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

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

Introduction to standards 6 to 15

Making choices - feeling safe and secure

You have the right to make decisions about your support and care. You can feel safe and secure while living in the residential accommodation. You also have the right to choose the risks you want to take, as long as there is a sensible balance between your individual needs and preferences, and the safety of others living there.

For a few people, individual circumstances will limit the opportunity to make decisions. If lacking the capacity to take a decision, you will come under the provisions of The Adults with Incapacity (Scotland) Act 2000. Where relevant, you may be safeguarded by the provisions of The Mental Health (Scotland) Act 1984.

Exercising your rights - expressing your views

The provider must always respect and actively promote your rights. Using the service, you keep your rights and you have a responsibility not to infringe the rights of others. The service must take your comments, concerns and complaints seriously. They are your way of contributing to, and influencing how, the service is run.

Lifestyle - social, cultural and religious belief or faith

The standards in this section make it clear that you can continue to live your life in line with your own social, cultural and religious beliefs or faith when you are using the service.

Eating well (where meals are provided as part of the service)

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

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.

Daily life

Staff will respect your wish for privacy where possible. If you are a parent, you have support in continuing that role.

Supporting communication

People may use different languages or methods of communication for a variety of reasons. As a result, they may have difficulty in making themselves understood. However, being able to communicate is essential to playing an active part in daily life and you should be able to get help to do so if you need it.

Making choices

Standard 6

You achieve the aims set out in your personal plan helped by the support and care of skilled staff.

1 You have information about the choices available to you within the service, and the effect they will have on you. This will be provided by staff. If you want, you can ask for an independent advocate (representative) or for specialist advice.

2 You have time to consider your choices without pressure.

3 Unless there are legal reasons for you not to do so, you can carry out your own financial, legal and other business at a time that suits you. You can decide who should know about, and have access to, your personal business.

4 You can keep and control your money and your personal belongings unless your individual circumstances mean that specific legal arrangements have been made.

5 You collect your own benefit and control your own income and personal allowances. If your personal plan puts a temporary restriction on this, staff will explain this clearly to you.

6 You can receive independent support and advice in making a will or in any other money matters.

7 When you give notice, you will have access to your savings and money, which is kept in a secure office.

8 You know that if staff are involved in any money matters, these will be carefully witnessed, recorded and audited.

9 You can choose your key worker and will be helped to understand any limiting factors in this choice.

Feeling safe and secure

Standard 7

You take responsibility for your own actions, secure in the knowledge that the service has proper systems in place to protect your interests.

1 You have a sensible balance offered to you in everyday events and activities, between the reasonable risks you want to take and the safety of others. This results from the service's individual risk assessment approach.

2 You are fully involved in your own risk assessment, as are any other people you may want to be involved, such as a family member or independent advocate (representative). You receive a copy of your risk assessment report.

3 You can discuss risks with staff.

4 You can be confident that staff will record and investigate any accidents or incidents, including any episodes of restraint, telling relatives or other representatives if you want them to. The staff will take the action that is needed to prevent similar incidents, where lessons can be learned.

5 You can be confident that you are living in an environment that is free from bullying, harassment, discrimination and any other form of abuse.

6 You know that staff will identify and defuse any potentially violent situations. If this fails, they will manage these situations safely.

7 You can be confident that staff will not use restraint at all unless it is permitted by law and even then, restraint will not be used until other interventions have failed (unless it is legally required).

8 If you have experienced childhood abuse and want to speak about this, you know that the service will have a system for responding to you which makes sure that you get the appropriate specialist help.

9 If you have experienced overdose or self-harm, you know that the service will have a system for responding to you which makes sure that you get the appropriate specialist help.

10 You can contact a member of staff quickly when you need help or in an emergency.

11 You are told by staff about the need for insuring your personal belongings.

Exercising your rights

Standard 8

You keep your rights as an individual.

