Deprivation of Liberty Safeguards

If you are a care home, to make a referral for a DOLS authorisation complete our online DOLS referral form. If you experience any technical difficulties contact DOLS Duty on 01772 535444.

DOLS referral form

If you are a hospital or hospice, to make a referral for a DOLS authorisation email: ACSCustomer.Services@lancashire.gov.uk

Hospitals making a referral need to use the Lancashire County Council secure messaging facility (and for those who do not already have access this) you are also advised to contact DOLS duty on 01772 535444.

Court of Protection Deprivation of Liberty (COPDOL)

To make a referral about COPDOL email: ACSCustomer.Services@lancashire.gov.uk

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Continue past the 'criteria' page

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Other information that you want to share

Towards the end of the form there is a box to provide any other information you want to share.

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Ordinary resident of Lancashire

If the person is funded by another local authority other than Lancashire County Council it is unlikely that they will be an ordinary resident of Lancashire and you will need to contact the other local authority.

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Attaching my signature to the urgent authorisation

Scan or take a photo of your signature. Save it somewhere sensible on your computer so you can use it again for future urgent authorisations.

Record of my DOLS submission reference number

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Form 1

• Relevant medical history

  Type 1 diabetes; hypertension; Alzheimer's diagnosed in August 2014; subdural haemorrhage in December 2014

• How the care is funded, please provide details

  A social worker from Lancashire County Council recommended Mr Smethy needed residential care and his daughter chose Stoney Edge as it is close to where she lives

• What is the purpose of the Standard Authorisation

  Mr Smethy frequently experiences disorientation and confusion; does not initiate his own care; cannot reliably and accurately verbally express what he needs/wants; what he tries to say can often be difficult to understand; and he does not always understand what he is being asked or said to him. He relies on staff to anticipate his support needs; establish what support he is asking for; and provide direct support/supervision/prompting in all areas of daily living.

• Night care: Hourly welfare checks and pressure mat to alert staff as he can be wakeful and walk about for a variety of reasons which we try to establish e.g. pain, continence needs, hungry/thirsty, feeling lost. Reassurance, a cup of tea and a biscuit generally help him settle back to bed.

• Management and administration of medication: He is not keen on taking mediation but accepts it if told what it is and the purpose of it.

• Mobility, moving and handling: Mobility can be variable between independent but with supervision and needing a wheelchair, particularly over longer distances, which staff need to push for him. His ability is assessed throughout the day and when independently mobile he is monitored/observed so we can assist/guide/support when necessary.

• Continence needs: Needs frequent/regular reminders to use the toilet and may need support to locate the toilet/get there in good time. We ensure he wears continence products as he becomes very distressed if he does not make it to the toilet in time.

• Personal care: Relies on staff to support him with all aspects of this. Depending on his mood he can be agitated and pushing staff away during personal hygiene tasks so there are times when he needs lots of reassurance and 2 staff to attend to essential care with the use of safe holds. He is cooperative with other personal care.

• Nutrition: Staff ensure a choice of nutritious healthy foods and fluids. He has a poor appetite and loses concentration during meal times so requires prompting/encouragement; a fortified diet; and is prescribed dietary supplements.

• Daily routing and activities: Mr Smethy is quietly sociable, preferring to watch rather than participate in activities. He likes being in communal areas so when mobility is poor he needs support to ensure he is not left alone. He likes lots of naps during the day and will go to his bedroom for these so when mobility is reduced staff need to support him to do this. He prefers going to bed at about 9pm and tends to wake up about 7am. He is reminded of the options for activity and social interaction, including just watching, and offer him support to participate if he wishes. We always ask him to have meals in the dining room which he accepts.

• Behaviour: Mr Smethy sometimes shows low level verbal aggression and threats to male staff e.g. "Bugger off", "Leave off me", raising fists, who ask him to do something so female staff are asked to assist which alleviates the issue. As above he can sometimes be agitated and push staff away during personal care.

• Going out: Mr Smethy needs 1 person (staff or family) to take him out if he is in his wheelchair but if he is walking 2 people are needed due to risk of falls. Hi daughter takes him out once a week for lunch.

