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 March 2015 – V4 - Final Deprivation of Liberty Safeguards Form 3 Page 1 of 16 Combined Age, Mental Capacity, No Refusals and Best Interests 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. March 2015 – V4 - Final Deprivation of Liberty Safeguards Form 3 Page 2 of 16 Combined Age, Mental Capacity, No Refusals and Best Interests 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.