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Registration Number: {{org_field_registration_no}}

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Restrictive Practices and Physical Interventions Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} prevents unnecessary restrictive practice and that any restriction, restraint or physical intervention used within the service is lawful, necessary, proportionate, person-centred and the least restrictive option available to manage the identified risk.

This policy must be read and applied in accordance with the Health and Social Care Act 2008 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including Regulation 9 – Person-centred care, Regulation 10 – Dignity and respect, Regulation 11 – Need for consent, Regulation 12 – Safe care and treatment, Regulation 13 – Safeguarding service users from abuse and improper treatment, Regulation 17 – Good governance and Regulation 18 – Staffing. It also reflects the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS), the Human Rights Act 1998, the Equality Act 2010, applicable Care Quality Commission guidance and relevant national guidance on reducing restrictive interventions.

Restrictive practices must never be used as punishment, retaliation, coercion, for staff convenience or because of inadequate staffing. Any restriction or restraint must be necessary to prevent a risk of harm, proportionate to the likelihood and seriousness of that harm, used for no longer than necessary and discontinued as soon as the justification for its use no longer exists.

Where a person may be deprived of their liberty, {{org_field_name}} will consider the arrangements on an individual basis in accordance with the Mental Capacity Act 2005, Article 5 of the European Convention on Human Rights, current case law and the applicable Deprivation of Liberty Safeguards framework. This includes the legal approach established by the UK Supreme Court judgment of 2 June 2026 concerning the meaning of deprivation of liberty.

2. Scope

This policy applies to all employees, including care staff, managers, and agency workers, people we support who may require interventions for their safety, external professionals such as healthcare providers and safeguarding teams, and family members and advocates involved in care planning.

3. Policy Statement

{{org_field_name}} is committed to ensuring that the use of restrictive practices is minimised and only applied where absolutely necessary, all staff are trained in positive behaviour support (PBS) to prevent restrictive interventions, interventions are proportionate, lawful, and the least restrictive option available, any restrictive practice is recorded, reviewed, and monitored, people we support are involved in decisions regarding restrictive practices whenever possible, and compliance with CQC’s Fundamental Standards of Care is maintained.

4. Definitions

For the purposes of this policy:

• Restrictive practice means any practice or intervention that restricts a person’s rights, choices, freedom of movement or ability to act independently. A restrictive practice may or may not amount to restraint or a deprivation of liberty.
• Restraint includes using or threatening to use force to secure an action that a person resists, or restricting a person’s liberty of movement whether or not the person resists. Restraint may include physical, mechanical or chemical means.
• Physical restraint or physical intervention means direct physical contact or the use of physical force that restricts, controls or limits a person’s movement.
• Mechanical restraint means the use of equipment or a device for the primary purpose of preventing, restricting or controlling a person’s movement. Equipment used for a therapeutic, postural or safety purpose may nevertheless constitute a restriction or restraint depending upon its purpose, effect and the circumstances in which it is used.
• Chemical restraint means the use of medication where its purpose or effect is to control or restrict a person’s behaviour, movement or freedom rather than solely to provide appropriate treatment for a diagnosed health condition. Medication must only be used in accordance with lawful prescribing and medicines-management arrangements and the requirements relating to consent, mental capacity, necessity and proportionality.
• Environmental restriction means a restriction arising from the person’s environment, such as locked doors, restricted access to particular areas or belongings, barriers, surveillance arrangements or other measures that limit freedom or choice.
• Seclusion means the supervised confinement of a person away from other people in an area from which they are prevented from leaving freely. Seclusion is a highly restrictive intervention and must not be used as punishment, for staff convenience or as a substitute for appropriate care, staffing or support.
• Deprivation of liberty has the meaning given by Article 5 of the European Convention on Human Rights and applicable domestic case law. Whether restrictions amount to a deprivation of liberty must be considered on an individual and multifactorial basis in accordance with current law and guidance.

5. Decision-Making Process

5.1 Person-Centred Approach

{{org_field_name}} will use person-centred assessment, proactive support, Positive Behaviour Support where appropriate, effective communication, environmental adjustments and de-escalation to prevent or minimise the need for restrictive practices.

People using the service must be supported, so far as practicable, to understand and participate in decisions concerning their care, treatment and any proposed restrictions. Their wishes, feelings, preferences, communication needs, cultural needs and previous experiences must be identified and taken into account.