Please tick the restrictions that apply:

• Any physical intervention (PI) used to manage behaviour (this includes safe holding), please provide details

  Staff are trained in safe holds which are used as a last resort when reassurance, revisiting the task and changing staff has not settled Mr Smethy and he continues to be agitated and push staff away during essential personal care.

The person's request to go out into the community are denied, please provide details

• Mr Smethy often approaches doors and asks to go out - usually 3 or 4 times in a week depending on his mobility. He usually says he needs to go to work or wants to go to the pub. Staff use various diversion/redirection depending on the time or the day e.g. offering tea and biscuits (a favourite of his); if his daughter is visiting we say she will be here soon; if it is late in the day we tell him work is closed, or closed for another reason such as a bank holiday; or if it is nearly a meal time we suggest he has that first; or we suggest sitting in the garden. This always works and Mr Smethy makes no attempts to leave.

  Please explain why the person is or will not be free to leave and why they are under continuous or complete supervision and control

  Due to confusion/disorientation Mr Smethy lacks any real awareness of his care needs so is at very high risk of self-neglect. He is heavily reliant on others to anticipate his daily needs and provide his care to avoid serious and rapid deterioration in his mental and physical health. He is unable to assess risk and predict/avoid potential harm and has difficulty accurately communication and receiving information.

  Without the current levels of supervision, monitoring and support Mr Smethy is at very high risk of:

• Neglecting medication

• Deterioration in physical health

• Failing to recognise and report the need for medical attention

• Falls and resultant personal injury

• Going out unaccompanied with the risk of getting lost, becoming agitated/distressed, road accident, falls and being without essential care

• Malnutrition and dehydration

• Harm from everyday environmental and domestic hazards, most significantly from inadvertently starting fires

• Isolation and lack of social interaction with others

What is the purpose of the Further Standard Authorisation

Mrs Nicolson's main needs arise from the impact dementia in Alzheimer's disease has on her, in particular her behaviour and ability to assess risk and keep herself safe. She has a poor understanding of her current situation, potential risks to her health and well-being and does not understand why she is in a nursing home rather than living independently. Mrs Nicolson requires:

• encouragement and prompting to attend to personal care at times.

• all domestic activities are on her behalf.

• all medication is managed and administered by staff. Sometimes she refuses this so requires reminders of why she needs to take it plus encouragement and revisiting the task. A convert medication plan is in place to be used as a last resort but only for anti-depressants and pain relief.

• supervision whilst in the garden or out in the community as on a few occasions she attempted to leave the premises by climbing over the garden fence although she was discouraged by staff.

• staff are aware of her whereabouts at all times in order to provide support/diversion/redirection to manage a variety of behaviours such as pinching staffs bottoms; invading personal space; taking food from other residents plates; angry shouting; agitation and restlessness; frustration; pushing others; fixations about her husband having affairs; his bowels, staff poisoning his tea and that he is going abroad; and hallucinations of people being in his room. Instances appear to greatly reduced since the previous standard authorisation and moving to the new unit.

• all medical appointments to be made and any referral to health and social care professionals made on her behalf. Staff accompany her to all appointments.

Please provide details of any changes to the information previously given in Form 1

• Mrs Nicolson has moved from the downstairs Oak Unit to the upstairs Rowan Unit which has a higher staffing ratio and where staff have increased skills and training in managing her behaviour.

• A convert medication plan is in place for anti-depressants and pain relief.

• Mrs Nicolson's husband died in August 2020 which she is aware of but occasionally forgets. The main contact for consultation is her daughter, Melaine Sykes, 1 The Cottage, Springfield, telephone 03456 789123

Restrictions that apply

• Sedation/ medication is used to control challenging behaviour

• Lorazapam 5mg as needed when behaviour cannot be managed by distraction/ diversion/ reassurance

Please provide details as to why the requirements are no longer met

Mrs Bloggs GP has recommended medication can be administered covertly as she is regularly refusing to take it. He recommends only her anti-depressants and pain relief are given in this manner.