CHW132-Restrictive Practices and Physical Interventions Policy

Registration Number: {{org_field_registration_no}}

Restrictive Practices and Physical Interventions Policy

1. Purpose

The purpose of this policy is to provide clear guidance on the appropriate use of restrictive practices and physical interventions at {{org_field_name}}, ensuring they are used only as a last resort, in a legal, ethical, and proportionate manner, and in compliance with Care Inspectorate Wales (CIW) regulations. The policy supports the least restrictive approach, prioritising de-escalation techniques, positive behaviour support (PBS), and person-centred care.

This policy ensures compliance with:

The Regulation and Inspection of Social Care (Wales) Act 2016, which requires providers to promote safe, person-centred, and least restrictive care.
Care Inspectorate Wales (CIW) regulations, ensuring that restrictive interventions are appropriately justified, recorded, and reviewed.
The Social Services and Well-being (Wales) Act 2014, promoting service user rights, dignity, and inclusion.
The Mental Capacity Act 2005, which ensures that restrictive practices comply with the best interest principle.
The Deprivation of Liberty Safeguards (DoLS) and Liberty Protection Safeguards (LPS), ensuring that service users are not unlawfully deprived of their liberty.
The Human Rights Act 1998, ensuring that all actions respect individual freedoms and protections.

This policy aims to:

Define restrictive practices and physical interventions and when they may be used.
Ensure that all interventions are necessary, proportionate, and legally justified.
Promote proactive approaches to prevent the need for restrictive interventions.
Set out clear procedures for recording, reporting, and reviewing restrictive practices.
Ensure staff are appropriately trained in de-escalation and safe intervention techniques.

2. Scope

This policy applies to all employees, agency staff, and volunteers at {{org_field_name}}, service users receiving care and support, visitors, including family members, advocates, and external professionals, and management and safeguarding leads responsible for oversight and reporting.

This policy covers the definition of restrictive practices, positive behaviour support strategies, risk assessments and individual care planning, authorised use of physical interventions, reporting and monitoring, and staff training and competency requirements.

3. Definition of Restrictive Practices

Restrictive practices are any actions that limit a service user’s rights, movement, or freedom of choice. They must only be used when absolutely necessary to prevent harm and must always follow the least restrictive principle. Restrictive practices include:

Physical interventions – Any form of hands-on restraint used to prevent harm, including holding, guiding, or preventing movement.
Mechanical restraint – Use of equipment (e.g., bedrails, lap belts, mittens) to restrict movement.
Environmental restrictions – Locking doors, restricting access to certain areas, or using alarms to monitor movement.
Chemical restraint – Administering sedative medication not for a diagnosed condition but to manage behaviour.
Seclusion and time-out – Isolating a service user in a locked or controlled environment.

4. Preventing the Use of Restrictive Practices

At {{org_field_name}}, we use a proactive, person-centred approach to prevent the need for restrictive interventions. Staff are trained to use:

Positive Behaviour Support (PBS) – Identifying triggers, understanding behaviour, and developing personalised care strategies.
De-escalation techniques – Using verbal and non-verbal communication, redirection, and offering choices to reduce distress.
Engagement and meaningful activities – Providing opportunities for independence and reducing frustration.
Risk reduction plans – Identifying potential risks and implementing early interventions to avoid crisis situations.

Restrictive practices are only used as a last resort, when all alternative interventions have failed, and there is an immediate risk of serious harm.

5. Risk Assessments and Individual Care Planning

Before any restrictive practice is used, a comprehensive risk assessment must be completed, ensuring:

The practice is necessary, proportionate, and in the best interests of the service user.
Alternative approaches have been exhausted.
The intervention does not violate human rights.
The service user’s mental capacity and consent are considered under the Mental Capacity Act 2005.

Risk assessments must be:

Documented in the service user’s care plan.
Reviewed regularly to assess ongoing necessity.
Developed in partnership with the service user, family, advocates, and multidisciplinary teams.

6. Use of Physical Interventions

6.1 When Physical Intervention is Permitted

Physical intervention should only be used when:

A service user is at imminent risk of harming themselves or others.
All other de-escalation techniques have failed.
The intervention is proportionate to the level of risk.
The service user does not have capacity and intervention is in their best interests (or under DoLS/LPS if applicable).

6.2 Authorised Physical Intervention Techniques

Only approved, minimal force techniques should be used, including:

Guiding away techniques to redirect movement.
One or two-person holds for brief interventions.
Blocking movements to prevent harm without physically restraining.

Techniques never permitted include:

Prone (face-down) restraint.
Pressure on the chest, neck, or joints.
Pain compliance techniques.
Holding for excessive periods.

7. Reporting and Monitoring Restrictive Practices

7.1 Immediate Reporting

Every incident involving restrictive practice must be:

Reported immediately to the Registered Manager.
Documented in the incident log, including:
- What led to the intervention.
- The type and duration of intervention used.
- Alternative strategies attempted.
- The service user’s response and any injuries sustained.

7.2 External Notifications

Serious incidents must be:

Reported to CIW within 24 hours if it results in injury or prolonged restriction.
Referred to safeguarding teams if there are concerns about improper use.

7.3 Post-Incident Review

A debriefing session must be conducted with staff involved.
The service user (if able) should be consulted about their experience.
A care plan review should assess how to prevent future incidents.

8. Staff Training and Competency

8.1 Mandatory Training

All staff working in direct care roles must complete:

Positive Behaviour Support (PBS) training.
De-escalation and conflict resolution training.
Safe physical intervention training, ensuring techniques align with best practices.

Training must be refreshed annually, with competency assessments conducted every six months.

8.2 Staff Responsibilities

All staff must:

Follow this policy at all times.
Report any inappropriate use of restrictive practices.
Ensure all interventions are necessary and proportionate.
Participate in regular training and debriefing sessions.

9. Related Policies

This policy should be read alongside: Safeguarding Adults from Abuse and Improper Treatment Policy, Mental Capacity and Deprivation of Liberty Safeguards Policy, Risk Management and Assessment Policy, Incident Reporting and Investigation Policy, Staff Training and Development Policy.

10. Policy Review

This policy will be reviewed annually or sooner if regulatory guidance, legal updates, or operational needs require changes. Regular audits of incident reports and staff training records will ensure ongoing compliance and effectiveness.

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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