Meeting Template - Lancashire Safeguarding · Web viewLancashire Safeguarding Adults Board LSAB...

Meeting Template

- 7 -

Lancashire Safeguarding Adults Board

LSAB Board

Notes of meeting – 8 December 2017 – Cabinet Room D, County Hall, Preston

(Extended for SAR Presentations, SAR minutes sent separately)

Present

Zakyeya Atcha

Consultant in Public Health

Lancashire County Council

Kristy Atkinson

Deputy Designated prof for SA&MCA

Greater Preston, C&SR, WL CCG

George Binns

DI

Lancashire Constabulary

Jane Booth

Independent Chair

Lancashire Safeguarding Boards

Tammy Bradley

Operations Director

Progress Housing Group

Peter Chapman

Head of Safeguarding

East Lancashire CCG

Hayley Clarke

Business Co-ordinator


Tony Crook

Service Group Manager

Lancashire Fire & Rescue Service

Sarah Cullen

Deputy Nursing and Midwifery Director

Lancashire Teaching Hospital NHST

Joanne Dann

Deputy Director

Community Rehabilitation Company

Edwards, Charles

County Councillor

Morecambe South Council

Lorraine Elliot

Designated Lead Nurse for SA & MCA

Greater Preston, C&SR, WL CCG

Victoria Gibson

Business Manager


Kelly Grainger

Business Support Officer


Michael Grime

Interim Business Co-ordinator


Sarah Harris

Safeguarding Practitioner

North West Ambulance Service

Derek Harrison

Governor

Lancaster Farms Prison

Glenn Harrison

Patient Experience Manager

NHS England

Laura Nuttall



Fiona O'Donoghue

Lead Nurse

Fylde & Wyre CCG

Sandra O'Hear

Deputy Director of Nursing & Quality

Merseycare

Garry Payne

Chief Executive

Wyre District Council

Andrew Roberts

Senior Operational Support Manager

Probation

Robert Rushton

Victims & Vulnerable People Lead

Police & Crime Commissioners

Julie Seed

Deputy Nurse Director

Lancashire Care Foundation Trust

Lisa Slack

Head of Service Patient Safety&Safeg


Louisa Swift

Deputy Director Mental Health


Sheralee Turner-Birchall

Chief Executive

Healthwatch Lancashire & Blackpool

Bridgett Welch

Associate Director of Nursing


Rachael Willis

Social Care Lead


Jayne Wilson

Voluntary Representative

Lancashire Sport

Louise Wilson

Business Support Officer


Lynne Wyre

Deputy Chief Nurse

Uni Hospitals of Morecambe Bay

Apologies

Sarah Hargreaves



Marie Hill

Safeguarding Lead

LCA/Cornmill Nursing Home

Jane Jones

Head of Safeg&Desig NurseSafegChild

Morecambe Bay CCG

Graham Lowe

On-line Safeguarding Advisor


Alice Marquis-Carr

Head of Safeguarding

Fylde & Wyre CCG

Yvette McGurn

Principal Social Worker


Joanne McHugh

DCI

Lancashire Constabulary

Tony Pounder

Director of Adult Services


Louise Taylor

Corporate Director, Ops & Delivery


Absent

Richard North

Head of Safer Preston

HMP Preston

No.

ITEM

ACTION

1.

WELCOME AND APOLOGIES FOR ABSENCE

JB welcomed everyone to the group and accepted apologies as above. JB noted that there was an item that has not been included on the agenda the Self-Neglect Framework which we will fit in and include under Action 116 of the Action Monitoring Log. JB noted that there were also a few standing reports that were tabled and not sent with the agenda and asked that people ensure reports are completed before the agenda is sent out in the future.

2.

NOTES OF MEETING HELD 13/10/17 - ACCURACY

The notes of the previous minutes were approved for accuracy.

AZ would like it noting that on page 6 of the notes where it noted that she had not received information for the QAAP Sub-Group she had in fact received it but had not been able to read before leaving for sick leave. She will make contact with the Chair of this group to clarify what is required from her for this group.

3.

REVIEW OF MATTERS ARISING AND/OR ACTION LOG

Action Monitoring Log updated attached and the following discussions took place:

Action 145 – DASG – JB reported she had spoken to JMcH and was looking at joint piece of work following on from our audits re domestic abuse and dementia.

Action 144 – MCA Provider Engagement – LS reported impressive work but it not following through to providers.

Action 143 – Call Blockers – HW Lancashire have received information from Trading Standards and have uploaded and cascaded the ‘call blocker’ message out via thier website.

Action 140 – Call Blockers – VG reported ordered and arriving in January 2018, TH to progress once received.

Action 138 – Sheralee to share wider findings in relation to HWLs children and young peoples project with Saeed Sidat, LCC once the project is concluded possibly Jan 2018.

Action 137 – Hoarding 7MB – TC reported this has been delayed due to the Self-Neglect Framework which has not yet been approved, awaiting guidelines for agencies on who to contact to progress the multi-agency meetings.

Action 127 – Policies & Procedures Sub-Group – VG replacing SH on group and LS agreed to Chair the group.

Action 116 – Self-Neglect Framework – LS reported and documents tabled as below were shared with the group.

LCC have taken advice from Senior Managers who offered advice on services, JB noted that agencies around the table have seen this document previously.

LE noted that there is a high risk to complex cases and every case should involve a multi-agency team and we need to know how to manage extreme cases and professional disagreements. GP noted that there needs to be guidelines on operational structure as it is not clear about who to contact to bring a multi-agency meeting together. TC noted that the likes of the Fire Service and Lancashire Constabulary would also not be qualified to know who to contact. JB said that it is not an LCC responsibility but could agencies enquire through the MASH team. ZA noted that this is a strategic document and would need an operational document to support frontline staff. FO noted that the document needs to include information to ensure agencies follow-up after reporting so that these people continue to be supported. SO noted that the document mentioned complex mental health cases but neglects other sections of the public. PC noted that we need something in place for commitment from agencies to arrange and be present at multi-disciplinary team meetings.

JB said that updating the document can be done electronically to avoid further delays with an aim to get approval for the new year. JB expressed the importance of careful roll out of this document but GP noted this could be done, TB welcomed the guidance.

Revisions to be made and consulted on via email exchanges and then to be taken to the LSAB Policies & Procedures group.

