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DCW132-Restrictive Practices and Physical Interventions Policy

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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 and implemented alongside the following legal and regulatory requirements and guidance:

Where legislation, statutory guidance, CIW requirements or Welsh Government guidance changes, this policy will be reviewed and updated without delay. Staff will be informed of changes and, where required, additional training or supervision will be provided.

4. Definitions

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 any restrictive practice that is unlawful, punitive, abusive, degrading, discriminatory, disproportionate, used for staff convenience or used as a substitute for adequate staffing, training, planning or skilled support.

The following practices are prohibited:

Any worker who witnesses or suspects prohibited practice must stop the action immediately if safe to do so, protect the person from further harm, report to the Registered Manager without delay, record the concern, and follow safeguarding, whistleblowing, duty of candour and CIW notification procedures where required.

6.1 Identifying Subtle or Hidden Restrictive Practices

Restrictive practices are not limited to physical restraint. Staff must be alert to subtle or hidden restrictions that may become normalised in day-to-day care. A practice may be restrictive if it makes a person do something they do not want to do, or stops them doing something they want to do, unless the restriction is lawful, necessary, proportionate and individually justified.

Examples of subtle restrictive practices include:

Where staff identify a subtle or hidden restriction, they must report this to the manager so that the restriction can be reviewed, reduced or removed. Any restriction that remains in place must be recorded in the person’s personal plan with the reason, lawful basis, alternatives considered, impact on the person, review date and exit plan.

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.

PBS plans must be used as a proactive well-being and prevention tool, not only as a response to behaviour. The plan must identify what improves the person’s quality of life, emotional well-being, communication, relationships, choice, meaningful activity, sensory regulation and sense of safety. The aim is to reduce the likelihood of distress and prevent situations where restrictive practice may be considered. Any restrictive strategy included within a PBS plan must have a clear rationale, lawful basis, time limit, review date, reduction plan and exit criteria.

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.

Where an individual lacks capacity to consent to care or support arrangements, staff must follow the Mental Capacity Act 2005. Any restrictive practice must be assessed as a decision-specific best-interests decision and must be necessary, proportionate, the least restrictive available option and clearly recorded.

Where arrangements in a domiciliary care or community setting may amount to a deprivation of liberty, this must be escalated immediately to the Registered Manager. The Registered Manager must review the person’s capacity, restrictions, supervision, freedom to leave, objections, risks, alternatives and the cumulative impact of the care arrangements. The Registered Manager must liaise with the placing authority, commissioner, legal representative or relevant responsible body and seek legal advice where required.

DoLS authorisations apply to care homes and hospitals. In a person’s own home, supported living or another community setting, a deprivation of liberty will usually require Court of Protection authorisation unless another lawful framework applies. No staff member may implement or continue arrangements that amount to a deprivation of liberty without lawful authority. Any urgent concern must be treated as a safeguarding and human rights matter.

Following the Supreme Court judgment of 2 June 2026 and CIW’s 15 June 2026 statement, {{org_field_name}} will keep deprivation of liberty arrangements under active review and will seek legal advice where changes to practice may be required.

9. Authorising Planned Restrictive Practices

Planned restrictive practices must be exceptional and:

10. Emergency (Unplanned) Physical Intervention

Emergency physical intervention may only be used where there is an immediate risk of harm to the person or another person, and where de-escalation, distraction, withdrawal, environmental adjustment or other less restrictive approaches have been tried or are not possible in the circumstances.

Any emergency physical intervention must:

Staff must notify a manager as soon as possible and on the same day. A record must be completed within 24 hours. The manager must review whether the incident meets safeguarding, duty of candour, CIW notification, commissioner notification, prescriber notification, police or health professional referral thresholds.

Emergency interventions must not become routine. If an emergency intervention happens more than once, or if a pattern is identified, the person’s risk assessment, PBS plan, personal plan, staff training and commissioning arrangements must be reviewed without delay.

10.1 CIW Notifications, Safeguarding and Duty of Candour

The Registered Manager must consider whether any restrictive practice or physical intervention requires notification or referral. This decision and the rationale must be recorded.

