Restrictive Practice in Adult Social Care: What CQC Expects Providers to Evidence
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Restrictive practice is one of the most sensitive and closely scrutinised areas of adult social care inspection. CQC does not expect services to eliminate all restrictions, but it does expect providers to demonstrate that any restrictions used are lawful, proportionate, time-limited and actively reviewed.
This article explains how CQC assesses restrictive practice and what providers must evidence to meet expectations under risk and safeguarding requirements and the CQC Quality Statements.
How CQC Defines Restrictive Practice
CQC defines restrictive practice broadly. It includes physical restraint, environmental restrictions, restrictions on movement, supervision arrangements, limits on choice, and practices that reduce a person’s freedom or autonomy.
Inspectors assess not just obvious forms of restriction, but also subtle or embedded practices that may have become routine without review. Providers should be able to identify and explain all forms of restriction used within their services.
Justification and Legal Frameworks
CQC expects providers to clearly justify why any restrictive practice is necessary. This includes demonstrating compliance with the Mental Capacity Act, best interests decision-making and, where applicable, DoLS or Liberty Protection Safeguards.
Inspectors will look for clear documentation showing capacity assessments, best interests decisions, involvement of relevant parties and consideration of less restrictive alternatives. Restrictions without documented rationale are a common inspection concern.
Proportionality and Least Restrictive Options
Proportionality is central to inspection judgments. CQC assesses whether restrictions are the least restrictive option available to manage identified risks.
Providers should evidence how alternative approaches have been considered, trialled and reviewed. This may include environmental adjustments, changes in staffing, positive behaviour support or additional therapeutic input.
Review and Time-Limited Use
Restrictive practices must not be static. Inspectors expect to see regular review of restrictions, including whether they remain necessary and whether they can be reduced or removed.
Review processes should be built into care planning and governance systems. Providers should be able to explain how often restrictions are reviewed, who is involved and how decisions are recorded.
Staff Understanding and Practice
CQC often tests staff understanding of restrictive practice during inspection. Staff should be able to explain why restrictions are in place, how they apply them proportionately and what steps they take to minimise impact on individuals.
Training and supervision should reinforce ethical decision-making and reflective practice around restriction use.
Inspection-Ready Restrictive Practice Evidence
Providers that can clearly demonstrate lawful decision-making, proportionality, review and learning around restrictive practice are far more likely to evidence safe and well-led care.
Restrictive practice, when managed transparently and reflectively, becomes evidence of strong governance rather than a source of inspection risk.
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