Deprivation of Liberty Safeguards (DoLS) Audit - Care Homes

Evidence to check

• • DoLS policy is current, reviewed and accessible to staff
• • Policy explains MCA principles, capacity, best interests, restrictions, DoLS applications, conditions and reviews
• • Policy reflects that DoLS remains the current framework for care homes
• • Staff can explain how the policy applies in daily care practice

Evidence to check

• • MCA and DoLS training records, including refresher training
• • Staff can explain the five MCA principles
• • Staff can describe when care may become a deprivation of liberty
• • Supervision, team meetings or competency checks include MCA/DoLS scenarios

Evidence to check

• • Capacity assessments are decision-specific and relate to care and accommodation
• • Assessments record how the resident was supported to understand, retain, weigh and communicate the decision
• • Capacity is not assumed based on diagnosis, age, dementia or disability
• • Assessments are reviewed when needs, risks or presentation changes

Evidence to check

• • Best-interest decision record is completed for care and accommodation
• • Resident's wishes, feelings, beliefs and values are considered
• • Family, advocate, attorney, deputy or professionals are involved where appropriate
• • Least-restrictive options are considered and recorded

Evidence to check

• • Central DoLS tracker is current
• • Tracker includes urgent authorisations, standard applications, authorisations, refusals, expiry dates and conditions
• • Relevant Person's Representative or advocate details are recorded where applicable
• • Manager reviews the tracker regularly to avoid missed renewals or conditions

Evidence to check

• • Urgent authorisation forms are completed correctly
• • Rationale explains why the deprivation of liberty is immediately necessary
• • Urgent authorisation dates and expiry are tracked
• • Standard authorisation request is submitted alongside or promptly after urgent authorisation

Evidence to check

• • Standard authorisation applications are completed and submitted to the supervisory body
• • Applications are made before restrictions become ongoing where this is foreseeable
• • Records explain why the acid test is met: continuous supervision and control, and not free to leave
• • Delays or pending applications are monitored and escalated where needed

Evidence to check

• • Care plan states whether DoLS is applied for, pending, authorised, refused or expired
• • Staff know which residents are subject to DoLS
• • DoLS status is included in handovers or key risk summaries where appropriate
• • Care guidance explains what restrictions are authorised and how care should be delivered lawfully

Evidence to check

• • Authorisation conditions are recorded in the care plan and DoLS tracker
• • Named person is responsible for each condition
• • Evidence shows conditions are being met
• • Non-compliance or difficulty meeting conditions is escalated promptly

Evidence to check

• • Expiry dates are monitored on the DoLS tracker
• • Renewal applications are submitted before expiry where deprivation of liberty continues
• • Expired authorisations are identified and escalated immediately
• • Interim risk and legal advice are considered where gaps occur

Evidence to check

• • Relevant Person's Representative details are recorded
• • IMCA involvement is requested where required
• • Family or advocate input is recorded where appropriate
• • Resident's own voice remains central as far as possible

Evidence to check

• • Each restriction is identified in the care plan and risk assessment
• • Restriction is linked to a specific risk and not used as a blanket rule
• • Less restrictive alternatives have been considered
• • Restriction is reviewed for necessity, proportionality and impact on dignity

Evidence to check

• • Observation of care shows staff promote choice and autonomy where possible
• • Staff do not add extra restrictions beyond those assessed and authorised
• • Care records show residents are supported to move, choose and participate as freely as possible
• • Any additional restrictions are escalated for review

Evidence to check

• • Care reviews include restriction review
• • Restrictions are reviewed after changes in health, mobility, behaviour or risk
• • Reduction or removal is trialled where safe
• • Reviews consider the resident's wellbeing, dignity and quality of life

Evidence to check

• • Staff can identify sampled residents with DoLS authorisations
• • Staff understand conditions and restrictions for those residents
• • Staff know that DoLS does not remove the need to seek consent for daily care
• • Staff know when to escalate concerns about restrictions or changes in need

Evidence to check

• • Care records show efforts to involve the resident
• • Communication aids, time, familiar people or preferred approaches are used
• • Resident's wishes, objections, preferences and emotional responses are recorded
• • Care is adapted in response to the resident's views where possible

Evidence to check

• • Care plans promote freedom and independence where possible
• • Residents are supported to access communal areas, gardens, activities and visitors where appropriate
• • Restrictions on movement or privacy are clearly justified and reviewed
• • Staff avoid institutional or controlling routines

