In many cases, the facilities did not recognise that preventing residents from leaving an area could constitute a deprivation of liberty. Deprivation of liberty does not only arise where there are absolute obstacles such as locked 44 doors. Covering a door in the manner outlined above has the result that residents are unable to recognise the exit due to their reduced cognitive abilities. If the act of concealing the exit has the effect that an individual is under the impression that it is physically impossible to leave the area they find themselves in, then this constitutes a deprivation of liberty within the meaning of section 1906 of the German Civil Code 45 [Bürgerliches Gesetzbuch, BGB]. The same applies to complicated locking mechanisms or any other method whereby staff prevent 46 individuals from leaving a particular area. were in use in certain cases without court permits or consent from the persons concerned. When asked about this, the facility replied in a particular case that the person concerned was immobile. However, there was no medical certificate to confirm this. Nor was the facility able to provide any explanations for the other cases. A further case was observed where a bed rail was still in use even after the relevant court order had been annulled. The facility had continued to use the bed rails for a period of more than two years before consent was obtained from the person concerned. As a fundamental principle, every human being has a right to personal freedom. In accordance with section 1906 of the German Civil Code [Bürgerliches Gesetzbuch, BGB], the placement of a person in a closed living area against his or her will and the application of measures involving deprivation of liberty require judicial authorisation, unless there are exceptional circumstances in the particular case that would justify such a measure, or the person concerned has expressly given consent. It must be ensured that measures involving the deprivation of liberty are applied in accordance with legal requirements at all times. Procedure instructions for deprivation of liberty In one facility, the procedure instructions on measures for the deprivation of liberty did not comply with legal requirements in several respects. As a consequence, there was a danger that legal provisions might not be observed when residents were being deprived of their liberty. Preventing residents from leaving a living area In several facilities, measures were found that were designed to prevent residents (in particular those with dementia) from leaving a living area or facility without the exit door having to be locked. In order to prevent violations of residents’ rights of personality, procedural instructions for employees must comply with the relevant laws. Such measures included, for example, number code locking mechanisms on exit doors or lifts. It was also seen in many facilities that the exit doors were covered with curtains, colourful blinds or printed wallpaper so that they would not be immediately recognisable as exits. In other facilities, certain residents were equipped with transponders, which would set off a ring tone whenever the resident opened the door of the living area. The facilities explained that when a ring tone is activated, the employees run to the door to prevent the residents from leaving the living area or the facility. 2.2.11 – Violence prevention In some facilities, it appeared that the topic of violence had not been sufficiently addressed. No central record was kept to document violent incidents between residents or between residents and staff. Furthermore, some facilities had no violence prevention strategy. The topic of violence should be discussed openly in order to raise awareness among 44 Walther, “Freiheitsentziehende Maßnahmen nach § 1906 Abs. 4 BGB”, BtPrax 6/2005, p. 215; Jacobs, “Freiheitsentziehende Maßnahmen nach § 1906 Abs. 4 BGB durch optische oder verbale Täuschung”, BtPrax 2012, vol. 3, p. 99; Stalinski, “Unterbringungsähnliche Maßnahmen - § 1906 Abs. 4 BGB”, BtPrax 2/2014, p. 58 45 Ibid. 46 Palandt/Götz, “BGB-Kommentar” [Commentary on the German Civil Code], 76th ed., sections 1906 margin no. 35 Generally in these cases, no placement orders or orders for measures involving deprivation of liberty had been issued by the courts. The National Agency sees this as a threat to the civil liberties of the persons concerned. 42