April 2020: Changes in relation to Coronavirus
During the COVID-19 outbreak, additional measures to reduce risk need to be taken to further prevent the spread of the virus. This is especially important where face to face contact with adults, their families or other staff is required. Your line manager will give you information about how to keep yourself safe at this time. Click on the link for information from the UK Government: How to protect yourself and others – Coronavirus (COVID-19): what you need to do and Responding to COVID-19: the ethical framework for adult social care (Department of Health and Social Care).
Risk taking is part of daily life and does bring benefits, including wellbeing (see Promoting Wellbeing). Not all risks can be eradicated, but they can be managed to prevent or reduce the impact of harm. In each case risk should be assessed, including:
- what is the presenting risk;
- is there a risk to the service user;
- is there a risk to others;
- is it a potential risk that yet may happen;
- is it an actual risk that has already happened;
- what are the benefits of taking the risk to the individual?
Undertaking a comprehensive risk assessment involves collating evidence based information, evaluating that information –including balancing possible positives of a course of action against potential drawbacks – and using professional judgment to ascertain the potential for the occurrence of harm.
Good risk assessments can rarely be done by one person alone and a joint approach is required. Good relationships between professionals and the adult and their carers makes the assessment easier and more accurate, and may reduce risk.
A risk assessment needs to identify and balance different perceptions of risk, including the adult, their carers and professionals; the adult’s right to make informed choices about taking risks should be safeguarded and encouraged. Decisions about risk, however, do need to balance any risk to other adults, carers, staff, the wider public and the needs and wishes of the adult.
1.1 Mental capacity
If the adult does not have the capacity to make their own decisions, the risk assessment must take account of the views of family members or friends important to the adult and who have an interest in their welfare or, where appointed, their attorney or Independent Mental Capacity Advocate (IMCA) (see Section 3, Risk Assessment Process below, Mental Capacity and Advocacy).
2. Roles and Responsibilities of Staff
Staff undertaking a risk assessment should be supported throughout the process by their manager, to ensure all aspects of the situation have been understood, evaluated and the views of the adult, their attorney and / or advocate where appointed and other agencies and service providers have been considered. Staff undertaking the assessment should ensure a referral for an IMCA is made, where appropriate, to protect an unsupported person who lacks mental capacity to make a decision (see Mental Capacity and Advocacy).
Lines of accountability with other agencies should be established for high risk area. A clear management reporting structure within the service and with the other agencies involved should be in place.
Staff undertaking risk assessments should be competent and able to evaluate and act upon a risk of danger, harm or abuse. Staff should therefore know how to reduce or remove risk. Ongoing risk management tasks include staff supervision.
In high risk situations staff should be supported by their manager, enabling them to gain insight into their work, their personal stress, their decisions and the appropriate plan of action.
There are risks associated with all aspects of support, each support need will be risk assessed and managed. The risks will be recorded in detail as part of the care and support planning process (see Care and Support Planning).Where there are activities that include serious risks, there will be specific monitoring followed by analysis to ensure the risk rating remains accurate and the risks still able to be managed.
See also Supervision.
3. Risk Assessment Process
The adult should be involved as far as possible in the process and their independence should be the main focus. Their attorney and / or advocate where appointed should also be involved (see Mental Capacity and Deprivation of Liberty Safeguards).
A multi-disciplinary approach should form the basis of the risk assessment process. Information should be collated from a variety of sources and agencies. Contributions from agencies such as the police, probation and the adult’s GP should always be considered at each stage in the process.
The professional/s undertaking the risk assessment should be aware of the different types of risk that may exist. These may include risks in four main areas:
- physical health;
- mental health;
- emotional wellbeing;
- social circumstances.
Risk should be considered in terms of the likely risk to:
- the person;
- others including care staff, carers, visitors and other professionals;
- the wider community including neighbours or other residents of the area or service.
Types of risk may include the following:
- the physical environment, for example an unsafe home conditions;
- mental health issues which result in, for example confusion, wandering or leaving the gas on;
- the adult’s behaviour, for example fire setting or aggression;
- major life changes, such as bereavement / loss, moving to residential care;
- health issues refusing medication;
- a poorly managed service;
- sharing accommodation or services with people who have violent behaviour;
- relationships which involve emotional, physical, financial or sexual abuse or neglect.
Risks that involve the allegation or suspicion that an adult may be experiencing, or at risk of, abuse or neglect should be dealt with under the local Safeguarding Adults Board procedures (see Safeguarding Adults from Abuse and Neglect).
In assessing the likelihood of the risk occurring, staff should consider the:
- patterns of behaviour, which may help identify triggers for risky situations;
- severity of the risk;
- the ability of the adult or their carer to manage the situation;
- different opinions about the level of risk within the agencies involved, the adult and / or the carer;
- how various risks may interact with each other’s timescales – and whether the risk can be contained during particular time frames or whether it is ongoing and likely to deteriorate.
Other factors to be considered by the professional include:
- previous incidents of harm;
- history of falls;
- poor social relationships;
- poor compliance with services;
- presence of substance or alcohol misuse;
- family history of harmful behaviour;
- significant life events;
- home circumstances or places where incidents have occurred;
- environment of the service;
- disturbances in the individual’s mental state caused by brain damage, dementia or mental illness;
- fears and threats made by the individual;
- challenging behaviours;
- health and physical state;
- frailty and general health condition;
- effects of any medication, including side effects.
Risk assessments should be subject to frequent review, as an adult’s circumstances may change. Interventions can increase risk, as well as decrease it.
Recording of the risk assessment should be structured with the identification of each risk in order of priority, and the likelihood of the realisation of the risk and its impact. Each risk should have recommendations to control, reduce or remove the risk (see also Record Keeping).
4. Multi-Agency Meetings
Multi-agency meetings may be required where:
- there are concerns about potentially serious outcomes;
- previous experience indicates a probability of high risk and resulting harm;
- several agencies need to be involved to manage the risk;
- there is conflict between key individuals or agencies;
- consideration is being given to using legislation to restrict liberty and freedom of choice;
- the adult departs from an agreed plan of action aimed at managing risk;
- several agencies, acting in isolation, have withdrawn services in response to an adult’s behaviour and where a coordinated response needs to be re-established.
5. Decision Making and Risk Management Plan
Staff completing the risk assessment should conclude how serious the risk is, how specific it is and its immediacy.
Not every adult will require a risk management plan, but where there are concerns, a plan should be developed.
The risk management plan should:
- identify each risk and detail the measures taken or services applied to remove or reduce it;
- identify who is responsible for each aspect of the required monitoring;
- identify and plan the frequency of reviews;
- identify who is responsible for coordinating reviews;
- identify the role and contribution of each agency in the management of the identified risk/s;
- contain a contingency plan in case of emergency or in response to risks identified.