Deprivation of Liberty Safeguards Procedure

Deprivation of Liberty Safeguards Procedure 1. Flowchart Managing authorities Social worker/asc placement panel alert the Quality and Assurance Team to possible deprivation of liberties Care home staff need to deprive a resident of his/her liberty Hospital staff need to deprive a patient (who does not meet the criteria for detention under the MHA) of his/her liberty Submit DOLS application SBSO/DBSO checks application to ascertain DOLS criteria is met; if the criteria is not met the SBSO/DBSO advises the managing agent, and closes the case Yes Is urgent authorisation needed? No Urgent cases should be turned around within 7 days (14 with an extension) The managing authority should speak to the person s carers and consider alternative measures. The managing authority can grant an urgent authorisation if they have a reasonable belief that a standard authorisation would be granted The managing authority submits a Deprivation of Liberty Safeguard form to the Quality Assurance and Safeguarding Team. The SBSO/DBSO allocates the case to a Section 12 Doctor, a BIA, and an IMCA service within 1 working day The assessors consult people close to the person and/or their IMCA The Section 12 Doctor assesses whether the service user has mental capacity, and the BIA assesses whether the service user meets DOLS conditions Are all of the conditions met? The urgent authorisation allows the managing authority to deprive the service user of their liberty for up to 7 days. No No The SBSO/DBSO notifies the BIA. The BIA contacts the service user to cancel their appointment The SBSO/DBSO submits a Authorisation Not Granted Form to a signatory for approval The managing authority submits a Deprivation of Liberty Safeguard form to the Quality Assurance and Safeguarding Team. The SBSO/DBSO allocates the case to a Section 12 Doctor, a BIA, and an IMCA service THE Section 12 Doctor assesses whether the person has mental capacity within 10 days Does the individual lack capacity? No Yes The SBSO/DBSO notifies the BIA The BIA consults people close to the person and/or their IMCA Within 17 days the BIA assesses whether the service user meets DOLS conditions Are all of the conditions met? Standard cases should be turned around within 21 days Yes Yes The SBSO/DBSO submits a Authorisation Granted Form to a signatory for approval The authorising party authorises the recommended outcome before the deadline. The SBSO/DBSO submits a Authorisation Granted Form to a signatory for approval The SBSO/DBSO notifies the service user and managing agent of the outcome in writing If the DOL is granted, the SBSO/ DBSO will refer the service user to receive support from a RPR if they are not supported by NoK. Adult Social Care. 1

2. Procedure The scope of this procedure is limited to when a managing authority (a hospital or a care home) identifies the need to deprive an adult in their care of their liberty, and authorisation is required from Southwark Council (as the supervisory body) in order to enact Deprivation of Liberty Safeguards (DOLS). This procedure does not apply to when parties intend to deprive individuals of their liberty outside of a hospital or care home setting; in such cases an application must be made to the Court of Protection. 2.1 Making a DOLS request 2.1.1 Managing Authorities In order to safeguard service users from harm, it may be necessary for a managing authority to take actions in the service user s best interests that deprive him/her of their liberty. If the managing authority identifies that a service user has inadvertently been deprived of their liberty (for example following changes to their mental capacity), they must complete and submit a Deprivation of Liberty Safeguards form (form 1) to the Quality Assurance and Safeguarding Team within 24 hours. If the managing authority identifies that it is necessary to deprive a service user of their liberty, they must complete and submit a Deprivation of Liberty Safeguards form to the Quality Assurance and Safeguarding Team. Managing authorities can submit an application up to 28 days in advance of when they plan to deprive the service user of their liberty. Managing authorities must indicate whether the authorisation being sought is standard or urgent when completing the Deprivation of Liberty Safeguards form. 2.1.2 DOL concerns raised by Southwark staff Adult Social Care (ASC) placement panels and individual Social Workers also raise potential DOL issues for the attention of the Quality Assurance and Safeguarding team. Placement panel ASC placement panels should submit a list of accommodation placements arranged each month to the Quality Assurance and Safeguarding Team. On receipt of the list of placements, the Senior Business Support Officer (SBSO) or the DOLS Business Support Officer (DBSO) considers the list against DOLS applications received during the period; checks the records of any service user for whom a DOLS application has not been received for evidence of mental capacity concerns; asks the care home to submit a Deprivation of Liberty Safeguards form within 5 working days if records suggest that the service user lacks mental capacity. If the care home does not submit a Deprivation of Liberty Safeguards form by the deadline, the SBSO/DBSO will complete a Deprivation of Liberty Safeguards form. The Adult Social Care. 2

SBSO/DBSO must log on the DOLS spreadsheet that they completed the form on behalf of the managing agent. Social Workers Social Workers may become aware of an accommodation placement where there are mental capacity concerns, but for which a DOLS authorisation was not sought. If this occurs the Social Worker must ask the care home to submit a Deprivation of Liberty Safeguards form within 5 working days, and notify the Quality Assurance and Safeguarding Team. If the care home does not submit the Deprivation of Liberty Safeguards form by the deadline, the SBSO/DBSO will complete a Deprivation of Liberty Safeguards form. The SBSO/DBSO must log on the DOLS spreadsheet that they completed the form on behalf of the managing agent. 2.2 Receiving and recording DOLS requests The SBSO/DSBO should review all new Deprivation of Liberty Safeguards applications within 1 working day, and undertake initial checks to ensure that the managing agent s concerns are likely to meet DOLS criteria, for example by ascertaining: that there are likely mental capacity issues; that the service user is subject to 24 hour supervision and control by staff; whether staff would need to take steps to stop the service user from leaving the site if they attempted to. The SBSO/DSBO will provide the managing agent with appropriate advice in the event it becomes obvious that the circumstances do not meet DOLS criteria. The SBSO/DSBO must request that the managing authority provide additional information within 1 working day where vital information has not been provided. The DOLS assessment process will not usually commence until there is sufficient information on which to proceed. The SBSO/DBSO must record the DOLS application on the DOLS spreadsheet, and continue to update relevant milestones on the spread-sheet (capacity decisions, best interest recommendations, referrals for support) until a decision is taken that DOLS are not required. 2.3 Urgent requests The Council aims to make decisions on urgent applications within 7 days (14 with an extension). It is the Quality Assurance and Safeguarding Team s policy to treat all applications from hospitals as urgent applications. If a care home makes an urgent application, the SBSO/ DBSO will consider whether the need is in fact urgent. If the need is urgent the application will be treated as urgent in line with these procedures (section 2.3). If the SBSO/DBSO judges that the need is not urgent, they will communicate this to the managing agent, and treat the application as a standard request (see section 2.4). 2.3.1 Allocating a Doctor, IMCA and Best Interest Assessor Within 1 working day of receiving urgent applications, the SBSO/DBSO will allocate the case to a Section 12 Doctor; allocate the case to a Best Interest Assessor; Adult Social Care. 3

refer the service user to receive support from an Independent Mental Capacity Advocate (IMCA). The Section 12 Doctor and Best Interest Assessor must arrange to visit and assess the service user. The IMCA must make himself/herself available to support the service user during these assessments. 2.3.2 Capacity considerations and Best Interest Assessors The Section 12 Doctor must use the visit with the service user to assess whether they lack mental capacity, whether they should be detained under the mental health act and complete the Mental Capacity, Mental Health and Eligibility Assessment form (form 4). The Best Interest Assessor must use the visit with the service user to establish whether the remaining DOLS conditions are met (see section 5.4 of the Deprivation of Liberty Safeguards Policy). If the Best Interest Assessor establishes that the conditions have resulted in the deprivation of the service user s liberty, they must complete the Age, Mental Capacity, No Refusals, Best Interests Assessments and Selection of Representative form (form 3). If the Best Interest Assessor believes that the conditions have not resulted in the deprivation of the service user s liberty they must complete the Best Interest Assessment No Deprivation form (form 3A). Both the Section 12 Doctor and Best Interest Assessor must submit their completed assessments to the Quality Assurance and Safeguarding Team by the deadline (the 7 day deadline can be extended to 14 days if there is good reason). Before submitting their respective forms they must satisfy themselves that they have completed all the required sections of the assessments; completed the assessment to a good standard (including spelling and grammar); made their recommendations based on the required criteria, and clearly communicated the reasons behind their recommendations. 2.4 Standard requests The Council must make decisions on standard applications within 21 days. 2.4.1 Allocating a Doctor and IMCA The SBSO/DBSO will allocate the case to a Section 12 Doctor within 1 working day for standard DOLS applications. If the service user cannot access appropriate support from a carer or family/friend, the SBSO/DBSO will also refer the service user to receive support from an IMCA The SBSO/DBSO will also allocate a Best Interest Assessor (see section 2.4.2). The Section 12 Doctor must arrange to visit and assess the service user within 10 days. The Section 12 Doctor must communicate the date of the assessment in advance to the Quality Assurance and Safeguarding Team so that they can inform the Best Interest Assessor. The IMCA must make himself/herself available to support the service user during the assessments. The Section 12 Doctor must use the visit with the service user to assess and establish whether they lack mental capacity, and complete the Mental Capacity, Mental Health and Eligibility Assessments form (form 4). The Section 12 Doctor must submit his/her Adult Social Care. 4

completed assessment to the Quality Assurance and Safeguarding Team by the 10 day deadline. If the Section 12 Doctor finds that the service user has capacity, the SBSO/DBSO will complete the Authorisation not Granted form (form 6), and submit the form for authorisation to an approved signatory within 1 working day (see section 2.5). The SBSO/DBSO must also communicate the outcome of the assessment to the Best Interest Assessor within 1 working day so that they can take appropriate action. 2.4.2 Best Interest assessment The SBSO/DBSO will allocate a Best Interest Assessor within 1 working day of receiving the standard DOLS application. The Best Interest Assessor will contact the service user to agree a date to carry out a Best Interests Assessment at least 11 days after the DOLS application was received, but within 17 days; this is to allow the Section 12 Doctor to make an assessment of the service user s mental capacity in advance of the Best Interests Assessment. If the Section 12 Doctor finds that the service user lacks capacity, the Best Interest Assessor will undertake the Best Interest Assessment as planned; has capacity, the Best Interest Assessor will contact the service user and their IMCA, and cancel the assessment appointment. 2.4.3 Assessing DOLS conditions The Best Interest Assessor must establish whether the DOLS conditions are met (see section 5.4 of the Deprivation of Liberty Safeguards Policy) during the Best Interest Assessment. If the Best Interest Assessor establishes that the conditions have resulted in the deprivation of the service user s liberty, they must complete the Age, Mental Capacity, No Refusals, Best Interests Assessments and Selection of Representative form (form 3). If the Best Interest Assessor believes that the conditions have not resulted in the deprivation of the service user s liberty they must complete the Best Interest Assessment No Deprivation form (form 3A). Before submitting the relevant form, the Best Interest Assessor must satisfy himself/ herself that they have completed all the required sections of the assessments; completed the assessment to a good standard (including spelling and grammar); made their recommendations based on the required criteria, and clearly communicated the reasons behind their recommendations. 2.5 IMCA availability issues The IMCA must make themselves available to support the service user during the Section 12 Doctor and BIA assessments. If the IMCA does not make themselves available for the assessment despite several attempts the BIA and Section 12 Doctor should note that their respective assessments were completed pending the IMCA s input. 2.6 Disagreements between the Section 12 Doctor and Best Interest Assessor If the Section 12 Doctor and Best Interest Assessor disagree about the service user s mental capacity, the SBSO/DBSO will consider the respective assessments and discuss the case with the Section 12 Doctor and Best Interest Assessor. If the Section 12 Doctor and Best Interest Assessor are not able to agree, and the Quality Assurance and Adult Social Care. 5

Safeguarding Manager cannot resolve the issue based on the available information, the SBSO/DBSO will appoint a new Best Interest Assessor to reassess the service user. The deadline that the SBSO/DBSO sets for the review must take into account the available time before the 7/14 day (urgent authorisation) / 21 day (standard authorisation) deadline is reached. If it becomes clear that the council will not be able to respond to the DOLS application within the allotted timescale, action should be taken in line with section 2.7 of this procedure. 2.7 DOLS authorisation process In advance of seeking authorisation, the SBSO/DBSO must Check that the forms submitted by the Section 12 Doctor and Best Interest Assessor have been completed correctly and to a good standard. Assure themselves that the recommendations are sound based on the evidence recorded in the relevant forms. Complete a: Standard Authorisation Granted form (form 5) if the recommendation is to approve the deprivation of liberty arrangements; OR Standard Authorisation Not Granted form (form 6) if the recommendation is to deny the deprivation of liberty arrangements. The SBSO/DBSO must seek authorisation from an officer with designated authority to approve DOLS. Authorisation should be sought from appropriate officers at least 3 days before the application deadline. Designated officers can only agree to the deprivation of the service user s liberty for up to a year. The designated officer must make a decision in regards to the application before the deadline, and notify the Quality Assurance and Safeguarding Adults Team. If the designated officer rejects any of the conditions/ recommendations made by the BIA or introduces additional conditions, the reasons must be communicated to the BIA (in case these changes significantly affect the conclusions made in the BIA s report), and clearly recorded. For a list of current roles able to authorise DOLS applications, please see Appendix A. Once authorisation has been provided, the SBSO/DSBO should notify the service user, managing authority, and family/carer/imca of the decision in writing before the application deadline. If the SBSO/DBSO made the application on behalf of the managing agent, they must complete and submit a DOLS notification to CQC. If the managing agent completed the application they should submit the notification to CQC. 2.8 Delays to the DOLS assessment/authorisation process In the event that it becomes clear that the Council will not be able to make a decision in relation to a DOLS application within the statutory deadlines, the SBSO/DSBO will write to the service user, managing agent, and family/carer/imca to notify them. 2.9 Relevant Person s Representative Following the authorisation of DOL arrangements, the SBSO/DBSO will make enquires to identify whether the service user has access to next of kin who are able to support them. Adult Social Care. 6

The SBSO/DBSO must apply for a Relevant Person s Representative (RPR) to support the service user within 2 working days of the DOLS being granted if they do not have access to next of kin. 2.10 Authorisation to deprive liberty beyond the current authorisation The SBSO/DBSO runs weekly reports on DOLS coming to an end within 30 days, and contacts managing authorities to ask that they submit extension/renewal requests at least 7 days in advance of the current DOLS deadline. In the event that the managing authority does not submit a request before the deadline (and it is apparent that they still intend to deprive the service user of their liberty), the SBSO/DBSO will complete a DOLS authorisation request. The SBSO/DBSO must log on the DOLS spreadsheet that they completed the form on behalf of the managing agent. 2.10.1 7 day extensions for urgent requests Managing authorities can apply for an extension of urgent DOLS arrangements (by submitting a Request for Further Standard Authorisation form) if they are depriving a service user of their liberty (for a period of no more than 7 days) following an urgent application. The managing authority must make efforts to submit the extension authorisation before the current authorisation comes to an end. In advance of seeking authorisation, the SBSO/DBSO must Check that the form has been completed correctly and to a good standard. Assure themselves that the recommendations are sound based on the evidence recorded in the relevant forms. The SBSO/DBSO should seek authorisation to extend the DOL arrangements from a designated officer. Designated officers can only authorise the extension of the measures for an additional 7 days. The designated officer should make a decision in regards to the application before the deadline, and notify the Quality Assurance and Safeguarding Adults Team. The SBSO/DBSO should notify the managing authority within 1 working day of the designated officer s decision. 2.10.2 Standard requests If the managing authority intends that DOL arrangements continue beyond the current authorisation period, the managing authority should submit a Request for a Further Standard Authorisation form (form 2) if the intention is to extend the DOL as is, and the circumstances remain largely unchanged; Equivalent Assessment Being Used form (form 11) if the intention is to extend the DOL as is, the service user is in a hospital, and the hospital only need to extend the DOL for a period of 4 weeks or less; new application (as described in sections 2.3 and 2.4) if the managing authority intends to deprive the service user of their liberty in a way that is not described in the original DOLS application. The SBSO/DBSO can authorise extension requests made for service users in hospital using the Equivalent Assessment Being Used form. The SBSO/DBSO should communicate whether or not the DOL arrangements have been authorised to the hospital within 3 days of receiving the application. If the extension of DOLS is for a service user based in a care home (or for a service user Adult Social Care. 7

in a hospital if an extension of more than 4 weeks is needed), it will be necessary to review the service user s mental capacity again, and also reconsider the DOLS conditions. The SBSO/BSO should: screen the DOLS request to ascertain whether it may be suitable to undertake a desktop renewal (in line with ADASS guidance1, see figure 1); and arrange for a Section 12 Doctor and Best Interests Assessor to assess the service user. If the screening has identified that the DOLS may be suitable for a desktop review, the SBSO/BSO should notify the BIA. Desktop authorisation If the SBSO/BSO identifies the renewal as suitable to undergo a desktop review (see the screening criteria opposite), they should notify the appointed BIA. The BIA should then also consider the application against the criteria and satisfy themselves that a desktop renewal is appropriate. During the desktop renewal the BIA must consider a range of evidence (including but not limited to recent care reviews, care plans, discussions with Figure 1 ADASS emergency interim measures criteria Are ANY of the below criteria/concerns present with regards the renewal request - Significant changes are evident Objection by or distress evidenced by the person Objection or distress evidenced by the family Lack of agreement regarding the care plan by one or more family member Incompatibility issues with other residents Challenging behaviour requiring significant restrictions Unclear diagnosis or possibility of change Variable mental capacity Adult safeguarding concerns If yes the renewal should not be considered for a desktop review. If none of the above criteria are met the BIA should carry out a desktop renewal the care home, family members, carer and RPR). It will be necessary to visit the service user to carry out a full assessment if it becomes evident that the service user s needs have changed; there are concerns that the placement is no longer in the service user s best interests (for example the section 12 doctor assessment identifies objections to the placement and/or care regime); the care home plans to provide different care and support than that identified in the original application; additional restrictions will be introduced. If none of the above criteria are met (and there are no other additional concerns), the BIA should complete the desktop renewal, and submit the desktop renewal form to the Quality Assurance and Safeguarding Team before the current authorisation lapses. The SBSO/BSO should review the section 12 Doctor assessment (completed as normal, see section 2.4.1) and BIA renewal document, and seek appropriate authorisation. Regular authorisation If the SBSO/BSO and/or the BIA determine that it is not appropriate to conduct a desktop authorisation, the BIA should conduct an assessment in line with the processes detailed in sections 2.3 to 2.5 of this procedure. 1 Advice note for managing and processing cases generated by the supreme court decision in 2014 in relation to deprivation of liberty safeguards Adult Social Care. 8

See the below flowchart for guidance. Managing agent makes a DOLS renewal request SBSO/DBSO screens the renewal request using the ADASS emergency interim measures criteria Are any of the emergency measures criteria/concerns present? ADASS emergency interim measures criteria Use the screening to identify whether ANY of the below criteria/concerns are present with regards the renewal request - Any significant change highlighted on the request Objection by or distress evidenced by the person Objection or distress evidenced by the family Lack of agreement regarding the care plan by one or more family member Incompatibility issues with other residents Challenging behaviour requiring significant restrictions Unclear diagnosis or possibility of change Variable mental capacity Adult safeguarding concerns SBSO/DBSO refers the case to a section 12 doctor and BIA to undertake full DOLS assessments Yes No The section 12 doctor and BIA to undertake full DOLS assessments in line with section 2.4 of these procedures SBSO/DBSO refers the case to a section 12 doctor to undertake a full assessment SBSO/DBSO refers the case to a BIA to undertake a desktop DOLS assessment The section 12 doctor undertakes a full assessment in line with section 2.4 of these procedures. The BIA satisfies themselves that the case meets the renewal criteria. If it does not they must undertake a full assessment in line with section 2.4 of these procedures The BIA considers relevant review material (care reviews, care plans, electronic records) The BIA speaks to the managing agent to confirm that the needs remain unchanged In the course of the desktop review, does the BIA identify areas of significant change? Yes No The Section 12 doctor and BIA submit their assessments to the Quality Assurance and Safeguarding Team The BIA completes a full DOLS assessment in line with section 2.4 of these procedures The BIA completes the desktop assessment DOLS assessment 2.11 Reviewing DOLS arrangements It may be necessary to review DOLS arrangements due to a number of reasons, for example the: service user s circumstances change; Adult Social Care. 9

Relevant Person s Representative requests that the arrangements be reviewed; outcome of the DOLS assessments are disputed. If the Quality Assurance and Safeguarding Team are alerted to the need to review DOL arrangements, they will contact the relevant parties in order to submit a Deprivation of Liberties Safeguards Review form (form 10). Dependant on the basis of the review it may be necessary to appoint a: Section 12 Doctor to consider the service user s mental capacity; Best Interests Assessor to consider the DOLS conditions. Any assessments required must be completed within 7 days of the DOLS Review form being completed (for guidance on completing a Mental Capacity Assessment or a Best Interests Assessment, please see section 2.3.2). If the recommendation is to: grant the continuation of the DOL arrangements, the SBSO/DBSO should complete the Standard Authorisation Granted form; revoke the DOL arrangements, the SBSO/DBSO should complete the Suspension of Standard Authorisation form. The SBSO/DBSO should provide the designated officer with the appropriate form to review at least 3 days before the deadline. The designated officer should make a decision before the deadline, and notify the Quality Assurance and Safeguarding Adults Team. The SBSO/DBSO should notify the managing authority within 1 working day of the designated officer s decision. 2.12 Reporting the death of a service user where DOL authorisations are in place In the event that the service user dies following the authorisation of DOLS measures, the managing agent must alert the Quality Assurance and Safeguarding Team when the coroner has been notified. The coroner will undertake a formal inquest into the death. Once notified, the SBSO/DBSO will update the service user s records (section 2.12) and formally conclude the DOLS arrangements. 2.13 Recording DOLS actions Both the SBSO/DBSO are responsible for ensuring that all pertinent actions in relation to DOLS are recorded on the DOLS spreadsheet, including (but not limited to) Date of application Application deadline Current status Date DOLS approved/rejected 3. Performance and monitoring We will monitor the following performance standards Performance standard Number of referrals received Period Calendar month Adult Social Care. 10

Performance standard Number of cases allocated to a Section 12 doctor Best Interest Assessor Independent Mental Capacity Advocate Relevant Persons Representative Number of cases concluded Average number of days (total and phase time) to determine Urgent cases closed during the calendar month Standard cases closed during the calendar month % of Urgent cases approved Standard cases approved Period Calendar month Calendar month Calendar month Calendar month 4. Roles and Responsibilities Role Service Manager QA & safeguarding Responsibilities Oversee the DOLS process Approve DOLS applications DOLS signatories Approve DOLS applications Senior Business Support Officer / DOLS Business Support Officer Administrate DOLS application process (including applications to initiate, extend and renew). Allocate Section 12 Doctors and BIA assessors to cases. Submit DOLS applications where managing agents fail to comply. Make IMCA and RPR referrals as appropriate. Undertake checks to identify DOL arrangements coming to an end, and prompt the renewal/extension process. Seek authorisation for DOL arrangements Authorise limited hospital DOL extensions (see section 2.8.2). Notify the service user and managing authority of the application outcome in writing. Managing Authority Submit DOL applications (including applications to initiate, extend and renew) in a timely manner Consult family/friends/imca before considering authorising urgent (7 day) DOL measures Section 12 Doctor Undertake mental capacity assessment with the service user Submit appropriate assessment form to the Quality Assurance and Safeguarding Team within the allotted time constraints Adult Social Care. 11

Role Best Interests Assessor Social Worker/ASC placement panel Responsibilities Undertake BIA assessment with the service user Submit appropriate assessment form to the Quality Assurance and Safeguarding Team within the allotted time constraints Alert the Quality Assurance and Safeguarding Team to potential placements where there are deprivation of liberty concerns Advocacy service Provide a IMCA to the service user to support them during the assessment process Provide a RPR to the service user to support them if they are not supported by NoK 5. Standard documents Form No Form name 1 Standard and urgent request 2 Request for a further standard authorisation 3a Age, mental capacity, no refusals, best interests assessments and selection of representative 3b Best Interest assessment No Deprivation 4 Mental capacity, mental health and eligibility assessments 5 Standard authorisation granted 6 Suspension of standard authorisation 7 Termination of standard authorisation 8 Standard authorisation ceased 10 Review Statutory notification about an application to deprive a person of their liberty Appendix A List of DOLS signatories 6. Document control Approval date 10/10/2016 Last reviewed 24/01/2017 By Dean Thomas Adult Social Care. 12

Version 1.1 Scheduled review date 10/10/2019 Adult Social Care. 13