⚕️Care Handbook

Safeguarding Adults

Safeguarding means protecting an adult's right to live in safety, free from abuse and neglect. Under the Care Act 2014, safeguarding is everyone's responsibility — not just the safeguarding lead's. If you work in a care home, you have a legal and professional duty to recognise, respond to, and report abuse.

Legal Framework

  • •Care Act 2014, Sections 42–46 — establishes the legal framework for adult safeguarding in England, placing a duty on local authorities to make enquiries when abuse is suspected
  • •CQC Regulation 13 — Safeguarding service users from abuse and improper treatment
  • •Human Rights Act 1998 — Article 3 (freedom from torture and inhuman or degrading treatment) and Article 8 (right to respect for private and family life)
  • •Mental Capacity Act 2005 — safeguarding protections for people who lack capacity, including the Best Interests principle and Deprivation of Liberty Safeguards (DoLS)
  • •Domestic Abuse Act 2021 — extends recognition of domestic abuse and provides protections

Types of Abuse and Recognising Signs

Abuse can take many forms. In a care setting, it is important to recognise that abuse may be carried out by anyone — family members, other residents, staff, volunteers, or visitors. Below are the main categories of abuse recognised in the Care Act 2014 Care and Support Statutory Guidance, along with signs that may indicate abuse is occurring.

Physical Abuse

The use of physical force that results in pain, injury, or impairment. This includes hitting, pushing, slapping, rough handling, inappropriate use of restraint, forced feeding, or misuse of medication.

Possible signs and indicators:

  • Unexplained bruises, marks, or injuries (particularly in clusters, on the face, or in unusual locations)
  • Reluctance to be touched or flinching when approached
  • Unexplained falls or injuries that are inconsistent with the explanation given
  • Marks from restraints on wrists or ankles
  • Broken bones or fractures without a clear cause
  • Behaviour changes such as agitation, fearfulness, or withdrawal

Sexual Abuse

Any non-consensual sexual activity, including unwanted touching, sexual assault, or inducement to perform sexual acts. This also includes sexual activity with a person who is unable to give consent due to lacking mental capacity.

Possible signs and indicators:

  • Unexplained genital or anal pain, bleeding, or injury
  • Difficulty walking or sitting that may indicate physical trauma
  • Torn, stained, or bloody underclothing
  • Changes in behaviour — overtly sexual behaviour, withdrawal, or distress
  • Fear of a particular person or reluctance to be alone with them
  • STIs in a person who is not sexually active, or in someone unable to give consent

Psychological / Emotional Abuse

Acts that cause mental or emotional distress, including threats, humiliation, intimidation, verbal abuse, isolation, withdrawal of affection, or denial of choice. This is often the most difficult type of abuse to identify and prove.

Possible signs and indicators:

  • Unexplained withdrawal, fearfulness, or resignation
  • Appearing anxious, tearful, or agitated without clear cause
  • Loss of confidence or self-esteem
  • Reluctance to speak openly or appearing to be 'walking on eggshells'
  • Changes in appetite, sleep patterns, or mood
  • A carer or staff member speaking to the resident in a demeaning or controlling way

Financial or Material Abuse

Theft, fraud, exploitation, or pressure in connection with money, property, or possessions. This includes misappropriation of a resident's funds, coercion to change a will, or unexplained withdrawals from a resident's account.

Possible signs and indicators:

  • Unexplained withdrawals from bank accounts or missing money
  • Personal items or valuables going missing
  • Sudden changes to wills, property titles, or financial arrangements
  • A person appearing to control the resident's finances without authority
  • Bills not being paid despite adequate funds being available
  • Disparity between the resident's financial resources and their standard of living

Neglect and Acts of Omission

The failure to provide necessary care, resulting in harm or distress. This includes ignoring medical or physical care needs, failure to provide access to food, water, warmth, or medication, and failure to provide adequate supervision.

