The definition of an adult at risk requires an assessment to be made about the risk of harm to the person at the outset. Risk is the possibility of beneficial and harmful outcomes and the likelihood of their occurrence in a stated timescale. 

Risk assessment means making analysis about:

• The individual’s capabilities and coping mechanisms (social, material and personal).
• The gains for the individual’s physical, psychological and emotional wellbeing.
• Possible disadvantages and harms.
• The values placed on the outcomes.
• The consequences for the individual of not going ahead with the activity.
• The presence and impact of coercive control, disguised compliance or undue pressure.

Undue Pressure

An adult at risk can be considered to be under undue pressure if they are refusing consent and:

• The person causing the harm, that the order or action is intended to prevent, is someone in whom the adult at risk has confidence and trust.
• Pressure applied by the person that the adult is afraid of, or threatening them and the adult does not trust them.
• Pressure applied by person not causing harm (e.g. a relative not suspected of causing harm) but does not want the council to intervene.

 

Protection Orders

What follows are the salient points of each of the Protection Orders. This does not replace the more detailed information contained within the Act and the Code of Practice (2022). These should be referred to if consideration is being given to an application under this part of the Act.

Any protection order under the Act represents a serious intervention in an adult's life, a sheriff must be satisfied that the council has reasonable cause to suspect the person in respect of whom the order is sought is an adult at risk who is being, or is likely to be, at risk of serious harm. Where the adult has the capacity to make decisions, the application cannot be granted by the Sheriff if the adult does not consent to the order unless it can be proved that the adult has been subject to undue pressure to refuse consent. This does not require to be proven where the adult lacks capacity. Each order may only be executed once.

 

Assessment Orders – Warrant for Entry

The purpose of an assessment order is to determine whether the adult is an adult suspected to be at risk; and whether there is reasonable cause to suspect that the adult at risk is being, or is likely to be, seriously harmed; and whether any action should be taken to protect the adult from serious harm.

Application for an assessment order must be made by the council's legal department, which authorises the council, if necessary, to take the adult from a place being visited under the order to allow:

• the interview to be conducted in private and /or
• a private medical examination by a health professional nominated by the Council.

When an assessment order is granted, the sheriff must also grant a warrant for entry under Section 37. The warrant for entry to accompany an assessment order will detail a specified place and only that place can be entered using the warrant. The warrant permits a constable to accompany a Council Officer and to do anything, including the use of reasonable force, where necessary which the constable considers to be required in order to fulfil the object of the visit. Only the constable has a right to use reasonable force.

The date specified in the order may be different from the date the order is granted. The assessment order is valid for 7 days after the date specified in the order. For example, an order dated 13 November would expire at midnight on 20 November. An assessment order does not

contain powers of detention. The adult can refuse to be interviewed or examined despite the assessment order.

 

Removal Orders

A removal order is primarily for protection and not for a council interview or a medical examination. It permits the person named in the order to be moved from any place to protect them from harm. For example, the place the adult at risk actually lives may however be a contributory factor in the harm and the move may provide "breathing space" for the specified person.

The council can make application to the Sheriff (or Justice of the Peace in certain circumstances) for a Removal Order, which would allow the removal of the adult to another place primarily for the purposes of protection.

There is a 72 hour period in which to enact the removal order. It expires 7 days (or such shorter period as may be specified in the order) after the day on which the person specified in the order is moved to the named place of safety.

A removal order does not contain powers of detention. The adult can refuse to be interviewed or examined despite the removal order.

Banning Orders or Temporary Banning Orders

These orders will only be granted where the adult at risk is in danger of being seriously harmed,

A banning or temporary banning order, which bans the subject of the order from a specified place, may have other conditions attached to it, and may last for a period of time not exceeding 6 months. The purpose of these orders is to better safeguard the adult at risk's well-being and property more effectively than would removing the adult from a place where they are at risk of harm from another person.

A banning or temporary banning order may:

• ban the subject from being in a specified area in the vicinity of the specified place;
• authorise the summary ejection of the subject from the specified place and the specified area;
• prohibit the subject from moving any specified thing from the specified place;
• direct any specified person to take specified measures to preserve any moveable property owned or controlled by the subject which remains in the specified place while the order has effect;
• be made subject to any specified conditions; and
• require or authorise any person to do, or to refrain from doing, anything else which the sheriff thinks necessary for the proper enforcement of the order.

A condition specified in an order may authorise the subject of the order to be in a place or area from which they are banned, but only in specified circumstances, for example while being supervised by another person or during specified times.

An application for a banning order may be made by or on behalf of:

• an adult whose well-being or property would be safeguarded by the order; or
• any other person who is entitled to occupy the place concerned; or
• a Council.

 

Power of Arrest

The sheriff can make a decision to attach a power of arrest based on the facts and circumstances of the case presented. This would be based on the likelihood of the subject breaching the banning order or any of the conditions attached to the banning order.

 

Dumfries and Galloway use discrepancy matrixes. 

Wonnacotts discrepancy matrix encourages practitioners to reflect on what is known about a person and what is unknown or not yet known-a vital aspect of working with uncertainty. It supports the practitioner to tease out the information they hold into 4 types.

Evidence, Ambiguous, Assumption and Missing. 

