Escorting Patients Policy (Forensic Service) DOCUMENT CONTROL: Version: 4 Ratified by: Quality and Safety Sub Committee Date ratified: 22 August 2016 Name of originator/author: Deputy Assistant Director of Inpatient Services Forensic Business Division/ Assistant Director Forensic Business Division Name of responsible Clinical Quality Group committee/individual: Date issued: 21 September 2016 Review date: August 2019 Target Audience All staff working in the Forensic Business Division
Section Page No 1 INTRODUCTION 3 2 PURPOSE 3 3 SCOPE 3 4 RESPONSIBILITIES, ACCOUNTABILITIES and DUTIES 3 4.1 Board of Directors 3 4.2 Responsible Clinician 3 4.3 Multi-Disciplinary Team (MDT) 3 4.4 Managers 4 4.5 Nurse in Charge/Shift Coordinator 44 4.6 Lead Escort 4 4.7 Escorts 4 4.8 Children 4 5 PROCEDURE/IMPLEMENTATION 4 5.1 Risk Assessment 4 5.2 Modern Matron/Ward Manager/Team Leaders 5 5.3 Nurse in Charge/Shift Coordinator 5 5.4 Lead Escorts 6 5.5 Escorts 7 5.6 The Patient 7 5.7 Low, Medium, High Risk 8 5.7.1 Assessments and Standards 8 5.7.2 The standards expected of all escorting staff for all escorted leave 8 5.7.3 Low Risk 8 5.7.4 Medium Risk 9 5.7.5 High Risk 9 5.8 Preparation for high risk leave 9 5.9 Implementation of high risk leave 10 5.10 Contingency plans 10 6 TRAINING IMPLICATIONS 11 7 MONITORING ARRANGEMENTS 11 8 EQUALITY IMPACT ASSESSMENT SCREENING 12 8.1 Privacy, dignity and respect 12 8.2 Mental Capacity Act 12 9 LINKS TO ANY ASSOCIATED DOCUMENTS 13 10 REFERENCES 13 11 APPENDICES 13 Appendix 1 Escort Status Risk Assessment 14 Appendix 2 Home Leave Risk Assessment 15 Page 2 of 22
1. INTRODUCTION The Forensic Business Division (FBD) recognise that escorted leave is an important part of a patients recovery and enables clinical decisions to be made regarding a patients progress through the patients care pathway. This policy has been developed specifically for the Forensic Business Division to enable the division to be compliant with the Standards for Low Secure Services, Royal College of Psychiatrists (2012). 2. PURPOSE The purpose of this policy is: To provide a framework for consistency of approach to escorting patients and to set practice standards for staff of all disciplines throughout Amber Lodge. To set out the arrangements for managing the risks associated with escorting patients detained under the Mental Health Act outside the secure perimeter of Amber Lodge, to provide for the safety of patients, staff and the general public. 3. SCOPE This policy is for staff working within the forensic business division, who may be required to escort patients detained under the Mental Health Act and who are required to be escorted by staff during periods of leave; for recreation, home visits, leisure, hospital appointments, hospital transfers, court appearances or other additional reasons. 4. 4.1 RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES Board of Directors The Board of Directors are responsible for the Trust having policies and procedures in place to promote best practice and fulfil any requirements in order to be compliant with National or Local Standards. 4.2 The Lead Director responsible for this policy is the Doncaster Service Director. Responsible Clinician The Consultant Psychiatrist who has overall responsibility for the care and treatment of the patient / or nominated deputy is responsible for approving and completing Section 17 documentation stipulating the conditions of escorted leave together with reporting responsibilities to the Ministry of Justice. 4.3 Multi-disciplinary Team (MDT) The multi-disciplinary team will have clinical responsibility for the patient s care and treatment, and will also have responsibility for undertaking formal risk assessments and reviews. See 5.1 Page 3 of 22
4.4 Managers The Modern Matron/Senior Sisters are responsible for staff and must make certain that all Forensic Business Division staff are made aware of the escorting patient policy and implement this policy, and for bringing any issues which may affect implementation to the attention of the Multi-disciplinary Team (MDT). See 5.2 4.5 Nurse in Charge/Shift Coordinator The Nurse in charge/ shift coordinator is responsible for all escorted leaves that take place and must assure themselves that they are within the restrictions and directions stipulated by the Section 17 and Care Plan. See 5.3 4.6 Lead Escort The Lead escort will have the overall responsibility of the patient and their care whilst they are out of Amber Lodge. See 5.4 4.7 Escorts When patients are on 1-1 escorted leave the escort will take on the responsibilities of a lead escort. See 5.5 4.8 Children The Trust has specific duties under Section 11 of the Children Act 2004 to make arrangements to safeguard and promote the welfare of children and is committed to these responsibilities. The Mental Health Act 1983 and its Code of Practice (DoH, 1999 and draft revision 2007) set out the requirement for local policies to safeguard children s rights in relation to private and family life and to promote good practice. The decision to allow or deny the presence of children during a planned visit will be based on risk assessment. Where risk assessment identifies concerns, detailed planning will be required, which will involve other agencies. In accordance with the Children Acts (1989 and 2004), the welfare of a child is paramount and takes primacy over the interest of any and all adults. 