Mental Capacity and Consent Audit - Care Homes

Evidence to check

• • Staff can explain the MCA principles in practical terms
• • Staff assume capacity unless there is evidence otherwise
• • Staff can describe how they offer choices during daily care
• • Mental capacity and consent policy is current, accessible and understood

Evidence to check

• • MCA training records
• • Staff scenario-based responses
• • Observation or supervision records showing consent and choice in practice
• • Staff understand that unwise decisions do not automatically mean lack of capacity

Evidence to check

• • Decision-specific capacity assessments
• • Assessment states the exact decision being considered
• • Different decisions assessed separately where needed
• • No blanket statements such as 'lacks capacity' without decision-specific evidence

Evidence to check

• • Capacity assessment forms or records
• • Two-stage capacity test clearly recorded
• • Evidence of how the resident was supported to understand the decision
• • Rationale explains why the resident could or could not make the decision at that time

Evidence to check

• • Best-interest decision records
• • Resident's past and present wishes considered
• • Family, advocate, attorney, deputy or professional involvement where relevant
• • Care plan updated to reflect the best-interest decision

Evidence to check

• • Best-interest records include options considered
• • Least restrictive option clearly identified
• • Restrictions are proportionate to the risk
• • Review dates set for restrictive decisions

Evidence to check

• • Communication care plans
• • Use of glasses, hearing aids, pictures, easy-read information or interpreters where needed
• • Staff can explain how individual residents are supported to decide
• • Care notes show choices, preferences and refusals are recorded

Evidence to check

• • Capacity assessments reviewed after significant changes
• • Reviews after hospital admission, infection, delirium, deterioration or safeguarding concerns
• • Care plan updated after reassessment
• • Staff informed where decision-making arrangements change

Evidence to check

• • DoLS application records
• • Dates of application and outcome
• • Urgent authorisations used appropriately where required
• • CQC notifications completed when DoLS is authorised

Evidence to check

• • DoLS authorisation records
• • Expiry dates and review dates tracked
• • Conditions attached to authorisations reflected in care plans
• • Relevant Person's Representative involvement recorded

Evidence to check

• • Staff scenario-based responses
• • Staff understand continuous supervision and not free to leave indicators
• • Restrictions are recorded and reviewed
• • Potential unauthorised deprivation of liberty is escalated promptly

Evidence to check

• • Care plan includes decision-specific capacity and consent information
• • Staff know which decisions the resident can make independently
• • Care delivery matches recorded consent and best-interest decisions
• • No contradictions between care plan, MCA records and daily notes

Evidence to check

• • Consent records for relevant areas
• • Resident choices, refusals and limits of consent recorded
• • Staff understand what the resident has agreed to
• • Consent reviewed when circumstances or care arrangements change

Evidence to check

• • Care review records
• • Consent reviewed after change in condition or treatment
• • Care plan updated to reflect new consent position
• • Staff communication or handover records show changes were shared

Evidence to check

• • Observation of care where possible
• • Staff explain care before providing support
• • Care notes record refusals and staff response
• • Staff do not continue care where valid consent is withdrawn unless there is lawful authority

Evidence to check

• • Risk assessment for restrictive equipment or monitoring
• • Consent record or best-interest decision
• • Less restrictive alternatives considered
• • Review of whether the restriction remains necessary and proportionate

Evidence to check

• • Copy of registered LPA or verified access code/check
• • Office of the Public Guardian registration confirmed
• • Health and welfare LPA distinguished from property and affairs LPA
• • Attorney decisions are within the authority granted

Evidence to check

• • Deputyship order on file
• • Scope of deputy authority checked
• • Staff and managers understand when the deputy should be consulted
• • Care records show deputy involvement where relevant

Evidence to check

• • Staff scenario-based responses
• • Care notes showing concerns about pressure or coercion
• • Safeguarding referrals where required
• • Resident spoken with privately where safe and appropriate

Evidence to check

• • Advance care planning records
• • DNACPR or ReSPECT documentation where applicable
• • Capacity and consent records linked to the decision
• • Family, GP or relevant professionals involved appropriately

Evidence to check

• • Easy-read, large print, translated or visual information where needed
• • Communication aids used during decision-making
• • Staff check and record the resident's understanding
• • Advocate or interpreter involvement where appropriate

Evidence to check

• • Best-interest records include resident's views
• • Staff continue to offer choices during daily care
• • Resident preferences and objections are recorded
• • Care plans show how the resident is involved in decisions

Evidence to check

• • Records of consultation with relevant people
• • Resident's own wishes recorded separately from family views
• • Advocacy referrals where required
• • Rationale recorded where family views are not followed

Evidence to check

• • Team meeting minutes
• • Supervision records
• • Handover notes where MCA issues affect care
• • Staff are updated when consent, capacity or restrictions change

Evidence to check

• • Observation of care where possible
• • Staff offer choices and seek consent during care
• • Daily notes record preferences, refusals and decision support
• • Care plans identify how each resident is supported to decide

Evidence to check

• • Manager spot checks
• • MCA and consent record audits
• • Supervision notes discussing MCA practice
• • Actions taken where poor practice or gaps are identified

Evidence to check

• • Records of contact with GP, social worker, mental health team or legal advisers
• • Professional advice reflected in care plans
• • Escalation for complex or high-risk decisions
• • Outcomes of professional involvement recorded

Evidence to check

• • Records of disputes or disagreements
• • Management review and escalation notes
• • Advocacy, safeguarding, local authority or legal advice considered
• • Final decision and rationale clearly recorded

Evidence to check

• • Care file contains current MCA and consent records
• • Digital or paper records are secure
• • Authorised staff can access relevant records during care
• • Outdated or contradictory documents removed or archived

Evidence to check

• • MCA audit records
• • Audits include staff questioning, resident feedback and record sampling
• • Themes reported through governance meetings
• • Audit actions followed up and used to improve practice

Evidence to check

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

Evidence to check

• • Positive risk-taking records
• • Risk assessment balances safety with choice
• • Resident's reasons and wishes recorded
• • Staff do not impose restrictions simply because they disagree with the decision

Evidence to check

• • Care plan identifies fluctuating capacity triggers
• • Assessments timed around the resident's best presentation where possible
• • Staff record changes in alertness, confusion, delirium, fatigue or distress
• • Capacity reassessed when the resident's presentation changes

Evidence to check

• • Risk assessments identify restrictions
• • Capacity and best-interest records where the resident lacks capacity
• • Safeguarding considered where coercion or exploitation is suspected
• • Least restrictive alternatives considered and recorded