Safeguarding Adults in Care Homes

Safeguarding adults in care homes means protecting residents from abuse, neglect, exploitation and avoidable harm. It is about making sure people are safe, listened to, treated with dignity and supported to live as freely as possible, even when they need help with personal care, medication, mobility, dementia, nursing care or end-of-life support.

Most care homes work hard to care for residents well. But abuse and neglect can happen in any setting. Sometimes it is obvious, such as rough handling, unexplained injuries or staff shouting. Sometimes it is more subtle, such as poor hygiene, missed medication, pressure sores, dehydration, ignored call bells, financial pressure, unsafe restraint or a resident becoming withdrawn and frightened.

This guide explains what safeguarding means in care homes, the different types of abuse and neglect, warning signs families should look for, what care homes should do, how to raise a safeguarding concern, when to contact the local authority, when to contact CQC, and what may happen after a concern is reported.

If you are worried about quality of care more generally, you may also find our guides to care home red flags, what a good care home looks like and care home contracts useful.

What does adult safeguarding mean?

Adult safeguarding is the process of protecting adults who have care and support needs and may be unable to protect themselves from abuse or neglect. In a care home, this may include older people, people with dementia, people with disabilities, people with mental health needs, people recovering from stroke, people with Parkinson’s, people receiving nursing care, and people approaching the end of life.

The NHS explains that abuse and neglect of adults at risk can happen anywhere, including in care homes, hospitals, the person’s own home or public places. It also advises contacting the person’s local council and asking for the adult safeguarding co-ordinator if you are concerned. NHS guidance on abuse and neglect of adults at risk gives a clear overview.

Safeguarding is not only about reacting after serious harm. It should also prevent abuse and neglect from happening, reduce risks early, and make sure residents’ rights, wishes and dignity are respected.

The legal safeguarding duty in England

In England, adult safeguarding duties are mainly set out in the Care Act 2014. Section 42 of the Care Act says a local authority must make, or cause to be made, enquiries if it has reasonable cause to suspect that an adult in its area:

• has needs for care and support;
• is experiencing, or is at risk of, abuse or neglect;
• is unable to protect themselves because of those needs.

The official legislation is available at Care Act 2014, Section 42.

This is important because families sometimes think they need proof before reporting a concern. You do not need to prove abuse yourself. You need to raise a reasonable concern so the appropriate people can decide what enquiries or action are needed.

Safeguarding is not the same as every complaint

Not every problem in a care home is automatically a safeguarding issue. Some issues are quality concerns or complaints, such as poor communication, food preferences not being followed, laundry problems or delays in answering emails.

However, a complaint can become a safeguarding concern if there is harm, risk of harm, neglect, abuse, repeated serious failures or the resident cannot protect themselves.

For example:

• A single lost cardigan is usually a complaint.
• Repeated missing money or belongings may be a safeguarding concern.
• One delayed cup of tea is usually a complaint.
• Repeated dehydration, weight loss or ignored nutrition needs may be neglect.
• A disagreement about room decoration is usually not safeguarding.
• A resident being frightened, restrained, shouted at or isolated may be safeguarding.

If you are unsure, it is better to ask. The local authority safeguarding team can decide whether it meets the threshold for safeguarding action.

Types of abuse and neglect in care homes

Abuse and neglect can take many forms. It may be caused by one person, several people, poor systems, unsafe staffing, weak management, lack of training or a culture where residents are not listened to.

Physical abuse

Physical abuse may include hitting, pushing, slapping, rough handling, inappropriate restraint, force-feeding, inappropriate use of medication, or moving someone unsafely.

Possible signs include:

• unexplained bruises, cuts, burns or fractures;
• injuries in unusual places;
• the resident flinching or becoming frightened around certain staff;
• staff giving vague explanations for injuries;
• repeated falls without proper review;
• marks on wrists or arms from restraint;
• changes in behaviour after certain shifts or visits.

