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Mental Capacity Act 2005

What are the CQC looking for?

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Overview of the Session

• What should you and your staff be able to do

• What should you be recording

• Case Studies

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What as Managers must you be doing and be able to show CQC?

• Do your care plans show how you are promoting independence and liberty for all your residents?

• Do you know how to determine someone's “ordinary residence”

• https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/252864/OR_Guidance_2013-10-01_Revised__with_new_contact_details_New_DH_template.pdf

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What as Managers must you be doing and be able to show CQC?

• Do your staff know when a capacity assessment needs to be undertaken?

• Do you staff know that capacity assessments must be time and decision specific?

• Do your homes procedures identify who can make what level of decision?

• Do your staff know when a best interest decision may need to be made?

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What as Managers must you be doing and be able to show CQC?

• What resources do you have available about the MCA and DoLS? You must have copies of the Codes of Practice for MCA and DoLS

• Do your staff know how to access those resources?

• Do your records show if an LPA or EPA or Court Appointed Deputy is in place and do staff understand what that means in relation to their day to day care activities?

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What as Managers must you be doing and be able to show CQC?

• Do your records show if an advanced decision to refuse medical treatment is in place, what it means and where to find it?

• Do you review as part of best interest decision making if the placement is still right for the individual?

• Do your staff have access to the best interest decision making checklist?

• Do your records show who and how people are involved in making decisions?

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What as Managers must you be doing and be able to show CQC?

• Do your staff know what an IMCA is and what rights an IMCA has in your home?

• Do your capacity assessment records show that it is a two stage process involving three stages?

• Does the person have a disorder or disease of the brain or mind

• Does that disease or disorder have the potential to make decision making difficult for the individual

• Have you recorded the answer to each of the 4 capacity test questions

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What as senior staff must you be doing?

• Ensure you keep MCA and DoLS training records up to date, CQC will require them

• Do your induction procedures include MCA, DoLS, Human Rights Act?

• Have you or the company behind your home Identified the skill set needed in your staff to deliver your service

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What as senior staff must you be doing?

• Have you or the company behind your home established and reviewed operating procedures and practice guidance to ensure that:

1. Principles of MCA, empowerment, autonomy and respect are reflected in all working practices

2. Staff know how to access these operating procedures and practice guidance

3. That supervision includes discussion of cases where decisions will be made by others on behalf of the individual

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What should you be recording?

• You will need to record accurately the decisions you make about the assessment of capacity and determination of best interests

• You can use the templates that CCC has developed, these ensure you are recording the right information in enough detail

1. Capacity Assessment Form

2. Best Interest Recording Form

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What should you be recording?

• You need to identify how much to record for example decisions taken day to day such as washing, dressing, nutrition, involvement in activities do not need to be formal.

• At a minimum they need to say what decision was made, why it was made and who was involved in making it.

• “Mr Brown is currently unable to choose what food to eat as he no longer recognises different types of food. Staff will make those decisions for him at each mealtime to ensure he has a balanced and varied diet. I have spoken to Mr Browns daughter to establish his likes and dislikes, this list is kept in his care notes.

• This decision will be reviewed regularly in light of any changes in Mr Browns mental capacity to make these decisions.”

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What should you be recording?• Do you records show?• The persons past and present wishes and feelings• The persons beliefs and values, religious, cultural,

moral• The best way to communicate information to the

person• The names and contact details of people to be

consulted• Details of any LPA or Deputy or Appointee• Copy of any Advanced Decision to Refuse Medical

Treatment

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What should you be recording?

• Do you records show?

• Details of when you have made decisions on someone else's behalf

• Why you did this

• Who you consulted

• What you did when carrying out decisions not made by the person themselves

• When you will review this decision

• If the decision amounts to a deprivation of Liberty

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Specific to Deprivation of Liberty?

1. Are your records clear about what you tried to do to reduce restriction or restraint before applying for a DoL?

2. Do your records show how and when you explained the persons rights under a DoL to the individual and their family and friends?

3. Do your records show when a Relevant Persons Representative has visited and whether they are fulfilling their duties?

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Specific to Deprivation of Liberty?

1. Do you inform the CQC every time you apply for a DoL?

2. Did you know CQC may choose to “pathway track” an individual subject to DoLS – follow up on them during visits

3. CQC can only monitor MCA and DoLS during normal visits they cannot do a special visits just because someone is on a DoL

4. CQC will particularly look for unauthorised DoL situations

5. You must inform the coroner if a client on a DoL dies

6. You must request a review if situation changes or the client moves

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What does MCA Allow you to do?

• Undertake any action related to personal

• care, healthcare or treatment

• Restraint if it necessary to prevent harm, and it is a proportionate response to the likelihood of the person suffering harm – and to the seriousness of that harm

• use the person’s money to buy goods or pay for services if those goods or services are necessary and in the person’s best interests

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What does MCA Allow you to do?

• Take money from the person’s bank or building society account or to sell the person’s property to pay for goods or services – in this case formal authority will be required via the Court.

Personal care

• • helping with washing, dressing or personal hygiene

• • helping with eating and drinking

• • helping with communication

• • helping with mobility (moving around)

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What does MCA Allow you to do?

• helping someone take part in education, social or leisure activities

• going into a person’s home to drop off shopping or to see if they are alright

• doing the shopping or buying necessary goods with the person’s money

• arranging household services (for example, arranging repairs or maintenance for gas and electricity supplies)

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What does MCA Allow you to do?

• providing services that help around the home (such as homecare or meals on wheels)

• undertaking actions related to community care services (for example, day care, residential accommodation or nursing care)

• helping someone to move home (including moving property and clearing the former home).

• Deciding to move someone into new accommodation (residential care or supported living)

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What does MCA Allow you to do?

Healthcare and treatment

• carrying out diagnostic examinations and tests (to identify an illness, condition or other problem)

• providing professional medical, dental and similar treatment

• giving medication (including covertly)

• taking someone to hospital for assessment or treatment

• providing nursing care (whether in hospital or in the community)

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What does MCA Allow you to do?

Healthcare and treatment

• carrying out any other necessary medical procedures (for example, taking a blood sample) or therapies (for example, physiotherapy or chiropody)

• providing care in an emergency (including transporting someone to hospital)

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For example !

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Dilemma (1)George uses your home care services. He is self- neglecting and refusing to take his medication.  His GP has left a note at his home which says staff must give George his pills in a jam

sandwich from now on.

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Dilemma 2 (a)Mary (aged 50) uses your home care

services. When you arrive she is wearing very distinctive clothing.

She has a crop top on and low slung very tight trousers with her midriff

bulging out.

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Dilemma 2 (b)Mary has been out and has returned

home in a distressed state, a group of local children have been laughing at her, calling her names and throwing

stones.