Risk Assessment

1. Lone Working

This procedure focuses on risk assessment relating to people with Care and Support needs and carers with Support needs.

If you are assessing lone working risks to yourself or colleagues, see: Lone Working.

2. Risk Assessment

Defining risk assessment

Risk assessment is name given to the combined processes of:

  1. Identifying risk;
  2. Identifying the likely impact of the risk (positive and negative); and
  3. Identifying how to reduce the negative impact and maximise the positive.

A proactive approach

Wherever possible, risk assessment should be proactive. This means it should take place before any harm has occurred.

3. A Positive Approach to Risk

Adopting a positive approach to risk means recognising the positive benefits that risk taking can have and taking steps to:

  1. Actively encourage and support a person to take a risk; when
  2. Taking the risk is likely to achieve personal change, growth and promote individual wellbeing.

Wherever possible you should take a positive approach to risk assessment unless taking the risk will increase the risk of abuse or neglect of the person (or another vulnerable adult or child).

4. Contextual Requirements of Risk Assessment

Risk assessment can take place in various contexts, including but not limited to:

  1. The assessment of need;
  2. Care and Support Planning/Support Planning;
  3. Review;
  4. Following a safeguarding concern;
  5. Protection Planning;
  6. Arranging a reablement service;
  7. Arranging for equipment;
  8. Making a Best Interest decision under the Mental Capacity Act;
  9. When completing a best interest assessment as part of the DoLS process;
  10. Writing a social circumstances report.

It is important to understand the context in which the risk assessment is taking place, so that any assessment and plan to reduce risk meets the statutory requirements of any relevant legislation.

5. Key Principles of Risk Assessment

The following table sets out some key principles of risk assessment that apply regardless of the context in which risk is being assessed.

Principle How?
Maximise the person's involvement Encouragement, information, transparency, support and accessibility.
Evidence, evidence, evidence

Always make judgements about likely risk, impact and strategy based on evidence.

Never make judgements based on assumptions, emotion or anxiety.
A positive approach to risk taking Actively encourage and support a person to take a risk when taking the risk is likely to achieve personal change, growth and promote individual wellbeing.
Promote resilience, choice and control

Always have regard for the person's wishes, views and feelings.

Support and encourage people to find their own solutions and strategies to risk.
Seek to manage risk, not eliminate it

Risk is a normal everyday experience, from which we all learn and grow.

Unless the risk is abuse or neglect, seek to reduce the negative impact, but do not always seek to eliminate it.
Least restrictive The best way to manage risk should always be the option that is least restrictive of the person's human rights, particularly their right to liberty and their right to family life.
Monitor and Review

Risk is dynamic and constantly changing.

Always review plans and monitor them when their likely effectiveness is unclear, change is likely, or if they are unstable.

6. Involving the Person/Carer

Involving the person/carer

The person/carer's involvement in risk assessment can:

  1. Be empowering; and
  2. Increase the likelihood of positive engagement with any plan to manage risk; and
  3. Build resilience, confidence and independence.

As such it is important that, whenever it is practicable to do so, the person/carer is directly involved in risk assessment. This includes:

  1. Providing information to them about the purpose of risk assessment;
  2. Carrying out the risk assessment in an accessible way;
  3. Supporting the person with advocacy where appropriate;
  4. Talking with them about all of the risks that exist;
  5. Talking with them about all or the benefits and potential harmful consequences of taking the risk;
  6. Exploring with them all of the available options to manage risk; and
  7. Supporting them to make an informed decision about whether to take a risk, or how best to manage risk.

Substantial difficulty

If the risk assessment is being carried out as part of a care and support process under the Care Act (including safeguarding) and the person/carer is likely to have substantial difficulty being involved, the duty to provide an independent advocate will apply if there is no other suitable representation available.

See: The Duty to Provide an Independent Advocate for further guidance about when the advocacy duty applies under the Care Act.

Mental capacity

If there are concerns that the person may lack capacity to be involved in the risk assessment then a proportionate mental capacity assessment must be carried out to determine whether this is the case.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, with guidance about assessing mental capacity.

If the person has capacity

If the person has capacity following the mental capacity assessment they should be encouraged and supported to be involved in the risk assessment.

