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

Before using the service

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

Introduction to standards 1 to 5

Standards in this section are grouped around those aspects of the service that are offered beforehand. They will help you decide what your quality of life will be like as a result of using the service.

Informing and deciding

You make a positive and informed decision about the service, helped by the quality and accuracy of the information you receive.

You must have proper information to help you reach a decision. You can expect it to be up to date and reliable, in a format and language that you can easily understand and keep.

Your legal rights

You and your representatives must be confident that the residential services are being managed properly, in line with relevant legislation and guidelines. You must know what would happen in an emergency or if the service closed down.

Your environment

Residential facilities will have their own special features and layout depending on the nature of the building and the needs of the people who use the services. The design and layout of the physical environment help to make sure that you live in pleasant and safe surroundings.

The standards in this section do not describe in detail the wide variety of needs of everyone using residential services. The providers must make sure that the statement of function and purpose that they give to the Care 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 Care 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 Care 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 which have applied since April 2002. These are set out in this section. They show the differences between standards for new homes (all new buildings as well as extensions to existing homes) and existing buildings. 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

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.

Scottish Ministers recognise the importance of having sufficiently trained staff in care homes. They have set standards for this which have applied from April 2002 onwards. These are set out in this section.

Support arrangements

When you move into a home, the staff will develop a personal plan with you, showing how they will give you individual support and care. Where you have a care manager, he or she will already have helped you to draw up a care plan and this will be used to inform your personal plan. You can also expect to be able to discuss your needs with the provider before moving in.

If you have a young child or children with you in the home, their needs are recognised separately. Their welfare is the most important thing, and plans and programmes are designed to promote their wellbeing and safety while they are in the home.

Informing and deciding

Standard 1

You have all the information you need to help you decide about using the service.

1 You have an introductory pack which clearly explains the service that is being offered to you. Everything is available in plain English or in a language and format that is suitable for you. It should include information about:

• details of the aims and objectives of the service;
• details of the therapeutic programme the service offers for drug or alcohol dependency;
• details of the service provider, including the manager or owner (or both);
• the service's information brochure;
• the charges and the services they cover;
• admission criteria and process, clearly showing the steps that will be taken before you move in;
• a statement of your rights and responsibilities;
• any rules that the home has;
• any exclusion criteria and any restrictions on your liberty;
• the role of medication and other forms of treatment (which may include restraint) in the treatment programme and your rights in relation to these;
• what happens if you relapse from your treatment goal (set out in your personal plan);
• confidentiality;
• the complaints procedure;
• policies and procedures for:

• managing risk;
• recording and reporting accidents and incidents; and
• possession of unauthorised alcohol or unauthorised and/or illegal drugs during your stay (including temporary absences);

• insurance cover for you and your personal belongings; and
• arrangements agreed with the Care Commission to be put in place if the service closes down or the owner changes.

2 You choose where you live from the range of options available, and decide on the timing of the move in consultation with your care manager, where you have one, and your representatives.

3 The service provider helps you to understand how the service can meet your needs. She or he helps you to understand the thinking behind the therapeutic programme, picking out the main points in the programme that might be important to you.

4 You have a copy (in a language and format that you can understand) of the provider's understanding, definition and policy on relapse, and the provider's likely response if you relapse to drug or alcohol misuse. Staff also explain this to you personally.

5 You have a copy (in a language and format that you can understand) of the provider's policy and rules on the use of alcohol and drugs including prescribed medicines and/or illegal substances and over-the-counter medicines during your stay. Staff also explain these to you personally.

6 In homes for families or parents with young and dependent children, you receive information about the services they offer to your child or children.

Your legal rights

Standard 2

You receive a written agreement which clearly defines the service that will be provided to meet your needs. The agreement sets out the terms and conditions for receiving the service and arrangements for changing or ending the agreement.

1 You are fully involved in developing the detailed service agreement and any subsequent service agreement reviews.

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

3 You have a copy of the agreement that the provider has signed and dated.

4 The agreement includes:

• the signatures of everyone involved;
• the date that the agreement was made;
• the date the service starts;
• clear information on whether there are charges for the service, what these charges will be and who you should pay them to;
• how and by whom the service will be provided; and
• information about how to change any details of, or end the service agreement.

5 You can ask the provider for and be given a review of your service agreement.

6 You can ask for, and be given copies of, the service's policies and procedures.

7 You can ask for confirmation that the service complies with all relevant legislation and guidance relating to fire, health and safety procedures, food hygiene and risk management.

Your environment (for services in a care home)

Standard 3

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 home.

