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Kent and Medway – Safeguarding Adults Assessment, Risk Evaluation and Care Planning form July 09

Form SA 1

Safeguarding Assessment -- Risk Evaluation -- Safeguarding Plan.

SAFEGUARDING ADULTS – ASSESSMENT

Client details as at: Completed by:

Client ID No: Name: Date of Birth: Gender: Ethnicity: Marital status of the client:

Address: Phone:

Date Assessment Started: Date Assessment Completed:

Location(s) assessment carried out (s):

1.

2.

Name of worker: Team:

Contact details(tel):

Summary of concerns and previous history e.g. previous incidents:


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Outcome of time spent with and speaking to client: Record of meeting with client / alleged victim. (Please record the questions you asked. Include the client’s views about the allegations and what they would like to happen as a result of your meeting with them. If you have not been able to spend time with or speak to the client

please explain why.

Appearance & demeanour of client:


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Mental Capacity

Is a Mental Capacity Act Assessment required? Yes

No

Give reasons including decision making issues to be assessed: Consent & information sharing Were consent issues discussed?

Yes

No

Unable to consent

If Yes, was consent given for Information to be shared as needed?

Yes

Yes, with limitations

No

N/A

Details of any limitations in sharing: Assessments of client’s strengths / needs: Factors which restrict or may restrict independence (nature & extent of disability/illness): Communication:


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Dependence/Independence (extent to which the person is able to meet their own needs: Support network (informal and formal networks of support including family and friends): Support / Care & relationship indicators: Is support / care currently available:

Is support / care needed:

Name(s) (of person(s) or agency if relevant)

Relationship to client:

Is the client happy with the support / care they receive: Are there any difficulties with support / care or the support / care relationship(s): Is a full assessment required?

Yes No

Is a carer’s assessment required?

Yes No

Environment in which risk arises Describe Environment:


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Comfort: Suitability to individuals need (especially any environmental risk factors):

Signs/indicators of harm occurring or risk of harm: For a fuller summary of the signs and indicators of harm and abuse please see: WWW.kent.gov.uk/adultprotectioncommittee policy and guidance documents

Neglect: Physical: (additional body map may be required)

Psychological/emotional: Financial:


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Sexual: Other:

Assessed Hazards i.e. types of occurrence or abuse that may cause harm/danger. If possible discuss these with the client with the aim or empowering and encouraging them to consider/decide how the hazard(s) may be reduced

Dangers i.e. possible outcomes associated with identified hazards and likelihood of occurring (high/medium/low)

Danger Likelihood

1.

2.

3.

4.


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Views of significant others Name: Relationship to service user:

Details of any limitations in sharing information: Name:

Relationship to service user:

Details of any limitations in sharing information: Name: Relationship to service user:

Details of any limitations in sharing information:

Outcome of discussion with other agencies Name: Title:

Organisation/agency:


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Name: Title


Name: Title


Assessor(s) Name(s):

Assessor(s) Signature(s):

Date assessment completed:

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SAFEGUARDING ADULTS – Risk Evaluation (To be completed by with the assessor(s) Designated Senior Officer on completion of the assessment)

Vulnerability (Of individual and/or other vulnerable people

who may be at risk of harm)

Low (1)

Moderate (2)

Substantial

(3)

Critical (4)

Evidence

The person is fully able to

take action to protect

themselves

The person

needs support in some

areas/has a supportive network of

family, friends etc.

The person

needs support in most areas of their life/has a

limited network of support including

family, friends etc.

The person/s is unable to take

action to protect themselves and has

no access to appropriate help or

support.

Overall Impact*

(to individual and/or other vulnerable people)

Low (1)

Moderate (2)

Substantial

(3)

Critical (4)

Evidence

No evidence of harm or abuse

occurring

Some evidence of harm

occurring or risk of harm occurring but overall impact

on individual/s low

Evidence of serious risk of harm/criminal offence may

have occurred

.

Potentially life threatening/

serious criminal offence likely to

have occurred/others

may be at serious risk

Overall Impact score* 2 + 1 (see below) = 3 *Where the vulnerability is assessed as being substantial (3) or critical (4) the overall impact grade should be increased by one (up to a maximum score of 4).


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Likelihood of Future Harm

(to individual and/or other vulnerable people)

Low (1)

Moderate (2)

Substantial

(3)

Critical (4)

Evidence

No evidence of harm or abuse occurring. No

indicators present.

Unlikely. No evidence of

serious harm some indicators

present.

Likely to occur

unless significant

changes are made.

Evidence of harm occurring and/or number of indicators suggesting

harm.

Very likely evidence of

serious harm occurring indicators

suggested high risk of

reoccurrence unless significant

changes are made

Overall Likelihood score 3 x 3 To obtain an overall risk score the overall impact score should be multiplied by the overall likelihood score of future harm score. Overall Risk Score: 9 The following is intended as a guide: For grading risk, the scores obtained from the risk matrix are assigned grades as follows:

1 – 3

Low risk

No further action required at this time. Discuss with line manager.

4 – 6

Moderate risk

Risk Assessment & Safeguarding plan required. DSO to ensure plan co-ordinated, monitored and reviewed.

7 - 9

High risk

Multi agency risk assessment & safeguarding plan required – Will be coordinated by the DSO

10 – 16

Extreme Risk

Multi agency risk assessment & safeguarding plan required –Safeguarding Lead Manager must be informed of the high risk concerns.

Designated Senior Officers Name: Designated Senior Officers Signature:

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Safeguarding Plan for the Client: (Please summarise any actions taken to empower / safeguard the client e.g. information provided, change of service/carer, change of accommodation) Action Taken/Planned/Agreed By Whom Date

Review Date and by whom

1.

2.

3.

4.

5.

Client was not deemed to have capacity to consent to the protection plan at this time.

Additional Comments

Has the client consented to this plan?

Yes

No


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Review of Safeguarding Plan for the Client: (Please summarise any actions taken to empower / safeguard the person e.g. information provided, change of service/care, change of accommodation).

Review of Actions Taken/Agreed

Any changes recommended

Date

Further Review Date and

who will be involved

1

2

3

4

5

Comments

Date ………………………………….. Kent and Medway SGVA Committee acknowledges the support of Oxfordshire CC in the development of this form

Has the client consented to the revised plan?

Yes

No

Client was not deemed to have capacity to consent to the protection plan at this time.

safeguarding assessment -- risk evaluation -- safeguarding ... · kent and medway – safeguarding...

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