ACTIONS

· Review Self-Neglect Framework and take to LSAB Policies & Procedures Sub-Group

LS

4.

MASH UPDATE

LS reported that agreement to recruit a consultant to do a review of front door has been agreed. Some recent changes have taken place in management of referrals to ensure that they are relating to safeguarding and now have qualified Social Workers doing the screening. From the review an options paper will be brought to this group, approximately 95% of referrals are appropriate and the categories have been reviewed to reflect the urgency.

Recent changes to MASH with both children and adults and being geographically based is making a difference.

ACTIONS

· MASH options paper for front door safeguarding referrals to be brought to the group

LS

5.

DHR UPDATE

Robert Rushton from Police and Crime Commissioners Office presented a report which analysed 12 reviews and their action plans to promote key learning and trends across the county with a view to influencing strategy and policy. There is a larger review taking place through Lancashire versus a national picture which includes 40 reviews which will give a bigger picture of the issue.

RR noted that the Domestic Homicide Steering Group would continue to meet to provide a forum for sharing actions and learning, LE noted the L&D group are discussing domestic abuse and would welcome DHR input and RR also welcomed the idea. They are currently looking at the 1st recommendation out of 4, it would be important to reinforce these on a national level.

JB noted that we all need to be sharing the same message. BW noted that there is a health rep on the CSP group and is discussing with JMC membership so will consider involvement in the group. PC enquired if there is any multi-agency training being done, RR noted that there are currently no plans.

Noted that after the recommendations have been made it would also be good for the LSAB Policies & Procedures Group to look at.

ACTIONS

· Make contact with the DHR Steering Group to progress

· Look at DHR recommendations within LSAB Policies & Procedures Sub-Group

JMC

VG

6.

AUDIT FINDINGS FOR MENTAL HEALTH REFERRALS FOR UNDER 65s

PC shared a report for this, Louisa Swift and Rachel Willis also in attendance from LCFT for this item. The report was of an audit of safeguarding alerts for people 18-65 who were open or recently open to mental health services. It recognised that these adults received a different safeguarding response to other adults with the same needs. This audit was done as a desktop review so no members of staff were contacted.

Findings were that once the enquiry is received and reviewed by the LCC MASH team it is passed to the LCFT MH team. This results in data being collected using two differing computer systems LAS and ECR which give a lack of continuity. The findings from the audit were that, of the 10 cases reviewed, all were inadequate due to the lack of evidence of an enquiry being undertaken. The failings identified are listed and rated within the report.

JB noted that this was an alarming report. Prior to the Board meeting JB had called an immediate meeting to discuss further and draw agency attention to what appears to be a very serious deficit. BW noted that she had reviewed the cases and while some actions had been taken they were not recorded. She is undertaking enquiries, there is an assurance of a 28 day response and this will be built into work.

An action plan was presented to the Board. Lisa Swift and Rachel Willis looked at the process which needs enforcing and the action plan is welcomed.

JB asked for comments on this, BW noted governance arrangements are being made to strengthen the process, LS explained that there are Policies and Procedures on the LCC website so that people can identify decisions and she is doing a draft report for the Council.

LE asked whether the Duty of Candour applies for the 10 cases identified, PC noted that work has been done on these cases but there is still more to be done, LE noted that it is about knowing that these people are safe. ZA noted that the she is not sure the action plan captures all the issues, PC noted that they are working on a new process for assurance.

GP asked if there will be a further audit to be done to see if the process is successful, JB agreed that it should be in around 3-4 months. JB noted the QAAP Sub-Group will need additional resources from service users and practitioners to do this. LS agreed to circulate draft guidance once in place.

ACTIONS

· LCFT to provide detailed report to Chair of LSAB on the outcome of the internal audit on the 10 cases

· LCFT to provide further assurance to the Board following an internal audit of cases referred in the last month

· LSAB Quality Assurance Sub-Group to audit the process for U65s in March 2018

· Circulate draft guidance on safeguarding for mental health referrals

BW

BW

HC

LS

7.

PRIMARY AUTHORITY SCHEMES

TC from Lancashire Fire & Rescue presented a report on a Primary Authority Scheme which they are running which assures a standard for "high risk" businesses for fire regulations, this includes institutions such as care homes where vulnerable residents reside and sheltered accommodation. TC noted that smaller businesses can sign up to the scheme.

The scheme involves driving improvements in compliance, enforcement of resources where they are most needed and to inform consistent and proportionate responses to non-compliance. It was noted that it is the responsibility of the care home owner/manager to ensure their buildings are safe and know what to do to keep their residents safe.

Inspections are undertaken by the Fire & Rescue Service, STB asked if signing up to the PAS could identify good practice therefore establishments that are not signed up would need to be reviewed. JS asked if Lancashire Business Plus could provide Fire & Rescue with more technical information and TC will feed this back. Enquired if this is something the CQC could inspect and TC will look for further advice on this.

JB suggested that this also be presented to the Provider Sub-Group.

ACTIONS

· To take further advice from Lancashire Business Plus and CQC on PAS role out

· To contact the LSAB Provider Sub-Group to present on PAS

TC

TC

8.

MCA TRAINING PACKAGE & STRATEGY

LE and KA shared the strategy for Board approval as best practice guidance but noted that we cannot enforce, but it is the law.

JB asked the group for their response to this. PC noted that MCA is embedded into all agency training, JS noted that Boards representatives from all agencies need to be aware of this along with safeguarding leads within agencies. SO said that agencies need to know where to go to get the training.

KA went through the responsibilities of the groups A to E training and the reasons for grouping these. Group E is still under development with UCLAN which will be an accredited qualification which can contribute towards a degree. JB highlighted some levels are agencies responsibility and not the LSAB.

JS noted that we need to take into consideration the CQC, ZA noted that this is a large document and asked where people would go for foundation level. PC asked where newly qualified practitioners would start and KA explained that that would be open to discussion.

LE and KA will review the document taking into account discussions and bring back to the group. JB asked if the Learning & Development Sub-Group could also get involved with this.

ACTIONS

· Review the MCA Training Package and bring back to the Board

· Consider the MCA Training Package at LSAB Learning & Development Sub-Group

LE/KA

LE

9.

QA PERFORMANCE REPORT

HC shared a report for Board Performance.

