Registration Number: {{org_field_registration_no}}

Restrictive Practices and Physical Interventions Policy

1. Purpose

{{org_field_name}} adopts a rights-based, least-restrictive approach in line with Welsh law and CIW expectations. Restrictive practices (any practice that limits a person’s rights or freedom of movement) are used only to prevent immediate risk of harm, for the shortest possible time, and only after less-restrictive options have been tried or are not possible. All decisions are person-centred, lawful, necessary and proportionate, and are recorded, reviewed and governed through our quality framework, supervision, and quarterly personal-plan reviews.

2. Scope

This policy applies to all workers engaged by {{org_field_trading_name}} (employees, bank, agency, students and volunteers) and to any person we support in the community. Where other providers are involved, the lead provider is identified and joint plans are agreed to avoid conflicting instructions.

3. Legal and Regulatory Basis

This policy must be read alongside: the Social Services and Well-being (Wales) Act 2014; the Regulation and Inspection of Social Care (Wales) Act 2016 and the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017; the Mental Capacity Act 2005 and its Code of Practice; the Human Rights Act 1998 (Articles 2, 3, 5, 8); Welsh Government/CIW guidance for domiciliary care (including personal-plan review at least every three months); and the national approach to reducing restrictive practices.

4. Definitions

Restrictive practice: any act or omission that restricts a person’s rights or freedom of movement.
Physical intervention: direct physical contact to prevent imminent harm.
Mechanical restraint: equipment used intentionally to restrict movement (e.g., lap belt).
Environmental restriction: limits created by the environment (e.g., keypad locks, removal/positioning of items).
Chemical restraint: medication used primarily to control behaviour rather than treat a diagnosed condition.
Seclusion/long-term segregation: supervised confinement/isolation preventing the person from leaving — not used by {{org_field_name}} in domiciliary settings.

5. Principles

We prioritise prevention, positive risk-taking, and the least-restrictive option. People’s will and preferences, language and communication needs (including the Active Offer of Welsh), culture, and relationships are central. Equality, diversity and human rights are actively upheld. Restrictions are temporary, individually justified, and removed at the earliest opportunity.

6. Prohibited Practices

{{org_field_name}} does not permit: seclusion or long-term segregation in community settings; pain-compliance techniques; prone/floor holds or any method that impedes breathing/blood flow; blanket restrictions without individual justification; or using medication to sedate for staff convenience or as a substitute for adequate staffing/skills. Any worker who witnesses or suspects prohibited practice must stop the action if safe to do so, report immediately to {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}, and follow safeguarding and whistleblowing procedures.

7. Prevention and Positive Behaviour Support (PBS)

Each person who may present behaviours of concern has a Positive Behaviour Support plan that: identifies functional causes/triggers, early signs and agreed de-escalation; details communication approaches, sensory/regulation needs and meaningful activity; and records the person’s preferences and reasonable adjustments (including Welsh-language needs). Plans are co-produced, shared with staff, practised in supervision, and reviewed at least every three months or sooner after any incident or change in need.

8. Capacity, Consent and Best Interests

We presume capacity and support decision-making. For any planned restrictive practice, we complete a decision-specific capacity assessment where doubt exists. Where the person lacks capacity, a best-interests decision is recorded showing why the practice is necessary and proportionate, how less-restrictive alternatives were considered, and how the person’s wishes and feelings were taken into account. Representatives/advocates are involved where appropriate and agreed. If liberty may be significantly restricted in the community, the manager seeks legal advice and records the lawful basis/authorisation route.

9. Authorising Planned Restrictive Practices

Planned restrictive practices must be exceptional and:

be grounded in an individual risk assessment with clear triggers, thresholds and exit criteria;
be documented in the personal plan with rationale, technique, staff roles, time limits and review points;
be approved by {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}} following multi-disciplinary input where relevant (e.g., OT/SLT/prescriber);
be communicated to all relevant staff with practice guidance and competency checks; and
be reviewed at least every three months and after any incident.

