CHW49-Prevention of Falls and Injury Policy

Registration Number: {{org_field_registration_no}}

Prevention of Falls and Injury Policy

1. Purpose

The purpose of this policy is to ensure a safe and secure environment for all residents at {{org_field_name}} by implementing effective fall prevention strategies. Falls are a significant risk for older adults and can result in serious injuries, reduced mobility, and a decline in independence. This policy outlines measures to reduce the likelihood of falls, manage risks, and provide an immediate response when falls occur.

This policy is written to support 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; the Welsh Government statutory guidance for service providers and responsible individuals, updated March 2024; the Social Services and Well-being (Wales) Act 2014; the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards where applicable; CIW notification requirements; and current evidence-based falls prevention guidance, including NICE NG249, Falls: assessment and prevention in older people and in people 50 and over at higher risk.

Falls prevention will be delivered in a person-centred way. The aim is not to restrict residents unnecessarily, but to reduce avoidable harm while supporting independence, mobility, dignity, choice, control and positive risk-taking. Any falls prevention measures must be proportionate to the resident’s assessed needs, wishes, mental capacity, personal outcomes and best interests where applicable.

2. Scope

This policy applies to all staff members at {{org_field_name}}, including care workers, housekeeping, maintenance teams, and external healthcare professionals. It covers all areas within the care home, including resident rooms, communal spaces, bathrooms, and outdoor areas. This policy also applies to residents at risk of falls and provides guidance on how to support individuals with reduced mobility, cognitive impairment, or medical conditions that may increase fall risk. Additionally, it extends to family members and visitors who must be informed about fall prevention measures to ensure overall safety.

This policy applies to permanent, temporary and agency staff, volunteers, students, contractors, visiting professionals and the Responsible Individual where their role relates to governance, safety, monitoring or improvement. It applies to all residents aged 65 and over and to residents aged 50 to 64 who have one or more factors that may increase their risk of falls, including frailty, cognitive impairment, dementia, Parkinson’s disease, diabetes, arthritis, stroke, learning disability, reduced mobility, sensory impairment, continence needs, dizziness, medication-related risk or previous falls.

3. Principles of Fall Prevention

Comprehensive Falls Assessment, Provider Assessment and Personal Planning

Each resident must have their falls risk considered as part of the pre-admission decision-making process, the provider assessment, the personal plan and ongoing reviews. The falls assessment must not rely solely on a falls risk prediction score or tool to predict whether a resident will fall. Any tool used must support professional judgement and care planning, not replace a comprehensive, person-centred assessment.

On admission, and within the provider assessment process, staff must consider the resident’s history of falls, circumstances of any previous falls, mobility, gait, balance, muscle strength, functional ability, cognition, mood, delirium risk, continence, dizziness, lying and standing blood pressure where clinically indicated, long-term conditions, pain, nutrition, hydration, weight loss, footwear, foot condition, vision, hearing, medication, psychotropic medicines, osteoporosis or fragility fracture risk, environmental hazards, use of mobility aids, and the resident’s own views, wishes, feelings and concerns about falling.

Where a resident is identified as having falls-related needs or risks, their personal plan must clearly set out: the identified risk factors; how risks will be reduced; what support is required on a day-to-day basis; how independence and positive risk-taking will be maintained; the resident’s preferred routines; the equipment or adaptations required; when staff must provide assistance; when referrals to GP, pharmacist, physiotherapist, occupational therapist, optometrist, falls service or other professionals are required; and how the resident will be supported to achieve their personal outcomes.

The falls element of the personal plan must be reviewed at least every three months, or sooner following any fall, near miss, change in mobility, change in cognition, change in medication, hospital attendance or admission, infection, deterioration in health, change in continence, change in footwear, change in equipment, or any concern raised by the resident, representative, staff member or visiting professional.

Falls History and Immediate Triggers for Review

Staff must ask about and record the details of any fall, including when and where it happened, what the resident was doing, whether it was witnessed, whether there was loss of consciousness, dizziness, pain, injury, head injury, inability to get up, new confusion, medication changes, infection symptoms, footwear or environmental factors.

A falls review must be completed immediately after any fall or near miss and must consider whether the resident requires medical assessment, neurological observations, pain assessment, moving and handling reassessment, equipment review, medication review, continence review, hydration and nutrition review, environmental changes, increased observation, referral to therapy services, or safeguarding consideration.

Safe Environment and Hazard Reduction

All areas must be well-lit, with clear pathways and minimal clutter to prevent accidental trips.
Flooring should be non-slip and in good condition, with secure rugs and mats, and all spills must be cleaned immediately.
Handrails and grab bars should be installed in hallways, bathrooms, and other high-risk areas to aid mobility and reduce fall risks.
Regular safety audits must be conducted to identify and eliminate hazards, and staff must remain vigilant in maintaining a hazard-free environment.

