Recognising and escalating deterioration

RESTORE 2 stands for: Recognise Early Soft-signs, Take Observations, Respond, Escalate. The tool has been designed by West Hampshire CCG and Wessex AHSN to help care and nursing professionals to:

  • Recognise when a resident may be deteriorating or at risk of physical deterioration
  • Act appropriately according to the resident’s care plan to protect and manage the resident
  • Obtain a complete set of physical observations to inform escalation and conversations with health professionals
  • Speak with the most appropriate health professional in a timely way to get the right support
  • Provide a concise escalation history to health professionals to support their professional decision making

In March 2020, in response to the emergence of COVID-19, the British Geriatrics Society (BGS) released a new guideCOVID-19: Managing the COVID-19 pandemic in care homes, offering key recommendations to help all care home staff and the NHS staff who work with them to support residents through the epidemic. One of these recommendations advises staff in care homes in the practice of taking vital signs to use the RESTORE2tool to recognise deterioration in residents, measure vital signs and communicate concerns to healthcare professionals.

Later in July 2020, guidance was released by the Care Quality Commission, Department for Health and Social Care, NHS England and Public Health England, who included the recommendation to use RESTORE2 to support resident care - Admission and care of residents in a care home during COVID-19.

The RESTORE2Mini is a ‘soft signs’ only version of the RESTORE2 tool for use in settings where it is not possible to take clinical observations.

As a recognised tool, RESTORE2 has been a useful resource during the COVID-19 pandemic as it helps care professionals to spot deterioration from COVID-19-related illness or recognise non-COVID-19 related deterioration, and contributes to a decrease in avoidable hospital admissions. 

RESTORE2 training

In response to COVID-19, the South West AHSN is working with its partners across Somerset, Devon and Cornwall to enhance the confidence of care home, domiciliary care staff and informal carersin detecting and appropriately escalating deteriorating residents and people they care for. Our partners include CCGs, local councils, primary care networks (PCNs), NHS trusts, training providers and the voluntary sector.

In addition, our partners from all three counties come together on a bi-monthly basis in the South West RESTORE2 Training Teams Collaborative to share best practice and resources as well as overcoming barriers and collectively sculpt solutions to common challenges.

Sign up for online training in RESTORE2 and RESTORE2Mini
Facilitated online training in RESTORE2and RESTORE2Mini is now available to care home, domiciliary and learning disability care providers across the South West with plans to re-start face-to-face training when it is safe to do so.

To register an interest in training please contact Jude Glide at Judith.Glide@YDH.NHS.UK


Torbay and South Devon

RESTORE2 and RESTORE2Mini training in this region of Devon is being delivered by Torbay and South Devon Trust. To find out more information please contact Sarah Couth, Education Centre Co-ordinator at

West Devon 

Currently RESTORE2 training is being delivered to learning disabilities settings in this region by LiveWell South West. To find out more please contact Jamie-Lee Cosgree, Primary Care Liaison Nurse at

North Devon 

Currently RESTORE2 training is being delivered to care home settings in this region by the Northern Care Homes Team. Please contact Sarah.Winfield-Davies, Safeguarding Nurse/Team Lead at

For RESTORE2 training in the rest of Devon please contact the Devon Clinical Commissioning Group (CCG) at


RESTORE2 training is being delivered by Truro and Penwith College. To register an interest in training, please email Amanda Thompson, Curriculum designer and lecturer at

For free training resources for care home and domiciliary care workers in using RESTORE2 and recognising deterioration please visit the Hampshire, Southampton and Isle of Wight CCG here.

Already familiar with RESTORE2?

Use the RESTORE2 Adult Physiological Observation & Escalation Chart – available here.


Interactive toolkit to support virtual RESTORE2 and RESTORE2Mini training
To enable trainers to spread the training further afield, the South West AHSN has developed a new online toolkit featuring in-depth guidance, templates and resources to support the delivery of training in RESTORE2 and RESTORE2Mini. Click here to explore the interactive toolkit and request a copy.

RESTORE2 resources for primary care

Across the South West, primary care teams are working closely with CCGs, care homes and domiciliary care providers to support RESTORE2 training through the sharing of awareness raising and training resources. Both care homes and GP surgeries have seen improvements in communication, information exchange and escalation as a result of the care home and primary care training.

To find out more about what is available in your county go to:

RESTORE2 case studies and videos are available to download.