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Registration Number: {{org_field_registration_no}}

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Consent to Care and Treatment Policy (Adults 18 and over)

1. Purpose and Scope

This policy outlines how {{org_field_name}} ensures that consent to care and treatment is obtained, recorded and respected in accordance with the law and Care Quality Commission (CQC) requirements. It applies to all staff and volunteers supporting adults aged 18 and over in their own homes and supported living settings.

This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, particularly Regulation 9 – Person-centred care, Regulation 11 – Need for consent, and Regulation 13 – Safeguarding service users from abuse and improper treatment.

No care or treatment will be provided without the person’s valid consent or another lawful authority. Where a person may lack capacity to make a particular decision, {{org_field_name}} will act in accordance with the Mental Capacity Act 2005 and its Code of Practice.

By adhering to this policy, the service demonstrates that no care or treatment is provided without the person’s valid consent or other lawful authority. It also ensures that any restrictive practices or potential deprivation of liberty are recognised as safeguarding issues and managed lawfully.

{{org_field_name}} is registered with the Care Quality Commission to carry out the regulated activity of {{org_field_regulated_activity}} for {{org_field_service_users_bands}} in supported living settings.

2. Policy Statement

{{org_field_name}} is committed to upholding each individual’s right to make informed choices about their care and treatment. We will obtain and document consent for all care interventions, respecting the autonomy and preferences of the people we support. Where a person lacks the mental capacity to give informed consent, we will act in accordance with the Mental Capacity Act 2005 (MCA) and its Code of Practice to ensure decisions are made in the person’s best interests. We have zero tolerance for abuse or unlawful treatment; any use of restraint or restrictive measures must be necessary, proportionate, and in line with legal safeguards. Unnecessary or unauthorised deprivations of liberty are not permitted and would constitute improper treatment under CQC Regulation 13. This policy also addresses the current legal framework for deprivation of liberty, including the distinction between Deprivation of Liberty Safeguards (DoLS) in care homes and hospitals and community deprivation-of-liberty arrangements in supported living or a person’s own home. It will be updated to reflect Liberty Protection Safeguards or any replacement legal framework if and when these provisions come into force to ensure ongoing compliance with evolving law.

3. Legal Framework and Regulatory Compliance

All staff must understand and comply with the relevant laws and regulations concerning consent and capacity, including:

• Mental Capacity Act 2005 (MCA) – The key legislation setting out how to assess capacity and make best-interest decisions. The MCA allows certain restraint or restrictions only if necessary and in the person’s best interests, and proportionate to the risk. More stringent safeguards (DoLS/LPS) are required if such restrictions will deprive a person of their liberty.
• Mental Health Act 1983 (MHA) – If a person is detained or being treated under the MHA (e.g. under a Community Treatment Order or guardianship), staff must act in accordance with that Act for treatments of mental disorder. (Per Regulation 11(4), where the MHA applies, its provisions take precedence for consent to treatment of mental illness.)
• CQC Regulation 11: Need for Consent – Care and treatment must only be provided with the consent of the service user or their lawful representative (e.g. donee of Lasting Power of Attorney or court-appointed deputy), except where the person lacks capacity and the provider acts in accordance with the MCA. Our consent procedures reflect this requirement and are a condition of our CQC registration.
• CQC Regulation 13: Safeguarding from Abuse and Improper Treatment – We must protect service users from abuse or improper treatment. “Improper treatment” includes unlawful restraint or inappropriate deprivation of liberty under the MCA. Any care practice that includes unnecessary or disproportionate restraint, or deprives someone of liberty without lawful authority, is prohibited. To comply with Reg. 13, the service has robust procedures to prevent abuse and will only use restrictive interventions in line with legal safeguards and as a last resort.

This policy should be read alongside our Safeguarding Policy, Mental Capacity Act Policy, and any Restraint/Positive Behavior Support Policy, to ensure a cohesive approach to consent and safeguarding.

