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Registration Number: {{org_field_registration_no}}

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Prevention of Falls and Injury Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides a safe environment for service users by implementing proactive measures to prevent falls and injuries. Falls are a leading cause of injury and hospitalisation among older adults and individuals with mobility issues, and this policy sets out our approach to risk assessment, prevention, staff training, and incident management.

This policy supports compliance with the Regulation and Inspection of Social Care (Wales) Act 2016; the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended); and the Welsh Government Statutory Guidance for providers of care home and domiciliary support services (last updated 27 March 2024).

In particular, it aligns to requirements relating to:

• Provider assessment and personal planning, including identifying and managing risks to an individual’s wellbeing and keeping assessments and plans under review.
• Duty of candour (openness and transparency) when things go wrong, including giving information and offering an apology where appropriate.
• Notifications to the service regulator (CIW) for specified events, including serious accident or injury, and ensuring notifications are made without delay (usually within 24 hours).
• Record keeping, including maintaining records of falls and consequent treatment and keeping records accurate, up to date and secure.
• Relevant wider legislation and guidance, including Health and Safety at Work etc. Act 1974, Equality Act 2010 (reasonable adjustments), and Mental Capacity Act 2005 (where decision-making or restrictions are involved).

2. Scope

This policy applies to:

• All staff members, including care workers, managers, and administrative staff.
• Service users receiving care and support from {{org_field_name}}.
• Family members, advocates, and external professionals involved in service user care.

It covers:

• Risk factors for falls and injuries.
• Preventative measures to reduce fall risks.
• Roles and responsibilities of staff.
• Training and competency requirements.
• Incident reporting and post-fall management.

3. Identifying Risk Factors for Falls

Staff must be aware of the factors that increase the risk of falls among service users, including:

3.1 Medical and Physical Factors

• Age-related balance decline and frailty.
• Chronic conditions such as osteoporosis, arthritis, Parkinson’s disease, and dementia.
• Medication side effects (e.g., drowsiness, dizziness, or low blood pressure).
• Recent surgery or hospitalisation, leading to temporary weakness.
• Poor vision or hearing impairments affecting spatial awareness.

3.2 Environmental and Home Hazards

• Slippery floors, loose rugs, or poor lighting.
• Cluttered spaces and trip hazards (e.g., wires, furniture obstacles).
• Unsafe stairs or missing handrails.
• Inappropriate footwear or lack of mobility aids.

4. Preventative Measures to Reduce Fall Risks

At {{org_field_name}}, we adopt a proactive approach to prevent falls by implementing the following strategies:

4.1 Comprehensive Risk Assessments

A falls risk assessment must be completed before care starts or on commencement (using information from the individual’s care and support plan where available) and must inform the individual’s personal plan/care plan.

The falls risk assessment and personal plan must be co-produced with the individual and, where appropriate and consistent with wellbeing, their representative, and must be kept under review and revised whenever there is a significant change in needs or following any fall/near miss.

Where specialist input is required (e.g., physiotherapy/OT, dementia, complex needs), this must be sought and recorded, and the plan updated accordingly.

4.2 Home Safety Assessments and Environmental Modifications

• Ensure good lighting in hallways, bathrooms, and stairways.
• Remove trip hazards such as rugs, electrical cables, or clutter.
• Ensure handrails and grab bars are installed where necessary.
• Recommend non-slip mats and properly fitted footwear.

4.3 Mobility Support and Assistive Devices

• Assess and provide mobility aids such as walking sticks, frames, and wheelchairs.
• Ensure service users use appropriate footwear to prevent slipping.
• Encourage gentle exercises and physiotherapy to improve strength and balance.

4.4 Medication Reviews

• Work with GPs and pharmacists to regularly review medications that may cause dizziness or drowsiness.
• Monitor for side effects that increase fall risk (e.g., sedatives, blood pressure medications).

4.5 Nutrition and Hydration

• Promote adequate calcium and vitamin D intake to support bone health.
• Ensure service users are hydrated, as dehydration can cause dizziness and confusion.

4.6 Adequate time to provide care safely (domiciliary support)

Care and support must be planned and delivered in a way that allows workers enough time to support safe mobility, transfers and toileting without rushing, in line with the individual’s personal plan. Visit scheduling and travel time must be sufficient to enable safe delivery of care and support, and staff must report where time allocations create a foreseeable falls risk so that rotas/plans can be adjusted.

