National Care Standards: Care at Home

Introduction

Care at home

National standards for care at home relate to services that you receive in your own home. Traditionally, much home-based care has been provided by local authorities. This has mainly been by providing services to older people through the home help service. Home care services are also provided to:

• children and young people and their families and carers;
• adults with a learning disability;
• adults with mental health problems;
• people with physical disabilities;
• people with alcohol and drug problems; and
• people with HIV/ AIDS.

In recent years, there have been a number of changes to home care services. These include:

• an increase in the number of private and voluntary sector agencies offering home care and support and home nursing;
• primary healthcare teams becoming involved in intensive home care schemes;
• more varied local authority services, with more intensive schemes in a number of areas providing care services over a 24-hour period;
• greater variety in the range of tasks that will help you in your own home; and
• extending the eligibility for direct payments, making it easier for you to purchase services for yourself in your own home.

The regulation of care at home is an essential part of making sure that as many people as possible are supported in their own home. The agency providing the service will be regulated in order to safeguard the person who is receiving care at home. The standards apply to the agency. The agency should ensure that the care given by the person it employs to work in your home reflects these standards.

Where a service is provided to children and young people, it may benefit both the child and their family. However, it is important to recognise that the views and wishes of the child or young person may be different from those of their families. The service provider must take account of these.

Service providers should also be aware of the safeguards that will be required when providing a service to children and young people. These include the need for training and qualifications suited to their particular needs. Safeguards must include the need for thorough vetting of all staff working with children and young people to ensure that they are suitable for the job. Vetting will include checks of criminal records. The provider should also consider the need for particular ways of working together with agencies such as social work departments if the service provided forms part of a wider support and monitoring plan (for example, where a child is on a child protection register or supervision order).

The national care standards

Scottish Ministers set up the National Care Standards Committee ( NCSC) to develop national standards. The NCSC carried out this work with the help of a number of working groups. These groups included people who use services, and their families and carers, along with staff, professional associations, regulators from health and social care, local authorities, health boards and independent providers. Many others were also involved in the consultation process.

As a result, the standards have been developed from the point of view of people who use the services. They describe what each individual person can expect from the service provider. They focus on the quality of life that the person using the service actually experiences.

The standards are grouped under headings which follow the person's journey through the service. These are as follows.

Before using the service (standards 1 to 4)
1 Informing and deciding
2 The written agreement
3 Your personal plan
4 Management and staffing

Using the service (standards 5 to 11)
5 Lifestyle
6 Eating well
7 Keeping well - healthcare
8 Keeping well - medication
9 Private life
10 Supporting communication
11 Expressing your views

Using the national care standards

As a user of the service, you may want to refer to the standards when you, your family, carer or representative are considering getting care services in your home. If you are already receiving support and care, you may want to use the standards when discussing the service with the staff or management.

If things go wrong, you can refer to the standards to help you raise concerns or make a complaint. ( See 'Expressing your views', standard 11.)

Service providers will use the standards to find out what is expected of them in offering care services in your home. The standards make it clear that everything about the service should lead to you enjoying a good quality of life. They should guide the provider over who to employ and how they should manage the service.

The principles behind the standards

The standards are based on a set of principles. The principles themselves are not care standards but reflect the recognised rights which you have as a citizen. These principles are the result of all the contributions made by the NCSC, its working groups and everyone else who responded to the consultations on the standards as they were being written. They recognise that services must be accessible and suitable for everyone who needs them, including people from black and ethnic minority communities. They reflect the strong agreement that your experience of receiving services is very important and should be positive, and that you have rights.

The main principles

The principles are dignity, privacy, choice, safety, realising potential and equality and diversity.

Dignity

Your right to:

• be treated with dignity and respect at all times; and
• enjoy a full range of social relationships.

Privacy

Your right to:

• have your privacy and property respected; and
• be free from unnecessary intrusion.

Choice

Your right to:

• make informed choices, while recognising the rights of other people to do the same; and
• know about the range of choices.

