National minimum standards for care homes for …1].pdfNational minimum standards for care homes for younger adults and adult placements Guidance on compliance for residential drug

National minimumstandards for care homes

for younger adults andadult placements

Guidance on compliance for residential drug and alcohol services

European Association for theTreatment of Addiction

National Treatment AgencyThe National Treatment Agency (NTA) is a special health authority, created by the Government on

1 April 2001, with a remit to increase the availability, capacity and effectiveness of treatment for drug

misuse in England.

The overall purpose of the NTA is to: double the number of people in effective, well-managed treatment

from 100,000 in 1998 to 200,000 in 2008; and increase the proportion of individuals completing or

appropriately continuing treatment, year on year.

Available online at www.nta.nhs.uk

© National Treatment Agency, London, November 2002

1

Contents

Foreword

Who this document is aimed at

Why this guidance is needed

How to use this guide

Background to the guidance

1 Setting the scene

1.1 National Treatment Agency

1.2 Audit tool

2 Implications of the National minimum care standards

2.1 Major issues

2.2 Minor issues

3 Restrictions on choice, freedom, services or facilities

4 Preparing for inspection

4.1 Self-audit and planning

4.2 Policies and procedures checklist

4.3 Tools and documentation

4.4 Staff qualifications and development

4.5 Summary of areas of non-compliance

4.6 Implementation planning proforma

5 Sources of further information

2

ForewordWho this document is aimed atThis implementation guide has been created to assist managers of registered residential care homes in

England, treating individuals with drug and alcohol dependencies and seeking to comply with the Care

Standards Act (2000).

The guide may also be of interest to those with responsibility for ensuring services are compliant with

the minimum standards and regulations. Such officials may include inspectors, drug action teams, health

authorities and social services departments.

Why this guidance is neededThe introduction of the minimum national care standards has generated new and increased

requirements on services in order to ensure compliance. The National Treatment Agency (NTA) is

committed to ensuring that services comply with the new regulations, exceeding minimum standards

where possible. The NTA has therefore commissioned this guidance to assist organisations in the

process of change. The NTA has commissioned an additional workstream focused on the human

resource management and qualification requirements within the standards. This project will be

completed in January 2003 when the learning and guidance pack will also be launched.

How to use this guideThe guide is split into distinct sections. Section one details the potential implications of the standards on

services and identifies actions that may be required to achieve compliance. Section two describes the

standards that may not require full compliance where there are clearly identified reasons for therapeutic

and treatment needs.

Section three aims to assist services prepare for inspection and undertake a self-audit. A series of

proforma are included which should be retained together with all relevant documents for inspection.

Development of the guidanceThis guidance has been produced jointly by the National Treatment Agency, European Association for

the Treatment of Addiction (EATA), Alcohol Concern and DrugScope, and following consultation with the

National Care Standards Commission (NCSC). It is based on information gathered from consulting with

providers of services and is designed to assist organisations comply with the regulations and prepare

for inspections.

The guidance has been written by Simon Shepherd and Ian Robinson from the European Association for

the Treatment of Addiction (EATA). Support and guidance was provided by Sue Baker (Alcohol

Concern), David Finney (NCSC), Fiona Hackland (DrugScope), Carole Richardson (NTA), Mala

Seecoomar (EATA) and Claire Wiggins (NTA).

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The authors would like thank staff from the following organisations whose help has been invaluable in

the preparation of this guidance:

• Broadreach House

• Broadway Lodge

• Clouds

• Nelson House Recovery Trust

• Phoenix House

• Turning Point

• Vale House

CopyrightThis document is copyrighted to the NTA but sections may be freely reproduced to assist with

preparations for the inspection process. A downloadable version of this guide and additional support

and guidance is also available from the NTA website, www.nta.nhs.uk.

4

1 Setting the sceneThe Care Standards Act (2000) replaced the Registered Homes Act 1984, and associated

regulations, which were repealed from 1 April 2002. The National Care Standards Commission

(NCSC) has been charged with responsibility for regulating and inspecting social and health care

services, a task previously entrusted to local councils and health authorities. The regulations and

standards form the basis of the new regulatory framework under the Care Standards Act 2000,

governing the conduct of care homes in England. It is the responsibility of the NCSC, an

independent, non-governmental public body, to ensure that the standards are applied consistently

across the country.

