You are here

Bearwardcote Hall Residential Home Good

All reports

Inspection report

Date of Inspection: 19 May 2014
Date of Publication: 13 June 2014
Inspection Report published 13 June 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 19 May 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 reviewed information given to us by the provider.

Our judgement

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

Reasons for our judgement

During our inspection we saw people consented to day to day decisions. For example, we heard staff asking one person if they were ready to eat their meal. People we spoke with confirmed they chose what time they got up in the morning, retired to bed and whether they wanted a bath or a shower. One person said, “They are brilliant, we make our own decisions.” Another person said, “We come and go as we please, there are no restrictions.” We saw that people were encouraged to have their meals in the dining area of the home but could choose to eat elsewhere if they wished. We saw that when needed appropriate support was offered with their eating and drinking. One person using the service was a vegetarian and they told us the cook accommodated their needs. They said, “I get quite a good variety and they make sure I like the food I’m offered. They always get something else if I’m not happy.” This meant that before people received any care or support they were asked for their consent and given choice in their daily routine.

As part of our inspection we looked at the care records for people using the service. We looked at how consent was obtained for people as part of the process of planning their care and support. We were told that people were involved in the reviewing of their care plans and that they, or their families, would be made aware of any changes. However, the provider was not documenting how people's consent was obtained following any changes to their plan of care.

We spoke with the deputy manager about how they ensured they acted in people’s best interests when they may lack the mental capacity to consent to their care, support and treatment. Having mental capacity means being able to make decisions about everyday things like what to wear or more important decisions like making a will and deciding where to live. People can lack mental capacity because of an injury or condition, stroke or dementia. Some people may have capacity to make decisions about some things but not others, or their capacity to make decisions may change from day to day. A capacity assessment determines whether people are judged to have the capacity to make a specific decision. We saw from people’s mental health assessments they may have lacked the capacity to understand their plan of care and, therefore, may not be able to consent to it. The provider was not documenting how they ensured people understood their care plan and whether they had consented.

We saw one care record had information demonstrating the person using the service should not be resuscitated (DNAR). When making such decisions evidence must be available to demonstrate whether people using the service have the capacity to do so. We saw the assessment was available in care records and the GP and family members had been involved in the process but there was no evidence available to show other people could make the decision on someone else’s behalf through a lasting power of attorney (LPA).

Whilst people have capacity they can choose to set up a LPA. This gives someone the authority to make decisions on the person’s behalf. The provider did not have evidence to demonstrate people had LPA in health and personal welfare. This would confirm decisions were being made by people who had the authority to do this in the person’s best interests.

Discussions took place with the deputy manager regarding the recent judgement on 19 March 2014 by the Supreme Court and how this will impact on the provider’s responsibility to ensure Deprivation of Liberty Safeguards (DoLS) are in place for people using the service. This judgement by the Supreme Court widened and clarified the definition of deprivation of liberty. It confirmed that anyone who required continuous supervision and would not be safe to leave the home independently would be deprived of their liberty and safeguards must be put in place to protect their rights. The deputy manager confirmed that they were aware of this recent judgement but