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Registration Number: {{org_field_registration_no}}

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Consent to Care Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} obtains, records, and manages valid and informed consent from individuals using our domiciliary care services. Consent is a fundamental human right and a core principle of person-centred care. It reflects the right of individuals to make decisions about their own lives and ensures that care is provided with dignity, autonomy, and respect.

This policy is designed to:

• Protect the rights of individuals to make informed decisions about their care and support.
• Ensure legal compliance with the Mental Capacity Act 2005, The Social Services and Well-being (Wales) Act 2014, and The Regulation and Inspection of Social Care (Wales) Act 2016​.
• Provide clear guidance to all staff on how to obtain, record, and respect consent appropriately.
• Outline procedures for assessing mental capacity, dealing with refusal of consent, and making decisions in the best interests of individuals.
• Promote transparency and accountability, ensuring that consent is an integral part of care planning and service delivery.

Effective consent procedures enhance trust between service users, their families, care providers, and regulatory bodies such as Care Inspectorate Wales (CIW).

2. Scope

This policy applies to:

• All individuals receiving care from {{org_field_name}}.
• Family members, legal representatives, and advocates acting on behalf of service users.
• All staff, including care workers, managers, and administrative personnel involved in care planning.
• Multi-disciplinary professionals involved in the care and decision-making process.

This policy covers:

• Different types of consent (verbal, written, implied).
• Procedures for obtaining consent before delivering care.
• Assessing and recording consent appropriately.
• Handling refusal or withdrawal of consent.
• Mental capacity assessments and best interest decisions.

3. Legal and Regulatory Framework

This policy ensures full compliance with:

3.1 The Regulation and Inspection of Social Care (Wales) Act 2016

• Establishes legal requirements for service providers and responsible individuals to respect individuals’ rights, including obtaining informed consent before providing care​.

3.2 The Social Services and Well-being (Wales) Act 2014

• Recognises the right of individuals to control their care and support and requires providers to actively involve them in decision-making​.

3.3 The Mental Capacity Act 2005

• Provides the legal framework for assessing mental capacity and making decisions in the best interests of those who lack capacity.

3.4 The Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended) and statutory guidance for providers of care home and domiciliary support services (Welsh Government).

These set out the detailed requirements for how domiciliary support services must be provided, including how people are supported to understand information, communicate, access advocacy, and how providers evidence lawful consent (or lawful authority where a person cannot consent).

3.5 Care Inspectorate Wales (CIW) Regulations and Safeguarding Policy

• CIW mandates that service providers ensure consent is properly obtained and recorded, and that individuals are protected from harm if they are unable to consent​.

3.6 The Human Rights Act 1998 and Equality Act 2010

• Ensures that individuals retain their rights regardless of age, disability, mental capacity, or personal circumstances​.

4. Principles of Consent

Consent must be:

1. Given voluntarily – Without coercion, pressure, or undue influence.
2. Informed – The individual must have full information about the proposed care, including benefits, risks, and alternatives.
3. Specific – Consent must relate to a particular intervention or care plan.
4. Capacity-based – The individual must have the mental capacity to make an informed decision.

5. Types of Consent

5.1 Informed Consent

• Individuals must be given clear, understandable information about:
  • The type of care being proposed.
  • The potential risks, benefits, and alternatives.
  • The right to refuse or withdraw consent.
• Information must be provided in a format suited to the person’s needs (e.g., easy-read documents, visual aids, or translation services).
• {{org_field_name}} will ensure the person has the information they need to make day-to-day decisions about their care, and that it is provided in the appropriate language, style, presentation and format. Where required, staff must ensure the person receives support to understand the information (for example interpreters, BSL, communication tools, easy-read) and this must be reflected in the care plan and daily records.
• Informed consent must be documented in the care plan.

5.2 Verbal Consent

• Suitable for routine tasks such as:
  • Assisting with personal care.
  • Administering medication.
  • Supporting mobility or meal preparation.
• Verbal consent must be reconfirmed each time care is provided and recorded in care notes.

