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Safeguarding adults in care homes

About

What is covered

This pathway covers keeping adults in care homes safe from abuse and neglect. It includes potential indicators of abuse and neglect (by individuals and by organisations), and covers the safeguarding process from identifying and reporting a concern through to making a safeguarding referral to the local authority and supporting people through a section 42 safeguarding enquiry. There are recommendations on policy, training, learning and care home culture, to help care homes improve staff awareness of safeguarding and ensure people are willing and able to report concerns when needed.

Updates

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on safeguarding adults in care homes in an interactive flowchart.

What is covered

This pathway covers keeping adults in care homes safe from abuse and neglect. It includes potential indicators of abuse and neglect (by individuals and by organisations), and covers the safeguarding process from identifying and reporting a concern through to making a safeguarding referral to the local authority and supporting people through a section 42 safeguarding enquiry. There are recommendations on policy, training, learning and care home culture, to help care homes improve staff awareness of safeguarding and ensure people are willing and able to report concerns when needed.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Safeguarding adults in care homes (2021) NICE guideline NG189

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

NICE has produced resources to help implement its guidance on:

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

6 core principles of safeguarding

The Care Act statutory guidance defines 6 principles:
1. Empowerment: People being supported and encouraged to make their own decisions and informed consent.
2. Prevention: It is better to take action before harm occurs.
3. Proportionality: The least intrusive response appropriate to the risk presented.
4. Protection: Support and representation for those in greatest need
5. Partnerships: Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse
6. Accountability: Accountability and transparency in delivering safeguarding.
As well as the 6 principles, these recommendations are also in line with the wellbeing principle within the Care Act, and the safeguarding approaches based on the Making Safeguarding Personal framework.
Sometimes referred to as the lead enquiry officer or enquiry officer. This person is appointed by the local authority when a safeguarding enquiry begins. They may be a local authority social worker or a designated member of staff from the care home or care home provider. They are responsible for coordinating responses to the enquiry, coordinating decision making and acting as a main point of contact. They make sure that enquiry actions are undertaken in accordance with Care Act duties, related statutory guidance and the recommendations in this pathway.
Induction, training and assessment that is undertaken one-to-one, or in groups led by either in-house staff experts, managers or external trainers. It may take place with participants all in the same room, or using video or telephone conferencing. It may include online materials, but participants are able to ask questions, discuss, reflect on current practice and use case studies and examples. This type of training looks at how safeguarding relates to the particular role of the person being trained, and to the personalised care and support needs of residents.
Reflective practice and reflective supervision are opportunities for staff to:
  • reflect on previous practice
  • talk about why they made the decisions they made, and why they acted or behaved in particular ways
  • talk about their emotional responses to their actions and the actions of others
  • engage in continuous learning.
Reflective practice and supervision may also provide insight into personal values and beliefs, and help staff understand how these influence action and decision making within the care home.
Reflective practice and reflective supervision are opportunities for staff to:
  • reflect on previous practice
  • talk about why they made the decisions they made, and why they acted or behaved in particular ways
  • talk about their emotional responses to their actions and the actions of others
  • engage in continuous learning.
Reflective practice and supervision may also provide insight into personal values and beliefs, and help staff understand how these influence action and decision making within the care home.
Care homes registered with the Care Quality Commission must have a registered manager, in line with the Health and Social Care Act 2008. The registered manager is responsible for leading and running the care home and making sure that standards are upheld. Note that other managers may also work within care homes and have responsibilities for staff supervision, line management or other aspects of running the home. However, the registered manager is the person accountable to the Care Quality Commission for the standards of care and safeguarding within the home.
Care homes registered with the Care Quality Commission must have a registered manager, in line with the Health and Social Care Act 2008. The registered manager is responsible for leading and running the care home and making sure that standards are upheld. Note that other managers may also work within care homes and have responsibilities for staff supervision, line management or other aspects of running the home. However, the registered manager is the person accountable to the Care Quality Commission for the standards of care and safeguarding within the home.
Safeguarding champions are staff already working within the care home, with good knowledge of safeguarding policy and procedure, who help ensure that procedures are followed and are available for discussion. They also ensure reflective learning about best practice in preventing abuse and neglect. Champions may also offer practical and emotional support to those worried about the impact of raising concerns. They are not a replacement or alternative to the safeguarding lead.
For the purposes of this Pathway, a safeguarding concern is defined as a consideration, suspicion or indication of abuse or neglect of a resident, or residents within a care home. Anybody who works in, lives in or visits the home may have a safeguarding concern, either because of something they have seen or because of something they were told. All safeguarding concerns should be responded to in line with this Pathway. Note that this definition relates to concerns in care home settings. For a more general definition, see the Local Government Association and ADASS definition in their report on understanding what constitutes a safeguarding concern.
For the purposes of this Pathway, safeguarding concerns are defined as a consideration, suspicion or indication of abuse or neglect of a resident, or residents within a care home. Anybody who works in, lives in or visits the home may have safeguarding concerns, either because of something they have seen or because of something they were told. All safeguarding concerns should be responded to in line with this Pathway. Note that this definition relates to concerns in care home settings. For a more general definition, see the Local Government Association and ADASS definition in their report on understanding what constitutes a safeguarding concern.
Organisational abuse (also known as institutional abuse) is distinct from other forms of abuse or neglect, because it is not directly caused by individual action or inaction. Instead, it is a cumulative consequence of how services are managed, led and funded. Some aspects of organisational abuse may be hidden (closed cultures), and staff may act differently when visitors are there (disguised compliance). Organisational abuse can affect one person or many residents. Therefore, it is important to consider each unique case, and the impact on individual residents as well as the whole care home.
Organisations working together in the context of safeguarding adults in care homes. Relevant organisations include:
  • local authorities and health and social care services
  • the police and other organisations in the criminal justice system
  • education and learning services
  • advocacy services
  • local voluntary and community groups.
National organisations or complaints services can also be included (such as the Local Government and Social Care Ombudsman).
Must be arranged by Safeguarding Adults Boards if:
  • there is reasonable cause for concern that partner agencies could have worked more effectively to protect an adult and
  • when serious abuse or neglect is known or suspected and
  • if certain conditions are met, in line with section 44 of the Care Act 2014 and related statutory guidance.
Care homes should give staff protected time for induction and mandatory safeguarding training. They should ensure that staff have enough time to read and understand the induction and training materials and improve their knowledge and confidence about safeguarding.
If the local authority agrees that the safeguarding referral falls within the duty set out within section 42 of the Care Act 2014 and related statutory guidance, they must undertake an enquiry into the suspected abuse or neglect. Note that this definition relates to enquiries about abuse and neglect in care homes. For a more general definition, see the Local Government Association and ADASS definition in their report on understanding what constitutes a safeguarding concern.
If the local authority agrees that the safeguarding referral falls within the duty set out within section 42 of the Care Act 2014 and related statutory guidance, they must undertake an enquiry into the suspected abuse or neglect. Note that this definition relates to enquiries about abuse and neglect in care homes. For a more general definition, see the Local Government Association and ADASS definition in their report on understanding what constitutes a safeguarding concern.