If the risk assessment is being carried out as part of a care and support process under the Care Act (including safeguarding) and the person is likely to have substantial difficulty being involved, the duty to provide an appropriate independent advocate will apply if there is no other suitable representation available.

See: The Duty to Provide an Independent Advocate for further guidance about when the advocacy duty applies under the Care Act.

If the person lacks capacity

If the person lacks capacity following the mental capacity assessment then:

  1. They must be appropriately represented during the risk assessment; and
  2. Their views, wishes and feelings in relation to risk must be ascertained and regarded.

If the risk assessment is being carried out as part of a care and support process under the Care Act (including safeguarding), the duty to provide an appropriate independent advocate will apply if there is no other suitable representation available.

If the risk assessment is not being carried out as part of a care and support process under the Care Act, the nature of representation will depend on the context in which the risk assessment is being carried out, and the duty to provide an independent mental capacity advocate may apply.

See: The Duty to Provide an Independent Advocate for further guidance about when the advocacy duty applies under the Care Act.

Declining to be involved

Carers

If the carer declines to be involved in a risk assessment about them you should encourage them to be involved, but ultimately the decision is theirs to make.

Where there is a statutory requirement to complete the risk assessment it should be completed based on the information available, and with regard for any views expressed by the carer about risk.

The carer's refusal to be involved should be clearly recorded, and a copy of the completed risk assessment should be provided to them. They should then have the opportunity to review and amend any plan to manage risk.

A person with capacity

If the person has capacity to decline to be involved you should encourage them to be involved, but ultimately the decision is theirs to make.

You must proceed to carry out the risk assessment based on the information available, and with regard for any views expressed by the person when:

  1. There is a statutory requirement to complete the risk assessment; or
  2. The risk assessment is being carried out to manage the risk of harm or abuse to the person.

The person's refusal to be involved should be clearly recorded, and a copy of the completed risk assessment should be provided to them. They should then have the opportunity to review and amend any plan to manage risk.

7. Involving Others

At the request of the person/carer

If a person requests that somebody is involved in the risk assessment then you should involve that person unless you have evidence that doing so would place the person (or another vulnerable adult or child) at increased risk of harm or abuse.

If a carer requests that somebody is involved in the risk assessment about them then you should involve that person unless you have evidence that doing so would place the person being cared for (or another vulnerable adult or child) at increased risk of harm or abuse.

Involving carers

If the risk assessment is being carried out in relation to a person with care and support needs as part of a formal care and support process under the Care Act (including safeguarding), the duty to involve any carer applies, even if the person does not consent to their involvement unless:

  1. The risk assessment relates to possible abuse or harm of the person caused by the carer; and
  2. The carers' involvement in the risk assessment is likely to increase the risk of further harm or abuse occurring.

When a person has not consented to the carer being a part of the risk assessment you should agree the most appropriate way to involve the carer (for example a separate meeting with the carer).

If the person has requested particular information not relating to needs is withheld from the carer, and they have capacity to do so normal confidentiality rules apply unless doing so would put the person at risk of abuse or neglect.

Advocates

If an independent advocate has been appointed to support the person/carer to be involved in the risk assessment their views must be regarded.

Involving others

It may be relevant to consult with, or involve others in one or more of the stages of risk assessment:

  1. Identifying risk;
  2. Identifying the likely impact of the risk (positive and negative); and
  3. Identifying how to reduce the negative impact and maximise the positive.

You can involve anyone in any way at any stage, so long as:

  1. It is relevant for them to be involved; and
  2. Doing so will not increase the likely risk of harm or abuse; and
  3. The person has consented; or
  4. The carer has consented (when the risk assessment relates to a carer);
  5. Or, if the person lacks capacity a best interests decision is made to this effect.

Examples of people it may be relevant to involve include, but are not limited to:

  1. Service providers;
  2. Family members, friends or neighbours;
  3. Health professionals;
  4. Another Local Authority; and
  5. The police.

Under the Care Act anyone that you ask to be involved in the risk assessment has a duty to co-operate with the request unless doing so would prevent them from carrying out their own duties under the Care Act or other legislation.