5.3 Written Consent

Written consent is required for significant decisions and higher-risk interventions, including (where applicable):

• Major changes to the care plan or agreed outcomes.
• Sharing personal information with third parties (including professionals) beyond what is necessary for direct care.
• Any planned use of technology/surveillance that affects privacy.
• Any element of care that may amount to control, restraint or restrictive practice, or restrictions on movement/access, where consent is required or where lawful authority must be considered.
• Covert administration of medication (only where appropriate best-practice and legal safeguards are in place and authorised through the correct decision-making process).
• Any delegated healthcare tasks undertaken by staff (e.g., where tasks are delegated by a regulated professional), ensuring competence, documentation and governance requirements are met.

5.4 Implied Consent

• Inferred from a person’s actions (e.g., extending an arm for assistance).
• Cannot be used for major care decisions.

5.5 Advocacy (support to express views and make decisions)

Individuals will be offered information about, and supported to access, advocacy services where they want help to understand information, express their wishes, or take part in decisions about care and support. Where an individual has substantial difficulty being involved and has no appropriate person to support them, staff must escalate this to management so that advocacy can be arranged through the relevant pathways (including statutory and complaints advocacy services). Any advocacy involvement must be recorded in the care plan and care notes.

6. Mental Capacity and Best Interests

6.1 Assessing Mental Capacity

• If a person’s ability to consent is in question, staff must follow the Mental Capacity Act 2005.
• Capacity must be assessed for each specific decision – a person may have capacity for some decisions but not others.
• A two-stage test must be used:
  1. Does the person have an impairment affecting their decision-making ability?
  2. Can they understand, retain, and weigh up information to make a decision?

6.2 Best Interests Decision-Making

If a person lacks capacity, decisions must be made in their best interests, considering:

• Their past wishes, values, and preferences.
• Input from family, advocates, or attorneys.
• The least restrictive option that still ensures safety.

Staff must document all capacity assessments and best interest decisions.

6.3 Deprivation of Liberty and lawful authority

An individual must not be deprived of their liberty for the purpose of receiving care and support without lawful authority. Where restrictions are proposed and the person lacks capacity to consent to the arrangements, staff must follow the Mental Capacity Act 2005, apply the least restrictive options, and escalate immediately to management to determine whether a Deprivation of Liberty Safeguards (DoLS) application or other lawful framework is required. All decisions, consultation and outcomes must be recorded in the care plan and care notes.

7. Refusal and Withdrawal of Consent

7.1 Managing Refusal of Care

• Individuals have the right to refuse care.
• Staff must:
  • Respect the decision unless it puts the person or others at serious risk.
  • Explore reasons for refusal and offer alternative solutions.
  • Document refusals and escalate concerns if refusal may cause harm.

7.2 Withdrawing Consent

• Consent can be withdrawn at any time.
• If withdrawal affects essential care, a review meeting will be arranged to discuss alternative options.

8. Staff Responsibilities and Training

8.1 Responsibilities of Care Staff

• Always seek informed consent before providing care.
• Respect decisions, including refusal or withdrawal of consent.
• Maintain clear, accurate records of consent.
• Escalate concerns regarding capacity or safeguarding.

8.2 Responsibilities of Management

• Ensure all staff receive annual training on consent procedures.
• Conduct regular audits to ensure compliance with consent policies.
• Oversee capacity assessments and best interest decisions.

8.3 Staff Training

• New staff receive detailed training on consent, mental capacity, and safeguarding.
• Annual refresher courses ensure knowledge remains current.
• Real-world case studies and role-playing exercises help staff apply consent principles effectively.

9. Documentation and Record-Keeping

9.1 Care Plans and Consent Forms

Written consent is recorded in care plans, with regular updates as needed.

Consent records and care notes must be accurate, contemporaneous, and stored securely in line with data protection requirements. Individuals (or their lawful representative) must be supported to access their records in accordance with legal requirements, and staff must know what to do if information is lost, incorrectly shared, or otherwise compromised.

9.2 Incident Reporting

Any refusal of essential care is documented and reviewed.

10. Policy Review

This policy will be reviewed annually or earlier if legislation changes or CIW updates guidance.

This policy ensures {{org_field_name}} operates with transparency, accountability, and respect, upholding the highest standards of consent management in domiciliary care.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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