204 of harm. 1.1f – Define self

204 cert – Principles of safeguarding and protection in health and social care.

204 cert 1 – Know how to recognise signs of abuse.
Changes to an individuals general behaviour, mood changes, lack of appetite, changes to sleep pattern, change of routine/habits, being withdrawn or lack of interest to do things.
1.1a – Define physical abuse – any intentional act causing injury or trauma to another person by way of bodily contact – slapping, punching, kicking, biting, scratching, pushing etc.
1.1b – Define sexual abuse – any behaviour of a sexual nature that is unwanted and takes place without consent or understanding.
1.1c – Define emotional/psychological abuse – any act including confinement, isolation, humiliation, intimidation, verbal assault or any other treatment that may diminish the sense of identity, dignity or self-worth.
1.1d – Define financial abuse – the misuse of an individuals funds/assets or obtaining property or funds without his/her knowledge or consent.
1.1e – Define institutional abuse – the mistreatment or neglect of adult at risk by a regime or individuals. This type of abuse takes place in settings adults at risk live in/use, it includes any organisation – in or out of the Health and Care sector. It may occur when regimes, systems and routines result in poor standards of care/poor practice and behaviours are in place/within strict regimes that violate the dignity and human rights of adults and place them at risk of harm.
1.1f – Define self neglect – failure of an adult to take care of themselves/ lack of interest in own general well being/personal hygiene or appearance/cleanliness of property, possessions and surroundings.
1.1g – Define neglect by others – the failure to provide the necessary care, assistance, guidance or attention that causes – or reasonably likely to cause the person physical/mental/emotional harm or substantial damage to or loss of assets.
1.2 – Identify the signs and/or symptoms associated with each type of abuse.
Physical abuse –
Multiple bruising/fractures/burns/bed sores
Unexplained weight loss
Sexual abuse –
Unexpected/unexplained changes of behaviour
Loss of sleep
Soreness around the genitals and/or bruising
Torn/stained/bloody underwear
Preoccupation with anything sexual
Sexually transmitted diseases

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Emotional/psychological abuse –
Unexpected/unexplained changes of behaviours
Loss of sleep
Financial abuse –
Unexplained activity in the bank accounts
Unexplained withdrawals
Unexplained shortage of money
Unpaid bills
Reluctance of the person responsible for the funds to provide basic food/clothes etc
Institutional abuse –
Inflexible and non-negotiable systems and routines
Lack of adequate physical care – unkempt appearance
Inappropriate ways of addressing people – name calling
Lack of consideration of dietary requirements/needs
Self neglect –
Unkempt appearance
Disregard of personal hygiene
Disregard of personal health – dietary requirements/needs
Behavioural changes such as hoarding, disregard of surroundings
Neglect by others –
Unkempt appearance – indication of lack of care
Untreated medical problems
Bed sores
1.3 – Describe factors that may contribute to an individual being more vulnerable to abuse.
Factors may include – if an individual has a history of being abused and therefore seeing abuse as normal behaviour, if they have a physical disability or illness creating dependency on others, if they have mental/emotional health problems such as depression, dementia or suffer stress, if the person has communication problems – unable to speak/hear, or have different beliefs/culture.

204 cert 2 – Know how to respond to suspected or alleged abuse.
Any suspected/alleged form of abuse should be reported immediately to your manager/nurse in charge, follow company policies and procedures for reporting/documenting suspected/alleged abuse,
2.1 – Explain the actions to take if there are suspicions that an individual is being abused.
Always be professional, follow policies and procedures, speak to the individual involved – reassure them, record what you are told – using the individual’s own words – explain to them it is your duty of care to report the abuse to your manager and relevant services, ensure that correct measures be in place to prevent further abuse and protect the individual.
2.2 – Explain the actions to take if an individual alleges that they are being abused.
Advise them of/assist them to contact relevant services to assist/advise them on correct procedures to take, they may require counselling services/medical treatment/legal advice. Again advise them it is your duty of care to report it to your manager, reassure them they are safe, keep up to date records/reports as necessary.
2.3 – Identify ways to ensure that evidence of abuse is preserved.
By leaving things as they are – do not touch anything
By not removing/cleaning anything the person is wearing – clothing, jewellery etc
Keep the area the alleged abuse has taken place safe – not allowing anyone to enter/leave
Record and report carefully and confidentially what you are told by the individual and others present at the time, stating facts only

204 cert 3 – Understand the national and local context of safeguarding and protection from abuse.
3.1 – Identify national policies and local systems that relate to safeguarding and protection from abuse.
National policies include –
The Care Act 2014 – This Act defines statutory responsibilities for adult safeguarding and replaces the No Secrets guidance. Other policies are:
Mental health act 1998
NHS and community care act 1990
The Police act 1997
Human rights act 1998
Data protection act 1998
Public interest and disclosure act 1998
Care standards act 2000

