Registration Number: {{org_field_registration_no}}

Supporting Individuals with Dementia Policy

1. Purpose

The purpose of this policy is to outline {{org_field_name}}’s commitment to providing high-quality, person-centred care for individuals with dementia. Dementia affects cognitive functions such as memory, thinking, and communication, requiring specialised support to maintain dignity, independence, and quality of life. Our approach ensures that individuals receive compassionate, structured and evidence-based care that aligns with the Care Quality Commission (CQC) Fundamental Standards, the CQC Single Assessment Framework, NICE Dementia Guidelines and the Mental Capacity Act 2005.

2. Scope

This policy applies to:

All employees, including care workers, coordinators, and management.
Service users diagnosed with dementia, ensuring their needs are met with dignity and respect.
Families and caregivers, promoting involvement and collaboration.
Healthcare professionals, ensuring multi-disciplinary support for holistic care.
Regulatory bodies, ensuring compliance with statutory and ethical standards.

It covers:

Principles of dementia care.
Early identification and assessment.
Person-centred care planning.
Supporting communication and engagement.
Managing behavioural and psychological symptoms.
Safeguarding and risk management.
Training and staff development.
Continuous improvement and monitoring.

3. Legal and Regulatory Framework

This policy aligns with the following current legislation, statutory requirements and national guidance:

Care Act 2014 and Care and Support Statutory Guidance – including wellbeing, prevention, person-centred support and safeguarding duties.
Mental Capacity Act 2005 and current Code of Practice – including:
- The presumption of capacity.
- Supporting people to make their own decisions.
- Decision-specific and time-specific assessment of capacity.
- Respect for unwise decisions.
- Best-interests decision-making.
- Least restrictive practice.
Human Rights Act 1998 and Article 5 of the European Convention on Human Rights – including the current legal requirements concerning deprivation of liberty.
The UK Supreme Court judgment of 2 June 2026 concerning deprivation of liberty – requiring a multifactorial assessment of whether care arrangements amount to a deprivation of liberty and replacing reliance on the former standalone Cheshire West “acid test”.
Health and Social Care Act 2008 and Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including:
- Regulation 9 – Person-centred care.
- Regulation 10 – Dignity and respect.
- Regulation 11 – Need for consent.
- Regulation 12 – Safe care and treatment.
- Regulation 13 – Safeguarding service users from abuse and improper treatment.
- Regulation 17 – Good governance.
- Regulation 18 – Staffing.
- Regulation 19 – Fit and proper persons employed.
- Regulation 20 – Duty of Candour.
CQC’s current assessment framework, including the five key questions of Safe, Effective, Caring, Responsive and Well-led and relevant quality statements concerning person-centred care, consent, safeguarding, risk management, staffing and governance.
Equality Act 2010 – including non-discrimination and the requirement to make reasonable adjustments for disabled people.
NICE Guideline NG97 – Dementia: assessment, management and support for people living with dementia and their carers – including person-centred care, involvement in decisions, care coordination, communication, management of distress, medicines, supporting carers and staff training.
Health and Care Act 2022, section 181, and sections 20(5ZA) and 21A of the Health and Social Care Act 2008 – establishing the statutory requirement for learning disability and autism training appropriate to role and the associated Code of Practice.
Oliver McGowan Code of Practice on statutory learning disability and autism training, final from 6 September 2025. The Oliver McGowan Mandatory Training on Learning Disability and Autism is the Government’s preferred and recommended training package; alternative training may be used where it demonstrably meets the statutory Code and is appropriate to role.
UK General Data Protection Regulation and Data Protection Act 2018, as amended by the Data (Use and Access) Act 2025 – governing the lawful, fair and secure processing of information concerning people living with dementia, including health records and information generated through monitoring or tracking technology.

{{org_field_name}} will ensure that dementia care remains person-centred, proportionate, evidence-based and consistent with the person’s legal rights, wishes, preferences and individual circumstances.

4. Principles of Dementia Care

{{org_field_name}} follows key principles to enhance dementia care:

Person-Centred Care: Recognising the unique needs and preferences of each individual.
Dignity and Respect: Treating service users with compassion and maintaining their independence.
Family and Carer Involvement: Engaging relatives in care decisions and emotional support.
Consistency and Routine: Establishing predictable care routines to reduce anxiety.
Evidence-Based Practice: Implementing the latest research in dementia care and interventions.

