Risk notification return guidance tool

• Repetitive falls, for instance, more than one for an individual that occurs within a 28 day period
   
• if the fall was impacted by an environmental hazard, such as poor lighting 

• any unobserved falls for a person living in their own home, including Extra Care
   
• a controlled fall where no injury was sustained
   
• where a person has a diagnosed health condition or infection that increases the risk of falls, such as Parkinson's disease or a urine infection

• an adult at risk sustains a significant injury that impacts on their health and wellbeing, such as a fracture, due to a fall
   
• where abuse, neglect or act of omission is suspected
   
• there was not an appropriate risk assessment in place (if there was a history of falls)
   
• if there was a risk assessment in place but it was not followed
   
• the care plan had not been reviewed and updated following a fall or a change of circumstance, or there was a delay in response/medical intervention

• when a medication incident has happened, where no harm has occurred, all appropriate actions have been taken, for example, sought medical advice from a healthcare professional, and this is an isolated accident
   
• when a person does not receive the correct prescribed medication, for example:
  • missed dose(s)
  • incorrect dosage
  • incorrect time interval between doses
     
• being administered another person's medication
   
• when medication is stored inappropriately - except within the person's home
   
• when any medication is administered which is out of date

• missed signature on medication administration record (MAR)
   
• if medication is dispensed from the pharmacy which is incorrectly labelled or the medication dispensed is incorrect, and the medication has not been administered

• if an incident has occurred which caused harm, or had the potential to cause harm
   
• the adult at risk is subjected to deliberate withholding of prescribed medication with no medical reason
   
• a deliberate attempt to harm or threaten an adult at risk through use of a medicine, including intentional over sedation
   
• deliberate falsification of records in order to cover up a medicine administration error
   
• failing to monitor the person's condition or seek appropriate medical advice and support following medicine administration error, for example, pain management
   
• covert medication administration without a documented best interest decision and written authorisation from the GP and with Deprivation of Liberty Safeguards (DoLS) authorisation in place or applied for

• when there has been a missed care and support call 

• a planned care and support call is missed and this has had an adverse effect on the adult at risk
   
• there are repeated missed care and support calls for the same person

• no heating is available
   
• no supply of hot water is available
   
• a power cut
   
• the call bell system is not working
   
• communal toilets are out of use
   
• communal bathrooms are out of use
   
• the lift is out of use
   
• a fault with the fire system
   
• the kitchen is out of use
   
• security systems in the building are compromised
   
• there is flooding at the service

• consider the impact on individual(s) and the resident group as a whole
   
• depending upon the seriousness of the situation and/or number of environmental issues, this may need to be addressed within organisational safeguarding
   
• consult with the Safeguarding Lead for your organisation

There is no requirement to complete a risk notification return for incidents between adults.

It is the responsibility of the Service Manager or Registered Manager to;

• review the support of the individual(s) involved in the incident
   
• ensure that an up-to-date risk assessment is in place for the immediate safety of all people who use the service, and this is reviewed on a regular basis

• an adult at risk has been harmed during an incident with another adult at risk, and there is an impact on their wellbeing
   
• there are repeated incidents or a risk of repeat incident(s) by the same person

There is no requirement to complete a risk notification return for nutrition and hydration.

It is the responsibility of the Service Manager or Registered Manager to;

• review the support of the individual(s) involved in the incident
   
• ensure that all mechanical equipment used to support people with nutrition and hydration is used correctly and is in good working order

• there is a failure to provide nutrition and hydration to an adult at risk
   
• there is unexplained weight loss or the person is at risk of showing signs of dehydration and a support plan is not in place or has not been followed and/or no referral has been made to the GP, Dietician, Speech and Language Therapy
   
• where errors are made with dietary requirements, for example soft diet, thickened fluids, allergies or adapted diet, for example, low sugar, high fibre, restricted fluids to an extent where it may endanger the safety or wellbeing of the person, including choking
   
• where an adult’s food/fluid charts have not consistently been completed and specialist advice has not been sought or followed

• where injury or harm has occurred due to poor moving and handling practice and techniques
   
• where there is no moving and handling plan or risk assessment in place to manage the risk
   
• where there is failure to follow a moving and handling plan, for example using the wrong equipment
   
• failure to provide appropriate moving and handling equipment
   
• where a person at risk has been moved or dragged manually
   
• where inappropriate use of wheelchair occurs, for example not using lap belts or foot plates
   
• where poor moving and handling techniques are being used 

• there is insufficient discharge/transfer of care planning from any area resulting in a risk of abuse or neglect
   
• where the adult at risk is discharged without necessary equipment, medication or personal items and this results in a risk of abuse or neglect
   
• where the adult at risk is discharged with a cannula in situ but there is no record on the discharge plan, and this results in a risk of abuse or neglect
   
• where the adult at risk is discharged with no/or incomplete discharge documentation and this results in a risk of abuse or neglect

• an adult at risk is denied access to his/her funds or possessions, where this is not part of a support plan or best interest decision
   
• there is a failure by a responsible person to pay care fees/charges and the adult at risk experiences distress or an adverse effect through having no or restricted access to personal allowances, resulting in a risk of eviction or termination of service
   
• where there is a misuse or misappropriation of property, possessions, benefits or finances by a person in a position of trust or control
   
• where the adult at risk is subject to theft
   
• where the adult at risk is subject to doorstep crime
   
• where the adult at risk is subject to being put under pressure in relation to money or other property, for example defrauding, either via mail, telephone or online
   
• where someone persuades/befriends the person to gift or loan them money by any means

There is no requirement to complete a risk notification return

Return for accidents, incidents or serious incidents

The provider is to follow their own procedures regarding reporting of incidents to the following:

• RIDDOR - Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
• Care Quality Commission notification - if you are a regulated service

• the provider using their own policies, procedures and guidance should determine if a safeguarding referral is required following a serious incident/accident