She has fallen in the care home: what to ask in the first 48 hours

The call lasts forty seconds. "Your mother had a little fall last night, she is fine, we just wanted to let you know." You put the phone down relieved — and you have learned almost nothing.

A fall is not an isolated mishap. It is clinical information. A first fall sharply raises the odds of the next one, and a fall nobody analyses repeats itself. What you ask in the first 48 hours changes what happens next month.

1. Ask these straight away

Ask on the phone, calmly, and write the answers down with the date.

• Exactly when, and where? A 3 a.m. fall in her room on the way to the toilet is a completely different problem from a 3 p.m. fall in the lounge.
• Was she found on the floor, or did someone see her fall? "Found" means nobody knows how long she was down there. It is the most important question and the least often asked.
• Who examined her, and when? A carer, a nurse, the GP?
• Was she checked for a head injury or a fracture — and if not, on what basis was that decided?
• Is she in pain, and what has she been given?
• Is this the first time? Ask for the number of falls in the last three months. The answer is nearly always higher than you expected.
• What has changed since? If the answer is "nothing", you know what the rest of this week is for.

Two specifics matter in Britain. A hip fracture does not always stop someone walking — impacted fractures are missed for days. And if she is on an anticoagulant, a head injury needs a much lower threshold for scanning: say so explicitly, and ask what monitoring was put in place.

2. Duty of candour is not a favour

Under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, a care home has a statutory duty of candour: when something goes wrong that causes harm, it must tell the resident or their representative, in person, explain what is known, apologise, and follow up in writing.

That means you are entitled to a proper account, not a forty-second phone call. The sentence that works: "I would like the duty of candour discussion, and the written follow-up."

Alongside it

• The home must keep a falls risk assessment and a care plan that is reviewed after each fall.
• Serious injuries and certain events must be notified to the CQC as statutory notifications.
• If there is any suggestion the fall involved neglect — she was left on the floor, the call bell went unanswered, no one had reassessed her — that is a safeguarding matter, and either you or the home can make a safeguarding referral to the local authority under section 42 of the Care Act 2014. You do not need the home's agreement to do this.

3. What a real falls review looks like

A fall filed as "an accident" is a missed opportunity. A proper review looks for causes that can actually be changed:

• Medication. The biggest single lever. Sedatives, sleeping tablets, antidepressants, blood pressure and diabetes medicines all raise the risk. Ask the GP for a structured medication review — and ask the specific question: "Is there anything here we could reduce?"
• Lying and standing blood pressure. It takes three minutes and explains a large share of falls.
• Vision and hearing. When was the last eye test? Are her glasses the right prescription — and can anyone find them?
• Feet and footwear. Nails, corns, backless slippers: foot care in a care home explains why this dull detail is a serious falls factor.
• Strength and balance. A physiotherapy referral, a walking frame that is actually the right height, daily movement.
• The environment and the night. Lighting, bed height, grab rails, the route to the toilet, the call bell within reach — and, above all, how long the call bell takes to be answered at night. Night-time care and falls sets out the questions.
• Infection and dehydration. A urinary infection causes confusion and falls in older people and is not always looked for.

4. What may be offered that is not a solution

Bed rails. They do not reduce falls; they increase the severity of the ones that happen, because the fall is from higher up. They need assessment, consent and review.

Restraint or a lap belt. Any restriction of movement engages the Mental Capacity Act and, where it amounts to a deprivation of liberty, the DoLS process. It must be the least restrictive option, in her best interests, time-limited and reviewed — never a substitute for night staffing.

"We will move her closer to the office." Helpful, but it is not a falls review.

5. Repeated falls mean something else

Three falls in two months is not bad luck. It usually signals one of four things: medication that needs changing, an undiagnosed condition, a level of supervision the home cannot provide overnight, or a fear of falling that stiffens her walking and causes more falls in turn.

That is the point to request a formal meeting — manager, nurse, GP if possible, you — in writing, with a date. And to ask the question that matters: "With the staffing you have at night, can you supervise her safely?" The honest answer, when it comes, tells you whether this is still the right home.

6. If nothing changes

In order, in writing at every step

1. The registered manager, by email, with dates and facts.
2. The provider's formal complaints procedure — every registered home must have one, with a timescale.
3. The local authority safeguarding team, if there is any question of neglect, and the council's commissioning team if it funds the placement.
4. The Care Quality Commission — 03000 616161. The CQC does not resolve individual complaints, but it uses what you tell it to target inspections.
5. The Local Government and Social Care Ombudsman, once the provider's complaints process is exhausted.

7. Stay or move?

Moving disorients, particularly with dementia, and it is not the first answer. But if the falls repeat, if night staffing cannot deliver the supervision she needs, and if nothing changes after a written request, then looking elsewhere is not disloyalty. It is the logical next step.

Run both tracks at once — the complaint on one side, alternatives on the other.

Curalune Care Help (£69) puts together, usually within 24 working hours, a shortlist of 3 to 5 homes matched to her area and needs — with contacts, a message ready to send and the questions to ask about night staffing and falls prevention.

*General information, not medical advice. Admission, fees and availability are always confirmed by the homes and the responsible authorities. In an emergency, call 999.*