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Archived: Dilston College

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Inspection report

Date of Inspection: 21 January 2014
Date of Publication: 20 February 2014
Inspection Report published 20 February 2014 PDF | 85.84 KB

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 21 January 2014, 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, talked with staff and talked with commissioners of services.

We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service.

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.

Reasons for our judgement

Students told us that staff explained things to them and although they were encouraged to complete certain tasks for themselves, if they refused to, staff respected this. One student said, "They help me make tea and they ask if I am happy with that first." Another student told us, "Staff are really good here, they ask you what you want to do. I would tell them if I wasn't happy with something we were doing."

We spoke with staff about consent and found that they understood the necessity to gain consent from people, so the choice was their own, before care or support was delivered. One staff member told us, "We always ask students if they are happy before we help them." Another member of staff said, "If students can't communicate with us we can tell by their behaviours if they are happy with what we are proposing. For instance, with 'X', I open the door and I wait for their indication by hand movement if they are happy for me to go in or not and help them." We saw students were given choices in relation to the care they received. For example, staff asked one student if they wanted their food cut up at lunch time and they indicated their agreement with this before assistance was given.

Our observations on the day of our inspection confirmed that students' consent was sought by staff before care was delivered. For instance, one student was asked if they would like help to pick up money they had dropped, but they did not and this was respected. In another situation, a person was asked by staff if they wanted to speak with us and when they shook their head to refuse, staff respected their decision and did not try and persuade them to do so. We saw that one person who could not verbally communicate with staff was able to register their agreement or displeasure with an element of care delivery, or an activity, via their behaviour and mannerisms. We saw that staff recognised and were able to read these behaviours and mannerisms, from their experience of working closely with this individual. We found that people were asked for their consent before any care or treatment was delivered and staff acted in accordance with people's wishes.

Whilst some people to whom the provider delivered care had the ability to make considered decisions about their day to day lives, some people did not. In addition, many student's did not have the capacity to consent to complex decisions related to their care and treatment. For these students we found the provider assessed their capacity in relation to individual decisions and 'best interests' decisions had been made. A 'best interests' decision, in line with the principals of the Mental Capacity Act 2005, is taken when a person lacks the mental capacity to make a decision for themselves. In relation to care based decisions, it is usually made collectively by a number of people, including the care staff in day to day contact with the individual concerned, other healthcare professionals involved in their care when necessary, and where possible, family members.

We spoke with four parents of students who resided at the college about their involvement in decisions made about their child's care where they could not advocate for themselves. They told us that the college always included them in more complex decisions about their son or daughter's care. All of the relatives we spoke with commented that they were always invited to events, activities and formal and informal meetings surrounding the life and support of their son or daughter. They said the college found ways to engage students and their families in the decision making processes, regardless of their capacity and understanding. One relative said, "My son has communication difficulties and the staff have tailored meetings in a way so that he can fully participate. I am impressed with the way the students are treated as individuals and solutions are found to enable them to participate in all decisions."

We spoke with care managers from several loc