4. Additional Legal and Regulatory Requirements

In addition to the Mental Capacity Act 2005 and CQC Regulations 9, 11 and 13, {{org_field_name}} will comply with:

• Equality Act 2010 – We will not discriminate against a person because of disability or another protected characteristic. Reasonable adjustments will be made to enable people to understand information, communicate their decisions and participate fully in decisions about their care.
• Accessible Information Standard – We will identify, record, flag, share and meet people’s information and communication needs where applicable. Information relating to care, consent and decision-making will be provided in a format the person can understand.
• UK General Data Protection Regulation (UK GDPR) and Data Protection Act 2018 – Information relating to consent, capacity, best-interest decisions and care will be processed lawfully, fairly, securely and only for appropriate purposes.
• Human Rights Act 1998, including Article 5 of the European Convention on Human Rights concerning the right to liberty and security and Article 8 concerning respect for private and family life.

5. Obtaining Informed Consent

Principle: Every individual has the right to consent to or refuse proposed care and treatment, as long as they have the capacity to do so. Staff will always seek informed consent before providing support or treatment.

• Communication and Information: When asking for consent, staff must provide the person with all relevant information about the care or treatment in a way they can understand. This includes explaining the nature of the intervention, its purpose, benefits, risks, and alternatives (including the option to do nothing). Explanations should be given using appropriate language, and with aids or support (e.g. simplified materials, translation, signing, or advocacy) according to the individual’s communication needs. The person should have the opportunity to ask questions and take time to consider their decision.
• Voluntary Decision-Making: Consent must be given freely and without coercion. Staff must never pressure or unduly influence a person’s choice. Consent is an ongoing process – the person can change their mind and withdraw consent at any time, and this decision must be respected. Staff will regularly check that the person remains comfortable with any continuing interventions.
• Recording Consent: All obtained consents (or refusals) will be documented in the person’s support plan/care records. Where written consent forms are used (for specific treatments or information sharing), these must be explained to the individual and signed by them (or their representative) before care is delivered. Implied consent (for minor day-to-day support, indicated by the person’s cooperation or behavior) should also be noted in daily records, but significant decisions require explicit consent.
• Refusal of Care or Treatment: If a service user with capacity refuses an aspect of care or treatment, their decision will be respected. Staff must not impose care in these circumstances, even if they believe it is in the person’s best interests, except in situations covered by law (for example, treatment under the Mental Health Act for a detained patient). The consequences of refusing will be explained to the person (without coercion), and any alternatives offered. Persistent or significant refusals will be discussed with the care manager or multi-disciplinary team to explore solutions or review the care plan, but the person’s right to refuse remains paramount.

6. Accessible Information, Communication and Reasonable Adjustments

Consent can only be valid where the person has been given information in a way they can understand and has been supported to communicate their decision.

{{org_field_name}} will identify and record each person’s communication and information needs and will make reasonable adjustments in accordance with the Equality Act 2010 and the Accessible Information Standard.

Depending on individual needs, this may include:

• Easy Read or plain-English information;
• large print;
• pictures, symbols or visual communication;
• British Sign Language or other communication support;
• interpreters or translated information;
• assistive communication technology;
• audio or alternative formats;
• additional time to process information;
• choosing an appropriate time and environment for discussion; and
• involvement of advocates, relatives or representatives where appropriate and lawful.

Staff will not assume that a person’s communication difficulty means they lack mental capacity. All practicable steps will first be taken to enable the person to understand, communicate and make the decision themselves.

7. Consent, Confidentiality and Data Protection

Information about a person’s consent, refusal of care, mental capacity assessments, best-interest decisions and legal representatives forms part of the person’s care record and will be managed in accordance with UK GDPR and the Data Protection Act 2018.

Records will be accurate, relevant, appropriately detailed, securely stored and accessible only to authorised individuals who require the information for a legitimate purpose.

Consent to care or treatment under Regulation 11 is separate from consent as a lawful basis for processing personal data under UK GDPR. Agreement to receive personal care does not automatically constitute consent to every use or disclosure of the person’s personal information.

{{org_field_name}} will identify an appropriate lawful basis for processing personal information and, where special-category information such as health information is processed, an appropriate condition under data-protection law.

Where consent is relied upon as the lawful basis for a particular use of personal information, it must be freely given, specific, informed and capable of being withdrawn.

