Safeguarding People from Abuse and Harm: Minimising Restraints, Physical Controls and Restrictive Practices in Care Homes (Wales) Policy

Policy Statement

This policy sets out the values, principles and procedures underpinning this care provider’s approach to issues of the rights of people living in the home, associated risks and use of legitimate means of restraint, including physical restraint. The home’s restraint policies are integral to its overall approach to the safeguarding of vulnerable.

The policy ensures that the respective human and citizens’ rights and responsibilities of people receiving care and staff regarding the use of restraints and actions that restrict freedom of movement and action are always upheld.

The home works on the basis that people receiving care have the same rights as anyone else in society, which must be fully respected. It would not seek to restrict people receiving care’ freedoms in any ways unless there were clear unacceptable risks to their safety and the safety of others without some form of restraint or restrictions being applied.

The policy applies to all those aspects of the service in which there are issues about the respective rights and responsibilities of people receiving care and providers concerning their freedom of action and movement. These include day-to-day care and relationships and specific aspects such as accessibility to health and social services outside the home and to community and citizen participation.

It specifically focuses on the inappropriate use of restraints and restrictions as breaches of human rights and possible criminal actions. The policy identifies when restraint could be justified and legally permissible and the procedures to be followed if staff must use restraint as a last resort.

The policy is written to comply with Regulation 29: The Appropriate Use of Control and Restraint, which is part of the safeguarding standards under the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.

{{org_field_name}} has developed its policy in line with this regulation, which states as follows.

Care and support must not be provided in a way which includes acts intended to control or restrain an individual unless those acts:
a. are necessary to prevent a risk of harm posed to the individual or another individual
b. are proportionate response to such a risk.
Control or restraint must not be used unless it is carried out by staff who are trained in the method of control or restraint used.
The service provider must have a policy on the use of control or restraint and ensure that any control or restraint used is carried out in accordance with this policy.
A record of any incident in which control or restraint is used must be made within 24 hours.
For the purposes of this regulation, a person controls or restrains an individual if that person:
a. uses, or threatens to use, force to secure the doing of an act which the individual resists
b. restricts the individual’s liberty of movement, whether or not the individual resists, including by the use of physical, mechanical or chemical means.

The home also accepts as policy Regulation 30, which forbids the use of any corporal punishment in any Wales social care setting.

The policy is also in line with local authority safeguarding responsibilities under the Social Services and Well-being (Wales) Act 2014.

The policy should be read and used with other safeguarding policies.

Definition of Curbs, Restraints and Restrictive Practices

{{org_field_name}} accepts a definition of restraint included in the new Regulation 29: The Appropriate Use of Control and Restraint, which states “a person controls or restrains an individual if that person:

uses, or threatens to use, force to secure the doing of an act which the individual resists
restricts the individual’s liberty of movement, whether or not the individual resists, including by the use of physical, mechanical or chemical means”.

Restraint is action intended to curb or restrict another person’s freedom of action.

{{org_field_name}} recognises that restraint and restrictions can take many forms and can happen under many circumstances, which includes situations where the risks to a person’s safety are considered too high to be acceptable.

The most common situations, where legitimate restraint may be indicated, include those where there are needs to protect another person or other people from harming or injuring themselves or others physically or psychologically or to protect property and possessions.

Restraint can be reasonable and acceptable in some situations but unreasonable and tantamount to abuse in others.

Types of Restraints and Restrictions

{{org_field_name}} is committed to only using forms of restraint lawfully and where required to the minimum necessary to keep everyone safe from harm. This policy extends to the following forms of restraint.

Physical restraint — physical intervention to prevent, restrict or subdue movements of the body, or part of the body of another person, including holding people chest down in prone positions (also referred to as “prone restraint”).
Psychological restraint — attitudes, discrimination or even social exclusion and punishment are all ways in telling someone repeatedly that they cannot leave or do something they want to do, including using unfriendly language and bullying, which people can exert pressure on an individual to comply, thus curtailing their freedoms.
Chemical restraint — the use of medicines and drugs specifically to control or subdue disturbed/violent behaviour. {{org_field_name}} will always follow initiatives such as STOMP and STAMP to stop the overprescribing of psychotropic medicines as methods of behaviour control.
Mechanical restraint — the enforced use of mechanical aids such as bed rails, belts and cuffs specifically to control an individual’s movements.
Withdrawal, seclusion and segregation — environmental restraints that involve removing a person involuntarily from a situation; removing any aids and belongings that effectively restrict the person’s movements; confinement and isolation of a person, away from others, which prevents them from leaving, and where a person cannot mix freely with others temporarily or on a long-term basis.