Environmental checks must include resident bedrooms, bathrooms, toilets, lounges, dining areas, corridors, entrances, gardens, external paths and any area used by residents. Checks must include lighting, call bells, flooring, thresholds, mats, trailing wires, furniture position, bed height, chair height, clutter, spills, wet floors, signage, handrails, grab rails, sensor equipment, mobility aid storage, access to personal items, footwear, and safe access to toilets. Any hazard identified must be made safe immediately where possible, escalated to the person in charge, recorded, and followed up until resolved.

Use of Assistive Equipment

Residents who require mobility aids (e.g., walkers, canes, wheelchairs) must receive proper assessment and training by occupational therapists or physiotherapists.
Hoists and transfer equipment must be maintained and used correctly to prevent injuries. Staff must be trained in safe manual handling techniques to assist residents effectively.
Bed and chair alarms may be utilised for high-risk residents to alert staff when assistance is needed, reducing unsupervised movement that could lead to falls.

Any use of bed rails, chair alarms, sensor mats, movement sensors, low beds, crash mats, lap belts, positioning equipment or increased observation must be based on an individual assessment and must be the least restrictive option available. The resident’s consent must be sought and recorded wherever they have capacity to decide. Where the resident lacks capacity for the specific decision, staff must follow the Mental Capacity Act 2005, complete and record a best-interests decision, consult relevant representatives where appropriate, and consider whether the measure may amount to a deprivation of liberty or require review under DoLS arrangements. Equipment must never be used for staff convenience or as a substitute for appropriate care, supervision, engagement or environmental management.

Medication Management and Structured Medication Review

Medicines that may increase falls risk must be considered as part of the resident’s falls assessment and personal plan. This includes, but is not limited to, sedatives, hypnotics, antipsychotics, antidepressants, anxiolytics, antiepileptics, opioids, antihypertensives, diuretics, medicines causing postural hypotension, medicines causing drowsiness, medicines affecting balance, and medicines with anticholinergic burden.

The home must liaise with the GP, pharmacist, mental health team or other relevant prescriber to request a structured medication review where a resident has fallen, is at increased risk of falling, has dizziness, drowsiness, postural hypotension, confusion, sedation, change in mobility, or is prescribed psychotropic medicines.

Where psychotropic medicines are prescribed, the increased risk of falls must be considered and discussed with the resident and/or representative where appropriate. Any reduction, withdrawal or change must only be undertaken by, or under the direction of, an appropriate prescriber and must be monitored and recorded in the resident’s personal plan and medication records.

Physical Activity, Mobility and Falls Prevention Exercise

Residents must be encouraged and supported to remain as active as possible, unless a healthcare professional has advised otherwise. Staff must not discourage safe movement because of a fear of falls; instead, staff must support proportionate risk reduction, confidence, independence and mobility.

The resident’s daily routine should include appropriate opportunities to get up, stand, walk, transfer, participate in meaningful activity and reduce prolonged sedentary periods. Where the resident is able to exercise, staff should consider, and where appropriate refer for, an individual or group programme that addresses the resident’s falls risks, including balance, coordination, strength and power.

Exercise and mobility support must be tailored to the resident’s abilities, preferences, goals, cognition, health conditions and personal outcomes. Where specialist assessment is required, referrals must be made to physiotherapy, occupational therapy, falls services or other appropriate professionals.

Proper Footwear and Clothing

Residents must wear well-fitted, non-slip footwear to reduce fall risks, and inappropriate footwear (e.g., loose slippers, worn-out shoes) must be avoided.
Loose or trailing clothing must be avoided to prevent tripping, and garments should be easy to manage to prevent dressing-related accidents.
Staff should assist residents in choosing appropriate attire for safety and comfort while encouraging personal choice and dignity.

Staff must consider both footwear and foot condition as part of falls prevention. Concerns such as pain, swelling, poor nail care, reduced sensation, poorly fitting footwear, unsafe slippers, pressure areas or changes in walking pattern must be reported and referred to the GP, podiatry, district nursing, physiotherapy or other appropriate professional as required. Residents must be supported to make informed choices about clothing and footwear, with risks explained and recorded where a resident chooses not to follow advice.

Emergency Response and Post-Fall Management

If a resident falls, staff must respond immediately, calmly and safely. The resident must not be moved until staff have assessed for pain, injury, head injury, suspected fracture, loss of consciousness, breathing difficulty, bleeding, new confusion, new weakness, spinal pain, hip pain, reduced range of movement or any other sign that movement may cause harm.

Emergency services or urgent clinical advice must be sought immediately where there is suspected fracture, head injury, loss of consciousness, chest pain, breathing difficulty, severe pain, uncontrolled bleeding, new neurological symptoms, sudden weakness, suspected stroke, repeated vomiting, seizure, acute confusion, suspected sepsis, or where staff are uncertain whether it is safe to move the resident.

Where it is safe to assist the resident from the floor, staff must use the resident’s moving and handling plan, appropriate equipment and safe moving and handling techniques. Manual lifting must not be used. If specialist lifting equipment is required, only staff trained and competent in its use may use it.