Emotional or psychological abuse

Emotional abuse may include shouting, humiliation, threats, intimidation, ignoring the person, mocking, blaming, isolating them, treating them like a child, or deliberately causing fear.

Possible signs include:

• the resident becoming withdrawn, tearful or anxious;
• fear around certain staff or residents;
• loss of confidence;
• changes in sleep or appetite;
• the resident saying they are being shouted at or threatened;
• staff speaking disrespectfully about residents;
• the person becoming unusually quiet when staff enter.

Neglect and acts of omission

Neglect means failing to provide necessary care and support. It may be deliberate, but it can also happen because of poor staffing, poor training, poor management or weak systems.

Possible signs include:

• poor hygiene;
• dirty clothes or bedding;
• missed medication;
• untreated pain;
• dehydration;
• unexplained weight loss;
• pressure sores;
• frequent falls without action;
• call bells ignored;
• poor mouth care;
• the resident being left in wet or soiled clothing;
• medical appointments missed;
• care plans not followed.

Financial abuse

Financial abuse means using someone’s money, property or possessions without proper consent or authority. In care homes, this may involve staff, other residents, visitors, relatives or outside scammers.

Possible signs include:

• missing cash or bank cards;
• unexplained withdrawals;
• pressure to give gifts or money;
• changes to wills or financial documents under pressure;
• missing jewellery or possessions;
• unpaid care home bills despite available funds;
• the resident seeming worried about money;
• someone controlling visits, phone calls or access to finances.

Sexual abuse

Sexual abuse includes any sexual contact, behaviour or exposure without valid consent. It can happen to adults of any age, including people with dementia or communication difficulties.

Possible signs include:

• unexplained genital pain, bleeding or bruising;
• torn or stained underwear;
• fear of a particular person;
• sexualised behaviour that is unusual for the person;
• new distress during personal care;
• the person disclosing unwanted contact;
• staff dismissing serious concerns as “confusion” without investigation.

If you believe a resident is in immediate danger, call 999.

Discriminatory abuse

Discriminatory abuse involves unfair or harmful treatment because of age, disability, race, religion, sex, sexual orientation, gender identity or another protected characteristic.

Possible signs include:

• racist, sexist, homophobic or ableist comments;
• religious or cultural needs ignored;
• mocking disability, speech or dementia symptoms;
• unequal access to activities or care;
• the resident being isolated or treated differently;
• staff dismissing identity, relationships or beliefs.

Organisational abuse

Organisational abuse is poor or abusive care caused by the way a service is run. It may affect many residents, not just one person.

Examples include:

• unsafe staffing levels;
• rushed personal care;
• residents left in bed too long;
• meals, medication or toileting needs delayed;
• poor infection control;
• blanket rules that ignore individual needs;
• residents discouraged from complaining;
• poor record keeping;
• failure to learn from incidents;
• normalising neglect as “just how things are”.

Domestic abuse

Domestic abuse can still affect someone living in a care home. It may involve a spouse, partner, former partner, adult child or other family member. It may include coercive control, threats, financial control, emotional abuse or physical harm.

Possible signs include:

• a resident becoming anxious before or after certain visits;
• a visitor speaking for the resident or controlling contact;
• pressure over money or property;
• threats or intimidation;
• the resident saying they are afraid of someone;
• family conflict that affects care decisions.

Self-neglect

Self-neglect means someone is not meeting their own basic needs, such as eating, drinking, washing, taking medication or accepting essential care. In a care home, this can be complex because staff must balance safety, choice, mental capacity and dignity.

Self-neglect may involve:

• refusing food or drink;
• refusing personal care;
• refusing medication;
• not allowing staff to clean or change clothing;
• unsafe behaviour despite support;
• severe hoarding or unsafe possessions in the room.

Self-neglect should not be ignored. Staff should consider mental capacity, health causes, pain, depression, dementia, trauma, communication and least restrictive ways to reduce risk.

