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Great Oaks Dean Forest Hospice Good

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Inspection report

Date of Inspection: 13 December 2013
Date of Publication: 25 December 2013
Inspection Report published 25 December 2013 PDF | 86 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 13 December 2013, observed how people were being cared for and talked with people who use the service. We 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. Consent was routinely sought by staff in relation to all aspects of people's care and treatment.

Reasons for our judgement

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We spoke with one person who used the service about this outcome area. They said, “Pretty much everything we have asked for has been done. They listened to what we wanted.” They also told us that staff always asked before giving care and said they felt in control. We reviewed six care records and observed a staff member carrying out an ‘outreach’ visit. This visit was the service’s initial contact/s with the person following referral. We saw that the assessment process began with supporting the person to identify their key concerns. From this, specific areas where Great Oaks could provide care and support were identified and a support plan agreed. People had signed care review records to indicate that they had consented to them. We also saw that consent had been routinely sought in respect to emergency treatment, management of medicines, information sharing and use of photographs.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. All but one person the service recently supported had been able to consent to their care. Staff told us that when a person’s capacity was in question they were referred for assessment. The two examples we discussed with staff included assessment by a palliative care consultant and by mental health services. In one of these examples a ‘best interests’ decision had been required and had involved the appropriate representatives. The provider may find it useful to note that in one record we saw that a person’s representative had signed consent forms on behalf of their relative. We discussed this with staff who told us that the person had been present for all discussions and had capacity to consent to the care discussed. They had given verbal consent but had been physically unable to sign the documents. We saw that this had been recorded on one consent form, but had not been noted on others. We were assured that the relative had signed to witness that the person had given consent, rather than to actually give consent. This would not have been appropriate as they did not have the legal authority to do this. During our discussions the registered manager demonstrated sound understanding of the requirements of the Mental Capacity Act 2005. Some staff were less clear about these requirements and had not received specific training in this. The registered manager told us that further to our inspection they planned to review staff training and documentation around mental capacity.