DoLS – PC noted that sub-groups need to be assured that these are being prioritised eg. the assumption behind hospital cases not being prioritised as they are there for a relatively short time may not be the case and how is it monitored. It was noted that the LA were no longer able to complete all priority 1 cases. JB accepted that we need to be pragmatic and acknowledged that a year ago we were in a better position and were sympathetic. This was however on the basis that all red priority cases were being dealt with. LS to feedback on rationale of prioritisation, the high decline in applications, what happens within hospitals, safeguards for high risk and case examples of how the system currently works.

MISPERS – HC noted that there is a link with hospitals with MH functions, this will be tracked over time and benchmarked. JS noted that this does happen in Acute settings as people can sign themselves out, GP ask if we can ask why they are doing this and JB noted that we should know the operational response is to this.

MASH referrals by abuse type – HC reported the notable increase in number of referrals flagged for domestic abuse, LS said that MASH record physical and domestic together but JB noted that the figure does not reflect this. HC noted that the complexity and priority are now being recorded better for this.

HC shared a report for CQC inspection for Lancashire – The report shows that there are less inadequate homes within the Local Authority than the Private Sector, LS noted that this is something they are working on and are speaking to providers and looking at leadership and systems. TC asked if they could have the names of the homes from the Private Sector who are inadequate so that they can also look into, LS agreed to share this information.

ACTIONS

· Report back on DoLS issues at the next meeting

· Send TC information on the Private Homes reporting as inadequate

LS

LS

10.

SUB-GROUP REPORTS

MCA/DoLS – LE shared report – MCA ADASS Action Plan – JB noted that there are a lot of actions rag rated red, PC noted the likes of the DoLS issue is out of this groups control. The group need to be realistic about what they can and cannot do, they are meeting to discuss in January.

GP letter to support COP – LE and FO noted that work still need to be done on this due to the anxiety of GPs to support "unsoundness of mind".

Safeguarding Adult Review – Report tabled by PC as attached. PC noted the group have been looking a more defined definitions for SARs. They are running a Learning from SCR/ SAR Conference in March 2018 and will hopefully have 4 to share by this date.

Comms & Engagement – Report tabled by GP as attached, noted that the report was tabled due to the last meeting being on 6/12/17. Discussed simplifying the work plan to 5 key messages initially to make it more manageable.

Learning & Development – LE shared report, Sarah Hargreaves has now been appointed as the LSAB Training Co-ordinator so now the group will be able to move forward.

Quality Assurance, Performance & Audit – STB shared report, noted that the Board will be receiving the MSP ADASS annual assurance tool to report on by 31/1/18.

Pracitce with Providers – No report provided. Chair, Kathryn Barron, Quality Improvement & Safety Specialist, LCC.

Leadership – Report shared from Chair Randip Bhogal, County Operations Manager, LCC as read.

Policies & Procedures – Report tabled by LS as attached, as read.

11.

ANY OTHER BUSINESS

a) ACE – VG noted for this to be an item to take to a joint Board meeting and Helen Lowey, PH Consultant, BWD Council has agreed to present.

b) Emollient Creams – TC noted that they now have a flyer which they are using to drop off on calls and agreed to share to be distributed as widely as possible.

12.

DATE OF NEXT MEETING

2 February 2018 9.30am-4.30pm The Exchange, County Hall, Preston

(Extended for SAR Presentation)

LSAB Action

Monitoring Log Oct 2017.docx

Lancashire Adults Safeguarding Board

1

BOARD Action Monitoring Log

OCT 2017

Ref.

Meet Date/

Agenda No.

Action

Lead

Date to Complete

Latest Update

149

13/10/17

Survey on interest of the Joint Board Meeting

LW

08/12/17

8/12/17 not yet complete

148

13/10/17(13)

Risk appetite to be completed on the Risk Register

VG

08/12/17

8/12/17 not yet complete

147

13/10/17(13)

Risk Register to be included within the LSAB Business Plan

LW

08/12/17

Complete

146

13/10/17(12)

VG to report final Business Plan at the Sub-Group Chairs meeting

VG

08/12/17

8/12/17 not yet complete due to last meeting being joint with LSCB

145

13/10/17(7)

JB and JMH to consider ways to ensure role and relationship and DASG are used to best advantage

JB/JMH

08/12/17

812/17 looking at joint piece of work using our audits eg. dementia, complete

144

13/10/17(6)

LS to report back findings on provider engagement work on MCA when complete

LS

08/12/17

8/12/17 work done is impressive but is not following through to providers, complete

143

13/10/17(6)

TB to contact LS to be involved in current work on MCA for housing

TB/LS

08/12/17

8/12/17 will discuss when strategy agreed

142

13/10/17(4)

STB to send message out to the public regarding call blockers

STB

08/12/17

12/12/17 HW Lancashire received info from Trading Standards and uploaded and cascaded message out via their website, complete

141

13/10/17(4)

TH to make contact with LCC Telecare to work with on call blockers

TH

08/12/17

8/12/17, TB progressing with lifeline

140

13/10/17(4)

VG to contact National Trading Standard to request 5 call blockers

VG

08/12/17

Complete, TH to progress

139

08/09/17(9)

Saeed Sidat to send LN information on hate crime for consideration for website

SS/LN

13/10/17

SS sent to LN 11/10/17 to put on website, 8/12/17 complete

138

08/09/17(8)

STB to send SS information on 14-25 year olds survey recently done for information

STB

13/10/17

13/10/17 Deferred, 8/12/17 Sheralee to share wider findings of HWLs children & young people’s project with Saeed Sidat once project concluded Jan 2018.

