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Mental Capacity and Deprivation of Liberty Safeguards (DoLS) Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} upholds the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) framework in accordance with Care Inspectorate Wales (CIW) regulations. This policy provides clear guidance on assessing, supporting, and safeguarding individuals who may lack the capacity to make certain decisions while ensuring their rights, dignity, and best interests are upheld.

2. Scope

This policy applies to all staff, including care workers, nurses, management, and external professionals working within {{org_field_name}}. It governs the decision-making process for service users aged 16 and over who may lack the capacity to make specific decisions due to cognitive impairment, illness, or disability. It also outlines the procedures for applying DoLS for individuals in care homes who may be deprived of their liberty to receive essential care and treatment.

3. Principles of the Mental Capacity Act (MCA) 2005

The five statutory principles of the MCA guide all decision-making:

• Presumption of capacity: Every adult is assumed to have the capacity to make their own decisions unless proven otherwise.
• Right to make unwise decisions: A person should not be treated as lacking capacity simply because they make an unwise decision.
• Individual support to make decisions: All practical steps must be taken to help a person make their own decisions before considering lack of capacity.
• Best interests: Any decision made on behalf of a person lacking capacity must be in their best interests.
• Least restrictive option: Any intervention must be the least restrictive necessary to achieve the intended outcome.

4. Assessing Mental Capacity A two-stage test

must be used to assess capacity:

1. Does the person have an impairment of the mind or brain (temporary or permanent)? This may be due to dementia, brain injury, learning disability, or mental health conditions.
2. Does this impairment prevent the person from making a specific decision? To assess this, the person must be able to:
   • Understand the relevant information.
   • Retain the information long enough to make a decision.
   • Weigh up the information to make a reasoned choice.
   • Communicate their decision. If a person fails any of these steps, they are considered to lack capacity for that specific decision at that time.

5. Supporting Decision-Making

Before assuming a lack of capacity, staff must:

• Use clear, simple language and visual aids if necessary.
• Provide additional time for the person to process information.
• Engage family members, advocates, or Independent Mental Capacity Advocates (IMCAs) to support the individual.

6. Best Interest Decision-Making Process

If a person lacks capacity, any decision made on their behalf must follow the best interest framework:

• Involve the person as much as possible.
• Consider their past and present wishes, values, and beliefs.
• Consult family members, carers, or IMCAs.
• Avoid discrimination based on age, appearance, or condition.
• Use the least restrictive approach.

7. Deprivation of Liberty Safeguards (DoLS)

When care arrangements restrict an individual’s liberty, a DoLS application must be made. Liberty is considered deprived if:

• The person is under continuous supervision and control.
• They are not free to leave.
• The restrictions are not consented to due to lack of capacity.

7.1 Applying for a DoLS Authorisation If it is determined that a person’s care plan may deprive them of liberty, the following steps must be taken:

1. Submit a Standard Authorisation request to the Local Authority.
2. The Local Authority will assign a Best Interests Assessor (BIA) and a Mental Health Assessor to review the case.
3. If granted, the DoLS authorisation must be reviewed every 12 months or earlier if circumstances change.

7.2 Urgent Authorisations An Urgent Authorisation can be applied if immediate deprivation of liberty is necessary to prevent harm, lasting up to 7 days, pending a full DoLS assessment.

8. Staff Responsibilities

All staff must:

• Recognise signs of lack of capacity and respond appropriately.
• Support service users in making decisions wherever possible.
• Adhere to best interest principles when making decisions for those lacking capacity.
• Follow the correct DoLS application process when necessary.
• Maintain accurate records of capacity assessments, best interest decisions, and DoLS authorisations.
• Attend mandatory MCA and DoLS training to stay updated on legal requirements.

9. Compliance and Monitoring

The Registered Manager is responsible for ensuring:

• Capacity assessments are completed and documented.
• DoLS applications are made correctly and in a timely manner.
• Staff are trained and comply with MCA and DoLS procedures.
• Policies are updated in line with legislative changes.

10. Related Policies

This policy should be read in conjunction with:

• CHW07 – Person-Centred Care Policy
• CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
• CHW36 – Initial Assessment and Care Planning Policy
• CHW42 – Communication and Engagement with Service Users and Families Policy

11. Policy Review

This policy will be reviewed annually or sooner if changes in CIW regulations, DoLS legislation, or operational requirements occur.

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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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