using them, as they give people the power to spend the money allocated to them on interventions that are tailored to their individual needs, as part of their care and support plan.
• There is a greater emphasis on advocacy, that means that those most in need are given access to someone who speaks up on their behalf when they are dealing with social care professionals.
• There is also a greater regulation for those who provide professional care and support, as well as tougher penalties for those who do not provide that support to a high enough standard.

When is it important?

The ethos and principles of the Care Act underpin all stages of contact that an adult, and their carer, may have with the local authority adult social care department including initial contact, assessment, care and support planning and review and safeguarding adults processes.

Who is responsible for putting it into practice?

Although the Care Act outlines clear responsibilities and duties for local authorities, its principles apply to all agencies providing for people’s care and support needs.

Why should care and support plans be reviewed?

The Care Act says that councils must regularly review care and support plans, and carry out assessments when the person’s circumstances have changed.

Reviews can:

• give people the opportunity look at what is working, what is not working and what might need to change;
• make sure that plans are kept up to date and are relevant to the person’s needs and what they want to achieve;
• give the person confidence that people who are working with them understand what is important to them;
• reduce the risk of crisis situations.

A review should be seen as a positive opportunity for everyone to take stock and to have a say in how the plan is working.

When should care and support plans be reviewed?

Reviews should take place at least every 12 months.

A light touch or short review – which checks that the plan is working as It was meant to and to spots any problems early on – should be considered six to eight weeks after the care and support plan has been agreed.

If someone’s physical or mental health is getting worse, reviews may need to be much more frequent.

If a person has few or no family members or friends to support them, the risks of problems occurring may be higher. So reviews may need to be more frequent.

Who should be involved in reviews?

All reviews must involve the person, their carer and anyone else the person wants to be involved, where appropriate.

If it is difficult for the person to be being fully involved and there is no family member or friend who can represent or support them, an independent advocate must be considered.

All efforts must be made to make sure the person is involved in the review, as much as possible.

What should be covered in a review?

Reviews should not be difficult or complicated.

They should cover the following:

• Has the person’s circumstances and / or care and support needs changed?
• What is working in the plan, what is not working, and what might need to change?
• Have the outcomes identified in the plan been achieved or not?
• Does the person have new outcomes they want to meet?
• Could improvements be made to the plan for the person to achieve better outcomes?
• Is the person’s personal budget helping them to meet their needs and outcomes identified in their plan?
• Is the current way of managing their personal budget still the best one for what they want to achieve, for example would direct payments be better?
• Are there any changes in support the person gets from family and friends that might affect the plan?
• Have there been any changes to the person’s needs or circumstances that might mean they are at risk of abuse or neglect?
• Is the person, their carer and / or independent advocate satisfied with the plan?

What are the different types of reviews?

There are several different types of review including:

• Planned review – dates are set with the person during the care and support planning;
• Unplanned review – results from a change in needs or circumstances, for example a fall or hospital admission of their main carer;
• Requested review – the person or their carer, family member, advocate asks for a review. This may happen because of a change in the person’s needs or circumstances.

Depending on the circumstances reviews can be:

• conducted over the telephone or video call;
• be face to face r with a social worker or other professional.

What does ‘wellbeing’ mean?

Wellbeing underpins all the care and support that the local authority offers to adults and carers in their area.

Everyone’s idea of wellbeing is different because it is personal to each person.

Wellbeing is a very wide term. It is much more than enjoying good physical, mental or emotional health but it is also about someone:

• being treated with dignity and respect;
• feeling safe from abuse or neglect;
• being in control of their life; – including any care and support needed and how it is provided
• being able to join in work, education, training or leisure activities;
• living in accommodation that is right for them;
• taking part in what’s happening in their local area;
• having relationships with family, friends and neighbours.

Some of the things listed above will be more important than others to different people.

The Care Act says that wellbeing must underpin all the care and support that the council provides to adults and carers in their area. Staff should work together with people to understand their individual needs and not make assumptions about what might be best for them.

Who does wellbeing apply to?

The wellbeing principle applies to all care and support services provided, as well as to decisions made about a person’s care.

