Name of organisation

Location covered by assessment

Assessment carried out by

Follow-up required?

Yes ☐

By this date

Date

No ☐

Task/

situation/

location

Slip, trip or fall hazard identified

Exact nature of risk identified

Who is at risk?

Severity of potential injury (1–3)

Likelihood of potential injury (1–5)

Risk rating (severity x likelihood)

Existing controls

Further controls needed/action required

Severity

Likelihood

1 = low/minor injury

1 = very unlikely/improbable

2 = medium/significant injury

2 = unlikely/remote

3 = high/death or major injury

3 = possible/could occur

4 = probable/likely/unacceptable risk

5 = almost certain/certain

Purpose

An at-a-glance form such as this should be included in the needs assessment/service user plan documentation to alert care staff of any risks associated with the service user in question. The form should also have instructions and procedures on what care staff should be looking out for and doing to manage the risk.

Note:

The form assumes that risk assessments have been carried out in the relevant areas: this form serves as a summary only.

Method

Care staff should:

1. make notes under the relevant headings

2. indicate clearly the level of risk; this can be displayed in different ways such as by using:

• initials (H, M, L)

• a “traffic lights” colour coding scheme (eg red = high, yellow = medium, low = green)

• coloured stickers that flag up any significant risks

3. summarise the key actions to be taken by staff to minimise the risks; this might include indicating where to look in the full care records to find further information.

Assessed risks

Description of risk 

(Summarise from the full risk assessment)

Risk Assessment

High (H)

Medium (M)

Low (L)

Key actions/alerts

H

M

L

Any aspect of personal safety 

(Describe)

Any aspect of personal safety 

(Describe)

Any aspect of personal safety 

(Describe)

Falls and falling

Nutritional and dehydration risks

Pressure sores/ tissue viability

Risks to other people from service user’s challenging behaviour and attitudes

Risks to service user from other people’s challenging behaviour

Specific risks of abuse, eg physical, sexual, financial

Other assessed risks 

(Describe)

Use the following flexible guide to assess the risks and develop risk management plans for an individual service user. Note all risk assessments should be made with the involvement of the service user and/or representatives. The outcomes should be included in the service user plan.  

The process has three stages:

1. Identify the risks and the risk levels, which result from the detailed risk assessments that will have been carried out in the needs assessment.

2. Consider which risks are increased or reduced by the characteristics and attitudes of the individual.

3. Consider the extent to which the support and resources available contributes to the level of risk.

Consideration of all these indicators should help to make risk assessments and management plans that determine the acceptability/unacceptability of the identified risk taking.

c

Name and details of service user

1. Nature of the risks

Key to assessed level of risk:

H = High (and will need risk control measures in the person’s care plan)

M = Medium (and might need risk alerts or degrees of risk control in the person’s care plan)

L = Low/Minimal/Non-applicable, ie unlikely to be a significant issue in the person’s care and support

Risk indicators

Assessed level of risk

Summary of the evidence for the risk level identified

H

M

L

There are identified risks to the individual’s personal safety from one or more of the following.

Healthcare risks

The extent and severity of the person’s disabilities and their progression, for example, caused by strokes and, progressive illnesses such as MS and dementia

☐

☐

☐

The extent and severity of a known medical condition such as diabetes, heart conditions (including such as high cholesterol and hypertension).

☐

☐

☐

Adverse effects from the person’s prescribed medication, eg because of the combination of medicines used

☐

☐

☐

Adverse effects from reluctance/failure to take the medicines as prescribed/difficulties with taking “as required medicines” in the correct manner 

☐

☐

☐

From the person choosing to self- medicate

☐

☐

☐

Vulnerability to falls, accidents and injury within or outside the home environment, which might or might not be related to a known medical condition

☐

☐

☐

Vulnerability to pressure sores and poor skin health, particularly where the person is bed bound

☐

☐

☐

Vulnerability to infections and other external causes of illness

☐

☐

☐

Vulnerability to general self-neglect, eg because of depression or lack of self-care abilities

☐

☐

☐

Vulnerability to lack of nutrition and dehydration, eg because of known medical condition or disability, mode of nutrition used or poor appetite or eating habits

☐

☐

☐

Vulnerability to infections from physical/ medical condition/devices such as catheters

☐

☐

☐

Use made of physical aids, equipment, appliances and devices, including bedrails, wheelchairs, specially designed chairs, etc

☐

☐

☐

Vulnerability to allergens and allergic reactions

☐

☐

☐

Effects on healthcare of generally unhealthy condition or life style, eg obesity, lack of physical activity, smoking, use of drugs, alcohol (proportionate to age and other factors)

