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Khaled (50) is a service user who is with the local community mental health team as well as the substance use team. He has a diagnosis of Bipolar Personality Disorder, and is also an alcoholic. Khaled is currently unemployed due to a number of factors, including both diagnosis and is receiving benefits. He has been with the team for over 10 years, and is on medication for his mental health, and his notes indicate that he had attempted suicide several years earlier.

You have been working with Khaled for several months to help him with his substance use however on the day of your next appointment he advises he is unable to make it, and the meeting is rearranged.

A short time later Khaled asks if he can come in to see you, which you respond you are busy as meetings and he says it is fine. However he then calls a while after, stating that as he needs money he has gone to a payday loan company, who accept applications for people receiving benefit, and requires a professional countersignature. When you investigate you find that the loan company as a very high APR - 1500%. After yiy recueve feedvacj from your manager that as a professional you would not be able to sign Khaled becomes irate, saying that he is going to sign off from the service. When you contact him again he says that he won't bother you and you will never see him again.

Is this a safeguarding risk?
What would your response be?

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Mark (76) has lived with his wife for 55 years. Mark has never cooked a meal for himself in all this time. Mark has a diagnosis of COPD (google it if needed!), but other than that is in good health. Mark's wife died recently. He visited his GP shortly after, and described that he wasn't sure what he was going to do without her, but didn't give any specifics about how he was feeling or what his life was now like. 3 weeks after his wife died, a neighbour walking by his window sees in and Mark is unconscious on the floor. An ambulance is called, and Mark is taken to the hospital, where he is found to be malnourished and dehydrated. Mark later reports that he has not eaten anything except for toast for the past 3 weeks, and has drank a lot of alcohol during this time as well.

Is this a safeguarding concern? What support might Mark need?

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Rachael (78) suffers from Diabetes and Dementia for some time. She lives alone in her flat and has a pet(cat) for company. She takes care of herself with the support of domiciliary care worker that visits four times a day. She is prone to falls and has given up leaving her house because of apprehensions about falling and injuring herself.
On few occasion she stated that her carers have stolen her money, her neighbours keep on threatening her. At one time she even stated that her social worker had threatened to send her to nursing home if she did not hand over the money that was with her.

As the new Social worker allocated to Rachael. What will be your first reaction? Is their a potential safeguarding concern in regards to the service user's complain

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Jacob (32) has a learning disability and lives in supported living. His support plan states that he has support with personal care tasks including being given medication. His medication keeps his epilepsy under control and he has not had a seizure for months. Prior to the carers supporting him with medication, his seizures were frequent. I am a student social worker who is on duty. I receive a call from Jacob’s carer to say they have gone to give Jacob his medication and noticed the carer the day before did not give Jacob his medication, that there is no record as to why or what actions have been taken around the missed medication. The carer has asked what they should do and if it is a safeguarding.

What actions would you advise the carer to do and would this be an adult safeguarding?

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1717078

Maggie (82) came into hospital after a fall, and on examination was found to be very frail and malnourished.  She was known to have severe hearing and cognitive impairments, though no formal diagnosis of dementia.  She was cared for by her son John (48) in the home they shared, but concerns were raised about John's capacity to care for his mother.  John has a history of alcohol problems and of declining or cancelling home care, though there is no suggestion that he is deliberately neglecting or mistreating Maggie.  Maggie wants to stay with her son and let him decide on all her affairs.  She has been assessed as lacking capacity in understanding her care needs and in safety awareness, as although she can understand and communicate effectively, she cannot retain or weigh up information.

On discharge, John reluctantly agrees to a package of home care for his mother and a key safe being installed, which Maggie consents to.  A few days later it emerges that the carers have not been able to access their home on several occasions - no one answers the door and the keys are not in the safe.  After several attempts the social worker manages to get through to John on the phone, who says that he will answer the door to carers, but he doesn't;  he appears confused and distressed, and concern is growing for both him and his mother who has not been seen by any carers for three days.  The social worker now considers consulting the CCG manager as to whether to call in the emergency services, as had to be done on a previous occasion, as prolonged negotiations with John are to no avail.

What should be the next course of action?  Consider the extent to which this is either a Safeguarding or a Deprivation of Liberty issue.

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Grace (72) has been diagnosed with vascular dementia with severe cognitive impairment and resides in a nursing home. She has been living at the care home for 2 years. Recently, Grace's day to day function has declined and refuses to take her daily medication. The nursing staff have tried many different methods to ensure Grace takes her medication however have been unsuccessful despite many attempts. They have now decided to give Grace her medication covertly by crushing the medication in her food. Grace is unaware of this. Furthermore, It has been reported that Grace has had many repeated falls in the past due to her declined mobility from which she sustained a severe hip fracture. Therefore, the staff have decided that Grace needs a wheel chair where she is strapped to avoid her falling and sustaining injury. Grace spends up to 9 hours in a day strapped in the wheel chair and often cries that she wants to get out.

