We have a resident who is cared for in bed who's verbal communication is very limited along with her body language. We know that she can understand what is being said to her like for example when she is asked if she would like a cup of tea, however we don't really know how much conversation she may be able to understand and how long she can retain information for.

A new format care plan has recently been put together for this lady (without her involvement) my manager has insisted that the daughter signs it on her mother's behalf to say that she is happy with the content. I asked my manager how do we know that this resident is happy with her care plan and understands it's content, my manager and two other seniors said you can tell by her facial expressions.

I also asked my manager how we are going to evidence that this resident is happy with her care plan because of her limited level of verbal and physical communication she said that the daughter has signed and that is all that's required.

Just because the daughter is happy with the care plan does not mean to say her mother is, the daughter did not look at any of the care plan before signing anyway.

I know that evidencing how we know that a resident is happy with their care plan is an area that CQC are quite hot on, and by saying the resident is happy with it by facial expressions is not an outcome they would be happy with or the daughter signing on the residents behalf.

Does anyone know of system/s I could use to demonstrate service user involvement and so on? I have looked on the internet but there is so much on there I do not know what would be relavant.

I want to use this towards my NVQ4 but do not know where to start. If the above also raises other issues I please let me know as my brain has turned to mush with this one as I have not encountered this before.


Best wishes
Purple749

Hi Purple749,

See here Pages 33 and 34 and each of the Outcomes:

http://www.cqc.org.uk/_db/_documents/Essential_standards_of_quality_and_safety_FINAL_ 081209.pdf

You might also get some ideas from these:

http://www.pmldnetwork.org/resources/bps_best_interests_guide.pdf

http://www.pterrywave.com/nursing/care%20plans/40.aspx

http://www.endoflifecareforadults.nhs.uk/assets/downloads/ACP_booklet_2011_Final_1.pd f

http://www.rethink.org/living_with_mental_illness/rights_and_laws/laws_you_need_to_kn ow_about/mental_capacity_act.html

http://www.justice.gov.uk/guidance/protecting-the-vulnerable/mental-capacity-act/inde x.htm

http://www.pterrywave.com/nursing/care%20plans/93.aspx

http://www.sabp.nhs.uk/policies/alphabetical/A-C/SABP0034%20Capacity%20and%20best%20i nterests%20guidelines.pdf/

There is probably more but this should give you a start.

Your individual needs her capacity to understand and communicate to be assessed by a professional so that she has the opportunity to demonstrate her ability to make choices and decisions. Her daughter also needs to demonstrate that she is capable of making decisions in the interest of her mother.

Hope that helps

Aunty Sue

Maybe the lady needs an independent advocate.Does she have dementia?Tha Alzheimer Society provides a free independent advocacy service. Care homes may be a little wary of them but the needs of the resident should be foremost to them.

If she is not comfortable, then you can understand that by her health improvement. A person who is not happy from within, he will not show you any improvement in his health. You can understand it by her recovery speed. If she is responding of your care that means she is happy with the policies.
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domestic staff agency

you need to hone in on the NVC communication of this lady- even limited body language should be in care plan. It is impossible to look happy if you are not the eyes are a give-away . An independant advocate sounds the road to go .