medication in order to ensure that treatment is provided safely. Needs-based medication should also be reviewed on a regular basis. In such cases, the capacity of the person concerned to provide consent should be documented in a clear and comprehensible manner. Legality Administration of medicine In cases where the person concerned was unable to provide consent, almost all of the facilities only retrospectively involved the guardians responsible for health care in changes of treatment and medication or did not involve them at all. In only a few cases did this comply with the guardian’s wishes. Some facilities only informed the guardian in the event that an order was given by a psychiatric or neurological specialist. In one facility, the delegation was told that the facility did not cooperate with guardians on the subject of health care. As a result, it was unclear whether valid consent had been provided for changes in treatment and medication. In cases where the affected person had provided consent personally, this was not documented. Likewise, there was no documentation stating that affected persons were demonstrably able to provide consent in the decision-making situation. As regards the administration of medicine, the National Agency observed mix-ups, omissions, and a lack of compliance with the appropriate regulations. On multiple occasions, tablets for specific residents were ground together before being administered so that the resulting powder could be given to the person concerned either with their food or via a feeding tube. This occurred even when the information provided by the drug manufacturer stated that the medication in question should not be crushed. Omissions and mix-ups in the distribution of medication can endanger the health of residents or cause life-threatening situations. This also applies to cases where improper administration alters or negates the effect of the medication. Certain foods, such as milk or fruit juices, can also alter the effects of a drug. Thus, as a general rule, facilities should refrain from mixing medication into residents’ food. The practices encountered in these facilities illustrate that, in the majority of cases, there is no guarantee of the protection that guardianship aims to provide against treatment or medication being given without legally valid consent. In the view of the National Agency, this constitutes a risk to residents’ right of personality. In order to prevent damage to health, it must be ensured that residents receive only the medication that has been prescribed to them, and that it is administered as prescribed by the doctor. Regulations on the administration of medication must be adhered to. A guardian is appointed to actively represent the interests of the person concerned towards third parties in accordance with their assigned area of responsibility. This also applies to appropriately authorised representatives. In the event that the affected person is unable to give consent, legal representatives must be informed of any changes in treatment or medication ahead of time by the attending physician; a decision should then be taken on this basis. In addition to communicating the purpose of any changes in treatment or medication, a comprehensive explanation should include reasoning, potential effects and alternatives. Facilities should make this possible by establishing appropriate workflows and documenting consent. 2.2.14 – Residents' participation Several facilities did not have any kind of residents’ committee at the time of the visit. In several cases, a residents’ advocate acted on behalf of the residents without the facility having encouraged the formation of a residents’ committee. In addition, it was repeatedly stated in the facilities that the residents’ committee did not have its own separate meeting. In two cases, the residents’ committee complained that management was not sufficiently approachable. The participation of residents in matters related to the facility's operation can help to safeguard their rights and ensure that dignified care and support is provided. The participation of residents should therefore be encouraged in order to prevent such issues from arising. Where the person concerned is capable of giving consent in a specific decision-making situation, they can take the decision themselves. 44