Risk Assessment

Risk assessment is the combined processes of:

1. identifying risk;
2. identifying the likely impact of the risk (positive and negative); and
3. identifying how to reduce the negative impact and maximise the positive.

Wherever possible, risk assessment should be proactive. This means it should take place before any harm has occurred.

The person’s involvement in risk assessment can:

1. be empowering; and
2. increase the likelihood of positive engagement with any plan to manage risk; and
3. build resilience, confidence and independence.

As such it is important that, whenever it is practicable to do so, the person is directly involved in risk assessment. This includes:

1. providing information to them about the purpose of risk assessment;
2. carrying out the risk assessment in an accessible way;
3. supporting the person with advocacy where appropriate;
4. talking with them about all of the risks that exist;
5. talking with them about all or the benefits and potential harmful consequences of taking the risk;
6. exploring with them all of the available options to manage risk; and
7. supporting them to make an informed decision about whether to take a risk, or how best to manage risk.

If the risk assessment is being carried out as part of a care and support process under the Care Act (including safeguarding) and the person is likely to have substantial difficulty being involved, the duty to provide an independent advocate will apply if there is no other suitable representation available.

See: The Duty to Provide an Independent Advocate for further guidance about when the advocacy duty applies under the Care Act.

If there are concerns that the person may lack capacity to be involved in the risk assessment, then a proportionate mental capacity assessment must be carried out to determine whether this is the case.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, with guidance about assessing mental capacity.

If the person has capacity

If the person has capacity following the mental capacity assessment, they should be encouraged and supported to be involved in the risk assessment.

If the risk assessment is being carried out as part of a care and support process under the Care Act (including safeguarding) and the person is likely to have substantial difficulty being involved, the duty to provide an appropriate independent advocate will apply if there is no other suitable representation available.

See: The Duty to Provide an Independent Advocate for further guidance about when the advocacy duty applies under the Care Act.

If the person lacks capacity

If the person lacks capacity following the mental capacity assessment then:

1. they must be appropriately represented during the risk assessment; and
2. their views, wishes and feelings in relation to risk must be ascertained and regarded.

If the risk assessment is being carried out as part of a care and support process under the Care Act (including safeguarding), the duty to provide an appropriate independent advocate will apply if there is no other suitable representation available.

If the risk assessment is not being carried out as part of a care and support process under the Care Act, the nature of representation will depend on the context in which the risk assessment is being carried out, and the duty to provide an independent mental capacity advocate may apply.

If the person has capacity to decline to be involved you should encourage them to be involved, but ultimately the decision is theirs to make.

You must proceed to carry out the risk assessment based on the information available, and with regard for any views expressed by the person when:

1. there is a statutory requirement to complete the risk assessment; or
2. the risk assessment is being carried out to manage the risk of harm or abuse to the person.

The person's refusal to be involved should be clearly recorded, and a copy of the completed risk assessment should be provided to them. They should then have the opportunity to review and amend any plan to manage risk.

If a person requests that somebody is involved in the risk assessment then you should involve that person unless you have evidence that doing so would place the person (or another vulnerable adult or child) at increased risk of harm or abuse.

If the risk assessment is being carried out in relation to a person with care and support needs as part of a formal care and support process under the Care Act (including safeguarding), the duty to involve any carer applies, even if the person does not consent to their involvement unless:

1. the risk assessment relates to possible abuse or harm of the person caused by the carer; and
2. the carers' involvement in the risk assessment is likely to increase the risk of further harm or abuse occurring.

When a person has not consented to the carer being a part of the risk assessment, you should agree the most appropriate way to involve the carer (for example, a separate meeting with the carer).

If the person has requested particular information not relating to needs is withheld from the carer, and they have capacity to do so, normal confidentiality rules apply unless doing so would put the person at risk of abuse or neglect.

If an independent advocate has been appointed to support the person to be involved in the risk assessment, their views must be regarded.

It may be relevant to consult with, or involve, others in one or more of the stages of risk assessment:

1. identifying risk;
2. identifying the likely impact of the risk (positive and negative); and
3. identifying how to reduce the negative impact and maximise the positive.

You can involve anyone in any way at any stage, so long as:

1. it is relevant for them to be involved; and
2. doing so will not increase the likely risk of harm or abuse; and
3. the person has consented; or
4. if the person lacks capacity, a best interests decision is made to this effect.

Examples of people it may be relevant to involve include, but are not limited to:

1. service providers;
2. family members, friends or neighbours;
3. Health professionals;
4. another Local Authority; and
5. the police.

Under the Care Act anyone that you ask to be involved in the risk assessment has a duty to co-operate with the request, unless doing so would prevent them from carrying out their own duties under the Care Act or other legislation.

