Involving people to manage risks

Are there up-to-date, specific risk assessments covering all identified hazards (e.g., mobility, environment, skin, choking)?

What we look for: Check that risks identified in the care plan have corresponding risk assessments with clear mitigation strategies. Good looks like specific guidance for staff on reducing risk. Fails if generic risks are used or mitigations are missing.

Evidence: Moving and handling risk assessment, environmental risk assessment, falls risk assessment

Do daily records show evidence that staff identify, document, and escalate emerging risks or changes in the person's condition?

What we look for: Look for logs detailing changes (e.g., red skin, worsening mobility, confusion). Good looks like clear documentation of the issue and escalation to the office or district nurse. A fail is documenting a clear risk but taking no action.

Evidence: Daily logs, incident reports, communication logs with office/health professionals

Where staff transport service users in their own vehicles, are specific risk assessments in place covering passenger safety, mobility aids, and vehicle suitability?

What we look for: If the service provides transport/escort services, review the risk assessments. They must cover how to assist the person in/out of the car and stow equipment safely. A fail is transporting individuals without assessing the vehicle's suitability or passenger risk.

Evidence: Service user risk assessments, Transport risk assessments, Care plans, Wheelchair tie-down training records

Are comprehensive falls risk assessments completed for all people using the service prior to or at the commencement of care?

What we look for: Sample 5 care files of new service users or those known to be at risk. Check that a validated falls risk assessment was completed. A fail is if the assessment is missing, incomplete, or not dated.

Evidence: Initial assessments, falls risk assessment tools (e.g., FRAT), daily notes

Are personal and environmental risk assessments immediately reviewed and updated following an incident?

What we look for: Trace an incident (e.g., a fall) through to the person's risk assessments. Verify that the falls risk assessment was updated with new mitigation measures. A fail is finding identical, unchanged risk assessments weeks after a significant incident.

Evidence: Updated risk assessments, incident follow-up checklists, date-stamped document revisions

Do individual care plans include specific IPC risk assessments tailored to the person's home environment and health conditions?

What we look for: Sample 5 care records, including individuals with known infections or catheters/stomas. Look for specific risk assessments detailing how staff should manage infection risks in that specific home environment. A fail would be generic risk assessments that do not address known infections or poor home hygiene.

Evidence: Care plans, Environmental risk assessments, Infection risk assessments (e.g., MRSA, C.Diff)

Are care plans and risk assessments promptly updated following an incident to prevent recurrence?

What we look for: Cross-reference 3 incident reports with the corresponding person's care plan and risk assessment. Good practice shows immediate updates to care instructions (e.g., requiring two carers instead of one for mobility). Fail if the risk assessment remains unchanged despite a clear change in risk level.

Evidence: Updated risk assessments, care plan review notes, daily logs showing new instructions

Is the use of any restrictive practices (e.g., bed rails, sensor mats, PRN sedation) supported by valid MCAs and Best Interests decisions?

What we look for: Identify people with restrictive interventions. Confirm that an MCA and BI decision exist for the specific restriction, proving it is proportionate to the risk of harm. Fails if restrictions are applied without legal framework or regular review.

Evidence: Risk assessments, Restraint logs, MCA/BI forms, Bed rail assessments

Is there an up-to-date medication risk assessment detailing the exact level of support required (e.g., prompt, assist, administer)?

What we look for: Review medication care plans and risk assessments. Good looks like a clear distinction between prompting, assisting, and administering, with environmental risks and swallowing difficulties addressed. It is a fail if the level of support is contradictory across documents.

Evidence: Medication risk assessments, care plans, consent forms

Are detailed moving and handling risk assessments documented, specific to the home environment, and regularly reviewed?

What we look for: Check that risk assessments identify specific hazards in the service user's home (e.g., tight spaces for hoists, trip hazards, carpet types). Good looks like clear mitigation strategies for each identified risk. Fail if risk assessments are generic, out of date, or fail to address the actual home environment.

Evidence: Moving and handling risk assessments, environmental risk assessments, review logs.

Where dysphagia or choking risks exist, are SALT recommendations (e.g. IDDSI levels) clearly documented and followed?

What we look for: Check records for individuals with swallowing difficulties. Ensure exact IDDSI levels for food and fluids are recorded. Fail if staff are not adhering to or recording the specific IDDSI requirements.

Evidence: Risk assessments, SALT reports, IDDSI guidance in care plans, daily care notes

Are robust environmental and personal risk assessments completed and documented before or on the very first visit?

What we look for: Review the risk assessments for new packages. Ensure the physical environment (e.g., trip hazards, pets, equipment) and personal risks are assessed. Good practice involves identifying hazards and documenting clear mitigation strategies. Missing home environment checks before staff enter the property constitutes a fail.

Evidence: Home environment risk assessment, moving and handling risk assessment, fire risk assessment, specific health risk assessments (e.g., falls).

Have required updates to individual risk management strategies, identified in previous audits, been signed off and communicated to care staff?

What we look for: Look at the previous month's care plan audit. Check if identified gaps in risk assessments were actually rectified. Good looks like completed updates and clear messages to staff about the changes. Fails if risks remain unmanaged despite being identified in a previous audit.

Evidence: Care plan audit action plans, updated risk assessments, staff communication logs, handover notes

Are moving and handling practical competencies assessed in the community setting during the probation period?

What we look for: Sample staff files to verify that practical, face-to-face moving and handling competency (e.g., using hoists) was observed and passed. Fail if only e-learning was provided for moving and handling tasks involving equipment.

Evidence: Moving and handling competency forms, spot check records, induction sign-offs

Are all required individual risk assessments completed before or at the commencement of the care package?

What we look for: Sample 3-5 new service users from the last 30 days. Verify that risk assessments were completed prior to care delivery starting. A fail would be care being delivered for days or weeks without a baseline risk assessment in place.

Evidence: New service user files, initial assessment forms, signed and dated risk assessments

Where applicable, are specific moving and handling risk assessments detailed, accurate, and reflective of the equipment used?

What we look for: Check files for people requiring hoisting or physical support. Ensure the assessment specifies the type/size of sling, hoist type, and number of carers required. A fail is contradictory information between the care plan and the moving and handling assessment.

Evidence: Moving and handling plans, mobility assessments, equipment servicing records within the home

Are all associated risk assessments reviewed and updated to reflect any changes identified during the care review?

What we look for: Cross-reference changes in the care plan to the risk assessments. If mobility has declined, has the falls risk assessment been updated? Fails if care plans are updated but risk assessments remain static.

Evidence: Moving and handling risk assessments, Environmental risk assessments, Medication risk assessments

Are comprehensive, validated skin integrity risk assessments (e.g., Waterlow, Braden, or PURST) completed and regularly reviewed for at-risk individuals?

What we look for: Sample 3-5 files of people with limited mobility. Good looks like a validated tool used correctly, scored accurately, and reviewed monthly or upon change in condition. A fail is an outdated, missing, or incorrectly calculated assessment.

Evidence: Risk assessments, Initial assessments, Care plan reviews

Do spot check records confirm direct, physical observation of moving and handling practices rather than just relying on self-reporting?

What we look for: Review recent spot check forms where the client requires hoisting or mobility support. Good looks like the supervisor explicitly noting how the carer used the equipment safely. Tick-box forms with no qualitative comments constitute poor practice.

Evidence: Completed spot check forms, field supervisor notes, manual handling risk assessments