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DC210-Restrictive Practices, Restraint and Physical Interventions Policy (LD/A)

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Restrictive Practices and Physical Interventions Policy(LD/A)

1. Introduction and policy statement

1.1 Policy statement

{{org_field_name}} provides domiciliary care (care and support delivered in people’s own homes and community settings). We recognise that people receiving care remain citizens with the same rights as anyone else. Their home is private space and their choices must be respected.

{{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.

Restrictive practices and restraint can cause harm, distress, trauma, injury and loss of trust. They can also breach a person’s legal rights. Therefore, we are committed to least restrictive practice and to reducing and preventing the use of restraint wherever possible.

Restraint may only be used:

We will ensure any planned restrictions are:

1.2 Purpose of this policy

This policy:

1.3 Scope

This policy applies to:

1.4 Related policies

This policy should be read alongside:

2. Definitions

2.1 Restrictive practice

A restrictive practice is any act, intervention, or omission that limits a person’s:

In domiciliary care, restrictive practices may be more subtle than physical interventions and can include:

2.2 Restraint (legal concept)

Restraint includes:

Restraint can be:

2.3 Restriction vs restraint

This distinction matters because restraint requires higher safeguards and scrutiny.

2.4 De-escalation

De-escalation is a set of strategies to reduce distress and risk without force. This includes communication, choice, reassurance, time-out, sensory adjustments, and stepping back from tasks.

2.5 Planned vs unplanned restrictive intervention

3. Legal and ethical framework

3.1 Core principles

Any restriction or restraint must be:

3.2 Relevant regulations and guidance

This policy supports compliance with:

3.3 Human rights approach (what it means for staff)

Staff must recognise that restrictive interventions can interfere with rights including:

In practice, this means staff must:

3.4 Unacceptable and unlawful practice

Restrictive practice and restraint must never be used:

Any allegation or concern of improper treatment must be escalated immediately as a safeguarding matter.

4. Commitment to least restrictive practice and prevention

4.1 Prevention first

We reduce restrictive practice by:

4.2 Positive Behaviour Support (PBS) and behaviour support planning

Where behaviour may pose risks, we will consider a PBS approach that:

PBS plans should be developed with relevant professionals where required and reviewed regularly.

4.3 Least restrictive practice in daily work (examples)

Staff should consider alternatives such as:

5. Roles and responsibilities

5.1 All staff

All staff must:

5.2 Authorised roles (domiciliary care)

Only staff in the following roles may apply physical restraint and only if training is in date and competence is confirmed:

Agency staff may only apply restraint if:

5.3 Authorisation: planned vs emergency

Emergency (unplanned) restraint:
A trained competent staff member may act immediately where there is an imminent risk of harm and no safer alternative is available. The staff member must contact:

Planned restrictions/interventions:
Must be authorised by the Registered Manager or Deputy Manager through:

Immediate Danger and Emergency Services

Where staff reasonably believe that a person or another individual is in immediate danger of serious harm, they must call 999 without delay.

Staff must prioritise safety, use appropriate de-escalation, seek assistance and withdraw to a place of safety where necessary.

Distress, refusal of care, emotional reactions or communication of unmet needs must not, by themselves, be treated as justification for restraint.

Any restrictive 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 follow the organisation’s Positive Restraint Policy, individual risk assessment, Positive Behaviour Support plan and incident-reporting procedures.

5.4 Registered Manager responsibilities

The Registered Manager must ensure:

5.5 Deputy Manager responsibilities

Deputy Manager supports the Registered Manager by:

5.6 Safeguarding Lead responsibilities

Safeguarding Lead: {{org_field_safeguarding_lead_name}} ({{org_field_safeguarding_lead_role}})

Responsibilities include:

Local Authority safeguarding contact details (adult):

(Where relevant for a person under 18 receiving support in the community, staff must follow children’s safeguarding routes as well.)

5.7 Staff support and wellbeing

Managers must ensure staff have:

6. Assessment and decision-making

6.1 Risk assessment and care planning

Risk assessments must:

Care/support plans must:

Additional Safeguards for Autistic People and People with a Learning Disability

Before considering any planned restrictive intervention, the organisation must undertake an individualised assessment that takes account of the person’s autism-related needs, learning disability, communication preferences, sensory profile, physical health, emotional wellbeing, trauma history and previous experiences of restrictive practice.

The assessment must identify how the person communicates distress, fear, discomfort, refusal and unmet needs.

Staff must consider whether reasonable adjustments, environmental changes, alternative communication, predictable routines, additional processing time, changes in staffing arrangements or other proactive Positive Behaviour Support strategies could prevent the need for restriction.

A diagnosis of autism or learning disability must never, in itself, be used to justify restraint, restrictions on liberty or assumptions about mental capacity.

Any proposed restriction must have a clearly documented lawful basis, individual risk assessment, identified purpose, consideration of less restrictive alternatives, monitoring arrangements and reduction or review plan.

Where the person lacks capacity for the relevant decision, the organisation must follow the Mental Capacity Act 2005. Restraint in connection with care or treatment must satisfy the applicable necessity and proportionality requirements and must not amount to an unauthorised deprivation of liberty.