137

08/09/17(7)

Hoarding task & finish group for 7MB with TC, YMG, SH, LN

TC/KB

/SH/LN

13/10/17

KB replacing YMG on group, TC drafted 7MB awaiting next meeting, 8/12/17 delayed due to Self-Neglect Framework not yet approved

134

08/09/17(8)

Joint

LN to produce key summary document for annual report for next Board

LN

13/10/17

6/10/17 LN working with Hannah Peake and young people on a short film

127

09/06/17(10)

Agree policies & procedures process and nominate key representative to the group

SH

08/09/17

Ongoing 13/10/17, VG now replaced SH, LS Chairing, complete

116

21/04/17(14)

Self-Neglect Framework to be shared with all agencies

YMG/TP/

LD

09/06/17

YMG finalising, RB 5/10/17 awaiting Senior Management approval, TP to report at next meeting, 8/12/17 LS to be reviewed with LSAB P&P Sub-Group

a. Lancashire

self-neglect framework v8 FINAL 2017.docx

Lancashire Safeguarding Adults Board

Multi-Agency Self-Neglect

Framework

Introduction

The purpose of this framework is to provide a process guide for all Lancashire Safeguarding Adults Board (LSAB) partner agencies on how to respond when concerns of self-neglect have been identified. All partner agencies must take all reasonable steps to work with the individual and address the concerns when they have been made aware themselves. When this has proved to be unsuccessful the LSAB partners should follow this framework. There should be operational procedures within each organisation which provide internal governance mechanisms and are compliant with this procedure. Each LSAB partner agency will be responsible to determine whether the individual has the mental capacity to make specific decisions relevant to the situation/risk. Mental capacity assessments are both time and decision specific and should therefore be considered and/or repeated as risk increases and in relation to each individual risk.

Where the intervention of a singular organisation has not been successful in addressing the concern nor the management of the risk itself, then the next step will be to confirm this with your manager and then use the multi-agency disciplinary approach. This will enable the relevant LSAB agencies to address the concerns directly within a multi-disciplinary framework.

This framework should be referred to for the management of cases where an adult is at high risk of severe injury and/or death due to lifestyle/self-neglect/refusal to engage with services (see 'Tool for decision-making re: Self-Neglect' appendix 1) and the criteria outlined below applies. It is designed to ensure effective multi-agency working and decision making.

Please note: This framework should be referred to where there is no perpetrator in relation to the self-neglect concerns and the adult at risk has mental capacity to make choices about their care and support. We would envisage this framework only therefore being used for a small number of individuals. This will respect the person's right to make unwise choices where they have capacity, in relation to the specific decision.

It is recognised that some people who self-neglect regularly use emergency services inappropriately and can make high demand on services on a day to day basis. This high usage or inappropriate use of services can be an indicator of vulnerability, which should be collated by agencies and the appropriate intervention considered.

Therefore this framework is intended to be used when:

· There are significant concerns by agencies about an individual's safety and/or /wellbeing as a result of self-neglect and /or significant concerns about the safety and /or wellbeing of others (risk of serious harm, injury or death).

And

· Existing agency involvement and appropriate multi agency working has been tried and been unable to resolve the issues.

Exclusions

This framework does not include:

· Situations where people do not have the mental capacity to make decisions about their care and support, in which case the Mental Capacity Act and associated Best Interests processes should be followed.

· Situations where people have mental health issues and should more appropriately be assisted by mental health teams and use of the Mental Health Act.

· Situations where self-neglect is associated with the action of, neglect by or influence of a third party, in which case a referral should be made under the safeguarding adult procedures.

· Situations associated with deliberate self-harm

· Situations where children at risk or in need should be referred to Children's Services

Information Sharing

Information sharing within these procedures should be in line with the principle of information sharing within Lancashire Safeguarding Adults Procedures, the Care Act 2014, the Care and Support Statutory Guidance 2016 and Data Protection Act 1998.

Consent

Wherever possible the person should be informed by the referring agency that this process is being followed and invite the person to the meeting. However, it is recognised that they may not wish or be able to attend; in which case the referring agency and/or advocate should ensure that the person's views are captured.

It is recognised that refusal to engage with services may be a concern and therefore referrals to relevant organisations should not be delayed because it is impossible or difficult to engage with the individual. Consent should be sought but a decision to follow the framework without consent may be justified where the person and/or others are at risk of serious harm, injury or death. This decision should be recorded on the person's records. Referrals to LSAB partner agencies of high risk cases should not be delayed because it has not been possible to effectively engage with the individual.

Multi-Disciplinary Team (MDT) Meeting

This arrangement would be undertaken by the organisation who has raised the issue with other LSAB partners. The role of that organisation is:

· Ensure the relevant partners are invited to address the concern

· Chair the meeting

· Provide a clear summary prior to the meeting for the attendees

· Clarify the roles and responsibilities

· To identify whether an independent advocate is required and to make the necessary referral

The responsibility of the MDT meeting is to:

· Provide expertise to effectively review the case

· Ensure there is full multi-agency sign up and engagement

· Consider risk assessments and risk management

· Look at strategies which may reduce risk and improve outcomes for the person and services

· Consider the support needs of the individual as well as the needs of the organisations involved to be accountable

· Consider whether there is a requirement to undertake further assessments and identify which LSAB partner agency would need to undertake these and identify who will be responsible for making the relevant referral

· Consider whether legal advice is required (each organisation would be responsible for sourcing/funding this following their own procedures)

· Agree a plan of action for the person, including the consideration of alternative or creative options to enable professionals and/or others to encourage engagement with the person at risk

· Ensure the Service User is offered Advice and Information regarding other Services that could also assist in offering support.

· Ensure that Children's Services are included in this process if children are visiting or living in the accommodation.

· Agree timescales for actions

· Record the agreed outcome

· Agree a review period where necessary

· Monitor and review the agreed plan of action where necessary

· Arrange for any further meeting(s) as required

It is recognised that the dilemma of managing the balance between protecting adults of risk from the potential consequences of serious self-neglect against their right to self-determination is a challenge for all services.

It should be agreed at the MDT meeting who will feedback the outcome and any proposed plan of action with the person and seek their consent to the plan, as well as a timescale for this discussion.

Actions following the MDT meeting

As outlined above, the identified agency/ professionals/person should discuss the proposed plan of action with the individual in order to try to engage the person with services.

The plan of action will have incorporated the next steps to be taken, in the event that the individual does not engage with the proposed actions. A review of the case will be required – process to be agreed in the plan of action.

It would be good practice for the agency leading on trying to engage the individual to record refusal to accept the plan of action, document ongoing risks and to ask the individual to sign to agree that they understand the risks involved.

Minutes from the MDT meeting will be circulated to attendees and each agency will take responsibility for the secure storage of these minutes on their relevant databases.

Disagreements between Agencies

Where there are disagreements between agencies that cannot be resolved at the MDT meeting or concerns about the participation of any agency in the process these will be escalated as appropriate to the senior leads within the organisations.

Exiting the Framework

Cases will exit the framework when either:

a) The desired outcomes are achieved and/or risks are reduced as far as possible, so that the individual no longer meets the threshold for this framework

Or

b) All options have been exhausted and there are no further interventions available to agencies.

