national care standards: care homes for older people: revised november 2007

1-6 Before moving in

1 Informing and deciding
2 Trial visits
3 Your legal rights
4 Your environment
5 Management and staffing arrangements
6 Support arrangements

Before moving in

Introduction to standards 1 to 6

Standards in this section are grouped around aspects of the service that you need to know about before you move in. You need to receive information about the home to help you judge in advance what your quality of life will be like in a care home.

Deciding to move into a care home is a major decision, and you must have proper information to help you reach that decision. You can expect the information to be up-to-date and reliable, in a format and language that you can easily understand.

Trial visits

Being able to visit the care home and spend some time in it, talking to people who live there and members of staff, is essential to making a positive choice about moving in. You may sometimes want your relatives, friends, carers or representatives to be able to visit as part of helping you to decide. You can expect that providers will respect your need to have time to make a decision.

Your legal rights

You and your carer, relatives or representative must be confident that the home is being managed properly, in line with relevant legislation and guidelines. You must know what would happen in an emergency or if the home closed.

Your environment

Each care home will have its own special features and layout depending on the building and the needs of the people who use its services. The design and layout of the physical environment help to ensure that you can enjoy living in safe, comfortable and homely surroundings.

The standards in this section do not describe in detail the wide variety of needs of everyone who lives in a care home. The providers must make sure that the statement of function and purpose that they give to the Commission when they are applying for registration describes the type of service they want to provide and who they want to provide it for. The Commission will make sure that the provider keeps to the statement of function and purpose.

Providers must meet legal requirements, such as those relating to the structure of the building, health and safety matters and fire safety procedures. There are other regulatory organisations which the provider must answer to about these matters. However, the Commission and you will want to know that the service meets all the necessary legal requirements.

Scottish Ministers have announced the physical standards for care homes for adults. These are set out in this section. They show the differences between standards for new homes ¹ (new buildings as well as extensions to existing ones) and existing homes. ² Existing homes will not have to meet the standards for new homes even if a change of proprietor triggers a new registration.

Management and staffing arrangements

One of the main reasons people decide to move into a care home is because they need and want the support and care it offers.

The standards in this section reflect the importance of knowing that the people who are responsible for your support and care have all the necessary experience, skills and training to meet your needs. If they are to provide you with the best possible service, they must be familiar with all the current good practice guidance. They must be able to put the guidance into practice.

Because your needs may change over time and because every person living in the care home will have their own changing needs, the provider must make sure that the management and staffing arrangements are always sufficient to meet these needs. This is reflected in the standards. They do not set exact requirements about the number and skills mix of the staff but make it clear that the service must always meet the needs of the people using it.

Scottish Ministers recognise the importance of having sufficiently trained staff in care homes. They have set standards for this which are set out in this section.

Support arrangements

You will want to know that the care home can meet your particular needs as well as giving you the opportunity to maintain or develop your interests. Personal plans take account of this and describe the way you will receive the individual support and care that you need. You can expect that the provider will discuss your needs with you before offering you a place in the care home. You can also expect that your personal plan will change as your needs for support and care change.

Informing and deciding
Standard 1

You have all the information you need to help you decide about moving into the care home.

1 You have an introductory pack which clearly explains the moving-in process. Everything is written in plain English or in a language and format that is suitable for you. It should include:

• the care home brochure;
• a guide to the care home's charges and a breakdown of the services they cover. In particular, for the provision of accommodation (including food), personal care, and, if appropriate, nursing care; and clear information on the arrangements for paying and reviewing these charges;
• a list of any other optional services and extras on offer (other than those set out above), with an up-to-date price list;
• the accommodation and service provided;
• the number of places provided;
• arrangements that need to be made if private funding runs out;
• the home's philosophy;
• any rules that the home has;
• the complaints procedure;
• the most recent inspection report on the home;
• a statement of your rights and responsibilities as a resident;
• policies and procedures for managing risk and recording and reporting accidents and incidents; and
• arrangements agreed with the Commission to be put in place if the care home closes or if there is a new owner.

Trial visits
Standard 2

You have the opportunity to visit the home and to meet the staff, management and some of the people who live there before you move in.

