Ensuring safety
This theme focuses on how we work with people and our partners to ensure care is safe and how we support people to live in safety free from abuse and harm.
Safe systems, pathways and transitions
What was the situation?
Thomas is an 18-year-old young man who was living in a Children's residential placement in Telford. He moved there as an emergency when his last residential placement in Coventry had to close suddenly. He settled well and had a good relationship with staff there. He also attended a local specialist college. Thomas has a diagnosis of a Severe Learning Disability, Autism and Epilepsy. Thomas’s family were unable to care for him at home and he needed support from Children’s Services, but they maintained regular contact with him and attended all meetings in relation to Thomas’ care and support. He is a much-loved member of the family having close links to both of his parents and his sister who live in Coventry. Thomas has a very limited understanding of risk and danger and needs supervision at all times, which includes the need for 2 to 1 staff support. He communicates through his behaviour and actions. Thomas enjoys the freedom to walk around and to be outside, and he likes to have structure and routine to his day. He likes to be on the go and enjoys activities that allow him to be. Thomas is Catholic and this religion has been an important aspect of his upbringing. Thomas needed to move from his children’s residential placement when he turned 18. This is a process called Transition or Preparing for Adulthood. This means the time when a young person moves from using children’s social care services to having an assessment for services and potential support from Adult Social Care.
What did we do?
Thomas initially moved to a supported living placement which wasn't successful, this then required the extra support of a multi-disciplinary team including learning disability health colleagues to ensure the success of any next move. Thomas’ advocate is his uncle, Karl. He was involved in decisions regarding Thomas’s next potential placement to ensure this was the right move for him taking into account his wishes. Thomas has a Deprivation of Liberty Safeguards (DoLS) in place as he needs continuous supervision and support in the least intrusive way. The ultimate aim was to try and ensure Thomas' next move was as close to home as possible and to provide intensive support to understand his communication and sensory needs better (from the learning disability team). This was to ensure that Thomas was supported in a way that suited him. His accommodation needs were also very specific needing lots of outside secure space and access, alongside his own apartment and living space.
What difference did it make and how are things now?
A suitable supported living placement funded jointly by health and social care, with the involvement and coordination of a full multidisciplinary team, his family and of course Thomas was identified. Naomi his social worker said:
"This all sounds really simple but it required lots of working together towards the same goal and what was best for Thomas and setting him on the right path for life".
It was initially thought this was a temporary placement being outside of Coventry, but the staff have worked closely with Thomas and his family, and this has worked really well for Thomas, and he now attends a local day centre that is able to meet his specific needs. Thomas now lives in his own apartment, with an open door so he can access the secure garden whenever he likes. He has constant access to the foods he likes to eat, with his own fridge and snacks available at all times, to minimise any potential distress as Thomas cannot tell people when he is hungry. Thomas is living his best life due to very individualised care planning, routines to reduce stress and anxiety and regular contact with his family Thomas’ Uncle, Karl, said:
"As a family it has been lovely to see the change in Thomas these last 12 months, he appears more settled and happy in his current home and on each visit we get to spend quality time with him, it's so lovely and comforting to know that Thomas is being well looked after and also to see him smiling and interacting with his family and the staff. Naomi his social worker has been absolutely fantastic in supporting myself, Thomas and his family throughout the transition alongside other professionals so thank you".
Tracey Denny, Head of Service Localities and Social Care Operations said:
Young people face so many challenges when they turn 18 but not many have to move home like Thomas, it is great to read that Thomas has now found somewhere that he can call home and has the things that so many of us take for granted, like his own fridge and food available when he wants it. I am aware that this transition was not straightforward but was successful due to the partnership working and the support from Thomas’s Uncle.
Coventry Adult Social Care has created a Direct Work Toolkit. These resources for download have been developed to aim to give practitioners the tools to communicate, engage and support improved participation with those people we support in our direct work. It is hoped better communication leads to better relationships and a better understanding of what is important to the individual and/or carer.
