Little Oldway

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People were not always supported to have maximum choice and control of their lives and staff did not fully understand their roles and responsibilities under the Mental Capacity Act 2005 (MCA) including Deprivation of Liberty Safeguards (DoLS). However, the provider had systems and processes in place to help ensure people were supported to understand their rights and staff had received training in MCA and DoLS. We have recommended the provider undertakes a review of all documentation relating to MCA, best interest decisions and DoLS.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People who were able to share their views with us told us they were able to come and go as they chose, and staff offered them everyday choices. However, this was not everybody’s experience. We used the Short Observational Framework for Inspection (SOFI) during this assessment. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We saw people were not always offered choice and some interactions, were task orientated and not person centred. For example, we observed people’s mealtime experience and noted that only 2 people were told what their meal was when it was served. Most people were served drinks in plastic beakers, they were not offered a choice of drink or told what was in the cup. Only one relative we spoke with specifically told us they had been asked to take part in capacity discussions or best interests’ decisions. However, it was clear from our conversations with relatives they were involved in their loved one’s care and that staff kept them informed of any changes. Comments included, “They consult me and let me know any changes,” “Never had a problem, they tell us everything that goes on,” and “They rung me to ask if I wanted him to move room.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. The care manager and staff told us they had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), and whilst they describe the importance of obtaining people's consent and following the principles of the mental capacity act. We found this knowledge and understanding was not applied consistently. For example, some people's care records did not always show their consent and/or views had been sought in relation to decisions being made on their behalf or that people were always being supported and empowered to have maximum choice and control over their lives.

The provider had a clear policy and developed systems and processes to help ensure people were supported to understand their rights. Records showed, and staff confirmed they had received training in safeguarding adults, the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, we found some mental capacity assessments lacked detail and /or contained limited information to demonstrate that staff were following the principals of the MCA. People were not always supported to make decisions about their care and staff did not fully understand their roles and responsibilities under the Mental Capacity Act 2005 (MCA). This meant people who lacked capacity or who had fluctuating capacity, did not always have decisions made in line with current legislation. For example, where staff supported people with their personal relationships. People’s capacity to consent to these arrangements had not been assessed nor had staff followed a best interests’ process. Where the service had submitted DoLS applications to the local authority for consideration. It was not clear that some of the information which underpins these assessments were accurate, necessary or in the persons best interests. We recommend the provider reviews all documentation relating to the MCA to ensure that all assessments and best interest decisions are made in line with the principles with the Mental Capacity Act 2005.