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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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Positive Restraint Policy For Adults (LD/A)

1. Purpose

{{org_field_name}} is committed to delivering safe, person-centred, compassionate care that upholds the rights, dignity, freedom and wellbeing of every adult who uses our service. The purpose of this policy is to set out how {{org_field_name}} prevents, reduces and, where there is no safer alternative, lawfully manages the use of restraint and other restrictive practices when supporting adults in domiciliary care.

{{org_field_name}} is registered with the Care Quality Commission to carry out the regulated activity of {{org_field_regulated_activity}} for {{org_field_service_users_bands}} in their own homes.

Our approach is based on prevention first, positive behaviour support, de-escalation, least restrictive practice and respect for human rights. Restraint is never used for punishment, staff convenience, discipline, coercion or because of poor staffing, poor planning or lack of training. It is only ever considered as a last resort, for the shortest possible time, when it is necessary, proportionate and lawful to prevent harm.

2. Scope

This policy applies to all employees, bank staff, agency staff, apprentices, students, volunteers, contractors and managers working on behalf of {{org_field_name}} in connection with regulated activities carried on in England.

It applies to services delivered to:

• adults aged 18 and over;
• people with physical disabilities, sensory impairments, learning disabilities, autism, dementia, acquired brain injury, mental health needs, communication needs or behaviours that challenge; and
• people receiving care in their own home or in the community as part of domiciliary care support.

This policy applies to any restrictive practice used or proposed in the course of providing care or support, whether planned or unplanned.

Supporting Autistic People and People with a Learning Disability

When supporting autistic people and people with a learning disability, staff must take account of each person’s communication needs, sensory preferences, emotional wellbeing, reasonable adjustments and individual Positive Behaviour Support plan.

Distressed behaviour must not automatically be interpreted as deliberate aggression or non-compliance. Staff must consider whether the person is communicating pain, fear, anxiety, sensory overload, an unmet need or difficulty understanding the situation.

Prevention, communication support, environmental adjustments and de-escalation must be prioritised.

Any restrictive intervention must comply with the organisation’s Restrictive Practices, Restraint and Physical Interventions Policy, the Mental Capacity Act 2005 where applicable, relevant safeguarding requirements and the individual’s documented care arrangements.

Where two organisational policies address the same intervention, staff must not apply conflicting procedures. Any inconsistency must be escalated to the Registered Manager for resolution before a planned intervention is undertaken.

3. Policy Statement

{{org_field_name}} will:

• promote a culture in which restrictive practices are reduced to the lowest possible level;
• assess each person holistically and plan support around communication, sensory needs, trauma, physical health, emotional wellbeing, environmental triggers, routines, preferences and protective factors;
• use proactive, therapeutic and relational approaches to reduce distress and risk;
• ensure any restraint is lawful, clinically and ethically justified, necessary to prevent harm, proportionate to the risk, and the least restrictive option available;
• involve the adult and, where appropriate, their family, advocate, attorney, deputy or relevant professional in planning support and reviewing any incident;
• comply with safeguarding duties for adults, including referral to the local authority and notification to the Care Quality Commission where required;
• record, review, audit and learn from every restraint incident; and
• support staff through training, supervision and post-incident debrief.

4. Regulatory and Practice Framework

This policy is informed by, and should be read alongside, the following legislation and guidance:

• Health and Social Care Act 2008 and the CQC regulatory framework;
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, especially Regulations 9, 10, 11, 12, 13, 17, 18 and 20;
• Mental Capacity Act 2005, including the statutory principles, best interests framework and the lawful use of restraint where it is necessary and proportionate to prevent harm;
• Human Rights Act 1998;
• Care Act 2014, including safeguarding duties for adults at risk of abuse or neglect;
• CQC guidance on restraint policies and restrictive practice reduction;
• Positive and Proactive Care: reducing the need for restrictive interventions; and
• relevant NICE guidance where applicable.

5. Definitions

Positive restraint
A lawful and proportionate restrictive intervention used as a last resort to prevent imminent or immediate harm to the person or another person, and carried out in a way that seeks to preserve dignity, safety and the person’s rights.

Restrictive practice
Any act or omission that restricts a person’s movement, liberty or freedom to act independently. Restrictive practice may be physical, mechanical, chemical, environmental, psychological or procedural.

Restraint
For the purpose of this policy, restraint includes the use or threat of force where a person is resisting, and any restriction of a person’s liberty of movement, whether or not the person resists.

Physical restraint
Direct physical contact intended to limit a person’s movement.