8. The Five Principles of the Mental Capacity Act 2005

{{org_field_name}} will apply the five statutory principles of the Mental Capacity Act 2005 whenever supporting a person with decision-making:

1. Presumption of capacity – Every adult will be assumed to have capacity to make their own decisions unless it is established that they lack capacity for the particular decision.
2. Supporting people to make decisions – A person will not be treated as unable to make a decision until all practicable steps have been taken to help them make the decision themselves. This may include providing information differently, using communication aids, interpreters, Easy Read information, allowing additional time, choosing an appropriate environment, or involving someone the person trusts.
3. Right to make an unwise decision – A person will not be treated as lacking capacity merely because they make a decision that staff, relatives or professionals consider unwise or risky. Where the person has capacity, their decision will be respected.
4. Best interests – Any decision made or action taken on behalf of a person who lacks capacity must be in that person’s best interests. The person’s past and present wishes, feelings, beliefs and values will be considered, together with relevant views from others involved in their welfare.
5. Least restrictive option – Before making a decision or taking action on behalf of a person who lacks capacity, consideration will be given to whether the intended outcome can be achieved in a way that is less restrictive of the person’s rights and freedom.

Staff will apply these principles to individual decisions and will not make assumptions about capacity based on a person’s diagnosis, disability, appearance, behaviour, age or communication needs.

9. Mental Capacity and Best-Interest Decisions

In accordance with Regulation 11 and the Mental Capacity Act 2005, if an individual is 18 or over and unable to give consent because they lack capacity, our staff must follow the MCA’s legal requirements. The following procedures apply:

• Presumption of Capacity: Every adult is presumed to have capacity to make their own decisions unless assessed otherwise. Staff will never assume someone lacks capacity solely because of their age, disability, diagnosis, or appearance.
• Capacity Assessments: Mental capacity will be assessed whenever there is a reasonable reason to doubt whether a person can make a particular decision at the time that decision needs to be made.

Capacity is both decision-specific and time-specific. A diagnosis of dementia, learning disability, autism, mental illness, acquired brain injury or any other condition will never, by itself, be treated as evidence that a person lacks capacity.

The person responsible for the particular decision will normally be responsible for ensuring that capacity is assessed, provided they are appropriately trained and competent to do so. For significant, complex, disputed or high-risk decisions, the Registered Manager will seek involvement from an appropriate health or social care professional and, where necessary, obtain legal advice.

The assessment will follow the Mental Capacity Act two-stage test and will establish whether:

• the person has an impairment of, or disturbance in the functioning of, the mind or brain; and
• because of that impairment or disturbance, the person is unable to understand, retain, use or weigh the relevant information, or communicate their decision.
• The assessment, evidence considered, steps taken to support decision-making and outcome will be clearly recorded.

• Supporting Decision-Making: Before concluding someone lacks capacity, staff must take all practicable steps to help the person decide for themselves. This includes presenting information in an accessible format, choosing the best time/location for discussions, involving people the individual trusts (if appropriate), and addressing communication needs.
• Best Interest Decisions: If a person is assessed as lacking capacity for the specific decision at hand, any decision or intervention taken on their behalf must be done in their best interests (per MCA Section 4). The key factors considered will include the person’s past and present wishes, feelings, values, and beliefs, the views of their family or others close to them, and all relevant circumstances. A Best Interest decision-making meeting may be held for significant decisions, involving relevant professionals and the person’s representatives. The outcome (what decision was made and why it is in the person’s best interest) will be recorded.
• Least Restrictive Option: Whether the person has capacity or not, staff must always consider less restrictive alternatives when planning care. Under Reg. 13 and MCA principle 5, if any intervention might restrict a person’s rights or freedom of action, we must ensure it is the least restrictive option to meet the person’s needs and is proportionate to the harm prevented. This is both a legal requirement and a safeguard against unwarranted control or restraint.
• Involvement of Representatives: If the person who lacks capacity has a legally authorised representative, such as a Lasting Power of Attorney (LPA) for health and welfare or a Court-appointed deputy, that representative will be consulted and, where appropriate, will make decisions within the scope of their authority. (Note: An attorney or deputy cannot, by virtue of their appointment alone, authorise arrangements that amount to a deprivation of liberty. Where supported living or home-based arrangements may amount to a deprivation of liberty and lawful authorisation is required, the appropriate Court of Protection process will be followed.) If no family or friends are appropriate to consult for best interest decisions, an Independent Mental Capacity Advocate (IMCA) will be appointed for decisions that meet IMCA criteria (serious medical treatment or long-term accommodation moves, etc.).
• Verification of Legal Authority: Before accepting a decision from an attorney or Court-appointed deputy on behalf of a person who lacks capacity, {{org_field_name}} will verify the individual’s legal authority and the scope of the powers granted to them.

