Risk notification return guidance tool

• when there are repetitive falls for unexplained reasons
• where there is an environmental hazard, such as poor lighting or clutter, resulting in a fall which does not result in any injury

• an adult at risk sustains a significant injury due to a fall
• where abuse, neglect or act of omission is suspected or
• there was not an appropriate risk assessment in place (if there was history of falls) if one was In place but was not followed, there is no evidence of the care plan being reviewed and updated following a fall or a change of circumstance
• there is a delay in response/medical intervention

No requirement to complete a Risk Notification Return.
Note: It is the responsibility of the Service Manager or Registered Manager to;

• review the support of the individuals involved in the incident
• ensure that a risk assessment is in place for the immediate safety of all people who use the service

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

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

• person does not receive prescribed medication (missed/wrong dose) on one occasion – no harm occurs and appropriate action has been taken and this is an isolated incident
• repeated errors or delays in administration of medicines because of consistent failure to maintain professional standards, where it does not affect the person or there is no harm to the individual. However, there may be the requirement to review the member of staff’s competency
• when a domiciliary care provider own policy does not meet NICE guidelines
• medication stored inappropriately (care home setting only)

• the adult at risk is subjected to deliberate withholding of prescribed medication with no medical reason
• failing to report or document a medicines administration error, according to the organisations’ policy and procedure
• deliberate falsification of records in order to cover up a medicines administration error
• failing to monitor the persons’ condition or seek appropriate medical advice and support following medicines administration error e.g. pain management
• a deliberate attempt to harm or threaten an adult at risk through use of a medicine, including intentional over sedation
• covert medication administration without documented best interest decision and written authorisation from the GP and with DoLS/DoL authorisation in place (or applied for)

• a planned visit is missed and this has an adverse effect on the adult at risk
• where repeat missed visits to an adult at risk, whether or not an adverse effect has resulted, as this could indicate neglectful care and there may be others at risk

• where there is no Moving and Handling Risk Assessment and where identified a Moving and Handling plan to manage the risks is required, but has not been completed
• where there is failure to follow a Moving and Handling plan and this is having an adverse effect on the adult with care and support needs e.g. using the wrong equipment, failure to provide equipment, “sitting on slings” etc. (Note: Unless they are specialised in “situ slings” that are specifically designed to stay in place and have had a suitable assessment re skin integrity)
• where an injury has occurred due to poor moving and handling practice
• where any of the following condemned techniques are used;
  • drag lift/underarm drag
  • shoulder/Australian lift
  • through arm/hammock lift
  • two sling lift
  • unorthodox lift
  • bear hug transfer/front assist stand
  • assistance walking supporting at underarm
  • flip turn
• where a person is using a wheelchair where there is no appropriate risk assessment in place or one is not followed regarding the correct use of the wheelchair, lap belt and foot rests
• where poor moving and handling techniques are being used on a repeat basis across the service

• 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 allowance to personal allowances, risk of eviction or termination of service
• where there is a misuse or misappropriation of property, possessions or 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 scamming, either via mail, telephone or online
• where someone persuades/befriends the person to gift or loan money by any means
• where the adult at risk is subject to having money or property misused

Extra Housing Care – no requirement to submit a Risk Notification Return

• heating problems and supply of hot water
• inadequate lighting
• power cut
• call bells not being heard/not working
• hazards in the home - boxes/wheelchairs
• communal toilets/bathrooms out of use
• lift out of use
• fire system not working
• kitchen out of use
• lack of security in the building
• insufficient fire tests not being undertaken
• restriction to access areas of the home
• floods
• fire regulations are not met
• lack of furniture and space in communal areas

Complete the Risk Notification Return where this is not a Notifiable Incident under Care Quality Commission Regulations (other Statutory Notifications may be required by Care Quality Commission and this process has no bearing on a providers regulatory responsibilities) or if the service is non-regulated.
Please refer to Care Quality Commission Notification section below.

Ensure that you review your business continuity plan and ensure it remains fit for purpose.

• consider the impact on individuals 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

Statutory Notifications (this is not a comprehensive list of all Statutory Notifications that may be required by Care Quality Commission): 

• absence of a registered Individual for 28 days or more consecutive days – Regulation 14
• return of a registered individual from an absence of 28 days or more – Regulation 14
• changes affecting a provider or manager – Regulation 15
• changes to a statement of purpose – Regulation 12(3)
• events that stop the service running safely and properly – Regulation 18(2) (g)
• liquidator or trustees plans for the service – Regulation 22
• incidents reported to or investigated by the police – Regulation 18(2)
• certain incidents or injuries arising out of or in connection with work are reportable to Health and Safety Executive under the requirements of the Reporting of Injuries
• Diseases and Dangerous Occurrence Regulations 2013 (RIDDOR). Whether and unexpected death of a service user or serious safety incident resulting in major injury to a service user has arisen out of or in connection with work will depend, amongst other things, on whether the accident was related to
• the way the work was carried out
• any machinery, other plant substances or equipment, used for the work
• the condition of the site or premises where the accident happened

Note: Care Quality Commission also need to be notified when an event/incident occurs, including when safeguarding concerns are raised.

• absence of a manager for 28 days or more consecutive days
• changes affecting a service
• events that stop the service running safely and properly
• liquidator or trustees plans for the service
• incidents reported to or investigated by the police
• certain incidents or injuries arising out of or in connection with work are reportable to Health and Safety Executive under the requirements of the Reporting of Injuries Diseases and Dangerous Occurrence Regulations 2013 (RIDDOR)

Whether and unexpected death of a service user or serious safety incident resulting in major injury to a service user has arisen out of or in connection with work will depend, amongst other things, on whether the accident was related to.

• the way the work was carried out
• any machinery, other plant substances or equipment, used for the work
• the condition of the site or premises where the accident happened.

Provider to follow their own procedures regarding the following:

• RIDDOR
• CQC notification (if you are a regulated service)