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 smells and intrusive sounds throughout. There are systems in place to control the spread of infection, in line with relevant regulation and published professional guidance.

4 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.

5 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.

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

7 You can expect that the rooms and corridors are kept in good decorative order and that the home and furnishings are well maintained and that only essential notices are displayed.

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

9 If you are in a longer-stay unit, you can bring personal belongings with you, including items of furniture.

When you are moving into an existing home, the following standards will apply:

10 By 2007, you will 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 ¹.

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) ².

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 ³.

14 If the provider is upgrading accommodation, they must discuss this with the Care Commission ⁴.

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 home ⁵ the following standards will also apply.

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 840mm off wide corridors (of at least 1200mm). 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 (for services in a care home)

Standard 4

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 with all applicable legal requirements and best-practice guidelines.

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

• staffing and training;
• administration of medication;
• health and safety;
• 'whistle-blowing';
• environmental health;
• fire safety;
• managing risk; and
• proper record-keeping, including recording accidents, incidents and complaints.

2 You can be 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 can be 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 can be 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:

• taking up references;
• criminal records checks, where appropriate; and
• cross-reference to the registers of the Scottish Social Services Council, Nursing and Midwifery Council or other professional organisations, where appropriate.

6 You can be 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 to put these into practice.

7 You can be 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 Care Commission and the home owner or manager.

8 You know that at least 50% ⁶ 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 SSSC⁷.

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 SSSC⁸.

10 You know that the service 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 ⁹. If it is necessary to restrain you on certain occasions this will be written into your plan and records kept of any incidents involving your restraint. You can expect to be supported after any episode of restraint.

11 You can be sure that the staff who are organising your medication 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.

12 You know that whenever staff are involved in any financial transaction, it will be carefully recorded. This will be in a way that can be checked by the Care Commission.

Support arrangements

Standard 5

You can be confident that the service 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 You have a copy of your plan in a language and format that you can understand.

2 Your plan reflects your changing hopes, choices, needs and responsibilities. The provider, with your permission, will use the plan to help them decide if the care service can meet your needs.

3 You are consulted and helped to set goals to achieve greater independence.

4 Staff help you to have a clear understanding of the philosophy of the service, the model of care and the therapeutic programme it offers for drug or alcohol dependency, such as harm reduction or abstinence.

5 You can discuss and clear up any concerns or questions about the service before you use it. You can do this at any time during your stay.

6 Where you have an identified care manager, the service provider works closely with him or her to ensure that you receive the service that is set out in your personal plan.

7 If you have complex or changing needs, you can expect specially-trained staff to give you the level and degree of care that you need.

8 Your personal plan includes information and decisions about:

• your 'goals of admission' (treatment goals), assessment of care needs and interventions required;
• learning, practising and developing new coping skills in how to avoid misuse of alcohol or drugs (or both);
• health assessment and social care assessment, including consideration of family, parental and offending issues;
• record of the care you receive;
• issues that will be addressed as part of the rehabilitation process, and the services that will enable this, such as:

• individual and family counselling;
• healthcare;
• groupwork and support from other people who are in a similar position;
• risk profile; and
• arranging access to external services such as training and employment schemes;

• what you prefer to be called;
• personal preferences as to food and drink;
• cultural, religious and spiritual preferences;
• leisure interests;
• who should be involved in reviews of care;
• any communication arrangements that need to be put in place to assist you; and
• an independent person to contact if you want to make a complaint or raise a concern.

9 You will be involved in regular care reviews which will be planned in advance and identified in the plan.

10 You will be supported to attend care reviews and know who else will be there.

11 Staff will invite your care manager and independent advocate (representative) to come to each review with you. Staff will record what happens at the review and tell anyone involved who cannot be there.

12 Staff will help you to understand the decisions made at the review meetings, and what these will mean in terms of your personal plan.

13 If you have a relapse in your drug or alcohol addiction during your stay, staff will fully assess the circumstances. Details of any action or treatment plan will be recorded in your personal plan.

If you have young and dependent children in the home

14 Your child or children's needs will be taken into account when your own personal plan and goals of admission are decided. These will include their ethnic, cultural, language, religious, faith and food needs.

15 Staff will help you to understand and fulfil your childcare responsibilities. They will help you to make the most of your parenting skills.

16 Staff will use assessment procedures and tools that are family-friendly and suited to the age, culture and language of the children.

17 Each child will have a separate written plan which will meet developmental, emotional, social, recreational and educational needs, alongside your own personal plan.

18 You will be closely involved in making decisions about your child or children.

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