MCA / Consent / Best Interests

Is the use of any restrictive practices (e.g., bed rails, sensor mats, PRN sedation) supported by valid MCAs and Best Interests decisions?

What we look for: Identify people with restrictive interventions. Confirm that an MCA and BI decision exist for the specific restriction, proving it is proportionate to the risk of harm. Fails if restrictions are applied without legal framework or regular review.

Evidence: Risk assessments, Restraint logs, MCA/BI forms, Bed rail assessments

Have all care staff and management completed comprehensive training on the Mental Capacity Act 2005?

What we look for: Check the training matrix. Ensure MCA training is mandatory, up to date for all staff, and discussed in supervisions. Fails if staff compliance is below the provider's target (e.g., 90%) or if staff cannot explain basic MCA principles during spot checks.

Evidence: Training matrix, Training certificates, Staff supervision records

Do care plans clearly state the person's current capacity status, communication needs, and how they make choices day-to-day?

What we look for: Read 5 care plans. Look for clear instructions for staff on how to support the person's decision-making, maximize capacity, and communicate choices. Fails if care plans lack guidance on the person's cognitive status or assume lack of capacity without assessment.

Evidence: Care plans, Support plans, Communication profiles, Review documents

Is there documented evidence of signed, general consent to care and treatment from the person or their legal representative?

What we look for: Sample 5 care files. Check that a general consent form is completed and signed by the person. If signed by a relative, verify they have legal authority (LPA). Fails if consent is missing or signed by a relative without legal authority.

Evidence: Signed consent forms, Initial assessment records, Care plan signature pages

Are decision-specific Mental Capacity Assessments completed when there is doubt about a person's capacity to make a specific decision?

What we look for: Review files of people living with dementia or cognitive impairment. Ensure MCAs are decision-specific (e.g., capacity to consent to medication, care provision) and apply the two-stage test correctly. Fails if MCAs are generic or absent when capacity is clearly impaired.

Evidence: MCA forms (Stage 1 and 2), Decision-specific care plans, Care reviews

Are Best Interests decisions properly documented, involving relevant stakeholders such as family, professionals, or IMCAs?

What we look for: Check files where a person lacks capacity for a specific decision. Verify a clear best interests process was followed, documenting who was consulted and why the decision is the least restrictive option. Fails if care is provided against their will without a documented BI decision.

Evidence: Best Interests meeting minutes, Best Interests decision forms, IMCA reports, Care plans

Is legal authority verified and documented when family members or representatives make decisions on behalf of a person?

What we look for: Where a family member signs care plans or makes health decisions, check for a verified copy of an LPA (Health & Welfare) or Deputyship order on file. Fails if the service accepts family decisions overriding the person without verified legal authority.

Evidence: Copies of Lasting Power of Attorney (Health and Welfare), Court of Protection Deputyship orders

Do daily care records evidence that staff seek ongoing, day-to-day consent and respect the person's choices before providing care?

What we look for: Sample daily notes over a one-week period for 3 people. Look for evidence that staff offer choices (e.g., food, clothing, timings) and respect refusals of care. Fails if notes only read 'care given as per plan' without reflecting the person's daily consent.

Evidence: Daily log notes, Care worker logs, MAR charts

Is there effective management oversight and a central register of all people who lack capacity, have LPAs, or are subject to restrictive practices?

What we look for: Ask the manager for their tracker of capacity, LPAs, and restrictions. Check that it is accurate, up to date, and used to trigger reviews. Fails if the manager relies solely on individual files and lacks a service-wide overview of MCA compliance.

Evidence: MCA/LPA central register, Audits of care plans, Management meeting minutes