How Services Should Evidence Restrictive Practice Governance for CQC

Restrictive practices sometimes arise in adult social care where safety risks must be managed. However, CQC expects providers to demonstrate that restrictions are necessary, proportionate and regularly reviewed. Services reviewing broader CQC risk and safeguarding expectations alongside the regulatory framework within the CQC quality statements should therefore be able to evidence strong governance around restrictive practices. Inspectors typically examine whether restrictions are clearly justified, whether alternatives have been considered and whether services actively work to reduce restrictions where possible.

For a broader view of regulatory readiness, it helps to explore the CQC hub covering registration, inspection and governance systems.

Why restrictive practice governance matters

Restrictions may be introduced to manage significant safety concerns. However, without clear oversight they can become routine rather than exceptional. Inspectors therefore examine whether services review restrictions regularly and ensure they remain proportionate.

Strong governance means that leaders understand where restrictions exist, why they were introduced and whether they continue to be necessary.

Understanding least restrictive practice

Least restrictive practice means supporting individuals to live safely while maintaining as much freedom and independence as possible. Services must demonstrate that restrictions are the last resort and that alternative approaches have been considered.

Inspectors often assess whether staff understand the difference between necessary safety measures and unnecessary restrictions that may reduce autonomy.

Operational example 1: reducing supervision restrictions

Context: A supported living tenant initially required continuous supervision during community outings due to safety concerns.

Support approach: The service introduced a structured plan to gradually increase independence while maintaining safety.

Day-to-day delivery detail: Staff supported shorter independent activities and monitored progress through regular reviews.

How effectiveness was evidenced: The tenant gradually regained independence while safety risks remained managed.

Operational example 2: reviewing environmental restrictions

Context: A residential home had restricted access to certain communal areas for a resident due to previous behavioural incidents.

Support approach: Managers reviewed the restriction with clinical professionals and explored alternative behavioural support strategies.

Day-to-day delivery detail: Staff introduced positive behaviour support plans and monitored how the resident responded.

How effectiveness was evidenced: The restriction was gradually reduced as the resident engaged safely with communal areas.

Operational example 3: ensuring lawful restrictive practice

Context: A person receiving care required monitoring at night due to safety risks.

Support approach: The service ensured the restriction was clearly documented, regularly reviewed and supported by appropriate legal frameworks.

Day-to-day delivery detail: Staff documented monitoring practices and discussed progress during care reviews.

How effectiveness was evidenced: Records demonstrated lawful use of restriction with ongoing review to determine whether it remained necessary.

Commissioner expectation

Commissioner expectation: Commissioners expect restrictive practices to be carefully governed and regularly reviewed. Providers should demonstrate that restrictions are clearly justified, documented and reduced where possible.

Regulator / Inspector expectation

Regulator / Inspector expectation: CQC inspectors expect services to demonstrate least restrictive practice. Evidence should show that restrictions are proportionate, lawful and subject to clear leadership oversight.

Strengthening restrictive practice governance

Services that perform strongly in this area maintain oversight of all restrictions within governance systems. Managers review restrictions regularly, assess whether alternatives exist and ensure staff understand least restrictive principles.

When providers demonstrate thoughtful oversight and commitment to reducing restrictions, inspectors gain confidence that people receiving care retain dignity, autonomy and independence wherever possible.

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