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Inspection report

Date of Inspection: 12 December 2012
Date of Publication: 25 January 2013
Inspection Report published 25 January 2013 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 12 December 2012, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members and talked with staff.

Our judgement

There was no evidence to show that where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

Reasons for our judgement

We reviewed how the provider followed the principles of the Mental Capacity Act 2005. Mental capacity is the ability to make an informed decision based on understanding a given situation, the options available and the consequences of the decision. People may lose the capacity to make some decisions through illness or disability, in these circumstances other people can be authorised to make decisions on their behalf as long as they are in the person's best interests.

We looked at the care records for five people who used the service, spoke with three people and two relatives. We also spoke with six members of staff. We did this to help us understand the outcomes and experiences of selected people who use the service.

The care records we reviewed showed that mental capacity assessments had not been completed. This meant that evidence was not available to demonstrate if people were able to make decisions or that decisions were being made in people’s best interests.

We spoke with the relatives of two people who were unable to make decisions about their care. Both relatives told us that they were involved in some decision making on behalf of their relatives. We reviewed one of these people’s care records and found no written evidence to support that the person’s relative had been involved in decision making.

One person who used the service told us they had been involved in the planning of their care. Staff we spoke with confirmed this. When we looked at this person’s care records there was no written evidence to confirm this.

All staff we spoke with told us they had received Mental Capacity Act 2005 training and were able to give examples of how this act relates to the people they care for. Training records conformed this. This meant the staff had the knowledge and skills to apply the principles of the Mental Capacity Act 2005, but they had not always complied with the requirements of the Act with regards to assessing individual’s capacity.

People with reduced or limited capacity who live in care homes need extra protection to ensure they are cared for in a way that keeps them safe and free from unnecessary restrictions. This extra protection is provided through The Mental Capacity Act 2005 Deprivation of Liberty Safeguards. These safeguards ensure that important decisions are made in people’s best interests.

We saw one person sitting in a chair in a reclined position, preventing the person from getting up from the chair. We asked staff why this person was sitting in this position. Staff told us that this chair was used when this person was ‘very active’ to keep them safe. The provider told us this person was being 'trialled' using this chair for a period of one week and the person's relative had given their consent for this to happen. When this person’s care records were reviewed, there was no evidence of a mental capacity assessment or a Deprivation of Liberty application to determine whether this practice was in their best interests or was used as a form of restraint. This meant that there was no evidence to show if this person was being appropriately restricted in their best interests. We spoke to the provider about this, they agreed that this may require a Deprivation of Liberty application and would take further action.