5. PROCEDURE/IMPLEMENTATION Each patient s requirements for each individual escorted outing will differ, and this policy/procedure is aimed at protecting these patients whilst providing continuity of practice standards for those staff designated to provide escorting duties. The procedure refers to, and should be applied in relation to individual patients risk assessment and risk management plans. 5.1 Risk Assessment All patients will have formal risk assessments completed on admission which will include identification of their risk of absconding and any other relevant factors Page 4 of 22
whilst on escorted leave. The risk assessment will identify whether the patient falls into a low, medium or high risk category. This assessment will be documented in the individuals care plan. The risk assessment and care plans will be subject to regular review and updated at each MDT meeting and will be reviewed whenever any changes in the patients condition or risk profile are identified by the patients named nurse/mdt. Dependent upon the risk assessment the patient will require a care plan for escorted leave identifying, the gender of escorting staff and the number of staff required. Before or upon admission, patients identified as a medium or high risk will also need care plans in place to cover unplanned leave such as emergency medical treatment at a general hospital, court attendance or hospital transfer etc. Before a patient is permitted leave outside Forensic Business Division the responsible Clinician will complete a Section 17 form in line with the risk assessments, agreed MDT decision and Ministry of Justice restrictions and stipulations (if any). The MDT will ratify all risk assessments and care plans and will also examine any other qualifying factors such as, appropriateness of leave, the times of the leave, means of transport (if any), means of communication between the escorting staff and the ward, such as mobile phone. The MDT will also support the named nurse in the identification of risk factors and the development and formulation of care plans. Restrictions will only be applied where clinical risk has been identified. All patients will receive both verbal and written confirmation of any restrictions (i.e. random drug and alcohol testing, random drug pat down searches) that will be imposed upon them as part of their section 17 leave, these restrictions will be included in the patients Leave Care plan. These restrictions will also be brought to the attention of staff escorts or any other individuals who may form part of the section 17 leave group. 5.2 The Modern Matron/Senior Sisters/Team Leaders The Modern Matron/Senior Sisters will provide supervision and access to training in order that all named nurses allocated to patients, formulate appropriate escorted leave care plans in accordance with the decisions of the MDT. This training will be recorded in the staff member s file. 5.3 Nurse in Charge/Shift Coordinator When determining which staff should escort the patient, the nurse in charge/shift coordinator will take into account the number of escorts required, the qualifying factors identified by the MDT and match these to the available gender and skill mix of the staff on duty. Where more than one patient is involved, escorts will be allocated according to each individual patient s leave status and associated qualifying factors. Escorts will be allocated to be responsible for named patients prior to leaving the ward and the lead escort will have overall responsibility for the group. On occasion there may be specific clinical reasons for the nurse in charge/shift coordinator to reconsider whether a patients` leave session should go ahead e.g. concerns about mental state or increased risk of absconding. In such an Page 5 of 22
event the nurse in charge/shift coordinator will make the decision most appropriate to the circumstances. If the decision is taken not to allow the escorted leave to take place, then the patient will be informed of the reasons for this decision and the reasons for this decision will also be recording on the patient notes in Electronic Patient Records System (silverlink) and in the Care Plan. If deemed necessary the nurse in charge/shift coordinator will inform the Responsible Clinician and senior nursing staff of this decision as soon as practicable. Reference to this decision will be recorded in the fortnightly MDT nursing report for further discussion and review of current risk and care plans. The nurse in charge/shift coordinator will brief staff escorts on the patients leave, whether any specific requirements, conditions or stipulations that apply to the leave, this could include escort