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Inspection report

Date of Inspection: 14 October 2013
Date of Publication: 6 November 2013
Inspection Report published 06 November 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 14 October 2013, 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 sent to us by local groups of people in the community or voluntary sector. We talked with local groups of people in the community or voluntary sector and used information from local Healthwatch to inform our inspection.

Our judgement

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes. People’s preferences and experiences were taken into account in relation to how care and support was delivered.

Reasons for our judgement

Care plans were written with input from the people who used the service and/or their relatives. People’s wishes were respected where possible. The care plans we reviewed were individualised and reflected individual backgrounds, cultures and preferences.

Information in the care plans demonstrated that people had been assessed in relation to their capacity to make their own choices and decisions about their care needs. People and their families were involved in discussions about their care needs and the risk factors associated with this. Individual choices and decisions were documented in the care plans.

Staff were clear that where people had the mental capacity to make their own decisions, this would be respected. Staff told us that when necessary, they would hold a best interest meeting to discuss a person’s care and treatment if necessary. (A best interest meeting takes place when informed choices cannot be made by a person using the service, and considers the views of all those involved in the individual's care). We saw written evidence of these discussions in people’s care plans. The manager told us that staff would recognise people’s lack of capacity so that best interest meetings could be arranged. This showed us that care and treatment was being planned in accordance with people’s individual needs and abilities. Most of the care plans we looked at had been signed by the person involved and this showed us that they had been consulted and given their consent.

Staff had an awareness of the Mental Capacity Act and deprivation of liberty safeguards. Staff understood their obligations in respect of people’s rights and choices when they appeared to lack the capacity to make informed and appropriate decisions. The general manager told us that staff had received training around the Mental Capacity Act and dementia awareness. Training had involved a test paper which was marked and feedback was given to staff.

Some people were not able to tell us about their experiences, because of their complex needs or levels of understanding. We therefore used a number of different methods to help us understand their experiences, including observing the care being delivered and looking at records. Other people told us about their views and shared their experiences with us. People told us staff were respectful and always asked permission before carrying out any personal care or assisting them, for example with mobility, drinking and bathing.

People who used the service and their relatives had access to a choice of literature. This included the statement of purpose, service user guide, information on advocacy services and the complaints procedure. One visitor we spoke with told us, “I am always talking to staff, they are very good at sorting things out. They are excellent with the people here.” Another person told us, “I can’t think of anything they could improve on. My relative is more than happy, it suits her here.”

Staff told us that people had a choice about their daily routines and were given options about getting up or going to bed, what they ate and when to have a bath. This was confirmed by the people we met during our visit. This demonstrated that people were able to make their own choices and were not restricted by rules or strict routines.