Escalating Concerns

Escalating concerns arise where there are accumulating issues relating to the operation of, or quality of care provided in, a registered care home providing services to adults. These concerns may have been identified through a number of routes including:

• Statutory agencies involved in regulating or purchasing services;
• By visiting professionals, such as care managers and nurse assessors;
• Complaints or disclosures directly from service users, their families, friends, advocates, or from current or ex-employees of care homes; and
• As a result of the seriousness of an individual adult protection referral or the concerns arising from a series of adult protection referrals in a particular home, or in a group of homes managed by a particular provider.

In instances where accumulating issues are being identified there should already be interaction between key agencies including, as appropriate, commissioners, the police, the service provider, service users and their families. Regulatory involvement will include CIW along with other regulators where indicated, such as the Health and Safety Executive. This will have led to the identification of issues and, given a failure to address and resolve them by the home, an ‘escalating concern status’ will have been reached.

The safety and well-being of services users is paramount. In circumstances where a failure in the provision of care which causes suffering is identified this is adult abuse which is a breach of the duty of care and could amount to a criminal offence being committed by the home.

Escalating concerns will warrant proactive or reactive intervention from those commissioning services, possibly from one or more commissioning agencies, designed to improve the quality of services and, where possible, prevent what might be avoidable home closures.

Where abuse is suspected the policy and procedures to protect vulnerable adults must take precedence. The overriding objective should be to ensure the safety of vulnerable service users. In many situations it will be in the best 1 interest of service users to use the escalating concerns procedure alongside the adult protection procedures in an effort to keep the home open. In such situations, clear communication between staff and agencies involved in both processes is essential. However, in the most serious situations it may neither be possible nor in the services user’s best interests to attempt this and closure could be unavoidable.

Closures of care homes fall into two main categories under the Care Standards Act 2000; ‘voluntary’ (where the home chooses to close) or ‘enforced’ (where the home is forced to close). Whichever the category of closure the Act sets out the legal basis governing the process.

More information can be found at: www.gov.wales