gender (due to privacy and dignity reasons) for physical health appointments. The nurse in charge/shift coordinator holds the responsibility for briefing the patient regarding any specific requirements, conditions or stipulations that apply to the leave. Particular attention should be given to briefing the escorts on what action to take, by means of prevention of absconding, or if the patient should actually abscond. Any other factors relating to the care and wellbeing of the patient should also be shared with escorting staff (for example any emotional, physical or social risk factors). The nurse in charge/shift coordinator will also debrief escorts when they return from the leave session and that they make appropriate records of the leave on the bed states recording form and in the patients` records. The patient should also be debriefed and their views of the session also recorded in the Care Plan file and included in the MDT progress report. Any leave facilitated for faith purposes, staff should seek support and advice and work with faith leaders through the Trust chaplaincy department. 5.4 Lead Escorts Where more than one member of staff is designated to escorting a patient, or a group outing is to take place, it is important that one member of staff is designated lead escort by the nurse in charge/shift coordinator. The lead escort is responsible and needs to be certain they are fully briefed about the patient/patients undertaking the leave and the conditions or stipulations that have been applied to the leave, by the nurse in charge/shift coordinator. This briefing is not limited to, but issues covered should include, the following; The purpose of the escorted leave. Details of transport and expected time of return. The conditions, stipulations of the leave, to cover issues such as location, behaviour boundaries, meeting specified individuals, intake of alcohol etc. Familiarity with the patient and their individual needs and care plans. Medications required during the leave, including PRN medication for physical health issues. The risk of absconding and instructions on what action to take if a patient does abscond (see Contingency Plans in 5.10).The risk of patient self harm or risk of patient harm to others and instructions on what action to take should this happen (see Contingency Plans in 5.10). Arrange the method of the lead escort communicating with the Forensic Business Division and the nurse in charge/shift coordinator. This is to verify that the time of return can be confirmed and that escorting staff have the means to Page 6 of 22
communicate any problems to the nurse in charge. All escorts leaving the Forensic Business Division to go into the general community (for whatever purpose) must have an agreed means of communication with the ward. The lead escort will make sure that they are in possession of any information or documentation necessary for the escorted leave e.g. medical notes, prescription card and appointment card for a hospital outpatient appointment. The lead escort will brief the patient prior to leaving the ward on conditions and stipulations agreed to for the leave to take place. The lead escort must be in possession of a Trust Staff Identity Card and carry this at all times as proof of authority to act as escort to the patient. Upon return to the ward the lead escort will record the outcome of the escorted leave on the bed states recording form and in the patients` records and that the nurse in charge/shift coordinator is briefed on the event. The lead escort holds will debrief the patient and any comments made by the patient are reported to the nurse in charge/shift coordinator and documented in the Care Plan to be included in the fortnightly MDT progress report. 5.5 Escorts When patients are on individual 1:1 escorted leave, the escorting staff will be the lead escort as detailed in 5.4 All escort staff along with the lead escort be certain that they are fully briefed about the patient(s) undertaking the leave and the conditions or stipulations that have been applied to the leave, by the nurse in charge/shift coordinator. Escorts should have full information of a patient s leave care plan and current section 17. Escort staff must be in possession of a Trust Staff Identity Card and carry this at all times as proof of authority to act as escort to the patient. The overall organisation and planning of escorted leave is mainly within the role and function of the lead escort and the nurse in charge/shift coordinator; all escorting staff will be clear that they understand their roles, responsibilities and maintain the practice standards dictated by these procedures. 