Evidence to check

• • Resident, representative or advocate is informed of rights to challenge
• • Information is provided in an accessible format where possible
• • Relevant Person's Representative understands their role
• • Any request to challenge or review DoLS is escalated and documented

Evidence to check

• • Advocacy need is considered during DoLS process
• • IMCA referral records where required
• • Advocate involvement is documented in care decisions and reviews
• • Staff know how to request advocacy support

Evidence to check

• • Communication records with family or representative
• • Information about DoLS and rights is shared where appropriate
• • Questions or concerns from family are recorded and responded to
• • Confidentiality and resident wishes are considered when sharing information

Evidence to check

• • Incident reviews consider restraint, locked doors, one-to-one supervision, refusal of exit, sensor use or restricted contact
• • New or increased restrictions trigger MCA/DoLS review
• • Safeguarding is considered where restriction may be abusive or unlawful
• • Care plans are updated after incident-related restriction reviews

Evidence to check

• • Care reviews include DoLS status and restriction review
• • Significant changes trigger updated capacity, best-interest or DoLS consideration
• • Authorisation conditions are reviewed during care reviews
• • Relevant people are involved in reviews where appropriate

Evidence to check

• • Restraint or restrictive intervention records are reviewed
• • PRN or sedating medication is monitored for possible chemical restraint
• • Consent, capacity and best-interest decisions are recorded where relevant
• • Use of restraint triggers review of DoLS status and care plan

Evidence to check

• • Assessments consider diagnosis, presentation, supervision and restrictions without making assumptions
• • Staff understand that diagnosis alone does not justify deprivation of liberty
• • Specialist input is sought where presentation is complex
• • Care planning reflects individual needs and least-restrictive support

Evidence to check

• • Records identify when capacity may fluctuate
• • Staff assess capacity at the relevant time and for the specific decision
• • Support is adapted around time of day, communication, pain, distress or medication effects
• • Decisions are reviewed when capacity improves or declines

Evidence to check

• • DoLS audit records are completed regularly
• • Audit checks applications, authorisations, conditions, care plans, staff knowledge and restrictive practice
• • Actions have owners and timescales
• • Audit findings are reported through governance

Evidence to check

• • Named DoLS/MCA lead is identified
• • Lead reviews DoLS tracker and pending applications
• • Lead supports staff with complex MCA/DoLS queries
• • Lead escalates risks or delays to senior management

Evidence to check

• • Meeting minutes include MCA/DoLS themes
• • Supervision discusses consent, restrictions or best-interest decisions where relevant
• • Learning from audits, incidents or authorisation conditions is shared
• • Staff are updated on changes in residents' DoLS status

Evidence to check

• • Staff can explain continuous supervision and control and not free to leave
• • Staff understand examples such as locked doors, constant supervision, restraint or refusal to allow leaving
• • Staff know who to report concerns to
• • Concerns raised by staff are recorded and reviewed

Evidence to check

• • Records of advice from local authority, legal team, safeguarding, IMCA or professionals
• • Complex cases are escalated promptly
• • Advice is documented and reflected in care plans
• • Managers do not leave unclear restrictions unreviewed

Evidence to check

• • DoLS documents are stored securely
• • Staff who need the information can access the current authorisation and conditions
• • Access to sensitive records is restricted appropriately
• • Outdated documents are archived but not confused with current authorisations

Evidence to check

• • DoLS status is checked during hospital transfer, readmission or move
• • Receiving service or hospital is informed of relevant legal status and restrictions where appropriate
• • New application or review is considered if circumstances change
• • Care plans are updated after transitions

Evidence to check

• • Training or briefings make clear that DoLS remains the current framework for care homes
• • Managers monitor official updates on LPS and MCA reform
• • Policies do not state that LPS has replaced DoLS
• • Staff continue to follow MCA and DoLS processes until lawful changes are implemented

Evidence to check

• • Changes in behaviour, mobility, cognition, risk, supervision or restrictions trigger DoLS review
• • Applications or review requests are submitted where needed
• • Care plans and risk assessments are updated promptly
• • Staff are briefed on changed restrictions or conditions

Evidence to check

• • Audit includes observation of practice and staff questioning
• • Audit checks whether residents have meaningful choice, movement, privacy and autonomy
• • Audit reviews whether restrictions are actually least restrictive
• • Actions from audits improve daily practice and reduce unnecessary restriction