Care providers safeguarding referral form
If anyone is in immediate danger, call 999.
Use this online form for non‑urgent safeguarding concerns only.
It may take up to 24 hours for the Safeguarding Team to receive and review your referral.
Who should use this form
This form is for registered care providers, including:
- nursing homes
- domiciliary care (home care)
- supported living services
- extra care housing (assisted living)
- day centres or day services
When to raise a safeguarding concern (Section 42, Care Act 2014)
Raise a concern when you know or suspect an adult:
- has care and support needs, and
- is experiencing, or at risk of, abuse or neglect, and
- cannot protect themselves because of those needs.
Please give all relevant details so we can take the right safeguarding action.
Before you submit this form
- If a crime is happening now or someone is in immediate danger, call 999 straight away.
- Do not use this form if your concern is only about someone having suicidal thoughts or self-harming.
Instead, please contact the adult’s GP or one of these urgent mental health services:
Mental health crisis support
North Staffordshire Combined Healthcare – Crisis Care Centre
(Covers Stoke-on-Trent, Newcastle-under-Lyme, and Staffordshire Moorlands)
Call: 0800 032 8728, then press option 1
South Staffordshire NHS urgent mental health helpline
(Covers Stafford, Stone, Rugeley, Cannock, South Staffs, Lichfield, Burton, Uttoxeter, Tamworth)
Call: 0808 196 3002
Email: mhsi.staffordshire@mpft.nhs.uk
When you may not need to raise a safeguarding concern
Staffordshire and Stoke-on-Trent Safeguarding Enquiry Procedures state there is no requirement to raise a safeguarding concern for single instances of poor practice where no lasting harm or distress has occurred and you have a plan in place to protect the adult from harm.
In these cases, providers are expected to:
- carry out internal investigations
- take disciplinary or remedial action as needed
- report significant incidents to the relevant regulators in line with regulations and legislation
- log and regularly review incidents not raised as safeguarding to identify themes, trends and lessons learned, and put preventive actions in place
For more on when to raise a concern, please visit MIDOS.
Raise a safeguarding concern
Use the button below to raise a new safeguarding concern.
Provide clear, relevant details in each section so we understand the concern and can respond appropriately.
This form is for non‑urgent safeguarding concerns only.
For referrals that need immediate attention, call Staffordshire adults safeguarding on 0345 604 2719.
