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Caterham Domiciliary Care Agency Requires improvement

All reports

Inspection report

Date of Inspection: 21 March 2013
Date of Publication: 18 April 2013
Inspection Report published 18 April 2013 PDF | 84.8 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 March 2013, checked how people were cared for at each stage of their treatment and care and talked with people who use the service. We talked with carers and / or family members, talked with staff and reviewed information sent to us by commissioners of services.

Our judgement

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Reasons for our judgement

We reviewed all of the information we held about this agency before we did our inspection and this did not raise any concerns in this outcome area.

We spoke with two people using the service and two relatives; we also spoke with four staff and the manager to assess compliance.

The people we spoke with told us they were given choices and could make their own decisions which they felt the staff respected. They told us they had been consulted about the way staff were to provide their care. One person commented, “I have seen my care plan and I agree with what is in it. If I need any treatment I tell the staff and they contact my community psychiatric nurse or psychiatrist.”

The staff we spoke with said they encouraged people to make their own decisions where possible and they felt they consulted people regularly about their care and treatment. We saw people’s wishes and preferences were recorded in their care plans showing they had been consulted about how they would prefer care be delivered.

The staff we spoke with had received training on the Mental Capacity Act. This is a law which protects people's rights to make their own decisions about their life, care or treatment where they have the ability (or capacity) to do this. If staff suspect the person may not have the ability to make the specific decision they can assess their capacity formally using a two stage test, and if they are found to lack capacity the staff then assess what is in the person's best interests. The staff we spoke with told us they had received training and information and felt quite confident in their knowledge.

We saw in one of the care and support plans that a person had a chronic health condition but continued to smoke against medical advice. We saw that the person had been assessed as having the capacity to make this decision, albeit that it was unwise given their health care needs. We spoke with this person who came to the agency office to collect their cigarettes. This showed that staff had respected the person’s right to make their own decisions.

The relatives we spoke with told us their loved ones could not make their own decisions as they lacked the capacity to do this, but they said they had been consulted by staff about how they should meet the person’s needs. This shows they had been consulted about what was in their loved one’s best interests.

Some of the people who used the service were the subject of Community Treatment Orders (CTO). This is a legal order made under the Mental Health Act to make sure people continue taking their prescribed treatment or therapy. People could still refuse treatment but this would be reported to their care co-ordinator and their clinical team may make a decision to recall the person to hospital for compulsory treatment in such circumstances.

We spoke with the staff about this and they understood people still retained their rights to consent or refuse treatment even when they were the subject of a CTO. A senior member of staff told us in such circumstances they documented the refusals clearly and tried to explain the possible repercussions of their refusal to the person. The staff member told us, “We have to respect their right to refuse treatment.” The evidence we gathered showed that people were afforded and retained the right to make their own decisions about care and treatment.