☐

☐

☐

Other healthcare risks not included in the above list (Describe)

Personal and social care risks

Adverse personal and social effects of lifestyle including smoking, alcohol and drug habits, lack of physical activity and exercise (proportionate to age and other factors), eg causing loneliness, poor relationships, social exclusion, low self- worth, image and esteem

☐

☐

☐

Adverse effects of lack of mental capacity on self-care abilities, freedom of movement and independence, eg might get lost, confused — note high level of risk will probably imply need for restrictions and supervision that could amount to deprivation of the person’s liberty and require authorisation  

☐

☐

☐

Adverse effects of mental health difficulties, eg from anxiety and depression on personal and social life 

☐

☐

☐

Vulnerability to different forms of abuse, bullying, harm and exploitation by others

☐

☐

☐

Vulnerability to perpetrating — deliberately or unintentionally — forms of abuse, bullying, harm and exploitation against others 

☐

☐

☐

Personal care issues that have adverse effects on the person’s wellbeing, eg:

• dressing and appearance, grooming

• body odour or bad breath

• physical mobility

• continence

• sleeping patterns

• lack of occupation or stimulation, or

• taking part in risky activities 

• eating and drinking self-care abilities

☐

☐

☐

Other personal and social care risks not included in the above list (Describe)

Summary of the risks and levels of risk: High risks

Summary of the risks and levels of risk: Medium risks

Summary of the risks and levels of risk: Low risks

Overview of the risk factors for the person, which need to be reflected in their care and support plan  

2. Additional risk indicators (These issues might be found in the person’s situation and environment and therefore should be considered in the risk assessment)

These factors could also increase levels of risk

Assess as:

Very important

Quite important

Not very important

There are risks posed by the person’s wishes to do more for himself or herself than he or she is capable of

☐

☐

☐

The person does not have or use the physical supports to minimise risk (eg aids and appliances, etc)

1. Screening checklist

Use this sample checklist to determine current nutritional status and to help develop a suitable action plan. The results should help determine whether to refer the service user for specialist nutritional assessment and advice. Use the checklist in association with the following two frameworks.

Question

Responses

Does the person show a loss of appetite and lack of interest generally in food?

Is he or she in the habit of missing meals or eating regularly or living just by “snacking”?

Has there been a gradual or sudden change in the person’s eating and drinking patterns resulting in low or poorer nutritional intake?

Is “typical” body weight — too low or too high — being maintained? (Alternatively, is the person losing or putting on weight rapidly?)

Is he or she having a well balanced diet, making “wise” eating choices, with adequate fruit and vegetables, not too much fat and sugar etc?

Does the person have any tooth and mouth problems resulting in difficulties in chewing and swallowing food?

Does he or she have repeated digestive problems?

Does he or she NOT take in recommended amount of liquids and become dehydrated?

Does he or she exceed the recommended alcohol limits?

Is there a history of recent infectious illness, colds, viruses etc. that might have resulted in a temporary loss of appetite or weight?

Does the person suffer from an illness or condition that makes eating and drinking difficult or which is made worse by inappropriate eating and drinking patterns?
Examples:
Heart Disease
Strokes
Diabetes
Dementia
Cancer
Dementia
Other progressive diseases
Osteoporosis
Rheumatic conditions
Arthritis

Environment used by the person has many hazards increasing risks to the person’s safety

☐

☐

☐

Emergency help is not always available (so increasing risks)

☐

☐

☐

Person is not self aware of the risks to which he or she might be exposed and unable to plan

☐

☐

☐

He or she enjoys taking unsafe and dangerous risks

☐

☐

☐

Summary of the importance of these risk indicators for that individual

3. Support issues (These issues might also be found in the person’s situation and environment, and therefore should be considered in the risk assessment)

These factors could also increase levels of risk

Assess as:

Very important

Quite important

Not very important

The support available is not enough to reduce risks to personal safety to acceptable levels

☐

☐

☐

The person’s immediate carers (including care staff) are not sufficiently confident, competent or trained to manage any risks to the service user

☐

☐

☐

There is insufficient professional, skilled supervision available to enable the risks to be controlled confidently and competently.

☐

☐

☐

The community services available or needed are not good enough to help manage the identified risk, thereby making the person’s care unsafe

☐

☐

☐

The neighbours and public are unsupportive making management of the risks more difficult

☐

☐

☐

The care service is concerned about press and media coverage of anything that goes wrong, which affects its acceptance of the responsibility to manage the risks that have been identified

☐

☐

☐

Summary of the importance of these risk indicators for that individual

Signed:

_______Bukola Adebusoye_____________

Date:

______1st June 2022____________

Policy review date:

_____30th November 2022______________