Mental Capacity Act

Policy Statement

Woodlands & Hill Brow Ltd complies with the principles of the Mental Capacity Act 2005 by first treating all of its residents and prospective residents on the basis that they are able to take their own decisions. Consistent with the legislation the home is prepared to take a decision for a person in their best interests if there is evidence that they cannot take the decision (at the time it needs to be made) because of mental incapacity.

Background

The Mental Capacity Act, or MCA as it is often known, was introduced into England and Wales in April 2007 to provide a statutory framework to protect those who lack the mental capacity to make their own decisions, such as those with severe dementia or any other significant brain dysfunction, and those who are dying and no longer capable of making decisions for themselves.

The Act applies only to people aged 16 years and over and sets out:

• who can take decisions for people who lack capacity
• in which situations this can be done
• how they should go about this.

Certain groups of people are legally required to have regard to the Act and its associated Code of Practice when making decisions on behalf of people who lack mental capacity. This includes doctors, nurses, health and social care managers and staff.

Fundamental Standards Compliance (from April 2015)

From April 2015 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 will apply, replacing the Essential Standards.

The home understands that the Regulations contain the following with respect to mental capacity:

• Regulation 9: Person-Centred Care, requires service providers to ensure that the care and treatment of residents must be appropriate, must meet their needs, and must reflect their preferences and wishes. The regulation specifically requires service providers to act in accordance with the Mental Capacity Act 2005 with regard to people who may lack capacity.
• Regulation 11: Need for Consent, requires that care and treatment is only provided with the consent of the relevant person.

Definition of Capacity

The ‘capacity’ referred to in the MCA refers to the mental capacity to make a decision. Where a person is described as ‘lacking capacity’ this means that the person is judged as being unable to make a decision for him or herself because of an impairment of (or a disturbance in the functioning of the mind or brain, whether temporary or permanent.

Importantly, capacity can change and may relate to different decisions differently. Therefore a lack of capacity should never be assumed or presumed.

Procedures

The home will only take a decision for one of its residents after it has exhausted every means of enabling the person to take it of their own accord. It will also show its actions in taking the decision are reasonable and in the person’s best interests.

Where the home has information that suggests the person might be unable to take some decisions at some times it carries out an assessment of that person’s mental capacity. The assessment follows the two step assessment process recommended in the Mental Capacity Act 2005 Code of Practice. The home ensures that it complies with the all aspects of the law in the cases of residents who are subject to guardianship proceedings or who need legal protection on account of their lack of mental capacity. It includes here residents, who have assigned powers of attorney or who are subject to Court of Protection proceedings.

The home familiarises itself with and acts upon any advance directives or “living wills” that its residents have chosen to make in contingency situations where they might lose the ability to take a decision. The home also encourages residents to make end-of-life plans so that their wishes are known in the event of their death.

A resident’s needs assessment and plan of care contain all the information needed relating to a person’s decision taking capacity and the decisions over which they might need help on account of their possible lack of capacity.

The information included indicates:

• which decisions the person is able to take at all/most times
• those that the person has difficulty in taking
• those that the person is unable to take.

In respect of each area of decision taking where there are difficulties or an inability to take decisions, the residents plan of care records the actions to be taken for the person that are deemed in their best interests.

The individual is always as fully involved as possible. Decisions are only taken on the basis of the best information available and the agreement of those concerned in the person’s care and future. All decisions taken for that person are fully recorded and made subject to regular review.

Residents who lack mental capacity as any others, are only subject to any form of restraint when by not doing so would result in injury or harm to them or to other people. All incidents where restraint has been used follow the home’s procedures for reporting and recording.

Residents who might need them to help take decisions have access to independent advocates (IMCAs) and other professionals who can assist in the assessment and who understand the implications for that person’s care.

Staff Involvement

The home expects its care (and nursing) staff to implement the agreements and decisions that are identified on an individual’s plan of care.

The home also expects its staff to involve residents in all day-to-day decisions that need to be taken by seeking their consent and checking that the actions to be taken are consistent with their plan of care if the individual resident lacks capacity at the time.

Where the resident needs to take a decision that lies outside of their ability at the time staff must do everything to help the resident to decide for her or himself.

The home expects its staff to avoid taking decisions on behalf of a resident unless they can show that it is necessary and the resident at the time is unable to take that decision her or himself. Any such incident must be fully recorded.

The home expects its staff to take decisions for residents lacking capacity only because they have reasonable beliefs that they are necessary and in the person’s best interests. When in doubt that they can proceed in this way they must seek advice from their line manager.

Training

The home provides staff training on all aspects of mental capacity to improve their knowledge and develop skills in working with residents over their decision-making abilities.

Signed: _____________________________
Date: _____________________________
Policy review date: _____________________________

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