5. Early Identification and Assessment

To ensure timely intervention, we:

Work closely with GPs, memory clinics, and specialists to identify early signs of dementia.
Conduct comprehensive initial assessments to determine cognitive function, mobility, and social needs.
Develop individualised care plans with ongoing reassessment and adaptation as dementia progresses.

6. Person-Centred Care Planning

Care plans are tailored to the needs of each service user, including:

Daily living support (e.g., personal care, meals, mobility assistance).
Medication management in collaboration with healthcare providers.
Reminiscence therapy, music therapy, and life story work to stimulate memory.
Adjustments to the living environment to enhance safety and reduce confusion.
Regular reviews to adapt care as needs evolve.

7. Mental Capacity, Consent and Deprivation of Liberty

{{org_field_name}} will support people living with dementia in accordance with the Mental Capacity Act 2005, Regulation 11 – Need for consent, and current deprivation-of-liberty law.

A diagnosis of dementia does not mean that a person automatically lacks capacity.

Capacity is:

Presumed unless established otherwise.
Specific to the particular decision.
Assessed at the time the decision needs to be made.
Capable of changing or fluctuating.

7.1. Supporting Decision-Making

Before concluding that a person lacks capacity, staff must take all practicable steps to support them to make the decision themselves.

Support may include:

Using simple and clear language.
Breaking information into smaller parts.
Using pictures, objects, Easy Read information or other communication aids.
Allowing additional time.
Choosing a familiar or calm environment.
Considering the best time of day for the person.
Addressing pain, distress, delirium, infection or other factors that may temporarily affect decision-making.
Involving a trusted person where appropriate and with due regard to confidentiality.
Making reasonable adjustments for sensory or communication needs.

A person must not be treated as lacking capacity merely because they make a decision that others consider unwise.

7.2. Capacity Assessment

Where there is reasonable doubt about the person’s capacity to make a specific decision, an appropriate decision-specific and time-specific assessment must be undertaken and recorded.

The assessment must consider whether there is an impairment of, or disturbance in the functioning of, the person’s mind or brain and whether this means the person is unable to:

Understand the information relevant to the decision.
Retain that information long enough to make the decision.
Use or weigh that information as part of the decision-making process.
Communicate their decision by any means.

Capacity must not be assessed globally.

A person may, for example, have capacity to choose what they wish to eat, wear or do during the day while lacking capacity to make a more complex decision concerning medication, finances or residence.

7.3. Best-Interests Decisions

Where a person lacks capacity for a particular decision, any decision made on their behalf must be in their best interests.

The decision-maker must:

Involve the person as far as reasonably practicable.
Consider the person’s past and present wishes and feelings.
Consider their beliefs and values.
Consider other factors they would likely consider if they had capacity.
Consult relevant family members, carers, attorneys, deputies or advocates where appropriate.
Consider whether the decision can wait until capacity may improve.
Consider all reasonably available alternatives.
Select the least restrictive option compatible with the person’s best interests.

Significant best-interests decisions must be documented clearly.

7.4. Restrictive Practice

Any restriction affecting a person living with dementia must be individually assessed.

Restrictions may include:

Locked or controlled doors.
Preventing a person from leaving their home.
Continuous or extensive supervision.
Physical restraint.
Restrictions on community access.
GPS tracking.
Door or movement sensors.
Video or other monitoring.
Covert medication.
Sedating medication used to manage behaviour.
Restrictions on contact with other people.
Controlling access to possessions or activities.

Restrictions must never be imposed merely:

Because the person has dementia.
For staff convenience.
Because the person’s behaviour is considered difficult.
Because the restriction has historically been included in the care plan.

Any restriction must have a lawful basis and must be necessary, proportionate, clearly documented and regularly reviewed.

7.5. Current Legal Test for Deprivation of Liberty

Following the UK Supreme Court judgment of 2 June 2026, staff must not rely on the former Cheshire West standalone “acid test” as the sole means of deciding whether a person is deprived of their liberty.

