1. Purpose
This policy sets out how the Service assesses falls risk, reduces avoidable risk, responds after a fall and learns from falls patterns across the Service.
The Service must verify this policy against current NICE falls guidance, CQC source material, local falls pathway and local emergency escalation routes before adoption.
2. Sources to verify before adoption
- NICE CG161, Falls in older people: assessing risk and prevention: https://www.nice.org.uk/guidance/cg161
- NICE NG249, Falls: assessment and prevention in older people and in people 50 and over at higher risk: https://www.nice.org.uk/guidance/ng249
- NICE NG249 recommendations: https://www.nice.org.uk/guidance/ng249/chapter/Recommendations
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12: https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17: https://www.legislation.gov.uk/uksi/2014/2936/regulation/17
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 20: https://www.legislation.gov.uk/uksi/2014/2936/regulation/20
3. Scope
This policy applies to:
- people living in or receiving support from the Service
- falls, near falls and unwitnessed suspected falls
- mobility, transfer and environmental risk
- staff who assess risk, provide care, respond after a fall or review incident patterns
The Service treats falls as a safety, care-planning and governance issue. A fall is not treated as inevitable because a person is older, frail or living with dementia.
4. Falls risk assessment
The Service completes a falls risk assessment:
- before or on admission where the service type allows it
- when care starts in the person's own home
- after a fall or near fall
- after hospital discharge
- after medication change that may affect mobility, alertness or blood pressure
- after illness, infection, delirium or major change in presentation
- at planned care-plan review
The assessment considers:
- fall history
- balance, gait and transfer ability
- dizziness, syncope or postural symptoms
- vision and hearing
- cognition, delirium or distress
- continence and urgency
- nutrition, hydration and bone-health risk
- medicines that may increase falls risk
- footwear and clothing
- equipment, aids and adaptation needs
- environmental hazards
- the person's goals, routines and risk preferences
The Service verifies the assessment content against current NICE guidance and local falls pathway before adoption.
5. Environmental risk factors
Staff check the environment for avoidable falls risk.
Checks include:
- flooring, thresholds, rugs and trailing cables
- lighting and night-time access
- bed, chair and toilet height
- call bell or alert system access
- clutter and storage
- wet floors and cleaning routines
- garden, entrance and external path risks where relevant
- suitable handrails, grab rails and walking routes
- equipment position and maintenance
Environmental risks are recorded in the care plan or premises record and assigned to an owner for action.
6. Mobility and footwear assessment
The care plan records the person's mobility, transfer support and footwear needs.
The assessment includes:
- usual mobility level
- transfer support needed
- walking aid use and maintenance
- footwear fit, grip and suitability
- orthotics or specialist footwear where used
- support needed to put footwear on
- safe access to glasses, hearing aids and mobility aids
- staff handling plan where support is needed
Staff seek occupational therapy, physiotherapy, podiatry or GP input where risk cannot be managed by routine care planning.
7. Post-fall management
After a fall or suspected fall, staff:
- stay with the person and make the area safe
- assess for immediate danger within their training
- do not move the person until safe to do so
- call emergency services where required by clinical presentation or local protocol
- seek senior staff or clinical advice where the person is injured, unwell, taking anticoagulants or cannot give a reliable account
- record observations and actions taken
- inform the Registered Manager or senior person on duty
- inform family or representative according to the care plan and consent position
- record the fall in the incident register
- review the care plan and falls risk assessment
The Service does not use this policy as a clinical algorithm. Staff follow current first-aid training, local falls pathway and emergency escalation advice.
8. Medical escalation criteria
Staff seek urgent medical advice or emergency support where the person's presentation, injury, symptoms or history indicates risk.
The local post-fall protocol includes escalation prompts for:
- suspected head injury
- loss of consciousness
- new confusion or marked change in alertness
- suspected fracture
- uncontrolled pain
- breathing difficulty or chest pain
- seizure
- repeated vomiting
- anticoagulant medicine use
- unwitnessed fall with concern about injury
- any concern that the person is deteriorating
The Service verifies these prompts against current local NHS falls pathway and clinical advice before adoption.
9. Documentation
The incident record includes:
- date, time and location
- whether the fall was witnessed
- what happened before, during and after the fall where known
- injuries or symptoms observed
- observations taken
- medical advice sought
- emergency service contact where relevant
- family or representative contact
- immediate changes made
- care-plan review outcome
- action owner and review date
Staff record facts and avoid blame language.
10. Pattern detection across the Service
The Registered Manager reviews falls patterns at least monthly.
The review considers:
- time of day
- location
- staff deployment
- person-specific patterns
- medication changes
- continence patterns
- equipment issues
- environmental themes
- repeat falls
- unwitnessed falls
- injuries and near misses
Patterns are reported to the governance group and converted into improvement actions where needed.
11. Multi-disciplinary input
The Service seeks input from relevant professionals where falls risk is repeated, complex or increasing.
This may include:
- GP
- community nursing team
- falls service
- physiotherapist
- occupational therapist
- pharmacist
- optometrist
- podiatrist
- dementia or mental health team
The care plan records advice received and whether it was implemented.
12. Equipment, adaptations and falls champion
The Service keeps equipment and adaptations under review.
Equipment may include:
- walking aids
- transfer equipment
- sensor equipment where proportionate and lawful
- grab rails
- bed rails where risk assessed and lawful
- hip protectors where agreed with the person or representative
- lighting and contrast adaptations
The falls champion supports staff practice by:
- checking that falls risk assessments are current
- reviewing falls incidents with senior staff
- sharing learning at team meetings
- checking equipment and adaptation actions
- supporting audits
The falls champion does not replace the Registered Manager's accountability.
13. Audit cadence
The Registered Manager audits falls practice at least quarterly.
The audit sample includes:
- falls risk assessments
- care-plan actions
- post-fall records
- medical escalation decisions
- repeat-fall pattern review
- equipment actions
- staff training records
- governance group minutes where falls themes were discussed
Review cadence: annual or on regulatory change, whichever sooner. Owner: Registered Manager.