Before a planned restrictive intervention is introduced, an individual assessment must identify:

• the specific risk of harm being addressed;
• the likelihood and seriousness of that harm;
• the causes, triggers or circumstances associated with the risk;
• less restrictive alternatives that have been considered or attempted;
• the person’s communication needs, preferences, wishes and feelings;
• relevant physical or mental health conditions;
• the possible physical and psychological effects of the proposed restriction; and
• how the intervention will be monitored, reviewed and reduced or withdrawn.

Mental capacity must be considered in relation to the specific decision that needs to be made. A person must not be treated as lacking capacity merely because they make an unwise decision.

Where the person has capacity to make the relevant decision, their decision must be respected unless there is another lawful basis for intervention.

Where the person lacks capacity to make the relevant decision, any decision or action taken on their behalf must comply with the Mental Capacity Act 2005, including the statutory principles, best-interests requirements and the requirement to consider whether the purpose can be achieved in a way that is less restrictive of the person’s rights and freedom of action.

5.2 Legal Considerations and Safeguards

Restrictive interventions must only be used where there is a lawful basis for doing so. Staff must consider the person’s capacity to make the relevant decision, their wishes and feelings, any valid consent or refusal, any applicable advance decision, and the authority of any attorney appointed under a Lasting Power of Attorney, Court of Protection deputy or relevant court order.

Where an intervention is undertaken within the Mental Capacity Act 2005 framework and amounts to restraint, staff must reasonably believe that the intervention is necessary to prevent harm and that it is a proportionate response to the likelihood and seriousness of that harm. The intervention must be the least restrictive practicable response and must continue for no longer than necessary.

Where the person lacks capacity to make the relevant decision, a best-interests decision must be made and recorded in accordance with the Mental Capacity Act 2005. Those involved in caring for the person and anyone interested in their welfare should be consulted where it is practicable and appropriate to do so. A relative or family member does not acquire legal decision-making authority solely because of their relationship to the person.

The Registered Manager must ensure that care arrangements involving significant restrictions are reviewed to determine whether they may amount to a deprivation of liberty.

Following the UK Supreme Court judgment of 2 June 2026, the assessment of whether arrangements amount to a deprivation of liberty must be undertaken on an individual, multifactorial basis. Staff and managers must consider all relevant circumstances, including:

• the type and nature of the restrictions;
• their duration;
• their effect on the person;
• the way in which the restrictions are implemented;
• whether and how the person objects;
• the person’s expressed wishes and feelings;
• the relative normality of the arrangements in their particular setting; and
• the purpose and overall circumstances of the arrangements.

No single factor is determinative.

Where there is reason to believe that a person aged 18 or over in the care home is deprived of their liberty and the applicable legal criteria are met, the Registered Manager or other authorised person must make the appropriate application to the relevant local authority under the Deprivation of Liberty Safeguards. Where an urgent authorisation is lawfully required and permitted, this must be completed in accordance with the Mental Capacity Act 2005 and DoLS requirements.

The existence of an application, authorisation or delay in assessment does not remove the responsibility of {{org_field_name}} to continue to review the arrangements, minimise restrictions, act in the person’s best interests where required and protect the person’s rights.

Any conditions attached to a DoLS authorisation must be identified, communicated to relevant staff, incorporated into the care plan and complied with. The person’s rights to representation, review and challenge must be respected and supported.

Where there is uncertainty about the lawful authority for significant or continuing restrictions, the Registered Manager must obtain appropriate professional or legal advice and must not assume that a care plan, family agreement or general best-interests decision by itself authorises a deprivation of liberty.

6. Prevention and Alternative Strategies

Staff training in de-escalation techniques is conducted to prevent crises. Use of therapeutic activities and environmental adjustments are encouraged. Enhanced communication methods help to understand distress signals. Regular review of behaviour support plans is conducted to reduce restrictive interventions.

7. Implementing Restrictive Interventions

7.1 Physical Interventions

Physical intervention must only be used where it is lawful, necessary and proportionate to the identified risk of harm and where a less restrictive response is not sufficient to manage that risk safely.

Staff must wherever practicable use prevention, communication, reassurance, de-escalation, environmental changes and other less restrictive strategies before resorting to physical intervention.

Only staff who have received training and have been assessed as competent for the intervention they are expected to use may undertake planned physical restraint. In an unforeseen emergency, staff must act within the law, their competence and the circumstances necessary to protect the person or another individual from harm.