Safety

Your right to:

• feel safe and secure in all aspects of life, including health and wellbeing;
• enjoy safety but not be over-protected; and
• be free from exploitation and abuse.

Realising potential

Your right to have the opportunity to:

• achieve all you can;
• make full use of the resources that are available to you; and
• make the most of your life.

Equality and diversity

Your right to:

• live an independent life, rich in purpose, meaning and personal fulfilment;
• be valued for your ethnic background, language, culture and faith;
• be treated equally and live in an environment which is free from bullying, harassment and discrimination; and
• be able to complain effectively without fear of victimisation.

The Scottish Commission for the Regulation of Care

The Regulation of Care (Scotland) Act 2001 ('the Act') set up the Care Commission, which registers and inspects all the services regulated under the Act, taking account of the national care standards issued by Scottish Ministers. The Care Commission has its headquarters in Dundee, with regional offices across the country. It will assess applications from people who want to provide care at home services. It will inspect the services to make sure that they are meeting the regulations and in doing so will take account of the national care standards. You can find out more about the Care Commission and what it does from its website ( www.carecommission.com ).

The Scottish Social Services Council

The Act created the Scottish Social Services Council ('the Council') which was established on 1 October 2001. It also has its headquarters in Dundee. The Council has the duty of promoting high standards of conduct and practice among social services workers, and in their education and training. To deliver its overall aims of protecting service users and carers and securing the confidence of the public in social services, the Council has been given five main tasks. These are: to establish registers of key groups of social services staff; to publish codes of practice for all social services staff and their employers; to regulate the conduct of registered workers; to regulate the training and education of the workforce; to undertake the functions of the National Training Organisation for the Personal Social Services. The Council has issued codes of practice for social service workers and employers of social service workers. These describe the standards of conduct and practice within which they should work. The codes are available from the Council website ( www.sssc.uk.com ).

How standards and regulations work together

The Act gives Scottish Ministers the power to publish standards which the Care Commission must take into account when making its decisions. It also gives Scottish Ministers the power to make regulations imposing requirements in relation to care at home services.

The standards will be taken into account by the Care Commission in making any decision about applications for registration (including varying or removing a condition that may have been imposed on the registration of the service). All providers must provide a statement of function and purpose when they are applying to register their service. On the basis of that statement, the Care Commission will determine which standards will apply to the service that the provider is offering.

The standards will be used to monitor the quality of services and their compliance with the Act and the regulations. If, at inspection, or at other times, for example, as a result of the Care Commission looking into a complaint, there are concerns about the service, the Care Commission will take the standards into account in any decision on whether to take enforcement action and what action to take.

If the standards were not being fully met, the Care Commission would note this in the inspection report and require the service manager to address this. The Care Commission could impose an additional condition on the service's registration if the provider persistently, substantially or seriously failed to meet the standards or breached a regulation. If the provider does not then meet the condition, the Care Commission could issue an improvement notice detailing the required improvement to be made and the timescale for this. Alternatively, the Care Commission could move straight to an improvement notice. The Care Commission would move to cancel the registration of any service if the improvement notice does not achieve the desired result. In extreme cases (i.e. where there is serious risk to a person's life, health or wellbeing) the Care Commission could take immediate steps to cancel the registration of any service without issuing an improvement notice.

Regulations are mandatory. In some cases not meeting a regulation will be an offence. This means a provider may be subject to prosecution. Not meeting or breaching any regulation is a serious matter.

Decisions by the Care Commission on what to do when standards or regulations are not met will take into account all the relevant circumstances and be proportionate.

You can get information on these regulations from the Regulation of Care (Scotland) Act 2001, which is available from the Stationery Office Bookshop at a cost of £7.95 a copy. You can also see the Act on-line ( see Annex B for the address).

You can also see the Scottish Statutory Instruments for the Regulation of Care Regulations 2002 on-line ( see Annex B for the address).

Comments

If you would like to comment on these standards you can visit our website and send a message through our mailbox: www.scotland.gov.uk/health/standardsandsponsorship

You can also contact us at:

Tel: 0131 244 3520
Fax: 0131 244 4005