Promoting Less Restrictive Practice
The Local Government Association, adass, published a reducing restrictions tool which aimed to help organisations identify restrictions in a person’s care and to examine whether the support delivered is the least restrictive option possible. The question posed in the assessment tool ‘Is the person as free as anyone else’ and, taking into account any legal restrictions, do the people who we support in Cristal Care have the same human rights as everyone else.
The Mental Capacity Act Guiding Principles underpin all our work:
- Assumption of capacity
- A person must not be assessed as lacking capacity unless all practicable steps have been taken to help them make the decision.
- People are allowed to make unwise decisions
- Anything that is done on behalf of someone who lacks capacity must be done in their best interests
- The least restrictive option should always be taken
There are 9 Domains in which we asked the questions, Is it lawful?, Is it necessary? And Is it proportionate? This summary is Cristal Care’s response.
Freedom of movement
There are some residents who are on a DOLs authorisation who have restrictions and then those who do not. Although people are free to come and go, all the residents are expected to let us know where they are going and how long they are going to be.
Positive aspects of practice include residents do have access to their own gardens, they have keys to their own flats, and are not restricted to one area and have staff available to go out whenever they wish to.
Residents do have the right to leave the premises when they wish to and often do to visit friends, family and engage in activities specified to them.
Residents who do have support when leaving site do so because of their specific diagnosis and in effect to safeguard them from harm, exploitation and potential abuse.
Many residents have allocated 1:1 staffing and this is authorised through a thorough assessment and DoLS authorisation, people are supported to have time on their own if they choose.
Eating and drinking
Cristal Care staff work in a person-centred way with the residents we support enabling them to make informed choices when shopping for provisions. We will try to introduce a Healthy eating programme but, the residents are always given a choice to either follow the healthy eating plan or not.
Positive aspects of practice include the residents are taught the skills when choosing food in the shop, preparing and cooking meals. They have access to their own kitchen in their own flats. They go out shopping for themselves with or without support. They make their own decisions in respect of what food they want to eat.
Some people have MHA restrictions on use of alcohol, other people have specialised diets as a result of medical conditions, people are supported to make good choices in all areas.
Washing and toileting
Although some of our residents need support with their personal hygiene, this is done in a way to promote as much independence as possible to the resident.
Positive aspects of practice include all residents have access to their own bathrooms which encourages them to do more for themselves. Morning routines are written in a support plan with the resident to encourage them to wash, shower and take care of their personal hygiene daily, which staff may use visual prompts to assist the resident in their routines and develop skills.
Any personal care can be supported in a timely manner as a result of intensive staffing and this is a positive way to ensure that people’s self esteem is maintained.
Residents are encouraged to wear the appropriate clothing if they are going out taking in to account what the weather is like outside.
Positive aspects of practice include all residents can access the hairdressers in the community to have their hair cut, washed and styled, if they wish to do so. All residents can access shops in the community and can access online shopping, choosing clothes that they like to wear, there are no restrictions in this area promoting personal choice.
On a day to day basis people are given choices as to what they want to wear, as people are supported to look after their own clothes they know when items are clean and when they need washing and are supported in this area.
Some people have had tattoos and piercings matching their own personal choices and have been supported to make safe choices in where these have been done.
We have residents who need support to clean their flat, we encourage them to keep their environment clean and meeting required standards
Positive aspects of practice include when our residents move in, they are involved in personalising their flat. We provide furniture, wardrobes, side units, drawers, table and chairs, TV, settee and people are involved in these choices. Residents can choose colours for their walls on how they want it to look and can also bring their own things with them with a view to make it as home like as possible. There is availability to wi-fi.
People can have visitors and have private space to meet with their families and friends and can cook meals and entertain their visitors. In people’s kitchens they have access to all cooking utensils, risk assessments are completed as necessary to ensure safety and the hobs are induction to help prevent any accidents.
Family and Social Life
There are no restrictions in relation to visits and people can see who they like, or not, when they like.
Positive aspects of practice include the fact that the majority of residents have a mobile phone to keep in contact with their families and friends, those who do not have a mobile phone then we provide assistance for the residents to use a phone with support from staff.
Residents do have visitors throughout the day time, we only ask for them to sign in from the office to ensure we know who is on site at any one time.
Staff fully respect the resident’s privacy and knock on doors and wait for a response before entering.
Positive aspects of practice include residents can choose to go to their flat to have some privacy. Resident has their own front door key to their own living space.
Residents are encouraged to speak to staff/managers in private where confidentiality can be maintained.
Health and Healthcare
Some residents lack the capacity around medication which has been determined through the MCA Act and they have support, other people are encouraged to administer their own medication. All medication is stored in the residents living space and is administered with the level of assessed support.
Cristal Care follows the principles of STOMP and closely monitors any use of ‘as and when required’ medication.
Positive aspects of practice include residents are registered with a GP and Dentist of their choice.
All residents have annual eye tests and are provided with glasses if they need to wear them.
Residents can be referred to the Learning Disability Team, who have local consultants they can see when reviewing their medication needs.
Residents are encouraged to have their own input into their healthcare. They may arrange their own appointments and are supported to facilitate independent appointments without staff support. They can take phone calls from medical professionals independently, securing their own health support including medication, which remains confidential.
Residents are aware of their right to refuse and easy read information is available to support people making decisions.
The complaints procedure is in place for if they wish to challenge any aspects of their care and support. This information is presented in a person-centred way to each individual as best suits their method of communication.
Cristal Care, as an organisation encourages staff to support people and give positive choices, this includes activities at home and in the local community, we support people in a person centred way to ensure people have a positive and individually tailored lifestyle. In approach we ‘support’, ‘assist’, ‘help’ enabling people to make choices and working together.
The principles and practice in relation to the Mental Capacity Act for part of each Independent Person’s visit and provide objective feedback based on observations of staff practice.