National Care Standards: Care homes for people with drug and alcohol misuse problems

Introduction

The demand for residential rehabilitation in specialist registered establishments is greater than the number of places currently available in Scotland. There are a number of residential accommodation services for people with drug or alcohol related problems (or both), offering a variety of services. The alcohol services include:

• 'designated places', for people who would otherwise be arrested by the police;
• detoxification services - planned, or on a crisis basis;
• traditional models of rehabilitation; and
• supported accommodation.

A similar pattern of provision is reflected in the network of services for drug-related problems, with the exception of the designated place.

Residential services for alcohol and drug misusers have to cater for people with a wide range of needs. To meet these needs, a variety of approaches have been developed over the years. The therapeutic programmes of each service are designed to reflect their particular philosophy and are in line with their aims.

People who misuse alcohol and drugs often have a range of problems which may contribute to, or be made worse by, substance misuse. Residential care is only one part of a continuum of rehabilitation services. A residential place may be the preferred option to meet your individual needs because you need 'time out' from your own home. You may have complex problems which can best be addressed in a residential setting. There you will have the opportunity to receive intensive support, including physical and social care, and to take part in programmes where you can gain new skills.

In other client groups, most people who need residential care usually need supervised accommodation because they cannot live independently in their own home. For alcohol or drug misusers, accommodation is only one of a range of needs which have to be addressed. This residential care is rarely provided as a permanent home, except in the case of 'wet hostels'.

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, 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 5)

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

Using the service (standards 6 to 15)

6 Making choices
7 Feeling safe and secure
8 Exercising your rights
9 Expressing your views
10 Lifestyle - social, cultural and religious belief or faith
11 Eating well
12 Keeping well - healthcare
13 Keeping well - medication
14 Daily life
15 Supporting communication

Moving on (standard 16)

16 Moving on

Using the national care standards

As a user of the service, you may want to refer to the standards when you, your family or representative are considering care services. If you are already receiving residential 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 9.)

Service providers will use the standards to find out what is expected of them in offering support and care services. The standards make it clear that everything about the service should lead to you enjoying a good quality of life. They should guide the owner or manager over:

• building requirements;
• who to employ; and
• how they should manage the service.

In a small number of cases, people may be subject to compulsory orders under The Mental Health (Scotland) Act 1984 or The Adults with Incapacity (Scotland) Act 2000. These orders may affect the way in which some of the standards are delivered. If this affects you, then anything in the standards that has to be different, and the legal reasons for that difference, will be shown in your personal plan. It will be in line with the principles and legal requirements of the legislation.

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 enjoy 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 to 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 homes for children and young people. 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 homes for people with drug and alcohol misuse problems.

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. 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 5387
Fax: 0131 244 4005