Following any fall, staff must record the incident, complete body-map documentation where injury is present or suspected, record observations in line with the resident’s condition and local clinical guidance, inform the nurse or person in charge, inform the GP or other healthcare professional where required, inform the resident’s representative in accordance with the resident’s wishes and best interests, and update the resident’s falls assessment, moving and handling plan and personal plan.

A post-fall review must be completed as soon as practicable and must consider the cause or likely contributing factors, including environment, footwear, mobility, continence, hydration, nutrition, infection, pain, cognition, medication, blood pressure, equipment, staffing, supervision, activity at the time of the fall, and whether any specialist referrals are required.

The Manager or person in charge must consider whether the fall is notifiable to CIW as a serious accident or injury, whether a safeguarding referral is required, whether the local authority or commissioner must be informed, and whether the incident identifies wider service risks requiring action.

CIW Notifications and Safeguarding

The Manager, Responsible Individual or delegated authorised person must consider whether a fall must be notified to CIW. Falls must be notified where they result in serious accident, serious injury, hospital attendance or admission, significant harm, death, police involvement, safeguarding concern, or any event that prevents or could prevent the service from being provided safely. Notifications must be submitted through CIW Online in accordance with CIW requirements.

A safeguarding referral must be made where there is any allegation, suspicion or evidence that the fall may be linked to abuse, neglect, improper treatment, unsafe care, failure to follow the personal plan, poor moving and handling practice, unlawful restraint, unexplained injury, repeated unexplained falls, medication error, environmental neglect, or failure to obtain timely medical assistance. The reason for making or not making a safeguarding referral must be recorded.

4. Staff Training and Responsibilities

All staff must receive training appropriate to their role in falls prevention, person-centred care, positive risk-taking, hazard identification, safe moving and handling, use of mobility aids and lifting equipment, post-fall response, incident reporting, safeguarding, Mental Capacity Act and DoLS awareness where relevant, and escalation to healthcare professionals.

Staff who complete falls assessments, post-fall reviews, moving and handling assessments, equipment checks or neurological observations must be trained and competent to do so. Where a resident has complex needs, nursing needs, cognitive impairment, repeated falls, unexplained falls or specialist equipment, the assessment must be completed by a suitably competent person and specialist advice must be sought where required.

Staff must report changes in mobility, balance, cognition, continence, medication, footwear, pain, dizziness, drowsiness, vision, hearing, nutrition, hydration, skin integrity or general health that may increase the risk of falls. These concerns must be recorded, escalated and reflected in the resident’s personal plan.

The Manager must ensure falls prevention is discussed through handovers, staff meetings, supervision, audits, incident reviews and quality assurance processes. Learning from falls, near misses, safeguarding concerns, complaints and professional advice must be shared with staff and used to improve practice.

5. Resident and Representative Information

Residents must be given information and support, in a format they can understand, about how to reduce their risk of falls while maintaining independence and quality of life. This must include how to call for assistance, how to move around safely, how to use call bells, bed controls, mobility aids and movement sensors where applicable, what to do if they fall, how to alert staff to hazards, and how family members or visitors can raise concerns.

Families, representatives and visitors should be encouraged to support falls prevention by keeping areas free from clutter, ensuring personal items are within reach, reporting hazards, supporting safe footwear choices, and informing staff of any changes in the resident’s mobility, confidence, cognition or health. Information must be provided in a way that respects the resident’s consent, confidentiality, wishes and mental capacity.

6. Related Policies

CHW07 – Person-Centred Care Policy
CHW08 – Dignity and Respect Policy
CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
CHW16 – Health and Safety at Work Policy
CHW17 – Infection Prevention and Control Policy
CHW18 – Risk Management and Assessment Policy
CHW37 – Moving and Handling Policy

7. Records to be Kept

The following records must be completed and retained in accordance with the service’s record keeping policy: falls assessment; provider assessment where relevant; personal plan and review records; moving and handling assessment; equipment assessment; environmental checks; incident report; body map; post-fall review; observations; healthcare professional advice; medication review request or outcome; referrals to GP, pharmacist, physiotherapist, occupational therapist, falls service or other professionals; communication with representatives; safeguarding decisions and referrals; CIW notifications; actions taken; and evidence that actions have been reviewed for effectiveness.

8. Monitoring and Review

This policy will be reviewed at least annually, or sooner following changes in legislation, statutory guidance, CIW requirements, NICE guidance, safeguarding procedures, organisational learning, serious incidents or identified practice concerns.

The Manager will monitor falls, near misses, injuries, hospital transfers, ambulance call-outs, post-fall reviews, safeguarding referrals, CIW notifications, medication review requests, therapy referrals, environmental audit findings, equipment checks, complaints and resident/representative feedback.

Falls data must be analysed to identify patterns, including time of day, location, activity, staffing, resident-specific trends, repeated falls, injury type, medication factors and environmental causes. Findings must be used to update personal plans, improve staff practice, reduce environmental risks and inform the service’s quality assurance and quality of care review processes.

The Responsible Individual must have oversight of falls-related themes, actions and improvements as part of the governance, monitoring and quality review arrangements for the service.

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.