Mental Capacity and Consent Audit - Domiciliary Care

Evidence to check

• • Staff can explain the MCA principles in practical terms
• • Staff assume capacity unless there is evidence otherwise
• • Staff describe how they support choice during visits
• • MCA and consent policy is current, accessible and relevant to domiciliary care

Evidence to check

• • MCA training records
• • Staff scenario-based responses
• • Spot checks or supervision records showing consent and choice in practice
• • Evidence of additional guidance where staff understanding is weak

Evidence to check

• • Care plans identify decision-specific capacity where relevant
• • Staff understand which decisions the person can make independently
• • Care records reflect the person's choices and refusals
• • No blanket statements such as 'lacks capacity' without context

Evidence to check

• • Decision-specific capacity assessments
• • Assessment states the exact decision being considered
• • Assessment records the information given to the person
• • Different decisions are assessed separately where needed

Evidence to check

• • Capacity assessment forms or records
• • Date, time and assessor clearly identified
• • Evidence of the two-stage capacity test
• • Assessment explains why the person could or could not make the decision

Evidence to check

• • Best-interest records consider less restrictive alternatives
• • Care plan avoids unnecessary restrictions
• • Staff can explain how they promote choice and independence
• • Restrictions are reviewed and reduced where possible

Evidence to check

• • Staff can describe indicators of possible lack of capacity
• • Care notes show concerns escalated to the office or manager
• • Capacity concerns trigger review rather than staff making assumptions
• • Professional advice sought where the decision is complex or high risk

Evidence to check

• • Best-interest decision records
• • Decision clearly linked to the person's welfare, rights and wishes
• • Care plan updated following the best-interest decision
• • Staff understand the decision and how to apply it during visits

Evidence to check

• • Records of consultation with relevant people
• • Advocacy referral where the person has no appropriate representative
• • LPA or deputy involvement where legally authorised
• • Rationale recorded where family views are not followed

Evidence to check

• • Best-interest record explains options considered
• • Person's past and present wishes are considered
• • Risks and benefits are balanced
• • Final decision and review arrangements are recorded

Evidence to check

• • Consent records before care begins
• • Care plan reflects what the person has agreed to
• • Refusals or conditions of consent are recorded
• • Consent is not assumed from family agreement alone

Evidence to check

• • Consent records for care, medication and data sharing
• • Review notes show consent revisited after changes
• • Staff understand what the person has consented to
• • Care records show consent being sought during visits

Evidence to check

• • Care plan identifies any LPA
• • Staff understand the difference between health and welfare LPA and property and affairs LPA
• • Decisions are referred to the correct attorney where relevant
• • Staff do not assume family members have legal authority without evidence

Evidence to check

• • Copy of registered LPA document or verified access code/check
• • Office of the Public Guardian registration confirmed
• • Restrictions or conditions in the LPA checked
• • Care records show the attorney was involved only in decisions within their authority

Evidence to check

• • Staff scenario-based responses
• • Care plan records the correct legal role
• • Financial decisions are not confused with health and welfare decisions
• • Deputyship or appointeeship evidence is recorded where relevant

Evidence to check

• • Care plan identifies restrictions such as locked doors, constant supervision, restricted access or control of movement
• • Mental capacity and best-interest records support the restriction
• • Less restrictive options considered
• • Escalation to local authority, commissioner or legal route where deprivation of liberty may arise

Evidence to check

• • Records identify restrictions that may amount to deprivation of liberty
• • Manager has sought local authority, commissioner or legal advice where required
• • Staff understand DoLS applies to care homes and hospitals, not ordinary domiciliary care in the same way
• • Court of Protection route considered where a community deprivation of liberty may exist

Evidence to check

• • Staff can explain internal escalation routes
• • Whistleblowing and safeguarding procedures are accessible
• • Records of concerns raised about restrictions or poor practice
• • Managers respond to challenges and review decisions

Evidence to check

• • Care plan records communication needs and preferred decision-making support
• • Records show choices and refusals are respected
• • Capacity reassessed when the person's presentation changes
• • Staff use timing, familiar people or communication aids to support decisions

Evidence to check

• • Easy read, large print, translated or visual information where needed
• • Staff can explain how they check understanding
• • Care notes show information was discussed before decisions
• • Family or advocate support used appropriately without overriding the person

Evidence to check

• • Care review records
• • Capacity and consent revisited after changes
• • Updates made to care plans and risk assessments
• • Staff informed where consent or decision-making arrangements change

Evidence to check

• • Advance decision or advance care planning records where applicable
• • Care plan reflects the person's future wishes
• • Staff know where to find relevant information in an emergency
• • GP, family or professionals involved where appropriate

Evidence to check

• • Positive risk-taking records
• • Risk assessment balances safety with choice and independence
• • Person's views and reasons are recorded
• • Staff do not impose unnecessary restrictions because they disagree with the choice

Evidence to check

• • Care notes record concerns about pressure or coercion
• • Safeguarding referrals where required
• • Staff speak to the person privately where safe and appropriate
• • Capacity and consent decisions consider whether the person is making a free choice

Evidence to check

• • MCA audit records
• • Audits include staff questioning, care record sampling and practice review
• • Audit actions are followed up
• • Findings inform training, supervision or policy updates

Evidence to check

• • Incident records linked to MCA or consent
• • Lessons learned records
• • Care plans or risk assessments updated after incidents
• • Learning shared through supervision, meetings or staff briefings

Evidence to check

• • Manager review of MCA and consent records
• • Supervision notes showing MCA guidance to staff
• • Evidence managers challenge blanket restrictions or poor consent practice
• • Complex decisions escalated appropriately

Evidence to check

• • Care plan, consent forms and MCA records are consistent
• • Staff know where to find current decision-making information
• • Outdated or contradictory records removed or archived
• • Digital and paper records match where both are used

Evidence to check

• • Observation during spot checks where possible
• • Care notes record refusals or changes of mind
• • Staff can explain how they seek consent before personal care, medication or moving and handling
• • Staff do not continue care where valid consent is withdrawn unless there is lawful authority

Evidence to check

• • Care plan review records after change in circumstances
• • Handover or staff communication records
• • Capacity or best-interest decisions updated where required
• • No delay between change in need and updated guidance to staff

Evidence to check

• • Care notes record refusals and staff response
• • Staff consider pain, distress, communication, timing or preference
• • Repeated refusals trigger review
• • Escalation to family, GP, manager or safeguarding where required

Evidence to check

• • Records of family disagreement or pressure
• • Capacity assessment where decision-making is questioned
• • Person's wishes clearly recorded
• • Staff and managers do not override a capacitous decision to satisfy relatives

Evidence to check

• • Risk assessments and care plans identify restrictions
• • Mental capacity and best-interest records where the person lacks capacity
• • Safeguarding concerns considered where coercion or undue influence is suspected
• • Least restrictive alternatives considered and recorded

Evidence to check

• • Care plan identifies fluctuating capacity triggers
• • Decision-making support is timed around the person's best presentation
• • Staff record when capacity appears to fluctuate
• • Assessments are not completed at unsuitable times without reason