Local systems include –
Court of Protection
Care Quality Commission
Disclosure and Barring Service
Safeguarding Adults Board

3.2 – Explain the roles of different agencies in safeguarding and protecting individuals from abuse.
Court of Protection – to make decisions on welfare/finance matters for individuals who cannot make a decision at the time it needs to be made (a person who ‘lacks mental capacity’)
Police – to investigate fully all reports of vulnerable adult abuse, to safeguard and protect and uphold the rights of vulnerable adults.
Care Quality Commission – to ensure health and care services provide service users with safe, effective, high quality compassionate care, to register/monitor/inspect/rate services, protect the rights of vulnerable people, to take action on reports of abuse.
Disclosure and Barring Service – to assist employers to make safer recruitment decisions to help protect vulnerable individuals from risk of abuse. Formerly known as CRB – Criminal Records Bureau.
Safeguarding Adults Board – bring together a range of agencies to agreed to work together to develop/implement and monitor work to safeguard adults with care/support needs by assuring itself that local safeguarding arrangements are in place in accordance with the Care Act 2014 and statutory guidance, assuring itself that safeguarding practice is person centred and out come focused.
3.3 – Identify reports into serious failures to protect individuals form abuse.
Winterbourne View/Castlebeck Care Ltd – reported nationally for serious failure to safeguard and protect vulnerable service users from physical/verbal/mental/emotional abuse resulting in several staff being charged with serious abuse and the home being closed.
Wentworth Croft/Bupa – reports of failure to protect service users from physical/mental/emotional abuse, including nurses withholding/over medicating individuals. This resulted in 6 staff being charged with serious abuse. This home has since changed ownership/name, it is now owned by Athena Care Homes and known as Ashlynn Grange – as of CQC report 07/09/ 2017 – needs improvement.
3.4 – Identify sources of information and advice about own role in safeguarding and protecting individuals from abuse.
My company policies and procedures on safeguarding, manager/nurse in charge/colleagues, CQC, local authority adult services such as Social Services, Safeguarding Adults Board, Independent Safeguarding Authority, training and advice from training centres.
204 cert 4 – Understand ways to reduce the likelihood of abuse.
By always working with person centred values, treating individuals with respect and dignity at all times.
4.1a – Explain how the likelihood of abuse may be reduced by: working with person centred values.
Person centred values involve respecting the individuality of the person, their rights, independence, privacy, choice, good communication and respecting the individual’s decisions.
4.1b – By: encouraging active participation.
Recognising an individual’s right to participate in the activities/decisions of their daily life as independently as possible, allowing the individual choice in decisions about their care needs reduce risk of abuse.
4.1c – By: promoting choice and rights.
By promoting choice and rights you will help a person feel valued/empowered having a say in what happens in their daily life, reducing the likelihood of becoming a victim of abuse.
4.2 – Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse.
An accessible complaints procedure is important to allow individuals to make complaints easily and effectively, allowing them choice in what/how they would like things to proceed and the outcome of the complaint. Any complaints should be reported/recorded in detail, kept up to date, responses recorded and outcome, if the complaint has been resolved promptly and effectively.

204 cert 5 – Know how to recognise and report unsafe practices.
Unsafe practices include insufficient staff to be able to provide a high quality level of care, use of unserviced/broken equipment or lack of correct equipment, not following policies and procedures putting individuals in need of care/support at risk of abuse, not reporting identified unsafe practices.
5.1 – Describe unsafe practices that may affect the well-being of individuals.
Staff shortages lead to individuals not receiving the correct high quality care to support their needs – those in need of being regularly repositioned being left resulting in pressure sores developing – neglect. The use of incorrect/broken/unserviced equipment – risking injury to the service user or staff. Lack of correct equipment such as Personal Protective Equipment (PPE) risking cross infection. Lack of relevant/correct training leaving individuals at risk of harm/abuse.
5.2 – Explain the actions to take if unsafe practices have been identified.
All unsafe practices should be reported to your manager, ensure the individual involved is safe, document concerns/issues and any responses should be recorded.
5.3 – Describe the action to take if suspected abuse or unsafe practices have been reported but nothing has been done in response.
If nothing has been done in response to suspected abuse or unsafe practice you should ensure the person’s safety, report your concerns to manager, contact Care Quality Commission (CQC), Social Services, Police, Safeguarding Adults Board directly. Anyone can report abuse or unsafe practices. As a carer it is your duty to protect the individuals in your care.

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Last updated: April 26, 2019


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