Staff will check that any Lasting Power of Attorney is valid and applies to health and welfare decisions relevant to the matter being considered, or that a deputy has authority under the relevant Court order. Appropriate evidence of this authority will be recorded or referenced within the person’s care records. An attorney or deputy will not be asked to make decisions outside the scope of their lawful authority.

All staff are expected to be familiar with the MCA Code of Practice and implement its guidance when caring for individuals who may lack capacity. Compliance with the MCA is monitored through care plan audits and supervision.

10. Consent and the Mental Health Act 1983

Most people using our supported living service are not under formal detention; however, if a service user is subject to the Mental Health Act 1983 (for example, on a Community Treatment Order or guardianship), specific rules about consent to treatment for mental disorder will apply. In such cases, staff and management will:

• Verify the individual’s legal status under MHA (e.g., Section 17A Community Treatment Order, Guardianship under Section 7, etc.) and understand any conditions or powers this entails.
• Adhere to Part 4 or 4A of the MHA regarding treatment: Certain treatments for mental disorder may be given without the patient’s consent if authorized by the MHA (e.g., medication after capacity assessment and second opinion, under Section 58), or subject to consent/second-opinion requirements under the Act. We will act in accordance with those provisions as required by Regulation 11(4).
• Continue to involve the person in decision-making as much as possible. Being under the MHA does not remove the duty to explain treatments and consider the person’s wishes. We aim to obtain voluntary consent for treatments even when a legal authority exists to proceed without it.
• Ensure that any treatment or care not directly covered by the MHA (for example, treatment of physical health conditions, or social care decisions) remains subject to the Mental Capacity Act and consent principles outlined in this policy.

Where conflict arises between the MHA and MCA (for instance, if a person under MHA lacks capacity and resistances care unrelated to their mental disorder), senior management will seek legal advice or Court of Protection input as needed to ensure lawful and ethical practice.

11. Deprivation of Liberty and Community Deprivation of Liberty in Supported Living

{{org_field_name}} recognises and protects every person’s right to liberty and security in accordance with Article 5 of the European Convention on Human Rights, the Human Rights Act 1998 and the Mental Capacity Act 2005.

Deprivation of Liberty Safeguards (DoLS) are the statutory authorisation process used in registered care homes and hospitals. They do not provide the authorisation process for people living in supported living arrangements or in their own homes.

Where care and support arrangements in supported living or a person’s own home may amount to a deprivation of liberty, the arrangements must be considered under the law relating to community deprivation of liberty. Where lawful authorisation is required, the appropriate Court of Protection process will be followed.

12. Identifying a Potential Deprivation of Liberty – Supreme Court 2026

Following the UK Supreme Court judgment of 2 June 2026, the previous approach based on the “continuous supervision and control” and “not free to leave” test is no longer a single determinative test

Whether a person’s arrangements amount to a deprivation of liberty must now be assessed on a case-by-case basis, considering the overall impact of the arrangements on the individual.

The Registered Manager, together with relevant professionals where appropriate, will consider all relevant circumstances, including:

• the type, nature and intensity of any restrictions in place;
• the duration and frequency of those restrictions;
• the effect of the restrictions on the person’s daily life and autonomy;
• how the restrictions are implemented in practice;
• the person’s wishes, feelings, values and beliefs;
• whether the person objects, verbally or non-verbally, to any aspect of the arrangements;
• the level and nature of supervision or monitoring;
• any restrictions on the person’s ability to leave, move freely or make choices about their environment;
• the extent to which the arrangements reflect ordinary life for someone in similar circumstances; and
• whether the overall arrangements amount to a significant curtailment of liberty.

No single factor will determine the outcome. All factors must be considered together in the context of the individual person and their specific situation.

