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Archived: Kingsmead Lodge

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Inspection report

Date of Inspection: 4 August 2014
Date of Publication: 4 September 2014
Inspection Report published 04 September 2014 PDF | 89.46 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 4 August 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff.

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

People living at Kingsmead Lodge had complex needs and most had difficulty in giving written or verbal consent for their care and treatment. However staff were knowledgeable about the people they cared for and were able to describe how those with limited verbal ability communicated their wishes and feelings through facial expression and gestures. For example one staff member said, “One person closes their eyes when they have had enough to drink and another gets restless when they are in pain and in need of pain relief”.

Staff spoken with were aware of the importance of explaining to people the reasons for their care as well as giving them sufficient time to consider their responses. We saw that staff were positive and patient in their interactions with people. They explained the proposed actions in simple terms, giving them choices if appropriate and they gained their consent before providing the support or assistance. We saw that staff respected a person’s right to refuse care. They told us that if this happened in respect of the receipt of personal care, medicines or a blood test for example, they would offer them again later. If they continued to refuse they would document the reasons for refusal and inform the nurse in charge or manager who would notify the responsible medical professional if necessary.

The manager told us that when required they involved people's relatives to help them understand their options and make informed decisions but the service also had access to an independent advocacy service to help them if necessary.

We looked at the personal care and treatment records of three people using the service and saw they were personalised and described people’s chosen routines, activities and preferences for care delivery. They also included their preferred methods of communication and guidance on how best to gain their consent, such as ‘eye pointing’ and the need for ‘no long instructions and no interruptions’. We saw that the care plans were reviewed and amended regularly and most relatives we spoke with confirmed that they were involved in the planning and review process. The provider might find it useful to note that not all plans and risk assessments were signed by people who were able, or their relatives, to indicate that their agreement to the plan of care and support had been obtained.

We saw that written consent had been obtained for the use of photographs used for display and as a record within the home and for the administration of the annual influenza vaccine. In addition we saw that mental capacity assessments had been carried out where required. Where people did not have the capacity to consent we found the provider acted in accordance with legal requirements. Where decisions needed to be made about people’s care and treatment and they lacked capacity to consent we saw relatives and healthcare professionals were involved in decision making. For example we saw evidence that a recent ‘best interest’ meeting had been held with the relatives, GP, speech and language therapist, manager and named nurse to consider a possible change in a person’s treatment regime. This ensured that people’s human rights were respected and taken into account and people were protected from inappropriate care.

In addition we saw that some people’s records included Do Not Attempt Resuscitation (DNAR) forms completed by their GP, taking into account their best interest, established after consultation with their next of kin, professionals responsible for their clinical care and involved care staff. This ensured that a robust process had been followed and people’s interests, wishes and welfare were protected.

We saw that the provider had a Mental Capacity Act (MCA) policy in place with guidance for staff on issues of consent and making best interest decisions. The manager told us that regular training in relation to the principles associated with the MCA and Deprivation of Liberty Safeguards (DoLS) was held. They said