For this article, Care Ideals have liaised with Neil Grant (Health and Social Care Solicitor; https://www.gordonsols.co.uk/).
In less than a year, we have encountered three situations of poor practice related to the locking of bedroom doors, capacity and consent. We felt it could be helpful to clarify good practice on this topic for owners and managers of Care Homes (elderly residential, learning disability, etc).
1) Any Care Home may have residents who choose to have their bedroom door locked when they’re in the room. That is fine, so long as the resident in question has the capacity to make this decision. The Manager must then ensure that they have signed confirmation from each of these residents, confirming that they’re choosing to be locked in or to lock themselves in their bedroom.
The Home must also ensure that the resident is able to let themselves out of their bedroom i.e. with a key or the door has an internal door handle that when it’s pulled down, the door unlocks and the resident can leave.
A resident with capacity would understand that if they injured themselves whilst in the room, even if the door is closed and / or locked, they could call for help.
2) This entire situation changes completely if a resident lacks capacity. Someone who lacks capacity mustn’t be able to lock themselves in their room and mustn’t ever be locked in their bedroom.
3) When we’ve encountered this issue, we’ve been told that the reason for the locked bedroom doors or locking people without capacity in their bedrooms, was to prevent certain residents from wandering into other residents’ bedrooms.
However, these aren’t reasons that justify this course of action. The situation of one or a few residents wandering into other resident’s rooms must be managed in a less restrictive and more compassionate manner.
4) Under no circumstances should a resident without capacity be locked in their bedroom! Think about the following:
a) Even if you give them a key to unlock the door, or if the door handle can be pulled down to release the lock, the resident might not understand what the key is for, nor understand that the door handle being pulled down releases the lock. A resident could then want to leave their room for a long time, but not understand how to leave their room. In this circumstance, the resident is being deprived of their liberty in a manner that can’t be justified.
b) If a resident without capacity was locked in their room, how often is the resident checked? In situations that we’ve dealt with first-hand, we were told the checks took place hourly. However, the resident without capacity might not understand that if they injure themselves, they need to call for help. They could fall and injure themselves 2 minutes after the check is completed, and then lie in pain for 58 minutes until the next check takes place.
5) There are some residents without capacity who like to wander around the Home or their floor in the Home i.e. along the corridor, into the lounge, back along the corridor, etc. This helps to burn off energy and enables them to see other people, be mentally stimulated, etc.
Locking them in their rooms prevents them from being able to partake in any type of activity, or receive mental stimulation. Neil Grant comments about this particular scenario:
“If this is happening within the care home, almost certainly it would be classified as ill-treatment. However, one could also classify such practice as inhumane and degrading. A care home is obliged to ensure the least restrictive practices as possible are put in place. In relation to residents who lack capacity, locking doors is clearly a form of control or restraint.”
6) There are also compliance issues in terms of the Fundamental Standards. Neil comments on this as follows:
“Such practice raises serious questions about due process in terms of consent and best interests. From a compliance perspective, the home is at serious risk of being found to be in breach of Regulations 9, 11, 12 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Further, such practice is institutional in nature which runs counter to CQC’s guidance about closed cultures”.
7) A further point in relation to locking all the bedroom doors is this:
Locked doors are closed doors! This creates a ‘closed-in’ environment that is the opposite of what one would expect when talking about ‘person-centred’ care.
It also prevents staff being able to glance into the room as they’re walking past, just to check that all is ok in the room, or just to chat to the resident. Chatting to a resident, even if only briefly when walking past their room, can make all the difference to their outlook and mood.
8) To manage this issue safely and correctly, please think about it in terms of:
a) How can we create the least restrictive environment possible?
b) Do we have the correct paperwork and permissions in place, that will stand up to scrutiny by the CQC and your Local Authority?
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