The current assessment is multifactorial.

Where restrictive arrangements exist, consideration must be given to the person’s individual circumstances, including:

The type of restrictions imposed.
How long the restrictions operate.
The effects of the restrictions on the person.
How the restrictions are implemented.
The level of supervision and control.
Whether the person is prevented from leaving.
Whether the person objects to the arrangements.
The person’s current wishes and feelings.
Whether they appear content, distressed or unhappy.
Previous expressions of wishes or objections where relevant.
The relative normality of the person’s living arrangements.
How far the arrangements resemble confinement.
The purpose of the restrictions, including whether they are imposed for care and protection rather than punishment or coercion.

No single factor is determinative.

Particular attention must be given to behaviour that may indicate objection, including:

Attempts to leave.
Repeatedly asking to leave.
Refusing or physically resisting care.
Pushing staff away.
Distress associated with restrictions.
Physical restraint being required.
One-to-one supervision used to prevent particular behaviour.
Covert medication where the person objects to taking medication.
Sedating medication that materially affects the person’s ability to express objection.

7.6. Wishes, Feelings and Article 5 Valid Consent

Following the 2026 Supreme Court judgment, a person may in some circumstances be capable of giving valid consent for the limited purposes of Article 5 even though they lack legal capacity under the Mental Capacity Act to consent to their overall care and residence arrangements.

This requires careful consideration of the person’s actual wishes and feelings.

Relevant considerations include whether the person:

Is conscious of their environment.
Has a basic understanding of their living and care arrangements.
Can express, verbally or through behaviour or other communication, whether they accept or are happy with the arrangements.

Staff must not assume that compliance, silence or an absence of resistance automatically means that the person consents.

The question must be what the person actually understands, wants and feels.

Where there is serious doubt about valid consent, no conclusion that valid consent exists should be drawn.

This Article 5 concept does not replace the Mental Capacity Act requirements for assessing capacity and obtaining consent to care and treatment.

7.7. Deprivation of Liberty in a Person’s Own Home

The statutory Deprivation of Liberty Safeguards procedure applies to qualifying arrangements in hospitals and care homes.

It is not the standard authorisation mechanism for domiciliary care delivered in a person’s own home.

Where arrangements in the person’s own home may amount to a deprivation of liberty and lawful authorisation is required, {{org_field_name}} will:

Review the care plan and restrictions.
Establish the person’s current wishes and feelings.
Consider all less restrictive alternatives.
Seek relevant professional advice.
Liaise with the local authority, NHS body or commissioner where appropriate.
Seek legal advice where necessary.
Ensure that consideration is given to an application to the Court of Protection where required.

Where there is uncertainty, significant restriction, fluctuating objection or doubt about valid consent, the matter will be escalated promptly rather than assuming that the arrangements are lawful.

7.8. Liberty Protection Safeguards

The Liberty Protection Safeguards were created by the Mental Capacity (Amendment) Act 2019 but are not currently in force.

Staff must not apply proposed LPS procedures as though they are current law.

Until any replacement system is legally commenced:

Existing DoLS arrangements continue where applicable in hospitals and care homes.
The Court of Protection remains the relevant authorisation route for deprivation of liberty in community settings such as a person’s own home.
Current Mental Capacity Act and Article 5 requirements must continue to be followed.

{{org_field_name}} will update this policy if and when new statutory arrangements are brought into force.

7.9. Recording and Review

Where restrictions are used, records must clearly identify:

The restriction.
Why it is required.
Its legal basis.
The person’s capacity concerning relevant decisions.
The person’s wishes and feelings.
Any objection.
Less restrictive alternatives considered.
The views of relevant representatives or professionals.
The outcome of any deprivation-of-liberty assessment.
Any Court of Protection involvement or authorisation.

Restrictions will be reviewed whenever:

The person’s condition changes.
Capacity changes.
The person begins to object.
Restrictions increase or decrease.
Medication changes materially affect behaviour or communication.
An incident occurs.
A safeguarding concern is identified.
The person’s residence or care arrangements change.

Unnecessary restrictions must be reduced or removed promptly.

