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Registration Number: {{org_field_registration_no}}

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Mental Capacity Act Implementation Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} fully complies with the Mental Capacity Act 2005 (MCA) in all aspects of care and support provided to service users. The MCA is a legal framework designed to empower individuals who may lack capacity to make decisions, ensuring their rights, dignity, and autonomy are protected while enabling appropriate decision-making when necessary.

This policy outlines how {{org_field_name}} ensures that:

• Service users are supported to make their own decisions wherever possible.
• Where individuals lack capacity, decisions are made in their best interests.
• Staff understand their responsibilities under the MCA, ensuring compliance with legal, ethical, and regulatory requirements.
• Records and documentation are maintained to demonstrate adherence to the MCA.

This policy aligns with the Regulation and Inspection of Social Care (Wales) Act 2016, the Social Services and Well-being (Wales) Act 2014, and Care Inspectorate Wales (CIW) standards.

2. Scope

This policy applies to:

• All staff employed by {{org_field_name}}, including care workers, support workers, and managers.
• All individuals receiving care, particularly those with conditions affecting cognitive function such as dementia, learning disabilities, acquired brain injuries, or mental health conditions.
• Families, advocates, and external healthcare professionals involved in decision-making processes.

It covers:

• Assessing mental capacity.
• Supporting decision-making.
• Best Interests decisions.
• Advance decisions and Lasting Power of Attorney (LPA).
• Deprivation of Liberty Safeguards (DoLS).

3. Policy Statement

{{org_field_name}} is committed to ensuring that all individuals receiving care are treated with dignity, respect, and autonomy. The MCA underpins our approach to person-centred care, ensuring that service users:

• Have the right to make their own decisions, even if those decisions seem unwise.
• Receive the necessary support to make informed choices.
• Are protected from decisions that could cause harm, using a least restrictive approach.

All staff at {{org_field_name}} are required to understand, implement, and adhere to the MCA to safeguard the rights of service users and ensure legal compliance.

4. Managing Mental Capacity Act Implementation Efficiently

4.1. The Five Key Principles of the MCA

All staff must apply the five key principles of the MCA in all interactions with service users:

1. Presumption of capacity – Every adult is assumed to have the capacity to make their own decisions unless proven otherwise.
2. Right to make unwise decisions – A person has the right to make decisions others may view as unwise, provided they have the capacity to do so.
3. Support to make decisions – Every effort must be made to support a person in making their own decisions before determining they lack capacity.
4. Best Interests – If a person lacks capacity, any decisions made on their behalf must be in their best interests.
5. Least Restrictive Option – Any intervention must be the least restrictive necessary to achieve the intended outcome.

4.2. Assessing Mental Capacity

Capacity assessments must be decision-specific and undertaken when there is reason to believe a service user may lack the capacity to make a particular decision.

A two-stage test is used:

• Stage 1: Diagnostic Test – Does the person have an impairment or disturbance in the functioning of their mind or brain (e.g., dementia, stroke, learning disability)?
• Stage 2: Functional Test – Does this impairment prevent them from:
  • Understanding the information relevant to the decision?
  • Retaining that information long enough to make a decision?
  • Weighing up the information to make an informed choice?
  • Communicating their decision in any way?

If the answer is yes to any of these, the individual may lack capacity, and further support or intervention is required.

Capacity assessments must be:

• Documented in the service user’s care plan.
• Reviewed regularly and updated if circumstances change.
• Undertaken by trained staff or relevant professionals, where necessary.

4.3. Supporting Individuals to Make Decisions

Before concluding that a person lacks capacity, staff must take all practical steps to support them in making their own decision. This includes:

• Providing information in an accessible format (e.g., using pictures, simple language, or sign language).
• Allowing extra time for decision-making.
• Breaking down complex decisions into smaller steps.
• Involving family members, advocates, or interpreters where needed.

If, despite support, the individual is unable to make a decision, a Best Interests process must be followed.

4.4. Best Interests Decision-Making

When a service user lacks capacity, all decisions made on their behalf must be in their best interests. This process must involve:

• Considering the person’s past and present wishes and feelings.
• Involving family members, advocates, or those with Lasting Power of Attorney (LPA).
• Consulting professionals, such as GPs or social workers, where necessary.
• Choosing the least restrictive option to promote independence.

All Best Interests decisions must be fully documented, including:

• The reason for the decision.
• Who was involved in the decision-making process.
• What alternative options were considered.

4.5. Lasting Power of Attorney (LPA) and Advance Decisions

A Lasting Power of Attorney (LPA) allows a trusted person to make decisions on behalf of an individual who lacks capacity.

• Staff must check whether a service user has an LPA and record this in their care plan.
• Only attorneys registered with the Office of the Public Guardian (OPG) have legal authority to make decisions.

Advance Decisions to Refuse Treatment (ADRT):

• If a service user has an Advance Decision, this must be followed and recorded in their care plan.
• Staff must not override a valid and legally binding ADRT.

4.6. Deprivation of Liberty Safeguards (DoLS)

If a service user lacks capacity and is subject to restrictive practices, a DoLS application may be required to ensure lawful care.

• Staff must not impose restrictions without legal authorisation.
• A DoLS application must be made to the Local Authority if the individual is being deprived of liberty in their own home under a Community DoLS.
• Regular reviews are required to ensure the least restrictive care is provided.

4.7. Staff Training and Compliance

All staff must complete mandatory MCA training upon induction and receive annual refresher training. Training covers:

• Understanding the MCA and its legal implications.
• How to conduct a mental capacity assessment.
• Best Interests decision-making.
• Record-keeping and documentation standards.
• Understanding DoLS procedures.

Managers must ensure staff demonstrate competency in applying the MCA in daily practice.

4.8. Record-Keeping and Documentation

Accurate record-keeping is essential for compliance. Staff must:

• Document all capacity assessments and decisions.
• Record Best Interests meetings and decision-making processes.
• Maintain up-to-date records on LPAs and DoLS authorisations.
• Ensure confidentiality and GDPR compliance when storing records.

5. Related Policies

• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13).
• Restrictive Practices and Physical Interventions Policy (DCW40).
• Confidentiality and Data Protection Policy (DCW34).
• Person-Centred Care Policy (DCW07).

6. Policy Review

This policy will be reviewed annually or sooner if required due to changes in legislation, CIW regulations, or organisational needs.

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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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