Mental Capacity, Consent and Decision-Making Audit - Supported Living

Evidence to check

• • Mental capacity and consent policy is current and aligned with the Mental Capacity Act 2005
• • Policy is adapted to supported living, tenancy rights, community settings and positive risk-taking
• • Staff can explain the MCA principles in practical terms
• • Staff understand that tenants must be assumed to have capacity unless there is evidence otherwise

Evidence to check

• • MCA training records for all relevant staff
• • Staff can answer scenario-based questions
• • Staff understand that unwise decisions do not automatically mean lack of capacity
• • Supervision or spot checks show staff supporting consent and choice in practice

Evidence to check

• • Decision-specific capacity assessments
• • Assessment identifies the exact decision being considered
• • Time, context and assessor are recorded
• • Assessment explains how the conclusion was reached

Evidence to check

• • Best-interest decision records
• • Tenant’s wishes, feelings, beliefs and values are considered
• • Advocate, family, attorney, deputy or professional involvement recorded where relevant
• • Support plan is updated to reflect the best-interest decision

Evidence to check

• • Care plan records communication and decision-making support needs
• • Accessible information or visual prompts used where needed
• • Assessments record how the tenant was supported to understand
• • Staff can describe how they adapt communication for the tenant

Evidence to check

• • Decision-making records are reviewed after changes in need or risk
• • Care reviews include consent and capacity where relevant
• • Financial, tenancy and relationship decisions are considered separately
• • Staff are informed when decision-making arrangements change

Evidence to check

• • Best-interest records consider less restrictive options
• • Support plans avoid unnecessary restrictions
• • Staff can explain how they promote independence and choice
• • Restrictions are reviewed and reduced where possible

Evidence to check

• • Support plan identifies when capacity may fluctuate
• • Staff record changes linked to mental health, infection, distress, fatigue, substances, medication or time of day
• • Assessments are completed at the best practicable time where possible
• • Capacity is not judged from one poor presentation without review

Evidence to check

• • Registered LPA or deputyship documents are verified
• • Health and welfare LPA is distinguished from property and affairs LPA
• • Appointeeship is not treated as authority for health and welfare decisions
• • Staff and managers understand who can lawfully make which decisions

Evidence to check

• • Risk assessments include tenant views and choices
• • Unwise decisions are respected where the tenant has capacity
• • Staff support the tenant to understand risks and options
• • Restrictions are not imposed simply because staff or family disagree with the tenant’s choice

Evidence to check

• • Consent records are current and decision-specific where needed
• • Tenant has agreed who information can be shared with
• • Consent for access arrangements, photos or digital records is recorded where applicable
• • Consent is reviewed when circumstances change

Evidence to check

• • Spot checks or observations show staff asking before support
• • Daily notes record refusals, changes of mind or preferences
• • Staff explain support before providing it
• • Staff do not continue support where valid consent is withdrawn unless there is lawful authority

Evidence to check

• • Advance decisions or advance statements recorded where applicable
• • Future care preferences are reflected in support plans
• • Staff know where to find relevant documents in an emergency
• • GP, family, advocate or professional involvement recorded where appropriate

Evidence to check

• • Staff can explain escalation routes
• • Safeguarding concerns linked to coercion or undue influence are recorded
• • Tenant is spoken with privately where safe and appropriate
• • Concerns are escalated to manager, safeguarding team, police or professionals where needed

Evidence to check

• • Staff can describe how to escalate concerns
• • Whistleblowing and safeguarding routes are accessible
• • Records show restrictive decisions are questioned where appropriate
• • Managers review and respond to staff concerns

Evidence to check

• • Best-interest meeting notes or decision records
• • Relevant people involved, such as advocate, attorney, deputy, family, social worker or health professional
• • Tenant’s wishes and feelings are considered
• • Options, risks and least restrictive alternatives are recorded

Evidence to check

• • Easy-read, visual, translated, audio or other accessible formats used where needed
• • Communication aids or advocacy used where appropriate
• • Staff check and record the tenant’s understanding
• • Information is not only given verbally where the tenant needs another format

Evidence to check

• • Consent to involve others is recorded
• • Advocacy referrals made where the tenant needs support to be heard
• • Tenant’s own views are recorded separately from family or representative views
• • Others are not allowed to override a capacitous tenant’s decision

Evidence to check

• • Restrictions are clearly identified in the support plan
• • Capacity and consent considered for each restriction
• • Best-interest decision recorded where the tenant lacks capacity
• • Restrictions are proportionate, least restrictive and reviewed

Evidence to check

• • Staff understand tenants have rights to privacy, visitors, access and control of their home
• • Support plans distinguish care decisions from housing or tenancy matters
• • Staff do not impose care-provider rules as if the setting were a care home
• • Housing provider or landlord responsibilities are clearly separated from care-provider responsibilities

Evidence to check

• • Restrictions and supervision arrangements are clearly recorded
• • Manager has considered whether arrangements may amount to deprivation of liberty
• • Local authority, commissioner or legal advice is sought where required
• • Court of Protection route is considered where a community deprivation of liberty may exist

Evidence to check

• • Support plan includes decision-specific guidance
• • Staff know how to support the tenant to understand, retain, weigh and communicate decisions
• • Plan avoids global statements about capacity
• • Guidance is updated when the tenant’s ability or circumstances change

Evidence to check

• • Care review records include consent and capacity where relevant
• • Capacity reviewed after incidents or changes
• • Support plan updated after review
• • Staff are briefed about changes before providing support

Evidence to check

• • Capacity, consent and best-interest records are stored securely
• • Authorised staff can access current records when needed
• • Digital and paper records are consistent where both are used
• • Outdated or contradictory documents are removed or archived

Evidence to check

• • Daily notes record choices, refusals and staff response
• • Support plans balance safety with choice and ordinary life
• • Staff respect capacitous decisions even when others disagree
• • Safeguarding or MCA escalation is used only where risk, coercion or lack of capacity requires it

Evidence to check

• • MCA audit records include staff questioning, record review and tenant feedback where possible
• • Audit checks quality of capacity assessments and best-interest decisions
• • Themes are reported through governance or quality meetings
• • Actions from audits are followed up and used to improve practice

Evidence to check

• • Support plan gives clear refusal guidance
• • Staff record refusals and the tenant’s reason where known
• • Capacity, risk and safeguarding are considered where refusals create significant concern
• • Repeated refusals trigger review rather than automatic control

Evidence to check

• • Records show who has legal authority and for what decisions
• • Tenant consent to involve others is recorded
• • Staff challenge inappropriate decision-making by others
• • Tenant’s own wishes remain central

Evidence to check

• • Consent or best-interest decision recorded for technology use
• • Privacy impact and least restrictive options considered
• • Tenant understands the purpose of the technology where possible
• • Use of technology is reviewed and stopped if no longer justified

Evidence to check

• • Support plans identify known triggers for fluctuating capacity
• • Staff record changes in presentation and decision-making
• • Assessments are timed to give the tenant the best chance to decide
• • Professional advice is sought where capacity is complex or changing