Mechanical restraint
Use of equipment or devices to limit a person’s movement which they cannot easily remove themselves. In domiciliary care this will be treated as highly exceptional and must not be used unless specifically authorised, lawful, risk assessed, care planned and consistent with current legal and professional requirements.

Chemical restraint
Use of medication primarily to control behaviour or to restrict liberty, where that medication is not a clinically justified treatment for a diagnosed condition. {{org_field_name}} does not authorise staff to use medication as a form of chemical restraint. Medicines must only be given in line with a lawful prescription, the prescriber’s directions, the person’s care plan and the organisation’s medicines policy.

Environmental restraint
Restriction arising from the physical environment, such as preventing access to rooms, objects, exits or communication tools.

Seclusion
Supervised isolation of a person away from others to contain severely disturbed behaviour. Seclusion is not part of routine domiciliary care practice at {{org_field_name}} and staff must not create improvised seclusion arrangements in a person’s home.

De-escalation
Skilled verbal and non-verbal approaches used to reduce distress, conflict or risk.

Positive behaviour support (PBS)
A person-centred framework that aims to understand the meaning and function of behaviour, improve quality of life, prevent distress and reduce restrictive interventions.

Best interests decision
A decision made under the Mental Capacity Act 2005 for a person who lacks capacity in relation to a specific matter, taking account of their wishes, feelings, beliefs, values and the views of others involved in their care.

6. Principles

{{org_field_name}} adopts the following principles:

• the welfare, dignity, safety and rights of the person are paramount;
• restrictive practices must be avoided wherever possible and reduced wherever they exist;
• support must be person-centred, trauma-informed, culturally responsive and communication-aware;
• the least restrictive option must always be chosen;
• restraint must never be used as punishment, humiliation, discrimination, retaliation or convenience;
• capacity, consent, choice, voice and participation must be considered in every case;
• for adults who lack capacity, restraint must meet the Mental Capacity Act requirements of necessity and proportionality;
• any use of restraint must trigger review, reflection and learning; and
• governance systems must evidence oversight, incident analysis and continuous improvement.

7. Roles and Responsibilities

7.1 All Staff

All staff must:

• read, understand and follow this policy;
• work preventatively and use de-escalation first;
• know the person’s care plan, risk assessment, communication plan and behaviour support plan;
• only use approved, trained and authorised interventions;
• stop the intervention as soon as the risk has reduced;
• monitor the person’s physical and emotional wellbeing throughout;
• report and record all incidents promptly and honestly;
• escalate safeguarding concerns immediately; and
• participate in debrief, supervision and learning.

7.2 Registered Manager

The Registered Manager is responsible for:

• implementing this policy;
• ensuring restraint reduction is embedded in practice;
• ensuring lawful decision-making, documentation and review;
• ensuring only trained and competent staff are involved in any restrictive intervention;
• reviewing incidents, trends, themes and lessons learned;
• making required CQC notifications and ensuring safeguarding referrals are made without delay; and
• ensuring duty of candour obligations are met where applicable.

7.3 Safeguarding Lead

The Safeguarding Lead is responsible for:

• advising on safeguarding thresholds and referrals;
• liaising with the local authority adult safeguarding team and other agencies as appropriate;
• overseeing safeguarding aspects of restraint incidents; and
• supporting staff and managers with immediate protective action and review.

7.4 Senior Leaders

Senior leaders are responsible for:

• setting the organisational culture and expectation of least restrictive practice;
• ensuring sufficient resources, staffing and training;
• receiving governance reports and directing quality improvement action; and
• holding the Registered Manager to account for compliance.

8. Prevention and Reduction of Restrictive Practice

{{org_field_name}} will take all reasonable steps to prevent the need for restraint. Preventative action includes:

• comprehensive assessment before care starts and at review;
• identifying known triggers, early warning signs and protective factors;
• understanding pain, illness, trauma, sensory overload, communication difficulties, medication issues, environmental stressors, unmet needs and relationship factors;
• agreeing personalised support strategies, preferred responses and calming approaches;
• adapting the environment and the way care is delivered;
• offering choice, time, reassurance, space, visual prompts, simple language, alternative communication methods and predictable routines;
• involving families, advocates and relevant professionals; and
• using positive behaviour support approaches where indicated.

Where a person has a history of distress, aggression, self-injury, absconding, refusal of essential care, or other risk behaviours that may lead to restrictive intervention, {{org_field_name}} will ensure there is an up-to-date, person-specific support plan that focuses on prevention and clearly identifies lawful responses.

