CQC Governance and Leadership: Using Restrictive Practice Review, Rights-Based Oversight and Positive Risk Management to Improve Quality

Restrictive practice is a core governance issue because it tests whether leadership can balance safety, dignity, human rights and lawful decision-making in daily care. Providers must show that restrictions are identified clearly, reviewed regularly and reduced wherever possible, rather than becoming routine through habit, poor confidence or weak oversight. They must also evidence how positive risk management supports people to maintain choice and control without exposing them to unmanaged harm. As outlined in CQC governance and leadership frameworks and CQC quality statements, strong governance depends on leaders being able to explain why a restriction exists, how it is monitored and what has been done to reduce it.

Many providers improve compliance maturity by aligning with the CQC compliance hub for governance, quality assurance and provider control.

Why restrictive practice and positive risk are governance issues

A provider can have well-written policies and still drift into restrictive care if staff become risk-averse, if incidents are reviewed narrowly or if managers fail to challenge routine controls that no longer reflect the person’s needs. Good governance therefore requires rights-based review, structured recording, multi-level oversight and evidence that staff understand the least restrictive option. Positive risk management also matters because CQC and commissioners will expect providers to show how people are supported to do as much as possible safely, not simply prevented from harm through blanket rules.

Commissioner expectation: Providers must evidence that restrictive practices are necessary, proportionate, reviewed at defined intervals and linked to positive risk approaches that preserve independence, choice and lawful decision-making.

Regulator / Inspector expectation: CQC inspectors will expect leaders to show that restrictive practices are clearly recorded, regularly challenged and reduced where possible, with evidence drawn from observations, records, feedback and incident trends.

Operational Example 1: Reviewing door access restrictions in supported living

Context: In one supported living service, staff routinely lock the communal back door because one person has previously left the building during periods of distress. Although intended as a safety measure, the arrangement has become normal practice for everyone and is no longer clearly justified in current support plans or daily records.

Support approach: The provider uses a restrictive practice review linked to positive risk planning. This is chosen because environmental controls can become normalised quickly, and leadership must test whether the restriction is still necessary, clearly authorised and proportionate for the person and others affected.

Step 1: The Registered Manager records the identified door restriction, affected person, current rationale and gaps in support-plan authorisation in the restrictive practice register the same day, and places the issue on the weekly governance agenda because the restriction may be broader than necessary.

Step 2: The PBS lead reviews incident records, daily notes, support plans and staff handover entries within five working days, records whether the restriction remains justified in the rights review form, and identifies alternative positive risk measures that could reduce blanket environmental control.

Step 3: Staff implement interim changes agreed at review, recording times when the door remains open, supervised access arrangements, distress triggers and response strategies in daily notes and communication logs, and discuss every related incident at each shift handover for consistency.

Step 4: The Registered Manager conducts two observation checks over the next fortnight, records whether staff apply the revised approach proportionately in the observational assurance tool, and addresses any over-restrictive wording or practice through immediate direction and supervision follow-up.

Step 5: Provider leadership reviews the restriction monthly, records incident trends, observation findings, staff practice and family or advocate feedback in governance minutes, and keeps the item open until evidence shows the person can be supported safely with a less restrictive arrangement.

What can go wrong: Staff may continue the old routine because it feels safer or simpler. Early warning signs: vague handovers, blanket wording and weak rationale in daily notes. Escalation and response: any environmental restriction affecting more than one person triggers manager review and provider governance scrutiny.

Governance link: Restrictive practice review is evidenced through care records, observation findings, feedback and incident data. Baseline review found weak authorisation and routine locking. Improvement is measured through clearer records, reduced blanket restriction, stable incident patterns and positive feedback on access and choice over six weeks.

Operational Example 2: Reducing routine escorting during community access in a residential service

Context: A residential service notices that one resident is being routinely escorted on all community walks despite no recent falls, no active absconding history and improving road-safety skills. The concern is that a once-justified control may now be limiting independence without regular governance challenge.

Support approach: The provider uses a positive risk review rather than simply continuing the established escort arrangement. This is chosen because routine restrictions often persist after circumstances change, and leaders need evidence that risk decisions remain proportionate and person-centred.