If the reason for the exit is due to b) and has been agreed by MDT members and recorded as appropriate in the individual's and agency's record; this will need to include a rationale of the decision-making process and actions (including current mental capacity assessment).

Appendix 1

Tool for decision-making re: Self-Neglect

Level of Risk

Minimal Risk

Moderate

High / Critical

Self-Neglect

Access to support services is limited

Health care and attendance at

appointments is sporadic

Person is not currently losing weight (but may have done in past 6 months)

Person has limited access to social and community activities

Person is able to contribute to some daily living activities

Personal hygiene is relatively good

Low risk of harm

Carers are not present

Health care is poor, but no current deterioration in health

Person is of low weight

Limited ability to maintain nutrition

Persons wellbeing is partially affected

Person does not access social or community activities

Person's ability to contribute toward daily living activities is affected

Personal hygiene is becoming an issue

Some loss to independence, some level of self-neglect/non-compliance, i.e. inconsistent engagement with medical staff or medication management

Medium risk of harm or injury

The person refuses to engage with necessary services

Health care is poor and there is a significant deterioration in health

Care is refused

Malnutrition/severe weight loss

Wellbeing is affected on a daily basis

Person is isolated from family and friends

The person does not engage with social or community activities

The person does not manage daily living activities

Hygiene is extremely poor and causing significant skin problems

Aids and adaptations refused or not accessed

Limited or no financial viability

High risk of severe injury and/or death

Hoarding

Small collections of items, not rubbish and not causing obstructions

At least one room is severely impaired by level of clutter

Several animals present that are currently well cared for

Responds to relationship building and rapport with professionals

Residents and communal areas unaffected

Low risk of harm

More than one room unusable, or use severely impaired by level of clutter; this may include rubbish.

Some items present that may increase risk of severity of fire – such as hoarded paper.

Unable to use most rooms, lack of utilities

Environment causing illness/ hospitalisation

Several animals present; some signs of neglect and/or animal faeces in property

Signs of infestation that could spread

Non-fatal fire in last 6 months

Strong odour

May be some small items in communal area, but not constantly.

Light odour in communal areas.

Medium risk of harm or injury

Hoarding items severely limiting free movement including entry/exit.

Imminent fire risks (Consider: Flammable materials, working smoke alarms, evidence of previous fire/smoke damage anywhere)

Unstable piles/avalanche risk leading to severe injury, permanent disability,

Disconnection of utilities

Several animals present; obvious signs of neglect, faeces present in property

Severe odour

Eviction/ legal enforcement by Environmental health and/ or housing.

Severe infestation that could spread, causing infection or injury

Severe infestation to neighbours and surrounding properties.

Inability to safely access and use communal areas due to clutter impinging on these areas from affected property.

Severe odour in communal areas

Clutter spreading to the garden and surrounding areas

High risk of severe injury and/or death

Yvette McGurn PSW July 2017

b. Self neglect

images.pdf

Indicative Level 1 - Signposting

• Indicative Level 2 – Escalate Concerns

• Indicative Level 3 – Multi-Agency Response

c. Guidance for LCC

staff working with individuals who self-neglect V3 FINA.._.docx

4

Guidance for LCC staff working with individuals who self-neglect

The various legislation a worker will need to consider

The Care Act 2014 is very clear in Part 1 of the Act about the responsibilities of the local authority with regards to assessing need:

9Assessment of an adult’s needs for care and support

(1) Where it appears to a local authority that an adult may have needs for care and support, the authority must assess—

(b) whether the adult does have needs for care and support, and

(c) if the adult does, what those needs are.

This duty applies regardless of the level of the adult's financial resources (if they are deemed to meet the Care Act eligibility criteria).

However, an adult does have the right to refuse an assessment and this is covered in Part 11 of the Act:

11Refusal of assessment

(1) Where an adult refuses a needs assessment, the local authority concerned is not required to carry out the assessment (and section 9(1) does not apply in the adult’s case).

(2) But the local authority may not rely on subsection (1) (and so must carry out a needs assessment) if—

(a) the adult lacks capacity to refuse the assessment and the authority is satisfied that carrying out the assessment would be in the adult’s best interests, or

(b) the adult is experiencing, or is at risk of, abuse or neglect.

With regards to Safeguarding adults at risk of abuse or neglect (and self-neglect falls within the parameters of abuse or neglect):

42Enquiry by local authority

(1) This section applies where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there)—

(a) has needs for care and support (whether or not the authority is meeting any of those needs),

(b) is experiencing, or is at risk of, abuse or neglect, and

(c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.

(2) The local authority must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case (whether under this Part or otherwise) and, if so, what and by whom.

The Care and Support Statutory Guidance 2015 also clearly states that:

14.4 The safeguarding duties have a legal effect in relation to organisations other than the local authority on for example the NHS and the Police.

The Guidance also clearly lists self-neglect in the types of abuse and neglect (14.17) and states:

This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case by case basis. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support. It should be noted that the individual LSAB partner is responsible for taking all reasonable steps to engage with the individual and would be responsible for arranging the MDT meetings. In most cases, it would not be a proportionate response to raise a section 42 enquiry and therefore the individual LSAB partner agency would be required to follow the LSAB Multi-agency Self-Neglect Framework.

The Mental Capacity Act 2005 sets out the following principles:

1 The principles

(2) A person must be assumed to have capacity unless it is established that he lacks capacity.

(3) A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

(4) A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

The Human Rights Act 1998 sets out in Schedule 1, Article 8:

Right to respect for private and family life

1 Everyone has the right to respect for his private and family life, his home and his correspondence.

2 There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

Information Sharing

Information sharing should be in line with the principle of information sharing within Lancashire Safeguarding Adults Procedures, the Care Act 2014 and the Care and Support Statutory Guidance 2016 and Data Protection Act 1998.

Consent

Wherever possible the person should be informed by the referring agency that a referral for a social care assessment is going to be made, because the individual appears to have care and support needs, and they are in agreement for this.

It is recognised that refusal to engage with services may be a concern and therefore referrals should not be delayed because the individual does not give consent. Consent should be sought but a decision to initiate the referral process without consent may be justified where the person and/or others are at risk of serious harm, injury or death. This decision should be recorded on the person's records. Referrals of high risk cases should not be delayed because it has not been possible to effectively engage with the individual.

