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Environmental HealthSocial LandlordsPractitionersEmergency ServicesAnimal WelfareSafeguarding AdultsEHASHLevel 3Clutter image rating 7-9Property structure,services & garden areaRefer for support assessmentReferral to GPReferral to debt advice if appropriateRefer to Animal welfare if there are animals at the property.Ensure information sharing with all agencies involved to ensure acollaborative approach and a sustainable resolution. Refer to Environmental Health with details of client, landlord (ifrelevant) referrer’s details and overview of problems whereappropriate At time of inspection, Environmental Health Officer decides onappropriate course of action Consider serving notices under Public Health Act1936,Environmental Protection Act 1990, Prevention of Damage ByPests Act 1949 or Housing Act 2004 Consider Works in Default if notices not complied with by occupier Visit resident to inspect the property & assess support needs Refer for housing related support. Ensure residents are maintaining all tenancy conditions Enforce tenancy conditions relating to residents responsibilities Ensure information sharing with all agencies involved to ensure acollaborative approach and a sustainable resolution. Refer to “Guidance for Hoarding Guidance Questions to Ask” Complete Practitioners Assessment Tool Ensure information sharing with all agencies involved to ensure acollaborative approach and a sustainable resolution. Ensure information sharing with all agencies involved to ensure acollaborative approach and a sustainable resolution. Provide feedback to referring agency on completion of home visits. Visit property to undertake a wellbeing check on animals at theproperty. Educate client regarding animal welfare if appropriate- seek advicefrom the RSPCA. Provide advice / assistance with re-homing animalsNo action unless other concerns of abuse are noted.If other concerns of abuse are of concern or have been reported,progression to safeguarding referral and investigation may benecessary.Consider referring any children or young persons present to Early Helpunless other sources of abuse are noted, in which case refer to EHASH.Household environment will require intervention with a collaborativemulti-agency approach with the involvement from a wide range ofprofessionals. This level of hoarding constitutes a Safeguarding alertdue to the significant risk to health of the householders, surroundingproperties and residents. Residents are often unaware of theimplication of their hoarding actions and oblivious to the risk it poses. Limited access to the property due to extreme clutter Evidence may be seen of extreme clutter seen at windows

Evidence may be seen of extreme clutter outside the propertyGarden not accessible and extensively overgrownServices not connected or not functioning properlySmoke alarms not fitted or not functioningProperty lacks ventilation due to clutterInterior doors missing or blocked openEvidence of structural damage or outstanding repairs includingdampThere may be evidence of internal damp and / or mould.Evidence of indoor items stored outsideClutter is obstructing the living spaces and is preventing the use ofthe rooms for their intended purpose.Room(s) scores 7 - 9 on the clutter image scaleRooms not used for intended purposes or very limitedBeds inaccessible or unusable due to clutter or infestationEntrances, hallways and stairs blocked or difficult to passToilets, sinks not functioning or not in useResident at risk due to living environmentHousehold appliances are not functioning or inaccessibleResident has no safe cooking environmentResident is using candles, electric or gas heating appliancesDiscarded cigarettes in the propertyEvidence of outdoor clutter being stored indoors.No evidence of housekeeping being undertakenBroken household items not discarded e.g. broken glass or platesConcern for declining mental healthProperty is not maintained within terms of lease or tenancyagreement where applicableProperty is at risk of notice being served by Environmental HealthHuman urine and or excrement may be presentExcessive odour in the property, may also be evident from theoutsideRotting food may be presentEvidence may be seen of unclean, unused and or buried plates &dishes.Broken household items not discarded e.g. broken glass or platesInappropriate quantities or storage of medication.Pungent odour can be smelt inside the property and possibly fromoutside.Concern with the integrity of the electricsInappropriate use of electrical extension cords or evidence ofunqualified work to the electrics.Concern for declining mental healthEvidence of excessive use of drugs, alcohol or cigarettes.Safeguard of Children & Family members Animals and Pests Hoarding on clutter scale 7-9 constitutes a Safeguarding Alert.Please note all additional concerns for householdersAnimals at the property at risk due the level of clutter in the propertyHousehold Functions Health and Safety