5.6 The Patient It can be assumed that, because leave is to be escorted, the patient has not yet reached the point in their treatment to be granted full unescorted leave, or that legal constraints eliminate unsupervised leave as an option. It is important that the MDT and/or named nurse keep the patient, and patient s carer, informed of the planning process and the patients are given the opportunity to comment on care plans and to agree with the conditions of any escorted leave. All section 17s must have attached a copy of the updated leave care plan, which should be given to the patient and as appropriate to carers. Where a patient is being escorted by a carer staff must ensure the carer has been given clear verbal and written guidance and the arrangements for leave contact number where they can seek advice and guidance if needed. This to include a copy of the section 17 leave care plan. Along with the section 17 leave plan, patients should receive a copy of their leave care plans which outline any restrictions imposed on them in respect of their section 17 leave. Additionally, the patient is given the opportunity to express their views and Page 7 of 22
participate in the formulation of their care plans, to agree to comply with conditions or stipulations that have been applied. The patient can expect to receive a briefing by the staff before the leave takes place and to have the opportunity to express their views, relate their experience/s and make comments to the nurse in charge/shift coordinator upon return from leave. 5.7 5.7.1 LOW, MEDIUM, HIGH RISK (See Appendix 1) Assessments and Standards There are minimum standards which apply to all three categories of risk (see 5.1) with additional requirements for medium and high risk categories. All escorting staff are expected to adhere to the minimum standards for escorted leave and also for the additional standards for medium and high risks. If the service user is going to visit their family in a home environment - then a further home risk assessment is completed, which is again discussed, agreed and minuted in the MDT (see Appendix 2). 5.7.2 The Standards expected of all escorting staff for all escorted leave Be aware of all items of patient property taken on leave i.e. money, clothing, food etc are not too excessive (for example - if patient planning to try and escape.) To be fully briefed about the patient(s) undertaking the leave and the conditions or stipulations that have been applied to the leave, by the nurse in charge/shift coordinator. To adhere to the plan of leave. To be aware of the patients whereabouts at all times, and be aware of their individual care plans and of any special instructions given regarding individual patients during the outing e.g. use of toilet areas which may need to be supervised. To encourage the patient to take full advantage of any escorted leave; taking part in any planned activity with the patient. To intervene if the patient displays any undesirable behaviours in line with their individual care plans and guidelines. For staff to make every effort to keep the patient safe. Try to prevent the patient from absconding, in line with pre-leave briefing and individual care plans and guidelines, using reasonable means. To be conversant with the procedures to be undertaken in any eventuality or emergency. To make every effort to return safely to the unit. To undertake a debriefing following the leave with the patient and the nurse in charge/shift coordinator and record details of the leave on the appropriate forms. To be able to observe the patient and engage appropriately with them at all times and remain in close proximity during the leave period. 5.7.3 Low Risk Patients who are assessed as a low risk, ratified by MDT, will have no recent history of absconding or of threats to abscond and will be assessed as presenting no Page 8 of 22
immediate danger to themselves or others if they do abscond. They will not be detained by the courts on remand and currently have a stable mental state. They may already have unescorted leave authorised. They will be able to undertake escorted leave as a group activity with a ratio of a minimum of 2:1 (two patients to one staff), as well as 1:1 leave (one patient to one staff). A driver may act as an escort for a patient assessed as a low risk. Staff escorting patients on a 1:1 basis should be conversant with the Trusts Lone Working Policy. 5.7.4 Medium Risk Patients who are assessed as a medium risk, ratified by MDT, will have a historical history of absconding and of threats to abscond, or may be assessed as having some impulsivity of behaviour that poses a risk to themselves or to others if they do abscond. Their mental state may currently be in a state of flux and they will have no unescorted leave authorised. They will be able to undertake escorted leave only on a minimum of 1:1 staffing ratio (one patient to one staff). They can only take part in group escorted leaves if they have one staff specifically designated to escort only them on a 1:1 staffing ratio. If a driver is required for a medium risk escorted outing they will not be counted as the escorting staff. 