Things to consider

What are the steps that will need to be taken when practitioners have been allocated an individual, where concerns have been raised that the individual may be neglecting their self and the individual is refusing to engage or refusing a social care assessment/services?

· What evidence will be required to demonstrate an offer of a social care assessment has been made and refused?

· How many attempts to engage the individual would be enough to satisfy a Court that we have discharged our duty to determine whether an adult has a need for care and support?

· What evidence will be required to demonstrate a multi-agency involvement and who the lead organisation will need to be, if the individual does not have care and support needs (or does refuse an assessment and has capacity to do so)?

· What evidence will be required to demonstrate that the worker believes that the individual has capacity to make an informed decision regarding whether to refuse such an assessment, given the concerns raised?

· How does the worker demonstrate what the risks are – what these may be, how likely they are to occur and whether there is a risk to others – if the individual is refusing to engage?

· Who are the relevant people in that person's life/network and whether it is appropriate to consult with them. Consider whether not consulting with them would place the individual at greater risk. Confidentiality should not be a barrier to sharing information with relevant individuals where there are significant concerns/risks.

Proportionality and the wellbeing principle

According to the Care and Support Statutory Guidance 2015, the 'core purpose of adult care and support is to help people achieve the outcomes that matter to them in their life' (1.1).

The challenge for social care workers following a referral regarding an individual who may be self-neglecting, is that the outcomes that matter to the individual may not directly relate to the issues concerning the person who made the referral, other professionals or society as a whole.

When the person hasn't made the referral, they may not want to have a social care assessment or involvement from social care staff.

The assessment must always be 'appropriate and proportionate' (6.3) – but what does this mean when the individual is refusing to engage?

Where possible, the social care worker must attempt to inform the individual of the concerns and the need to discuss any issues or concerns the individual may have. If, initially, the individual will not answer the door or speak with the worker, a letter could be left explaining what the concerns are and that the worker will return, with the aim to continue to try to engage (the letter could give the individual the option to let us know that they wish to refuse an assessment).

The social care worker should attempt to engage with the individual along with the person who made the referral (if they are willing), especially where that individual is another professional/representative from an organisation. This will help with continuity, and will also be an opportunity for the referrer to communicate with the social care worker their belief regarding the individual's mental capacity and the level of risk posed.

If the social care worker has seen or spoken with the individual on a number of occasions (at least 5 different times – although this would depend on the circumstances and may differ) and written to the individual giving them the opportunity to make contact with the worker, then this may be enough to evidence that the local authority has attempted a proportionate assessment, but the individual has refused and has capacity to do so. If the worker is in any doubt about the individual's capacity to make an informed decision regarding this, then they would need to follow the best interest principles.

For services that have case progression meetings (or similar) it would be advisable for the worker to present the issues/concerns at this meeting, for support and advice from colleagues as to possible progression. For services that do not currently have case progression meetings, then discussions with a Senior Social Worker or Team Manager and/or supervision would be required to fully explore the options and actions required.

If the worker has concerns regarding the level of risk posed by the self-neglect, then they will need to organise (or request the referrer to organise, if they have more information/involvement with the individual) a Multi-Disciplinary Team Meeting – refer to Multi-Agency Self-Neglect Framework. This MDT meeting will enable a sharing of information and knowledge to take place, as well as a shared understanding of the risks identified/potential risks and any mitigation. At this meeting, clearly defined actions will be recorded. Risk should be discussed within the meeting and a defined risk management plan developed and agreed, with key organisational responsibilities identified – with timescales – including the consideration of alternative or creative options to enable professionals and/or others to encourage engagement with the person at risk.

It is recognised that the dilemma of managing the balance between protecting adults at risk from the potential consequences of serious self-neglect against their right to self-determination (and the legislation that underpins this) is a challenge for all services. It should be agreed at the meeting who will feedback the outcome and any proposed support plan with the person and seek their consent to the plan, as well as a timescale for this discussion.

It may be appropriate, dependent upon the level of risk, to involve the Safeguarding Team in this MDT Meeting – this may be purely an advisory role or the situation may be severe enough to warrant a Safeguarding alert to be raised.

Other agencies, especially voluntary organisations, may be more successful in engaging with the individual initially. It may also be more appropriate to consider referring to the Wellbeing Service or the Reablement Service, as a way to identify options to enable the individual to take some control and express some choices. Consideration must always be given as to whether a referral to Advocacy Services would be appropriate.

When considering the closure of the case by social care staff and the reasons for this, following discussions with a manager or Senior Social Worker, this should clearly be documented on the individual's records, as to why this has been deemed appropriate; this action should be communicated with all parties, including the individual. Other agencies may still be required to continue engaging with the individual, dependent upon their legislative responsibilities, as per the LSAB Multi-Agency Framework.

Yvette McGurn PSW July 2017

Primary Authorities

-CFA presentaion.pdf

PRIMARY AUTHORITY & FIRE SAFETY

WHAT IS A PRIMARY AUTHORITY SCHEME?

Primary Authority- encouraging growthPrimary Authority- business leaders

Presenter

Presentation Notes

Videos about Primary Authority –Right click on video required and “open hyperlink”

Primary Authority - encouraging growth: a simple explanation of the scheme with four business examples. 10mins

Primary Authority - endorsements from business leaders. 3.5mins

http://www.youtube.com/watch?v=ynp-M7nmers

https://youtu.be/uCz1--9e60c

Statutory Basis Of The Scheme

• A statutory scheme established by the Regulatory Enforcement and Sanctions

Act 2008 (‘RES Act’)

• The scheme provides for a partnership between a business and a single local

authority - its ‘primary authority’, in a specified area of regulation

• Partnerships are formed through nomination by the Secretary of State

• A primary authority is entitled to recover its costs for providing primary

authority services

• The Act creates a number of statutory duties for ‘enforcing authorities’

Presenter

Presentation Notes

Bullet 1: The scheme came into operation in April 2009. It is administered by the Regulatory Delivery (RD) which sits within the Department for Business, Innovation and Skills. Fire Safety became part of the scheme in April 2014, in England & Wales. (not Scotland/Northern Ireland)

Bullets 2 & 3: RD administers the online application and nomination process. The application process involves consultation with any relevant national regulator. However, there is no relevant national regulator for fire safety

Bullet 4: Cost recovery is optional. In practice, some primary authorities are choosing not to cost recover, particularly for smaller businesses, but most primary authorities are choosing to cost recover, to a greater or lesser extent, as this allows them to resource a better service.

