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Inspection report

Date of Inspection: 5 August 2013
Date of Publication: 20 September 2013
Inspection Report published 20 September 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 5 August 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 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

Staff involved people by using information that was readily understandable and used different formats to engage people. Where some people’s capacity to make decisions was impaired other people such as relatives, professionals and advocates were consulted. People were also made aware of additional support services including independent advocacy services. This was in addition to the organisations own support networks and focus groups set up to give channels of communication for feedback on the care received.

The use of healthcare passports meant that when a person was in hospital or being looked after by staff less familiar with them there were clear instructions on the care and treatment they wished to receive. This included key people to be contacted if any decisions about treatment where required.

We spoke with staff on how they implemented the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) within the service. A DoLs is a legal process that makes sure people's rights are protected and actions are only taken in people's best interest to keep them safe from harm. We saw evidence that each person’s capacity to consent was being assessed and recorded by professionals qualified to do so. Multi disciplinary meetings were recorded and the rationale for making decisions in people’s best interests was noted, along with family involvement and advocate input. The service demonstrated a good working knowledge of the legislation to ensure that people’s rights were safeguarded. This was an area that was frequently reviewed in peoples care plans, and discussed at multi-disciplinary meetings. We noted that guardianship orders and community treatment orders were discussed as options to manage peoples rights in the least restrictive way. This was to ensure that they had the right balance between keeping a person safe and maintaining people’s rights and independence.

Some people in the home occasionally needed physical restraint to keep themselves and others from harm. Staff placed an emphasis on using restraint as the last resort and used positive management plans to reduce the need for restraint. People had detailed intervention plans that used de-escalation and distraction techniques. These were based on detailed analysis of behaviour to identify and hence avoid triggers leading to challenging incidents. An emphasis was placed on involving the person and gaining their consent prior to any restraint. This involved getting them to agree to the restraint methods being used to support them. This was recorded and the home could demonstrate through data collection that incidents of restraint for all people in the home had significantly decreased over time.

All of these measures ensured that Low Fauld placed an emphasis on gaining people’s consent and this helped to minimise the risk of abuse and infringements on people’s rights.