www.coventry.gov.uk
Mental Capacity Act 2005
What are the CQC looking for?
www.coventry.gov.uk
Overview of the Session
• What should you and your staff be able to do
• What should you be recording
• Case Studies
www.coventry.gov.uk
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/u
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www.coventry.gov.uk
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?
www.coventry.gov.uk
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?
www.coventry.gov.uk
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?
www.coventry.gov.uk
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
www.coventry.gov.uk
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
www.coventry.gov.uk
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
www.coventry.gov.uk
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
www.coventry.gov.uk
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.”
www.coventry.gov.uk
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
www.coventry.gov.uk
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
www.coventry.gov.uk
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?
www.coventry.gov.uk
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
www.coventry.gov.uk
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
www.coventry.gov.uk
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)
www.coventry.gov.uk
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)
www.coventry.gov.uk
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)
www.coventry.gov.uk
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)
www.coventry.gov.uk
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)
www.coventry.gov.uk
For example !
www.coventry.gov.uk
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.
www.coventry.gov.uk
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.
www.coventry.gov.uk
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.