5.7.5 High Risk Patients who are assessed as a high risk, ratified by MDT, will have a historical and recent history of absconding or of threats to abscond. They may pose an immediate risk to themselves or to others if they should abscond. They may exhibit a marked deterioration in mental state, have no authorised leave and may be detained or restricted by the courts. There may be significant political or media interest attracted if the patient should abscond. Patients who are assessed as a high risk will not be authorised escorted leave for leisure purposes but only for essential purposes such as: Transfer to another hospital. Attendance at Court. Attendance at a Police station. Hospital appointments. All high risk escorted leave will be authorised by the MDT. A minimum of three staff trained in reducing restrictive intervention techniques will be required for the high risk escorted leave and the lead escort will be a qualified member of staff. If any drivers are required for the high risk escorted leave, they will not be included as part of the escort team. 5.8 Preparation for high risk leave The lead escort, qualified staff, is responsible for making the appropriate transport bookings and confirming arrangements. The driver must not be counted in the escort team. The escorting staff must be adept at implementing reducing restrictive interventions techniques and be up to date with training requirements. The lead escort must check that all the requirements and arrangements specified in the care plan are confirmed e.g. appointment times. Page 9 of 22
The lead escort must obtain a copy of any care plan introduced for the high risk leave and to take this on the escort and that the care plan is adhered to. The lead escort must maintain communication with the ward and will take Forensic Business Division mobile phone with them on the escorted leave in order to facilitate this. The lead escort will brief all escorts, and drivers, before commencing the high risk leave with the patient. 5.9 Implementation of high risk leave Only when all the escort team are satisfied that they are conversant with all the requirements stipulated within the care plan e.g. Section 17 papers completed and that there preparation has been thorough and complete, then and only then will they commence on high risk leave with the patient. 5.10 Contingency Plans According to the Mental Health Act Code of Practice 1983; staff who are escorting patients detained in accordance with the Mental Health Act are expected to prevent the absconding of a patient under their care using every reasonable means at their disposal. A detained patient on any escorted leave who runs away from their escorting staff or refuses to return to hospital when required to do so can be deemed to have absconded, in which case it is lawful for the escorting staff, as the person who had the patient s custody immediately before he absconded, to retake him, but only if staff feel it was safe to do so. Prior to high risk escorted leave taking place, all escorts will be briefed by the nurse in charge/shift coordinator as to what action they should take, in the event that the patient attempts to abscond. Examples of contingency plans can include the following: The Responsible Clinician or MDT may include in the care plan the contingency that escort staff should telephone 999 and inform the police of an absconded patient before they contact Amber Lodge. The Responsible Clinician or MDT may stipulate that escorting staff may utilise approved reducing restrictive intervention techniques in order to prevent a patient absconding. The Responsible Clinician must document these instructions in the clinical notes before the leave commences. If reducing restrictive interventions requirement has been identified then the leave should be identified as high risk and the escorts must be appropriately trained and are sufficient in number to apply the techniques. There should be no ad hoc changes to the content of the planned escorted leave unless an emergency situation arises. If this should happen, nurse in charge/shift coordinator must be contacted by the lead escort at the earliest opportunity. If at all possible, advice should be sought from the nurse in charge/shift coordinator before any changes to the planned escorted leave is Page 10 of 22
implemented. It is not recommended that a single escort follows a patient who absconds in order to keep them in view. A minimum of two staff should follow the patient, which enables one to make contact with Forensic Business Division and/or police to inform them as to the patients` location. Before carrying out this action, staff must satisfy themselves that their safety will not be compromised by such an action. Escorting staff must understand that they must not put their own safety at risk or that of others in taking measures in order to prevent a patient from absconding. In the event of a patient absconding, escorting staff should report the incident to Forensic Business Division immediately and if identified in the care plan the police. Escorting staff who have any concerns about their ability to retake the patient safely should request assistance from the Police. Any incidents of absconding will be reported at the earliest opportunity to the Responsible Clinician and all relevant documentation will be completed, including the completion of an IR1 form. 6. TRAINING IMPLICATIONS All staff will be made aware of the policy on Escorting Patients as part of their induction to Amber Lodge. As part of the mandatory training requirements each member of staff receives an annual update as part of the in-house Annual Security Awareness Training which includes the policy on escorting patients. All staff will also have undertaken the required reducing restrictive interventions training within the required timescale. All training will be evidenced within Forensic Business Division training record and individual staff files. 