5. Roles and Responsibilities

5.1 Responsibilities of the Registered Manager

• Oversee fall prevention policies and procedures.
• Ensure all staff receive fall prevention training and competency assessments.
• Ensure compliance with CIW regulations and safety audits.

5.2 Responsibilities of Care Workers

• Conduct daily visual checks of the service user’s environment for hazards.
• Follow care plans and risk assessments for mobility support.
• Encourage safe movement and use of assistive devices.
• Report any fall incidents immediately.

5.3 Responsibilities of Service Users and Families

• Follow safety recommendations provided by care staff.
• Report concerns regarding mobility difficulties.
• Engage in preventative exercises and mobility strategies.

6. Incident Reporting and Post-Fall Management

6.1 Immediate Response to a Fall

If a service user falls, staff must:

1. Assess for injuries – Check for bruising, pain, swelling, or loss of consciousness.
2. Call emergency services (999) if necessary – If the service user has a head injury, significant pain, or is unable to move.
3. Do not move the service user unless safe to do so – If there is a risk of spinal injury, keep them comfortable until medical professionals arrive.
4. Provide reassurance and support – Keep the service user calm and comfortable.
5. Document the fall – Complete an Incident Report Form and update the care plan.

6.2 Post-Fall Review and Prevention

• Conduct a root cause analysis to identify why the fall occurred.
• Adjust the care plan and risk assessments to prevent recurrence.
• Report concerns to family members, medical professionals, and CIW if required.

6.3 Duty of Candour (openness and transparency)

Following a fall or injury, we will act in an open and transparent way with the individual and, where appropriate, their representative. This includes explaining what is known about what happened, what immediate actions were taken, what will happen next (including any reviews/investigation), and offering an apology where appropriate. Staff must record duty of candour discussions and share learning to reduce recurrence.

6.4 CIW notifications (service regulator) and escalation

The Registered Manager (or delegated person) must consider whether the fall/injury is a notifiable event and ensure CIW notifications are made without delay (usually within 24 hours) and in the required format.
CIW must be notified where an accident or injury, in the reasonable opinion of a health care professional, requires treatment and has (or may have) resulted in:

• permanent impairment or impairment likely to last more than 28 days, or
• changes to body structure, or
• prolonged pain or psychological harm, or
• death or shortening of life expectancy.
  Notifications must be made using CIW’s required process (including CIW online notifications where applicable).

6.5 Recording and documentation

Every fall (including unwitnessed falls and near misses) must be recorded in line with our records management arrangements. Records must include: circumstances, injury check, action taken, escalation/medical input, and consequent treatment provided. This supports the regulatory requirement to maintain a record of falls and consequent treatment.

Records relating to individuals must be accurate, up to date, kept securely, and retained in line with regulatory requirements.

7. Staff Training and Competency Requirements

• All staff must receive fall prevention training during induction and complete annual refresher courses.
• Training includes:
  • Recognising fall risks and conducting assessments.
  • Safe manual handling and mobility support.
  • Using assistive devices correctly.
  • Emergency response procedures for falls.
• Training must also reinforce record-keeping requirements, recognising and reporting safeguarding concerns, and working in line with Social Care Wales Codes of Practice and core training expectations.
• Competency assessments will be conducted to ensure staff can apply fall prevention techniques effectively.

8. Monitoring and Compliance

Falls and injury prevention will be monitored through:

• routine review of falls incidents, near misses and outcomes (themes/trends);
• checks that assessments and personal plans are updated following falls and significant changes;
• audit of record quality (completeness, timeliness, accuracy) and follow-up actions;
• learning shared with staff through supervision/team meetings and updates to practice.
  CIW may review our falls prevention arrangements, notifications, and records during inspection.

9. Related Policies

This policy should be read in conjunction with:

• Risk Management and Assessment Policy (DCW18).
• Moving and Handling Policy (DCW37).
• Health and Safety at Work Policy (DCW16).
• Emergency and Business Continuity Plan (DCW19).
• Medication Management and Administration Policy (DCW21).

10. Policy Review

This policy will be reviewed annually or sooner if required by legislative changes, CIW regulations, or operational needs.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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