Examples of arrangements that may require careful consideration include restrictions on leaving the property, locked doors, continuous or intrusive supervision, restraint or physical intervention, significant restrictions on social contact or movement, use of medication to control behaviour where this is not freely agreed, covert administration of medication where the person objects, or any combination of measures that significantly restrict a person’s freedom.

13. Wishes, Feelings and Objection

The person’s wishes and feelings are central to any assessment of whether arrangements may amount to a deprivation of liberty.

Staff will actively seek to understand the person’s views using all available communication methods, including verbal communication, behaviour, emotional responses, body language, attempts to leave, refusal of care, distress, and previously expressed preferences.

A lack of verbal objection must not be assumed to mean agreement or consent. Staff must ensure that the person is supported to communicate their views as fully as possible and that appropriate communication support is provided where needed.

Where there is uncertainty, disagreement, or fluctuating views about the arrangements, the matter must be escalated to the Registered Manager. Where appropriate, advice will be sought from relevant professionals, the local authority, commissioning bodies, or legal advisers.

14. Important Distinction – Consent to Care and Treatment

The assessment of whether arrangements amount to a deprivation of liberty is separate from the requirements relating to consent to care and treatment under the Mental Capacity Act 2005 and CQC Regulation 11.

{{org_field_name}} will continue to obtain valid consent to care and treatment in accordance with Regulation 11. Where a person lacks capacity to make a specific decision, any decision made on their behalf will be taken in accordance with the Mental Capacity Act 2005, including the principles of best interests and the least restrictive option.

The consideration of a person’s wishes and feelings when assessing deprivation of liberty must not be confused with the legal requirements for obtaining consent to care or treatment.

15. Escalation and Lawful Authorisation in Supported Living

Where {{org_field_name}} identifies that a person’s care and support arrangements may amount to a deprivation of liberty, the Registered Manager will act promptly.

The Registered Manager will:

• review whether the restrictions remain necessary and whether less restrictive alternatives are available;
• ensure that relevant mental capacity assessments and best-interest decisions are completed and recorded where required;
• establish and document the person’s wishes, feelings and any objections;
• consult relevant health and social care professionals, family members, representatives or advocates where appropriate;
• notify and work with the relevant local authority, commissioner or other responsible professional body;
• provide information and assessments required to support consideration of lawful authorisation; and
• obtain legal advice where the position is unclear, disputed or urgent.

For a person living in supported living accommodation or their own home, where a deprivation of liberty requires legal authorisation, the appropriate Court of Protection process will be followed.

{{org_field_name}} will cooperate fully with the relevant public authority and Court process and will comply with any conditions, directions or review requirements imposed by the Court.

Where there is uncertainty as to whether arrangements amount to a deprivation of liberty, the service will take a cautious and proportionate approach and seek appropriate professional or legal advice rather than allowing potentially unlawful restrictions to continue without review.

16. Monitoring and Review of Authorisations

• Record-Keeping: The service will maintain a Community Deprivation of Liberty / Court Authorisations Register to track all individuals in the service who are subject to a Court-authorised deprivation of liberty. This record will include the date and terms of the Court Order, any conditions attached, the expiry/renewal date, and the lead staff member for monitoring compliance.
• Compliance with Conditions: If the Court of Protection attaches conditions to the authorisation (for example, requiring particular activities, contact arrangements, or periodic reports), the keyworker and manager are responsible for ensuring these conditions are fulfilled. All staff involved with the person will be made aware of the conditions to ensure full compliance.
• Ongoing Oversight: The person’s keyworker and the manager will regularly review whether the care arrangements remain necessary and in the person’s best interests. If the person’s situation changes – for instance, if they regain capacity, if restrictions can be reduced, or if they express consistent objections – we will not wait for authorisation to expire. The manager will liaise with the local authority or Court of Protection to modify or discharge the order as appropriate. Keeping a person under greater restrictions than needed is not acceptable; the aim is to liberate and empower the individual as far as possible.
• Renewal: Court of Protection authorisations and orders will be reviewed in accordance with the terms and review requirements specified by the Court. The Registered Manager will monitor any review dates, conditions or directions and will liaise with the relevant local authority, commissioner or legal representatives in sufficient time before any required review. Where circumstances materially change before the scheduled review, the arrangements will be reconsidered without waiting for the review date. If continued deprivation of liberty is believed necessary beyond the current order, the manager will proactively work with the local authority to apply for renewal before the expiry date. This will involve fresh assessments of capacity and best interests to ensure up-to-date justification. If renewal is not granted or sought, the restrictive measures must cease or be adjusted to no longer constitute a deprivation of liberty.
• Advocacy and Rights: Any person whose supported living or home-based arrangements are subject to Court-authorised deprivation-of-liberty arrangements will be informed (in an appropriate manner) of their rights to challenge the decision. Advocacy and Rights: Any person whose arrangements are subject to Court-authorised restrictions will be supported to understand, in an accessible way, the arrangements, their rights and any available means of challenge. {{org_field_name}} will facilitate access to appropriate legal representatives, advocates, family members or other representatives appointed or recognised through the relevant legal process. Where an IMCA or other advocate is appointed or required, the service will facilitate their involvement. We will facilitate contact between the individual and their representative or an Independent Mental Capacity Advocate (IMCA) if one is appointed, and we will support the exercise of their rights (such as appealing to the Court if needed).
• Advocacy and Independent Support: {{org_field_name}} will support people to access independent advocacy where this would help them understand information, communicate their wishes, participate in decisions or protect their rights.