8. Supporting Communication and Engagement

Effective communication strategies include:

Using clear, simple language and non-verbal cues.
Encouraging active listening and patience.
Maintaining eye contact and using reassuring tones.
Adapting interactions based on the individual’s communication ability.
Promoting social activities and cognitive stimulation.

9. Managing Behavioural and Psychological Symptoms

To support individuals experiencing agitation, anxiety, or aggression, we:

Use de-escalation techniques to manage distress.
Create calm and structured environments.
Identify and address triggers for behavioural changes.
Work with healthcare professionals to adjust medications if necessary.
Support caregivers with education and stress management techniques.

10. Safeguarding and Risk Management

{{org_field_name}} will protect people living with dementia from abuse, neglect, improper treatment and avoidable harm while recognising their right to autonomy, freedom and positive risk-taking.

We will:

Carry out individual risk assessments appropriate to the person’s needs.
Implement proportionate falls-prevention and environmental measures.
Consider the person’s strengths, preferences and abilities rather than focusing solely on risk.
Review risk assessments when needs or circumstances change.
Follow {{org_field_name}}’s Safeguarding Adults Policy and applicable local Safeguarding Adults Board procedures.
Report actual or suspected abuse, neglect or improper treatment promptly.
Ensure safeguarding concerns are documented and escalated appropriately.

Restrictive Practice and Monitoring Technology

Monitoring or tracking arrangements, including:

GPS devices.
Door sensors.
Movement sensors.
Cameras or other monitoring systems.

must not be introduced automatically because a person has dementia or is considered at risk of going missing.

Before such technology is used, {{org_field_name}} will consider:

The particular risk being addressed.
Whether the person has capacity to consent to its use.
The person’s wishes and feelings.
Whether they object.
The proportionality of the intervention.
Less restrictive alternatives.
Privacy and data protection implications.
Who will have access to monitoring information.
How long information will be retained.
How the arrangement will be reviewed.

Where the person has capacity, valid consent will be obtained unless another lawful basis applies.

Where the person lacks capacity for the relevant decision, a documented Mental Capacity Act best-interests decision will be required.

Where monitoring forms part of wider restrictive arrangements, staff must also consider whether the overall arrangements may amount to a deprivation of liberty using the multifactorial legal assessment applicable following the Supreme Court judgment of 2 June 2026.

The former standalone Cheshire West acid test must not be used as the sole test.

Any restrictive or monitoring arrangement will be:

Necessary.
Proportionate.
Individually assessed.
Properly documented.
Kept under regular review.
Reduced or withdrawn when no longer required.

Concerns about potentially unlawful restriction or deprivation of liberty will be escalated promptly to the Registered Manager and appropriate external professionals or legal advisers.

11. Training and Staff Development

To maintain high-quality dementia care, our staff receive:

Mandatory dementia awareness training.
Specialist training on advanced dementia care techniques.
Workshops on communication skills, behaviour management, and safeguarding.
Regular updates on best practices and research findings.

In line with section 20(5ZA) of the Health and Social Care Act 2008 and the associated code of practice on learning disability and autism training, {{org_field_name}} ensures that all staff working in regulated activities receive training on learning disability and autism that is appropriate to their role. This training sits alongside our dementia training, recognising that some people using our service may have dementia as well as a learning disability or be autistic, and supports staff to make reasonable adjustments and to communicate and provide care safely and effectively.

12. Continuous Improvement , Duty of Candour and CQC Compliance

{{org_field_name}} will monitor and continuously improve the quality of dementia care through:

Regular audits of dementia care plans.
Review of risk assessments.
Review of Mental Capacity Act assessments and best-interests decisions.
Monitoring of restrictive practices.
Review of visit records.
Staff supervision and competency assessment.
Feedback from people using the service.
Feedback from families and representatives.
Complaints and compliments.
Safeguarding concerns.
Incidents and near misses.
Feedback from healthcare and social care professionals.

Findings will be reviewed through the organisation’s governance arrangements and used to improve care plans, staff training and working practices.

Duty of Candour

{{org_field_name}} will act openly and transparently with people receiving care.

Where an incident meets the statutory definition of a notifiable safety incident under Regulation 20, the formal Duty of Candour procedure will be followed.

