Adult Safeguarding Risk Assessment Matrix
Consider the level of risk of neglect to others who are in an institutional care setting where neglect, due to poor practice and/or inadequate
care, has been identified in a sample group of vulnerable adults
Formula (A + B x C = D) + E =F
Complications of frailty, unexplained or identified harm (This list is not exhaustive)
A
Dehydration
Inadequate nutrition
Recurrect care setting acquired infections – urinary tract infection / chest infection / Thrush
Urinary Incontinence/excoriation
Constipation / faecal incontinence
Intractable pain / poor pain management
Insomnia / Twilight state of awareness / drowsiness
Failure to administer medicines/incorrect administration/deliberate over or under medicating
B
Confusion not linked to mental condition / Delirium
Sense of hopelessness / resigation
Recurrent falls without identified cause
Pressure ulcers
Unexplained fractures / Unexplained injury / Unexplained bruising
Acute illness / exacerbation of long term condition
Financial irregularity/Financial loss
Sexual disinhibition/sexual assault/ serious sexual offence
Potential or actual Impact of care, management or leadership deficits on the health / well-being of vulnerable adults
Level 1 harm:
Level 2 harm:
Level 3 harm:
Level 4 Harm
Level 5 harm
Low Harm
Moderate Harm
Serious Harm
Significant Harm
Catastrophic Harm
No harm identified –
physical or psychological.
Minor non-compliance with
standards.
A small number of
shortcomings in
The lack of
 Care identified;

Care;

Administration;

Leadership or
management
 Poor administration;
 Ineffective management and
weak leadership
Minor injuries.
Minor financial loss < £500
Isolated incident not
compounded by other
issues
A lack of care or
clinical/nursing/AHP/social work
management has caused
complications of frailty or
continued ill health for the
service user.
are identified but require only
good practice development to
rectify
Moderate Financial Loss >£500
has had a negative impact on
an individual or a small number
of service user’s physical /
mental health over a short time
only; however, improvement is
anticipated with prompt
rectification
Major Financial Loss > £1K
This may cause long term harm,
death or self injurious behaviour
for the individual or has an
identified effect on other service
users.
There is significant
maladministration and/or
Major leadership and
management failure identified
Significant financial loss > £5K
Rare
Unlikely
The effects are specific
to the individual / their
medical condition / the
personal choices / of
the vulnerable person
and unlikely to affect
others.
Failings may be due to lack of
knowledge around specific area of
care or clinical practice, relating to
specific health conditions, which
does not have repercussions on
vulnerable people with different
conditions, but may be relevant to
all and/or failings may be due to
a lack of experience, leadership or
management competency.
C LIKELIHOOD of
health concerns
found (in sample
group) on other
vulnerable people
RARE
UNLIKELY
POSSIBLE
LIKELY
ALMOST CERTAIN











There is a demonstrable absence of
effective leadership and management
contributing to systemic failure and
catastrophic harm
Failings focus on specific areas of
care or clinical practice for an
identified health condition / one
complcation of frailty which could
apply to a large proportion of
vulnerable people in that care setting
and/or failings are attributable to a
lack of experience, leadership or
management competency.
Almost certain
Failings are identified as causing
complications of frailty which, because of the
type of service user, are likely to be
experienced by other vulnerable people. This
may impact on other medical conditions
present in the other vulnerable people which
may or may not be known about and/or
failings are directly attributable to a lack of
experience, leadership or management
competency.
The level of risk to other vulnerable adults
D
E
There is maladministration which has
had catastrohic impact on the health
and well being of one or more service
users or affecting the care
environment.
Likelihood of finds affecting other vulnerable adults
Possible
Likely
C
Minimal impact. No
risk to others.
Acts of omission or comission related
to care or clinical/nursing/AHP/social
work management, has caused
complications of frailty or ill health
resulting in catastrophic harm. And/or
there are systemic failings which
have had a catastrophic impact on
the health and/or wellbeing of one or
more service users.
B Potential IMPACT of health concerns found (in sample group) on other vulnerable people
NEGLIGIBLE
MINOR
MODERATE
MAJOR
LOW
LOW
MODERATE
HIGH
LOW
LOW
MODERATE
HIGH
LOW
MODERATE
HIGH
HIGH
MODERATE
HIGH
HIGH
VERY HIGH
MODERATE
HIGH
HIGH
VERY HIGH
Other Professional and Organisational factors to consider (Intelligence)
Local information / intelligence from staff / families / others
Observation of manner of staff and their interaction with service users
Recent relevant complaints / alerts / audit reports
Recent CQC inspection reports
Staffing levels / organisation of staff / leadership / management
Level of staff understanding about adult safeguarding
Service user(s) express feelings of fear / bullying / intimidation
Service user(s) feel unable or are afraid to make a complaint
Concerns about possible other types of harm or abuse
Level of knowledge / evidence of current evidence based practice
Availability / suitability of equipment / practical resources






Extremely
Serious / life
threatening
HIGH
HIGH
HIGH
VERY HIGH
VERY HIGH
Environmental factors
Recent team/service/corporate reorganisation / take over / merger /
acquisition affects focus on business and financial priorities of organisation
Response of agency/provider/organisation and co-operation to initial
investigation to rectify identified issues (e.g. prompt and effective)
Identified infection control concerns/issues
Level of vulnerability/dependency of service users
Service users capacity and ability to make specific decisions
Involvement of other health and safety organisations e.g. HSE
Environmental Health / Health Protection Agency
(D+E) Overall decision, response and action
Based on the considered view of the level of risk for other service users / vulnerable adults in the same/similar care setting as the sample patient/group, of
being harmed, exploited or neglected through deliberate actions, poor practice and / or inadequate care, the decision on action to be taken
F
Risk Assessment Matrix Determination
NHS Number:
Name of patient:
Address:
Post Code:
GP:
Identified issues:
Summary of concerns:
Risk Assessment:
Decision making formula:
A
(A + B x C = D) + E = F
Complications of frailty, unexplained or identified harm:
Outcome:
+
B
Potential or actual Impact of care, management or leadership deficits on the
health / well-being of vulnerable adults:
Outcome: Level X: XXXXXX Harm
x
C
Likelihood of findings affecting other vulnerable adults:
Outcome:
=
D
The level of risk:
Outcome:
+
E
Other Professional and Organisational factors to consider (Intelligence):
Outcome:
=
F
(D+E) Overall decision, response and action:
Outcome:
Person completing this risk determination:
Position:
Date Completed: