| Recommendation | Action | Lead | Key milestone achieved in enacting recommendation |
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Tower Hamlets SeniorLeadership Team (SLT) carry out a dip sample of reports to ensure that ACN reports are being created where required
Tower Hamlets Police
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Ongoing dip sampling ofreports to ensurecompliance with MPS Vulnerability and Protection of Adults at Risk Toolkit
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MPS
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Dip sample search created to assess compliance
Completed: 31 October 2016
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All officers involved in the investigation of the domestic abused incidents reported to police should be de-briefed by the SLT in order to assess the officers’ knowledge of the Vulnerable Adult Framework (VAF)
Tower Hamlets Police
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All serving officers involved in Domestic Homicide Review advised of recommendation and reminded of requirements of MPS Vulnerability and Protection of Adults at Risk Toolkit
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MPS
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SLT arranged personal debriefs for all officers involved.
Completed: 26 October 2016
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In complex cases, or where concerns are raised, practitioners convene professionals meetings to share information
LBTH Adult social care
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Instruction to staff and managers to be advised of recommendation.
A Practitioner checklist audit process will be introduced.
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LBTH Adult social care |
Practitioner checklist audit process
Complete and ongoing: 31 October 2016
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Where, as a result of concern around safeguarding or risk behaviour, referrals are made to other agencies, practitioners do not close casework and they monitor responses so that their support planning can respond to advice and provision of the other agency. Where responses are delayed or insufficient to manage risk, practitioners remain involved to secure a response or escalate according to the risks or concerns that trigger the original request
LBTH Adult social care
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Instruction to staff and managers to be advised of recommendation. Supervision and practitioner checklist will identify unusual delays in casework progress and closure on a monthly basis.
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LBTH Adult social care
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Supervision and practitioner checklist to be introduced and auditing to start.
Complete and ongoing: 31 October 2016
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No patient should be considered for discharge from THCfMH within 24 hours of admission without the agreement of a senior member of staff. Senior members of staff include the following: the borough lead nurse and deputy borough lead nurse, the responsible clinician or duty consultant and the modern matron or ward manager.
ELFT
|
Instruction to be issued for dissemination to senior nurses and medical staff
setting out learning from the Serious Incident review: ‘During weekends no patient reviewed within 24 hours of admission should be discharged without discussion with the following staff: the Responsible Clinician or the Duty Consultant, the
Borough Lead Nurse or Matron’
|
ELFT |
Issue of internal memo Director of nursing to all senior nurses and medical staff.
Completed: 22 July 2016
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The senior management team of Tower Hamlets Specialist Addictions Services to review the migration strategy between EDM and Nebula and analyse the risks and benefits of further migration of all EDM patient data.
ELFT
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The strategy for on-going migration of patients between EDM and Nebula is that ALL new referrals should be checked against EDM, when a new referral is identified as previously being treated and having a record on EDM this record should be uploaded to the client record on Nebula.
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ELFT |
Policies and procedures for
paperless offices were
issued in November 2014
Recommendations as a
result of review:
1. Formalise in-service operational policy
2. Re-affirm policy with support system staff
3. Extend policy to include ex-service users who are subject to either a subject access request or request for information from complaints/incidents
4. Carry out audit of caseload to ascertain current compliance RESET are using Nebula, the team's operational policy reflects this. An audit has been completed to ensure that the system is functioning
Completed
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LBTH Adult Safeguarding Board to commission a task and finish group to review the specific learning from this review about effective communication between safeguarding agencies, adopting a ‘think family’ approach to develop a narrative case study to be shared at relevant Tower Hamlets Partnership learning event
LBTH
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Identify membership and form task and finish group to undertake review of learning from this review and prepare a narrative case study for use in learning events in LBTH
|
LBTH |
1. Form task and finish group within LBTH
2. Adopted ‘think family’ approach to develop a narrative case study from this review
3. Prepare plan for presentation of case study at relevant learning events in LBTH
4. Complete plan for presentations
5. Risk assessment resources created promoting Think Family Approaches.
6. High Risk Transition Panel set up to consider range of cases including cases where there is children and families involvement.
Completed: 31 December 2016
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LBTH Adult Safeguarding Board to commission a project working group to explore the greater use of CCTV in the context of adult safeguarding within a suspected domestic abuse environment and present findings and recommendations for consideration
LBTH
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Identify membership and form project working group to undertake review of potential use of CCTV in the context of an adult safeguarding environment and present findings and recommendations for consideration by LBTH Adult Safeguarding Board
|
LBTH
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1. Form project working group
2. Identify potential use of CCTV in the context of adult safeguarding
3. Identify risks, benefits and control measures (eg RIPA consent issues)
4. Present findings and recommendations to CSP
5. The CSP action plan did not recommend taking forward closed circuit TV idea. SAB did not consider it appropriate. Deemed unworkable by the police.
Completed: 31 December 2016
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