Minimising Use of Physical Restraint

{{org_field_name}} understands physical restraint to refer to the restriction of a person’s freedom without their permission. In the context of a nursing or care home, restraint could relate to the use of force or firm physical intervention:

in the event of a person receiving care or visitor becoming aggressive or behaving in a threatening manner, or losing control of their behaviour through acute emotional distress
to prevent self-harm or injury to a person receiving care (for instance, by using bed rails, locking doors, restrictive clothing, etc)
to prevent a person receiving care from leaving the home in situations where staff are concerned as to the safety of that person.

Minimising Use of Restraints and Restrictions

{{org_field_name}} understands that restraint is illegal unless it can be demonstrated that for an individual not being restrained would conflict with the duty of care of the home and that the outcome for the individual would be harm to themselves or for others.

{{org_field_name}} considers that physical restraint represents bad practice in care and should be avoided wherever possible. Staff will use physical restraint only as a last resort or in exceptional circumstances.

Restraint and restrictions will be used only where:

the form of restraint or restriction has been agreed as necessary following a risk assessment and has been entered in the person’s care and support plan
the restraint is needed in an emergency to prevent serious physical harm to the person receiving care or other people
those involved in the intervention have received the appropriate training and supervision.

Any restraint or restriction must be in the best interests of the person. It should be based upon the level of risk present, taking account of the person’s size, gender, age and medical conditions. It should be used for the minimum amount of time and with the least amount of intervention.

It is accepted that some people receiving care can be challenging at some time or another. Staff are always expected to deal with these events in a calm and professional manner. Whenever restraint must be used, management must be informed of the incident, full details must be entered in a restraint incident reporting form and on the person’s care records.

Restraint should never be used as an easy option and all staff should be aware of the people receiving care’s legal and moral rights to freedom, dignity and autonomy.

Using Minimal Restraint in Situations of Aggression or Violence

Physical and verbal aggression by a person receiving care should be dealt with in line with home’s health and safety policy on aggression and violence and never met with counter aggression from staff. Physical interventions should be used only as a last resort by trained staff and to protect the rights and best interests of the person receiving care and should be the minimum consistent with making sure that all involved are kept safe from harm.

Care staff must only use minimum force when it is absolutely necessary to restrain someone. People receiving care who are acting in an aggressive or threatening manner must not be subject to undue restraint.

The law gives protection to people from being abused or attacked and, if a member of staff is attacked, they may use “minimum reasonable force” to defend themselves. Staff should remember that if they restrain a violent person and injure them because of the amount of force they use, they could be charged for assault. Because of this risk, staff must always follow the established procedure.

Because of this risk, staff must always follow established procedures required by health and safety laws, which are set out in corresponding safeguarding staff policies. (See the Disrespectful Behaviour and Abuse of Staff, Including Aggression and Violence and Appropriate Response in Care Homes Policy.)

Applying the Least Restrictive Principle Under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards

Whenever the home identifies that a person receiving care who lacks mental capacity is being, or risks being, deprived of their liberty, it must apply to the local authority for authorisation.

Anyone with a concern, for example, a family member, can apply to the supervisory body to trigger an assessment if they have asked the home to apply for an authorisation but it has not been done.

Each case that is referred for authorisation will be assessed by a trained Best Interests Assessor (BIA) appointed by the local authority.

Following authorisation, a representative will be appointed to support the person receiving care and look after their interests.

{{org_field_name}}, in partnership with the local authority, must then:

make regular checks to see if the authorisation is still necessary
remove the authorisation where it is no longer necessary
provide the person who has an authorisation and their representative with information about the authorisation and their rights and entitlements.

Where conditions are attached to the authorisation issued, for example, any steps to be taken to keep contact with family or to ensure cultural or faith-based needs are met, then {{org_field_name}} will ensure that they are met.

Inappropriate forms of restraint

Restraints can have harmful effects on people’s physical and mental health by reducing their freedom of action and mobility. Restraining a person consistently can result in a decline in people’s levels of fitness, their ability to walk, sleep patterns and general deterioration in their wellbeing.

Staff who deliberately use any form of illegitimate restraint, or use restraint inappropriately, face disciplinary proceedings and dismissal. If it is proved they have committed an act of misconduct causing harm to a vulnerable adult, they will be referred to the Disclosure and Barring Service for inclusion on its barred list, preventing them from working with vulnerable adults.