Warning signs families should not ignore

One small concern may have an innocent explanation. But patterns matter. Families should pay attention to repeated issues, changes in personality, poor explanations and concerns that are dismissed.

Possible warning signs include:

• unexplained bruising or injuries;
• frequent falls without a clear prevention plan;
• pressure sores or worsening skin problems;
• weight loss or dehydration;
• resident appears frightened, withdrawn or unusually quiet;
• dirty clothing, bedding or room;
• strong smell of urine or poor continence care;
• medication errors or missed medication;
• call bell out of reach;
• staff seem rushed, dismissive or defensive;
• the resident says they are being hurt, shouted at or ignored;
• family are discouraged from visiting at certain times;
• visiting feels unusually restricted without good reason;
• records are missing or inconsistent;
• other residents appear distressed or neglected;
• money or belongings go missing;
• complaints are ignored or lead to hostility.

Do not assume that a person with dementia is “making it up”. Dementia can affect memory and interpretation, but disclosures should still be taken seriously and explored safely.

What should a care home do to prevent abuse and neglect?

A good care home should have safeguarding built into everyday care, not treated as paperwork only.

This should include:

• safe recruitment checks;
• staff training in safeguarding;
• clear reporting procedures;
• good staffing levels and supervision;
• person-centred care plans;
• proper medication management;
• falls prevention and review;
• pressure sore prevention;
• safe moving and handling;
• respect for dignity and privacy;
• regular care plan reviews;
• open visiting and communication where appropriate;
• whistleblowing policy for staff;
• learning from incidents and complaints.

SCIE says care home managers and staff should be trained in their responsibilities for reporting and recording concerns about abuse or neglect, and care homes should have whistleblowing policies so staff can raise concerns safely. SCIE guidance on safety and safeguarding in care homes explains these responsibilities.

What is the care home manager’s role?

The care home manager has a key role in safeguarding. They should make sure concerns are taken seriously, recorded, reported and investigated appropriately.

A good manager should:

• listen to residents and families;
• take immediate action if someone is at risk;
• report safeguarding concerns to the local authority where required;
• notify CQC of relevant incidents in England;
• protect evidence where needed;
• support staff to report concerns;
• make sure care plans are updated;
• communicate clearly with families where appropriate;
• avoid defensiveness or retaliation;
• learn from incidents and improve systems.

If a manager dismisses serious concerns, refuses to record them, blames the resident, threatens family, or discourages reporting, this is itself a warning sign.

What is the local authority’s role?

The local authority is the lead organisation for adult safeguarding. If it believes the Care Act Section 42 criteria may be met, it must make enquiries or arrange for others to make enquiries.

A local authority safeguarding enquiry may look at:

• what happened;
• whether the adult is still at risk;
• what the adult wants to happen;
• whether immediate protection is needed;
• whether the care home followed procedures;
• whether other residents may be at risk;
• whether police, CQC, NHS or other professionals should be involved;
• what action is needed to reduce risk.

The CQC’s local authority assessment framework says Section 42 safeguarding enquiries should be carried out sensitively and without delay, keeping the wishes and best interests of the person at the centre. CQC safeguarding framework for local authorities explains these expectations.

What is CQC’s role?

In England, the Care Quality Commission regulates care homes and home care agencies. CQC does not usually investigate individual safeguarding concerns in the same way as the local authority, but it uses information from the public, staff and professionals to decide when and where to inspect and whether action is needed.

You can tell CQC about concerns such as:

• unsafe care;
• neglect;
• poor staffing;
• medication problems;
• poor management;
• failure to report incidents;
• patterns affecting several residents;
• serious concerns about a provider’s safety or leadership.

CQC says people can report concerns about the safety of a person receiving care and that this information helps it decide what to inspect. CQC guidance on safeguarding people explains how CQC uses concerns.

