Restrictive Practice Policy & Procedure

What counts as restrictive practice?

Restrictive practice means making someone do something they do not want to do, or stopping them doing something they want to do. It runs from blanket rules, such as set bedtimes or a locked kitchen, to physical restraint. In supported living people live in their own homes, so a rule that seems normal in a staff-run building may be a restriction there.

This policy is written for supported living. Specialist services for autistic people and people with a learning disability must send CQC a restraint policy.

The four types of restraint

CQC asks services to define four types:

• Physical: direct contact by staff that stops or limits movement

• Mechanical: a device that does the same

• Chemical: medicine used to control behaviour or movement, including "as required" medication

• Environmental: changing the surroundings to limit movement or choice, such as locked doors or items kept out of reach

How the policy keeps restriction rare

Following CQC's position, restrictive practice is used only to prevent serious harm. It must be the least restrictive option for the shortest possible time, with the correct authorisation beforehand. Afterwards the person gets support to recover, and their care plan gets a detailed review. The service does not use seclusion, long-term segregation or blanket restrictions, and it never restricts visitors, friends or food because of a lack of staff.

Before a planned restriction, staff complete a risk assessment and ask the person for their consent, respecting a refusal from someone with capacity. If capacity is in doubt, they assess it and make a best interests decision under the Mental Capacity Act 2005. The intervention then goes into the behaviour support plan, saying exactly what staff may do, when, for how long and when to stop. The Registered Manager must sign it off in writing first.

Deprivation of Liberty Safeguards do not reach supported living. There, the Court of Protection can authorise a deprivation of liberty, so if in doubt the service refers to the local authority.

After any restraint, staff check the person's wellbeing, offer support and a debrief, and record it on the same shift. The plan is then reviewed.

Before you use it

Add the roles that can authorise restrictive interventions, your approved training provider and your on-call details. If your service never uses physical restraint, say so in the policy statement and keep the rest for emergencies.

Prevention starts with the Positive Behaviour Support Policy. Best interests decisions can be written up on the Best Interests Decision Record. Restraint that was not needed, or went too far for the risk, is reported under the Safeguarding Policy & Procedure (Supported Living).