NICE guidance on safeguarding adults in care homes

A key toolkit for commissioners of residential care for adults, care home providers, local authorities and Safeguarding Adult Boards and other health and care staff working with adults in care homes.

The National Institute for Health and Care Excellence (NICE) extended its community and social guidance by publishing Safeguarding adults in care homes on 26 February 2021. This is designed to support care home providers keep vulnerable adults safe from abuse, improper treatment or neglect. However, in our view this is also a good source of guidance to use as a starting point for wherever there are safeguarding concerns, including those individuals that live in their own homes which often present complex issues.

So, why the need for guidance? According to the CQC’s annual state of care report 2019/20, the “quality of care in many homes is good, but this is not always the case” with the regulator rating homes as follows:

  • Inadequate: 2 per cent of nursing homes and 1 per cent of care homes
  • Requiring improvement: 21 per cent of nursing homes and 14 per cent of care homes
  • Good: 72 per cent of nursing homes and 81 per cent of care homes
  • Outstanding: 5 per cent of nursing homes and 4 per cent of care homes

In addition to the regulator’s ratings data, the Safeguarding Adults 2019 Annual Report finds that care homes (including care homes with or without nursing) accounted for 34 per cent of all safeguarding enquiries conducted under section 42 of the Care Act 2014.

NICE explain that despite the legal frameworks and associated statutory guidance, safeguarding procedures and practice vary at the local level with care homes struggling to understand:

  • the difference between safeguarding issues and poor practice
  • when and how to make safeguarding referrals to the local authority

The NICE guidance includes potential indicators for abuse and neglect by individuals and organisations, and walks through the safeguarding process from when a concern is first identified through to section 42 safeguarding enquiries. It includes a set of recommendations on policy, training and care home culture to help improve care home staff awareness of safeguarding and ensure people can report concerns when needed. The guidance is supported by an interactive flowchart together with a number of visual summaries on the recommendations.

The specific recommendations NICE makes for NHS commissioners are as follows:

  • Ensure that all care homes they work with are fulfilling their statutory and contractual safeguarding responsibilities
  • Support improvements in safeguarding practice in the care homes they work with, by sharing:
    • key messages from Safeguarding Adults Reviews; and
    • helping care homes to learn from their own experience of managing safeguarding concerns
  • Ensure that care homes are maintaining records about safeguarding
  • Make record-keeping responsibilities clear as part of contract management

You can read the guidance here.

How we can help

Safeguarding is complex with cases often involving multiple agencies requiring care providers to have in place clear policies and procedures which reflect the Care Act statutory guidance and the regulatory framework. We support commissioners on safeguarding matters – and this month we delivered a series of webinars on commissioning complexities covering issues such as safeguarding community patients. You can catch up on this webinar here.

Do get in touch if you require support with your safeguarding policies, training or enquiries – we have an experienced and friendly team

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