In all cases the consent of the person to share information with others should be sought unless:

1. they lack capacity to consent (in which case information sharing must only be carried out if it is in their best interests); or
2. information sharing is necessary to protect the person (or another vulnerable adult or child) from abuse or neglect (in which case the person must be notified but information should be shared regardless of consent).

All information gathering and sharing should take place with regard to the Caldicott Principles, Data Protection Legislation and local information sharing policies.

The Adult Care My Assessment tool should be used to ensure that consideration is given to any risk issues which arise as each area of the assessment is worked through with the person. This should include recording how concerns about risks are impacting on the person’s wellbeing, which could be both positive and negative impacts.

Risk issues must be discussed with the person and their carer, unless there is evidence that doing so may heighten the risks.

The Living Safely and Taking Risks section of the Adult Care Assessment should be used to pull together the areas of risk which have been identified within the assessment. This section should:

• state what the risk is;
• state what the nature of the risk is using one of the four categories:
  • Risks to self;
  • Risks to others;
  • Risks from others;
  • Environmental risks;
• evaluate the severity of the risk using the standard risk matrix described below;
• state how risks are intended to be addressed.

The Risk Assessment and Management Plan (RAMP) provides a framework for more detailed consideration of risk, to prompt thinking and discussion with the person, their representatives and partners about risks, and to provide a tool for recording and sharing an agreed plan for managing the risks.

The Risk Assessment and Management Plan should be recorded as a separate assessment, and linked to the assessment or reassessment that triggered it.

The tool is designed to support multiple or single risks, to record the nature of the risk and to record whether the risk is to self, to others, from others or environmental. It is important that the RAMP is reviewed regularly and discussed in supervision.

Professional judgement and curiosity will determine when a RAMP needs to be completed in addition to risks identified in a needs assessment. If a practitioner is unsure, they should discuss this with their manager for further guidance and support.

Here are some potential examples of when a RAMP may need to be completed: (this is not an exhaustive list)

• where circumstances dictate a more detailed exploration of risk issues not covered in routine needs assessment and support planning;
• where risks require a shared Multi-Disciplinary Team approach;
• where risks are more complex;
• where there are severe or substantial high risks not reduced by measures already taken. (Using the risk rating scale);
• where there may be alleged perpetrators;
• where a person has returned home from hospital / emergency or crisis placement. (RAMPs may be required if not explored within routine assessment / care planning. The RAMP in this circumstance will provide opportunity to evidence exploration of previous risks and how they may be minimised / mitigated to allow the person’s safe return home);
• where risks remain due to an unwise decision or lack of capacity which may support Best Interest decisions;
• for all individuals subject to a Community Treatment Order;
• for all individuals subject to a s41 restriction order under the Mental Health Act;
• for those identified at risk of hospital admission due to mental health concerns;
• consideration should be given when Team Around the Adult services are involved;
• if someone is subject to Multi-Agency Public Protection Arrangements (MAPPA) and/or Multi-Agency Risk Assessment Conference (MARAC).

Adult Care uses the risk rating matrix when evaluating the severity of risk.

The risk rating matrix assigns a score to a risk by plotting the projected likelihood of a risk occurring against the consequences or impact on the person or other people.

The matrix grades risk scores using the following scale:

This risk rating is useful to show where risks indicate the need for more in depth assessment and risk management. The score also enables risks to be re-scored once measures to manage or mitigate the risk have taken effect, and give a clear indication as to whether interventions are working or not.

To access the risk rating matrix, and a guide to using it as effectively as possible, see the Assessment folder (Section 5) of the Local Resource Library.

Risk is broadly defined as 'the probability that an event will occur with beneficial or harmful consequences'.

When identifying risks you need to consider all of the following:

1. risk to the person;
2. risks to a carer;
3. risks to another vulnerable adult;
4. risk to a child;
5. risk to the public;
6. risk to providers of care and support/support; and
7. risk to property and belongings.

Every situation is different, but the table below sets out some examples of risk that may be present.

When risks have been identified, and both positive and negative likely impacts agreed you should:

1. explore all of the available options to manage risk; and
2. consider all the benefits and risks associated with each option; and
3. agree the best way to manage risk.

Risk is a normal everyday experience, from which we all learn and grow.

Unless the risk is abuse or neglect the purpose of risk assessment is to:

1. maximise the positive impact of taking the risk; and
2. reduce the negative impact; and this
3. may or may not lead to the elimination of risk.

If the risk is abuse or neglect the risk assessment should seek to eliminate the risk wherever possible.