It applies to:

• adults with care and support needs;
• carers;
• children transferring from children’s services to adult social care, their carers and young carers; and
• those whose care and support needs mean they do not get council support, but who come into contact with the care system in some other way.

It applies equally to the above regardless of their mental capacity and regardless of their ability or willingness to receive help from the council.

Why is wellbeing important?

Wellbeing means a shift away from local councils providing services making sure that the care and support a person receives meets their needs, in an individual and personal way. This is so they are supported to reach the goals that are important to them, for instance to live near members of their family.

Feelings of wellbeing are key to the overall health (mental and physical) of an individual.

Promoting wellbeing and independence is a principle duty of the Care Act 2014.

How can we promote wellbeing?

Council staff and those in partner agencies must promote wellbeing when providing care and support, but how this happens will depend on each person’s own circumstances

There is no set approach but some things to consider include:

• making sure the person is able to make their own choices and decisions;
• their views and feelings and the goals that they want to reach are fully taken into account;
• that all services and support provided help people to live as independently as possible;
• recognise that everyone’s needs are different and personal to them;
• assume that the person is the expert and knows best their own outcomes, goals and wellbeing
• ensure that the person can participate as fully as possible in all decisions about them
• providing information and advice to help the person to make informed decisions;
• protecting people from abuse and neglect;
• understanding that care and support can be provided in a number of different ways; and
• taking a flexible approach to the provision of care and support which focuses on the aspects of wellbeing which matter most to the person concerned.

The focus should be on supporting people to live as independently as possible for as long as possible.

What is mental capacity?

Mental capacity is about being able make a decision and understand what will happen as a result of making that decision.

Everyone should have the right to make choices about their own life. But sometimes injury, illness or disability can affect a person’s ability to understand difficult choices and make decisions.

Someone’s mental capacity could be affected by having:

• a brain injury;
• dementia;
• a stroke;
• a severe learning disability.

Every situation is different. In some cases, a person’s mental capacity might only be affected for a short time for example if they are unconscious after an accident, but then they get better. Or it may change from time to time, meaning that they are able to make decisions one day but not the next. Or they might be able to make day-to-day decisions about shopping and meals, but be unable to make bigger decisions, about their money or where to live.

Every person’s situation is different.

How does the Mental Capacity Act support people to make decisions?

The main purpose of the Mental Capacity Act is to keep people safe and ensure that they have the right to make their own decisions, as far as possible. It sets out a way of carrying out assessments which helps to decide if a person lacks mental capacity.

It does this in three ways:

1. By making sure people make decisions for themselves wherever possible (empowering them);
2. By protecting people who lack mental capacity by having a process which is flexible and can adapt to their particular needs;
3. By allowing people to plan ahead for a time in the future when they might not have mental capacity any more.

The MCA helps to make sure that people make their own decisions for as long as possible.

Who is the Mental Capacity Act for?

The MCA is a law that applies to people over the age of 16.

There is a two stage test to help decide who the Mental Capacity Act applies to.

Stage 1. Does the person have an illness or disability of their mind or brain?

If so,

Stage 2. Does that mean that the person lacks the mental capacity to make a particular decision?

How is it decided if someone has mental capacity?

The Mental Capacity Act provides a set of questions to help decide if a person lacks mental capacity. If the answer is no to one or more of the following questions, the person lacks capacity.

1. Can they understand information given to them?
2. Can they retain that information long enough to be able to make the decision?
3. Can they weigh up the information available to make the decision?
4. Can they communicate their decision? This could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.

When should capacity be assessed?

We can all have problems making decisions from time to time, but the Act covers situations when there is concern that a person cannot make a particular decision at a particular time because their mind or brain is affected by illness or a disability.

The decision may be about a day to day part of their life or a long term decision about where to live or whether to have medical treatment.

Their lack of capacity may not be a permanent condition.

Are any decisions not covered by the Mental Capacity Act?

Some decisions cannot be made for another person. This is because the decision is either so personal, or because it comes under other laws.
Decisions that cannot be made include:

• agreeing to a marriage or a civil partnership;
• agreeing to having sex;
• agreeing to the person’s child being placed for adoption;
• voting at an election.