9. Consent, Capacity and Best Interests

9.1 Adults with Capacity

Where an adult has capacity to make the relevant decision, their valid consent, refusal, preferences and choices must be respected. Staff must not use restraint simply because the person disagrees with care or declines support, unless there is an immediate and lawful justification to prevent serious harm.

9.2 Adults who Lack Capacity

Where there is reason to doubt capacity, staff must follow the Mental Capacity Act 2005. Capacity is decision-specific and time-specific. Any restraint used in connection with care or treatment for an adult who lacks capacity must only be used where staff reasonably believe it is necessary to prevent harm and it is a proportionate response to the likelihood and seriousness of that harm.

Best interests decision-making must be documented where relevant. Staff must consider:

• the person’s past and present wishes and feelings;
• beliefs and values;
• less restrictive alternatives; and
• the views of family, attorney, deputy, advocate and professionals where appropriate.

Nothing in this policy authorises an unlawful deprivation of liberty. Any situation suggesting a deprivation of liberty, or a level of restriction beyond routine care and support, must be escalated immediately to the Registered Manager for legal review and liaison with commissioners or the local authority as appropriate.

10. When Restraint May Be Used

Restraint may only be used where all of the following apply:

• there is an immediate or imminent risk of harm to the person or another person;
• de-escalation and less restrictive options have been tried, considered or are not safe or feasible in the circumstances;
• the action is lawful, necessary and proportionate;
• the action is the least restrictive option available;
• the intervention is carried out by staff who are trained, competent and authorised to do so; and
• the restraint ends as soon as the risk reduces.

Examples of situations that may justify emergency restraint include preventing a person from running into a road, preventing serious self-injury, preventing assault causing likely harm, or preventing immediate harm during essential care where delay would create significant risk.

Restraint must not be used:

• to enforce compliance with routine care where there is no immediate risk;
• to compensate for inadequate staffing, rushed care or poor planning;
• to punish, intimidate or humiliate;
• in a discriminatory way; or
• as a blanket approach for a diagnosis or circumstance.

11. Authorisation

11.1 Planned Restrictive Interventions

Any planned restrictive intervention must be exceptional and must only be included in a person’s care records after:

• multidisciplinary consideration where relevant;
• documented risk assessment;
• consideration of capacity and best interests where applicable;
• a clear rationale for why the intervention may be needed;
• identification of least restrictive alternatives;
• management approval by the Registered Manager or delegated senior manager; and
• discussion with the person and, where appropriate, their family member, advocate, attorney, deputy, commissioner or relevant professional.

11.2 Emergency Interventions

In an emergency, the staff member present may take immediate action to prevent harm if delay would increase risk. Any emergency restraint must be reported to the Registered Manager immediately or as soon as practicable and reviewed without delay.

Emergency Services and Immediate Danger

If a staff member reasonably believes that the person, another service user, a family member or a member of staff is in immediate danger of serious harm, they must call 999 immediately.

Staff must prioritise their own safety and the safety of others, use de-escalation wherever safe and practicable, and withdraw to a place of safety where necessary.

Physical restraint must not be used simply because a person is distressed, communicating an unmet need, refusing care or expressing an emotional reaction.

Any intervention must have a lawful basis, be necessary and proportionate to the immediate risk, use the least restrictive available approach and cease as soon as it is safe.

Staff must not attempt physical intervention techniques for which they are not trained and assessed as competent. An exceptional emergency does not remove the need for lawful justification, incident reporting, safeguarding consideration and management review.

Following the incident, the Registered Manager must ensure appropriate welfare checks, recording, debriefing, supervision and review of the person’s care plan and Positive Behaviour Support plan.

12. Procedure for Managing Risk and Using Positive Restraint

12.1 Before Any Incident

Staff must know the person’s support plan and risks, identify signs of distress early, attempt verbal and non-verbal de-escalation, reduce demands and stimulation where safe to do so, seek assistance where needed, and consider withdrawal, repositioning and environmental adjustment before any physical intervention.

12.2 During the Incident

If restraint is unavoidable, staff must use the minimum force for the minimum time, use only trained and approved techniques, explain what is happening in a calm and respectful way, protect the person’s airway, breathing, circulation and dignity at all times, avoid pain-based techniques, dangerous holds, chest compression, obstruction of breathing, pressure on the neck, prone restraint or any intervention that creates unnecessary risk, monitor continuously for pain, fear, breathing difficulty, distress, injury or medical deterioration, and stop immediately once the danger has passed.

12.3 Summoning Help

Staff must call emergency services without delay where the person is injured or unresponsive, breathing is affected, the level of risk cannot be safely managed, weapons are involved, or the incident may amount to serious assault, serious self-harm or another serious criminal matter.