It should be noted that the standards cover all residential services for adults aged 18 - 65 and are

not specific to substance misuse services. Some exemptions apply and allowances are written into

the standards for short stay substance misuse services (See Section 3, Restrictions on choice,

freedom, services or facilities).

Although the standards came into force from 1 April 2002, existing homes will not need to comply

with specific standards until a later date. Relevant standards are detailed in this report.

1.1 National Treatment AgencyIn order to ensure that the new care standards realise their objective of raising standards and

promoting national consistency without adversely affecting capacity, the National Treatment Agency

(NTA) has commissioned this document to highlight their potential impact. This document, written by

the European Association for the Treatment of Addiction (EATA), with support from Alcohol Concern

and DrugScope, outlines the impact of some of the new standards and will assist in their

implementation.

EATA, DrugScope and Alcohol Concern raised a series of questions during the consultation process

on the new national minimum care standards for younger adults and adult placements. Alongside the

NTA, these organisations led a concerted effort to address any potential impact on capacity for those

providing residential drug and alcohol treatment and rehabilitation programmes. Concern was

expressed that the original standards did not take into account the requirements of short-stay

therapeutic regimes and would, in addition, severely impact on the capacity of what is already a

relatively small sector.

The concerns expressed by EATA, Alcohol Concern, DrugScope and the NTA appear to have been

accommodated in the final standards.

The first part of this guidance outlines the potential, immediate and long-term implications of each of

the revised standards, as well as an overall summary of the potential impact on treatment capacity of

implementing the care standards. The report assesses the impact of the standards on the following

areas:

• Physical environment

• Therapeutic regime

• Staff training and development

• Policies and procedures

• The need for additional support

EATA has undertaken a small consultation exercise with 10 representative provider organisations to

ascertain levels of preparedness for implementation and to address concerns already identified by

these organisations.

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Such consultation took the form of a detailed questionnaire outlining areas of current compliance,

non-compliance and perceived future difficulties with compliance, and was followed up by a

telephone interview where necessary.

1.2 Audit toolThe second part of this guidance consists of an audit tool and accompanying guidance to

support service providers preparing for inspection. This audit tool is designed to assist in the

review of any changes needed internally within the organisation and to produce a systematic

timetable for implementation in respect of workforce planning and physical environment. This

area of work will also identify where additional costs will be incurred by organisations.

2 Implications of the National minimum care standards

In April 2002, EATA undertook a survey of ten residential substance misuse treatment providers,

inviting them to conduct a self-audit of performance against the care standards for residential homes

for younger adults.

Seven organisations completed the audit - Broadreach House, Broadway Lodge, Clouds, Nelson

House, Phoenix House, Turning Point and Vale House. These organisations covered the full spectrum

of residential treatment services, including detoxification, first and second stage rehabilitation and

therapeutic communities.

The survey indicated that all of the services considered they were broadly compliant with most

requirements of the care standards. However, a number of areas of non-compliance were also

identified. As set out in the tables below, these fall broadly into two categories – a) major issues

which will require further time and resources, and b) more relatively minor issues which can be

addressed in a relatively straightforward fashion.

In addition, the providers were asked to identify any ‘restrictions on choice, freedom, services or

facilities’ (in relation to any of the other requirements in the standards) which would need to be

applied under the provisions of standard 2.5. Standard 2.5 provides for specified restrictions on

choice and freedom where this is necessary for the provision of drug and alcohol treatment and

rehabilitation.

The following section details the implications of each of the standards as well as highlighting where

further action may need to be taken. Some actions will be required by the treatment service while

others will necessitate added guidance and/or action by the NTA and the NCSC.

The information in this section has been informed by the responses to the survey of providers as well

as the views of the authors.

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2.1 Major issuesCompliance with a number of standards will not prove straightforward, raising significant issues in

relation to costs and/or treatment capacity. In a number of cases compliance will also require action

by other parties.