What do we mean by ‘information’ and ‘advice’?

‘Information’ means giving people facts about care and support.

‘Advice’ means helping someone to make choices and giving an opinion or recommendation about what to do about care and support.

These terms are taken from the Care Act.

What information/advice should be provided?

The council must provide information and advice on:

• how their care and support system works;
• the different of types of care and support they offer,
• the different care providers available in the local area and how to contact them;
• how to get independent advice about the costs of getting care and support;
• how to raise concerns if they are worried about the safety or wellbeing of someone (known as safeguarding) – see Adult Safeguarding).

Other types of information should include:

• housing;
• health services;
• services that may help people be more independent in their homes, for example home improvement agencies, handyman or maintenance services;
• befriending services;
• aids and adaptations for the home or for the person;
• welfare benefits;
• employment support for disabled adults;
• children’s social care services;
• carers’ services and welfare benefits;
• advocacy services, for people who may need someone to represent them.

Who should information/advice be provided to?

People, including carers, who are likely to need information and advice include:

• anyone who has needs for care and support now, or may have these in the future;
• people whose current care and support needs may increase;
• people who are already known to the council because they have already been in contact with adult social care services;
• family members and carers of adults with care and support needs;
• adults involved in the adult safeguarding process; and
• care and support staff who provide information and advice as part of their job.

How should information/advice be provided?

Advice and information should be given to a person in a way that people understand, this could be:

• face to face;
• as part of a group in workshops / talks in the community;
• through advice and advocacy services;
• by telephone;
• through leaflets or posters (for example in GP surgeries);
• using ‘free’ media such as newspaper, local radio stations, social media;
• through the council’s website;
• by email.

It is also important to remember that some people may have particular needs such as:

• sight or hearing problems;
• people whose first language is not English;
• people who are not able to read very well;
• those who have difficulty getting out and about;
• people with learning disabilities or mental health problems which might make understanding some information difficult.

When should information/advice be provided?

Information should be provided by staff at any point that an adult or their carer has contact with the council.

There may be times during someone’s life where they might need particular advice or information, not just from the council, such as:

• the death of a family member or close friend;
• being admitted to or discharged from hospital;
• being diagnosed with particular illnesses – such as dementia, or having a stroke for example;
• when thinking about their future, for example organising power of attorney;
• contact with the Court of Protection;
• welfare benefits;
• looking for work;
• contact with local support groups or charities;
• private care and support services, including home care;
• moving house or losing accommodation;
• contact with police or probation;
• being sentenced to or released from prison.

What is the National Eligibility Criteria?

The National Eligibility Criteria is set out in the Care Act 2014. It is a way of deciding whether, following an assessment, the person’s care and support needs (or, for carers if their support needs) meet the level required for the council to give them support.

How is the National Eligibility Criteria used to determine eligibility?

When deciding whether someone meets the level, or is eligible, for support, the council must consider the following three questions.

1. Does the person have care and support needs because of a physical or mental disability or illness?
2. Do these needs mean that the person is not able to achieve 2 or more of the following (these are called outcomes):
   • eat and drinking properly;
   • managing to wash, bathe / shower, and dress themselves;
   • managing their toilet needs;
   • are appropriately dressed, for the weather for example;
   • being safe around their home;
   • keeping an acceptable home environment;
   • having regular contact with family, friends and other people;
   • getting involved in work, training, education or being a volunteer;
   • using local services including public transport and entertainment and leisure facilities;
   • caring responsibly for a child or children the person has.
3. If they are not able to achieve these outcomes, is there much of a significant impact on the person’s wellbeing? (See Promoting Wellbeing)

‘Yes’ must be answered to all of the above questions in order to decide if the person’s needs can be supported by the council.

When should the criteria be used?

The National Eligibility Criteria can only be applied after an assessment of the persons needs has been completed by the council. Eligibility criteria cannot lawfully be applied before an assessment has been completed.

What is a direct payment?

A direct payment is money paid by the council, to help buy the support it has assessed a person as needing.

It is a way for a person to use all or part of their personal budget (see Personal Budget chapter). The person will receive money directly from the council so that they can arrange their own care, rather than having it arranged for them by the council.