1 You can be confident that staff will treat you politely at all times and always respect your individuality.

2 You know that staff do not assume that the way you behave is all due to a substance misuse problem.

3 Staff call you by your preferred name or title at all times.

4 If you need help, your request will be dealt with as soon as possible.

5 Confidential information about you is only shared with others if you give permission, unless the law requires otherwise.

6 You will be told why any information cannot be kept confidential and who has the right to look at it.

7 You can be sure that your confidential records are held securely.

8 You are supported in keeping your civil rights (for example, in voting at elections).

9 If your behaviour challenges the service you receive, you receive good professional support to understand and, if possible, change your behaviour.

10 You are treated with respect and keep your dignity in all activities, including personal care, healthcare, social activities and community life.

11 You read or have explained to you any information about you that is kept on file or computer, in line with Open Access policies and the Data Protection Act.

Expressing your views

Standard 9

You are encouraged to express your views on any aspects of the service at any time.

1 You can freely discuss any concerns you have with your named worker or any member of the management.

2 You know how to make a complaint or comment to the provider about the service. You are also aware of the procedure for making complaints directly to the Care Commission.

3 You can expect that the service will deal with concerns and complaints quickly and sympathetically, and provide full information about what happens as a result.

4 You are encouraged and supported to use an independent and confidential advocacy service that can act for you. Staff will have information about any service that would help you in this way.

5 If you have an independent representative (for example, an independent advocate), staff will listen to what he or she has to say on your behalf, as if you were expressing the views yourself.

6 If you belong to an advocacy group, staff will take seriously any suggestions or proposals that come from the group.

7 You can play a part in the Care Commission's inspection of your service.

8 You can expect that the provider will make available a copy of each Care Commission inspection report about the service so that you and your representative can look through it.

Lifestyle - social, cultural and religious belief or faith

Standard 10

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

1 Staff make sure they are properly informed about the implications for you and others of your social, cultural and religious belief or faith.

2 Your holy days and festivals are recognised and ways found to make sure you can observe these.

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

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

Eating well (where meals are provided as part of the service)

Standard 11

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 care staff get to know your food choices and preferences, including ethnic, cultural and faith ones. These and details of any special diet (for example, vegetarian, low fat or high protein) are 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 contain fresh fruit and vegetables.

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

4 Meals are nutritionally balanced for your dietary needs, for example, if you are diabetic or have poor kidney function.

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

6 If you do not know if you are eating or drinking enough, staff can check this for you. If there are concerns, staff will explain them to you or your representative. With your agreement, staff will take any action needed, such as seeking advice from a dietician or your GP.

7 Your meals are well prepared and well presented. All food handling follows good food hygiene practices.

8 If you are in a longer-stay unit, you may be able to choose where to eat your meals, for example in your own room or in the dining room.

9 You must be able to eat and enjoy all your food. If you need any help to do so (for example adapted cutlery or crockery) staff will arrange this for you.

10 Staff will regularly review anything that may affect your ability to eat or drink, such as your dental health. If there are concerns they will help you to arrange to get advice from the dentist, GP or other healthcare professional.

Keeping well - healthcare

Standard 12

You are confident that 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, community psychiatric nurse or advice on your diet) and still need them, you continue to receive them. Otherwise the staff will help you make new arrangements for you, including giving you information about local healthcare services.

3 If you have been receiving hospital healthcare services and still need them, staff will support you in this. Staff will give you relevant information about the range of hospital services for any healthcare needs you have.

4 During your first week in the service and at least every six months after that, the staff will make sure that you receive a full assessment to find out all your healthcare needs. The staff will also make sure that these needs are reviewed and met and that all assessments and reviews are recorded.

5 If your review shows that you need health advice from your GP, community psychiatric nurse, dentist or other member of the primary care team, staff will arrange this for you and help you to follow any advice you have been given.

6 You can see your GP or other healthcare professional in private.

7 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. These assessments and reviews will take account of any changes in your health. If there are concerns, staff will explain them to you or your representative. With your agreement, staff will take any action needed, such as seeking advice from a dietician or your GP.