Staff must not organise people living in {{org_field_name}}’s rooms and other environments in such ways as to restrict their freedom of movement, for example, by deliberately seating them in chairs from which they cannot get up without help or permission.

Staff must make sure that mobility aids (or deprivation of), harnesses, straps, belts and cot sides are used solely for ensuring safety and not to control and restrain.

Staff must not restrict freedom of movement and access by locking people in bedrooms and other areas of the home.

Restrictions to keep people safe should follow only after completion of a full risk assessment and management plan.

The home deplores the use of psychotropic drugs and medication that are solely or mainly used to control and restrain behaviour. The home accepts that any medication that can have the effect of restricting or controlling behaviour should be prescribed only after full medical assessment and is regularly and rigorously reviewed.

Staff must not use threats of actual physical punishment or any form of intimidation, harassment or bullying to control and restrain the behaviour of people using the services.

The home does not use any form of surveillance methods such as CCTV and other technological aids, which intrude into people’s privacy and dignity, to monitor and restrict their freedom of movement. Any use of such devices must be justified as necessary only to keep people safe.

When minimal restraint is acceptable and reasonable

{{org_field_name}} accepts that restraints and restrictions might form part of a care plan based on a risk assessment — usually as part of a wider process of best-interests decision taking for people who might lack the mental capacity to recognise any dangers to themselves or others.

The use of restraint is only acceptable when people’s safety is clearly at risk. Restraining interventions must then be appropriate to the situation and must be discontinued once the immediate danger has gone.

Staff actions should be directed at preventing the need for any form of restraint. If physical or any other form of restraint is needed it should be undertaken solely with the interests of keeping the person and other people safe.

The least restrictive form of intervention appropriate to the situation should always be used.

The home undertakes to provide its staff with appropriate guidance, supervision and training in those interventions that are seen to be acceptable and reasonable for the people receiving care.

Importance of Risks and risk assessments

Staff are expected to promote and enable people receiving care to exercise their rights and not seek to curb them or any of their civil liberties. To achieve this, it is recognised that staff must assess and manage any risks to people receiving care’s safety that may occur.

Any risks to personal safety requiring intervention that could be interpreted as restraint or restriction are assessed and a risk management plan developed so that all parties are aware of the possible consequences and responsibilities for the actions taken.

The risk assessment must be comprehensive, fully recorded and signed by all parties within the individual care plan. All significant parties including relatives, advocates and other professionals are made aware of the risk assessment and management plan.

Reporting and recording

Any instance involving the restraint of a person receiving care should be reported immediately to the manager in charge and fully recorded as a critical incident and on the individual’s file/care plan.

A full description of the incident must be given together with details of what took place and the reasons for the restraining actions.

It can be expected that the incident will be discussed in a meeting/supervision/case review to explore further the issues raised by the situation.

As far as possible, the aim will be to discover the lessons to be learned to minimise or prevent the need for such actions in the future.

In cases where there is evidence that the restraints used were unreasonable or inappropriate, the staff member(s) involved may be warned that they may face disciplinary action (or disciplinary action may need to be taken if there is strong enough evidence that abuse has occurred).

In these instances, the home will alert the local safeguarding authority and notify the CIW as safeguarding incidents.

Monitoring and auditing

All restraints and restrictions imposed on people receiving care are regularly reviewed through their care plans and their use is monitored and audited by senior management. The object is always to make sure that restraints and restrictions are kept to the minimum and only used when there are no reasonable alternatives.

Training

All new staff receive training on the policy on dealing with aggression and violence as well as this policy on physical restraint as part of their induction process in line with the safeguarding learning requirements of the All Wales Induction Framework for Health and Social Care.

All staff are expected to receive refresher training after an annual review to update them in any aspects of the home’s restraints policies and procedures that need to change. The home provides existing staff with further training to address challenging behaviour and aggression and violence.

The home provides ongoing training and yearly refresher courses so that staff can develop skills to manage and reduce unacceptable behaviour based on detailed problem analyses and the selection of interventions appropriate to each person’s needs.

The home provides ongoing training so that staff can develop skills to manage and reduce unacceptable behaviour based on detailed problem analyses and the selection of individualised interventions appropriate to each case.

Staff are trained in a range of intervention strategies in line with the training standards produced by the Restraint Reduction Network (2020) as they apply to Wales, all national guidance and the resources made available by Social Care Wales.

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}}

WCH255. Safeguarding People from Abuse and Harm: Minimising Restraints, Physical Controls and Restrictive Practices in Care Homes