LEARNING DISABILITIES & AUTISM — OXARA CONSULTING

Learning Disabilities Service – Restrictive Practice Reduction & Culture Reset

The Crisis

A supported living service registered for adults with learning disabilities and autism received an Inadequate rating following an unannounced CQC inspection. The inspection was triggered by a whistleblower referral alleging that restrictive practices — including physical restraint, mechanical restraint, and de facto seclusion — were being used without lawful authority, proper recording, or oversight.

CQC Rating: Inadequate (Safe, Caring, and Well-led). Requires Improvement (Responsive). Good (Effective)

Warning Notices were issued under Regulation 11 (Need for Consent), Regulation 12 (Safe Care and Treatment), and Regulation 17 (Good Governance). The local authority commenced a safeguarding enquiry under Section 42 of the Care Act 2014. Three individual residents were subject to active safeguarding investigations. The provider faced an urgent timeline — demonstrate compliance within 6 months or face cancellation of registration.

Our Intervention

Oxara Consulting deployed a clinical and governance team on-site within 48 hours. Given the complexity of the legal framework — including the interaction between the Mental Capacity Act 2005, the Liberty Protection Safeguards transitional provisions, and the Right Support, Right Care, Right Culture framework — the intervention required both clinical and governance expertise working in parallel.

Phase 1: Immediate Safeguarding & Legal Compliance (Weeks 1–4)

• Conducted a full restrictive practice audit across all 16 residents — identified 11 instances of unlawful restriction with no Mental Capacity Act assessment, Best Interests decision, or DoLS authorisation in place.
• Immediately suspended all informal restrictive practices pending lawful authorisation.
• Worked with the provider's legal team to submit urgent Deprivation of Liberty Safeguards applications to the supervisory body for 6 residents within 72 hours.
• Contacted the local authority safeguarding team to update on immediate actions taken — establishing transparency as a core strategy throughout.
• Reviewed all Positive Behaviour Support plans — only 4 of 16 residents had a current PBS plan; none referenced least restrictive options or de-escalation hierarchies.
• Introduced an emergency Restrictive Practice Register, recording every instance of restriction with date, duration, legal basis, and staff involved.

Phase 2: Culture Reset & Staff Retraining (Months 2–3)

• Delivered Right Support, Right Care, Right Culture training programme to all staff — 100% completion by the end of Month 2.
• Introduced PROACT-SCIPr-UK restraint reduction training delivered by an accredited external trainer, co-ordinated by Oxara Consulting.
• Replaced all existing behaviour protocols with individual, co-produced PBS plans developed with residents, families, and advocates where appropriate.
• Introduced a Restraint Reduction Action Plan with monthly targets — reduced use of physical intervention by 68% by the end of Month 3.
• Established a Restrictive Practice Oversight Group meeting fortnightly, chaired by Oxara Consulting — attended by the Registered Manager, clinical lead, and a family representative.
• Implemented a human rights-based approach framework across all care planning — each resident's plan explicitly referenced their Article 5 and Article 8 ECHR rights.
• Introduced accessible communication tools for non-verbal residents — including PECS, Makaton, and object-of-reference systems — to reduce frustration-triggered behaviours.

Phase 3: Governance Rebuild & Evidence Portfolio (Months 4–6)

• Rebuilt the entire governance framework to meet Regulation 17 — introduced a structured quality assurance cycle with documented evidence mapped to the CQC quality statements.
• Created a comprehensive Right Support, Right Care, Right Culture compliance evidence portfolio demonstrating adherence across all three pillars of the framework.
• Submitted Written Representations to CQC at Month 3 evidencing immediate actions against all three Warning Notices — CQC acknowledged receipt and agreed no further emergency action.
• Local authority safeguarding enquiry concluded at Month 4 — no further action required; provider commended for transparency and responsiveness.
• Achieved zero unlawful restrictions by Month 4 — all remaining restrictions lawfully authorised, reviewed, and recorded.
• Conducted a pre-inspection readiness review at Month 5 — all staff able to articulate PBS plans, legal frameworks, and individual communication profiles for their key residents.

Outcome

Month 3: CQC acknowledged Written Representations — Warning Notices under active review, no further enforcement escalation.

Month 4: Safeguarding enquiry closed — no findings against individual staff.

Month 4: Zero unlawful restrictions in place — all DoLS authorisations granted.

Month 5: Physical interventions reduced by 78% from baseline.

Month 6: CQC re-inspection — rating improved to Requires Improvement overall, with Good achieved in Safe and Caring.

Month 6: All three Warning Notices formally lifted.

Month 11: Full Good rating achieved across all five domains at follow-up inspection.

Clinical Lead Note: “Restrictive practice in learning disability services is rarely malicious — it is almost always the product of a culture that has never been given the right tools. The staff in this service were overwhelmed and undertrained. Once we gave them a lawful, person-centred framework and the confidence to use it, the restrictions fell away almost on their own. The culture reset was the intervention.”

Client Testimonial: “The safeguarding enquiry felt like the end. The Oxara team didn’t just help us survive it — they used it as the starting point for building something genuinely better. Every one of our residents now has a care plan that reflects who they actually are, not just what they need to be managed.”
— Registered Provider