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Social workers

The following illustration may help:

I recently had to review a care placement for an 86-year-old woman who was living in a private residential care home. She had been deaf for several years prior to being in residence and recently experienced a fairly minor stroke which had left her partially paralysed on one side. The stroke had also affected her speech. She spent time each day in the home's day room in between meals and sleeping in her room. I could see that the quality of her life was rather poor, but she also had bruises on her face and forearm. I tried to ask her how she had got these bruises and I think she told me that someone had hit her, but it was difficult to make out what she was saying. I asked the staff if I could see the day log but there was no mention of her being injured; nor was there any reference in her case notes to the injuries. I was quite shocked but knew that I had to carefully consider what to do next. I was aware that my service user could be at continued risk; if she had been assaulted, I had to protect the evidence such as it was. I decided to speak with the manager about the bruises. She was somewhat taken aback when I mentioned it and said it was the first time she had seen the injuries. She thought they might have occurred getting in and out of her wheelchair, which I thought unlikely. I had to reflect on my feet during this discussion. I asked the manager to conduct an enquiry about how the bruises had occurred and to report to me before the end of the working day. I specifically told her that I had seen the log entries and case notes and that these did not refer to the injuries, in case post hoc notes where made. I returned to my office and discussed the incident with my supervisor. We decided to launch an adult safeguarding inquiry. I followed the authority's procedures and asked for my service user to be medically examined immediately and I informed the police about a potential assault. With my supervisor, I also discussed learning about observation and the importance of ensuring regular contact with our service users.

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