Any physical intervention must:

• be necessary to prevent the identified harm;
• be proportionate to the likelihood and seriousness of that harm;
• use the least restrictive and least forceful option that is effective;
• preserve the person’s dignity and privacy as far as practicable;
• take account of known physical health conditions, psychological needs, trauma history and communication requirements;
• be used for the shortest possible period;
• cease immediately when it is no longer necessary; and
• be carried out in accordance with the person’s current care plan and risk assessment where the intervention is foreseeable or planned.

There is no automatic requirement for two members of staff to be present during every physical intervention. The number of staff required must be determined by the person’s individual risk assessment, the intervention being used, the approved training method and the circumstances at the time. Staffing arrangements must not result in unnecessary or disproportionate restraint.

The person’s physical and psychological wellbeing must be monitored throughout and following the intervention. Any sign of breathing difficulty, loss of consciousness, significant deterioration, injury or other medical emergency must result in the intervention being released as soon as this can safely be achieved and appropriate emergency medical assistance being obtained.

7.2 Chemical Restraint

Medication must not be used to punish, discipline, sedate for staff convenience, compensate for insufficient staffing or routinely control behaviour without a lawful and clinically appropriate justification.

Any medication that may have the effect or purpose of controlling behaviour or restricting movement must:

• have a lawful prescription or other lawful medicines authority;
• be administered only in accordance with the prescription and the home’s medicines-management procedures;
• comply with the requirements for consent or, where the person lacks capacity for the relevant decision, the Mental Capacity Act 2005 and best-interests requirements;
• be necessary and proportionate where its use constitutes restraint;
• have a clear indication, dose, route, maximum frequency and relevant monitoring requirements;
• where prescribed on a ‘when required’ basis, have clear person-specific guidance explaining the circumstances in which it may be considered and any non-pharmacological measures that should be attempted first where appropriate;
• be monitored for effectiveness, side effects and adverse effects; and
• be subject to appropriate clinical review so that its continued necessity can be established.

The use of medication as a restrictive intervention must be documented and reviewed alongside other restrictive practices. Repeated or increasing use must trigger review of the person’s needs, care plan, medicines, behavioural or distress-related triggers and alternative strategies.

7.3 Seclusion and Environmental Restrictions

Seclusion and significant environmental restrictions are highly restrictive practices and must not be used routinely, as punishment, to enforce compliance, for staff convenience or as a substitute for adequate staffing or appropriate care.

Any use must have a lawful basis and must be necessary and proportionate to the identified risk. The least restrictive practicable option must be used for the shortest possible period.

Where seclusion or another significant environmental restriction is foreseeable, the person’s care plan and risk assessment must clearly identify:

• the circumstances in which it may be considered;
• the identified risk being managed;
• alternatives and de-escalation measures;
• the level and method of observation or monitoring required;
• how the person’s physical and psychological wellbeing will be protected;
• how communication, hydration, toileting and other essential needs will be met;
• who may authorise or implement the intervention;
• the criteria for ending the restriction; and
• the arrangements for review.

The person must be monitored throughout any period of seclusion or significant restriction at a level proportionate to the risks involved. The restriction must end as soon as the circumstances requiring it no longer exist.

Every episode must be recorded, reviewed and considered as part of the person’s ongoing care planning and the provider’s restrictive-practice monitoring arrangements.

The Registered Manager must consider whether the restriction, alone or together with the person’s wider care arrangements, may amount to a deprivation of liberty and must take appropriate action under Section 5.2 of this policy.

The use or duration of seclusion does not by itself create a separate statutory requirement to notify CQC. CQC must be notified without delay where the circumstances meet a notification requirement under the Care Quality Commission (Registration) Regulations 2009 or another applicable statutory requirement.

8. Recording and Reporting

Every use of restraint or other significant restrictive intervention must be recorded accurately and as soon as practicable after the event.

The record must be sufficiently detailed to demonstrate why the intervention was necessary and proportionate and must include, where applicable:

• the date, time and location;
• the circumstances and events leading to the intervention;
• the risk of harm identified at the time;
• de-escalation or less restrictive measures considered or attempted;
• the type of restrictive intervention used;
• the reason for choosing that intervention;
• the names or roles of staff involved and any witnesses;
• the duration of the intervention;
• observations and monitoring undertaken during the intervention;
• any injury, distress, adverse effect or medical treatment;
• the person’s response, wishes and feelings following the event;
• any debrief undertaken with the person;
• any staff debrief;
• whether the person’s care plan, risk assessment or behaviour support plan requires amendment;
• whether a safeguarding referral is required;
• whether a CQC statutory notification or notification to another external body is required; and
• any immediate or longer-term actions arising from the review.