Confidentiality when involving others

In all cases the consent of the person to share information with others should be sought unless:

  1. They lack capacity to consent (in which case information sharing must only be carried out if it is in their best interests); or
  2. Information sharing is necessary to protect the person (or another vulnerable adult or child) from abuse or neglect (in which case the person must be notified but information should be shared regardless of consent).

All information gathering and sharing should take place with regard to the Caldicott Principles, Data Protection Legislation and local information sharing policies.

8. Risk Assessment Tools and Templates

Local requirements

It is your responsibility to familiarise yourself with:

  1. The local templates that you are required to use when carrying out a risk assessment; and
  2. The local risk assessment tools that are available.

These should always be used unless:

  1. They are not appropriate to the risk being assessed; or
  2. The person is to be involved, and they are not accessible to them.

Examples of alternative formats could include:

  1. Picture or drawing formats;
  2. Video or audio formats;
  3. Alternative written formats.

You should discuss the use of an alternative format with your line manager, and ensure that a formal record of the risk assessment is made on the person's electronic file, regardless of the template used.

Balance sheet for risks and benefits

tri.x has developed a tool that can be used as required to support risk assessment.

See: Balance Sheet for Risks and Benefits.

9. Identifying Risks

Defining risk

Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.

Identifying risk

Need to know

Always make judgements about likely risk based on evidence.

Never make judgements based on assumptions, emotion or anxiety.

When identifying risks you need to consider all of the following:

  1. Risk to the person;
  2. Risks to a carer;
  3. Risks to another vulnerable adult;
  4. Risk to a child;
  5. Risk to the public;
  6. Risk to providers of care and support/support; and
  7. Risk to property and belongings.

Every situation is different, but the table below sets out some examples of risk that may be present.

Risk Examples
Risk associated with an impairment or disability
  • Slips, trips and falls;
  • Inability to carry out tasks safely, such as cooking;
  • Inability to manage finances;
  • Social isolation;
  • Aggression to others or self;
  • Refusal to engage with daily living tasks and routines;
  • Carer breakdown.
Risk of accidental injury
  • From traffic in the community;
  • Using a household appliance at home;

  • When using manual handling equipment.
Risk around medication
  • Taking the wrong medication;
  • Taking medication incorrectly;
  • Overdose and hospitalisation.
Risks around the use of drugs or alcohol
  • Inability to care for children;
  • Inability to manage routines;
  • Financial insecurity;
  • Overdose, self harm and hospital admission
Risk from environment
  • Illness caused by unhygienic food preparation areas;
  • Loose carpets and steep stairs;
  • Insecure doors and windows.
Risk of abuse or neglect
  • Exploitation by others;
  • Domestic violence;
  • Self neglect;
  • Repercussions from members of the public in response to challenging behaviours.
Risks to a Care and Support Plan/Support Plan/Care Plan
  • Disengagement with the plan;
  • Unsustainable or ineffective services;
  • Carer breakdown;
  • Misuse of a Direct Payment.

10. Identifying the Likely Impact of Risks

When the risks have been identified you must consider, based on the available evidence:

  1. How likely it is that the risk will occur; and
  2. What the likely positive impact of the risk will be on the person/carer; and
  3. What the likely negative impact may be on the person/carer; and
  4. What the likely negative impact may be on others; so that
  5. The level of risk can be determined.
Need to know

Always make judgements about the likely impact of risk based on evidence.

Never make judgements based on assumptions, emotion or anxiety.

There could be:

  1. A high likelihood of risk;
  2. A low likelihood of risk;
  3. Risks that are likely to have a significant impact on the person/carer;
  4. Risks that are likely to have a minimal impact on the person/carer;
  5. Risks that are likely to have a significant impact on others;
  6. Risks that are likely to have a minimal impact on others.

The impact of a risk can be related to:

  1. Physical or mental health;
  2. Feelings and perceived happiness;
  3. Finances;
  4. Personal Relationships;
  5. Safety;
  6. Dignity;
  7. Human Rights.

When determining the overall level of risk to a person more weight should be given to:

  1. The impact of the risk on the person (particularly their wellbeing); and
  2. The likelihood of the risk occurring; rather than
  3. The number of risks that exist.

11. Managing Risk

Using this section of the procedure

When risks have been identified, and both positive and negative likely impacts agreed you should:

  1. Explore all of the available options to manage risk; and
  2. Consider all the benefits and risks associated with each option; and
  3. Agree the best way to manage risk.

