The examples below provide insight into how other Good or Outstanding rated services are succeeding in this area of inspection.
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Reassessing capacity, removing restrictions
Staff had an excellent understanding of their responsibilities around the Mental Capacity Act and the need for best interest decisions to be made for people who lacked the mental capacity to make these decisions for themselves.
Staff gave an example where they had transitioned one person from a long stay hospital placement. After a settling in period staff recognised this person's ability to make decisions and that some of the care first identified was unnecessarily restrictive. This person's capacity to consent was being reassessed with many of the initial restrictions in place, removed.
Read more about this service here.
Care provider: Orbis Support Offices
Date published: March 2023
Consenting to the flu jab
Staff used creative ways to support people to have the knowledge and understanding to make their own decisions and choices. For example, staff sourced information from government health organisations and developed a communication booklet to explain flu jabs. Staff went through this with the person, using the booklet, pictures and signs. The person decided to have the flu jab.
Read more about this service here.
Care provider: SENSE - 89 Hastings Avenue
Date published: April 2019
Effectively communicating about Mental Capacity Act (MCA) and consent
Due to a thorough understanding of the MCA and focussing on people's rights, the provider and staff had noticed that some relatives struggled with understanding the MCA ethos and could sometimes become anxious. For example, a visitor had commented on one person not having shaved or not acting in the way they expected. The provider then delivered a bespoke training session for relatives, helping them to understand how the home enabled people to make their own choices as much as possible. The provider also kept the MCA on staff meeting agendas and randomly asked staff questions when they visited to promote the ethos of people's choice.
People who were able to confirmed and recorded evidence that consent was sought through verbal, nonverbal and written means. For example, if people were unable to verbally communicate, staff were observant of their body language and pictures. People had been asked about the frequency they wished to be checked at night. Staff ensured people were able to make an informed choice and understood what was being planned. Care plans gave clear guidance for staff to ensure explanations were provided to people about their care and treatment, and their views respected.
Read more about this service here.
Care provider: Wisteria House Dementia Care Ltd
Date published: January 2019
Seeking consent while making adjustments to minimise risk
The service met to discuss best interest issues and decide what to do. For example, following a recent incident where the person they were caring for undid their seatbelt whilst the vehicle was moving, the service discussed what practical solutions could be considered to mitigate future risk. After consultation with the person and everyone else involved in their care, a best interest decision was made that a ‘harness’ type of seatbelt would be used, to help to keep the person safe during journeys and to continue with their daily lives. Records were maintained of every occasion the harness was used and regular review meetings held. The person still used the harness but on their own terms and only on occasions when they recognised they felt anxious.
Care provider: Anonymous
Date published: April 2018
Communicating the DoLS process to staff, people and family members
The provider had produced a small booklet titled called ‘communicating kindness - how we make decisions on a resident’s behalf’. It contained information about what ‘lack of capacity’ meant, and explained the process in respect of DoLS. It also gave an overview of who should be involved in the process. A family member interviewed by the CQC highlighted how this booklet had answered many of their questions and reassured them of the quality of care being provided.
Care provider: Anonymous
Date published: April 2018
Reviewing staff knowledge around capacity
As part of monthly self-audits, one manager had asked staff to explain the MCA. Initially this proved difficult and they couldn’t answer clearly, even if their training had been recently refreshed. However, the fact that staff began to realise this was part of our internal auditing resulted in them wanting to retain this knowledge and demonstrate their understanding. Momentum soon built, with staff wanting to deepen their understanding around the MCA and put their latest learning into practical use.
Care provider: Anonymous
Date published: April 2018
Reviewing training processes to reflect best practice
Staff had received training on the Mental Capacity Act (MCA) but this was customised to reflect on examples from within the service.
Care provider: Anonymous
Date published: April 2018
Using aids to help offer choice to people
The service uses pictures, charts or ‘objects of reference’ to help people understand what’s happening and offer choice and control. For example, if someone can’t make the decision about receiving personal care, they may still be able to choose between a bath, wash down or shower, or choose who does it and when.
Care provider: Anonymous
Date published: April 2018