8 If you are unwell (physically or emotionally) and feel that you need healthcare, you know that the staff will contact your doctor or other relevant healthcare team member or hospital service (such as dentist, counselling or psychiatry), if you cannot do so yourself. Where necessary, your personal plan will be reviewed.

9 You will receive information about preventive healthcare (for example, screening, immunisation and regular check-ups) and on developing and maintaining a healthy lifestyle. If you want to take part in any of these, staff will help you to do so.

10 On your discharge (either planned or unplanned, such as in an emergency when you have to go to hospital) you will be given a written summary of the treatment you received from the service which you should give to your GP. The summary will also include details of your current care and healthcare needs, including medication.

11 On your discharge, the service makes sure that your GP and care manager (if you have one) know about it. If it is an unplanned discharge, the service will tell them within 24 hours.

12 If you cannot leave the building, you will be able to take part in physical activities arranged by the staff that aim to help you to keep physically fit.

Keeping well - medication

Standard 13

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 If medication is a routine part of your treatment programme or might be used as part of the programme, this is explained to you before you start using the service. You know the reasons for this, including any risks of the medication interacting with alcohol or drugs. If medication is part of your treatment programme, this is with your agreement and its use is regularly reviewed. The agreement and reviews are recorded.

2 If you choose not to take your medication as directed, you are responsible for what happens. However, you are encouraged to discuss your reasons with the staff and to agree how to start taking the medication again as directed, or to look at other solutions.

3 If you are legally required to take or to be given your medication as directed and you fail to do so, you know and understand that the staff must report this to the relevant authorities. Staff will work in line with legal powers that allow other people to give permission to receive treatment if it is necessary for your health and welfare ¹⁰.

4 If you are on medication that someone else needs to administer (for example, an injection), the staff 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 advice.

6 If you have to have your medication managed for you, you can be confident that the service has comprehensive systems in place for ordering medication and for its safe storage and administration, and for the safe disposal of unused medicines. You are confident that the service keeps accurate, up-to-date records of all the medicines that have been ordered, taken or not taken, and disposed of.

7 You know that any medication you receive will have been prescribed for your own use.

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

Daily life

Standard 14

Your privacy is respected and your personal hopes and needs are also respected, encouraged and helped by having access to resources and staff.

1 You know that staff will knock on your bedroom, toilet and bathroom doors and wait for you to say they can come in. There is a clear policy (which is explained to you) about the rights of staff to enter bedrooms and toilets to ensure safety, while protecting your privacy and rights.
The doors will have a locking system that you can use but staff will be able to open them if there is an emergency.

2 If you need intimate physical care or treatment, it will be carried out sensitively and in private, in a way which maintains your dignity.

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

4 You know that staff are aware of the complexities of mixed gender and group living. They have clear policies and practice in managing applications from existing couples and dealing with relationships which form in the home.

5 Your family or other representatives can discuss their concerns with relevant staff members in private and without interruption.

6 You understand clearly if the service has a policy about the management and opening of mail, where the mail is opened but not read. Staff explain this clearly to you from the start, and they regularly repeat it. The arrangements will include a secure facility for receiving personal mail and access to a mail collection point.

7 You have access to a phone. If its use is restricted, the reason will be explained clearly to you.

8 You have the opportunity to continue or to make meaningful personal relationships, including (where appropriate) your children and significant family members.

9 The staff offer practical help (where needed) to arrange meetings with visitors, and to help your disabled friends and relatives into and around the building.

10 You can be confident that the staff will be sensitive and supportive during the difficult times if someone close to you dies.

Supporting communication

Standard 15

You have help to use services, aids 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.

2 If you need it, the staff can help you to get and use specialist communication equipment.

3 You are supported by your named worker or trained communication support workers, including trained interpreters.

4 You can ask your family or representative to support your named worker and staff in communicating with you in ways that suit you and at your own pace.

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