The purpose of risk management

Risk is a normal everyday experience, from which we all learn and grow.

Unless the risk is abuse or neglect the purpose of risk assessment is to:

  1. Maximise the positive impact of taking the risk; and
  2. Reduce the negative impact; and this
  3. May or may not lead to the elimination of risk.

If the risk is abuse or neglect the risk assessment should seek to eliminate the risk wherever possible.

A positive approach to risk

Wherever possible you should take a positive approach to risk assessment unless taking the risk will increase the risk of abuse or neglect of the person (or another vulnerable adult or child).

This involves taking steps to:

  1. Actively encourage and support a person to take a risk; when
  2. Taking the risk is likely to achieve personal change, growth and promote individual wellbeing.

A strengths based approach

Wherever possible, every conversation with a person/carer about risk should be from a strengths based perspective. This means supporting them to explore whether there is:

  1. Anything within their own power that they can do to manage the risk; and
  2. Anything within the power of their family, friends or community that they can use to manage risk.

A strengths based approach is empowering for the person and gives them more control over the situation and how best to manage risks in the best way for them. Strengths based approaches are often more sustainable and can help to build the resilience of the person and their informal networks.

Appropriate and Proportionate measures

It is important that the measures to manage risk are:

  1. Appropriate and proportionate to the overall level of risk present;
  2. The least intrusive that they can be; and
  3. The least restrictive of the person's human rights, particularly their right to liberty and family life.
Need to know
The Local Authority is not permitted to stop or limit contact with someone if the person lacks capacity to consent to this, including sexual contact. This decision must be made by the Court of Protection.
Need to know

If the measures are a deprivation of liberty this must be authorised:

  1. Under the Deprivation of Liberty Safeguards (DoLS); or
  2. If the DoLS framework does not apply, the Court of Protection.

Identifying all the ways to manage risk

When deciding the best way to manage risk it is important to identify all of the available options, including:

  1. What the person/carer can do for themselves;
  2. What others in the person's informal network can do (for example family members, friends);
  3. What steps providers of services can take; and
  4. What steps professionals can take.

People with capacity and carers

In the Care Act people are seen as experts in their own lives, and as such are best placed to make their own decisions if they are able to do so. Supporting people to make their own decision about how best to manage risk can:

  1. Be empowering; and
  2. Increase the likelihood of positive engagement with any plan to manage risk; and
  3. Build resilience, confidence and independence.

Therefore, if a person (with capacity) or a carer has a clear view about how best to manage risk any risk management plan should be based upon this unless:

  1. The method to manage risk is not available; or
  2. The method does not reduce the risk of abuse or neglect; or
  3. The method increases the risk of abuse or neglect; or
  4. The method places another vulnerable adult (or child) at risk of abuse or neglect.

If any of the above circumstances apply you must explain to the person/carer why the plan cannot reflect their wishes, and then make risk management decisions that:

  1. Are evidence based; and
  2. Have regard for their views, wishes and feelings; and
  3. Are appropriate and proportionate to the overall level of risk present; and
  4. Are the least intrusive that they can be; and
  5. Are the least restrictive of the person's human rights, particularly their right to liberty and their right to family life.

Unwise decisions

The Mental Capacity Act 2005 permits any person or carer with capacity to make an unwise decision.

An unwise decision is any decision that you, or anyone else thinks is not the best decision for them.

There may be cause for concern if someone:

  1. Repeatedly makes an unwise decision that puts them at serious risk of harm, abuse or exploitation; or
  2. Makes an unwise decision about risk that is obviously irrational or out of character.

In this situation you must carry out an assessment of capacity where it is appropriate and relevant to do so before making any decision about risk on their behalf.

Need to know

A mental capacity assessment can only be carried out if:

  1. The person/carer has (or is believed to have) an impairment of, or disturbance in the functioning of the mind or brain; and
  2. You believe the impairment or disturbance is the reason that they are not able to make a decision about risk; and
  3. All practicable steps have been taken to support them to make their own decision about risk.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, which provides further guidance about unwise decisions and assessing mental capacity.