Direct payments are not counted as income and do not effect tax or welfare benefits.

How much money can people get?

Different people will get different amounts of money depending how much money they have and what services the council has agreed they need (see Assessment chapter).

The council works out the amount of the direct payment based on the personal budget that has been agreed in the person’s care and support plan.

The amount of money should be enough to meet their needs and will take into account whether the person has to pay any money themselves.

Who can have a direct payment?

To get a direct payment, the person must have been assessed by the council as being eligible to receive services (see Eligibility chapter). They must also be:

• over the age of 16;
• a carer;  or
• the parent of a disabled child.

They must also be:

• able to arrange and manage their own care; and
• able and willing to agree to a direct payment and manage the payment.

They can get support to do this if they need it.

Although most people will be given a direct payment if they ask for one, there are some people who cannot get a direct payment, for example those under various court orders or treatments for using drugs or alcohol.

A direct payment can be requested at any time.

Why have a direct payment?

Direct payments give people more freedom and flexibility. Instead of having services organised by the council, with a direct payment people can arrange the support and care that works best for them. It allows them to:

• be more independent;
• have more control in their life;
• make their own decisions;
• choose who helps them manage their money and;
• decide who gives them the support that they need.

Direct payments give a person control over their care and this means that if they are not happy with the services they are getting, they can decide to change them without the council getting involved.

However, the person has to be able to show how the money is spent, to make sure it is being used in the way agreed in the care and support plan, by keeping records and receipts

How are direct payments paid?

The money is usually paid every four weeks into the person’s bank or building society account. It has to be kept separate from their private money. It can be paid into another person’s or organisation’s account, if the council has agreed to this.

Some councils use different types of payment, such as pre-paid cards.

What can direct payments be used for?

Direct payments can be used in creative, flexible ways, as long the needs and outcomes agreed in the person’s care and support plan are met.

Examples are:

• employing a personal assistant to help with daily household tasks or personal care – at times that best suit the person and their daily routine;
• buying services from a private care provider that the person chooses;
• helping someone to stay in touch with friends and family or make new social contacts;
• paying toward leisure, education or social activities;
• buying support to give unpaid family carers a break.

There are some things that it can’t be spent on, including:

• permanent residential or nursing care;
• any services or goods that haven’t been agreed with the council in the care and support plan;
• employing a close relative who lives with the person;
• support provided by the council; and
• household bills, clothes, food and housing.

What is deprivation of liberty?

Liberty means being free to do the things someone wants to do (within the law) and being free to live where they want to live.

Deprivation of liberty means that these freedoms have been taken away.

The law says that a person is deprived of their liberty when they are:

• under constant supervision and control (by staff);
• they are not free to leave the place they are in; and
• they lack ‘mental capacity’ to agree to what happens to them. This means they are not able to make some or all decisions themselves.

What is Deprivation of Liberty Safeguards (DoLs)?

DoLS is part of the Mental Capacity Act 2005. It means that people in care homes and hospitals are looked after in a way that keeps them safe, while not restricting all of their freedom, just things that may put them or other people at risk of being hurt.

DoLS protects the human rights of people who do not have mental capacity to agree to their freedoms being limited.

Examples include:

• using locks or keypads to prevent a person leaving;
• giving medication to calm a person down;
• managers saying a person needs to be supervised when they are outside;
• restricting a person’s contact with family and friends, including if they could harm someone;
• physically stopping a person from doing something when they could have injure themselves or someone else;
• removing items from a person which could harm them;
• holding a person so they can be given care or treatment;
• using bedrails, wheelchair straps or splints;
• needing close supervision when they are at home;
• the person has to stay somewhere they do not want to be.

Where do DoLs apply?

DoLs apply to people who receive care and support in:

• care homes;
• hospitals;
• accommodation projects, like supported housing.

Who is responsible for applying the safeguards?

The care home or hospital is responsible for making sure that if they need to deprive someone of their liberty it is done within the law.

A manager must apply to the local authority for them to agree to limit the person’s freedom.