1 You can visit the home at least once, to help you reach a decision in your own time about moving in.

2 If you want, family members, friends, carers or an independent representative (for example, an independent advocate) may be involved in these visits.

Your legal rights
Standard 3

You have full information on your legal position about your occupancy rights in the care home. You are confident that the home is run in line with legal requirements for health and safety, fire safety and food hygiene.

1 You receive a written agreement which clearly defines the service that will be provided. It sets out the terms and conditions of accommodation and residence, including your rights to live in the home, payment arrangements, and arrangements for changing or ending the contract. Your written agreement will also include an Annex which sets out all the options available should you or your representative wish to raise any concerns or make a complaint.

2 You have a copy of this written agreement in a format you can understand.

3 You can ask for copies of the care home's policies and procedures.

4 You can ask for confirmation that the home meets with all the relevant legislation and guidance relating to fire, health and safety procedures, anti-discriminatory practice and risk management.

Your environment
Standard 4

Your environment will enhance your quality of life and be a pleasant place to live.

1 You will be able to move around easily in the house and its grounds.

2 You can expect that the home is run in a way that protects you from any avoidable risk or harm, including physical harm and infection. The nature of its design, facilities and equipment also protect you.

3 You can expect that the premises are kept clean, hygienic and free from offensive odours and intrusive sounds throughout. There are systems in place to control the spread of infection, in line with relevant regulation and published professional guidance. (See annex B.)

4 You can bring personal belongings with you, including items of furniture.

5 All bedrooms and public rooms will have windows. You should expect to be able to sit somewhere and have a view out of a window.

6 The door to your room will have a lock which you can use. Staff will be able to open the door if there is an emergency.

7 You can control the heating, lighting and ventilation in your room.

8 You can expect that the rooms and corridors are kept in good decorative order and that the home and furnishings are well-maintained.

9 You receive information about what to do if there is a fire or other emergency.

When you are moving into an existing home:

10 By 2007, you will be able to have a single room if you want.

11 Your room should have at least 10.25 square metres of usable floor space, not including en-suite facilities ³ (see note below).

12 If you choose to share a room, it should have at least 16 square metres of usable floor space, not including en-suite facilities ⁴ (see note below).

13 If the provider wants to install en-suite facilities (which may only be a toilet and wash-hand basin) these must be 3.5 square metres or more. If providers want to install a shower or bath, the same conditions as for new care homes apply ⁵ (see note below).

14 If the provider is upgrading accommodation, they must discuss this with the Commission's inspectors ⁶ (see note below).

15 The communal space will be 3.9 square metres for each person living in the care home, not including corridors and circulation areas.

16 You will be able to lock the toilets, bathrooms and shower rooms but staff will be able to open the door if there is an emergency.

When you are moving into a new care home⁷the following standards will also apply (see note below).

17 You will be able to have a single room if you choose.

18 Your room will have at least 12.5 square metres of usable floor space, not including en-suite facilities.

19 If you and your husband or wife, partner or friend want to share a room, new homes will provide larger bedrooms of at least 16 square metres. All sizes exclude en-suite facilities.

20 You will have your own en-suite bath or shower facilities. The en-suite will include a toilet and wash-hand basin, with a shower or bath. Where the en-suite has a 'wet' floor shower, wash-hand basin and toilet, the size will be at least 3.5 square metres. For a shower tray or bath, the size will need to be more than 3.5 square metres.

21 You will enjoy easy access, with all inside doors having a clear opening width of 840 mm, off wide corridors (of at least 1200 mm). Communal space will be at least 3.9 square metres for every resident in the home, not including corridors and circulation areas.

22 You will be in a building where there is the capacity to install modern equipment, such as:

• hoist tracking;
• environmental control equipment;
• call systems and alarms;
• specialist communication equipment;
• signage (taking account of individual needs such as sight and hearing difficulties, learning disabilities and dementia);
• grabrails; and
• smart technology.

23 If the home has more than one floor, there will be a passenger lift which you can operate.

24 You will be able to lock the toilets, bathrooms and shower rooms but staff will be able to open them if there is an emergency.

