National Care Standards: Care homes for people with learning disabilities

Day-to-day life

12 Your lifestyle - social, cultural and religious belief or faith
13 Eating well
14 Keeping well - healthcare
15 Keeping well - medication
16 Private life
17 Daily life
18 Supporting communication
19 Support and care in dying and death

Introduction to standards 12 to 19

The standards in this section focus on the ways in which the service promotes your general health and wellbeing. They are an important means of making sure that your quality of life is maintained or improved, and that you feel part of the everyday activities that are going on around you.

Your lifestyle - social, cultural and religious belief or faith

The principle of valuing diversity means that you are accepted and valued for who you are. The standards in this section make it clear that you can continue to live your life in keeping with your own social, cultural or religious beliefs or faith when you are in the care home.

Eating well

Good, nutritious food and drink are important in keeping and improving your health. Individual choices of food and drink vary, as do dietary needs. Having your own needs and choices met is an important part of the quality of day-to-day life.

Keeping well

Keeping healthy or regaining your health are important to your wellbeing and quality of life. You have a right to have your health needs met and to have support in using the full range of healthcare services. You also have a right to have your medication arranged efficiently and safely.

Private life

How you spend your day is up to you. You do not have to be with other people all the time. Staff will respect your wish to be on your own. You can entertain your friends and relatives in your own room.

Daily life

Living in a care home, you continue to be very much part of your own community, and to enjoy ordinary daily life.

Supporting communication

People have different ways of communicating. Some speak a language other than English while others may use their own gestures or signs. Sometimes as a result, people may have difficulty making themselves understood. However, being able to communicate is an essential part of letting staff know what your needs are and playing an active part in the care home. For more information about making information accessible contact The Scottish Accessible Information Forum, Royal Exchange House, 100 Queen Street, Glasgow G1 3DN.

Support and care in dying and death

The staff at the home should care sensitively for people who are dying, with extra services brought in if they are needed. The staff should handle each person's death with dignity and sensitivity, in line with their spirituality, culture and faith, and those of their family.

Friends, relatives and carers outside the care home also need help and support at these times. They should be welcome to visit the care home while the person is being cared for, and after his or her death as part of their grieving process.

Lifestyle - social, cultural and religious belief or faith

Standard 12

Your social, cultural and religious beliefs or faith are respected. You are able to live your life in keeping with these beliefs.

1 You are given the opportunity and support you may need to practise your beliefs, including keeping in touch with your faith community.

2 Staff make sure they are properly informed about the implications of your social, cultural and religious belief or faith for you and other people living in the care home.

3 Your holy days and festivals, birthdays and personal anniversaries are recognised and ways found to make sure you can mark and celebrate these as you choose.

4 The social events, entertainment and activities provided by the care home will be organised so that you can join in if you want to.

Eating well

Standard 13

Your meals are varied and nutritious. They reflect your food preferences and any special dietary needs. They are well prepared and cooked, and attractively presented.

1 Catering and other staff get to know your food choices and any ethnic, cultural, faith or other preferences you have. Any special diet (for example, vegetarian, low-fat or high-protein) is recorded in your personal plan.

2 You are offered a daily menu that reflects your preferences. The menu varies regularly according to your comments, and will always include fresh fruit and vegetables.

3 You have a choice of cooked breakfast and choices in courses at the midday and evening meals.

4 Meals are nutritionally balanced for your dietary needs, for example, if you have diabetes or poor kidney function or need a liquidised or textured soft diet.

5 You can have snacks and hot and cold drinks whenever you like.

6 If you are unable to check if you are getting enough of the right things to eat or drink, staff will keep an eye on this for you. If, for any reason, you are not taking enough staff will explain this to you or your representative. With your agreement, staff will take any action needed, including seeking advice from a dentist, dietician, speech and language therapist or your GP.

7 If there is anything that may affect your ability to eat or drink, for example problems with your teeth or with swallowing, you are confident that this will be assessed and regularly reviewed. Staff will provide appropriate help, for example, adapted cutlery and crockery, a liquidised diet, or someone to assist you with eating and drinking in a discrete manner, in a way that suits you and respects your dignity.

8 If your are unable to take food or drink by mouth you get these by other means, for example PEG or parenteral feeding, in a way that best suits you and respects your privacy and dignity.

9 You enjoy meals that are well presented. All food handling follows good food-hygiene practices.

10 You are free to eat your meals wherever you like, for example, in your own room or in the dining room. You can take them in your own time.

Keeping well - healthcare

Standard 14

You are confident that the staff know your healthcare needs and arrange to meet them in a way that suits you best.