People must always be cared for in a way that:

• does not limit their freedom without good reason
• does not limit all their choices or freedoms, just those that need to be put in place to make them safe.

So that deprivation of liberty should be seen as a last resort.

An assessment is then carried out to decide whether the person needs to be deprived of their liberty to keep them safe and what care or treatment they need.

Is is important that care should always be given in the way that least restricts the persons freedom while still keeping them and others safe and well.

Case Study

A man with autism was admitted to hospital. The way that he was cared for by staff meant that his ability to do what he wanted was very limited. For example, his family was not allowed to take him home, and he was given medication without his agreement.

The man’s lawyers took his case to the European Court of Human Rights. They said the way he had been kept in hospital was against the law and that he had been deprived of his liberty under the Human Rights Act.

Following this, the DoLS legislation came into force so that if someone in a care home or hospital is cared for in a way that limits their freedom and they are not mentally able to agree to it, this must be done within the DoLS legislation.

What is the aim of an assessment?

The aim of an assessment is to find out what needs someone may have and what goals (also known as outcomes) they want to achieve to maintain or improve their situation.

Assessments should help people to understand their strengths and abilities, areas of their life that they need support and what help available.

What is covered during an assessment?

Councils should consider the following areas when carrying out an assessment:

• how the person manages everyday tasks;
• what are their needs and wishes;
• their skills, strengths and abilities;
• the emotional and social side of their life;
• their choices and goals;
• any health or housing needs;
• their views, religious and cultural background and social supports;
• any physical difficulties they may have, and any risks;
• any needs of their family or carers.

Assessments must consider what support is needed right now and what might help in the future.

An assessment should involve not only the adult but also involve family, carers and any other person / professional that the person might want included.

How can assessments be carried out?

An assessment can be carried out in a number of ways including:

• face-to-face assessment: between the adult and the assessor, who is usually a social worker or other trained professional;
• supported self-assessment: if the adult agrees and is able to, they can fill out a questionnaire that the council gives them. This should cover the same information as a face-to-face assessment;
• online or telephone assessment: this may be used when an adult’s needs are quite straightforward or where an adult is already known to the council and an assessment is happening because of a change in their needs or circumstances;
• joint assessment: this is where an adult’s assessment is carried out at the same time as another assessment, for example an assessment for continuing healthcare;
• combined assessment: this is where an adult’s assessment is combined with a carer’s assessment for example, so that both their needs are taken into account together.

Who can carry out an assessment?

Assessments can be carried out by a range of professionals who have the right skills, knowledge, training and experience. This may be:

• a social worker;
• an occupational therapist;
• a rehabilitation officer;
• someone else who is suitably qualified.

When should assessments take place?

Assessments should start from when information starts to be collected about the adult.

After this first contact, full information about the assessment process should be given to the person. This should include what they should expect to happen during the assessment, and how it will be carried out and the time it will take.

What is adult safeguarding?

Safeguarding means protecting an adult’s right to live safely and free from abuse or neglect.

It is also about people and organisations working together to prevent and stop abuse and neglect.

Who needs to be safeguarded?

People who need to be safeguarded:

• have care and support needs;
• are experiencing, or are at risk of, abuse or neglect; and
• are unable to protect themselves from either the risk of, or experiencing, abuse or neglect because of their care and support needs.

Who abuses or neglects adults?

Anyone can be responsible for abuse or neglect, including:

• spouses / partners;
• other family members;
• neighbours;
• friends;
• acquaintances;
• local residents;
• people who deliberately exploit adults they perceive as vulnerable to abuse;
• paid staff or professionals and volunteers;
• strangers.

Although we often think of abusers as being strangers, it is more likely that the adult will know them and will be someone they trust. They may have some power or influence over the adult.

Where can abuse take place?

Abuse can happen anywhere. For example:

• in someone’s own home;
• in a public place;
• in hospital;
• in a care home or;
• in college.

It can take place when an adult lives, alone, or with others.

How should I respond?

If you are concerned an adult may be at risk of or experiencing abuse or neglect, you should discuss the situation with a manager or the safeguarding adults lead for your organisation.

Your local safeguarding adults board procedures should always be followed.