Suspected abuse or neglect in a care home: what to do in the first 72 hours

First: it is not paranoia, and it is more common than anyone admits

A bruise on the arm nobody can explain. Your mother suddenly "settled" and absent. A pad wet for hours. A call bell ringing while you stand there. The feeling that something is wrong almost always arrives before the evidence — and the first instinct (raising your voice on the corridor, taking her out that afternoon) is understandable but usually weakens your position.

Here is the order that works.

What counts as abuse — not just hitting

• Neglect: hygiene left undone, dehydration, meals not given to someone who cannot eat unaided, pressure sores that developed in the home, repeated falls with no action taken.
• Improper restraint: bed rails, belts, chairs that immobilise — with no assessment, no review and nobody having told you. Restraint must be necessary, proportionate and recorded; anything restricting liberty for someone who lacks capacity requires proper authorisation under the Mental Capacity Act.
• Chemical restraint: sedatives or antipsychotics used to keep someone quiet. For people with dementia these must be justified, documented and reviewed — not standing practice on a shift.
• Physical or psychological abuse: rough handling, shouting, humiliation, threats, isolation as punishment.
• Financial abuse: money or belongings going missing, signatures on documents, pressure on the resident.

The first 72 hours

1. Photograph, with the date showing. Bruises, redness on the sacrum and heels, the state of the room. Dated photographs count for far more than recollection.
2. Keep a log: date, time, what you saw, who was present, what you were told. Record the "I don't knows" too.
3. Get your relative seen by a doctor from outside the home if there are physical signs — the GP or A&E. An independent record is the strongest evidence there is.
4. Do not confront the carer on shift alone. Ask in writing for a meeting with the manager and the clinical lead, setting out the facts and your questions. A letter or email creates a date; a remark in the corridor leaves nothing.
5. Request the care records: daily notes, the medication administration record (MAR chart), falls log, pressure-area risk assessments. Ask in writing and keep proof of the request.
6. If there is immediate danger, call 999. Do not wait for the meeting.

Who to report to, in order of effect

• The home's manager, in writing — they must respond and log the complaint.
• The local council's adult safeguarding team. This is the one that matters most: a safeguarding concern triggers a formal enquiry under Section 42 of the Care Act, and you do not need proof to raise one — a reasonable concern is enough. Anyone can raise it, including a relative.
• CQC (or the Care Inspectorate in Scotland, CIW in Wales, RQIA in Northern Ireland): they cannot resolve an individual complaint but inspections and ratings follow the intelligence they receive.
• Police: 101 for a non-emergency, 999 for immediate danger. Physical assault and theft are crimes wherever they happen.
• Local Government and Social Care Ombudsman, once the home and the council have responded and you are not satisfied.
• Attorney or deputy, if one is appointed: they have a duty to act, and the Office of the Public Guardian can be told if they are not.

If your relative cannot describe what happened, your observations and the records stand. "She says that, but she's confused" is not an acceptable answer — ask for it to be minuted.

Move her, or stay?

Moving immediately is not always right: an abrupt move disorients, and a formal safeguarding referral often changes a home's behaviour within days, because nobody wants an enquiry. But if there is violence, if the signs repeat, or if nothing changes after your written concern, do not wait — safety comes before continuity.

If you decide to move, run both tracks at once: the safeguarding referral on one side, alternatives on the other. Families who only start looking once they have decided to leave end up taking the first available room.

If you need an alternative quickly

Curalune Care Help (£69) puts together, usually within 24 working hours, a shortlist of 3 to 5 homes matched to your area, the level of care needed and the budget — with direct contacts and the questions to ask about restraint, medication and night staffing.

*General information, not legal or medical advice. If someone is in immediate danger, call 999.*