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{{org_field_name}}

Registration Number: {{org_field_registration_no}}

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People’s Decision-Making and Autonomy Policy

1. Purpose

This policy outlines {{org_field_name}}’s commitment to upholding the right of every individual receiving care to make their own decisions, exercise autonomy, and have control over their day-to-day lives and future plans. In line with the Regulation and Inspection of Social Care (Wales) Act 2016, the Social Services and Well-being (Wales) Act 2014, and CIW’s quality standards, this policy promotes a culture of respect, dignity, empowerment, and person-led care. It provides staff with clear guidance to support individuals to make informed choices, understand and assess capacity, avoid unnecessary restrictions, and respect the diversity of views, preferences, and lifestyles within the home.

2. Scope

This policy applies to all staff members at {{org_field_name}}, including care workers, domestic staff, administrative staff, volunteers, and agency personnel. It relates to all individuals using our service, regardless of age, background, health status, or communication needs. The policy also supports engagement with family members, advocates, representatives, and external professionals who contribute to care planning and decision-making.

3. Related Policies

This policy should be read in conjunction with:
CHW07 – Person-Centred Care Policy
CHW08 – Dignity and Respect Policy
CHW09 – Consent to Care Policy
CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
CHW36 – Initial Assessment and Care Planning Policy
CHW39 – Mental Capacity and Deprivation of Liberty Safeguards Policy
CHW42 – Communication and Engagement with Service Users and Families Policy

4. Policy Details

4.1 Promoting Autonomy and Choice

At {{org_field_name}}, we believe that every person has the right to make their own decisions and be supported to live the life they choose. This includes decisions about daily routines, personal care, food and drink, clothing, relationships, hobbies, spiritual beliefs, cultural identity, risk-taking, and long-term planning. Staff must never assume that a person cannot make a decision because they have a disability, live with dementia, or make choices that others may consider unwise. We promote autonomy by:
Taking time to understand each person’s preferences, values, and communication style
Providing information in accessible formats to support understanding
Giving people time to consider their options
Asking for and listening to people’s views before decisions are made about their care or the service
Supporting people to change their minds and make different decisions as their circumstances evolve

4.2 Supported Decision-Making

{{org_field_name}} will take all practicable steps to support an individual to make their own decision before concluding that they are unable to do so. The support provided must be appropriate to the particular decision, the individual’s communication needs, language needs, level of understanding and circumstances.

Staff must ensure that individuals are given the information they need to make or participate in decisions about their care, support and personal outcomes. Information must be provided in an appropriate language, style, presentation and format and must be explained or repeated where necessary.

Support may include:

• identifying and using the individual’s preferred method of communication;
• taking reasonable steps to meet the individual’s language needs, including their Welsh-language needs;
• providing information in Welsh where this is the individual’s language of need or choice;
• using communication aids, assistive technology, interpreters, British Sign Language, Makaton, pictures, objects of reference, easy-read material or other appropriate communication methods;
• ensuring that any communication aids or equipment required by the individual are available, accessible, maintained and used correctly;
• presenting information in smaller or simpler parts;
• considering one choice or issue at a time;
• choosing a time of day when the individual is most able to understand and engage;
• providing sufficient time for the individual to process information and communicate their decision;
• reducing noise, distraction, anxiety or environmental barriers;
• involving a person whom the individual trusts where the individual wishes this and the person’s involvement is lawful and appropriate; and
• arranging access to advocacy where required or requested.

Support must be proportionate, must not amount to coercion or undue influence and must not be used to steer the individual towards the decision preferred by staff, relatives or professionals.

An individual must not be treated as unable to make a decision merely because they make a decision that staff, relatives or professionals consider unwise.

The person’s personal plan and care records must identify relevant communication and decision-making support and, where significant decisions are made, record the support provided and the individual’s wishes, feelings and decision.

4.3 Assessing Mental Capacity

All staff must work in accordance with the Mental Capacity Act 2005 and its statutory principles.

Staff must apply the following principles:

• an individual must be presumed to have capacity unless it is established that they lack capacity;
• an individual must not be treated as unable to make a decision unless all practicable steps to help them make the decision have been taken without success;
• an individual must not be treated as unable to make a decision merely because they make an unwise decision;
• any act done or decision made on behalf of an individual who lacks capacity must be in their best interests; and
• before an act is done or a decision is made on behalf of an individual who lacks capacity, consideration must be given to whether the purpose can be achieved in a way that is less restrictive of the individual’s rights and freedom of action.

Capacity is decision-specific and time-specific. A diagnosis, disability, dementia, learning disability, mental illness, communication difficulty, age, appearance, behaviour or previous finding of incapacity must never by itself be treated as evidence that an individual lacks capacity to make the decision in question.