Management and staffing arrangements
Standard 5

You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line withall necessary legal requirements and best-practice guidelines( see annex B).

1 You can be assured that the home has policies and procedures which cover all legal requirements, including:

• staffing and training;
• administration of medication;
• health and safety;
• 'whistle-blowing';
• environmental health;
• fire safety;
• managing risk;
• proper record-keeping, including recording incidents and complaints; and
• visits made to the home, including visits by children.

2 You are confident that staff know how to put these policies and procedures into practice. They have regular training to review this and to learn about new guidance.

3 You are confident that the staff providing your support and care have the knowledge and skills gained from the experience of working with people whose needs are similar to yours. If they are new staff, they are being helped to get this experience as part of a planned training programme.

4 You are confident that all the staff use methods that reflect up-to-date knowledge and best-practice guidance, and that the management are continuously striving to improve practice.

5 You know that the home's staff, managers and volunteers are all recruited and selected through a process which includes:

• equal opportunities procedures;
• Disclosure Scotland checks;
• taking up references; and
• cross-reference to the registers of the Scottish Social Services Council, UKCC or other professional organisations, where appropriate.

6 You are confident that any volunteers who work in the care home are familiar with all the home's policies and procedures. They receive all the relevant training to help them put these into practice.

7 You are confident that at all times the number of staff who are trained and who have the necessary skills will be sufficient to meet your support and care needs. The levels are agreed between the Commission's inspectors and the home owner or manager.

8 You know that at least 50% ⁸ of the staff directly caring for you are either trained to at least SVQ2 level or equivalent or are working towards achieving the relevant qualification required for registration with the SSSC. ⁹

9 You know that the service has a staff development strategy and an effective yearly training plan for all its staff. For staff caring for you directly, this focuses on them achieving the qualifications required for registration with the SSSC. ¹⁰

10 You are confident that the home has a policy and clear targets to enhance equal opportunities. The staff are trained in, and practise, anti-discriminatory and anti-harassment policies and procedures.

11 You know that the care home has a written policy and procedures on the conditions under which restraint is used, and that staff are fully trained and supported in the use of restraint. ¹¹ If it is necessary to restrain you on certain occasions this will be written into your personal plan and records kept of any incidents involving your restraint. You can expect to be supported after any episode of restraint.

12 If your medicines are being organised for you, you can be sure that the staff who are doing this are knowledgeable and trained to do so, following up-to-date best-practice guidance. The staff are fully aware of the home's systems for giving medication. They know how to store and administer your medication safely and in the way that suits you best.

13 You can be sure that, whether or not you are organising your own medication, the staff are trained to check this. They will, with your agreement, get advice from your GP if there are any concerns about your condition or the medication.

14 You know that whenever staff are involved in any financial transaction, it will be carefully witnessed and recorded. This will be in a way that can be checked by the Commission's inspectors.

15 The manager will make sure that the staff group contains people of the same social, cultural and faith and religious background to you where this is possible and practical, and in keeping with the provisions of equalities legislation.

Support arrangements
Standard 6

You can be confident before moving in that the home will meet your support and care needs and personal preferences. Staff will develop with you a personal plan that details your needs and preferences and sets out how they will be met, in a way that you find acceptable.

1 Your personal plan will include:

• what you prefer to be called;
• personal preferences as to food and drink, and any special dietary needs;
• social, cultural and spiritual preferences;
• leisure interests;
• any special furniture, equipment and adaptations you may need;
• who should be involved in reviews of your care;
• any special communication needs you may have;
• what communication arrangements need to be put in place if your first language is not English;
• your individual health needs and how these should be met (where appropriate they take account of your ethnic and cultural background);
• when, and in what circumstances, friends, relatives and carers will be contacted;
• your arrangements for taking any medication, including any need to inform professionals;
• an independent person to contact if you want to make a complaint or raise a concern; and
• any measures of restraint which staff may have to use for your own safety or for the safety of others.

2 You will receive a copy of your personal plan to keep.

3 Your personal plan will be reviewed with you every six months, or sooner if you want or if your needs change.