Do you believe Grace is being deprived from her liberty and is this a safeguarding concern?what reasonable steps would you take?

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Mrs A (85) has been medically diagnosed with dementia and she lives in her privately owned home, with her unmarried daughter as a full time carer. Just the two of them live there. She has two other children who are not involved and do not live nearby.
Mrs A can make basic decisions but relies on her daughter for more complex decisions. She is clearly very attached and reliant on her daughter and gets upset when they are apart for too long.
Carers come in twice a day to assist getting in and out of bed, the daughter manages all other care needs. The carers have noticed that the daughter appears to be spending a lot of money on expensive items for herself, such as phones and other electronics. They are concerned about what is the source of the money and if Mrs A is aware of this and if any of her money is being spent. The care agency have reported this to social services.

Do you think this is a potential safeguarding and what actions would you take?

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Leah (35) has diagnoses of Learning Disability and Emotionally Unstable Personality Disorder, and lives in a private hospital setting under Section 3 of the Mental Health Act 2007. You are a social worker and see Leah for a routine visit. Leah informs you that staff kicked her yesterday. Leah has a history of regular unsubstantiated allegations against staff at the hospital and this is detailed in her behavioural support plan.

Is this a safeguarding concern? What would be your initial actions as this social worker?

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Sam (32) who has personality disorder is homeless since she relapsed at rehab and was kicked out by the rehab. Sam's Social worker tried to find another rehab for sam, but Sam was adamant that they did not want to go to another rehab and wanted to get high asap. After sam arrived back they were picked up from the station by their S/W there was a negotiation between sam's brother and s/w that sam could stay the weekend as long as sam didn't leave the house giving the s/w enough time to find another rehab by Monday. However sam left the family house, and the s/w had no way contacting sam as she had no phone, so because of this the s/w has been in constant contact with sams brother as sam has been harassing their brother for money. This has been the only way that the s/w can pass information to sam through her brother. Sam is continuously threatening her brother that is looking after her children. It has gotten so bad that social services are now involved and have given the children a psychotherapist in which they have said that sam does not visit the house and have any contact with her children as the children have expressed being afraid of Sam. Sam is now sofa surfing at drug dealers house and also has confessed to helping sell drugs for them but very adamant that she is not going to do it anymore. Furthermore sam has said that she has woken up with needle marks and says that dealers have been injecting her. Sam has also said that while staying at another addicts house due to Sam not wanting to engage in sexual favours with the person they ended up breaking Sams Ribs and would not let Sam leave for a while.

Is this a safeguarding concern? What actions would you have taken, and what would you do now?

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Loreen (45) has lost her job, and this has led to her being very anxious about money. Loreen has also started gambling. It now seems that she is going to lose her home. Loreen has family, but they do not want to speak to her, stating that all she does is ask them for money for gambling. Loreen has also robbed her family on several occasions. Prior to losing her job, Loreen was a successful manager of a large store, but she also managed to get into a lot of debt during this time. Loreen has started using pay day loan companies.

Is there any adult safeguarding concern here?

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Vivien (67) has been diagnosed with early onset dementia, and has had to leave work because she is no longer able to work at the level required. This has led to her becoming substantially depressed, and neglecting daily tasks. Vivien has become malnourished, and her house is very messy, with mouldy food laying around. It is unclear to professionals if her lack of attention to her daily care is due to her cognitive impairment, or due to her depression. Vivien has declined help from carers to support her.

Consider what is important in this case, apply the law, and consider the approach you would take.

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Sean (78) has a diagnosis of vascular dementia, and is living alone at home. He receives support from carers three times per week who visit to help clean his flat and to help him have a shower. Sean has a daughter, Alice (45) who lives about one hour away and visits occasionally. On a recent visit Alice noted that her dad didn’t have any money. Alice went with him to the cash point, and found that he had no money in it. When Alice asked Sean what happened to the money, he said that he gave it to a friend of his, Peter. Alice has never heard of Peter, and Sean says that he doesn’t remember where he met Peter, but he comes over to see him when he needs money. Alice is concerned about this, and although Sean asks her not to, she raises this concern with you.

Consider what is important in this case, apply the law and suggest what approach you would take.

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I worked as an OT student with a young man with learning disabilities who also had ongoing back problems impacting on his mobility. He lived with his mother, and she refused to let him go outside the flat, fearing that he would be hurt. While I didn’t think that this was nice for the individual, I didn’t think it met the criteria for adult safeguarding. When I spoke to him about going outside, it seemed he didn’t understand what I was trying to say.

Would this be safeguarding?

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As a social work student, I visited someone in the hospital to assess them for a return home. He had been in the hospital for several weeks after breaking his leg, and then having some issues with his heart. When I visited him, he showed me that he had a significant pressure sore on his bottom, and said that the nurses have only noticed this today, and are now trying to treat it. I then had to decide what to do?

Consider what is important in this case, apply the law and suggest what approach you would take.