Bullet 5: ‘Enforcing authorities’ are all local authorities that regulate the business (including fire and rescue services).

Features Of Primary Authority

• The scheme encourages a flow of information, and the use of that information

to drive improvements in compliance

to target enforcement resources where they are most needed

to inform consistent and proportionate responses to non-compliance

• Primary Authority Advice is underpinned by the statutory requirement for

notifications of proposed enforcement action

Presenter

Presentation Notes

Bullet 1: Enforcing authorities share information with the primary authority that it can use to identify and understand compliance issues, and to address them with a partner business, or, in the case of co-ordinated partnerships, with a group of businessThe primary authority shares information with enforcing authorities, helping them to regulate the business more effectively at a local level. The secure area of the Primary Authority Register is used to publish inspection plans and Primary Authority Advice to Local Authorities but also allows primary authorities to share other information. For example, primary authorities are sharing FAQs, commonly requested company procedures etc.

Bullet 2: The statutory assurance mechanism, to notify all enforcement action to the primary authority - in advance for most action - retrospectively for specified enforcement action where the legislation recognises a need to act urgently

How Is Primary Authority Working In Practice?

UPDATE (as at 25th July 2017)

• Over 17696 businesses in partnerships

• 805 businesses in fire safety partnerships

• 187 local authorities providing partnerships (including 30 fire and

rescue authorities)

• A variety of business sizes, from micro businesses to multi-national

manufacturers and retailers

• A wide range of business types and sectors

Presenter

Presentation Notes

Bullet 1: The number of businesses in Primary Authority is growing steadily and more than 80% of the businesses that are choosing to participate in Primary Authority are small businesses (less than 50 employees).

Bullet 2: Fire safety partnerships established since fire safety came into scope in April 2014 include:Pub and hotel chains such as St Austell Brewery and Hilton HotelsHousing associations, including Hyde Housing Association and Sanctuary GroupFast food outlets such as Pizza Hut and GreggsNational supermarket chains such as Asda, Sainsbury, Tesco Well-known retailers such as Argos, B&Q and Marks and SpencerMembers of the British Frozen Food Federation, the Association of Convenience Stores and the Charity Retail Association.

A public list of nominated partnerships is available at via the Primary Authority Register

LFRS Partnerships

• Barchester Healthcare, (PAS since 2014)

• Four Seasons Healthcare, (August 2016).

• Torus 62 Ltd ( August 2017)

• E.H Booths & Co Ltd, (Feb 2017)

• Amber Taverns PLC, ( Jan 2017)

Presenter

Presentation Notes

Barchester Healthcare, over 200 care facilities across UK (PAS since 2014) As a result of the reduction in FS Enforcement, cost saving and advice received from working with LFRS, their H&S adviser recommended LFRS to the Four Seasons Directors when she went to work for them.

Four Seasons Healthcare, One of UK largest independent care providers with over 350 care facilities across UK (August 2016).Torus 62 Ltd-, based in St Helens, Merseyside. Torus have 22,000 homes, predominately across mid-Mersey and North West regions, consisting of sheltered accommodation, purpose built flats, houses of multiple occupancy and single private dwellings.

LFRS main aim is to focus on high life risk / and support vulnerable people through PASSecondary aim, to have also a spread of PAS across differing business types

E.H Booths & Co Ltd, 28 stores across the North West Amber Taverns PLC- Based in Blackpool, 0wn and manage over 130 Public houses across UK. Refurbished to a very high standard

Working to sign :Regenda Housng -13,000 properties across the region, including social rented housing, housing for older people, supported housing, private rented property, shared ownership and housing for sale.

DW Thwaites – Based in Blackburn, 17 Hotels/Inns/Spas and over 200 Tenanted public houses

Progress Housing –provides nearly 11,000 homes for rent in England and Scotland, making them one of the UK’s leading social housing providers.

Warwick Estates - managing agents appointed by premises Management Companies to administer the day to day running of the buildings and estate. Portfolio of over 650 premises from high rise & purpose built flats to SPD.

A primary authority is entitled to recover its costs for providing primary authority services

LFRS Role as Primary Authority

Practically LFRS will, for the duration of the agreement, provide:

• ‘Primary Authority Advice' with regards to fire safety, provided by

competent officers with relevant qualifications, skills and experience;

• A Single Point Of Contact (SPOC) and access to advice on a 3 day per month

basis.

• An ‘arbitration’ process between Partners and other Fire Authorities.

• Respond to all notifications received via the Primary Authority Register

promptly and within statutory timeframes.

• Quality assurance and review of your current Fire Safety Policies, Strategies

and procedures.

Presenter

Presentation Notes

A primary authority is entitled to recover its costs for providing primary authority services.For example:Annually 60 Hours in advance (£3420 = £57p/h) – non refundable

LFRS will, for the duration of the agreement, provide: •LFRS Over 40 qualified FS officers, levels 3/4/5 diplomas + fire engineers, experience•A Single Point Of Contact (SPOC) and dedicated PAS officer, via email, mobile & direct phone and dedicated email [email protected]. Access to advice. Responding to queries from the business within agreed timeframes, and advise the business as soon as practicable where this is not possible• An ‘arbitration’ process between business and other Fire Authorities. Responding to all notifications received via the Primary Authority Register promptly and within statutory timeframes.• Quality assurance and review the business current Fire Safety Policies, Strategies and procedures. And carry out sample inspections as required to support the business. The business will: • Work constructively with the primary authority in relation to the provision of primary authority services; • Inform the primary authority as soon as possible of any significant change affecting the business that may impact on the provision of primary authority services; • Provide the primary authority with reasonable notice of its requirements for provision of primary authority services; • Provide the primary authority with information and assistance that the primary authority may require in order to provide a quality service. • advise the primary authority as soon as reasonably practicable of any change in circumstances which might affect the validity of the Primary Authority Advice provided. • make available to the primary authority relevant advice that it receives from any national regulator or other relevant source.

Any Questions?

PRIMARY AUTHORITY �& FIRE SAFETYStatutory Basis Of The SchemeFeatures Of Primary AuthorityHow Is Primary Authority Working �In Practice?LFRS PartnershipsLFRS Role as Primary AuthorityAny Questions?