Where there is a reasonable basis for questioning an individual’s capacity to make a particular decision at a particular time, the appropriate decision-maker must assess capacity in accordance with the Mental Capacity Act 2005.

The assessment must establish:

• whether the individual has an impairment of, or disturbance in the functioning of, the mind or brain; and
• whether, because of that impairment or disturbance, the individual is unable to make the particular decision when it needs to be made.

For the purposes of the assessment, an individual is unable to make a decision if, after all practicable support has been provided, they are unable to:

• understand the information relevant to the decision;
• retain that information for long enough to make the decision;
• use or weigh that information as part of the decision-making process; or
• communicate their decision by any means.

The assessment must be proportionate to the significance and complexity of the decision. Where the decision is complex, disputed, high risk or outside the competence of care staff, an appropriately qualified health or social care professional must be involved.

Capacity assessments and the evidence supporting the conclusion must be recorded clearly in the individual’s care records. The record must identify the specific decision, the relevant information considered, the practicable steps taken to support the individual, the outcome of the assessment and the reasons for the conclusion.

Capacity must be reconsidered where circumstances change, where there is evidence that the person’s ability to make the decision may have changed, or where the decision needs to be made again.

Where an individual lacks capacity to make the particular decision, any decision made or action taken on their behalf must comply with the best-interests requirements of the Mental Capacity Act 2005. The decision-maker must, so far as reasonably practicable:

• encourage and enable the individual to participate;
• consider whether the individual may regain capacity and whether the decision can reasonably wait;
• consider the individual’s past and present wishes and feelings;
• consider any relevant written statement made by the individual when they had capacity;
• consider the individual’s beliefs, values and other factors they would be likely to consider if they had capacity; and
• consult relevant people where it is practicable and appropriate to do so, including anyone named by the individual, persons engaged in caring for them, close family members where appropriate, an attorney acting under a valid Lasting Power of Attorney, a Court of Protection deputy and an Independent Mental Capacity Advocate where the statutory criteria apply.

No family member, friend or representative may make a decision on behalf of an adult who lacks capacity merely because of their relationship with the individual. They must have the individual’s consent or appropriate legal authority where decision-making authority is required.

The least restrictive lawful option that achieves the required purpose must always be considered.

4.4 Consent and Refusal of Care

Staff must seek valid consent before providing care, support or treatment where consent is required.

Consent must be:

• given by a person who has capacity to make the particular decision;
• voluntary and free from coercion, undue influence or pressure; and
• informed by sufficient information about what is proposed, including relevant options and consequences.

Consent is an ongoing process and must not be treated as permanently established because an individual previously agreed to care or because a consent form has been signed. Staff must remain alert to verbal and non-verbal indications that the individual has changed their mind or is withdrawing consent.

An individual who has capacity to make the relevant decision has the right to refuse care or treatment, even where staff or professionals consider the decision unwise or believe that refusal may adversely affect the individual’s health or well-being.

Where an individual with capacity refuses care, staff must not provide that care against the individual’s wishes unless another lawful authority specifically permits this.

Staff must:

• ensure that the individual has been given relevant information in a form they can understand;
• establish whether the refusal is voluntary;
• explore the reasons for refusal sensitively;
• consider whether an alternative acceptable approach is available;
• consider any immediate risks;
• seek appropriate clinical, safeguarding or management advice where necessary; and
• clearly record the refusal, discussions, risks identified and actions taken.

A safeguarding concern does not, by itself, remove the right of an adult with capacity to make their own decisions.

Where an individual lacks capacity to consent to a particular act of care or treatment, staff must identify and record the lawful basis on which the act is carried out. This may include a best-interests decision under the Mental Capacity Act 2005, a decision made by an attorney acting within the scope of a valid Lasting Power of Attorney for health and welfare, a decision made by a Court of Protection deputy acting within their authority, or another relevant court order or statutory authority.

Staff must identify whether the individual has made a valid and applicable advance decision to refuse treatment. A valid and applicable advance decision to refuse treatment has legal effect in accordance with the Mental Capacity Act 2005 and must be brought promptly to the attention of the relevant healthcare professional.

Any known advance statement, advance decision to refuse treatment, Lasting Power of Attorney for health and welfare, Court of Protection deputyship or relevant court order must be recorded in the individual’s personal plan and made available to staff who need the information to provide lawful care.

Where there is uncertainty or disagreement about consent, capacity, an advance decision, an attorney’s authority, a deputy’s authority or the lawfulness of proposed care, the manager must obtain appropriate professional or legal advice before proceeding, except where immediate action is lawfully required in an emergency.

