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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
We are committed to providing the support individuals may need to make decisions for themselves. This includes:
Using communication aids, interpreters, or visual prompts
Breaking information down into smaller parts
Offering choices one at a time
Creating a calm, private environment to support focused discussions
Involving people they trust, such as family or advocates, if they wish

Support must always be proportionate, free of coercion, and respectful of the individual’s right to make decisions others may disagree with. Staff must record how decisions have been supported in the person’s care notes and personal plan.

4.3 Assessing Mental Capacity
Where there is reason to believe that a person may lack the capacity to make a specific decision at a particular time, a formal capacity assessment must be carried out in line with the Mental Capacity Act 2005 and CHW39. Capacity assessments must:
Be decision-specific and time-specific
Follow the two-stage test (impairment + inability to decide)
Explore whether capacity can be improved with support
Be conducted by a trained member of staff or appropriate professional
Be clearly documented in the individual’s care records

Where a person is found to lack capacity, a best interests decision must be made in accordance with legal frameworks. The individual’s past and present wishes, beliefs, and values must be central to this process, and the least restrictive option must be chosen.

4.4 Consent and Refusal of Care
Every person has the right to give or withhold consent to care and treatment. Staff must seek consent before carrying out any intervention and must respect the individual’s decision to refuse care unless there is a legal or safeguarding justification to act otherwise. Staff must not pressure, persuade, or intimidate a person into accepting care. If a person consistently refuses care that affects their well-being, this must be discussed sensitively, risk-assessed, and reviewed with the multidisciplinary team. The refusal, discussion, and any actions taken must be recorded.

4.5 Risk and Positive Risk-Taking
Autonomy includes the right to take risks and make lifestyle choices that may involve an element of danger. At {{org_field_name}}, we take a balanced approach to risk. Instead of avoiding risk entirely, we work with individuals to understand and minimise risks while supporting their rights and freedom. Risk assessments must reflect the individual’s perspective, cultural context, and desired outcomes. Staff must not impose restrictions unless absolutely necessary, and all restrictions must be justified, proportionate, time-limited, and regularly reviewed.

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 have a duty to:
Respect each individual’s rights, decisions, and dignity
Avoid making assumptions about people’s capacity or preferences
Support individuals to express themselves and participate in decisions
Seek consent before delivering care
Report concerns where an individual’s autonomy may be compromised
Record all decisions, assessments, discussions, and plans clearly in the care file

Managers must ensure that staff are trained in mental capacity, consent, safeguarding, and person-centred practice, and that supervision and care audits include discussion of autonomy-related matters.

4.8 Safeguarding and Deprivation of Liberty
If restrictions are necessary to keep someone safe, they must be authorised through the Deprivation of Liberty Safeguards (DoLS) or, for individuals under 18, appropriate legal orders. Safeguarding concerns must be reported immediately to {{org_field_safeguarding_lead_name}}, {{org_field_safeguarding_lead_role}}, and to the local authority’s safeguarding team: {{org_field_local_authority_authority_name}}. Staff must remain alert to signs of undue influence, coercion, neglect, or forced decision-making.

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.