Advocacy may be considered where:

• the person has substantial difficulty understanding, retaining, using or weighing relevant information;
• the person has substantial difficulty communicating their wishes or preferences;
• there is disagreement or conflict concerning the person’s care or support;
• the person has no appropriate family member, friend or representative to support their involvement;
• significant restrictions on the person’s freedom are being considered; or
• independent support would help ensure that the person’s voice is heard.

Where the statutory criteria for an Independent Mental Capacity Advocate (IMCA) are met, an IMCA will be instructed or the relevant responsible body will be contacted to arrange appropriate advocacy in accordance with the Mental Capacity Act 2005.

By following these steps, we ensure that no service user is deprived of their liberty without lawful authority and that we remain compliant with CQC Regulation 13. The CQC inspectors will expect to see evidence of these authorisation and review processes for any individuals with restrictive care plans in supported living.

17. Liberty Protection Safeguards (LPS)

The Mental Capacity (Amendment) Act 2019 provides for Liberty Protection Safeguards (LPS), which are intended to replace the existing Deprivation of Liberty Safeguards framework.

At the date of review of this policy, LPS are not yet in force. {{org_field_name}} will therefore continue to follow the current legal framework, including the Mental Capacity Act 2005, applicable Court of Protection processes for community deprivation of liberty, and current government and CQC guidance.

The Registered Manager will monitor developments relating to LPS and any revised Mental Capacity Act Code of Practice. This policy and associated procedures will be reviewed and updated before any new legal framework takes effect, and relevant staff will receive appropriate training before implementation.

18. Consent, Restrictive Practices and Safeguarding

There is a critical link between obtaining consent and safeguarding people from harm or abuse. Any care practice that overrides a person’s will, or limits their freedom, must be rigorously justified and legally sanctioned – otherwise it may constitute abuse or improper treatment. Thus, consent and safeguarding are two sides of the same coin in our service delivery:

• Consent as a Safeguard of Autonomy: Respecting a person’s consent (or refusal) is fundamental to protecting their dignity and human rights. Providing treatment to someone without consent (when they have capacity) can be abusive. Therefore, our emphasis on informed consent serves to safeguard individuals from unwanted interventions. Staff are trained to recognize that ignoring a competent person’s refusal, or failing to seek consent, is unacceptable and could lead to disciplinary action and regulatory sanctions.
• Restrictive Measures and Abuse Prevention: When a person lacks capacity and we consider restrictive measures (such as close supervision, use of bedrails, securing doors, or administering sedating medication), we treat these actions with great caution. According to CQC Regulation 13, using restraint or control that is not necessary or not proportionate to the risk of harm is abuse. Any restraint must be the minimum needed for safety and must be part of a documented plan in the person’s best interests. The plan is subject to multi-disciplinary review and, if it imposes significant restrictions, to appropriate lawful authorisation, including Court of Protection authorisation where required for supported living or home-based arrangements. This process ensures transparency and oversight, thereby safeguarding the individual.
• Deprivation of Liberty as a Safeguarding Issue: An unauthorised deprivation of liberty – where a person is effectively detained or restrained beyond their consent without the proper legal process – is a serious breach of human rights and is considered improper treatment. It exposes the individual to harm and the provider to legal liability. By proactively authorising and reviewing any potential deprivation of liberty, we safeguard service users from the harm of being unlawfully deprived of liberty. In line with Reg. 13(5), no service user will be deprived of liberty for care or treatment purposes without lawful authority.
• Monitoring for Signs of Improper Restriction: Our safeguarding procedures include being vigilant to any signs that staff or caregivers might be imposing restrictions not agreed to or assessed. For example, if a staff member were to lock a person in a room or use physical force inappropriately, this would be identified as a safeguarding incident. All staff have a duty to report any concerns or incidents of potential abuse, including misuse of restraint or ignoring of consent. These reports will be investigated in line with our safeguarding and whistleblowing policies, and appropriate action (including notification to authorities and CQC) will be taken.
• Consent and Safeguarding in Care Planning: Each support plan includes a risk assessment and a section on consent/preferences. When planning care interventions that could be restrictive (e.g., managing exit-seeking behavior in dementia, or giving medication covertly), the plan will explicitly address consent and capacity. Safeguarding measures (such as regular review meetings, involving an advocate, or setting a review date for any restrictions) are built into the plan. This ensures that any loss of liberty or choice is continually scrutinised and justified.

By linking consent processes with safeguarding oversight, we ensure that the rights and safety of service users are maintained in tandem. In practice, this means every restrictive care decision triggers a safeguard: an assessment, authorisation, consultation, or review – so the person’s welfare is always at the centre of what we do.

19. Staff Training and Responsibilities

All staff members, from support workers to managers, have roles in implementing this Consent to Treatment Policy effectively:

• Training: Staff will receive appropriate training on the Mental Capacity Act 2005, consent, mental capacity assessments, best-interest decision-making, restrictive practices, community deprivation of liberty and the current legal framework following the 2026 Supreme Court judgment. Training will include how to recognise circumstances that may amount to a deprivation of liberty using the current multifactorial approach. Relevant staff will also understand the distinction between DoLS in hospitals/care homes and Court of Protection authorisation in supported living or a person’s own home. Additional focused training will be provided when LPS is introduced to ensure a clear understanding of the new procedures.
• Knowledge and Application: We expect staff to be familiar with the five principles of the MCA (presumption of capacity, support to decide, unwise decisions, best interests, least restriction) and to apply them daily. Staff should know how to obtain valid consent and how to document it. They must also recognize when a person might lack capacity and then follow the proper steps (seek guidance, involve seniors, etc.). Each staff member should understand what constitutes a restraint or restrictive practice and the importance of only using these as per approved plans.
• Seeking Guidance: If staff are unsure about a person’s ability to consent or the legality of an intervention, they must consult a senior or the Registered Manager before proceeding. The culture in our service encourages speaking up – it is far better to pause and check than to risk a violation of someone’s rights.
• Management Oversight: The Registered Manager ({{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}) is responsible for the implementation of this policy. They act as the MCA and Deprivation of Liberty Lead, advising staff and liaising with relevant local authorities, commissioners, health and social care professionals, advocates, legal representatives and the Court of Protection where required. The Manager will also keep abreast of changes in legislation (e.g., LPS rollout plans) and ensure policies and practices are updated accordingly.
• Supervision and Support: Through regular supervision meetings, managers will discuss real cases of consent and capacity with staff, reinforcing good practice and addressing any mistakes in a supportive manner. Any incidents where consent was not properly obtained or where unauthorized restraint occurred will be treated seriously – managers will investigate, take corrective action, and use it as a learning opportunity for the team.
• Ethos of Respect: Ultimately, all personnel are expected to uphold an ethos of respect for the people we support – seeing each individual as an active partner in their care. This ethos, reinforced by training and leadership example, is what ensures this policy isn’t just a document, but a lived practice.