The Registered Manager must seek appropriate legal and professional advice where a proposed arrangement may amount to deprivation of liberty. In domestic and community settings, the applicable authorisation route must be considered; management approval or a best-interests record alone does not authorise deprivation of liberty.

All staff must follow the individual’s current care plan, Positive Behaviour Support plan and agreed emergency procedures.

6.2 Consent (Regulation 11)

If the person has capacity:

6.3 Mental Capacity Act 2005: capacity assessments

Where capacity is in doubt for a specific decision:

6.4 Best interests decisions

Where the person lacks capacity for a specific decision, staff must ensure:

6.5 Deprivation of liberty in domiciliary care (home care)

In domiciliary care, restrictions in a person’s own home can, in some cases, amount to a deprivation of liberty. If staff suspect restrictions may mean the person is:

they must:

Staff must not introduce highly restrictive arrangements without lawful decision-making and documented safeguards.

7. Implementing restraint

7.1 General rules

Restraint must only be used:

7.2 Approved techniques and prohibited techniques

{{org_field_name}} will only permit physical interventions taught in our approved training programme and assessed as competent.

Staff must not use techniques that:

7.3 Home care context: completing tasks safely

In domiciliary care, restraint must never be used simply to complete tasks. If a person refuses personal care, medication, meals, or other tasks:

7.4 Decision pathway (staff must follow)

  1. Recognise early warning signs and reduce demands.
  2. Use de-escalation (calm voice, space, reassurance, options).
  3. Use least restrictive alternatives (withdraw, delay task, call manager).
  4. If there is immediate serious risk:
    • call for help / on-call manager {{org_field_out_of_hours}}
    • if needed call 999
    • use minimum physical intervention to prevent harm
  5. End the restraint as soon as it is safe.

7.5 Monitoring during restraint

During restraint, staff must continuously monitor:

If at any point there are signs of medical distress:

7.6 Time limits and escalation triggers

Restraint must be as brief as possible. Minimum service expectations:

If restraint happens repeatedly:

7.7 Environmental restrictions and access restrictions in the home

Because the person’s home is private:

Any restriction that affects contact with others, finances, or communication must be treated as high risk and may require safeguarding/multi-agency oversight.

8. After restraint

8.1 Immediate aftercare for the person

After restraint staff must:

8.2 Debrief (person and staff)

Debrief should happen:

Debrief should cover:

8.3 Updating care plans and risk assessments

Following restraint:

9. Recording and incident reporting

9.1 What must be recorded

Every restraint incident must be recorded using the internal incident reporting system and include:

9.2 Quality expectations for records

Records must:

10. External reporting and notifications

10.1 Safeguarding referrals

Safeguarding concerns must be considered where:

Safeguarding contacts:

10.2 CQC notifications and other bodies

Where incidents meet notification thresholds (e.g., serious injury, allegations of abuse, police involvement, significant events affecting safety), {{org_field_name}} will notify relevant bodies without delay, which may include:

Managers are responsible for:

11. Training, supervision and competency

11.1 Mandatory training

All staff must complete training relevant to their role, including:

Staff authorised to use restraint must also complete:

11.2 Supervision and refresher training

We provide:

Staff who are not in date or not competent must not apply restraint.

Supervision and Competency Assurance for Restrictive Interventions

The Registered Manager must ensure that any staff member authorised to undertake a planned restrictive intervention has completed training appropriate to the intervention, demonstrated practical competence and received individual-specific instruction.

Training completion alone does not constitute evidence of competence.

The organisation must maintain records identifying each staff member’s training, assessed competence, authorised interventions, assessment dates and refresher requirements.

Competence must be checked through appropriate practical assessment, observation, questioning, scenario-based exercises and review of incident-related practice.

Supervision must consider whether the staff member:

Following any restrictive intervention, the Registered Manager or delegated competent senior must review the circumstances, staff actions, person’s wellbeing, records and need for additional support or reassessment.

Where competence is uncertain or unsafe practice is identified, the staff member must not undertake planned restrictive interventions until the concern has been addressed and competence has been reassessed.

All supervision, reassessment and improvement actions must be documented.

11.3 Staff support after incidents

Staff must be offered:

12. Monitoring and governance

12.1 Governance aims

We monitor restrictive interventions to:

12.2 What we monitor (minimum)

12.3 Audit and review schedule

12.4 Escalation triggers for governance

Immediate escalation to Registered Manager (and Safeguarding Lead where appropriate) if:

13. Equality and human rights

13.1 Reasonable adjustments

Staff must consider and record:

13.2 Equality impact assessment (EIA)

For any planned restriction or repeated restraint, an EIA must be considered and documented. This should explore:

13.3 Human rights in daily practice

Staff must ensure:

14. Complaints, concerns and whistleblowing

People using the service and families can raise concerns via:

Staff can raise concerns through:

All concerns will be recorded, investigated and used to improve practice.

15. Policy review

This policy will be reviewed:

after serious incidents or safeguarding investigations

annually

earlier if guidance changes, incidents indicate gaps, or CQC requirements change

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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