If someone is in immediate danger, call 999 first. If you are raising an adult safeguarding concern, contact the local authority safeguarding team. CQC can also be informed, especially if the concern suggests wider service failure.

Who should you contact if you are worried?

Who you contact depends on urgency and risk.

If there is immediate danger

Call 999 if someone is at immediate risk of serious harm, has been assaulted, has a serious injury, is in danger, or a crime may be happening now.

If urgent medical help is needed

Call NHS 111, the GP, district nurse or 999 depending on severity.

If you suspect abuse or neglect

Contact the resident’s local council adult safeguarding team. Ask for adult safeguarding or the safeguarding adults team.

If the concern is about the care home’s quality or safety

Raise it with the care home manager if it is safe to do so. You can also inform CQC in England, especially if the problem may affect other residents.

If you need advice

The NHS suggests contacting the free Hourglass helpline for advice about abuse of older people. You can also contact Age UK, Citizens Advice, a social worker, GP or local advocacy service.

How to raise a safeguarding concern

When raising a concern, be specific and factual. You do not need perfect evidence, but clear examples help.

Include:

• the resident’s name and care home;
• what you are worried about;
• dates and times if known;
• names of staff or witnesses if known;
• injuries, changes or incidents you have seen;
• what the resident said;
• photos or documents if relevant and appropriate;
• whether the person is in immediate danger;
• whether the care home has been told;
• what response you received;
• what you think needs to happen now.

You might say:

“I want to raise an adult safeguarding concern about my mother in a care home. She has unexplained bruising, has lost weight, and told me staff are rough when helping her wash. I raised this with the manager on Monday but have not received a clear explanation. I am worried she may be at risk of abuse or neglect.”

What evidence should families keep?

You do not need to become an investigator, but keeping clear records can help professionals understand the pattern.

Keep:

• dates and times of concerns;
• photos of visible injuries or poor conditions, where appropriate;
• notes of what the resident said;
• names of staff spoken to;
• copies of emails and letters;
• records of phone calls;
• care home explanations;
• medical letters or hospital notes if relevant;
• photos of pressure sores, bruises or unsafe conditions where appropriate;
• records of missed medication, falls or weight loss;
• complaints and responses.

Do not secretly record staff unless you have taken legal advice and understand the risks. If you are considering cameras, audio recording or covert monitoring, get advice first because privacy, consent and legal issues can be complicated.

What happens after a safeguarding concern is raised?

The process varies depending on the concern, risk and local authority. But common steps may include:

• initial screening by the safeguarding team;
• checking whether the Section 42 criteria may be met;
• immediate safety action if needed;
• speaking to the resident where possible;
• considering mental capacity and consent;
• asking the care home for information;
• reviewing care records;
• involving social workers, NHS staff, police or CQC where needed;
• holding a safeguarding meeting;
• creating a protection plan;
• reviewing whether risks have reduced.

The adult’s wishes should be central where possible. Safeguarding should not be done “to” a person without considering what they want, unless immediate risk, mental capacity or wider public interest requires action.

Can you report without the resident’s consent?

This depends on the situation. If the resident has mental capacity and does not want a concern raised, professionals should usually consider their wishes carefully. But there are situations where concerns may still need to be reported, for example if:

• the person is at serious risk;
• others may also be at risk;
• a crime may have been committed;
• the person may lack capacity to understand the risk;
• there is coercion or control;
• staff or organisational abuse is suspected;
• the concern involves serious neglect or unsafe practice.

If you are unsure, contact the safeguarding team and explain the situation. They can advise on next steps.

Mental capacity and safeguarding

Mental capacity is decision-specific. A resident may be able to decide what to eat but not understand the risk of refusing pressure sore care, medication or protection from abuse.

If a safeguarding concern involves a resident who may lack capacity, professionals should consider whether a mental capacity assessment is needed for relevant decisions.

