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Archived: The Old Rectory Inadequate

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Inspection report

Date of Inspection: 26, 27 June 2014
Date of Publication: 9 August 2014
Inspection Report published 09 August 2014 PDF

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Not met this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 26 June 2014 and 27 June 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and reviewed information sent to us by other authorities. We talked with other authorities.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Our judgement

Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

Reasons for our judgement

Where some people needed support to make a big decision about their lifestyle or health, the service sought the support they needed to be able to make the decision in their best interests.

Out of the four staff we talked to about the Mental Capacity Act, three staff had a good understanding of how this related to the care of the people using the service. They were able to demonstrate how they enabled people to make informed choices and referred to assessments that had been completed in people’s care plan folders.

For people who needed to make a decision about a health treatment or invasive intervention or procedure advice had been sought to help them weigh up the benefits and risks. One person had ongoing health conditions and had received support from the community learning disability nurse and staff in enabling them to understand the conditions and the treatment options available to them. We saw the Mental Capacity Assessment in the person’s health action plan. The person had had discussions and support had been given including the use of picture cards and easy read statements. Other professionals were involved so that it was clear what the consequences of each decision would be and the person had been able to make the decision. The records showed the process and that this decision was kept under review. Another person needed medical intervention and this was explained to the person in a way they would understand. They made the decision with support and were assessed to have capacity to make this decision. The process and decision were clearly documented in the person’s plan of care.

Two people needed dental treatment and both had been referred to the IMCA (Independent Mental Capacity Advocate) service.

People were given the information they needed to make an informed choice and consent to care and treatment. For example, one person was receiving ongoing treatment in hospital and had attended appointments for this. The person did not want to attend the next appointment despite staff encouragement and explaining the different options. The person was sure they did not want to attend so staff respected this and made another appointment.

However for more day to day decisions there was a lack of systems in place to regularly assess and review people’s capacity and ability to consent. People had formed relationships and some of these were physical relationships that were potentially sexual. There had been involvement with other professionals, including psychiatrists and care managers; for some people and staff were aware of which people using the service had physical relationships. Some of these relationships had been long standing as many people using the service had lived in the home for over 30 years. Staff gave examples where they felt people were consenting, although they acknowledged that people had not had Mental Capacity Assessments to make sure of this. Where risks had been identified of potential sexual relationships where one person may be vulnerable and not able to give consent staff explained the strategies that were in place to protect people. There were insufficient processes in place to make sure people were able to understand the risk, benefits and whether they had the capacity to consent.

There were Mental Capacity Assessments in three people’s care plans that stated that the care plan had been discussed with the person and devised with them but that they were unable to sign to say they agreed with them. This was not the case for everyone.

We observed people being asked by staff for their permission before receiving care and before entering people’s rooms.

Generally people were free to come and go in the home and outside. Some people went out to the local shops and surrounding areas independently. People who needed support to go out looked happy to wait for staff assistance and chose not to go out on their own. The front door and gates were unlocked.

One person’s care plan we looked at stated tha