Possible signs and indicators:

  • Unexplained weight loss or malnutrition
  • Dehydration or untreated medical conditions
  • Poor personal hygiene or unchanged continence aids
  • Pressure sores or skin breakdown
  • Inadequate clothing or heating
  • The resident appearing withdrawn, listless, or socially isolated

Discriminatory Abuse

Abuse motivated by discriminatory attitudes towards a person's race, gender, gender identity, age, disability, sexual orientation, religion, or cultural background. This can overlap with other forms of abuse but is distinguished by its motivation.

Possible signs and indicators:

  • A resident being treated less favourably than others
  • Derogatory or discriminatory comments or 'jokes' directed at the resident
  • Lack of respect for cultural or religious practices (e.g. dietary requirements, prayer times)
  • Exclusion from activities or social opportunities based on a protected characteristic
  • Unequal access to care, support, or resources
  • Staff making assumptions about what a resident wants based on stereotypes

Institutional Abuse

Abuse occurring within a setting that should provide care, where the regime, routines, or culture impose rigid expectations on residents. This includes treating residents as a group rather than as individuals, enforcing unnecessary rules, and failing to respect dignity and choice.

Possible signs and indicators:

  • Rigid routines that do not accommodate individual preferences (e.g. set mealtimes, set bedtimes)
  • Residents being expected to fit around staff schedules rather than the reverse
  • Lack of personalisation in care — identical care plans, identical activities
  • Closed culture — restrictions on visiting, monitoring, or external scrutiny
  • Staff speaking about residents in a dismissive or dehumanising way
  • Lack of choice in meals, activities, clothing, or daily routines

Reporting Procedures: Recognise, Respond, Report, Record, Review

If you suspect or witness abuse, or if someone discloses abuse to you, you must act. The following five-step framework is widely used in adult safeguarding practice:

1

Recognise

Be alert to the signs of abuse. Trust your instincts — if something does not feel right, it probably is not. Look for physical signs (bruises, weight loss, poor hygiene), behavioural signs (withdrawal, fearfulness, agitation), and environmental signs (poor living conditions, locked doors, restricted access). Remember that abuse can happen to anyone, and anyone can be an abuser — including family members, other residents, staff, and volunteers.

2

Respond

If someone discloses abuse to you, listen carefully and take them seriously. Do not promise confidentiality — you have a duty to report. Stay calm, reassure the person, and avoid asking leading questions. Use open questions such as 'Can you tell me what happened?' rather than 'Did [name] hit you?'. Do not confront the alleged abuser. Make the person safe and comfortable, and preserve any physical evidence. Record exactly what was said using the person's own words where possible.

3

Report

Report your concerns immediately to your manager, safeguarding lead, or designated person. Under the Care Act 2014, you must also consider reporting to the local authority Adult Social Care team — they have a statutory duty to make enquiries. If there is immediate danger, call 999. If you are concerned about criminal activity, contact the police. If your manager does not act on your concerns, or if your concerns involve your manager, you should escalate to the local authority, the CQC, or use the whistleblowing procedure.

4

Record

As soon as possible, make a written record of what you have seen, heard, or been told. Include the date, time, location, and your signature. Record facts and observations rather than opinions. If recording what someone said, use their exact words and put them in quotation marks. Note any witnesses. Records should be factual, legible, and contemporaneous (written at the time or as soon as possible afterwards). These records may be used in a safeguarding enquiry or legal proceedings, so accuracy is essential.

5

Review and Support

After reporting, follow up to ensure the concern has been actioned. Cooperate fully with any safeguarding enquiry. Support the person who may have been abused — they may need advocacy, medical attention, or emotional support. You should also access support for yourself — witnessing or reporting abuse can be distressing. Your employer should have a policy on staff wellbeing and access to counselling. Reflect on the incident: were there any wider lessons for the team or the organisation?

If There Is Immediate Danger

If a person is in immediate danger of harm, call 999and ask for the police or an ambulance. Do not wait to report internally first — the person's safety always comes first. If you are unsure whether the situation is an emergency, it is always better to call and let the professionals decide. After contacting emergency services, follow your organisation's safeguarding procedure and inform your manager.