Important questions include:

• Does the resident understand the concern?
• Can they weigh up the risks?
• Can they communicate what they want?
• Is there a health and welfare Lasting Power of Attorney?
• Is an advocate needed?
• What is in the resident’s best interests?
• What is the least restrictive way to keep them safe?

A resident should not be ignored because they have dementia or communication difficulties. Professionals should make reasonable efforts to understand their wishes.

Safeguarding and restraint

Restraint can be physical, chemical, environmental or psychological. It may include holding someone down, blocking exits, using bed rails without proper assessment, overusing sedating medication, locking someone in, or threatening consequences if they move.

Sometimes restrictions may be necessary to prevent serious harm, but they must be lawful, proportionate, properly recorded and the least restrictive option.

Warning signs include:

• staff using restraint casually;
• bed rails used without assessment;
• sedating medication used mainly to make care easier;
• residents prevented from leaving without legal safeguards;
• lack of mental capacity or best interests records;
• families not told about restrictions;
• residents appearing over-sedated or unusually drowsy.

If you are worried about restraint, ask the manager for the assessment, care plan, mental capacity decision and legal authorisation where relevant.

Safeguarding and Deprivation of Liberty Safeguards

Some care home residents who lack mental capacity may be under continuous supervision and not free to leave because this is necessary to keep them safe. In England and Wales, Deprivation of Liberty Safeguards, often called DoLS, have historically been used to authorise this in care homes and hospitals.

This is a complex and developing legal area. Recent court decisions and future reforms may affect how deprivation of liberty is interpreted and authorised. Families should ask the care home or local authority for current advice if a resident lacks capacity and is being prevented from leaving or is under significant restrictions.

Questions to ask include:

• Has mental capacity been assessed?
• Is the resident free to leave?
• Is a DoLS authorisation in place or being considered?
• Who is the relevant person’s representative?
• How are restrictions reviewed?
• What is the least restrictive option?

Safeguarding and medication

Medication errors can be safeguarding concerns if they cause harm, create serious risk or reveal poor systems. This may include missed medication, wrong doses, medication given to the wrong person, over-sedation, poor controlled drug records or repeated failures to follow prescriptions.

Be alert to:

• missed medication without explanation;
• new drowsiness or confusion;
• medication used to control behaviour without proper review;
• Parkinson’s medication given late;
• pain relief not given when needed;
• insulin or blood thinners mishandled;
• family not told about medication changes;
• poor medication records.

Ask to speak to the manager, GP, pharmacist or nurse if medication safety is a concern. If there is immediate risk, seek urgent medical help.

Safeguarding and pressure sores

Pressure sores can sometimes occur even with good care, especially in very frail or seriously ill residents. But pressure sores may also indicate neglect if risks were not assessed, equipment was not used, repositioning did not happen, nutrition was poor, or concerns were ignored.

Ask:

• Was pressure sore risk assessed?
• Is a pressure-relieving mattress or cushion used?
• Is there a repositioning plan?
• Are skin checks recorded?
• Has a nurse, GP or tissue viability service been involved?
• When was family informed?
• What action is being taken now?

If a pressure sore is severe, worsening or unexplained, it may need safeguarding consideration.

Safeguarding and falls

Falls are common in care homes, but repeated falls without proper assessment or prevention may be a concern.

Ask:

• What happened before the fall?
• Was the resident injured?
• Was medical help needed?
• Was family informed promptly?
• Was a falls risk assessment updated?
• Were medication, eyesight, footwear, mobility and environment reviewed?
• Does the person need more supervision?
• Are staff following the care plan?

A fall is not automatically neglect. But repeated falls, poor records, delayed medical help or no prevention plan should be taken seriously.

Safeguarding and nutrition

Care homes should support residents to eat and drink safely and adequately. Weight loss, dehydration or swallowing problems should be assessed and acted on.

Possible safeguarding concerns include:

• significant unexplained weight loss;
• poor fluid intake;
• meals left out of reach;
• lack of support for residents who cannot feed themselves;
• swallowing guidance ignored;
• food preferences or cultural needs repeatedly ignored;
• no action after choking, coughing or chest infections;
• poor mouth care affecting eating.

