Positive Behaviour Support and Restrictive Practices Audit - Supported Living

Evidence to check

• • PBS policy is current and specific to supported living
• • Policy promotes prevention, quality of life, communication and least-restrictive practice
• • Staff can explain how PBS is different from controlling behaviour
• • Examples show staff use proactive support before behaviour escalates

Evidence to check

• • PBS, de-escalation and trauma-informed training records
• • Staff can describe individual tenants’ triggers, early signs and calming strategies
• • Training includes supported living scenarios such as visitors, community access, relationships and tenancy risks
• • Refresher training is provided after incidents, concerns or changes in need

Evidence to check

• • Behaviour support plan includes the tenant’s views, wishes and preferences
• • Professional input from PBS practitioner, psychologist, learning disability team, mental health team or social worker where needed
• • Family, advocate or representative involvement is recorded where appropriate and consented to
• • Plan is explained to the tenant in an accessible way where possible

Evidence to check

• • Plan identifies triggers, early warning signs and proactive support
• • Plan includes what staff should do before, during and after distress
• • Recovery and post-incident support for the tenant are included
• • Staff can explain prevention strategies, not only what to do during crisis

Evidence to check

• • Incident records include date, time, location, trigger, behaviour, staff response and outcome
• • Records include what happened before and after the incident
• • Tenant injury, distress, dignity and emotional impact are considered
• • Records avoid blaming or judgemental language

Evidence to check

• • Restrictive practices are clearly identified in support plans and risk assessments
• • Consent, capacity and best-interest records are in place where relevant
• • Least-restrictive alternatives are considered and documented
• • Restrictions are not used as blanket rules or staff convenience

Evidence to check

• • Restrictive intervention logs
• • Reviews consider frequency, duration, impact and alternatives
• • Reduction plan is in place for ongoing restrictions
• • Progress toward reducing restrictions is monitored through supervision and governance

Evidence to check

• • Consent record or MCA/best-interest documentation
• • Purpose of the monitoring tool is clearly recorded
• • Privacy, dignity and proportionality are considered
• • Monitoring is reviewed and removed where no longer needed

Evidence to check

• • Plan describes the tenant’s strengths, preferences, communication and goals
• • Plan includes meaningful activity, relationships, choice and independence
• • Language is respectful and non-blaming
• • Support focuses on reducing distress and improving quality of life

Evidence to check

• • Review dates are recorded and current
• • Reviews take place after incidents, new restrictions, medication changes, safeguarding concerns or changes in behaviour
• • Specialist input is sought where behaviour is complex, escalating or restrictive practice is used
• • Plan is updated and staff are briefed after review

Evidence to check

• • Post-incident debrief or reflection records
• • Supervision discusses staff responses and learning
• • Staff consider what could have prevented escalation
• • Learning is added to the behaviour support plan where relevant

Evidence to check

• • Clear policy on physical intervention and restrictive practice
• • Staff training and competency records for any authorised physical intervention
• • Incident records show why intervention was necessary, proportionate and least restrictive
• • Use of physical intervention is reviewed and reported through governance

Evidence to check

• • Incident records show dignity and privacy were considered
• • Staff use respectful language and avoid punitive responses
• • Tenant is offered reassurance, recovery time and support after incidents
• • Feedback from the tenant is sought where possible

Evidence to check

• • Any use of seclusion, withdrawal or exclusion is clearly recorded
• • Legal, safeguarding and MCA implications are considered
• • Strategy is not used as punishment or behaviour control
• • Ongoing use is escalated for senior and professional review

Evidence to check

• • Incident trend analysis by time, location, trigger, staff member, activity or environment
• • Patterns are used to update behaviour support plans
• • Preventive strategies are changed where patterns emerge
• • Analysis includes near misses and low-level distress, not only serious incidents

Evidence to check

• • Support plan includes communication, sensory and trauma-informed guidance
• • Health checks, pain, medication, sleep, hunger, anxiety or environmental factors are considered
• • Staff do not assume behaviour is deliberate or manipulative
• • Professional advice is sought where underlying causes are unclear

Evidence to check

• • Restrictive practice review records
• • Capacity, consent, best-interest or legal advice considered where relevant
• • Human rights, privacy, dignity and autonomy are considered
• • Ongoing restrictions have senior oversight and review dates

Evidence to check

• • Consent to involve family, advocate or representative is recorded
• • Tenant’s own views remain central
• • Advocacy is offered where the tenant needs support to be heard
• • Others’ views do not override a capacitous tenant’s wishes

Evidence to check

• • Outcome measures are included in behaviour support reviews
• • Incident reduction is considered alongside quality of life improvement
• • Daily notes show progress in choice, confidence or independence
• • Achievements are recognised in a way meaningful to the tenant

Evidence to check

• • Restrictive practices and incidents are screened for safeguarding concerns
• • Safeguarding referral made where threshold is met
• • Rationale recorded where safeguarding is considered but not referred
• • Tenant is protected from abuse, neglect, punitive practice or unlawful restriction

Evidence to check

• • Named senior lead for restrictive practice or PBS oversight
• • Restrictive practice data is reviewed by managers
• • Reduction actions are tracked through governance
• • Leaders challenge unnecessary or poorly evidenced restrictions

Evidence to check

• • Staff debrief records
• • Supervision includes emotional impact and wellbeing after incidents
• • Staff know how to access support
• • Learning is captured without blame while maintaining accountability

Evidence to check

• • Tenant feedback is recorded after incidents or during reviews where possible
• • Accessible communication methods are used
• • Tenant views influence changes to the plan
• • Staff consider non-verbal feedback, distress or behaviour as communication

Evidence to check

• • PBS plans are available to authorised staff
• • Staff know where to find the current plan
• • Outdated plans are removed or archived
• • Confidentiality is maintained when plans include sensitive information

Evidence to check

• • Governance reports include behaviour incidents and restrictive practice data
• • Themes are reviewed by location, tenant, staff team, restriction type and outcome
• • Actions are recorded with owners and timescales
• • Governance checks whether restrictions are reducing and quality of life is improving

Evidence to check

• • Staff can answer rights-based behaviour scenarios
• • Support plans avoid punitive consequences
• • Tenant rights to privacy, visitors, relationships and community access are protected unless lawful restriction is required
• • Managers challenge practice that becomes controlling or institutional

Evidence to check

• • Medication records and PRN protocols are reviewed where behaviour-related medicines are used
• • Use of sedating medication or PRN is monitored for frequency, reason and effectiveness
• • GP, psychiatrist or pharmacist review is requested where concerns arise
• • Non-medication strategies are clearly included in the PBS plan

Evidence to check

• • PBS audit includes tenant outcomes, choice, independence, relationships and community access
• • Tenant feedback is included where possible
• • Audit reviews whether restrictions are reducing
• • Actions focus on improving the tenant’s life, not only reducing behaviours that challenge staff