Personal health andsafetyActionsAgency holding thecaseEnvironmental HealthLandlordPractitionersEmergency ServicesAnimal WelfareSafeguarding AdultsEHASHResident may not able to control the animals at the propertyAnimal’s living area is not maintained and smellsAnimals appear to be under nourished or over fedHoarding of animals at the propertyHeavy insect infestation (bed bugs, lice, fleas, cockroaches, ants,silverfish, etc.) Visible rodent infestation Refer to RSPCA Visits where Personal protective equipment (PPE) required: i.e.Latex Gloves, boots or needle stick safe shoes, face mask, handsanitizer, insect repellent.Level 3 Raise Safeguarding concern within 24 hours Raise a request to the GM Fire and Rescue Service within 24 hoursto provide priority safe and well visit. Refer to Environmental Health with details of client, landlord (ifrelevant) referrer’s details and overview of problems At time of inspection, EHO decides on appropriate course of action Consider serving notices under Public Health Act 1936,Environmental Protection Act 1990, Prevention of Damage By PestsAct 1949 or Housing Act 2004 Consider Works in Default if notices not complied by occupier Visit resident to inspect the property & assess support needs Attend multi agency MRM meeting Enforce tenancy conditions relating to residents responsibilities If resident refuses to engage serve Notice of Seeking Possessionunder Ground 13 to Schedule 2 of the Housing Act 1988 Refer to “Hoarding Guidance Questions for practitioners” SeeAppendix 1 Complete Practitioners Assessment Tool Ensure information sharing with all agencies involved to ensure acollaborative approach and a sustainable resolution. Attend multi agency MRM meeting on request Ensure information sharing with all agencies involved to ensure acollaborative approach and a sustainable resolution. Provide feedback to case holding agency on completion of homevisits. Notify the RSPCA for further advice and guidance. Visit property to undertake a wellbeing check on animals at theproperty. Remove animals to a safe environment Educate client regarding animal welfare if appropriate Take legal action for animal cruelty if appropriate Provide advice / assistance with re-homing animalsSafeguarding concern should progress to section 42 enquiry for multiagency approach and further investigation of any concerns of abuse.Multi-agency strategy meeting required.Refer to EHASH if children or young people present within 24 hours

Guidance for Practitioners (from all agencies)Hoarding Insight characteristicsUse this guide as a baseline to describe the client’s attitude towards their hoarding.Provide additional information in your referrals and reports to enable a tailoredapproach that is relevant to you client.Good or fair insight:The client recognises that hoarding – related beliefs and behaviours (relating todifficulty discarding items, clutter or excessive acquisition) are problematic. The clientrecognises these behaviours in themselves.Poor insightThe client is mostly convinced that hoarding – related beliefs and behaviours (relatingto difficulty discarding items, clutter or excessive acquisition) are not problematicdespite evidence to the contrary. The Client might recognise a storage problem buthas little self – recognition or acceptance of their own hoarding behaviour.Absent (delusional) insightThe Client is convinced that hoarding- related beliefs and behaviours (relating todifficulty discarding items, clutter or excessive acquisition) are not problematic despiteevidence to the contrary. The Client is completely accepting of their living environmentdespite the hoarding and possibly a risk to health.Detached with assigned blameThe client has been away from their property for an extended period. The client hasformed a detachment from the hoarded property and is now convinced a 3 rd party isto blame for the condition of the property. For example a burglary has taken place,squatters or other household members

Practitioners Hoarding AssessmentThis assessment tool below will be completed by a practitioner of the agency holdingthe case in order to decide whether this case should be addressed through a multiagency strategy meeting, or if this can be managed ‘in-house’ with the support ofpartners.Date of home assessmentClients NameClients date of birthAddressClient contact detailsType of dwellingOwneroccupierLeaseholderHousehold MembersTenant - Nameand address oflandlordNameRelationshipDate of birthPets - indicate what pets and anyconcernsAgencies currently involved - withcontact detailsNon agency support currently inplaceClients attitude towards hoardingPlease indicate if present at the propertyStructuralInsect ordamage torodentpropertyinfestationLarge numberof animalsClutteroutside

Rotten foodAnimal wastein houseConcern ofself- neglectConcerned forchildren at thepropertyConcerns overthe cleanlinessof thepropertyConcerned forother adults atthe propertyVisiblehumanfaecesEvidence ofsmall burnmarks inthepropertyUsing the Clutter Image Scale please score each of the room belowBedroom 1Bedroom 4Separate toiletBedroom 2KitchenLoungeBedroom 3BathroomDining RoomPlease provide a description of the hoarding problem ;( presence of human or animal waste, rodents orinsects, rotting food, are utilities operational, structural damage, problems with blocked exits, are therecombustibles, is there a fire risk?Please refer to the multi-agency hoarding Strategy and Guidance Document tool, based on the informationprovided above, what level is your case graded?Level 1 GreenLevel 2 OrangeLevel 3 RED- Take case toHigh Risk PanelName of practitionerundertaking assessmentName of organisationsContact detailsNext actions to be takenList of agencies refereed towith dates and contact names

References and further information Bath and North East Somerset Local Safeguarding Adults Board (n.d.)Guidance to staff on managing self-neglect. Retrieved frombathnes.gov.uk/sites/default/files/self neglect guidance pdf.pdfGibbons et al (2006) Self-Neglect: A proposed new NANDA diagnosis,International Journal of Nursing Terminologies and Classifications, 17 (1), pp10-18.Help for Hoarders http://www.helpforhoarders.co.ukSCIE (2011) Self-neglect and adult safeguarding: findings from research(Report 46) available from www.scie.org.ukSuffolk County Council – Multi – agency policy and procedures in respondingto concerns of Self Neglect.London Borough of Merton - Multi - agency Hoarding Protocol.London Borough of Camden. High Risk Panels.GMFRS hoarding prevention and protection guidance

Please use the clutter image rating to assess what level the adult's hoarding problem is at: Images 1- 3 Level 1 Images 4- 6 Level 2 . Room(s) scores between 4-5 on the clutter scale. Inconsistent levels of housekeeping throughout the property