Ask for weight records, food and fluid charts where used, dietitian input, speech and language therapy advice if swallowing is a concern, and the current nutrition plan.

Safeguarding and dementia

Residents with dementia may be at higher risk because they may struggle to report abuse, remember events, understand risks or protect themselves. They may also be wrongly dismissed if they do speak up.

Safeguarding concerns in dementia care may include:

• rough handling during personal care;
• distress dismissed as “challenging behaviour”;
• unsafe wandering without a plan;
• inappropriate restraint;
• over-sedation;
• poor continence care;
• ignored pain;
• family concerns dismissed because the person has dementia;
• staff not trained in dementia care.

Read our guide to dementia care homes in the UK for more on what good dementia support should look like.

What if the care home retaliates after a complaint?

Families sometimes worry that complaining will make care worse. A good care home should welcome concerns and protect residents from retaliation. Retaliation or hostility after a concern is raised is a serious warning sign.

Examples may include:

• staff becoming hostile to the resident;
• family visits becoming difficult without good reason;
• threats to evict the resident because family complained;
• care suddenly becoming less responsive;
• the resident being blamed for family concerns;
• family being labelled as troublemakers.

If you fear retaliation, raise the concern directly with the local authority safeguarding team and explain why you do not feel safe handling it only through the care home.

Can a care home ask a resident to leave after safeguarding concerns?

A care home may sometimes give notice if it can no longer meet a resident’s needs, but it should follow the contract and proper process. It should not use eviction threats to silence legitimate safeguarding concerns.

If notice is given after you raise concerns, ask:

• What is the stated reason?
• What does the contract say?
• Has the local authority been informed if the resident is funded or at risk?
• Is the resident safe while alternatives are arranged?
• Is this linked to family raising concerns?
• Should safeguarding be informed?

Read our guide to care home contracts if you are dealing with notice periods, fees or guarantor issues.

What if other residents are at risk too?

If the concern suggests a wider service problem, such as unsafe staffing, poor medication systems, rough handling by a staff member, or neglect affecting several residents, make this clear when reporting.

Wider concerns may require:

• local authority safeguarding enquiry;
• CQC notification or inspection activity;
• police involvement if a crime is suspected;
• NHS involvement if clinical care is affected;
• provider action plan;
• review of other residents’ safety.

Do not assume someone else has reported it. If you are worried, raise it.

Whistleblowing by care home staff

Care home staff may see things families do not. They may worry about poor care, unsafe staffing, abuse, neglect or management ignoring concerns.

Staff should be able to raise concerns internally and, where necessary, externally. SCIE notes that all care homes should have a whistleblowing policy to guide staff in raising concerns where it is unsafe to do so internally or where a concern has been ignored.

If a staff member tells you they are worried, take it seriously. Encourage them to follow whistleblowing procedures, contact the local authority safeguarding team, CQC or relevant professional body where appropriate.

How to talk to the resident

If you are worried, speak to the resident gently and privately if possible. Do not interrogate them, especially if they are distressed or have dementia.

You might ask:

• “Do you feel safe here?”
• “Has anyone upset you?”
• “Are staff kind when they help you?”
• “Is there anything you want me to know?”
• “Would you like me to speak to someone for you?”

If they disclose abuse or neglect, stay calm. Reassure them that you believe them and that they have done the right thing by telling you. Do not promise to keep it secret if they or others may be at risk. Explain that you may need to get help to keep them safe.

How to raise concerns with the care home

If there is no immediate danger and it feels safe to do so, you can raise the concern with the care home manager.

Ask for:

• a meeting with the manager;
• written notes of the concern;
• an explanation of what happened;
• copies or summaries of relevant care records where appropriate;
• a clear action plan;
• a timescale for response;
• confirmation of whether safeguarding has been notified;
• confirmation of whether CQC has been notified if required.