Glossary

(residential care home [with or without nursing care] that is registered with and regulated by the Care Quality Commission)
(residential care homes [with or without nursing care] that are registered with and regulated by the Care Quality Commission)
(companies that own and operate one or more care homes regulated by the Care Quality Commission)
(a company that own and operate one or more care homes regulated by the Care Quality Commission)
(local authorities, clinical commissioning groups and other public sector commissioners who oversee contracts for care and support services provided by care homes that pay for care home residents who are eligible for public funding – the term 'commissioner' does not apply to individuals who pay privately for their care)
(to 'consider' abuse or neglect means that this is one possible explanation for the indicator)
(staff who are not employed on a permanent contract with the care home, who may be supplied by an employment agency on a short-term basis, or who might be employed on a zero hours contract or on a casual labour basis)
(induction, training and assessment that people undertake on a computer or mobile device, without interacting with other people)
(adult aged 18 and over who lives and receives care and support in care homes, or who uses care homes to access care and support from time to time [for example respite care, including day care])
(adults aged 18 and over who live in and receive care and support in care homes, or who use care homes to access care and support from time to time [for example respite care, including day care])
(the resident at the centre of a safeguarding concern, when abuse or neglect is considered or suspected or a safeguarding referral has been made to a local authority or a section 42 safeguarding enquiry is taking place)
(this may be the care home registered manager or someone with delegated responsibility for safeguarding within the care home – it is a statutory requirement for care homes to have a designated safeguarding lead; safeguarding leads should have had training in safeguarding, and should have the relevant skills and competencies to ensure the safety and protection of residents, in line with Care Quality Commission guidance)
(this may be the care home registered manager or someone with delegated responsibility for safeguarding within the care home – it is a statutory requirement for care homes to have a designated safeguarding lead; safeguarding leads should have had training in safeguarding, and should have the relevant skills and competencies to ensure the safety and protection of residents, in line with Care Quality Commission guidance)
(if abuse or neglect is suspected this must be reported to the local authority; this is called making a safeguarding referral)
(other organisations providing services within care homes or contracted by care homes to provide services, including health and social care services (for example, GP services, clinical psychology and occupational therapy) but also other services such as cleaning, catering, gardening, transport, education, learning or activities)
(anyone paid to work in a care home and involved either directly or indirectly in the care and support of residents, including care workers, nurses, managers, administrative staff, cleaners, caterers, gardeners or anyone else who the care home employs directly or via agencies or contractors, on a casual, part-time, full-time, temporary or permanent basis)
(to 'suspect' abuse or neglect means a serious level of concern about the possibility of abuse or neglect)

Paths in this pathway

Pathway created: February 2021 Last updated: February 2021

© NICE 2021. All rights reserved. Subject to Notice of rights.

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