Deprivation of Liberty Safeguards (DoLS) Snapshot/Refresher

Content Introduction- what is the Act about Why it’s important to your role How will it work (very briefly!) Where to learn more

Deprivation of Liberty Safeguards 2007 The Act applies to anyone over the age of 18 who lacks the mental capacity to consent to residing in a particular place in order to receive the care or treatment they need. The safeguards apply to care homes and hospitals, your own home, shared lives, supported living and housing with care. A person is said to be deprived of their liberty if: they are not free to leave do what they want, when they want they are under your continuous supervision and control It is based on the same 5 principles as the Mental Capacity Act It uses a formal assessment to determine deprivation of liberty It has its own Code of Practice Code of Practice

What DoLS means to workers “People should be cared for in a way that does not limit their rights or freedom of action unless approved by law” DoLS is statutory & introduced a way to approve restrictions on people’s freedom in such a way as to protect those people from harm There are local procedures for care homes and hospitals and the Court of Protection for everywhere else. It also protects staff who are caring for someone without capacity and being restricted, provided that they have followed what the law says and worked in the person’s Best interests

Decision Making – is this a deprivation? First steps in the decision? Where is the Deprivation taking place? Is the person aged 18 years or over Are you actively doing or planning to do something that might be a deprivation Do they lack mental capacity i.e. are they free to leave are you deciding what care they receive Does the person have a mental disorder? Are your actions in the persons best interests

Deprivation Indicators 1. Has the person consented to reside in the place they are living? Do they have the mental capacity to agree to be where they are and to receive the care they are receiving 2. Was force or sedatives used because the person was resisting going to reside somewhere? This does not include the use of benign force, such as gently guiding someone by the arm.

Deprivation Indicators 3. Do staff have control over the residence, care and movement of the person? This can include any or all of the following: Do you provide the care directly including giving prompts and support, do you provide food and fluids and monitor if it is taken, do you know where the person is at any given time, does the person need to be escorted if they go outside, does the home have locks to stop people leaving, do you use sedation at any time, do you use physical interventions at any time. Do you administer medication, do you plan, monitor and record the care you give. If someone becomes unwell do you decide that they should see a doctor or decide to call an ambulance. Does the person need someone with them all the time. 4. If the person is not in their own home did the person’s relatives, or carers who live with the person, object to them being admitted?

Deprivation Indicators 5. If family or friends tried to remove the person from where they are living would you stop them if you did not think it was the right thing to do? 6. Is the person able to maintain the social contacts they want to or would you control their contact with others if you thought it might not be the right thing for them to do?

Other things CQC take note of Arm Cuffs Splints helmets Bed rails Belts Tables Chairs Keypads Poor lighting Narrow corridors Tags Alarms CCTV Pressure pads One to one supervision or more Use of physical restraint techniques

What if we decide we have to do these things (Care Homes and Hospitals)? Hold a Best Interest meeting Record steps One And two Are you Already Depriving The person If YES Complete urgent and standard application Undertake a Mental Capacity Assessment If the person is not with you as yet, but you anticipate they will need to be deprived on admission – then complete standard authorisation up to 28 days in advance Inform CQC using their on line form

What if we decide we have to do these things (own home, shared lives, supported living, housing with care)? Hold a Best Interest meeting Record steps One And two Do you think you are Depriving The person Undertake a Mental Capacity Assessment Contact the DoLS Office to discuss what you need to do next Ensure your managers are aware

Assessors Carry out assessments Managing Authority Hospital or Care Home Responsible for care and requesting an assessment of deprivation of liberty Relevant Person Person being deprived of liberty Representative Providing independent support Family/Friends/Carers Consulted, involved and provided with all information Supervisory Body LA Responsible for assessing the need for and authorising deprivation of liberty IMCACourt of Protection Responsibilities in Deprivation of Liberty

DoLS Assessments

What happens Next? 14 Approval is either given or not given If not given you will receive reasons and advice If given the order lasts any where up to a year The Assessor may place some conditions for you to meet The assessor will arrange for a persons representative who will monitor the care and conditions If the situation changes you must ask for a review If the person dies you must inform the coroner

Decision: Preventing access to food Ben has learning disabilities and Prader-Willi syndrome. There are serious concerns about his health because his weight has been increasing steadily and now stands at 120kg. Staff in his residential home have tried to support Ben to limit what he eats and to make healthy choices but with little effect. Ben has been assessed as lacking capacity to make decisions about the amount and type of food he eats (this is common among people with Prader-Willi syndrome). It has been proposed that it is in Ben’s best interests to stop him going into the kitchen, and always supervising him when out to prevent him spending all his money on, or stealing food. An application is made by the home manager for an urgent and standard authorisation because they believe that the restrictions would deprive Ben of his liberty. 15

Decision: Preventing someone leaving the home Brian has been living in a nursing home for the past three years. Recently he has become very agitated and distressed which is thought to be linked to his dementia. He tells people he wants to go home not remembering that he had to give his flat up when he moved into the home. He also spends a lot of time trying to open the front door which has a key pad lock on. An incident has occurred where he climbed out of his ground floor bedroom window and was only found a couple of hours later on a main road. They want to continue to use the key code so that Brian does not go out unaccompanied, to observe Brian when in the home, require him to be accompanied when leaving the home. and to put safety locks on some of the windows. Because of the seriousness of the recent incident, the home manager completes the form for the urgent and standard authorisation and arranges the window locks to be fitted the same day. 16

Further learning and advice Contact SCDC to book on the face to face DoLS course or complete the e-learning DoLS course on: Or complete the DoLS workbook available on Contact Kaye Drury for copies of the MCA/DoLS practitioners manual, posters etc. and for on-going advice Read the DoLS information on: if in doubt ASK!