Neglect and acts of omission

An ongoing failure to meet someone’s basic physical or psychological needs. Incidents relating to falls, pressure damage and medication concerns are addressed separately within this guidance document.

Non-reportable concerns

Examples of isolated incidents where no other similar concerns have been identified and that do not need to be reported as a safeguarding concern include:

• Appropriate care plan in place but care needs not fully met, such as incontinence needs not met on one occasion, but no impact or distress occurs.
• Missed home visit where there is no impact, and no other individual visits are missed.
• Incident of a person not supported with food/drink and reasonable explanation provided.
• A fall where no significant injury occurs, there are no other indicators of neglect, and action is taken to minimise further risk (see the falls section for further guidance).
• Issues or complaints around an adult’s admission and/or discharge from hospital where no harm has occurred.

Concerns requiring consultation

More serious incidents will require internal consultation, through relevant organisational policies and procedures and senior leadership as well as potentially through the Sussex Safeguarding Adults Policy and Procedures and other organisations being made aware.

Actions that should be considered to reduce risk include:

• Share information with the ICB Quality Team and or the CQC.
• Share information with district nurse, GP, Occupational Therapist, or Falls Prevention Service.
• Referral to local authority Adult Social Care department for assessment, carers assessment, or review of existing arrangements.
• Self-referral to local carers organisation.
• Review staffing arrangements.

Examples that require external consultation with the relevant Adult Social Care department, and may lead to a safeguarding referral needing to be submitted, include:

• Recurrent missed home care visits where risk of abuse or neglect escalates, or one missed visit where abuse or neglect occurs.
• Discharge from hospital where abuse or neglect or risk of abuse or neglect occurs but re-admission is not required.
• Carer unable to continue in caring role and at risk of breakdown.
• Risk cannot be managed appropriately with current professional oversight or universal services.
• Repeated health appointments missed due to unmet needs.
• Any fall where there is suspected neglect or a failure to follow relevant care plans, policies, or procedures.
• Any repeated incidents or pattern of similar concerns where no harm or distress has occurred.

Reportable concerns

Serious incidents need to be formally raised as a safeguarding concern with the local authority Adult Social Care department. Consideration should also be given as to whether the police or other emergency services need to be contacted. Professional curiosity is important and a Think Family approach if children or other adults may be impacted.

In these cases, it is important that you consider additional actions to contacting the local authority. These include:

• RAISE SAFEGUARDING CONCERN
• If there is an indication a criminal act has occurred, the police must be consulted.
• Immediate safety plans must be implemented.

Examples of reportable concerns include:

• Continued failure to adhere with care plan.
• Lack of action resulting in serious injury or death.
• Failure to arrange access to lifesaving services or medical treatment.
• Ongoing lack of care to the extent that health and wellbeing deteriorate significantly (e.g., dehydration, malnutrition, loss of independence).
• Missed, late or failed visit/s where the provider has failed to take appropriate action, and abuse or neglect has occurred.
• Discharge from hospital without adequate planning which results in the person experiencing significant harm or abuse.
• Adult self-harms within a hospital or care home setting and requires admission to A&E for emergency medical interventions.