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Archived: Ablewell Care

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Inspection report

Date of Inspection: 9 May 2013
Date of Publication: 15 June 2013
Inspection Report published 15 June 2013 PDF | 87.53 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 9 May 2013, observed how people were being cared for and talked with people who use the service. We 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

We talked to people who used the service about how they were consulted about the service provided for them. One person told us that the provider “listens to what I am saying” and another that they would “tell them if I wanted anything doing differently”. A third person said “they ask you what you want doing – you let them know”. People told us that they agreed the level and type of services they would receive at the initial interview with the provider.

We talked to the staff and manager about how they made sure that people consented to the care provided to them by the service. It was clear that where people had the capacity to give consent that this was taken to be implicit in their accepting the service offered. This meant that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. The provider might wish to note that some people said that they would like more communication from the provider including information about referrals to other agencies and where the provider could not send the usual staff to an appointment.

We talked to the staff about how they approached the matter of consent with people who did not have the mental capacity to make certain decisions. They told us that the care plan helped them to establish a baseline for the service which each individual person preferred. By establishing this baseline for each person they could detect if that person was unhappy by taking account of their behaviour and reactions. They also referred to relatives or to the social services for advice about how to establish a person’s preferences.

We asked staff what they would do if a person withheld consent. Staff told us that depending on the care being discussed they might try and persuade the person to accept it by explaining why it was important, and would try to offer people alternative options. Staff might wait for a period of time before asking the person again so that they had time to think about it, and sometimes a different member of staff might talk to the person to see if that made a difference. Staff were clear that they would not force people to accept care that they did not want. If care was still refused this would be reported back to the office who would take the appropriate action.

The provider had a policy and procedure relating to the Mental Capacity Act 2005 but we did not see this in place on any of the service plans we inspected. We were told that a member of staff was about to undertake training in the requirements of this legislation. We also saw that the provider had a support planning policy which required that consent must be obtained before the provider carried out an assessment and that if this was not possible an external advocate would be involved.

We saw that in the case of people who contracted for the service privately that a signed agreement was in place between them and the provider. If they did not have mental capacity then the contract would be between their representative and the provider. The provider may wish to note that we were unable to find similar arrangements for this from people who were funded by the local authority.