7. MONITORING ARRANGEMENTS Area of Monitoring How Who By Reported to Frequency Review of S17 Care plans IR1 information relating to any escorting incidents/issues or absconding MDT Monthly monitoring via the incident analysis process within the Business Division Responsible Clinician and Clinical Team Modern Matron Senior Sisters Safety Lead Business Division Clinical Governance Meeting Business Division Clinical Governance Meeting Assistant Director NHS England Commissioning Team Monthly Monthly reports or where exceptions are identified Page 11 of 22
Area of Monitoring How Who By Reported to Frequency Staff training: RRI training Security Awareness Training Staff records Staff records Modern Matron Modern Matron Assistant Director Forensic Business Division Annually Annually 8. EQUALITY IMPACT ASSESSMENT SCREENING The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website click here 8.1 Privacy, Dignity and Respect The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi s review of the NHS, identifies the need to organise care around the individual, not just clinically but in terms of dignity and respect. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided). Indicate how this will be met There are no additional requirements in relation to privacy, dignity and respect other than previously identified. 8.2 Mental Capacity Act Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court Therefore, the Trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible. Indicate How This Will Be Achieved. All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act 2005. (Section 1) Page 12 of 22
9. LINKS TO ANY ASSOCIATED DOCUMENTS This policy should be read and implemented in association with the following Trust policies: Policy of Clinical risk assessment and management, Clinical Policies, General, RDaSH Intranet: and in conjunction with: Lone Working Policy, Security Policies, RDaSH Intranet 10. REFERENCES Standards and Low Secure Services, Royal College of Psychiatry (2012) 11. APPENDICES Appendix 1 Escort Status Risk Assessment Appendix 2 Home Risk Assessment Page 13 of 22
FORENSIC BUSINESS DIVISIONLOW SECURE Appendix 1 ESCORT STATUS RISK ASSESSMENT INITIAL ASSESSMENTS Pre admission Review (Clinical Risk & Absconsion Risk Formulation) Prior to any agreed escort Reviewed at MDT, CPA (Clinical Risk & Absconsion Risk Formulation) PATIENT MUST HAVE ALL OF THE PATIENT HAS ONE OR MORE PATIENT HAS ONE OR MORE OF THE FOLLOWING: OF THE FOLLOWING: FOLLOWING: LOW RISK FACTORS MDT assess low risk of absconsion (No recent history or threat to abscond/escape) No immediate danger to self or others if patient absconds/escapes Current mental state stable Currently have escorted/unescorted outside secure perimeter Not detained by the courts, on remand or sentenced MEDIUM RISK FACTORS MDT assess medium risk of absconsion (some historical facts or threats to abscond/escape) Some impulsivity of behaviour that may pose a risk to self or others if patient absconds/escapes Current mental health in a state of flux Detained under any legislation HIGH RISK FACTORS MDT assess high risk of absconsion (historical and recent history or threat to abscond/escape) Pose an immediate risk to self or others if patient absconds/escapes Marked deterioration of mental state Restricted or detained by the courts Political/Media interest in patient STRUCTURED CLINICAL JUDGEMENT If Nurse in Charge/shift coordinator becomes aware of any information, situation or circumstance that would increase risk status they have the authority to amend the escorted leave risk assessment, amend the leave or cancel the leave until risk can be reviewed by MDT. LOW Escort according to current leave entitlement Transportation negotiable with what is available Routine observation and report Record on Care Plan MEDIUM Number of escorts to be agreed by MDT Care plan to be formulated and agreed with MDT Team Transportation negotiable with what is available Briefing Session to take place prior and post escort Page 14 of 22 HIGH Is trip necessary? Can procedure/event take place on the unit Minimum three escorts required (one registered nurse) Hospital Transport, with additional driver Care plan formulated with MDT Briefing session to take place prior to and post escort Inform Senior Nurse on-call (outside hours) record risk ass on care plan