CIW must be notified through CIW Online where the incident is notifiable, including where restrictive practice or physical intervention:

The local authority safeguarding team must be contacted without delay where there is any allegation, evidence or suspicion of abuse, neglect, improper treatment, unlawful restraint or inappropriate deprivation of liberty.

The duty of candour must be followed where something has gone wrong and has caused, or may cause, harm. The person and, where appropriate, their representative must receive a timely, open and honest explanation, an apology where appropriate, information about actions being taken and information about how to raise a concern or complaint.

The manager must ensure that notifications, safeguarding referrals, commissioner updates, family or representative communications and duty of candour actions are recorded clearly and reviewed for learning.

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.

Every administration of PRN medication used in response to distress or behaviour of concern must trigger a review of the reason for use, whether non-medicinal strategies were attempted, the effect on the person, side effects, whether the person’s presentation changed, whether medical advice is required and whether the PBS plan or personal plan needs updating. Repeated use, increased frequency, sedation, falls, reduced engagement, change in presentation or concern that medication is being used to manage staffing or service pressures must be escalated to the prescriber, commissioner and Registered Manager without delay. Where chemical restraint may amount to abuse, neglect, improper treatment or unlawful restriction, safeguarding and CIW notification procedures must be followed.

12. Mechanical, Environmental, Surveillance and Technology-Based Restrictions

Mechanical, environmental, surveillance and technology-based restrictions must only be used where they are individually assessed, lawful, necessary, proportionate, least restrictive and clearly recorded in the person’s personal plan.

Mechanical restrictions, such as lap belts, specialist seating, bed rails, harnesses or positioning equipment, must only be used following appropriate professional assessment or clinical recommendation. The assessment must identify the purpose of the equipment, risks, benefits, alternatives considered, consent or best-interests decision, checks required at each use, review date and plan to reduce or remove the restriction where possible.

Environmental restrictions, such as locked doors, keypad locks, restricted access to rooms, removal of items, placement of furniture, door alarms or access controls, must not be used as blanket restrictions. They must be individually justified and must include arrangements that allow the person to access areas, possessions, visitors, activities and community life wherever safe and lawful.

Surveillance and technology-based restrictions, such as cameras, sensors, GPS trackers, monitoring devices, electronic medication dispensers, falls monitors or door alerts, must have a clear assessed purpose. The person’s consent must be obtained where they have capacity. Where the person lacks capacity, a best-interests decision must be recorded. The privacy, dignity and human rights impact must be considered. Surveillance must never be used for staff convenience or as a substitute for safe staffing, skilled care, observation or person-centred support.

All restrictions in this section must be reviewed at least every three months, sooner after any incident, and sooner if the person objects, their needs change, the restriction increases, or the restriction may amount to deprivation of liberty.

13. Recording and Post-Incident Review

For every restrictive episode, staff complete an incident record the same day covering:

The incident record must also include:

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 oversight: {{org_field_nominated_individual_first_name}} {{org_field_nominated_individual_last_name}} receives quarterly thematic analysis of all restrictive practices and physical interventions, including frequency, type, duration, location, person affected, staff involved, injuries, safeguarding referrals, CIW notifications, duty of candour actions, patterns, recurrence, training needs, quality-of-care learning and whether actions have been completed. The Responsible Individual must use this information to support effective oversight, service improvement and compliance with CIW inspection expectations.

Quality-of-care review: Records and analysis of control, restraint and restrictive practice must be included in the service’s quality assurance and quality-of-care review processes. The review must identify whether restrictions are reducing, whether people’s rights and well-being are being promoted, whether personal plans remain accurate and whether staff have the competence and confidence to use least restrictive approaches.

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:

Coordinators and senior staff must:

The Registered Manager must:

The Responsible Individual must:

Agency workers, students and volunteers must follow this policy and must not use any restrictive intervention unless they have been authorised, trained, assessed as competent and briefed on the person’s plan, except in an immediate emergency to prevent serious harm.

18. Related Documents

19. Monitoring Against CIW Inspection Themes and Ratings

{{org_field_name}} will monitor restrictive practice and physical intervention as part of its quality assurance arrangements and CIW inspection readiness.

The service will review whether:

Findings will be used to improve practice, update training, revise personal plans, inform the quality-of-care review and evidence compliance with CIW inspection expectations.

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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