Safeguarding
Coventry Safeguarding Adults Board (CSAB)
Setting strategic priorities
The Coventry Safeguarding Adults Board (CSAB) is independently chaired and is responsible for publishing a Strategic Plan setting out how as a partnership we work in partnership to meet our safeguarding objectives. The Board Strategic Plan for 2024-2027 focuses on 4 themes:
- Making Safeguarding Personal (MSP)
- Prevention and Early Intervention
- Engagement and Communication
- Development and Assurance
A joined-up approach to policy, procedure and learning
The Board (and therefore all member organisations) have adopted the West Midlands Adult Safeguarding Policy and Procedures produced in 2019 (updated 2024) for the region. The policy sets out the approach taken across the West Midlands and the approaches to be taken to make this real for our communities. It requires that Section 42 safeguarding enquiries are carried out sensitively and without delay, keeping the wishes and best interests of the person concerned at the centre of decision making. Board audit activity is carried out via scheduled ‘enquiry panels’ over the course of the year and multi-agency learning events, are undertaken to ensure that guidance and its application is understood, reflect on practice and that practitioners continue to develop their learning in its’ application. These audits have included Safeguarding in Care Home NICE Guidance, Mental Capacity Act, Self-Neglect and Safeguarding Adult Review Toolkit Enquiry Panel.
Adapting to new and emerging safeguarding risks
In order to ensure we continue to improve our approach to safeguarding the Board has, in 2023, produced guidance in response to emerging issues such as rising safeguarding concerns and self-neglect which have included:
- A 'Practice Tool to Aid Decision Making - to assist agencies working with adults with care and support needs to identify if/when a safeguarding concern should be raised with the Local Authority. This was in response to rising numbers of concerns. This tool can also assist social care staff to assess the seriousness and level of risk associated with the concerns being received.
- A ‘Hoarding Best Practice Framework and Toolkit’ - in response to rising cases of self neglect, including hoarding, this framework and toolkit provides approaches and methods of working that can be utilised and adapted by organisations to meet the needs of the individuals they work with
To support learning the Board commissions a Safeguarding Adult Review (SAR) for any case which meets the criteria as identified in law supported by regional and local guidance and toolkits. The SARs we have undertaken are all published on the Board webpages as executive summaries.
The Board has undertaken 2 SARs in the last 2 years, one of these concerned a person who was experiencing self-neglect and the other a person with learning disabilities who experienced neglect as part of a discharge from hospital into a care home. Every SAR undertaken has an action plan to address any recommendations and learning from the review. The Board wants to ensure it continually seeks feedback on people’s experience and in 2023/24 launched a new survey.
To ensure all partners work together to provide safe systems of care in Coventry the Board also produces its own annual report on key safeguarding performance, progress in reducing or preventing harm and priorities for the following year.
James, his story
James is a 69-year-old man who lives independently in a high rise block of flats, he is experiencing low mood and has some spinal problems related to his work history as an electrician, before the days of health and safety, needing to bend his back a great deal and this means he is in pain a lot of the time and the stability of his walking is affected, experiencing frequent falls. James has difficulty leaving the property and feels quite isolated.
James can be described as self-neglecting due to his pain and isolation. James was referred to Adult Social Care over a year ago in the form of a safeguarding concern from a number of sources including primary care. James was also neglecting his home environment needing to move out of his home for a short period of time. James is very reluctant to accept care and support and we had to spend a significant amount of time getting to know James and build his trust. James is still reluctant to accept support apart from a domestic service to support his environment which has been of benefit to his mood. James is much more open about his situation and circumstances and is receiving weekly visits from his social worker. James has been experiencing financial abuse recently which means we are working with James to establish how we can support and what options are available to him. James said his relationship with his social worker is “good” and that he is “thankful” for all the support he has received thus far. James said that before his social worker got involved his flat was a “mess”, however, “it’s nice and comfortable now”. James said that his domestic workers are “nice” and that they “do a good job”. Regarding his financial circumstances, James is “hopeful” that we can arrange services that will help him to better protect his finances and reduce the risks associated with financial abuse. Regarding his personal care, James is still struggling to accept help and said he would feel “uncomfortable” and “embarrassed” to have carers. There are plans to explore a positive risk assessment with James thus highlighting his informed decisions around continued self-neglect. Regardless of his decision-making, James said that he is much “happier” now Adult Social Care are involved; he feels “much safer” and he feels “listened to”.
Andrew Errington Head of Practice Development & Safeguarding (Adults Principal Social Worker) said:
Supporting people who self-neglect can be very challenging, needing to balance rights, risks and taking time to understand the person, so it's great to see this being recognised in the support provided to James.