Care Home Risk Assessments: A Practical Guide to Getting Them Right

This guide provides template-level support for care home risk assessments. It does not constitute legal, clinical, or health and safety advice. For fire risk assessments, COSHH assessments, and clinical risk management, always engage qualified professionals appropriate to the risk area. References are current as of the last reviewed date above; verify against legislation.gov.uk and relevant guidance bodies for the latest position.

Risk assessments are among the most requested documents during a CQC inspection. They sit at the intersection of Safe, Effective, and Responsive key questions, and weak or missing risk assessments are a leading cause of enforcement action under Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The challenge for most care home managers is not understanding that risk assessments are needed — it is knowing which ones, how often to review them, and what standard of documentation CQC expects. This guide covers all three.

The three categories of risk assessment

Care home risk assessments fall into three broad categories. You need all three.

1. Individual (person-centred) risk assessments

These are specific to each resident and cover risks arising from their health conditions, abilities, and personal circumstances. They should be part of the care plan and reviewed whenever the resident's needs change.

Common individual risk assessments:

Falls — using a validated tool such as the FRASE (Falls Risk Assessment Scale for the Elderly) or equivalent. Document risk factors (medication, mobility, cognition, continence, environment) and the specific interventions in place.
Pressure ulcers — Waterlow score or Braden scale. Record the score, the date, and the prevention plan. NICE CG179 (Pressure ulcers: prevention and management) sets the evidence base.
Malnutrition — MUST (Malnutrition Universal Screening Tool). Score on admission and monthly thereafter. Refer to dietician if score is 2 or above (high risk).
Moving and handling — individual assessment of the person's mobility, weight, and preferred method of transfer. Must be kept current and accessible to all staff providing care.
Choking and dysphagia — for residents with swallowing difficulties, referral to SALT (speech and language therapy) and documented recommendations on food texture and fluid consistency. Reference IDDSI (International Dysphagia Diet Standardisation Initiative) framework.
Skin integrity — particularly for residents with diabetes, peripheral vascular disease, or immobility.
Behaviour that challenges — triggers, de-escalation strategies, and any restrictive practices with documented authorisation.
Self-neglect and self-harm — where identified, with clear escalation plans.
Continence — assessment of continence needs and a management plan that respects dignity.

Review frequency: On admission, after any significant change (fall, hospital admission, weight loss, new diagnosis), and at minimum monthly for high-risk residents and quarterly for stable residents.

2. Environmental risk assessments

These cover the physical building and grounds. The registered manager and the responsible person for fire safety share accountability here.

Required environmental risk assessments:

Fire risk assessment — required under the Regulatory Reform (Fire Safety) Order 2005. Must be conducted by a competent person and reviewed annually, or sooner after any building changes or fire incidents. Document covers emergency lighting, fire detection systems, escape routes, compartmentation, staff training, and personal emergency evacuation plans (PEEPs) for every resident.
Legionella — required under the Health and Safety at Work Act 1974 and the Control of Substances Hazardous to Health Regulations 2002. A written scheme from a competent person, with monthly temperature checks (hot water above 50°C at outlets, cold water below 20°C) and records of any remedial action.
COSHH — assessment of all hazardous substances stored on site (cleaning chemicals, clinical waste, laundry chemicals). Document storage arrangements, PPE requirements, and safety data sheets.
Slips, trips and falls — environmental assessment of flooring, lighting, handrails, external pathways, and trip hazards. Review quarterly and after any incident.
Security — entry and exit points, CCTV (with appropriate signage and data protection compliance), missing person protocols, garden and boundary security.
Outdoor spaces — uneven surfaces, garden equipment, pond or water features, fencing, and access for residents with dementia or mobility limitations.
Kitchen and food safety — food hygiene rating compliance, documented HACCP procedures, allergen management. Local authority environmental health officers inspect these, and CQC may ask for your most recent food hygiene inspection report.

Review frequency: Annually as a minimum for most environmental assessments. Fire and legionella on their prescribed schedules. Ad-hoc reviews following incidents or building changes.

3. Activity-specific risk assessments

These cover activities or situations that are not daily care tasks but carry additional risks.