LSAB SAR

Sub-Group Report to Board.docx

Report from : Safeguarding Adult Review Sub Group

Report to LSAB : December 2017

Last Meeting

13th November 2017

Attendance

Comment on attendance

Good

Work Programme

Comment on general progress

Good

Summary of Key Decisions and Actions

SAR Criteria: The group have reviewed the criteria for a Safeguarding Adult Review due to inconsistencies about the threshold of a SAR.

· The LSAB must commission a SAR for an adult with care and support needs if there is reasonable cause for concern about how the LSAB, members of it or other persons with relevant functions worked together to safeguard the adult, and condition 1 or 2 is met,

- Condition 1: the adult has died, and the LSAB knows that the death resulted from abuse or neglect

- Condition 2: the adult is still alive, and the LSAB knows that the adult has experienced serious abuse or neglect.

· Significant harm: For the purposes of the SAR criteria, significant harm is defined as a life limiting incident (including psychological harm) from which there will be no recovery.

Learning from Case Reviews Conference: It has been agreed for a conference outlining the learning from recent SCRs and SARs to be held. It will target frontline staff and managers, the purpose is to disseminate learning and enable multi-agency discussion regarding adults and childrens issues/ practice. The conference has been arranged for the 14th March 2018 in Valley Church, Bamber Bridge.

Terms of Reference: The terms of reference are to be reviewed at the next SAR Group meeting.

Vice Chair: Previously Julie Seed volunteered to be the vice chair of the SAR review Group however she has since left her role within Lancashire Teaching Hospital. Therefore the group is currently without a vice chair.

Update on Cases:

There are six actively ongoing SARs:

· One of these was presented to the LSAB in April and the action plan is being implemented,

· Two are being presented at the LSAB in December.

· One is at third panel stage and the practitioner event has been completed,

· One under way with the learning event taking place imminently,

· One has a reviewer and chair recently appointed and the SAR planning meeting has been organised,

· Two referrals due for discussion at the next SAR Meeting.

Additionally, there are 2 referrals pending a decision – these require information from the Coroner;

Any Decisions Required by Board

Chair of Sub-Group:_Peter ChapmanDate:4/12/17

LSB JOINT

Comms&Engage Sub-Group Report.docx

Report from : Pan-Lancs Communication & Engagement Sub Group

Report to LSAB : 8 December 2017

Last Meeting

6 December 2017

Attendance


Good attendance and representation with positive engagement throughout the meeting.

New representation from the Office of the Police and Crime Commissioner.

Gaps remain in representation from Education and VCFS.

Work Programme


This was the third meeting of the group. Much conversation around how we identify initial priorities and move forward effectively.

Garry Payne appointed as Chair and took up the role from this meeting.


Terms of Reference

Now fully signed off by all 6 Safeguarding Boards, with agreement to move forward as a Pan-Lancashire group

Communication & Engagement Strategy and /Work Plan

Both documents are currently in development, to clearly set out the aims, objectives and approach to Board communication/engagement activity, and the tasks to be undertaken in terms of delivery.

Members of the group agreed that both should not be over complicated and realistic in terms of delivery. The work plan will be streamlined to ensure actions are achievable.

It was agreed to identify approx. five key areas/messages to be prioritised as an area of focus on for the next 6 months and agree how; why; and to who these will be communicated. A Task and Finish Group will progress this.

It is expected that agency representatives take responsibility of ensuring information is disseminated widely, and be able to evidence this, providing feedback on any challenges/successes in doing so.

Working Together Consultation

The group discussed the current consultation on the revisions to Working Together and agreed that some co-ordinated communication/messages would be needed on behalf of the pan-Lancs LSCBs regarding the final guidance due for release in March and proposed changes within the pan-Lancs footprint.

Pan-Lancs Business Managers will pick this up at their next meeting in January.

Safeguarding Awareness Week

The group discussed the possibility of introducing an annual 'safeguarding awareness week', focussing on a range of issues relevant to child and adult safeguarding. It was agreed that a Task and Finish Group will consider arrangements for a week in April/May 2018. It was noted that due to timescales, the first year may take place on a smaller scale – perhaps 3 out of 5 working days – with a view to building on this for future years.

Sharing good news/good practice

Colleagues discussed the importance of sharing widely, good news stories and examples of good practice. This will allow a positive light to be shed on safeguarding issues and provide assurances to the public and professionals around the positive work being undertaken pan-Lancs.


To note the progress of the group.

Actions for other Sub Groups

To note the recent progress made and to ensure effective links are made as appropriate.

Chair of Sub-Group: Garry Payne, Date: 7 December 2017

LSAB P&P

Sub-Group Report.docx

Report from : Policy and Procedures

Report to LSAB : 8th December 2017

Last Meeting

8th November 2017

Attendance


5/11 members attended

Work Programme


First meeting


Terms of reference reviewed and amended to reflect

Function – to include a link to the LSCB Policies and Procedures Sub Group, Comms. and engagement sub group and Healthwatch.

Governance – the P&P Sub Group reports into the LSAB via a Chair's Report. Updates shared at quarterly sub group chairs meeting

Function to include horizon scanning with regard to new legislation and best practice.

To include policies and procedures commissioned by the LSAB

Terms of reference to be reviewed every 12 months

Current membership to include a Police representative, Advocacy Focus, Principal Social Worker from LCC and a NHS Provider representative.

Policy review programme agreed

1. People in Positions of Trust

2. Self-Neglect

3. Hoarding

4. Making Safeguarding Personal

5. FGM (LSCB)

6. Resolving Professional Disagreements (LSCB)

7. SAR Protocol

8. Financial Abuse – to be looked at in 2018

9. Domestic Abuse - to be looked at in 2018

10. Modern Slavery – to be looked at in 2018


Nominations for group reps from Lancashire Constabulary, Advocacy Focus, and NHS provider.

Chair of Sub-Group: Lisa Slack Date: 8th December 2017

Paraffin Oxygen

Advice for Carer.pdf

Page 1Page 2

Meeting Template - Lancashire Safeguarding · Web viewLancashire Safeguarding Adults Board LSAB...

Documents

Transcript of Meeting Template - Lancashire Safeguarding · Web viewLancashire Safeguarding Adults Board LSAB...