Bonnie lives in a care home and had recently had a stroke. There were concerns about how the care home were caring for her and how this was affecting her mental and physical wellbeing, and a safeguarding alert was raised. Bonnie was then referred to POhWER for help from an independent advocate to support with a Care Review as part of the Safeguarding Enquiry.

The Safeguarding Enquiry was looking into concerns of neglect as Bonnie was not being regularly transferred into her wheelchair and was being left isolated in her bedroom. This meant that she was unable to participate in any in-house activities arranged by the home. Also, that an Occupational Therapist had assessed Bonnie as needing a T-Roll so she could be repositioned in bed to avoid pressure sores and contractions because of the stroke, however this was not being used. 

Cassie, a POhWER advocate, visited Bonnie and observed her daily routine and how staff interacted with her, she also reviewed the records of her care. Cassie observed the issues that the Safeguarding Enquiry was looking into but also noticed other things that were concerning. Cassie raised her further concerns with the Safeguarding Team. She noted that Bonnie was being fed a purely pureed diet without having seen a Speech and Language Therapist (SALT) to assess any difficulties with swallowing and communication. Staff reported that Bonnie seemed to be getting fatigued when chewing solid foods, and was storing food in her mouth, which they felt caused a risk of her choking. 

Cassie also raised a concern that Bonnie was no longer being supported to access the community, although before her stroke it was reported that she used to really enjoy trips out. Staff explained that this was because the wheelchair Bonnie had been provided with after her stroke affected her mobility and was not suitable for use to access the community. The home manager reported that the home has a 'going out without going out' policy where residents are supported to attend other units of the home for afternoon activities to give them a change of scenery. Cassie pointed out that Bonnie had not been given the opportunity to take part in this and was told that this was also due to Bonnie’s wheelchair not being suitable as they would need to take her through the grounds to access the other units.

Cassie wrote up a Care Review Report which included the following points:

• A suggestion for the home to put in a referral for an Occupational Therapy Assessment to source a new outdoor wheelchair suitable for accessing the activities spaces in the home, and the community, to meet Bonnie’s wellbeing needs.
• A suggestion that, for the benefit of Bonnie’s physical and emotional wellbeing, her Care and Support Plan should include support to access the community once a suitable outdoor wheelchair has been sourced to reduce the level of deprivation that she is currently experiencing.
• It was a concern that the home were giving Bonnie only pureed meals without there having been a SALT assessment to recommend this practice.
• A suggestion for the home to put in a referral for a SALT assessment and in the meantime to give Bonnie the choice of whether she wants her meals blended.

As a result of the Care Review and Cassie’s report the home confirmed that the referral for the SALT assessment has been accepted, and in the meantime the home are giving Bonnie a choice of meals of either soft, bite sized food or blended food. Also, a referral to the wheelchair clinic has been accepted to ensure that Bonnie is reviewed and provided with an adequate wheelchair so that she can engage in social activities in a different part of the care home and in the community, reducing isolation and promoting positive wellbeing. The home also demonstrated that they were using the T-Roll to reposition Bonnie when she was in bed to avoid pressure sores and contractions.

After the completion of the Care Review, Cassie suggested that as part of the conclusion to the Safeguarding Enquiry Bonnie should be referred for advocacy support to ensure that the protective measures continue to be adhered to, and that the additional concerns she had raised are followed through to conclusion. This was agreed.

Cassie was allocated to the case and continues to advocate for Bonnie’s emotional and physical needs to be met and her rights to be upheld.