- Published: 11/11/2022
- Contains public sector information licensed under the Open Government Licence v3.0.
Over the next few months, we will be exploring the CQC key lines of enquiry by each question and sharing resources we think you might find useful.
Sources of evidence: what CQC inspectors look at against each KLOE
By effective, the CQC mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.
Questions
E7.1 Do staff understand the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005 and the Children’s Acts 1989 and 2004 and other relevant national guidance?
E7.3 How and when is possible lack of mental capacity to make a particular decision assessed and recorded?
E7.5 When people lack the mental capacity to make a decision, how do staff ensure that best interests decisions are made in accordance with legislation?
E7.6 How does the service promote supportive practice that avoids the need for physical restraint? Where physical restraint may be necessary, how does the service ensure that it is used in a safe, proportionate, and monitored way as part of a wider person-centred support plan?
E7.7 Do staff recognise when people aged 16 and over, who lack mental capacity, are being deprived of their liberty, and do they seek authorisation to do so when they consider it necessary and proportionate?
Potential sources of evidence
People & their carers, friends and relatives:
Feedback about:
- How and when people are asked to consent to care and treatment.
- How and when the service follows best interests decision making requirements.
- Experiences of any assessments and applications to deprive a person of their liberty.
- Whether people are appropriately involved in decisions as much as possible.
- Whether people were involved in / are aware of any ‘do not resuscitate’ decisions.
- Experiences of any use of restraint.
Customer Feedback
- Share your experience forms.
- Notifications: DoLS, safeguarding, references to use of restraint.
- Information of concern enquiries.
Observation and key individuals
Feedback from
- Independent Mental Capacity Advocates.
- People with Lasting Power of Attorney (‘LPAs’)
- Court of Protection Deputies.
- Supervisory Body’ staff.
- Safeguarding teams.
- Specialist community professionals, e.g community learning disability teams, dementia
teams, community mental health teams.
Staff and Voluneers
Discuss
- Mental Capacity Act / Code of Practice / DoLS / use of restraint training experiences
and awareness. - Examples of training being put into practice.
- The service’s expectations, policies and procedures
- How they support people to participate in decision making.
Observations
- How people are involved in decision making.
- How staff interact with people who may lack capacity to take a decision.
- How staff manage behaviour that challenges.
- How and when staff restrict people’s liberty.
Records and policies
- Consent to care and treatment records.
- Records of assessments of mental capacity to take a decision.
- Best interests decision-making records.
- Advance decisions about care and treatment.
- Completed DoLS application forms.
- Do Not Attempt CPR ‘notices’ in files.
- Policies and procedures on Mental Capacity Act / Code of Practice / DoLS / use of restraint / best interests decision making.
- Complaints and compliments.
Ratings characteristics
- Outstanding
The service is skilled in how it obtains people’s consent for care and treatment, involving them in related decisions and assessing capacity when needed, even where disability or other impairments make this very difficult.
The service has a very flexible approach to any restrictions it imposes on people; keeping them under constant review, making them in a time-limited way, and only when absolutely necessary.
Practices regarding consent and records are actively monitored and reviewed to improve how people are involved in making decisions about their care and treatment. Engagement with stakeholders, including people who use services and their family, friends and other carers, informs the development of tools and support to aid informed consent.
The service has nominated champions for mental capacity, restraint and consent. They make sure that staff are fully educated and trained and have a comprehensive understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
Staff are confident about using the Mental Capacity Act 2005, and use innovative ways to make sure that people are involved in decisions about their care so that their human and legal rights are respected. Best interest decisions are always made in accordance with legislation and people’s wishes.
- Good
Staff make sure that people are involved in decisions about their care so that their human and legal rights are upheld.
Staff judge whether people have capacity to make particular decisions whenever this is necessary. They involve relevant people and professionals when needed, and record their actions and assessments whenever this is proportionate and appropriate.
Managers gather information about consent-related activity in the service and use it to audit and improve how services are delivered, and to monitor appropriate use in line with national guidance.
Staff know what they need to do to make sure decisions are taken in people’s best interests and involve the right professionals.
Where people do not have the capacity to make decisions they are given the information they need in an accessible format of their choice, and where appropriate, their family, friends and other carers, advocates are involved.
Staff make sure people are referred for professional assessment at the earliest opportunity.
Staff uphold people’s rights to make sure they have maximum choice and control over their lives, and support them in the least restrictive way possible; the policies and systems in the service support this practice.
Staff understand and demonstrate a good working knowledge of the Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005. They can demonstrate how they put these into practice effectively, and ensure that people’s human and legal rights are respected.
- Requires improvement
The service does not make sure that staff fully understand the requirements about consent and they do not always seek people’s consent to care and treatment.
The service does not always assess people’s mental capacity to make particular decisions, or it may do so in a way that does not meet legal requirements.
Managers may gather information about consent and there may be related audit activity, but the information is not used to improve the service, or not used as effectively as it could be.
People’s family and friends are not always included or involved in such decisions.
Where restraint is used it is not always recognised, or less restrictive options are not always used where possible.
Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 may not be fully understood. People’s human and legal rights are not always understood and respected.
Some staff are unsure about what they should do to make sure that any decisions are made in people’s best interests. People do not always receive information in a format they understand.
- Inadequate
The service does not ensure that it obtains people’s consent to care and treatment, and staff are unclear about the requirements relating to consent. Managers do not check or audit consent activity.
The service does not ensure that people’s capacity to make decisions is assessed when needed.
Consent to care and treatment and best interests decisions have not been obtained in line with legislation and guidance, including the Mental Capacity Act 2005, the Children’s Acts 1989 and 2004 or Deprivation of Liberty safeguards. Staff do not understand these requirements.
Where restraint is used, it is not recognised, and no attempts are made to find less restrictive options to provide necessary care and treatment.
Does your service need some support with making sure you have the policies, processes, and evidence to respond to the CQC to achieve your desired rating?
Discover how we turnaround failing services, support executives, support managers, and implement our proven health and social care solutions.
LSW Care Solutions and our associates understand the challenges in Health and Social care, but, also know how incredibly rewarding it is to work in this industry every day and improve the lives of people we support.
Our expert associates provide a wide range of solutions from ‘hands-on’ support to the executive level with the ability to work nationally. We work with you to understand your specific needs and design a tailor-made package of support to suit your requirements and budget.
LSW Care solutions have experienced trainers within Health and Social care that can provide training and support. We have a package of E-Learning courses that can be purchased online and run a variety of addition face to face training and workshop
Related Posts
Is It Effective: Consent to care and treatment
Is consent to care and treatment always sought in line with legislation and guidance?
Is It Effective: Accessible Premises
How are people’s individual needs met by the adaptation, design and decoration of premises?
Is It Effective: Supporting people to live healthier lives
How are people supported to live healthier lives, have access to healthcare services and receive ongoing healthcare support?