Follow up by email so there is a written record.

When to go straight to safeguarding instead of the manager

Go straight to the local authority safeguarding team, or 999 if urgent, if:

• someone is in immediate danger;
• a crime may have been committed;
• you suspect physical or sexual abuse;
• the manager may be involved;
• the care home has ignored previous concerns;
• you fear retaliation;
• several residents may be at risk;
• there is serious neglect;
• evidence may be hidden or altered;
• the resident cannot speak up for themselves.

You can still inform the manager later if appropriate, but immediate safety comes first.

What if the concern is not accepted as safeguarding?

Sometimes a local authority may decide that a concern does not meet the threshold for a Section 42 safeguarding enquiry. That does not necessarily mean nothing should happen.

You can ask:

• Why did it not meet the threshold?
• Will it be treated as another type of safeguarding enquiry or quality concern?
• Who will follow it up?
• Should the care home complete an action plan?
• Should CQC be informed?
• Can the decision be reviewed if more evidence appears?
• How can the resident be protected now?

If risk continues, keep records and raise further concerns with specific examples.

Safeguarding Adults Reviews

A Safeguarding Adults Review may be required when an adult with care and support needs has died or experienced serious abuse or neglect, and there is concern about how agencies worked together to safeguard them.

NHS England explains that Safeguarding Adults Reviews are required under the Care Act and are convened by Safeguarding Adults Boards in serious cases where there is reasonable cause for concern about multi-agency working. NHS England safeguarding guidance discusses these reviews.

Families affected by serious harm can ask whether a Safeguarding Adults Review should be considered, although the Safeguarding Adults Board decides whether criteria are met.

How to choose a care home with safeguarding in mind

Safeguarding should be part of choosing a care home, not only something considered after a problem.

When visiting, ask:

• Who is the safeguarding lead?
• How are staff trained in safeguarding?
• How are concerns reported?
• How do you manage complaints?
• How do you support whistleblowing?
• How do you prevent pressure sores?
• How are falls reviewed?
• How are medication errors handled?
• How do you support residents who cannot speak up?
• How do you involve families?
• How do you learn from incidents?

A good care home should answer openly. Defensive or vague answers are not reassuring.

Safeguarding checklist for families

If you are worried now

• Check whether the resident is in immediate danger.
• Call 999 if there is urgent risk or a crime may be happening.
• Record what you have seen, heard and been told.
• Raise the concern with the manager if safe and appropriate.
• Contact the local authority adult safeguarding team.
• Tell CQC if the concern suggests unsafe care or wider service failure.
• Seek medical help if there are injuries, illness, dehydration or pain.

Information to record

• Dates and times.
• Names of people involved.
• What the resident said.
• Visible injuries or changes.
• Photos where appropriate.
• Who you reported to.
• What response you received.
• What action was promised.

Questions to ask the care home

• Has this been recorded as a safeguarding concern?
• Has the local authority been notified?
• Has CQC been notified if required?
• What immediate action has been taken?
• How is the resident being protected?
• Are other residents at risk?
• Who is investigating?
• When will we receive an update?

Common mistakes families make

Waiting for proof

You do not need to prove abuse before reporting a concern. Safeguarding teams decide what enquiries are needed.

Accepting vague explanations

If explanations keep changing or do not fit the facts, ask for the concern to be recorded and escalated.

Only complaining verbally

Follow up important concerns in writing so there is a record.

Assuming dementia invalidates concerns

People with dementia can still experience abuse and neglect. Their concerns should be taken seriously.

Focusing only on one incident

Patterns matter. Record repeated falls, missed care, weight loss, injuries, poor hygiene or distress.

Not escalating when the home ignores concerns

If the care home does not respond properly, contact adult safeguarding and CQC where appropriate.