Step 1: The key worker records the current escorting practice, recent walking opportunities, confidence levels and support-plan wording in the positive risk review form, and submits it to the Home Manager within two working days because the restriction may no longer reflect current ability.

Step 2: The Home Manager reviews incident history, falls records, observation notes and family feedback within one week, records whether the escort requirement remains necessary in the governance tracker, and agrees a graduated independence plan with clear safety boundaries and review dates.

Step 3: Staff implement the graduated plan over the next fortnight, recording route choice, level of support, observed confidence, road-safety responses and any anxiety triggers in daily notes, and discuss progress at each handover so every shift applies the same agreed approach.

Step 4: The Home Manager observes two community sessions during the review period, records staff positioning, prompting style, resident decision-making and any unnecessary intervention in the observation template, and corrects restrictive drift through same-week supervision where needed.

Step 5: Senior leadership reviews the plan at the monthly governance meeting, records progress against the original restriction, resident feedback, family views and incident outcomes in governance minutes, and supports further reduction only where positive risk remains safe and consistent.

What can go wrong: Staff may either over-protect or remove support too quickly without consistent review. Early warning signs: different approaches between shifts, anxious relatives and vague recording of community outcomes. Escalation and response: inconsistent delivery or rising incidents trigger immediate manager review and re-evaluation of the plan.

Governance link: Positive risk review is measured through care records, practice observations, feedback and incident data. Baseline practice involved full escort on every walk. Improvement is evidenced through graduated independence, consistent staff delivery, positive resident experience and no increase in avoidable community-related incidents over one month.

Operational Example 3: Provider oversight of restrictive language and control-based routines in home care

Context: A home care provider receives feedback that some carers are using controlling language around meal choice, smoking times and when people may leave the house before visits. No formal safeguarding referral is made, but the pattern suggests culturally restrictive practice in how support is framed and delivered.

Support approach: The provider uses a rights-based quality review rather than waiting for a serious incident. This is chosen because restrictive cultures often begin with language, assumptions and convenience-led routines that only become visible when leaders review practice and feedback together.

Step 1: The quality lead records the feedback themes, affected care packages and examples of staff wording in the provider rights-based review log, and alerts the Registered Manager the same day because repeated control-based language indicates possible drift in care culture.

Step 2: The Registered Manager reviews call notes, complaints, spot checks and care plan wording within 72 hours, records where staff language or assumptions appear unnecessarily restrictive in the governance tracker, and identifies packages requiring immediate observational follow-up.

Step 3: Field supervisors complete observed visits during the next ten days, record communication style, choice offered, timing flexibility and any convenience-led restrictions in the spot-check template, and discuss concerns with carers before the end of each monitored shift.

Step 4: The Registered Manager provides focused supervision within one week of each observation, records examples of restrictive language, agreed alternative wording, person-centred expectations and review dates in supervision records, and updates the service risk log where culture change is needed.

Step 5: Provider leadership reviews findings monthly, records spot-check outcomes, service user feedback, complaint trends and supervision compliance in governance minutes, and keeps the issue open until language, flexibility and observed support practice consistently reflect a less restrictive approach.

What can go wrong: Restrictive culture may persist because no single incident appears serious enough to trigger action. Early warning signs: rule-based language, inflexible visit habits and service user frustration. Escalation and response: repeated rights-based feedback triggers provider review, observations and supervisory intervention.

Governance link: Rights-based oversight is evidenced through care records, spot checks, feedback and supervision files. Baseline review found repeated controlling language across several packages. Improvement is measured through better observation scores, fewer complaints, stronger service user feedback and more person-centred recording over the next review cycle.

Conclusion

Restrictive practice governance is strongest when providers can show that safety decisions are lawful, proportionate and reviewed with the person’s rights in mind. A Registered Manager should be able to evidence what restriction exists, why it was used, how it was reviewed, what alternatives were tested and how staff were supported to apply the least restrictive option consistently. CQC is likely to explore whether restrictions are genuinely necessary, whether positive risk is supported in practice and whether provider leadership challenges routines that have become normal without clear justification. Commissioners will also expect providers to show that quality of life, autonomy and safety are considered together. In practice, strong governance is visible when records, observations, staff practice, feedback and incident trends all show the same outcome: restrictions are understood, challenged and reduced where possible, while support remains safe and consistent.