Examples:

Outings and trips — transport arrangements, staffing ratio, individual risk factors for each participating resident, emergency contact information, medication arrangements
Events and entertainment — visiting performers, external catering, alcohol, large gatherings
Use of equipment — specialist baths, standing hoists, profiling beds, sensor mats. Each piece of equipment should have a generic risk assessment, and individual residents should have their use of specific equipment documented in their care plan
Visiting animals — pet therapy, resident-owned pets, infection control considerations
Seasonal risks — hot weather plans (fluid intake monitoring, room temperatures), cold weather plans (heating, flu vaccination, ice and snow on paths), festive activities

Review frequency: Before each occurrence for one-off activities. Annually for recurring activities, with updates if circumstances change.

What CQC assessors look for in risk assessments

CQC assesses risk assessments under multiple quality statements — primarily S1 (Learning culture), S4 (Involving people to manage risks), and S5 (Safe environments). Assessors check for:

Specificity. A generic "falls risk assessment" form with tick boxes and no narrative is weak evidence. Assessors want to see the individual's specific risk factors and the specific actions taken to mitigate them. A good falls risk assessment for Mrs Jones explains that she is at increased risk because of her postural hypotension, her bifocal glasses, and her preference for walking without her frame — and that the team has arranged a medication review, provided single-vision distance glasses for mobility, and placed a sensor mat by her bed.

Currency. A risk assessment completed 8 months ago for a resident whose needs have changed twice since is not worth the paper it is printed on. Assessors will cross-reference risk assessment dates against incident records, hospital discharge summaries, and care plan review dates.

Person involvement. Under the Mental Capacity Act 2005, a person with capacity should be involved in their own risk assessment. Document their views, including where they accept risks that staff have identified. For residents lacking capacity in a specific decision area, document the capacity assessment and best interests decision.

Positive risk-taking. CQC does not expect care homes to eliminate all risk. Quality statement S4 explicitly references risk enablement — supporting people to do things that carry some risk because the activity matters to them. A resident who wants to walk to the garden independently despite a falls history should have a risk assessment that supports that choice with appropriate safeguards, not one that confines them to a wheelchair.

Links between assessments. A resident's individual risk assessments should connect to each other and to the care plan. If someone scores high on Waterlow, their moving and handling assessment should reflect skin integrity considerations. If someone has a choking risk, their mealtime care plan should reference the SALT assessment.

Documentation standards

For every risk assessment, ensure you record:

The person's name (or location/activity for environmental and activity-specific assessments)
Date of assessment and date of next review
Assessor's name and role
Identified hazards — what could cause harm
Who is at risk — and why they are particularly vulnerable
Existing control measures — what you are already doing
Residual risk level — typically rated as low, medium, or high after controls are applied
Additional actions needed — with named owner and deadline
Resident's views (for individual assessments) — or capacity assessment if unable to contribute
Sign-off — by the assessor and, where applicable, by the resident or their representative

Store risk assessments so they are accessible to staff who need them. Individual risk assessments should be in or directly linked to the care plan. Environmental risk assessments should be in a central location (office or digital system) with key findings communicated to relevant staff.

Common mistakes

Completing risk assessments as a paperwork exercise. If staff cannot tell you what Mrs Jones's falls risk factors are without checking the file, the risk assessment is not serving its purpose. Embed risk information into daily handovers and care plan summaries.

Using the same risk assessment template for every resident. Templates are helpful starting points, but every completed assessment should read differently because every resident is different. If your risk assessments are interchangeable between residents, they are not personalised enough.

Not risk-assessing the environment after changes. New furniture, building works, a change of cleaning products, a new piece of equipment — all trigger a review. Build environmental reassessment triggers into your maintenance and procurement processes.

Forgetting to review after incidents. Every fall, every pressure ulcer, every medication error should trigger a review of the relevant risk assessment. Document what changed as a result.

Putting it into practice

Start with an inventory. List every resident and check that they have current risk assessments for at minimum: falls, pressure ulcers, nutrition, moving and handling, and any condition-specific risks. Then check your environmental assessments are in date. Finally, review whether any activities lack a risk assessment.

If building a review schedule feels daunting, consider integrating risk assessment reviews into your internal audit schedule. Monthly care plan audits should include a check on whether associated risk assessments are current.

For broader compliance guidance, including how risk assessments fit within the Safe key question under the single assessment framework, see our CQC compliance guide for small care homes.