Autism adult services: preparing for CQC inspection on restrictive practice and legal safeguards
CQC inspection risk around restrictive practice rarely comes from a single document gap. It comes from inconsistency: staff who cannot explain restrictions, records that do not match practice, and governance that cannot evidence review or reduction. Providers that perform well treat inspection readiness as a by-product of good daily governance. This article explains how to prepare for inspection within restrictive practices, DoLS, LPS and legal safeguards, and how readiness must align with actual service models and care pathways rather than relying on written policies alone.
What CQC will test in restrictive practice inspections
Inspectors typically test four areas that cut across the key questions:
- Recognition: do staff and leaders recognise restrictive practice and deprivation accurately?
- Lawfulness: are DoLS/LPS safeguards in place where required and conditions implemented?
- Reduction: is restriction actively reduced through positive risk-taking and review?
- Governance: can leaders evidence oversight, audit and learning?
Providers often focus on training completion and policy availability. CQC focus is usually more practical: what is happening to people day-to-day, and can staff explain why.
Building an inspection-ready evidence pack
A strong evidence pack is not a binder of everything. It is a curated set of materials that demonstrate control and governance. Typical components include:
- Restrictive practice register with trends and review dates.
- DoLS/LPS register with authorisation status, conditions and review schedule.
- Examples of restriction reduction plans with outcomes evidenced.
- Audit results and action tracking showing improvement over time.
- Training and supervision evidence linked to real restrictive decisions.
Evidence should demonstrate that the provider understands restriction, governs it, and reduces it, rather than merely recording it.
Operational example 1: staff cannot explain restriction rationale
Context: During a mock inspection, an inspector asks a support worker why a door is locked. The worker says, “It’s for safety,” but cannot explain what risk, what alternatives were tried, or when it will be reviewed.
Support approach: The provider uses the scenario to strengthen staff readiness. The goal is not to script staff, but to ensure they can explain real practice clearly.
Day-to-day delivery detail: The manager introduces a simple staff prompt used in handovers and supervision: “What is the restriction? What risk does it manage? What is the least restrictive alternative? When is the review?” Staff rehearse explanations using real restrictions in their service. Care plans are updated to ensure restriction rationale and review dates are clear and consistent.
How effectiveness is evidenced: Follow-up spot checks show staff can explain restrictions consistently. Audits show improved quality of documentation and increased frequency of review.
Operational example 2: DoLS/LPS conditions not implemented in practice
Context: A person has authorisation conditions requiring increased choice and community access. In practice, staffing patterns and risk aversion are limiting outings.
Support approach: The provider treats this as a governance failure and prioritises correction before inspection.
Day-to-day delivery detail: Conditions are translated into specific actions: scheduled outings, staged travel rehearsal, clear intervention thresholds and weekly review meetings. A “conditions compliance” check is added to management oversight. Staff guidance is rewritten so it is operationally usable on shift, not just a legal statement.
How effectiveness is evidenced: Community access increases, condition compliance is recorded, and the restrictive practice register shows restriction reducing. The provider can demonstrate to inspectors that it identified a risk and corrected it proactively.
Operational example 3: emergency restriction becomes normalised
Context: After a safeguarding incident, restrictions increase rapidly: observation, visitor limits and locked access. Weeks later, restrictions remain without clear review, and staff treat them as standard practice.
Support approach: The provider introduces an “emergency restriction governance” process to prevent drift.
Day-to-day delivery detail: Emergency restrictions are logged immediately in the restrictive practice register with a 72-hour review requirement and named reviewer. The provider documents the reason for each restriction, alternative supports introduced (environment changes, routine stabilisation), and the reduction step expected by the next review. Where deprivation may apply, legal safeguard escalation is triggered.
How effectiveness is evidenced: Restrictions step down according to plan, safeguarding oversight is documented, and the provider can show inspectors that restriction is controlled, reviewed and reduced rather than left to drift.
Commissioner expectation
Commissioners will expect providers to demonstrate inspection readiness as part of ongoing assurance. They look for evidence packs, governance records, and real examples showing that restriction is managed lawfully and reduced. Commissioners are also sensitive to reputational and legal risk: gaps in DoLS/LPS compliance or restrictive practice governance often trigger contract assurance activity.
Regulator and inspector expectation (CQC)
CQC expects providers to protect rights while keeping people safe, with strong evidence of least-restrictive practice. Inspectors will test staff knowledge, check whether care plans match practice, and examine governance: registers, audits, action tracking and learning. Providers that can demonstrate restriction reduction over time, with stable safety outcomes, are more likely to be viewed as well-led and safe.
Governance checks to complete before inspection
- Register accuracy check: restrictions and deprivation status reflect current practice.
- Review compliance: review dates are met and changes are documented.
- Condition compliance: DoLS/LPS conditions translated into daily actions.
- Staff readiness: staff can explain restrictions and reduction plans.
- Learning evidence: audits and incidents lead to measurable improvement.
What good looks like
Good inspection readiness is visible in daily practice: restrictions are specific, justified, reviewed and reducing; safeguards are applied correctly; staff can explain what they do and why; and governance can evidence oversight and learning. That combination is what inspectors recognise as safe, rights-respecting, well-led practice.