Sandra had originally spent over 40 years in a hospital for people with Learning Disabilities and psychiatric issues.  When these hospitals were closed Sandra was placed in accommodation for people with Learning Disabilities in the community.  In 2014 Sandra suffered a stroke which left her paralysed down her right side and she was discharged to a registered care home; no IMCA was involved in this decision as Sandra has family, however when Sandra became subject to a DOL an RPPR was appointed as her sister lives a distance away, could not visit regularly and could not take on RPR role.

RPPR received referral and reviewed BIA report and SA assessment.  At the care home RPPR talked with staff nurse in charge and got further information from client care notes.  RPPR then spoke with the client. 

After seeing Sandra it appeared that the BIA assessment contained inaccuracies; RPPR was also identified as a concern that Sandra although when she was first admitted to the care home was on a frail elderly unit, she had been moved soon after to a Dementia Unit. RPPR also established that Sandra was unhappy as she wanted to attend church services at the church she had attended when she lived in Harrow.  RPPR also noted that placement had been reviewed and made permanent by her social worker and had also been reviewed by the Learning Disabilities Unit at Local Authority and no issues had been raised.  

Case was discussed with manager and a placement and a review of the DOLS was requested as the BIA assessment did not demonstrate the current needs of Sandra, and also it was unclear to the RPPR that the staff on the dementia Unit could support Sandra with her Learning Disability needs as well as her physical needs. 

It appeared to the RPPR that all the assessments did not make any allowances for any further improvement in Sandra’s condition.

After speaking with Sandra it was clear that she liked all the staff and appeared to get on well with them and that they enjoyed talking with her.  After speaking with care staff it appeared that they were not aware that she did not have dementia. 

RPPR talked with Sandra about what she wanted and she just wanted to be able to do more activities and to go to her old church. I did ask her about speaking with her family and she told me that was fine and also she asked me to ask her sister to come and see her. RPPR talked with Sandra’s sister and she told me that she had no idea that her sister was on a dementia Unit.  I advised that there were concerns about her sister being on a dementia unit and that I was going to ask the SB about this issue.

Barriers were –Nurse in charge did not see that she could do anything about the placement on her unit as this was a management issue.  Activities and outings were organised by activities organizer and she was either on holiday at my visit or not around on the unit.

So the only way any changes were going to happen were if the SB organised a review of the DOLS.  Subsequently after RPPR representations. the social worker has completed her review and this is the outcome:

Following Sandra’s review on date, I will like to clarify the points raised in relation to her care and support at Care Home.  I also used the opportunity to complete a Mental Capacity Assessment in regards to decisions about accommodation with Sandra and I can confirm that she has been found to have the capacity to make decisions in relations to her accommodation.

In view of this, Sandra has communicated that she would like to continue living at Care Home however, she would like to live with residents that she could communicate and socialize with as this would provide her with some stimulation.  I have found that the current unit she is in, does not provide her with the opportunity of this and would request that she is moved to a more suitable unit within the home where she would have the opportunity to engage in stimulating activities of her choice with people with similar needs to hers.

Also, Sandra informed me that she has been stopped from smoking and this was not her choice and she would like to have her cigarettes back – please provide the reason behind the decision to stop her smoking without her consent.  A mental capacity Assessment should have been completed when the decision was taken, was this actioned? I have asked if she would like her cigarettes back and she has communicated that she would like to and I would like this action to be taken.

Sandra has also communicated that she would like to access church; she would be able to pay for transport to access church, please confirm if support could be provided in-house for when she accesses church.

I will also like your response to the following:

  • Please confirm when last Sandra has physiotherapy
  • Please confirm when was the last time Sandra seen by a SALT as she was prescribed pureed food and thickened diet at her discharge from hospital, during my visit I observed that her drink was unthicken.  I will be referring her to the CLDT SALT for an assessment.
  • Please provide a weekly activity plan for Sandra

Since representations were made for Sandra by RPPR, the care home has significantly amended her care plan and subsequent visits have reported a much improved level of mood and interaction from Sandra, and she presents as a much happier person now she is able to undertake activities she enjoys and consequently her DoL is as less restrictive as possible.