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Inspection report

Date of Inspection: 28 May 2013
Date of Publication: 4 July 2013
Inspection Report published 04 July 2013 PDF

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

Meeting 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 28 May 2013, checked how people were cared for at each stage of their treatment and care and spoke with one or more advocates for people who use services. We talked with people who use the service, talked with carers and / or family members and talked with staff.

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 acted in accordance with legal requirements.

Reasons for our judgement

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People who use the service, who could, told us they enjoyed making choices, whilst we used SOFI 2 to observe staff interactions with those who could not. Staff demonstrated their understanding of the Mental Capacity Act (2005)Through providing advocacy and person centred support. For example, we saw that all the people who use the service had tuck boxes in their rooms with treats of their choice that they could help themselves to at any time. We observed a person indicating that they would like an item from their tuck box but could not physically access it themselves. Staff brought the tuck box to them and supported them to choose what they wanted. On another occasion we observed a member of staff working with a person who uses the service to help them choose where they would like to go for a day out and encouraged them to have a second choice in case the weather was unsuitable. Therefore, we found that people were encouraged and supported to make as informed decisions as possible throughout their day to day lives.

We found that the provider acted in accordance with legal requirements where people did not have the capacity to consent. The arrangements to support people to make decisions were based on legislation and best practice. For example, we saw that the provider had built good links with specialist advocacy services and professionals from the local learning disabilities team. They worked jointly with them when best interests decisions had to be made for those who lacked capacity to do so themselves. This ensured that people were supported appropriately when consent or decisions about care or treatment were required.

Staff had received training about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards so that people’s rights were upheld. Mental capacity assessments were completed when people needed support to understand and make a decision. When complex decisions needed to be made on behalf of people, health care professionals, relatives and social services were involved. For example, we saw that one person who managed their learning disability, had previously lived independently in the community. However, it had been decided at a best interest meeting that due to their developing condition of dementia they could no longer thrive in the community and the person would need to be included in the service. We found evidence that the person was encouraged to continue to make decisions when they were able to, once they had been introduced to the service and had continued to receive appropriate support for day to day and major decision making. This meant that people's autonomy was maintained and that their human rights were upheld.