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Introduction
This guidance provides examples of concerns that do not meet the threshold for a safeguarding concern and should therefore be submitted by providers through the quality concerns process.
This guidance should be used by providers of adult social care and supported living services in conjunction with their own safeguarding policies and procedures.
There are 4 categories of quality concerns providers should self-report:
- falls
- medication errors
- pressure sores
- organisational concerns
This guidance describes the type of situation where a quality concern submission may apply for each of the four categories. This process is for quality concerns that pertain to your own service delivery.
Incidents caused by others such as incidents which have happened when someone has been away from the care setting staying with relatives should be reported to the relevant area team or placing authority.
Social care providers should always report safeguarding concerns in line with their statutory responsibilities under the Care Act 2014. Further information on this can be found in Surrey Safeguarding Adults Board Policy and Procedures.
If you have any queries in relation to this guidance, please contact Surrey Quality Assurance Team: quality.assurance@surreycc.gov.uk.
Key considerations
This guidance is for supporting providers when sharing information with Surrey County Council. Social Care providers should always consider the individual circumstances of each situation and use their professional judgement when deciding on the best course of action.
The Quality Concerns process should only be used where there is no reasonable cause to suspect abuse or neglect has taken place.
If there is any doubt, a safeguarding concern should be raised, Reporting safeguarding concerns.
For providers who are registered with the Care Quality Commission (CQC) they should continue to notify CQC as per the statutory requirements under the CQC guidance and notifications.
This process is not a substitute for providers following their own internal incident policies and processes and responding to practice issues.
Guidance
Medication error
Mismanagement or misadministration of medication by the social care provider.
Examples:
- a person has been accidently given the wrong medication or incorrect dose by care staff but there has been no impact
- a person has been given their medication at the wrong time, but no impact has resulted
- a person has missed their medication where the social care provider is responsible for administering or supporting with medication where no impact has resulted
- there is a medication recording issue such as staff do not follow the procedure to sign the Medication Administration Record (MAR) Chart but the medication was given and there was no impact
Pressure sore
Pressure ulcers are caused when an area of skin and the tissue below are damaged as a result of being placed under continuous pressure sufficient to impair blood supply.
Important note: This does not apply to skin tears or bruising.
Examples:
Single incident of Category 1 or 2 pressure ulcer.
Category 3 and 4, unstageable and suspected deep tissue injury, or multiple Category 2 pressure ulcers where:
- a care plan is in place
- action is being taken
- other relevant professionals are involved such as Tissue Viability Nurses
- there has been full discussion with the person, their family or representative
- there are no other indicators of abuse or neglect or unexplained deterioration
Steps
- The social care provider should follow relevant internal policies and procedures.
- Refer to the National Institute for Health and Care Excellence (NICE) guidance on pressure ulcers (2014).
- Refer to the Pressure ulcers: how to safeguard adults.
- Share information with district nurse or GP. Consideration of specialist support (for example Tissue Viability Nurses).
Falls
A fall does not automatically indicate neglect and each individual case should be examined to understand the context of the fall.
A fall where:
- there is a reasonable explanation as to why this occurred
- a care plan and /or risk assessment is in place and being adhered to
- actions are being taken to minimise further risk
- other relevant professionals have been notified
- full discussions with the person or people, next-of-kin, or any other representative have taken place
- there are no indication of abuse or neglect
Actions that the provider can consider:
- review and revise current care plans and risk assessments
- Falls: assessment and prevention in older people and in people 50 and over at higher risk
- a referral to the falls service or occupational therapy service
- share information with GP for any medical issues
Organisational concern
Events or circumstances that impact upon delivery and are not an isolated incident.
Quality concerns in this category should only be made if the concerns are affecting service users over a period of time, rather than isolated incidents.
Submissions must be made for each individual in the service who is affected by the concern. Submissions should include details on actions taken and contingency plans to minimise or remove the impact of concerns reported. Concerns or pressures due to the structure, policies, processes or practices resulting in ongoing issues with care or support delivery, for example:
Staffing pressures:
- due to staff sickness
- infection outbreak that is impacting on staffing
- recruitment challenges leading to under capacity
- leadership capacity due to illness, recruitment and so on
- UK Visas and Immigration (UKVI) sponsorship issues
- clinical capacity – issues re availability of nursing staff
Facilities or equipment issues:
- heating, power supply issues that are impacting residents
- lift not working and cannot be repaired in a timely way limiting some peoples access to areas of their home
- specialised facilities such as assisted baths, hoists and so on are unavailable, impacting service users
- IT issues impacting on for example rostering, care planning, risk assessment, daily notes
Environment:
- fire Safety report indicating urgent remedial actions required
- building works impacting on residents’ ability to access internal or external spaces such as the garden
Culture and practice:
- new management or ownership have identified institutionalised practices that do not indicate safeguarding concerns but are impacting service users