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Archived: Olive Mount Hospital

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Inspection report

Date of Inspection: 17 December 2013
Date of Publication: 17 January 2014

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 17 December 2013, checked how people were cared for at each stage of their treatment and care and talked with carers and / or family members. We talked with staff.

Our judgement

Before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where patients did not have the capacity to consent, the provider acted in accordance with legal requirements.

Reasons for our judgement

We included this outcome in the inspection to see what arrangements were in place for obtaining the consent of patients regarding their care and support.

In relation to this outcome, we spoke with two managers and two support staff. Patients were not available on the day of our inspection so we contacted six family members by telephone to seek their views of the service.

Families told us they were involved in planning and reviewing care for their relative who received respite care at Wavertree Bungalow. One person said to us, “We were involved in developing the person-centred plan. We have regular meetings with staff to go through the plan for [relative]. Another family member told us, “Staff contact us if there are any changes, like a change to medication. We are involved in reviews of care and can express an opinion. They listen to us.”

We looked at the health care record files for four patients who were receiving respite at the time of our inspection. They were highly personalised and clearly identified preferences and wishes, as well as health care needs. Support plans were worded in such a way that promoted patients to make choices. We could see from the records that the input and opinion from families and professionals was sought in relation to each patient’s care. With reference to decision making, the manager was clear as to the circumstances in which written consent was needed and when verbal or implied consent was needed.

In accordance with the Mental Capacity Act (2005), we saw good evidence that the service protected the rights and welfare of the patients who did not have mental capacity to make some important health related decisions. This was evident with decisions relatives were making, which were not necessarily in the patient’s best interest. The Mental Capacity Act (2005) is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances.

We observed that at least two mental capacity assessments had taken place; one regarding the need for chiropody and the other for the taking of blood. The records informed us that appropriate professionals were involved in the assessment and we noted that families had been consulted. The assessments were clear about the specific decision that needed to be taken, as opposed to a generic mental capacity assessment. We did note that the documentation was not completed as well as it could have been. For example, there was no summary explaining exactly what the rationale was for the decision and why this was in the patient’s best interests. We discussed this with the managers at the time of our inspection.

We heard from the manager that no Deprivation of Liberty Safeguards (DoLS) had been made. The manager told us they did not restrain patients and nobody who used the respite service either consistently or frequently tried to leave the building. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The safeguards ensure that a care home or hospital only deprives someone of their liberty in a safe and correct way. This is only done when it is in the best interests of the person and there is no other way to look after them.

Although the support staff we spent time with told us they had not received specific training the Mental Capacity Act and DoLS, they were clear about the principles and their responsibilities. In the event that a patient wished to leave the building, they said they would encourage them to stay by the use of distraction and/or engaging them to engage in an activity.