MCAGG Gloucestershire MCA2 for Significant Decisions (In Place of FACE MCA2 If No Licence)

MCAGG Gloucestershire MCA2 for Significant decisions (in place of FACE MCA2 if no licence)

Mental Capacity Assessment(MCA 2)
Identification Number:
Name: / Date of birth:
Address: / Ethnicity:
Date completed: / Assessor:
What is the decision that has to be made?
Key Roles
Name:
Tel no:
Role:
Roles – LPA Health and Welfare, LPA Finance, EPA Fianance, CPD Court of protection Deduties, NOK, other
Please give details of any docuements relating to roles
Details
Two stage test of Capacity / Yes/No / Details
Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn’t matter whether the impairment or disturbance is temporary or permanent.)
If so, does that impairment or disturbance mean that the person is unable to make the decision decribed above at the time it needs to be made?
Evidence to support two stage test above / Yes/No / Details
Does the person understand the information about the decision to be made?
Can the person retain the information?
Does the person use or weigh up that info as part of the decision making process?
Can the person communicate their decision (by any means)?
Outcome of assessment – does the person have capacity in relation to this decision at the time of the assessment?

Best Interests Decision

The remaining section should only be used where a Mental Capacity Assessment above has been recorded to show that the person lacks capacity in relation to the specific decision and a best interest decision is needed.
Medical treatment decisions:
Does the person have a valid and applicable advance decision to refuse treatment that relates to the above decision (this should have been recorded in the last assessment)?
Yes / No (delete as appropriate)
If yes, then stop this assessment and follow the advance decision.
Is there a lasting power of attorney, deputy or Court of Protection order in relation to the decision?
Yes / No (delete as appropriate)
If yes, then best interest decisions will be made by these people or stated in the court order. Please check relevant documents to see what powers they contain.
Serious healthcare and treatment decisions:
Some decisions must always be made by the Court of Protection, such as withholding of artificial nutrition and hydration, organ or bone marrow donation and non-therapeutic sterilisation. CHECK IF UNSURE.
The statutory checklist (MCA 2005 Section 4) requires that the following
issues are taken into account, as far as is reasonably ascertainable, in
deciding best interests. Please confirm that you have given due regard to each of the following by placing a tick in the right hand column of the tables below and providing detail where appropriate:
Issues to be Considered / Tick
All relevant circumstances (care needs, history etc):
The person regaining capacity and if so, can the decision be delayed
until then:
The person’s past and present wishes and feelings (written or verbal):
The person’s beliefs and values that would be likely to influence the
decision:
Any other factors the person would take into account:
Consultation with and account taken of the views of / Tick
Anyone previously named by the person as someone to consult with:
Anyone involved in caring for the person:
Anyone interested in their welfare (family, close friends, advocates etc.):
An attorney named in a valid Lasting Power of Attorney:
A deputy appointed by the Court of Protection:
An Independent Mental Capacity Advocate (IMCA). An IMCA must be appointed when the decision relates to serious medical treatment or a change in accommodation and there is no-one else to support the person other than paid staff:
Further considerations: / Tick
So far as is reasonably practicable, have you encouraged and permitted the person to participate in the decision?
Have you considered less restrictive options that may be available, in terms of the person’s rights and freedom of action?
If a life-sustaining treatment decision, confirm you are not motivated by a desire to bring about the person’s death.
Confirm that the decision is non-discriminatory and has not been made based solely on age, appearance, behaviour or condition:
Outcome of Best Interests Assessment:
Section 4(9) of the MCA 2005 confirms that if someone acts or makes a decision in the reasonable belief that what they are doing is in the best interests of the person who lacks capacity then, provided they have followed the above checklist, they will have complied with the best interests principle set out in the Act.
Having regard to all the above, please document below:
• How the decision about the person’s best interests was reached;
• Why the decision is in the person’s best interests;
• Who was consulted to help work out best interests;
• What particular factors were taken into account;
• Note any conflicts or disagreements regarding the decision;
If there are less restrictive options available, give details and explain why these are not being implemented.
Best Interests Decision Balance Sheet
Option 1 (e.g. go into residential / nursing care home or receive medical treatment) Please give details:
Advantages or benefits / Disadvantages
Option 2 (e.g. to stay at home with support package or not receive medical treatment)
Please give details:
Advantages or benefits / Disadvantages
Completed By / Signed / Date (DD/MM/YY)