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Archived: Cheverells Care Home

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Inspection report

Date of Inspection: 22 June 2013
Date of Publication: 19 July 2013
Inspection Report published 19 July 2013 PDF | 83.9 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 22 June 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 staff and reviewed information given to us by the provider.

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 spoke with six residents at Cheverells care home, six members of staff on duty, and looked in detail at the care records of the six residents we spoke with.

People told us that staff involved them in their care and treatment by explaining to them what they were doing as they undertook care tasks. Some people could not remember the discussions which had occurred or contents of their care plan due to their memory problems however, everyone we spoke with was happy with the care the staff delivered.

The staff we spoke with understood the principles of gaining a person’s consent in relation to their care and treatment. Staff gave us examples of consulting with the district nurses, a person’s doctor and their family if a person did not have the mental ability to participate in decision making because of their ill health or memory difficulties. For example, one person we met needed a special mattress to keep their skin healthy. Staff had appropriately consulted about this with their family because the person was not able to make this particular decision themselves. We saw in two people’s care records forms which had been completed to document that consent had been sought for people to have bed rails. Bed rails helped prevent people falling out of bed where this risk had been identified. We found there were procedures in place to gain valid consent and that these were followed.

Most people had a form in their care records to identify the aspects of their care where they were able to make decisions. For example, the form covered areas such as people’s personal care (washing and dressing), moving, food choices and finances. These assessments were completed with people shortly after they arrived at the home and detailed how people liked to be cared for in these areas and what support they required. These forms showed that people had been consulted about their care and in most cases the person or their family had signed to agree with the care being delivered by staff.

Although staff understood the concepts of seeking people’s permission before they delivered care and obtaining their consent, some staff we spoke with were unfamiliar with the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLs). Staff followed the principles of providing care in people’s best interests but these discussions were not documented as “best interest meetings.” One member of staff took the majority of responsibility for completing these forms and writing people’s care plans, to be sure that they were done consistently and in accordance with the legislation.

The training records showing that staff had received training in this area were not clear. There was evidence that some staff had completed training in this area but, the provider may wish to note all staff working with people who have memory difficulties and are not able to participate in decision making, need a good awareness of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards to ensure that care is delivered in accordance with the legislation.

We saw that some people had treatment escalation plan’s (TEP’s) in place. These are forms completed towards the end of someone’s life and relate to decisions about whether people are to be resuscitated and what other treatments may be appropriate if they become unwell. Most of the forms we saw were completed correctly but we saw one TEP form for a person who did not have capacity which was not completely filled in and there was no evidence of the family being involved in the decision making process. We discussed this with two senior care staff and the registered manager and they agreed to follow this up.

We observed staff caring for people on the day of our visit. We heard staff asking people for their consent before they carried out personal care to people. People felt they would be able to change aspects of their care plan if they wished to. All people we spoke with told us their human ri