The Registered Manager or an appropriately delegated competent person must review incidents involving restrictive practice to identify whether the intervention was lawful, necessary and proportionate and whether practice changes are required.

Where an incident raises a safeguarding concern or involves suspected, alleged or actual abuse, action must be taken without delay in accordance with the service’s safeguarding procedures and applicable local safeguarding arrangements.

The fact that restraint occurred does not, by itself, mean that a CQC statutory notification is required. The Registered Manager must assess the circumstances against the Care Quality Commission (Registration) Regulations 2009 and current CQC notification requirements. Where the event constitutes a notifiable incident, including a relevant allegation of abuse, specified serious injury or another prescribed event, the required notification must be submitted to CQC within the applicable statutory timescale.

Restrictive-practice records must be audited to identify patterns, repeated interventions, changes in frequency or severity, equality or human-rights concerns, inappropriate practice and opportunities to reduce restriction. Relevant learning must be incorporated into care planning, staff supervision, training and service governance.

9. Staff Training and Competency

All staff must receive training during induction that is appropriate to their role so that they understand restrictive practice, safeguarding, consent, mental capacity, human rights, prevention, de-escalation and their responsibilities for reporting concerns.

Staff whose role may require them to use physical restraint or another specialist restrictive intervention must receive appropriate training in the specific interventions they are authorised to use and must be assessed as competent before undertaking planned interventions.

Training and competency arrangements must:

• be relevant to the needs of the people using the service and the staff member’s role;
• promote prevention, person-centred care and least restrictive practice;
• cover the legal requirements for necessity, proportionality, consent and the Mental Capacity Act 2005;
• include recognition of physical and psychological risks associated with restraint;
• include monitoring and emergency responses where relevant;
• explain recording, reporting, safeguarding and escalation requirements;
• be refreshed or updated at appropriate intervals and when practice, guidance, law or the person’s needs change; and
• be supported through supervision, competency assessment and review of practice.

Staff must be informed of and trained appropriately in the change to the legal approach to deprivation of liberty resulting from the UK Supreme Court judgment of 2 June 2026. Relevant staff must understand that deprivation of liberty is now assessed using a multifactorial approach and that the former Cheshire West single ‘acid test’ must not be used as the sole legal test.

Staff must not use a restraint technique for which they have not been trained and assessed as competent, except where immediate action is lawfully necessary in an unforeseen emergency and the member of staff acts reasonably, proportionately and within the limits of their competence.

10. Safeguarding and Ethical Considerations

Restrictive practices must never be used as punishment, retaliation, coercion, humiliation, for staff convenience, because a person’s behaviour is perceived as difficult, or as a substitute for appropriate staffing, assessment, treatment, communication or person-centred support.

Any unnecessary, disproportionate, degrading or otherwise unlawful restraint must be treated as a potential safeguarding concern and responded to without delay.

Where staff become aware of suspected, alleged or actual abuse or improper treatment, they must immediately take appropriate action to protect the person and report the concern in accordance with {{org_field_name}}’s safeguarding procedures. The Registered Manager must ensure that appropriate safeguarding referrals are made, that CQC is notified where a statutory notification requirement applies and that concerns are investigated in accordance with applicable safeguarding arrangements.

Mental capacity must be considered in relation to the specific decision concerned. Where the person lacks capacity, decisions must comply with the Mental Capacity Act 2005, including the statutory principles, best-interests requirements and the obligation to consider less restrictive alternatives.

A person’s DNACPR or DNAR status must not be used as a reason to impose, withhold or determine a restrictive intervention. Decisions concerning restrictive practice must be based on the person’s individual circumstances, the applicable lawful authority, the identified risk of harm, necessity, proportionality and the least restrictive approach.

The person’s protected characteristics, disability, culture, religion or belief, sex, sexual orientation, gender reassignment, age, communication needs and other individual circumstances must not result in unlawful discrimination. Reasonable adjustments and accessible communication must be provided where required.

The Registered Manager must ensure that concerns about restrictive practice are subject to appropriate oversight, learning and action and that repeated or increasing restrictions trigger reassessment of the person’s needs and consideration of less restrictive alternatives.

11. Policy Review

This policy will be reviewed annually or earlier if legislation or CQC guidance changes, significant concerns arise regarding restrictive practices, or audit findings indicate a need for improvement.

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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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