Falls Prevention in Care Homes: What NICE and CQC Expect, Including the Change on Risk Tools
A practical guide for registered managers, built on NICE’s 2025 falls guideline and CQC’s safe care and treatment regulation: what to assess, what to do and what to record.
Falls prevention in a care home means identifying why each resident might fall and acting on those reasons: a comprehensive falls assessment, a medicines review, activity and exercise, a safe environment and clear information for residents and visitors. NICE’s 2025 guideline NG249 says to offer a comprehensive falls assessment and management to people in residential care settings, and not to use falls risk prediction tools to predict a person’s risk of falling. CQC inspects falls under Regulation 12, safe care and treatment.
Falls are among the most common serious incidents in care homes and one of the most predictable inspection findings: a resident falls, the incident form is completed, and nothing in the care plan changes. Inspectors look for the opposite: a clear link from risk, to action, to review.
This guide follows NICE’s guideline NG249: Falls: assessment and prevention in older people and in people 50 and over at higher risk (published April 2025) and CQC’s Regulation 12. It is written for care homes, with a short note for home care.
Key takeaways
- NICE says not to use falls risk prediction tools to predict who will fall. If your home relies on a scored tool to decide who is “at risk”, review that practice.
- In residential care, offer a comprehensive falls assessment and management, then address each individual risk factor promptly.
- NICE-recommended actions include a structured medication review, review of psychotropic medicines, staying active and a tailored exercise programme.
- Tell residents, families and visitors how to reduce risk and how to alert staff to hazards, including how to use call bells, bed controls and sensors.
- Record, review and learn: every fall should lead to a check of the care plan, and patterns should reach your governance meeting.
In this guide
What Does Falls Prevention in a Care Home Involve?
It is not a single policy or piece of equipment. It is a cycle: find the reasons a person is more likely to fall, act on each reason, check it worked and keep doing it as their condition changes. CQC’s Regulation 12 requires providers to assess risks to people’s health and safety and do all that is reasonably practicable to mitigate them, so a fall that was foreseeable and not acted on is a breach risk. See our Regulation 12 guide and what a risk assessment in care is.
Should Care Homes Still Use Falls Risk Scoring Tools?
NICE’s 2025 guideline changes the advice. Recommendation 1.1.1 says: do not use falls risk prediction tools to predict a person’s risk of falling. Recommendation 1.1.7 says to offer a comprehensive falls assessment and comprehensive falls management to people in hospital inpatient settings and residential care settings.
What this means for your home
A score on a checklist is not the same as understanding why this person might fall. If your falls risk assessment is a scored form that sorts residents into low, medium and high risk, make sure it is not the only basis for decisions. Build the assessment around the individual’s own risk factors and what will be done about each. Check your policy against NG249 and take clinical advice locally.
What Does NICE Recommend for Residential Care?
For people in residential care settings, NG249 recommends the following (recommendations 1.3.20 to 1.3.25 and 1.5.3):
- Tailor interventions to the person so they promptly address their individual fall risk factors.
- Carry out a structured medication review as set out in NICE’s care homes medicines guideline, to identify medicines that may increase the risk of falls and consider adjusting them.
- Review psychotropic medicines for older people, discuss the increased falls risk with the person and plan withdrawal as appropriate.
- Encourage activity: reassure people they should not avoid getting up and moving around, and use a structured daily routine with regular opportunities to stand and walk, as appropriate.
- Consider an exercise programme for people able to exercise, covering balance, coordination, strength and power, tailored to abilities and preferences, individual or group.
- Give information and education: discuss how to manage safety concerns, move around safely and stay active, how to use equipment such as bed controls, call bells and movement sensors, and how visitors can alert staff to hazards.
NICE also notes there is insufficient evidence for vitamin D supplements specifically to reduce falls, but encourages people to follow NHS advice on vitamin D for bone and muscle health.
What Should You Record After a Fall?
NICE does not prescribe a post-fall form, so use your clinical policy and local NHS pathway. At governance level, make sure each fall record answers:
- Was the resident checked for injury, and by whom, before they were moved?
- Did the incident meet a CQC notification criterion, such as serious injury (see notify CQC of a serious injury)?
- What was the likely cause, and what individual risk factor does it point to?
- What changed in the care plan, medicines review, environment or staffing as a result?
- Who reviewed it and when, and did it reach the governance meeting?
Look for patterns by time, place, resident and staffing. See learning from safety incidents and the incident management log.
What About Falls in Home Care?
NG249’s recommendations for people living in the community include asking about falls, and offering a home hazard assessment and intervention using a validated tool. Home care agencies should make sure care workers report falls, near misses and hazards they see in a person’s home, and that this reaches the person’s care plan and, where appropriate, their GP or falls service.
How Can CQC Logic Help?
CQC Logic does not provide a falls risk assessment tool, which is consistent with NICE’s advice. It helps you govern the process: an incident log for falls, a falls audit you can add as a custom audit alongside the care plan review audit, a medication audit to support medicines reviews, a governance meeting agenda to review trends and an action list so changes are owned and dated. See plans.
Sources: NICE NG249: Falls: assessment and prevention · CQC: Regulation 12, Safe care and treatment
Turn fall incidents into closed actions
CQC Logic helps you log falls, review patterns at governance meetings and track the actions that follow, so you can show inspectors what changed. See a sample improvement plan, view pricing or get started free.
Frequently Asked Questions
What is falls prevention in care homes?
It is identifying why each resident might fall and acting on those reasons: a comprehensive falls assessment, medicines review, activity and exercise, a safe environment and information for residents and visitors.
Does NICE recommend falls risk assessment tools?
No. NICE NG249, published in April 2025, recommends not using falls risk prediction tools to predict a person’s risk of falling, and instead offering a comprehensive falls assessment and management in residential care settings.
What are NICE’s falls prevention recommendations for care homes?
Tailored interventions for each individual risk factor, a structured medication review, a review of psychotropic medicines, encouraging activity, a falls prevention exercise programme where the person is able, and information for residents and visitors.
Should every fall in a care home be reported to CQC?
No. CQC requires notification of specified events, which include serious injury. A fall only needs notifying if it meets a notification criterion. Record every fall in your own incident log regardless.
Do vitamin D supplements prevent falls?
NICE says there is insufficient evidence to support vitamin D supplements specifically to lower falls risk, but encourages people to follow NHS advice on vitamin D for bone and muscle health.
What do CQC inspectors look for on falls?
Evidence that risks were assessed and acted on, that people’s individual risk factors were addressed, and that falls are reviewed for patterns and learning. That sits under Regulation 12 and Regulation 17.