12.4 After the Incident

As soon as possible after the incident, staff must ensure the person is safe and medically checked if needed, offer reassurance and emotional support, inform the Registered Manager or on-call manager, inform the family member, attorney, deputy, advocate or other lawful representative where appropriate and lawful, complete all required records before the end of the shift or as soon as practicable, participate in debrief and review, and update care plans and risk assessments where required.

13. Safeguarding and External Reporting

Any use of restraint that is excessive, avoidable, inappropriate, degrading, repeated, unexplained, not in line with a care plan, carried out by untrained staff, or causes injury or trauma may amount to abuse or improper treatment and must be treated as a safeguarding concern.

13.1 Adult Safeguarding

Where an adult with care and support needs is experiencing, or at risk of, abuse or neglect and is unable to protect themselves because of those needs, a safeguarding referral must be made to the local authority in line with local procedures.

13.2 CQC Notifications

{{org_field_name}} will notify the Care Quality Commission without delay where required under the Care Quality Commission (Registration) Regulations 2009, including for abuse or allegations of abuse and other notifiable incidents.

13.3 Police

Police must be contacted where there is immediate danger, suspected criminal assault, sexual assault, hate crime, unlawful restraint, serious injury, weapons or serious public safety risk.

14. Records and Evidence

A full, accurate and contemporaneous record must be made for every incident involving restraint or restrictive intervention. Records must be factual, respectful and free from blame.

The incident record must include the name of the person, date, time and location, staff involved and witnesses, antecedents, triggers and early warning signs, what de-escalation and alternatives were tried, why restraint was considered necessary, the type of restraint used, start and end time, monitoring undertaken during the incident, any injury, pain, distress or medical concern, what the person said or communicated before, during and after, whether family member, attorney, deputy, advocate or other representative was informed, whether safeguarding, CQC, commissioner or police notification was made, immediate outcomes and follow-up actions, and manager review.

15. Debrief, Review and Learning

Every restraint incident must be reviewed promptly. The person must be offered an opportunity, in a way they can understand, to talk about what happened, how they felt, whether they were hurt or frightened, and what might help prevent recurrence.

Staff involved must have a structured debrief covering what happened, what worked and what did not, whether the intervention was lawful, proportionate and in line with training, whether earlier prevention could have reduced the risk, any emotional impact on staff, and any need for further support, supervision or training.

The Registered Manager or delegated senior manager must review whether the intervention was justified, whether safeguarding thresholds are met, whether notifications were made, whether support plans require amendment, and whether there are themes relating to staffing, timing, communication, environment, medicines or training.

16. Training and Competency

{{org_field_name}} will ensure that staff receive training appropriate to their role and the people they support. Training must be refreshed at suitable intervals and supplemented by supervision and competency assessment.

Training must include, as relevant, least restrictive practice and human rights, person-centred care and dignity, de-escalation and conflict reduction, positive behaviour support, safeguarding adults, Mental Capacity Act 2005 and best interests, lawful and safe physical intervention techniques where the role requires this, recognising medical distress during restraint, recording and reporting, duty of candour, and post-incident debrief and reflective practice.

No member of staff may use physical restraint unless they have received approved training, been assessed as competent, and the use is within the scope of their role and this policy.

17. Governance, Audit and Monitoring

{{org_field_name}} will monitor the use of restraint through its governance systems. This will include review of every incident by a manager, monthly incident analysis for themes and repeat patterns, quarterly audit of documentation quality, safeguarding action, notifications, injuries, training compliance and care plan updates, oversight by senior management, and action plans where incidents identify learning, non-compliance or service risk.

18. Equality, Diversity, Communication and Human Rights

{{org_field_name}} recognises that restrictive practice can disproportionately affect disabled adults, autistic people, people with learning disabilities, people with mental health needs and people with communication differences. We will actively consider communication needs, sensory needs, culture, religion, language, trauma history, age, sex, gender, sexuality and other protected characteristics in assessment, care planning and review.

Any intervention must respect the person’s rights and must not be discriminatory.

19. Related Internal Policies

This policy should be read alongside the Safeguarding Adults Policy, Mental Capacity Act and Consent Policy, Behaviour Support Policy, Incident Reporting Policy, Complaints Policy, Duty of Candour Policy, Medicines Policy, Staff Training and Supervision Policy, Lone Working Policy, and Record Keeping and Confidentiality Policy.

20. Policy Review

This policy will be reviewed at least annually and sooner if legislation, regulation or guidance changes, there is a serious incident, learning from audit, safeguarding, complaints or CQC inspection indicates change is needed, or service delivery changes create new risks.

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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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