 

 

Discrepancy Matrix :

• Information known;

1. What do I know? For something to go into the ‘evidence’ category, it needs to be proven and verified (in other words, come from more than one source as a fact). Evidence also includes knowledge about legal frameworks and roles and responsibilities under the Children Act, as well

For something to go into "evidence" 

• Ambiguous information;

2. What is ambiguous? This relates to information that is not properly understood, is only hearsay or has more than one meaning dependent on context, or is hinted at by others but not clarified or owned.

• Missing information;

3. What I think I know This allows the practitioner to explore their own practice wisdom and also their own prejudices to see how this is informing the case. Emotion and values can also be explored in this area and the self-aware practitioner can explore how they are responding and reacting to risk

• Assumption-led.

4. What is missing? These are the requests for information coming from the people listening to the story (supervisors, peers, other agency staff) that prompt the practitioner to acknowledge there are gaps in the information. The gaps then have to be examined to see if the lack of information might have a bearing on the decision-making in the case; if so, it needs to be explored

Wonnacott, J. (2014). Developing and Supporting Effective Staff Supervision. Pavilion.

 

These matrices and accompanying form are drawn from a Scottish Government supported project, based on research from the University of Hull. 

 

Early Indicators of Concern in Care Services for Older People 

Click here to download a pdf version of this form. You can use this form to record your own observations of possible indicators of concerns.  If you wish, you can then email this form to a manager or colleague.

1. Concerns about management and leadership	2. Concerns about staff skills, knowledge and practice	3. Concerns about residents' behaviours and wellbeing
The Manager can't or won't make decisions or take responsibility for the service	Staff appear to lack knowledge of the needs of the people they are supporting e.g. behaviours	Residents behaviours change - perhaps putting themselves or others at risk
The Manager doesn't ensure that staff are doing their job properly	Members of staff appear to lack skills in communicating with individuals and interpreting their interactions	Residents communications and interactions change - increasing or stopping for example
The Manager is often not available	Members of staff use judgemental language about the people they support	Residents needs appear to change
There is a high turnover of staff or staff shortage	Members of staff are controlling and offer few choices	Residents skills change - self-care or continence management for example
The Manager does not inform Social Services that they are unable to meet the needs of specific service users	Communication across the staff team is poor	Residents behave very differently with different staff or in different environments e.g. day centre
	Abusive behaviours between residents are not acknowledged or addressed
4. Concerns about the service resisting the involvement of external people and isolating individuals	5. Concerns about the way services are planned and delivered	6. Concerns about the quality of basic care and the environment
There is little input from outsiders / professionals	Residents needs are not being met as agreed and identified in care plans	There is a lack of care of personal possessions
Individuals have little contact with family or other people who are not staff	Agreed staffing levels are not being provided	Support for residents to maintain personal hygiene is poor
Appointments are repeatedly cancelled	Staff do not carry out actions recommended by external professionals	Essential records are not kept effectively
Members of staff do not maintain links between individuals and people outside of the service.g.family, friends	The service is 'unsuitable' but no better option is available	The environment is dirty / smelly
Management and/or staff demonstrate hostile or negative attitudes to visitors, questions and criticisms	The resident group appears to be incompatible	There are few activities or things to do
It is difficult to meet residents privately	The diversity of support needs of the group is very great	Residents dignity is not being promoted and supported

Early Indicators of Concern - Services for People with a Learning Disability

Click here to download the Word version of this form. You can use this form to record your own observations of possible indicators of concerns.  If you wish, you can then email this form to a manager or colleague.

 

Name of service:
Concerns about management and leadership	Concerns about staff skills, knowledge and practice	Concerns about residents' behaviours and wellbeing
Concerns about the service resisting the involvement of external people and isolating individuals	Concerns about the way services are planned and delivered	Concerns about the quality of basic care and the environment

 

It is widely recognised that service users are most effectively safeguarded when professionals work together and share information. Individual events may appear to be insignificant ‘one-offs’.  However, they should be recorded in the chronology as they may be part of a pattern, which would raise serious concern.

Chronologies provide a sequential list of dates of significant events in a service user’s life.  They enable practitioners to gain a more accurate picture of the whole case and detail the history of a service user and their family. They highlight gaps and missing details that require further assessment and identification. Chronologies can also highlight risks, concerns, patterns, themes, strengths, resilience and weaknesses of a service user and their family. Current information can then be understood in the context of previous case history and inform professional assessment.

If chronologies are to be of value they should be:-

• Set out in the risk assessment format, to ensure that information can be effectively merged and sorted.
• Succinct recordings of significant events including people involved and dates.
• In ascending date order i.e. earliest date first.
• Systematically and regularly shared with relevant professionals.
• Owned by professionals and used as a tool in assessing progress and the level of concern.
• Record both positive and negative significant events – positive events might increase protective factors and decrease risk.
• Informing the decision-making process at any given point.

It is essential that all professionals and agencies understand that they should be active participants in preparing chronologies. Practitioners should ensure that information describing key incidents, events and facts are passed on to the Council Officer. The Council Officer’s responsibility is to ensure that the chronology is collated, up to date and presented appropriately.

The Care Inspectorate's Practice Guide to Chronologies provides more information.