Ensuring safety
This theme focuses on how we work with people and our partners to ensure care is safe and how we support people to live in safety free from abuse and harm.
Safe systems, pathways and transitions
What are Deprivation of Liberty Safeguards (DoLS)?
The Deprivation of Liberty Safeguards (DoLS) are a legal framework within the Mental Capacity Act (2005), protecting the rights of individuals who lack the mental capacity to consent to their care arrangements, and who are, or need to be, deprived of their liberty in a care home or hospital. Ensures deprivations are authorised, necessary, and in the person's best interests.
A Best Interests Assessor (BIA) is a professional, often a social worker or other qualified practitioner, who assesses whether a proposed deprivation of liberty is in the best interests of a person who lacks the mental capacity to make that decision for themselves. In Adult Social Care we have a dedicated DoLS team alongside BIAs in our wider operational teams who undertake assessments.
Lucy's story
What was the situation?
Lucy is 56 years of age, of Creole ethnicity and was born in Portugal and had been a British citizen for many years. Following a marriage breakdown, Lucy started to experience severe mental health episodes which led to her being detained under the Mental Health Act 1983.
Lucy was experiencing seizures which were affecting various parts of her brain and was left with an acquired brain injury from her seizure recurrence. Lucy was not able to walk anymore and she lost her verbal communication skills. Lucy was supported to move to permanent nursing care and was subject to a DoLS.
Lucy’s family live in Portugal. Lucy was supported with the DoLS assessment by a Paid Relevant Person Representative (PRPR), from VoiceAbility. At the time the care home manager was using her private mobile telephone so that Lucy could see her family via WhatsApp video calls. Lucy was allocated a Mental Health Social Worker for the purpose of a care and support review. The Best Interest Assessor as part of the request to reauthorise the DoLS, worked with Lucy, her Social Worker, the care home, Lucy’s family, and the PRPR to ascertain a better understanding of Lucy’s previous wishes, her likes, her interests and to get an understanding of Lucy’s lived experience by focussing on her strengths.
Through telephone consultation with her sister, the BIA was able to gain crucial information about Lucy’s way of life. Lucy was being supported with a vegetarian diet. She had been pulling at her own hair as it was combed into a plait. Lucy would not make eye contact and look at the ceiling or down at her feet. The BIA found out that Lucy’s religion was especially important to her. Lucy previously prayed at set times during the day. She enjoyed a meat halal diet. She liked to wear traditional customary attire. Music was important to Lucy as well as regular contact with her family.
As part of the DoLS authorisation the BIA made a number of recommendations to the home with a focus on ensuring that any deprivation of a person's liberty was necessary, proportionate, and in their best interests, with appropriate safeguards in place but also focusing on ensuring her cultural and spiritual needs were met.
What changes took place?
Lucy was supported to purchase an iPad. She had regular private video calls with her family, she would smile at the screen and appeared visibly happier. Her family were happy and very emotional to see her with oiled braided neatly combed hair and moisturised skin. This is a deeply rooted cultural practice which is often passed from one generation to another. Lucy was also supported by the care home to listen to prayers on her television. She wore both western and her traditional clothing. Her diet was prepared and permitted according to Islamic dietary laws. Her room was personalised with sensory activities such a touch, sound, picture books and word boards. Her bed was moved so that she could see through the window. The care home also allocated Lucy a keyworker who is from the same cultural background as her and supports her to access the local community.
The care home made positive changes to see Lucy as a whole person, considering her previous choices, giving her dignity and respect whilst acknowledging her unique sense of self and gained knowledge to support Lucy with a fulfilling quality of life. The BIA was careful not to offend their excellent work but wanted them to appreciate how culture and diversity is more than just food, music, and customs for some people. For Lucy it was her way of life, her spirituality and who she was.
Eric Williams House
Supporting people with their move into the home
Moving into a care home can be a very daunting experience, new surroundings, new people, leaving behind the familiarities of home, its life changing. It can also be very difficult for family and those caring for the person, taking time to adjust and perhaps having mixed feeling of guilt and relief. So, how we support someone with that transition is really important. Here are two examples of how Eric Williams House (residential care home) have supported people and their families in a move to live at Eric Williams.
Marion is an 88-year-old woman who moved to Eric Williams House after a period of time in the home following a discharge from hospital. Marion has dementia and had experienced a fall and fracture at her home, where she lived with her son, Martyn. Marion’s son was getting worried and had anxiety when he was at work and she was home alone. Martyn had also been a carer for his father, Marion’s husband before he needed to go into a residential care home.
Marion often says how well looked after she feels and how much she enjoys the company of both staff and other residents. Marion is an independent woman who likes her own space at times, she has a good sense of humour and enjoys chatting the other residents and staff about her family and where she grew up in Baginton.
Before coming to Eric Williams Marion was always trying to help others and would often put others before herself. She loved musicals particularly South Pacific, she was in the past a keen ballroom dancer and really enjoyed country music.
Martyn himself identifies that he did have feelings of guilt and still has those feelings sometimes, but knows his mum is in the best place for her.