1 You continue to be registered with your usual GP and dentist. If this is not possible, staff will help you to register as quickly as possible with a new GP and dentist of your choice from those providing services in the area of the home.

2 If you have been receiving community healthcare services (for example, physiotherapy, speech and language therapy, occupational therapy or advice on your diet) and still need them, you will continue to receive them in the home. Otherwise, the staff will make new arrangements for you.

3 If you have been receiving hospital healthcare services, for example review of your epilepsy and its treatment or for heart or eyesight problems, and still need these you are supported and helped to get them.

4 During your first week in the home, and at least every six months after that, you will receive a full assessment of your health to find out all your healthcare needs. This will include the need for any emergency treatment, for example, treatment for an epileptic seizure and the staff will ensure that these are met. Staff will record all assessments and reviews of your healthcare needs.

5 You are given information about the range of hospital services that you might need for your healthcare needs.

6 If your review shows that you need help or advice, for example, from a speech therapist, dentist, GP, dietician or someone else, staff will arrange this for you and help you to follow any advice you have been given.

7 If you become ill, or your health is not improving, either physically or emotionally, and you need healthcare ¹¹, you know that the staff will make arrangements for this straightaway, if you cannot do so yourself.

8 If you need it, you are given support and help to attend any consultations about your health and also have someone to help explain about your health if you have any difficulty with communication.

9 You can expect the staff to be aware of issues of assessing and managing any symptoms, including pain, that you may have, and how to access specialist services.

10 You will receive information about preventive healthcare (for example breast, cervical, and prostate cancer screening, blood pressure screening, immunisation and regular check-ups). If you want to take part in any of these, staff will help you to do so.

11 If you have any problems, or need advice, about intimate aspects of your health, for instance your sexual health, you can ask your key worker or other member of staff where to get information and help for this.

12 If you want to use complementary therapies you can ask your key worker or other member of staff where to get information about these.

13 You can be confident that the provider is aware of your nutritional state and will, with your agreement, arrange for this to be regularly assessed and reviewed. This assessment will take account of any special health needs you may have or any changes in your health.

14 If there are concerns from the review of your nutritional state, staff will explain these to you or your representative and will arrange further advice, for example, from your GP, dentist, a dietician, a speech and language therapist.

15 If you have any personal care equipment you can get help and support to look after it and maintain and repair it.

16 If you want to, you will be able to take part in physical activities in or outside the home which help you maintain a healthy lifestyle.

Keeping well - medication

Standard 15

If you need to take medication, staff know this and there are arrangements in place for you to take your medication safely and in the way that suits you best.

1 You can choose whether to manage your own medication unless there are specific legal provisions applying to you that prevent this.

2 If you are managing your own medication, you will be given your own lockable storage to keep your medication in your room. If you need it, you will also have special storage somewhere else (for example, in a fridge) that is secure and accessible to you.

3 You can get help from the staff with arranging the ordering and collecting of your prescriptions if you want or need it.

4 If you are on medication that someone else needs to administer (for example, an injection), the staff will do this in a way that recognises and respects your dignity and privacy, as set out in your personal plan.

5 If you have any questions or need advice about your medication which the staff cannot answer, they will help you to get the advice from your community pharmacist, GP or another member of the primary care team.

6 If you need tests as part of the routine review of your medication staff will make arrangements for you to have these.

7 If you have your medication managed for you, you can be confident that the home has comprehensive systems in place for ordering medication and for its safe storage and administration, and for the safe disposal of unused medicines.

8 You know that any medication you receive will have been prescribed for you.

9 You can expect staff to be aware of issues around the assessment and management of any symptoms you may have, including pain, and how to access any specialist services.

10 You are confident that staff will monitor your medication and the condition for which it has been prescribed. If there are any changes or concerns about the medication or the condition, including side effects they will get medical advice if you agree.

11 You are confident that the home keeps accurate, up-to-date records of all the medicines that have been ordered, taken or not taken, and disposed of.

12 If you are capable of understanding that you need to take medication and what will happen if you do not do so, but you refuse to take it, staff must respect your wishes.

13 You may not understand that you need to take medication and what will happen if you do not do so. If so, there are legal powers ¹² that allow other people to give permission for you to receive treatment if it is necessary for your health and welfare. Staff will not give medication except in accordance with the law. Even where the law allows medication to be given without consent, it will not be given in a disguised form unless you have refused and your health is at risk and this will be recorded.

14 You know that if any drugs go missing, the staff will take the necessary action to report this to the relevant authorities.

Private life

Standard 16

Your rights to privacy are respected.

1 You have control over who goes into your room or living space, and when this happens. Your door will have a locking system that you can use but staff will be able to open it if there is an emergency.