Appendix 2 FORENSIC BUSINESS DIVISION HOME RISK ASSESSMENT Introduction The following document is designed to assist professionals in undertaking a home risk assessment following a request made for home leave. It is important that patients are supported to undertake home leave however, it is essential that this is undertaken safely for all parties (patients, staff and public), and that all risk areas (individual to the patient) are considered and manageable for all parties concerned. The team must ensure that any legal framework (Section 37/41 restrictions due to licence conditions are considered and adhered to. This document must be completed in conjunction with the multi-disciplinary team, patient, carer support staff, taking into account The Trusts Safeguarding Adults Policy and The Safeguarding Children Policy and Forensic Business Division Low Secure Escorting Patients Policy. It is important that all parties understand the need for the assessment to take place prior to home leave being granted and that a valid Section 17 leave form has been completed. The outcome of the assessment is to be communicated to all parties and a copy is to be stored in the patients file. If home leave has been granted, a detailed Contingency Plan must be provided and a copy sent to the patient, carer, support staff and any professional involved and a signed copy received back in the file prior to any leave taking place. If home leave is declined, an explanation to the patient and the carer must be provided explaining the reasons why and when the decision will be reviewed. All home risk assessments are to be reviewed at patient s MDT. Page 15 of 22
Name of Patient DOB Legal Status Date Requested Date Undertaken Undertaken By Purpose of Visit People Present Has the assessment been explained to the family? Yes No Page 16 of 22
LOCATION Address (in full) Is the property located in a busy/highly populated area? Yes No If the property in the vicinity of any offence committed? Yes No If the client well known in the area (media / press coverage)? Yes No Is the property in the vicinity of the person that may have caused harm to the client/ patient? Yes No What are the feelings of the local community? Yes No Will there be concerns regarding any damage to property whilst visiting i.e. cars? Yes No Will there be concerns regarding patient / staff safety? Yes No Page 17 of 22
ENVIRONMENT What is the lay out of the property (Where are the toilets situated / where is the back door and where does it lead to? If a client wanted to abscond would this be possible? Yes No Is the property large enough to allow for escorting staff? Yes No Is disability access appropriate? Yes No Would there be access to sharps? Kitchen knifes Yes No Would there be access to alcohol? Yes No Would there be access to cigarette lighters? Yes No Are there animals in the property? Yes No Page 18 of 22
FAMILY / CARER Who do the family members consist of? What are the ages of minors? Are There any safeguarding concerns we should be aware of? And are you happy to share these concerns? If no please inform family / carer that this will need further discussion at MDT Yes No Are there any extended family members known to services? Yes No Details: Will any children be present and is there evidence that parental consent has been provided and that it is in the best interest of the children involved? (if so, this must be discussed and agreed in MDT and the family prior to any visit taking place) Yes No HAS CARE PLAN BEEN COMPLETED Yes No Details: Are the family known to the service? (i.e. disability issues, education, violence to others, drugs or alcohol related behaviour) Yes No Details: Page 19 of 22
Are there issues regarding family dynamics? (does the patient / client have a good relationship with all family members) Yes No Details: Are there any cultural issues? Yes No What is the family s attitude to services? Details: How will the family respond to the intrusion of staff escort? Details: Do the parties concerned understand the need for boundaries and structure during the visit? (zero tolerance to alcohol/drugs) Yes No Page 20 of 22
ADDITIONAL AGENCY INVOLVEMENT Are there any other agencies that may need to be involved / informed of the visit (Social Services / Police)? Yes No Details: Is the patient / client on the sex offenders register? Yes No Is the patient subject to MAPPA If yes: Yes No MAPPA Category: MAPPA Level: Any Restrictions: Have the MAPPA Unit been contacted in relation to Home leave being considered? Yes No If No complete MAPPA I Notification Form and send to the appropriate MAPPA Unit Date Sent If Yes has all information been shared with the MDT in relation to decision making on granting leave Date of MDT If applicable, has Ministry of Justice approval been sought and confirmation letter received? Date confirmed Page 21 of 22
OUTCOMES / RECOMMENDATIONS Details: Date discussed in MDT: MDT Decision / Recommendations Once completed the care plan for leave and agreement should be agreed, discussed and signed by the patient and family/carer prior to leaving taking place. Name: Name: Signed: Signed: Page 22 of 22