If the person lacks capacity

If a person lacks capacity to make a decision about the best way to manage risk this decision must be made in their Best Interests using the 4th and 5th principles of the Mental Capacity Act.

In particular, any decision must:

  1. Be evidence based; and
  2. Have regard for their views, wishes and feelings; and
  3. Be appropriate and proportionate to the overall level of risk present; and
  4. Be the least intrusive that it can be; and
  5. Be the least restrictive of the person's human rights, particularly their right to liberty and their right to family life.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, which provides comprehensive guidance about making best interests decisions.

12. Identifying Risks to Others

Under no circumstances should you agree a risk assessment plan that you know will place another vulnerable adult or child at risk of harm, abuse or neglect.

If the process of risk assessment identifies unrelated risks to another vulnerable adult or a child you must consider the measures that you can take to reduce the risk and protect others. This could be:

  1. Carrying out a proportionate risk assessment; or
  2. Arranging for a proportionate risk assessment to be carried out; or
  3. Notifying an allocated practitioner; or
  4. Raising a safeguarding concern; or
  5. Reporting concerns about a service provider; or
  6. Whistleblowing; or
  7. Reporting imminent harm to the police.

13. Recording a Risk Assessment

In all cases a proportionate record of risk should be made on the person's electronic file.

This should be in line with local requirements around the recording of risk and the following information should be clear:

  1. The risks that have been identified;
  2. The likely impact of the risk (positive and negative);
  3. The plan to manage risk; and
  4. The rational for the decisions made.

If there are any individual actions to be carried out, the record should also evidence:

  1. What the actions are;
  2. Who will be carrying them out;
  3. The timeframe to act; and
  4. How the impact of the action on risk will be monitored.

Where a formal strategy or risk management plan has been prepared this should be provided to:

  1. The person or carer to whom it relates; unless
  2. Doing so would increase the likely risk of harm or abuse; and
  3. Anyone who the person or carer asks to be provided with a copy; unless
  4. Doing so would increase the likely risk of harm or abuse; and
  5. Anyone directly involved in managing the risks in the plan.

If you believe it relevant to share the plan with anyone else it can only be shared if:

  1. The person has consented; or
  2. The carer has consented (when the risk assessment relates to a carer);
  3. Or, if the person lacks capacity a best interests decision is made to this effect.

14. Monitoring and Reviewing Risk Assessments

Monitoring

Risk is dynamic and constantly changing. Appropriate and proportionate arrangements should be made to monitor a risk assessment when:

  1. The risk of abuse and neglect is high;
  2. The plan to manage risk is unstable;
  3. The likely effectiveness of the plan to manage risk is unclear;
  4. The risk may be short term;
  5. The level of risk is likely to change; or
  6. Other less restrictive or intrusive ways to manage risk may become available.

Review

The timeframe for review

Risk assessments should be reviewed in line with any timeframes that were agreed when the assessment was completed.

If specific timeframes to review the risk assessment were not been agreed the review should take place as part of:

  1. A Protection Plan review;
  2. A Care and Support Plan review;
  3. A Support Plan review;
  4. A reablement plan review;
  5. A reassessment of need; or
  6. A review under the Care Programme Approach; or
  7. Any other statutory function being carried out.

A review of the risk assessment should also take place when there is evidence that indicates either:

  1. The level of risk has changed;
  2. The risk management strategies are not effective;
  3. The risk management strategies are no longer required; or
  4. There may be a less restrictive way of managing risk.

The purpose of review

Any review of risk should establish explicitly whether:

  1. Risks continue to be well managed by any plan;
  2. There have been any changes to risk;
  3. There is any risk of abuse or neglect; and
  4. Whether there is a risk to the sustainability or stability of any Care and Support Plan/Support Plan/Care Plan.

If risks have not changed and are well managed

If the review identifies that risks have not changed and the measures in place are effectively reducing risk this should be clearly recorded and the current plan should continue subject to further review or monitoring.

If risks have changed or are not managed

If the review identifies a change in risk, or that risks are not well managed you will need to explore:

  1. What is working and not working with current measures;
  2. What steps can be taken to resolve any issues with the current measures to reduce risk; and
  3. Any new measures to manage risk; and
  4. If risks have changed, carry out any new proportionate assessment of risk.