4.5 Risk, Positive Risk-Taking and Restrictive Practice

{{org_field_name}} recognises that autonomy, independence and control over everyday life include the opportunity to make choices and take positive risks.

Staff must work with individuals to identify risks, understand what matters to them and identify proportionate ways of reducing avoidable harm without unnecessarily restricting their rights, choices or independence.

Risk assessments and personal plans must take account of:

• the individual’s wishes, feelings and personal outcomes;
• their capacity to make the relevant decision;
• the nature and likelihood of the identified risk;
• the potential seriousness of harm;
• relevant cultural, religious, communication and personal factors;
• the impact on other individuals;
• reasonable adjustments that could reduce risk; and
• less restrictive alternatives.

A person with capacity must not be prevented from making a decision merely because that decision involves risk or because staff, relatives or professionals consider the decision unwise.

Care and support must not include acts intended to control or restrain an individual unless the act is necessary to prevent a risk of harm to the individual or another person and is a proportionate response to that risk.

Control, restraint or restrictive practice must:

• be used only where lawful;
• be necessary and proportionate to the identified risk of harm;
• be the least restrictive effective option reasonably available;
• take account of the individual’s needs and capacity to consent;
• be carried out in accordance with the service’s policy on control, restraint and restrictive practice;
• be carried out only by staff trained and competent in the method used where Regulation 29 applies;
• never be used as punishment, for staff convenience or because of inadequate staffing; and
• be discontinued as soon as it is no longer necessary.

For these purposes, restraint may include the use or threatened use of force to secure an act that the individual resists and restriction of an individual’s liberty of movement, including through physical, mechanical or chemical means.

Any incident involving control or restraint within Regulation 29 must be recorded within 24 hours.

Records must contain sufficient information to enable the provider to review:

• what happened before, during and after the incident;
• the risk of harm that made the intervention necessary;
• why the intervention was considered proportionate;
• the type and duration of restraint or restriction used;
• who was involved;
• any injury or adverse effect;
• actions taken following the incident; and
• whether the individual’s assessment, risk management arrangements or personal plan require review.

Patterns of control, restraint and restrictive practice must be monitored through the service’s governance and quality-assurance arrangements.

Where restrictions may amount to a deprivation of liberty, section 4.8 of this policy must be followed.

4.6 Advocacy and Independent Support

Where a person has difficulty making or communicating decisions, or where there is conflict over what is in their best interests, we will support access to an independent advocate. This may include:
Independent Mental Capacity Advocates (IMCAs) for serious medical treatment or care moves
Independent Mental Health Advocates (IMHAs) where applicable
Children’s rights advocates for young people
Advocacy services provided by the local authority or voluntary sector

Staff must make referrals promptly and work in partnership with advocates to ensure the person’s views and rights are fully represented.

4.7 Staff Responsibilities

All staff must:

• presume that an individual has capacity unless it is established otherwise in relation to the specific decision;
• take all practicable steps to support the individual to make their own decision;
• respect an individual’s right to make an unwise decision where they have capacity to do so;
• provide information in an appropriate language, style, presentation and format;
• use the individual’s identified communication aids and methods;
• take reasonable steps to meet the individual’s language needs, including Welsh-language needs;
• seek valid consent before providing care or treatment where consent is required;
• recognise and respond appropriately when consent is refused or withdrawn;
• follow any valid and applicable advance decision to refuse treatment and any lawful decision made by an authorised attorney, deputy or court;
• ensure that decisions made for an individual who lacks capacity comply with the Mental Capacity Act 2005 and are made in the individual’s best interests;
• seek advice where there is uncertainty about capacity, consent, legal authority, restrictive practice or deprivation of liberty;
• avoid unnecessary restrictions on an individual’s rights, choices or freedom;
• comply with the service’s policy on control, restraint and restrictive practice;
• report and record the use of control or restraint in accordance with Regulation 29 and the service’s procedures;
• remain alert to coercion, undue influence, abuse, neglect, improper treatment and unlawful restriction;
• report safeguarding concerns without delay in accordance with safeguarding procedures;
• recognise circumstances that may amount to a deprivation of liberty and escalate these promptly to the manager;
• follow any conditions attached to a lawful deprivation-of-liberty authorisation or court order; and
• make accurate, contemporaneous records of significant decisions, capacity assessments, best-interests decisions, refusals, restrictions, consultations and actions taken.

Managers must ensure that staff receive induction, training, supervision and refresher training appropriate to their role in relation to:

• the Mental Capacity Act 2005;
• consent;
• supported decision-making;
• best-interests decision-making;
• deprivation of liberty;
• control, restraint and restrictive practice;
• safeguarding;
• communication; and
• person-centred care.

