Policy – Locked door Suitable for adult residential social care or mental healthcare settings. Note: this worked example policy is for illustrative information only. It may be used by an adult social care or healthcare organisation as a basis upon which to develop their own policy but should be fully customised and adapted to the specific needs of the organisation concerned. Aim The aim of this organisation is to ensure that users of this service are free from unlawful and unjustified restrictions on their movements while protecting their safety and security. Background This organisation believes that respect for human rights and basic human freedoms is a fundamental element in the ethical provision of care services. Such freedoms include freedom of movement and freedom from unlawful restriction on movement and activities. However, at the same time the organisation also recognises its duty of care to protect its service users from unacceptable risks and to protect their security and the security of their belongings. Such an ‘unacceptable risk’ may include service users who are assessed as being in danger of leaving the premises unobserved and harming themselves or coming to harm. The organisation recognises the following relevant legislation and international conventions: UN Declaration of Human Rights 1948 European Convention on Human Rights (ECHR) Human Rights Act 1998 Equality Act 2010 Mental Health Act 1983 and the Mental Health Code of Practice 2015. This policy is intended as a guide to good practice in what is often seen as a difficult area of care. It should be followed by all staff, who should recognise the duty of the service under the above to safeguard and respect the human rights of service users to come and go as they please and to enjoy basic freedoms of movement and association free from unnecessary or unwarranted restrictions. In particular, the organisation recognises the requirement under the Mental Health Act 1983 Code of Practice to wherever possible ensure that the least restrictive care options are employed and that so-called ‘blanket’ restrictions, where these are unjustified, should be avoided. An example of such a blanket restriction is the locking of all doors to a health or social care premises to maintain the safety of a few service users who are assessed as at risk of harm from leaving the premises unobserved whereby the restriction applies to all of the other service users in the premises unnecessarily. In addition to the above, this organisation also recognises that respect for human rights is an important part of compliance with the registration requirements of the Care Quality Commission (CQC). CQC regulatory requirements All adult social care providers must comply with the regulatory requirements of the CQC in order to maintain their registration. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which include the fundamental standards, apply to health and social care providers from April 2015. Regulation 13: Safeguarding service users from abuse and improper treatment, states that service users must be protected from abuse and improper treatment. According to Regulation 13, a service user must not be deprived of their liberty for the purpose of receiving care or treatment without lawful authority, including restrictions to their movement. Regulation 15: Premises and equipment states that premises must be secure and suitable for the purpose for which they are used. Guidance for providers on meeting the regulations, published by the CQC in March 2015, includes prompts, described below, which service providers must take notice of. As part of their induction, staff must receive training that is relevant to their role and at a suitable level to make sure any control, restraint or restrictive practices are only used when absolutely necessary, in line with current national guidance and good practice, and as a last resort. If using restraint, providers must make sure that restraint: is only used when absolutely necessary is proportionate in relation to the risk of harm and the seriousness of that harm to the person using the service or another person takes account of the assessment of the person’s needs and their capacity to consent to such treatment follows current legislation and guidance. Providers and staff should regularly monitor and review the approach to, and use of, restraint and restrictive practices. Security arrangements must make sure that people are safe while receiving care, including: protecting personal safety, which includes restrictive protection required in relation to the Mental Capacity Act 2005 and Mental Health Act 1983 – this includes the use of window restrictors or locks on doors, which are used in a way that protects people using the service when lawful and necessary, but which does not restrict the liberty of other people using the service not inadvertently restricting people’s movements providing appropriate information about access and entry when people who use the service are unable to come and go freely and when people using a service move from the premises as part of their care and treatment using the appropriate level of security needed in relation to the services being delivered. When a person lacks the mental capacity to consent to care and treatment, a best interests process must be followed in accordance with the Mental Capacity Act 2005. Policy In this organisation: All service users should have their needs assessed and any risks relating to their care addressed in discussion with themselves and with their family, carers and representatives. In some cases the risk assessment may identify a risk of self-harm or of coming to harm for a service user leaving the premises on their own, or of moving from one part of the premises to another unobserved where this may be deemed a risk. In the event of such an assessment adequate intervention measures should be introduced to reduce the risks to an acceptable level. Assessments should be made with reference to the Mental Capacity Act 2005 where the service user involved is suspected of lacking capacity. In such cases all decisions should be made in the best interests of the service user and represent the least restrictive option. Assessments which are properly made under the Mental Capacity Act deprivation of liberty safeguards, and approved by a valid supervisory body, may include authorisation to deprive a service user of their liberty in their best interests. All risk assessments should be individualised as part of a person-centred care planning process for each person. In addition to individualised risk assessments, the premises itself should be subject to regularly reviewed risk assessment focusing on the security of the premises. The aim of this assessment will be to minimise the risk of theft and intrusion and to maintain the safety and security of service users, staff and possessions and property. The balance of freedom of movement and restrictions due to security policies should be maintained by reference to good practice and by consideration of the principle of ‘least restrictive’ care when conducting risk assessments. Managers and risk assessors should also balance security with the maintenance of a welcoming environment. Wherever possible, security and safety and the risks of service users leaving unobserved should be managed by adequate staffing and by one-to-one care for at-risk individuals, not by the use of locked doors. Locking doors to restrict movement should never be used as a ‘blanket restriction’ to enable easier care, to make up for short staff numbers or to reduce staff to service user ratios. Security arrangements should always be appropriate and justified within the security policy – security should never be used as a reason for locking doors and unnecessarily restricting the movement of service users or their visitors. Blanket restrictions are understood to be those restrictions which restrict a service user’s liberty and other rights, which are routinely applied to all service users without individual risk assessments to justify their application. Managers and staff should avoid the use of all such restrictions unless they can be justified as necessary and proportionate responses to risks identified for particular individuals. Care must always be based on the principle of the ‘least restrictive option’ where independence and autonomy are maximised and service users empowered, wherever possible, to make their own decisions. Effective governance arrangements will be in place which will include monitoring of human rights standards, including freedom of movement within the premises. All staff will work to eliminate discrimination by embedding equality through systems, processes and outputs and ensuring that all forms of discrimination are prohibited, prevented and eliminated. The locking of doors should never be used as a punishment or as a method of discriminating against an individual or a group of service users. All security arrangements and any use of locked doors should consider the access needs of disabled service users and the access plan for the premises. Any access restrictions should be marked with clear and adequate signage. All access restrictions should be kept under review. Management duties Managers and supervisors in the organisation have a duty to: regularly audit the use of this policy and the effectiveness of procedures to establish an effective locked door policy monitor complaints and compliments relating to locked doors or unnecessary restrictions on movement, taking action as required and fully investigating any complaints. Staff duties Staff in this organisation have a duty to: comply with all policies and procedures always act in full compliance with the Equality Act 2010, the Mental Capacity Act 2005 and the associated deprivation of liberty safeguards attend appropriate training. Training In this organisation: induction will include training and guidance on the locked door policy of the organisation, and on managing security risks all staff will be trained in the requirements of the Mental Capacity Act and with the associated deprivation of liberty safeguards. Applicability and scope This policy applies to all staff and volunteers working in or for the organisation without exception. All staff have responsibility for ensuring that they work within the remit of this policy and in the manner in which they have been trained. Associated policies and procedures Safeguarding and whistleblowing policies Mental Capacity Act policy Deprivation of liberty safeguards policy Missing service user policy Risk assessment and care planning policies Human rights policies. Responsibilities Responsibility for the implementation, monitoring and review of this policy lies with the service provider. Signed: Dated: Policy ref number and version: Author: Implementation date: Next review date: