Case ID Number: Uncle Albert Mock DoLS

DEPRIVATION OF LIBERTY SAFEGUARDS FORM 3 AGE, MENTAL CAPACITY, NO REFUSALS, BEST INTERESTS ASSESSMENTS AND SELECTION OF REPRESENTATIVE This combined form contains 4 separate assessments and includes selection of representative. If any assessment is negative there is no need to complete the others unless specifically commissioned to do so by the Supervisory Body. Please indicate which assessments have been completed (*Supervisory Bodies will vary in practice as to who completes the Mental Capacity Assessment)

Age X Mental Capacity* X No Refusals X Best Interests X

This form is being completed in relation to a request for a Standard Authorisation X This form is being completed in relation to a review of an existing Standard Authorisation under Part 8 of Schedule A1 to the Mental Capacity Act 2005.

Full name of the person being assessed Albert Gladstone Trotter

Date of birth Est. Age 19/11/20 (94) (or estimated age if unknown) This also constitutes the Age Assessment. If there is any uncertainty regarding the person’s age, please provide additional information at the end of the form. Name and address of the care home or Green Acres Lodge hospital in which the person is, or may Old Road become, deprived of liberty Peckham PE3 4RB

Name of the Assessor Jane Smith Address of the Assessor c/o Peckham Council Council Buildings Peckham High Street PE1 1AB

Profession of the Assessor Social Worker

Name of the Supervisory Body Peckham Council The present address of the person if different from the care home or hospital N/A – As Above. stated above.

In carrying out this assessment I have met or consulted with the following people NAME ADDRESS CONNECTION TO PERSON BEING ASSESSED Derek Trotter 368 Nelson Mandela House Great Nephew, Peckham Property & Affairs LPA PE1 8FH

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Rodney Trotter 368 Nelson Mandela House Great Nephew, Peckham PE1 8FH Raquel Trotter 368 Nelson Mandela House Great Niece-in-law Peckham PE1 8FH Cassandra Trotter 368 Nelson Mandela House Great Niece-in-law Peckham PE1 8FH The following interested persons have not been consulted for the following reasons

NAME REASON CONNECTION TO THE PERSON BEING ASSESSED Reginald Trotter Location unknown – currently Nephew estranged from family

I have considered the following documents (e.g. current care plan, medical notes, daily record sheets, risk assessments)

DOCUMENT NAME DATED

Care plan 01/04/15 Risk Assessment – falls, swallowing, awareness of danger 06/04/15 Overview Assessment 28/03/15 Mental Capacity Assessment – accommodation decision 28/03/15 Updated Memory Assessment 10/03/15

Daily record sheets 01/04/15 – Medication charts 09/05/15 Medical notes Care Management Profile Notes

MENTAL CAPACITY ASSESSMENT The following practicable steps have been taken to enable and support the person to participate in the decision making process:

In my opinion the person LACKS capacity to decide whether or not they should be accommodated in this hospital or care home for the purpose of being given the proposed care and/or treatment, and the person is unable to make this decision because of an X impairment of, or a disturbance in the functioning of, the mind or brain.

In my opinion the person HAS capacity to decide whether or not they should be accommodated in this hospital or care home for the purpose of being given the proposed care and/or treatment Stage One: What is the impairment of, or disturbance in the functioning of the mind or brain?

Mr Trotter was diagnosed with vascular dementia in 2002; his medical notes confirm that his condition has progressed according to the prognosis of a continuing cognitive deterioration associated with this condition.

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Stage Two: Functional test a. The person is unable to understand the information relevant to the decision Record how you have tested whether the person can understand the information, the questions X used, how you presented the information and your findings.

Mr Trotter was visited on one occasion for the puspose if undertaking a capacity assessment in relation to this decision. Information was provided in both written and pictorial forms , Mrs Raquel Trotter was present for some of the interview for the purposes of assisting in the provision of information and she also made attempts to explain the assessment to Mr Trotter,

Mr Trotter repeatedly refered to the weather outside his window during the interview, he referred to the assessor as Captain and Mrs Trotter as Nurse, and repeatedly asked what his orders were. Mr Trotter appeared to recognise Mrs Trotter as a family member but on three occassions called her Ada and appeared to believe she was his late wife.

Mr Trotter was non responsive to specific questions in either verbal or non-verbal communication, and did not appear to look at the pictures of the unit or his previous residence that were provided by the assessor satating that he was on HMS Peerless and was awaiting orders when asked if he knew where he was currently residing.

In the absence of any response or sign of recognition to the questions poses or the visual aids provided, it is my view that at the current time Mr Trotter does not appear to understand the information relevant to this decision, in this case the salient information being – • Where he is currently residing • The type of accomodation he now, or has previously lived in • The needs he appears to have in relation to care and support • That staff are supervising him on a regular basis to ensure his safety and welfare.

b. The person is unable to retain the information relevant to the decision Record how you tested whether the person could retain the information and your findings. Note X that a person’s ability to retain the information for only a short period does not prevent them from being able to make the decision.

As Mr Trotter appeared unable to understand the information being provided the ability to retain said information to make a decision is brought into question. Mr Trotter gave no signs of recognition of the assessor or the assessment process and when this was explained, and responded with statements such as ‘yes sir’ or ‘aye aye Captain’ on several occasions. he looked at the window to his right and referring to the weather several times.

Mr Trotter appeared unable to verbally respond to the interview and assessment process, fixating instead the weather and what his ‘orders’ may be as a result

Mr Trotter is displaying repetitive behaviours and communications (in this case in relation to the weather) and does not respond to specific questions when asked (for example, where do you think you currently are?), his long-term memory appears to be intact, however he required frequent prompting in relation to Mrs Trotters name and who she was and was not orientated to time or place during this interview. Mr Trotter is assessed as unable to understand the salient information in this case, and as such on the balance of probabilities it is my view that he is unlikely to be able to retain the said information in order to make this decision.

c. The person is unable to use or weigh that information as part of the process of making the decision X Record how you tested whether the person could use and weigh the information and your March 2015 – V4 - Final Deprivation of Liberty Safeguards Form 3 Page 3 of 16 Combined Age, Mental Capacity, No Refusals and Best Interests

findings.

As described Mr Trotters communication, both verbal and non-verbal is limited and he displays no awareness of his surroundings and appears to fixate on one specific communication, in this case in relation to the weather and his orders, when prompted with information or interpersonal interactions. Whilst it is recognised that non-engagement is a possible explanation for his presentation it is reported by a number of sources that the behaviour observed by the BA is typical of Mr Trotter’s usual presentation and it is reported by care home staff and family that as Mr Trotters cognitive function has declined he has become repetitive and abstract in any interactions he does have, often saying the same word throughout the day and making arm gestures to encourage others to focus on the same subject.

He is assessed as lacking the capacity to understand and, on the balance of probabilities, retain the relevant information, and with this being the case it appears that Mr Trotter is unable to use this information to make a decision. When interviewed he appeared unaware of where he was, what his needs might be, any other accommodation options, and that staff were supervising his day-to-day care and support. As such, on the balance of probabilities it is my view that Mr Trotter is unable to weigh or use information in order to make a decision in relation to whether his accommodation, treatment and care are a potential deprivation of liberty.

d. The person is unable to communicate their decision (whether by talking, using sign language or any other means) Record your findings about whether the person can communicate the decision.

Mr Trotter retains verbal communication, which although sporadic, he can still utilise along with pointing and other arm gestures and facial expressions when animated, as such it is my opinion that if Mr Trotter were able to understand, retain and weigh the information he would be able to communicate his decision. As such he does not lack capacity in this area of the functional test.

Stage Three: Explain why the person is unable to make the specific decision because of the impairment of, or disturbance in the functioning of, the mind or brain.

As Mr Trotter’s vascular dementia has progressed he has experienced a progressive deterioration in his cognitive function. Mr Trotter experiences marked memory difficulties and appears to be at an advanced stage where his coordination, orientation, and recognition of hazards is severely impaired and these symptoms are having a direct impact on his ability to understand, retain and weigh information in relation to the decision relating to accommodation, treatment and care which may constitute a deprivation of liberty.

NO REFUSALS ASSESSMENT To the best of my knowledge and belief the requested Standard Authorisation would not conflict with an Advance Decision to refuse medical treatment or a decision by a Lasting X Power of Attorney, or Deputy, for Health and Welfare. To the best of my knowledge and belief the requested Standard Authorisation would conflict with an Advance Decision to refuse medical treatment or a decision by a Lasting Power of Attorney, or Deputy, for Health and Welfare.

Please describe further:

No identified advanced decision. LPA in place for property and affairs but not personal welfare. No objections are being raised by the property and affairs LPA holder that conflicts with a standard authorisation, and no other legal order or deputies in place, therefore in my opinion Mr Trotter

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meets the requirement of ‘no refusals’ at the current time.

There is not a valid Advance Decision, Lasting Power of Attorney or Deputy for Health and Welfare in place X

BEST INTERESTS ASSESSMENT MATTERS THAT I HAVE CONSIDERED AND TAKEN INTO ACCOUNT I have considered and taken into account the views of the relevant person X

I have considered what I believe to be all of the relevant circumstances and, in particular, the X matters referred to in section 4 of the Mental Capacity Act 2005

I have taken into account the conclusions of the mental health assessor as to how the X person’s mental health is likely to be affected by being deprived of liberty

I have taken into account any assessments of the person’s needs in connection with X accommodating the person in the hospital or care home

I have taken into account any care plan that sets out how the person’s needs are to be X metwhile the person is accommodated in the hospital or care home In carrying out this assessment, I have taken into account any information given to me, or submissions made, by any of the following: (a) any relevant person’s representative appointed for the person X (b) any donee of a Lasting Power of Attorney or Deputy (c) any IMCA instructed for the person in relation to their current or proposed deprivation of liberty BACKGROUND INFORMATION Background and historical information relating to the current or potential deprivation of liberty. For a review look at previous conditions and include comments on previous conditions set.

Mr Trotter is a ninety-four year old white British man who was estranged from his wife (Ada) in 1979 and who has not had a significant partner relationship since this time. Prior to his move into Green Acres he had lived with his Great Nephews and their wives at their home at Nelson Mandela House from 1985– 2002. Mr Trotter was a member of the Royal Navy from 1937 until 1960 when he retired his commission following a court marshal hearing, he served on seven vessels and he appears to remember his navy career with affection, It is reported that he often recounts service stories to both staff and family. Mr Trotter joined the merchant navy on retirement from the Royal Navy, in which he continued until he retired and moved in with his family in 1985. Mr Trotter is able to recall these periods of his life in detail and during periods of confusion he has been observed as referring to staff members at Green Acres by Navy ranks and numbers, appearing to believe that he is a serving sailor on a ship named HMS Peerless. Mr Trotter is reported to have undertaken basic parachute training on the Isle of Wight during the 1940’s (date unspecified), which he reported enabled him to fall without injuring himself. According to Mr Derek Trotter he used this to his advantage during the post-war years, staging mock falls down the cellars of pubs in order to receive financial compensation. It is reported that he staged falls down at least fifteen cellars, gaining the nickname of "The Ferret" in the process

Mr Trotter was diagnoses with vascular dementia in 2001. When he began to experience difficulties with his short-term memory and orientation and moved into Green Acres in 2002 where he has

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resided since this time. At the time of admission it appears that Mr Trotter was considered to have the capacity to make the decision to reside at the organisation, however it should also be noted that this move took place prior to the introduction of the MCA 2005 and no formal assessment was carried out as such no best interest decision documentation is available to clarify the decision making processes involved in his initial placement.

The presumption of capacity appears to have been retained in Mr Trotter’s case until 2007 when a concern was raised under the MCA 2005 framework that Mr Trotter was making repeated unwise decisions in relation to staging mock falls whilst not recognising his increasing physical frailty, which included the onset of arthritis and subsequent limitations to his mobility. It is reported that on 25/11/07 he staged a fall down the stairs of Peckham Town Hall and experienced a hip fracture as a result. He was admitted to the local acute hospital. At this time Mrs Raquel and Mrs Cassandra Trotter both raised concerns that Mr Trotter needed to be prevented from this behaviour and be protected as he no longer understood the consequences of this behaviour as a result of his cognitive decline and memory issues which included a belief that he was a younger man in fitter physical health than was the case at this time. When Mr Trotter attempted to discharge himself from hospital against medical advice, the first formal mental capacity assessment was carried out by ward staff to determine whether he was able to make this decision within the context of the MCA 2005.

Mr Trotter has had a number of capacity assessment’s since this time and is reported to have had significant fluctuation of capacity over time, care home staff and family both report that mid-morning to early-afternoon is the best time to undertake any assessment or interview with Mr Trotter as this is the time he is most likely to be able to engage, recognise people and understand information.

It is reported by care staff and family members that Mr Trotter’s memory and orientation issues have deteriorated significantly over the last six months following a Urinary Tract Infection (UTI) which resulted in hallucinatory and delirium like symptoms over a three day period and which required hospital admission for the administration of IV antibiotics. On returning to Green Acres Mr Trotter’s periods of confusion and disorientation have increased and over the previous month he has made two significant attempts to leave the premises, which have created enough concern between family and staff that he has been prevented from doing so on each occasion. The last occasion was a week prior to this assessment-taking place and police returned him to green acres after he was reported as a missing person and found wandering around Docklands area. He reportedly stated he was looking for his ship when police initially located him.

Mr Derek Trotter has property and affairs LPA and manages all Mr Trotters financial affairs (copy of document provided). Mr Trotter has a military pension and state benefits as well as a small amount of savings (below the threshold for self-funding) and Mr Derek Trotter ensures that Mr Trotter has spending money for any personal items and community trips. Mr Trotter has no other identified savings or assets.

VIEWS OF THE RELEVANT PERSON Provide details of their past and present wishes, values, beliefs and matters they would consider if able to do so:

Mr Trotter did not appear to be orientated to time or place during interview and staff and family members all report that this is a usual presentation for him. Mr Trotter’s long-term memory remains in tact and he appears to have regressed to his period in the Royal Navy and his service on HMS Peerless. Despite these circumstances Mr Trotter was questioned in relation to how he felt about residing at his current placement to which he was unable to specifically respond but did state that ‘he was waiting for orders and may be re-deployed in the near future’. Mr Trotter expressed no dissatisfaction to his environment or the staff providing care and support, appearing to believe that staff where crew mates on his ship.

As stated there is no documentary evidence concerning Mr Trotter’s capacity at the time of his admission to Green Acres, however in light of principle 1, presumption of capacity, combined with

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documentation which indicates his initial capacity assessment was carried out in 2007 it is reasonable to believe, that Mr Trotter validly consented to his initial placement at the establishment and to remaining at the home during the periods of 2002-2007.

Whilst Mr Trotter is assessed as lacking capacity in terms of the care, treatment , accommodation and deprivation of liberty decision, as detailed, he is able to express dissatisfaction when relevant, for example it is reported that he will state if he does not like something or someone, and is not doing so at the current time. He has attempted to leave the premises as stated, however this appears to be due to disorientation rather than an objection to the placement or care/treatment he is being provided.

VIEWS OF OTHERS

Family members report that Mr Trotter selected Green Acres as his preferred accommodation when he moved into the establishment and that he has not expressed any desire to leave since this time. The family operate a ‘rota’ system with visiting Mr Trotter, ensuring that daily contact is maintained, specifically via Mrs Racquel and Mrs Cassandra Trotter.

Family members are in support of the placement, each independently verified that Mr Trotter appeared settled at Green Acres and that is was local, familiar to him and meant he remained connected to his family and home area.

Mrs Cassandra Trotter reported a positive relationship with care staff and idenfied two staff members in particular that Mr Trotter appeared to have a good relationship with, she stated she believed his needs were being appropriately met and family contact was positively encouraged by the establishment.

No objections or concerns were identified by any of those consulted – Mr Derek & Mr Rodney Trotter and Mrs Raquel and Mrs Cassandra Trotter – with all family members speaking highly of both the environemnt and the care and respect shown by staff towards both Mr Trotter and individual family members, with Mr Rodney Trotter reporting that they were always kept informed and invited to care reviews and consulted on care plans (the introduction of the door sensor more recently being cited as an example of this taking place).

THE PERSON IS DEPRIVED OF THEIR LIBERTY In my opinion the person is, or is to be, kept in the hospital or care home for the YES X purpose of being given the relevant care or treatment in circumstances that deprive them of liberty Note: if the answer is No then the person does not satisfy this requirement NO The reasons for my opinion: Note: Consider the concrete situation of the person including type, duration, effects and manner of implementation of the measures in question in order to determine whether they meet the acid test of continuous (or complete) supervision AND control AND are not free to leave.

Objective: Applying the acid test should provide evidence of confinement in a particular restricted space for more than a negligible period of time. Refer to the descriptors in the DoLS Code of Practice in light of the acid test.

1. Continuous Supervision & Control Mr Trotter maintains limited mobility but this is significantly impaired by chronic arthritis and disorientation to time and place as detailed elsewhere. Staff provide significant care and support, this includes personal care, medication administration, support with health needs (e.g. support to access dental and optical services, collection of prescriptions and travel to appointments). Social activities are carried out in the home and staff facilitate Mr Trotters

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engagement in these and provide supervision when in the community (1-1) to ensure his physical safety and wellbeing. Mr Trotter does not leave the establishment without the knowledge of the staff on duty on each shift, and regular checks are carried out during the day if Mr Trotter chooses to remain in his room rather than occupying space in the communal areas of the home (minimum 2 hourly) to ensure Mr Trotters’ needs are being met on a day-to-day basis. When in communal areas staff are always present, and it is reported to be the case that staff are aware of where residents are and what they are doing the majority of the time. A door sensor has recently (01/05/15) been installed to the back door to alert staff should residents access the secured garden area and require assistance re-entering the property. As a result Mr Trotter is considered to be under continuous supervision and control.

2. Not Free to Leave Green Acres operates a locked door policy, which is controlled by a keypad. Residents considered to have capacity in relation to leaving the premises or do not pose a safety concern as they remain able to identify hazards and dangers in the community (e.g. roads, other people etc.) are provided with the code in order to open the door. Mr Trotter is not provided with this information nor would he be able to retain said information if it did come into his possession, and as such is not able to leave the property without assistance from staff or another person (e.g. other residents, family members etc.). If Mr Trotter where to access the door and leave the premises both family and police would be informed and the MA would seek to return Mr Trotter to the premises at the earliest possible opportunity as evidenced during his recent absence from the home which culminated in being returned by local police officers.

Care home staff are clear that should Mr Trotter attempt to leave the care home environment he would be prevented from doing so and should family members wish to return him to the family home serious concerns would be raised and an attempt would be made to prevent this situation from occurring. As such Mr Trotter is assessed as not free to leave.

Subjective: Evidence that the person lacks capacity to consent to being kept in the hospital or care home for the purpose of being given the relevant care or treatment.

As per capacity assessment detailed within this form 3, Mr Trotter is assessed as being unable to understand, retain or weigh the relevant information in relation to this decision and this is considered to be - by both the BIA and the Mental Health Assessor - as a result of the progressive cognitive deterioration he is experiencing due to vascular dementia.

As such it is my opinion that Mr Trotter is unable to give valid consent to be accommodated in the care home for the purposes of care and treatment in a manner which objectively constitutes a deprivation of his liberty and as such meets the subjective element of the Storck criteria.

The placement is imputable to the State because:

Mr Trotter is now in receipt of CHC funding for his care home placement and had previously received social care funding for his placement prior to a further deterioration of his cognitive function. Green Acres is a CQC registered premises for the purposes of carrying out regulated activities (residential and nursing care – dementia related) as such his placement meets the criteria of being imputable to the state.

It is necessary to deprive the person of their liberty in this way in order to YES X

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prevent harm to the person. NO The reasons for my opinion are: Describe the risks of harm to the person that could arise which make the deprivation of liberty necessary. Support this with examples and dates where possible. Include severity of any actual harm and the likelihood of this happening again.

As already detailed Mr Trotter is disorientated to time and place, experiences signigicant memory and confusion difficulties and has limited mobility as a result of physical health issues. He appears to be unable to recognise hazards / danger and has become lost on at least two occassions, requiring family and police to look for him. Mr Trotter becomes confused when experiencing traffic or a large number of people and is supervised on a 1-1 basis in the community, on several occassions he has put himself at significant risk in relation to these issues, risk factors include - • Road safety – Mr Trotter becomes confused and disorientated when near busy roads and has required minimal restraint on several occassions (most recently 02/05/15; 14/05/15) to prevent him walking into busy roads / traffic. • Wandering / Disorientation – Mr Trotter can become disorientated and appears to have regressed to an earlier stage in his life, on two recent occassions he has become confused and required support from others to return to the home, once when he was found by Police in the Docklands area when he stated he was looking for his ship and once when he accessed the garden area and forgot how to use the back door handle and became very distressed (shouting and pacing) until staff intervened and opened the door. • Aggression – when frustrated and/or disorientated Mr Trotter has been observed to lash out at care staff, this has not caused significant injury and is an infrequent occurance ( 3 incidents recorded in the last 12 months) he also become verbally aggressive swearing and using derogatory terms towards those in close proximity. This feature creates a risk to Mr Trotter as if he exbhits said behaviour in a community setting retaliation of a member of the public is a possible outcome.

Mr Trotter is supported by staff to attend to his personal care and health needs, over the previous six months staff report that he requires increased support as a result of both his physical and cognitive health, risk factors include - • Underdosing or overdosing on medication – Mr Trotter has previously used a dosset box to enable self-management of his medication however staff have now taken over that responsibility as a result of Mr Trotter confusing days and times and taking double doses or no doses of essential medications. • Personal Care & Hygiene - Mr Trotter requires prompting to undertake personal care, he often forgets whether he has washed / shaved / brushed his teeth and will wear dirty clothes for extended periods unless prompted. Mr Trotter is on occasion incontinent of urine and requires prompting to use the toilet on a regular basis, and This is not typical behaviour in his case and is considered to be a risk to his personal dignity • Health Needs – Mr Trotter requires support to attend appointments and undertake routine health activities (eg repeat prescriptions, dental check ups, eye tests, appointments with his GP, Dementia or Arthritis consultants as such his health could be potentially at risk without support in this area. • Hydration & Nutrition – Mr Trotter is reported as often not identifying if he is hungry or thirsty, instead relying on staff and/or family to provide for these needs. Mr Trotter has experienced some weight loss in the last three months (12 pounds) and this is reported to be as a result of decreased appetite or interest in food/drink. Protein drinks have been prescribed by his GP however these are administered by care staff and Mr Trotter does not recognise what these are for or what they are. He is also beginning to experience difficulties in his swallowing action and his risk of choking has increased. Daily records indicate that staff have intervened on three occassions in the last month as a result of a potential choking episode (no medical attention required on these occassions to date).

Mr Trotter continues to be unable to recognise his own physical limitations and has engaged in risk

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behaviour in relation to his practice of faking falls in order to receive compensation. The capacity assessment that was carried out recently in relation to this issue (04/01/15) confirms the initial assessment carried out in relation to this issue (2007) and the subsequent assessments (12/02/10; 30/09/12; 24/07/14) that have been carried out formally when Mr Trotter has raised the subject with Mr Derek Trotter, and states that Mr Trotter is unable to understand or weigh the infomraiton in relation to the harm / injury that may occur as a result of this behaviour.

In summary my opinion is that Mr Trotter is at significant risk of harm in relation to physical injury health, self-care and medication needs as well as in relation to his ability to manage his nutritional and hydration needs.

Depriving the person of their liberty in this way is a proportionate response YES X to the likelihood that the person will otherwise suffer harm and to the NO seriousness of that harm. The reasons for my opinion are: With reference to the risks of harm described above explain why deprivation of liberty is justified. Detail how likely it is that harm will arise (i.e. is the level of risk sufficient to justify a step as serious as depriving a person of liberty?). Why is there no less restrictive option? What else has been explored? Why is depriving the person of liberty a proportionate response to the risks of harm described above?

As detailed the risks presented in Mr Trotter’s case include self-neglect, physical injury due to lack of awareness of hazards and exploitation by others due to his level of vulnerability and confusion. Mr Trotter is unable to access the community without support and is increasingly unable to attend to his health needs due to his continuing cognitive impairment. Mr Trotter wears an assistance alarm pendant to summon staff if required and he has recently used this aid when in the Garden as he became confused and was unable to open the back door to re-enter the property, becoming distressed as a result (detailed in care management profile notes 13/04/15), a door sensor has since been installed to the back door to alert staff if residents enter and exit the garden area. This is preventative in nature and Mr Trotter is not prevented from accessing the area but rather to ensure staff are aware that he may require assistance if he becomes disorientated.

Whilst it is reported that Mr Trotter retains some lucidity it appears that this is becoming increasingly infrequent and he appears to believe that he is a young man in the Royal Navy, actively seeking his ship and his orders when unsupervised. There have been a number of incidents over the last month that have presented significant risk to Mr Trotter, including becoming lost and wandering in unknown and recognised unsafe neighbourhoods and his ability to remember and undertake medication, personal care, and health related appointments and activities without substantial prompting and support is evidenced by staff.

Mr Trotter is able to access the establishment’s garden area, which is secured, and staff supervision is made available should he request visits into the community and whilst supervision is in place within the home (including the use of key pads and door sensors on the front and garden door) this appears to be managed in a non-invasive manner. Family members visit on a regular basis and also facilitate visits into the community (local pub, café and community centre) with staff support where required and as such Mr Trotter maintains freedom of movement within the establishment and grounds and is able to access the wider community when supported.

Staff supervision and support is available at all times due to the detailed risks and care and support needs evident in Mr Trotter’s case. This is in relation to activities of daily living (ADLs), meeting health needs and ensuring physical safety, in my view this level of supervision would be required by Mr Trotter in any environment (care home, hospital or home) due to his increasing and multiple health and social care needs, as such a deprivation of liberty to ensure these needs are met and the identified risks are mitigated is considered to be proportional in this case.

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This is in the person’s best interests. Note: you should consider section 4 of the Mental Capacity Act 2005, the additional factors referred YES X to in paragraph 4.61 of the Deprivation of Liberty Safeguards Code of Practice and all other relevant circumstances. Remember that the purpose of the person’s deprivation of liberty must be to give them care or treatment. You must consider whether any care or treatment can be provided effectively in a way that is less restrictive of their rights and freedom of action. You should provide evidence of the NO options considered. In line with best practice this should consider not just health related matters but also emotional, social and psychological wellbeing. The reasons for my opinion are:

Mr Trotter is unlikely to regain capacity in relation to this decision and is in fact showing a deterioration of cognitive function as his dementia progresses. Both his Dementia Consultant and the Mental Health Assessor appointed for the purposes of this DoLS assessment confirms that Mr Trotter’s symptoms are consistent with his diagnosis of vascular dementia, which has been confirmed by the necessary medical and diagnostic tests. His last appointment with his specialist consultant (Mr Green) was 03/04/15 during which a scan confirmed further deterioration had taken place.

Mr Trotter was involved in the original decision to move into Green Acres as a care home resident. He is not demonstrating dissatisfaction with the environment and has freedom of movement within the home and the secure garden area with staff on hand should he require assistance. Whilst disorientated on occasion and as such trying to leave the premises in order to locate HMS Peerless, this is not considered to be an attempt to leave Green Acres but rather as a result of his confusion. It is reported by Mr Rodney Trotter that Mr Trotter had acknowledged this fact in a lucid period in the week following his return by police (date unconfirmed). In light of this and in considering Mr Trotter’s largely friendly response to staff (observed at interview and confirmed by those consulted) and stated satisfaction with his room, the food provided and the garden area it is my view that Mr Trotter is not expressing an objection to his placement. Mr Trotter appears relatively settled at Green Acres and has resided there for a number of years, his care and support needs are being met by the care team at the establishment as detailed in relation to the evident risks and necessity of placement discussed elsewhere in this report and neither Mr Trotter or his family are expressing any desire to relocated to an alternative placement in order to meet these needs.

A number of family members are regularly involved with Mr Trotter’s care and support and Mr Trotter resided with these family members prior to his placement. Mr Derek Trotter holds Property & Affairs LPA and both Raquel & Cassandra Trotter ensure that Mr Trotter is visited by one of them every day, with family trips into the community taking place on most weekend Sunday afternoons. In discussion each family member independently confirmed that they believe Mr Trotter was receiving the care he needed and whilst they had wanted him to remain in the family home, when Mrs Racquel Trotter became pregnant in 2002 Mr Trotter had chosen to move into Green Acres as he felt unable to cope with living with a new baby and was beginning to experience both memory difficulties and restricted mobility.

In terms of considering the least restrictive option in this case the options considered are presented in the balance sheet detailed below. There are a number of restrictions that Mr Trotter is subjected to as part of his risk assessment/management plan and current care plan, these are as follows: • Locked door • Staff supervision • 1-1 support in accessing the community • Door sensors – front and back door • Assistance alarm pendant • Secured garden.

However as detailed within the home and garden environment a light touch approach is taken by the managing authority and this is considered a proportionate response to the risks and needs identified. In any care or home setting Mr Trotter would need the degree and intensity of care and

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support identified and whilst less restriction has been applied in terms of no door sensors prior to the recent incident, medication blister packs were in place prior to Mr Trotter becoming unable to manage self-administration of medication etc. these are no longer appropriate given the increase in his physical and cognitive dependencies which now require constant supervision to ensure his safety and mitigate the identified risks.

Whilst considered as part of the balance sheet exercise the family home is not a viable option in this case due to limited space and physical accessibility of the environment which Mr Trotter requires due to his increasing mobility needs and his need for intensive supervision, care and support which his family, whilst willing, would struggle to provide whilst carrying out other responsibilities such as work etc.

An alternative placement is unlikely to offer any decrease in the restrictions placed upon Mr Trotter at this time. He does not need to move to alternative accommodation, appears satisfied in his current environment and family members support his placement. As such his current placement meets his identified needs and mitigates the risks as stated and as such in my view a change of placement is an unnecessary disruption to Mr Trotters care and general wellbeing.

In light of all of these factors it is my opinion that the whilst Mr Trotter’s current placement constitutes a deprivation of his liberty as clarified in the March 2014 Supreme Court judgement this deprivation is in Mr Trotter’s best interest for the reasons discussed, the balance sheet presented below provides a systematic account of the benefits and burdens of each of the options considered in this case which support this assessment.

After giving your reasons above you should now carry out analysis of the benefits and burdens or each option identified.

Option 1: Return home Benefits: • Maintain close family relationships • Familiarity of local area • Least restrictive alternative

Burdens: • Overcrowding at premises (currently 4 adults and 1 child reside in 3 bedroom flat) Mr Trotter would need to share a room with his great great nephew or sleep in the families living area. • Disruption to current arrangements may cause additional confusion and distress • Family members unable to provide 24 hour support due to work commitments • New home carers required learning preferences building rapport with Mr Trotter. • 6th floor premises, lift not reliable, limited access to the community when in need of repair (reported to be faulty on a regular basis (April – 4 repairs) • Adaptations required to allow accessibility to bathroom and kitchen areas. • Left flat with consent and family support in 2002

Option 2: Remain in current placement Benefits: • Care and support meeting physical and health related needs • Staff support available if and when required • Relationships / rapport with care staff • Long-term established, settled, and self selected placement • Family support for placement, continued close family relationship. • Close to family home – regular visits and trips to the family flat.

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• Social activities and socialisation with other residents – friendships evident with other residents at Green Acres • Regular activities and access to therapies (i.e. music group, reminiscence group etc) • Mitigation of identified risks • Care plan in place meets needs and include • Light touch supervision in place • Relationship between family and care staff established.

Burdens: • Deprivation of liberty

Option 3: Alternative placement Benefits: • No identified benefits of alternative placement evident at the current time.

Burdens: • Unlikely to result in a reduction of the restrictions currently in place • Unfamiliar environment • Unfamiliar staff, staff not familiar with Mr Trotters needs, wishes, preferences.

BEST INTERESTS REQUIREMENT IS NOT MET This section must be completed if you decided that the best interests requirement is not met. For the reasons given above, it appears to me that the person IS, OR IS LIKELY TO BE, deprived of liberty but this is not in their best interests.

In my view, the deprivation of liberty under the Mental Capacity Act 2005 is not appropriate.

Consequently, unless the deprivation of liberty is authorised by the Court of Protection or under another statute, the person is, or is likely to be, subject to an unauthorised deprivation of liberty.

A Safeguarding Adult enquiry must be considered for any unauthorised deprivation of liberty. Please place a cross in the box if a referral has been made.

Date of Referral: N/A

Please offer any suggestions that may be beneficial to the Safeguarding Adult process, commissioners and / or providers of services in deciding on their future actions or any others involved in the resolution process.

N/A – no safeguarding issues identified, authorisation recommended as assessed as being in Mr Trotter’s best interests.

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BEST INTERESTS REQUIREMENT IS MET The maximum authorisation period must not exceed one year

In my opinion, the maximum period it is appropriate for the person to be deprived of liberty under this Standard Authorisation is: 12 months

The reasons for choosing this period of time are: Please explain your reason(s)

Mr Trotter is in a stable placement with active family support and evidence that the individual selected as RPR is able to raise challenge where care / treatment does not meet Mr Trotter’s needs and preferences.

Mr Trotter has resided at Green Acres for a number of years, he selected his own placement and has not expressed a wish to leave the accommodation or object to the care and support provided during his years residing at the home. He has positive relationships with staff and friendships within the establishment, and a light touch approach to supervision is in place and Mr Trotter has freedom of movement within the establishment and garden. It is my view that there is no concerns within this authorisation to indicate that a shorter time span would provide any benefit and as such 12 month authorisation is recommended with additional reviews to be trigger as per code of practice guidance if Mr Trotter’s need change or increased restrictions are required.

DATE WHEN THE STANDARD AUTHORISATION SHOULD COME INTO FORCE I recommend that the Standard Authorisation should come into force on:

10/05/15

RECOMMENDATIONS AS TO CONDITIONS (Not applicable for review) Choose ONE option only I have no recommendations to make as to the conditions to which any Standard Authorisation should or should not be subject (proceed to the Any Other Relevant information section of this form). I recommend that any Standard Authorisation should be subject to the following conditions X 1 Should additional restrictions be imposed on Mr Trotter as a result of cognitive or physical deterioration in addition to those directly specified in this assessment a review should be triggered at the earliest possible opportunity to ensure said restrictions remain a proportional response to the risks identified. 2 RPR to be provided access to IMCA support should a challenge to the deprivation be presented within the 12 month period 3

4

RECOMMENDATIONS AS TO VARYING ANY CONDITIONS (Review only) Choose ONE option only The exisiting conditions are appropriate and should not be varied

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The existing conditions should be varied in the following way: 1

2

3

4

SHOULD ANY RECOMMENDED CONDITIONS NOT BE IMPOSED: I would like to be consulted again, since this may affect some of the other conclusions that I have reached in my assessment. I do not need to be consulted again, since I do not think that the other conclusions reached in X this assessment will be affected. ANY OTHER RELEVANT INFORMATION Please use the space below to record any other relevant information, including any additional conditions that should or should not be imposed and any other interested persons consulted by you.

Mr Trotter is experiencing significant deterioration in his condition and further deterioration is likely to occur as per the opinion of his specialist consultant. Whilst exact timescales are not identified it is clear that Mr Trotter’s needs are set to increase, potentially with some speed given the cognitive and physical decline observed over the previous 6 months.

RECOMMENDATIONS, ACTIONS AND / OR OBSERVATIONS FOR CARE MANAGER / SOCIAL WORKER / COMMISSIONER / HEALTH PROFESSIONAL

• To consider developing an MDT forward plan, including end of life planning if appropriate, to respond proactively to Mr Trotter’s deteriorating health condition and identify his preferences where possible, involving both Mr Trotter and relevant family members. SELECTION OF REPRESENTATIVE– place a cross in one box (Note that the Best Interests Assessor must confirm below whether the proposed representative is eligible before recommending them ) The relevant person has capacity to select a representative and wishes to do so. Name of person selected: The relevant person who lacks capacity to select a representative but has a Lasting Power of Attorney, or Deputy, for Health and Welfare, this decision is within the scope of their authority and they have selected the following person Name of person selected: Neither the relevant person nor their Donee or Deputy wish to, or have the authority to, select a representative and therefore the Best Interests Assessor will select and recommend a X representative. RECOMMENDATION OF REPRESENTATIVE – place a cross in one box I recommend that the Supervisory Body appoints the representative selected by the relevant person above and confirm that they are eligible and would in my opinion maintain contact with the person, represent and support them in matters relating to or connected with the Standard Authorisation if appointed. (Read guidance notes for clarification of eligibility) I have selected and recommend that the Supervisory Body appoints the representative

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identified below. In so doing I confirm that: X • the person this assessment is about (who may have capacity but does not wish to select a representative) and / or their Donee or Deputy does not object to my recommendation; • the proposed representative agrees to act as such, is eligible, and would in my opinion maintain contact with the person, represent and support them in matters relating to or connected with the Standard Authorisation if appointed. (Read guidance notes for clarification of eligibility). Please tick this box if this section is being completed because an existing representative’s appointment has been terminated before it was due to expire and it is necessary for the Supervisory Body to appoint a replacement Full name of recommended representative Cassandra Trotter Their address 368 Nelson Mandela House Peckham PE1 8FH Telephone number(s) 0207 918 819 Relationship to the relevant person Great Niece-in-law Reason for selection Mrs Trotter is considered to be the most appropriate family member to act in RPR role and meets the required criteria of being willing and able to maintain regular contact with Mr Trotter and present any concerns of challenges in relation to his deprivation of liberty.

The RPR role was discussed with all four family members and the consensus of members was Mrs Cassandra Trotter undertakes the role as she is the family member who takes on the role of organising Mr Trotters care and has previously lodged a complaint on his behalf to the local hospital trust in relation to Mr Trotter’s treatment during his most recent hospital admission, therefore I concur that Cassandra Trotter be selected as RPR.

She has consented to this selection and has been provided information in relation to the expectations of this role, including the responsibility to maintain contact with Mr Trotter and represent his views in relation to this deprivation of liberty (standard RPR booklet provided) and has been advised of the availability of IMCA support should she wish to challenge Mr Trotter’s care, treatment or deprivation either now or in the future or if Mr Trotter begins to object to his placement and how to trigger a review of the authorisation. If you are not able to name a representative please place a cross in the box and record your reason below

PLEASE NOW SIGN AND DATE THIS FORM

Signed Jane Smith Date 10/05/15

Print Name Jane Smith Time 10:30

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