10. Emergency (Unplanned) Physical Intervention

Unplanned physical intervention may be used only to prevent immediate and serious harm where de-escalation is not possible. It must be the least restrictive option and be ceased immediately when risk reduces. Staff notify a manager the same day, and a record is completed within 24 hours. Post-incident support and debrief are offered to the person, staff and (where appropriate) family, focusing on learning and prevention. Managers consider safeguarding thresholds and external notifications (including CIW and the local authority) as required.

11. Chemical Restraint (Medication Used to Control Behaviour)

Medication must not be used to control behaviour unless prescribed for that purpose by a qualified prescriber following assessment, with a documented PRN/behavioural protocol that includes indications, maximum dose, contraindications and monitoring. Consent/best-interests is recorded and the primary purpose is explicit. The protocol is kept with the MAR and cross-referenced in the personal plan. Effects and side-effects are recorded at each administration, and the prescriber reviews necessity and effectiveness regularly; the manager seeks medicines optimisation/STOMP input where appropriate.

12. Mechanical and Environmental Restrictions

Mechanical restrictions (e.g., lap belts) are only used on clinical prescription, with an equipment risk assessment, time-limited objectives, checks at each use, and planned removal trials to reduce restriction.
Environmental restrictions (e.g., keypad locks, access control) must be individually justified, time-limited, accompanied by access arrangements to avoid blanket restriction, recorded in the personal plan, and reviewed at least three-monthly.

13. Recording and Post-Incident Review

For every restrictive episode, staff complete an incident record the same day covering: date/time/duration; location; precipitating events; less-restrictive strategies attempted; who used the intervention and their training/competency date; technique used; impact on the person; injuries/medical checks; debrief offered/completed; family/representative informed; manager’s review; actions to prevent recurrence. Managers analyse trends (e.g., ABC patterns, times/places, staff mix) and feed learning into supervision, refresher training and service improvement. Where there is injury, significant risk, pattern escalation or safeguarding concern, statutory notifications and commissioner/prescriber updates are considered and documented.

14. Welsh Language and Accessible Communication

We provide information, plans and debriefs in the person’s preferred language and format (Active Offer of Welsh; Easy Read; large print; interpreter). Staff follow the communication strategies set out in the personal plan.

15. Advocacy and Involvement

Where a person may be vulnerable or finds it difficult to be heard, we promote access to independent advocacy and involve chosen representatives. We document who supports the person and how they are involved in decisions and reviews.

16. Governance, Review and Oversight

Manager oversight: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}} reviews all incidents weekly, signs planned protocols, and ensures refresher training and competency checks are current.
Responsible Individual: {{org_field_nominated_individual_first_name}} {{org_field_nominated_individual_last_name}} receives a quarterly thematic analysis (frequency, type, duration, injuries, learning) and checks that actions are closed.
Care-plan review: all restrictive measures are reconsidered at least every three months with the person and representatives and removed at the earliest opportunity.
Supervision and training: complex cases and incident learning are discussed in 1:1 supervision and appraisals; targeted coaching and refresher training are arranged where needed.

17. Roles and Responsibilities

All staff must: follow PBS plans; use de-escalation first; use the least-restrictive option only when necessary to prevent harm; stop as soon as risk reduces; record accurately; and escalate concerns immediately. Coordinators ensure plans are accessible to staff, monitor incident patterns, and schedule reviews. The RM/RI provide governance, audits, and ensure multi-agency working where needed.

18. Related Documents

DCW169 Staff Supervision

DCW07 Person-Centred Care

DCW11 Safe Care and Treatment

DCW13 Safeguarding Adults from Abuse and Improper Treatment

DCW34 Confidentiality and Data Protection

DCW39 Mental Capacity and DoLS

DCW58 Medication Management

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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DCW132-Restrictive Practices and Physical Interventions Policy