2 You have a lockable space for personal belongings in your own living space.

3 Staff consult you about visits and visitors, and protect you from unwanted attention.

4 You can entertain visitors and friends in private.

5 You can give visitors refreshments and sometimes share meals with them.

6 Staff can help you to arrange meetings with visitors, and to help your disabled friends and relatives into and around the building.

7 You can discuss your needs in confidence and privacy with whoever you choose.

8 You will be helped with intimate physical care or treatment sensitively and in private, in a way which maintains your dignity.

9 Staff will knock on your bedroom, toilet and bathroom doors, and wait for you to say they can come in.

10 You have a key for, or some way of accessing, the main (front) door. You have support to safely leave or enter your home as you choose and if you need it.

11 Staff recognise that your sexuality and sexual needs and preferences are important to you. They accept and support your right to have intimate relationships that you have consented to in the privacy of your home and if it is legal to do so.

12 Your family can discuss their concerns with relevant staff members in private and without interruption.

13 If you are a parent you will be supported to retain and fulfil your parental responsibilities and if you wish can receive help and support with parenting skills.

14 You can make and receive phone calls in private and receive mail, including e-mails, in private, unless there are good reasons to prevent this. If this is the case, staff must explain these reasons to you and record them. You receive your mail unopened but receive help in dealing with it if you ask for this.

15 You can spend time on your own if you want to.

16 Young children coming to visit you have somewhere safe to play and to be looked after.

17 You do not have to stick to routines that fit in with staff.

18 You are free to come and go as you please, although sometimes this may need to be worked out in line with your personal plan. You will know about any restrictions on leaving or coming into the home, or when you get up or go to bed.

19 Your personal possessions and clothing are treated with respect. Your clothing will be clearly identified as yours and it will not be acceptable for you to have to share your possessions unless you choose to do so.

Daily life

Standard 17

You are supported to make choices and decisions about day-to-day aspects of your life and about how you spend your time.

1 You can keep up relationships with friends, relatives and carers and links with your own community. If you want, the staff will support you to do this.

2 If your personal plan says you should have opportunities for education, training and work, staff will help you find these. Staff do everything possible to give you access to college courses, community education and other learning. If you have serious disabilities, you have one-to-one support to help you to be included in these opportunities.

3 If you have serious disabilities, staff will help you to get involved in activities that benefit you, while still giving you a choice.

4 You can choose activities and holidays, with up-to-date information in a form you can understand. Information will include details of any concessionary schemes. Staff help you to get involved.

5 The social events, entertainment and activities provided by the care home will be organised so that you can join in if you want to.

6 You are supported and encouraged to use local services such as hairdressers, shops and banks.

7 You have access to information about local events, facilities and activities.

8 You know that the staff will explain, justify and record any limits on your independence in your personal plan and know that these limits will be reviewed regularly (for instance your activities may be affected by specific legal provisions which apply to you if you are on guardianship and as part of this are required to take part in particular education or employment projects).

9 You know that the staff are trained to listen to people living in the care home.

10 Young children who come to visit you will have somewhere safe to play and be looked after.

Supporting communication

Standard 18

You have help to use services, adaptations and equipment for communication, if your first language is not English or if you have any other communication needs.

1 Your communication needs are regularly assessed and reviewed by an appropriately qualified professional, for example a speech and language therapist or a clinical psychologist.

2 Where you need special assistance to communicate, staff will ensure that your needs are assessed by someone who is qualified to do so and that you will receive whatever training, adaptations or equipment are necessary.

3 You can ask family, friends, carers or other people to support your key worker and staff in communicating with you in ways that suit you and at your own pace.

4 You can prepare for important events (for example, reviews and hospital appointments) and have time to communicate feelings, views and answers.

5 Your family members receive support from staff to keep in contact with you. Where you choose, your family receive information on your social wellbeing and health and events in your life that are important to you and to them. This takes account of your right to privacy.

6 If at all possible, your family are offered overnight accommodation when they have to travel a long way to visit you.

Support and care in dying and death

Standard 19

You are confident that the staff will be sensitive and supportive during the difficult times when someone dies.

1 You are confident that any death in the care home will be handled with dignity, sensitivity and discretion.

2 If you lose someone close to you, you will be fully supported. You will have the opportunity to say goodbye or go to the funeral if you want. The staff will be available to help and support you.

3 If you wish, you can say what you want to happen and who should be informed about your physical, personal and spiritual care in dying, death and funeral arrangements. You can be confident that your wishes will be carried out.

4 The staff will make sure that your bereaved relatives, friends and carers can spend as much time with you after your death as they need to. They will support your relatives and friends through the formal processes relating to death, such as arrangements about your belongings.