Safeguarding and quality in commissioning care homes

Proportionate responses

Key points for commissioners

Commissioners work with local safeguarding leads to ensure that multi-agency policy and procedures:

  • support proportionate responses to abuse alerts
  • promote agreed understanding of good safeguarding practice among all partners
  • are clear about when it is, and is not, appropriate for a provider to lead an investigation.

Commissioners work with local safeguarding leads to ensure care homes can demonstrate that:

  • they are following multi-agency procedures
  • responses to alerts are based on good decision making and proportionality and that the process is transparent
  • they understand what constitutes a ‘complaint’ and what should be treated as a ‘safeguarding alert’
  • they are clear about what is poor, acceptable and best practice in safeguarding based on the Essential Standards of Quality and Safety.

Commissioners work with local safeguarding leads to ensure:

  • that care homes cannot evict people as a result of them complaining about the service
  • the quality of internal investigations and outcomes is monitored
  • that data from investigations is utilised to improve safeguarding responses.

It is important that the response to a safeguarding alert is in proportion to the alleged incident. For example, an allegation that one resident has stolen £5 from another would not warrant the same level of response as an allegation of rape. Many authorities have provided some guidance by way of ‘response levels’ within their multi-agency procedures. Commissioners, with support from their safeguarding lead, should ensure that providers are consistently making good decisions that are person-centred and proportionate.

Overzealous responses could result in reluctance to raise concerns for residents and staff. Multi-agency procedures should make clear when providers should raise an alert and what information should be shared between the commissioner, the provider and CQC. Risk assessment processes should be integral to this process.

The person who is at risk of or experiencing abuse should be at the centre of the decision making process in safeguarding procedures and should understand the reasons for decisions they do not agree with. If a person lacks the capacity to make decisions about their safety, their family or close friends should be included in decisions about their best interests. If there are no family or friends, an Independent Mental Capacity Advocate should be appointed.

What others are doing - ideas you could use

Develop a tool to help staff determine the seriousness of safeguarding alerts

Hampshire County Council has developed a multi agency level of seriousness tool.