Common use of Details of concern Clause in Contracts

Details of concern. Cause of death as set out in the death certificate (if appropriate) or suspected type of abuse or neglect Family / Next of Kin / Nearest Relative / Advocate / Representative: Date of incident: Location of Incident: Brief Summary of the Case: (Including notes of any Safeguarding meetings held) Other agencies known to be involved: Identify the factors that suggest this case meets the criteria for an SAR: Date of Notification: Name of Referrer: Agency of Referrer: Date considered by SAR group: Decision/Action taken: Please be aware that when this form has been completed, it will contain information that is personal and sensitive. When sending it to the Surrey Safeguarding Adults Board you must ensure you comply with all relevant data protection laws and, if relevant, your agency’s information sharing policies. Members of the public can use this form and should protect the document with a password and send the password separately to the Surrey Safeguarding Adults Board or alternatively send it by post. By email to: ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇.▇▇ Appendix 2 – Agency summary of involvement A SAR notification has been received for the person detailed below. Please complete this form with information from your organisation only. The information you supply on this form will be used for the purpose of deciding whether the criteria for holding a Safeguarding Adults Review has been met. Section 45 of the Care Act 2014 provides the legal context for you to share information that is necessary and proportionate to assist the Safeguarding Adults Board. The form is sent out to all agencies, you are asked to complete only those questions on which your organisation holds information, alternatively please indicate that this person and their family were not known to your services. This pro-forma should be completed by the Lead Safeguarding Adult’s professional in your organisation and sent to the Safeguarding Adults Board Manager by secure email with the appropriate protective marking. Agency: Person identified for completing IMR and chronology should a review be undertaken: (and e-mail) Factual summary of agency involvement: Provide a brief factual and contextual summary of your agency’s involvement with the adult for the time period identified for this Safeguarding Adult Review. Note the following key information:  significant events, attendance at appointments;  involvement of other agencies/friends/family (with contact info where possible);  changes in level of need/engagement with agencies and  referrals of concerns, and how these were received by other agencies. (Additional sections of the table can be added if required by clicking on ‘Layout’ and then ‘Insert Below’) I confirm that this is an accurate Summary of Involvement in line with the Sussex Safeguarding Adults Review protocol. Signed: Date:_ Job Title: Please ensure that all information requested above has been passed to Senior managers within your agency prior to returning to the Safeguarding Adults Board.

Details of concern. Cause of death as set out in the death certificate (if appropriate) or suspected type of abuse or neglect Family / Next of Kin / Nearest Relative / Advocate / Representative: Date of incident: Location of Incident: Brief Summary of the Case: (Including notes of any Safeguarding meetings held) Other agencies known to be involved: Identify the factors that suggest this case meets the criteria for an SAR: Date of Notification: Name of Referrer: Agency of Referrer: Date considered by SAR group: Decision/Action taken: Please be aware that when this form has been completed, it will contain information that is personal and sensitive. When sending it to the Surrey Safeguarding Adults Board you must ensure you comply with all relevant data protection laws and, if relevant, your agency’s information sharing policies. Members of the public can use this form and should protect the document with a password and send the password separately to the Surrey Safeguarding Adults Board or alternatively send it by post. By email to: ▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇.▇▇ Appendix 2 – Agency summary of involvement A SAR notification has been received for the person detailed below. Please complete this form with information from your organisation only. The information you supply on this form will be used for the purpose of deciding whether the criteria for holding a Safeguarding Adults Review has been met. Section 45 of the Care Act 2014 provides the legal context for you to share information that is necessary and proportionate to assist the Safeguarding Adults Board. The form is sent out to all agencies, you are asked to complete only those questions on which your organisation holds information, alternatively please indicate that this person and their family were not known to your services. This pro-forma should be completed by the Lead Safeguarding Adult’s professional in your organisation and sent to the Safeguarding Adults Board Manager by secure email with the appropriate protective marking. Agency: Person identified for completing IMR and chronology should a review be undertaken: (and e-mail) Factual summary of agency involvement: Provide a brief factual and contextual summary of your agency’s involvement with the adult for the time period identified for this Safeguarding Adult Review. Note the following key information:  • significant events, attendance at appointments;  • involvement of other agencies/friends/family (with contact info where possible);  • changes in level of need/engagement with agencies and  • referrals of concerns, and how these were received by other agencies. (Additional sections of the table can be added if required by clicking on ‘Layout’ and then ‘Insert Below’) I confirm that this is an accurate Summary of Involvement in line with the Sussex Safeguarding Adults Review protocol. Signed: Date:_ Job Title: Please ensure that all information requested above has been passed to Senior managers within your agency prior to returning to the Safeguarding Adults Board.