Training must be reviewed and updated where legislation, case law or national guidance changes.

Managers must use supervision, care-record audits, incident reviews and quality-assurance arrangements to check that individuals’ autonomy, capacity, consent and legal rights are being properly considered and recorded.

4.8 Safeguarding and Deprivation of Liberty

No individual may be deprived of their liberty for the purpose of receiving care and support without lawful authority.

{{org_field_name}} will act in accordance with the Mental Capacity Act 2005, the Deprivation of Liberty Safeguards where applicable, relevant court orders, current statutory guidance and binding case law.

Restrictions on an individual’s movement, choices or activities do not automatically constitute a deprivation of liberty. Where care arrangements include significant restrictions, the service must assess whether the arrangements amount to a deprivation of liberty under the law as it applies at that time.

Following the Supreme Court judgment of 2 June 2026 in [2026] UKSC 16, staff and managers must not rely solely on the former Cheshire West “acid test” of continuous supervision and control and not being free to leave as determinative of whether a deprivation of liberty exists.

Assessment must consider the individual’s concrete situation as a whole and the type, duration, effects and manner of implementation of the measures concerned, together with other legally relevant circumstances. The distinction between a restriction of liberty and a deprivation of liberty is one of degree and intensity and must be assessed on the facts of the individual case.

The individual’s actual wishes, feelings, experience and response to the arrangements must be considered. A finding that the individual lacks capacity under the Mental Capacity Act 2005 to make decisions about residence or care must not, by itself, be treated as automatically establishing the absence of valid consent for the purposes of Article 5 of the European Convention on Human Rights.

Where an individual who lacks legal capacity nevertheless has sufficient awareness of their living arrangements to communicate whether they are happy or unhappy with them, their wishes and feelings must be taken into account when assessing whether the arrangements amount to a deprivation of liberty. Where there is serious doubt about whether the individual genuinely agrees to the arrangements, valid consent must not be assumed.

Where there is uncertainty as to whether arrangements amount to a deprivation of liberty, the manager must seek appropriate advice from the relevant supervisory body, responsible public authority and, where necessary, legal advisers.

For adults aged 18 and over in care homes, where the arrangements amount to a deprivation of liberty and the Deprivation of Liberty Safeguards apply, the service must make or facilitate the required request to the appropriate supervisory body and must not treat an unauthorised deprivation of liberty as lawful merely because an application has been submitted.

The service provider must notify Care Inspectorate Wales of any request made to a supervisory body concerning the application of the Deprivation of Liberty Safeguards, in accordance with Regulation 60 and Schedule 3 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017. The notification must be made through the method required by CIW and without delay in accordance with the applicable notification requirements.

The service must monitor the progress and outcome of each application and comply with any conditions attached to an authorisation. The individual’s personal plan and relevant risk assessments must accurately record the restrictions authorised and the arrangements for monitoring and review.

The service must continue to consider whether restrictions can be reduced or removed. An authorisation must never be regarded as authority to impose restrictions beyond those that are necessary, proportionate and lawfully authorised.

Where a person’s circumstances, wishes, capacity, level of restriction or care arrangements materially change, the service must review the arrangements promptly and seek a review or further authorisation where required.

Where a child under the age of 18 is subject to arrangements amounting to a deprivation of liberty, the adult Deprivation of Liberty Safeguards must not be used. The service must ensure that appropriate lawful authority exists, which may include a relevant court order.

Where {{org_field_name}} provides a care home service for children and a child is subject to a deprivation of liberty order, the service must comply with the terms of that order and any applicable CIW notification requirements. Where required by CIW, the service’s Statement of Purpose must be reviewed and revised to accurately describe the service being provided.

All restrictions authorised under a deprivation-of-liberty arrangement or court order must be clearly communicated to staff, implemented only within the scope of the lawful authority and regularly reviewed.

Any suspected unlawful deprivation of liberty, unauthorised restriction, coercion, abuse, neglect or improper treatment must be reported immediately to the manager and dealt with under safeguarding procedures. Where required, concerns must be referred to the local authority safeguarding team, Care Inspectorate Wales, the police or another appropriate body.

Staff must be trained to recognise restrictions and potential deprivations of liberty and must receive updated training when legislation, case law or national guidance changes.

5. Policy Review

This policy will be reviewed annually or sooner if required following changes in legislation, CIW guidance, case law, or feedback from residents, staff, or regulatory visits. It forms part of {{org_field_name}}’s commitment to delivering rights-based, safe, and empowering care to all.

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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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.