For {{org_field_name}}, as a registered provider other than an NHS health service body, the statutory threshold requires an unintended or unexpected incident occurring during the provision of a regulated activity which, in the reasonable opinion of a healthcare professional:

Appears to have resulted in:

The death of the service user where the death relates directly to the incident rather than to the natural course of their illness or underlying condition.
An impairment of sensory, motor or intellectual function lasting, or likely to last, continuously for at least 28 days.
Changes to the structure of the person’s body.
Prolonged pain.
Prolonged psychological harm.
A shortening of life expectancy.

Or requires treatment by a healthcare professional to prevent:

Death; or
An injury that would, if left untreated, result in one or more of the outcomes above.

Where the statutory threshold is met, {{org_field_name}} will:

Notify the relevant person as soon as reasonably practicable.
Provide reasonable support.
Provide a truthful factual account of what is known.
Explain further enquiries or investigations considered appropriate.
Provide a sincere apology.
Follow up in writing.
Provide relevant investigation outcomes.
Maintain an appropriate record of the process.

Incidents that do not meet the statutory notifiable safety incident threshold will still be managed openly and transparently where appropriate.

CQC Compliance and Quality Monitoring

{{org_field_name}} will maintain evidence demonstrating compliance with applicable CQC Fundamental Standards and current assessment requirements.

Evidence may include:

Care-plan audits.
Mental capacity and consent records.
Safeguarding records.
Restrictive-practice reviews.
Deprivation-of-liberty assessments.
Staff training and competency.
Supervision and spot checks.
Complaints and feedback.
Incident learning.
Service-user outcomes.

The five CQC key questions of Safe, Effective, Caring, Responsive and Well-led will continue to inform the organisation’s quality-monitoring arrangements while they remain part of CQC’s current regulatory approach.

13. Policy Review and Updates

This policy will be reviewed at least annually, or sooner where necessary, to ensure that it remains accurate, lawful and consistent with current dementia-care guidance and CQC requirements.

An earlier review will be undertaken where:

The Mental Capacity Act 2005 or its Code of Practice changes.
Government guidance following the 2 June 2026 Supreme Court deprivation-of-liberty judgment changes materially.
Further Supreme Court or Court of Protection judgments materially affect deprivation-of-liberty practice.
DoLS arrangements are amended or replaced.
The Liberty Protection Safeguards or another replacement system is brought into force.
CQC requirements concerning dementia care, consent, safeguarding, restrictive practice or governance materially change.
NICE NG97 or other relevant dementia guidance is updated or replaced.
The Oliver McGowan Code of Practice or statutory learning disability and autism training requirements change.
Data protection requirements affecting monitoring or tracking technologies materially change.
A serious incident, safeguarding concern or potentially unlawful restriction identifies weaknesses in current practice.
Audits identify recurring concerns relating to capacity, consent, restraint or restrictive practice.
Feedback from people living with dementia, families, advocates or professionals identifies required improvements.

The Registered Manager is responsible for ensuring that this policy remains current.

The review will consider:

Dementia care plans.
Mental capacity assessments.
Best-interests decisions.
Restrictive-practice records.
The use of GPS, sensors or other monitoring technology.
Deprivation-of-liberty assessments.
Court of Protection involvement.
Safeguarding concerns.
Falls and other incidents.
Medicines concerns.
Duty of Candour cases.
Complaints and feedback.
Staff training and competency.
Service-user outcomes.
Family and carer feedback.
CQC findings.
NICE guidance.
Relevant legislation and case law.

In particular, {{org_field_name}} will ensure that policies, assessment tools, care-plan templates and staff training do not continue to use the former Cheshire West acid test as the sole test for deprivation of liberty.

Any amendment to this policy will be:

Recorded with the review date.
Approved by the appropriate responsible person.
Communicated to relevant staff.
Reflected in care plans, risk assessments and assessment tools where necessary.
Incorporated into staff training or supervision where required.

{{org_field_name}} will use learning from incidents, safeguarding concerns, complaints, audits, service-user feedback and legal developments to continuously improve the quality and rights-based nature of dementia care.

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.

DC44-Supporting Individuals with Dementia Policy