"The communication between Linda and the team, and myself has been excellent. They keep me informed with absolutely everything to do with my mum’s health and wellbeing, and the peace of mind this provides to me is priceless."
"The care staff are fabulous with mum (Carol, Becky, Angela, Caroline, Sandy - too many to mention) are all so caring, so loving, always encouraging mum but respecting her wishes too."
Gerald is 64 years old and has Down syndrome, learning disabilities, and dementia.
From the moment Gerald arrived, the staff at Eric Williams House made him feel welcome and valued. They took the time to get to know him, his interests, and his needs, ensuring a smooth transition. Gerald loves staying busy with activities he enjoys.
At Eric Williams House, he can indulge in his favourite pastimes like watching TV soaps, doing jigsaw puzzles, and gardening. The staff also play his favourite music, including songs from "The Lion King," which always brings a smile to his face.
Gerald thrives in the community atmosphere at Eric Williams House. He enjoys talking to people and getting involved in whatever is happening around the home. Whether it's chatting about historical events or singing hymns he knows from church, Gerald feels connected and engaged.
The staff are attentive to Gerald's emotional needs. They understand that he can become anxious when away from his mother and provide the reassurance he needs. Their patience and understanding help Gerald feel secure and content.
Maintaining strong family bonds is important to Gerald. The staff facilitate regular visits from his mother, Pat, and his cousins, ensuring he never feels isolated. These visits are a highlight for Gerald and contribute to his overall happiness. Gerald’s cousin Clive stated:
"Gerald being at Eric Williams House has helped his mum – she recognises that Gerald is happy and settled. This has helped her to let go – she knows that Gerald is happy and well cared for."
Want to know more about Mental Capacity?
In Coventry we have our own website which provides information for adults, carers and providers of health and social care services living and working in Coventry. It aims to make information and guidance about the Mental Capacity Act 2005, which applies in England and Wales, more accessible and easily understood by everyone involved.
Safeguarding
Sam's Story
What was the situation?
Sam is a 60-year-old man who worked as a gardener until his health prevented him from working 7 years ago. In March 2024 Sam had a stroke. As he lives alone, he was lying on the floor for 24 hours before a neighbour alerted police and they broke into his flat to find Sam lying on the floor. Sam was admitted to hospital and had a slow recovery assisted by the stroke rehabilitation unit.
On discharge from hospital Sam went for recovery to a Housing with Care where he could get support from carers. Sam lived in an Orbit tenancy and his property had become cluttered and stacked with food. Sam realised that he had a tendency to overbuy tins and packets of food and store these around his flat and was self-neglecting. Whilst living in his previous home Sam explained that he experienced depression due to social isolation and no longer being able to work. He had started drinking and neglecting his environment and himself.
During his time in Housing with Care rehabilitating Sam became more like his old self, he did not feel the need to drink alcohol and was enjoying socialising with other residents. Sam was provided with an Advocate to help him with his assessment and to help him express where he wanted to live and have care. Sam wanted to remain in a supported living environment where he could receive care and have support. A vacancy became available for Sam to move into. Sam was assisted to end his previous tenancy, sort out his gas and electricity bills and claim the disability benefit Personal Independence Payment (PIP). Age UK assisted Sam with moving home, applying for grants and in sourcing new furniture for his flat.
What difference did it make and how are things now?
Sam is now settled, he uses his 4-wheeled walker to go to the local shop to get his paper every day and enjoys socialising in the communal lounge with other residents. Housing with Care provides Sam with the care he needs and an environment where he has been able to thrive. Sam said:
"I am really settled here, I get on with everyone. I have a couple of close friends and chat with everyone. I have not wanted to drink alcohol since being here and my next goal is to cut down on smoking."
Stephanie who supported Sam said;
"When working with Sam, my approach was centred around ‘Making Safeguarding Personal' (MSP) recognising Sam's strengths and potential, despite the challenges he faced. The opportunity to live in Housing with Care provided a supportive environment where Sam could regain his sense of self and improve his mental well-being. Seeing Sam thrive and set new goals for himself has been incredibly rewarding."
Self-neglect is a category of abuse and neglect, and so the adult safeguarding duties outlined in the Care Act apply equally to cases of self-neglect. There are various reasons why people self-neglect.
Self-neglect can be a complex and challenging area of practice for professionals due to the diverse range of factors involved, the potential for high risks, and the difficulty in engaging individuals who may not recognize or accept the need for help.
Self-neglect also forms part of the Coventry Safeguarding Adults Board strategic plans for 2024 to 2027, being identified as a critical safeguarding issue and practice area involving work with partners across Coventry. The Board has produced a range of guidance and undertaken multi-agency audits and learning events.
Andrew Errington Head of Practice Development and Safeguarding (Adults Principal Social Worker) said:
"Supporting people who self-neglect can be very challenging, needing to balance rights, risks and taking time to understand the person, so it's great to see this being recognised in the support provided to Sam’. ‘Supporting people who self-neglect has become a common presenting need in our Complex Case and Risk Enablement Panel, chaired by myself as the Principal Social Worker since 2018 and features as a key part of our safeguarding training package for frontline staff."