Wherever possible, every conversation with a person about risk should be from a strengths-based perspective. This means supporting them to explore whether there is:

1. anything within their own power that they can do to manage the risk; and
2. anything within the power of their family, friends or community that they can use to manage risk.

A strengths-based approach is empowering for the person and gives them more control over the situation and how best to manage risks in the best way for them. Strengths based approaches are often more sustainable and can help to build the resilience of the person and their informal networks.

It is important that the measures to manage risk are:

1. appropriate and proportionate to the overall level of risk present;
2. the least intrusive that they can be; and
3. the least restrictive of the person's human rights, particularly their right to liberty and family life.

When deciding the best way to manage risk it is important to identify all of the available options, including:

1. what the person can do for themselves;
2. what others in the person's informal network can do (for example, family members, friends);
3. what steps providers of services can take; and
4. what steps professionals can take.

In the Care Act, people are seen as experts in their own lives, and as such are best placed to make their own decisions if they are able to do so. Supporting people to make their own decision about how best to manage risk can:

1. be empowering; and
2. increase the likelihood of positive engagement with any plan to manage risk; and
3. build resilience, confidence and independence.

Therefore, if a person (with capacity) has a clear view about how best to manage risk, any risk management plan should be based upon this unless:

1. the method to manage risk is not available; or
2. the method does not reduce the risk of abuse or neglect; or
3. the method increases the risk of abuse or neglect; or
4. the method places another vulnerable adult (or child) at risk of abuse or neglect.

If any of the above circumstances apply, you must explain to the person why the plan cannot reflect their wishes, and then make risk management decisions that:

1. are evidence based; and
2. have regard for their views, wishes and feelings; and
3. are appropriate and proportionate to the overall level of risk present; and
4. are the least intrusive that they can be; and
5. are the least restrictive of the person's human rights, particularly their right to liberty and their right to family life.

Unwise decisions

The Mental Capacity Act 2005 permits any person with capacity to make an unwise decision.

An unwise decision is any decision that you, or anyone else thinks is not the best decision for them.

There may be cause for concern if someone:

1. repeatedly makes an unwise decision that puts them at serious risk of harm, abuse or exploitation; or
2. makes an unwise decision about risk that is obviously irrational or out of character.

In this situation you must carry out an assessment of capacity where it is appropriate and relevant to do so, before making any decision about risk on their behalf.

If a person lacks capacity to make a decision about the best way to manage risk, this decision must be made in their Best Interests using the fourth and fifth principles of the Mental Capacity Act.

In particular, any decision must:

1. be evidence based; and
2. have regard for their views, wishes and feelings; and
3. be appropriate and proportionate to the overall level of risk present; and
4. be the least intrusive that it can be; and
5. be the least restrictive of the person's human rights, particularly their right to liberty and their right to family life.

See the Mental Capacity Act 2005 Resource and Practice Toolkit, which provides comprehensive guidance about making best interests decisions.

Risk is dynamic and constantly changing. Appropriate and proportionate arrangements should be made to monitor a risk assessment when:

1. the risk of abuse and neglect is high;
2. the plan to manage risk is unstable;
3. the likely effectiveness of the plan to manage risk is unclear;
4. the risk may be short term;
5. the level of risk is likely to change; or
6. other less restrictive or intrusive ways to manage risk may become available.

The timeframe for review

Risk assessments should be reviewed in line with any timeframes that were agreed when the assessment was completed.

If specific timeframes to review the risk assessment were not agreed, the review should take place as part of:

1. a Protection Plan review;
2. a Care and Support Plan review;
3. a reassessment of need;
4. a review under the Care Programme Approach; or
5. any other statutory function being carried out.

A review of the risk assessment should also take place when there is evidence that indicates either:

1. the level of risk has changed;
2. the risk management strategies are not effective;
3. the risk management strategies are no longer required; or
4. there may be a less restrictive way of managing risk.

The purpose of review

Any review of risk should establish explicitly whether:

1. risks continue to be well managed by any plan;
2. there have been any changes to risk;
3. there is any risk of abuse or neglect; and
4. whether there is a risk to the sustainability or stability of any Care and Support Plan/Support Plan/Care Plan.

If risks have not changed and are well managed

If the review identifies that risks have not changed and the measures in place are effectively reducing risk, this should be clearly recorded and the current plan should continue subject to further review or monitoring.

If risks have changed or are not managed

If the review identifies a change in risk, or that risks are not well managed, you will need to explore:

1. what is working and not working with current measures;
2. what steps can be taken to resolve any issues with the current measures to reduce risk; and
3. any new measures to manage risk; and
4. if risks have changed, carry out any new proportionate assessment of risk.