20. Monitoring Compliance and Policy Review

Compliance with this policy will be monitored through:

• Care Plan Audits: Regular audits of service users’ care files to check that consent forms, mental capacity assessments, and best interest decision records are present as needed and kept up to date. These audits will flag any missing documentation or deviations from the policy, which the manager will address promptly.
• Incident and Safeguarding Log Reviews: The management team will review logs of any incidents involving refusal of care, use of restraint, or possible deprivation of liberty. Patterns or incidents of concern will trigger a review of practice and additional training or corrective measures. All safeguarding incidents related to consent or restrictive practices will be analyzed to identify lessons learned.
• Feedback: We will gather feedback from service users (and their families/advocates) about whether they feel involved in decisions and respected by staff. Complaints or feedback relating to consent (e.g., a person feeling ignored or coerced) will be investigated and the policy enforced. Positive feedback where individuals felt supported to make choices will be noted as evidence of good practice.
• Management Reviews: The Registered Manager will periodically review overall compliance – for example, ensuring that any person who lacks capacity has an appropriate mental capacity assessment, best-interest decision and, where required, appropriate Court of Protection authorisation or other lawful authority in place. These reviews might be documented in quarterly quality monitoring reports.
• CQC Inspection Preparedness: This policy and associated records will be maintained as evidence of compliance with CQC requirements, including Regulation 9 – Person-centred care, Regulation 11 – Need for consent, Regulation 13 – Safeguarding service users from abuse and improper treatment, and the relevant quality statements within CQC’s current assessment framework.

Policy Review: This policy will be reviewed at least annually, and sooner if there are changes in legislation or guidance (for example, when Liberty Protection Safeguards come into force, or if CQC updates its regulations or expectations). The review process will involve consulting frontline staff and people who use the service (where possible) to gather input on how consent processes are working in practice. Any updates will be approved by the Registered Provider or appropriate governance committee and communicated to all staff. Old versions of the policy will be archived, and training will be provided on the new content as necessary.

21. References and Guidance

This policy is informed by the following key documents and guidance, which staff can refer to for further detail:

• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 11: Need for Consent and Regulation 13: Safeguarding from Abuse and Improper Treatment. (Available on the CQC website – Guidance for Providers.)
• Mental Capacity Act 2005 and MCA Code of Practice (TSO, 2007) – especially chapters on assessing capacity, best interests, and the Deprivation of Liberty Safeguards (note: a new Code of Practice is expected with LPS implementation).
• Mental Capacity (Amendment) Act 2019 – introducing Liberty Protection Safeguards (not yet in force at time of writing). Department of Health and Social Care LPS factsheets, which confirm LPS will apply in community settings like supported living – gov.uk.
• Mental Health Act 1983 and MHA Code of Practice (2015) – for guidance on consent to treatment under MHA and interface with MCA.
• CQC Guidance for Providers on Consent and Safeguarding: e.g., Regulation 11 Guidance (which emphasizes providing information in an understandable way and following MCA for those lacking capacity), and Regulation 13 Guidance (which highlights zero tolerance of abuse, need for policies on restraint, and the requirement of lawful authority for any deprivation of liberty).
• Social Care Institute for Excellence (SCIE) – At a Glance briefing on DoLS and related resources on the MCA. These outline the DoLS process and stress that outside care homes/hospitals, the Court of Protection must authorise a deprivation of liberty. Also, SCIE’s materials on Liberty Protection Safeguards offer an overview of upcoming changes.
• Local Authority Safeguarding Adults Board Policies – which may provide additional protocols on raising DoLS/Court of Protection applications and handling safeguarding concerns. Our service will always follow local safeguarding procedures in conjunction with this policy.
• UK Supreme Court judgment of 2 June 2026 concerning the definition of deprivation of liberty.
• Department of Health and Social Care – Changes to the definition of deprivation of liberty, published 15 June 2026.
• Care Quality Commission – Statement on the Supreme Court’s judgment on deprivation of liberty, June 2026.
• Human Rights Act 1998 and Article 5 of the European Convention on Human Rights.
• Equality Act 2010.
• Accessible Information Standard.
• UK GDPR and Data Protection Act 2018.

By following this Consent to Care and Treatment Policy, our supported living service ensures that we deliver care in a way that is lawful, respectful of individuals’ rights, and aligned with CQC’s fundamental standards. All staff must adhere to this policy at all times, thereby protecting service users’ autonomy and welfare while meeting our regulatory responsibilities.

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