Final thoughts

Safeguarding adults in care homes is about protecting people who may not always be able to protect themselves. It is about preventing abuse and neglect, responding quickly when concerns arise, and making sure residents are treated with dignity, respect and humanity.

If you are worried, do not dismiss your instincts. Speak to the resident if possible, record what you notice, raise concerns with the manager where safe, and contact the local authority adult safeguarding team if you suspect abuse or neglect. If there is immediate danger, call 999.

Good care homes welcome scrutiny. They listen, record, explain, report and improve. Poor services may minimise, delay, blame or intimidate. Families do not need to prove everything before asking for help. A reasonable concern is enough to start the right questions.

For related guidance, read our articles on care home red flags, what a good care home looks like, care home visit questions and care homes for people with challenging behaviour.

Frequently asked questions

What is safeguarding in a care home?

Safeguarding in a care home means protecting residents from abuse, neglect, exploitation and avoidable harm. It includes preventing problems, responding to concerns, listening to residents and reporting risks properly.

Who is responsible for safeguarding care home residents?

The care home has a duty to keep residents safe and report concerns. The local authority leads adult safeguarding enquiries. CQC regulates care homes in England and uses concerns to inform inspection and enforcement activity.

What are signs of neglect in a care home?

Signs may include poor hygiene, dirty clothes or bedding, dehydration, weight loss, pressure sores, missed medication, ignored call bells, repeated falls without review, untreated pain or the resident being left in unsafe conditions.

What are signs of abuse in a care home?

Signs may include unexplained injuries, fear around certain staff, sudden withdrawal, distress, missing money, rough handling, shouting, threats, sexualised distress, over-sedation or the resident saying they are being hurt or ignored.

Do I need proof before reporting a safeguarding concern?

No. You do not need to prove abuse or neglect yourself. If you have a reasonable concern, report it so the local authority or relevant professionals can decide what enquiries are needed.

Who do I report care home abuse to?

If there is immediate danger, call 999. Otherwise, contact the local authority adult safeguarding team. You can also raise concerns with the care home manager and inform CQC in England if the concern relates to unsafe or poor-quality care.

Should I tell the care home manager first?

If it is safe and not urgent, you can raise concerns with the manager. Go directly to safeguarding or emergency services if there is immediate danger, a crime may have occurred, the manager may be involved, or you fear the concern will be covered up.

Can I report anonymously?

Safeguarding teams and regulators may accept anonymous concerns, but giving contact details can help them ask follow-up questions. If you fear retaliation, explain this when reporting.

What is a Section 42 enquiry?

A Section 42 enquiry is a safeguarding enquiry under the Care Act 2014. The local authority must make enquiries if it has reasonable cause to suspect an adult with care and support needs is at risk of abuse or neglect and cannot protect themselves because of those needs.

What happens after a safeguarding concern is raised?

The local authority may screen the concern, consider risk, speak to the adult where possible, involve the care home and professionals, review records, arrange a safeguarding meeting and create a plan to reduce risk.

Can a person with dementia raise a safeguarding concern?

Yes. A person with dementia can still experience and disclose abuse or neglect. Their concerns should be taken seriously and explored carefully, even if memory or communication is affected.

What if the care home ignores my concern?

Escalate it. Contact the local authority adult safeguarding team, inform CQC in England where appropriate, seek medical help if needed, and keep written records of what you reported and how the home responded.

Can poor care be safeguarding?

Yes, if poor care causes harm, creates serious risk, is repeated, or shows neglect or unsafe systems. Minor service complaints may not be safeguarding, but patterns of serious poor care should be escalated.

What if other residents may also be at risk?

Tell the safeguarding team and CQC. Concerns affecting several residents may indicate organisational abuse or unsafe systems and may require wider investigation.

Can a care home evict someone after a safeguarding complaint?

A care home may give notice if it genuinely cannot meet a resident’s needs, but it should follow the contract and proper process. It should not use eviction threats to silence legitimate safeguarding concerns.