Carrying out risk assessments in care homes

Every organisation which provides care and support to individuals who are deemed as vulnerable should ensure that all individuals who use its services have a risk assessment.

A risk assessment looks at the following:

• Hazards – which are situations that have the potential to cause harm.
• Risks – which are defined as the probability that a negative event will occur because a hazard has not been identified and controlled. A clinical risk, which is relevant to mental health care, is the probability that a negative event will occur resulting from clinical investigation, treatment or service user care.

It is almost impossible to eliminate all risks but a risk assessment will help to ensure that staff protect those who use their services as far as is ‘reasonably practicable’.

A risk assessment should be as simple as possible, that way it avoids information that is irrelevant and remains accessible by as many people as possible who are involved in an individual’s care.

The best way to keep the risk assessment simple is to carry it out in five steps:

Step 1 – Identify the hazard

This stage involves finding out what might go wrong, how it might go wrong and why. Things in the past such as near misses should be considered so mistakes can be learnt from.

Step 2 – Decide who might be harmed and how

At this step, it is important to realise that the more vulnerable the individual, the more likely they are to suffer harm. This step also accounts for human error, so it is necessary to anticipate this in order to try and prevent it.

Step 3 – Evaluate the risks

This step involves considering the consequences of potential harm and what the likelihood is of it happening. This step may require service providers to provide additional risk measurements.

Step 4 – Record the findings

A risk assessment is useless if no one can see what it has concluded. Details that should be recorded include all findings and action plans, which need to be reviewed in the future.

Step 5 – Review the risk assessment and update if necessary

Good documentation should be fluid – this means that it is amended when it needs to be, to reflect a change in circumstances or perhaps in legislation whereby the individual is affected.

Risk assessments should form part of an overall care plan, which should be referred to by all staff that are involved in the individual’s care.

The importance of risk assessments

When a risk assessment takes place in a ‘normal’ place of work, this will usually mean that management there will look at things that might cause illness or injury to staff and others who may visit their premises. For example, they will look at the likelihood of chemical spillages or someone slipping on a tiled floor.

In mental health, whilst some of these generic risk assessments will still need to take place, to ensure the safety of everyone there, it is vital that a specific risk assessment is carried out with each individual who uses their services, and there are several reasons for this.

Firstly, a risk assessment will ascertain the chances that the individual will cause harm to themselves or others. Whilst the vast majority of people who have mental health conditions pose no threat whatsoever, some will be considered a risk because of their current or previous behaviour. Any previous successful or unsuccessful attempts at self-harm will be noted as will any incidents that have involved someone else. Regardless of how minor the incident, it must be included so that everyone is protected in the future and is aware, regardless of how minor the threat might be, that the individual does have some aspects of self-harm or harm to others in their past or present circumstances.

As well as the harm that an individual may cause to themselves or others, it is also necessary to look at the possibility of what harm could be caused to the individual by others. Therefore, details about previous experiences of abuse of any type should be recorded.

Some risk assessments will require certain details about an individual’s background so that a holistic picture of them and subsequently the type of care that they receive can be built up. For example, information will be gained such as:

• Age.
• Marital status.
• Religion/culture.
• Physical illnesses.
• Substance or alcohol dependence details.
• Any trauma in the past.
• Genetic and family information such as if there is a history of suicide, mental illness or abuse.

A risk assessment also gives specific details about how to support an individual whilst they are receiving care and support. For example, an individual may have certain triggers for emotions that need to be carefully monitored so that situations can be de-escalated. Information about the best way to go about de-escalation will also be determined from some of the details from the risk assessment, and this will help to ensure the individual’s safety is not compromised.

Risk assessments also help all health professionals and others involved in an individual’s care to find out information about them as and when they need to. The majority of information will be accessible by everyone and it will be consistent and reliable, ensuring that there is no misunderstanding between agencies who are involved in the individual’s care.

The ultimate goal of the risk assessment is to ensure that it informs an individual’s care plan, ensuring that they are cared for at the highest possible standards. It is crucial that the individual is as involved as possible when planning their care and, whilst this may not always be possible due to their condition, it is imperative that any decisions made on their behalf are done so in their best interests, based on the findings from the risk assessment.