Risk Assessments

Risk assessment has a terrible reputation — a form standing between people and everything enjoyable. Done properly, it's the opposite: the structured thinking that lets a woman with dementia still bake, a man with epilepsy still swim, and a night worker still enter a dark house safely. You identify what could go wrong, weigh how likely and how bad, and design the version of the activity where the benefits survive and the worst outcomes don't.

Care needs both halves of the discipline. The workplace half covers environments and tasks: hot water, chemicals, lone working, wet floors, equipment. The individual half covers each person's actual life: their falls, their swallowing, their road sense, their finances, their kettle. The individual half is where care either respects adults or quietly imprisons them — which is why "risk enablement" is written into modern practice: the risk of the activity must always be weighed against the certain, corrosive harm of a life with nothing in it.

And because people and days change faster than paperwork, workers carry the final layer in their heads: dynamic risk assessment. The plan says one carer; today he's dizzy and furious. The assessment in your head — pause, make safe, call in — is real risk assessment too, and it deserves recording once the moment passes.

• Management of Health and Safety at Work Regulations 1999 (reg 3): suitable and sufficient risk assessments, recorded where five or more are employed, reviewed when no longer valid.
• Regulation 12 (2014 Regulations): providers must assess risks to people's health and safety during care and do all that is reasonably practicable to mitigate — the individual half's legal anchor.
• Care Act 2014 wellbeing principle: control over daily life and participation matter — supporting the balance side of risk decisions.
• MCA 2005: capacity determines whose decision a risk is; best interests (including wishes and feelings) governs where capacity is lacking; restrictions must be least restrictive.
• HSE's "five steps" model: identify hazards; decide who might be harmed and how; evaluate and decide on controls; record; review.

CQC wants risk assessments that are individual, current and used: matching the real person (a falls assessment mentioning stairs for a ground-floor flat has been copied), linked to care plan actions staff can describe, reviewed after incidents, and balanced — evidence that independence was enabled, not just hazards eliminated. Blanket restrictions justified by generic risk ("residents don't go in the kitchen") attract criticism; so does the opposite failure, where known serious risks (choking, absconding into traffic) sit unassessed or unmitigated. Both extremes are Regulation 12 findings.

• Start each individual assessment from the person's goal: "Mrs B wants to keep making her own breakfast." Then hazards, likelihood/severity, and controls that keep the goal alive (kettle tipper, timer switch on the hob, prompts) before controls that kill it.
• Write controls as instructions someone can follow: "walk on his left, he veers right", "cut food to thumbnail size, upright for 30 minutes after meals" — not "staff to be vigilant at all times".
• Involve the person and record their view, including informed disagreement: "I've smoked since 1962 and I shall continue" plus the fire apron and the notified family is a documented, respect-worthy position.
• Score if your system scores (likelihood × severity), but never let matrix arithmetic overrule judgement — a "low" score on choking is still a swallow assessment away from being wrong.
• Set review triggers: any incident or near miss, health change, medication change, new equipment, seasonal change (icy paths, heatwaves), and a backstop date.
• Capture dynamic assessments after the fact: what you found, what you decided, why — it protects the person next time and you every time.

Example 1. A supported living resident wants to travel to the day centre by bus alone. Instead of "unsafe — staff to escort", the team builds a ladder: travel training for six weeks, a bus pass wallet with a help card, a phone with one-touch numbers, staff shadowing from a distance, then solo trips with a check-in text. The risk assessment documents each rung and the fallback plan. Nine months later the bus is simply his life, and the assessment that made it possible is his proudest paperwork.

Example 2. A home care worker arrives to find her client's son — occasionally aggressive when drinking — shouting inside, and the client's walking frame on the front path. Dynamic assessment: she does not go in. She retreats to the car, phones the office, and the agreed protocol runs (welfare check arranged with police support; visit completed later with two staff). Back at base she records exactly what she saw and decided. The lone working assessment gains a new line, and nobody pretends courage would have been competence.