Rights, Risks and Restraint
This policy sets out the values, principles and policies underpinning this home’s approach to the wider issues of residents’ rights, associated risks and use of legitimate means of restraint. The home’s restraint policies are integral to its overall approach to the safeguarding of vulnerable residents.
The purpose of this policy is to ensure that all residents and staff are aware of their respective human and citizens’ rights and responsibilities particularly in relation to the potential use of restraints and actions that restrain the resident’s freedom of movement and action. The policy is written in line with the letter and spirit of a wide raft of legislation, which includes the Human Rights Act 1998, the Equality Act 2010, the Mental Capacity Act 2005, the Health and Social Care Act 2008 and current Care Quality Commission guidance.
The home follows the principles of encouraging and supporting its residents to lead appropriate and fulfilling lifestyles in and outside the care home. This entails being able to participate as fully as they wish and are able to in the wider community and social activities, including political processes. The standards also stress that residents should have the same rights as anyone else in society and their legal and political rights need to be protected.
The policy applies to all those aspects of the service in which there are issues about the respective rights and responsibilities of residents and providers. These include day-to-day care and relationships and specific aspects such as accessibility to services outside the home such as health and social services and to community and citizen participation. It also covers the inappropriate use of restraint as a breach of human rights and a possible criminal action. The policy identifies when restraint could be justified and legally permissible and the procedures to be followed if staff have to use restraint in an emergency.
Standards of the home
The home works on the basis that residents have the same rights as anyone else in society, which must be fully respected.
Staff are expected to promote and enable residents to exercise their rights and not seek to curb them or any of their civil liberties. To achieve this, it is recognised that staff will need to accept, assess and manage any risks to residents’ safety that may occur as a result of residents exercising their rights.
Risks and risk assessments
Any risks to personal safety requiring intervention that could be interpreted as a form of restraint are assessed in consultation with the resident 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 is comprehensive, fully recorded and signed by all parties within the individual residents plan. All significant parties including relatives, advocates and other professionals are made aware of the risk assessment and management plan.
Curbs and restraints
The home accepts a definition of restraint as action intended to curb or restrict another person’s freedom of action. It recognises that restraint can take many forms including: physical restraint, forced care, physical intervention, chemical restraint, environmental restraint, electronic surveillance and medical restraint.
The use of restraint 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 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.
The use of restraint may be quite reasonable and acceptable in some situations but unreasonable and tantamount to abuse in others.
Inappropriate forms of restraint
The home believes that restraints have harmful effects on people’s physical and mental health by reducing people’s freedom of action and mobility. Restraining a person consistently can result in a decline in people’s levels of fitness, their ability to walk and sleep patterns.
Staff who deliberately use any form of illegitimate restraint or use restraint inappropriately face disciplinary proceedings, 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 residents’ 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 behaviour.
Staff must not restrict residents’ freedom of movement and access by locking their bedrooms and other doors. Nor should anyone be locked in their room to control and restrain their behaviour.
Where some limitations need to be applied in order to keep people safe, they should follow only after a full risk assessment and management plan has been completed.
The home deplores the use of drugs and medication that are solely or mainly used to control and restrain behaviour. The home accepts that any medication that has an effect on a person’s behaviour should be prescribed only after full medical assessment demonstrates its purpose in relation to the individual’s plan of care and is then regularly and rigorously reviewed against those objectives.
Staff must not use threats of actual physical punishment or any form of intimidation, harassment or bullying to control and restrain residents’ behaviour.
The home does not use any form of surveillance methods such as CCTV and other technological aids, which intrude into residents’ privacy and dignity, to monitor and restrict their freedom of movement.
When restraint is acceptable and reasonable
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 resident.
The Deprivation of Liberty Safeguards
Whenever the home identifies that a resident 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 appointed by the local authority.
Where the local authority approves the care it will grant an authorisation. In such cases, a representative will be appointed to support the resident and look after their interests.
The care home, 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, steps to be taken to keep contact with family or to ensure cultural or faith-based needs are met, then this home will ensure that they are met.
Reporting and recording
Any instance involving the restraint of a resident should be reported to the person in charge and fully recorded both as a critical incident and on the resident’s individual 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/incident 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 in order 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).
All new staff receive training in the home’s policies and procedures on restraint as part of their mandatory safeguarding training.
All staff receive training to update them about changes to the home’s restraints policies and procedures.
Policy review date: _____________________________