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Treatment and rehabilitation

2.6 The registered nursing

input required by

service users in homes

providing nursing care

is determined by NHS

registered nurses using

a recognised

assessment tool,

according to

Department of Health

guidance.

2.7 Rehabilitation and

therapeutic needs are

assessed by state

registered health

professionals using

regulated assessment

methods.

11.3 Service users in

treatment and recovery

programmes receive

effective, professionally

validated interventions,

counselling and

therapy.

The registration and validation

systems required do not

currently exist.

Once these are in place,

services will be able to comply

with the requirements - although

this is likely to take some time

to achieve and will generate

cost implications. In order for

services to become fully

compliant in this area,

facilitation from external

agencies will be required.

In the meantime, services

should demonstrate that they

are using a full assessment

procedure and ensure all staff

are using the same assessment

tool.

Training and workforce planning

20.10 The training for care

staff must be

accredited and must

include: i) basic

knowledge of how

medicines are used and

how to recognise and

deal with problems in

use; and ii) the

principles behind all

aspects of the home’s

policy on medicines

handling and records.

32.4 Trainees… are

registered on a Sector

Skills Council standard

training programme.

The substance misuse specific

competency based training and

qualification is currently being

developed.

NVQ 2/3 in care have been

mapped against the proposed

drug and alcohol occupational

standards. The two suites of

standards are compatible. For

the providers of residential care

to drug users, the two sets of

standards taken together offer a

framework within which service

provision can be planned and

delivered.

The NTA has commissioned a

number of pieces of work to

ensure that the requirements for

a trained and skilled workforce

are met. Full details can be

found on the National Treatment

Agency website.


should ensure that induction,

training plans and any work

carried out to meet training

needs is fully documented for

each member of staff.

Staff should commence NVQ

level 3 for residential care.

Standard Comments Action required


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32.5 Care staff hold a care

NVQ 2 or 3 (or a

nursing qualification if

providing nursing care);

are working to obtain

one by an agreed date;

or the registered

manager can

demonstrate that

through past work

experience staff meet

that standard.

32.6 50% of care staff

(including agency staff )

in the home achieve a

care NVQ 2 [by 2005].

35.3 All staff receive

structured induction… &

foundation training… to

Sector Skills Council

specification…

37.2 The registered

manager: i) has at least

2 years significant

management/supervisory

experience in a relevant

care setting within the

past 5 years; and ii)

qualifications at level 4

NVQ in both

management and care

[by 2005]; OR iii) where

nursing care is

provided by the home,

is a first level registered

nurse and has a level 4

NVQ in management

[by 2005].

33.7 …there is no more than

one trainee on duty at

any time.

A number of services, in

particular larger homes,

currently operate with more

than one trainee on duty.

Complying with this standard is

likely to have significant

implications in such cases.

Clarification is being sought as

to whether the NCSC will be

prepared to take a flexible

approach on this issue.


should consider the current

ratio of trainee to non-trainee as

well as issues of supervision.

Training and workforce planning (cont.)


9

24.3 Existing, larger homes

are organised into

clusters of up to ten

people … by 1st April

2007.

This may have a significant

impact on cost and capacity for

long stay treatment services.

Standard 24.4 provides

flexibility on this matter for

short-term rehabilitation services

up to 6 months where the

accommodation remains

domestic in scale and is

consistent with the home’s

Statement of Purpose.

Physical environment

25.3 Single rooms in current

use have at least 10

square metres of usable

floor space… or at least

9.3 square metres if

compensatory space…

is provided.

For some services this will lead

to the loss of a small number of

beds. However, where there is

additional communal space,

which is usually the case in

rehabilitation units, this should

be taken into account by

Inspectors.

Treatment services should seek

clarification from their local

NCSC representative prior to

any building work that may lead

to the loss of bed space.

25.5ii …[except in short stay

homes for people who

misuse substance]

double rooms are

phased out by 1st April

2004.

While this will not impact upon

services providing short-term

care (up to 6 months), this may

have a significant impact on

cost and capacity for long-stay

treatment services.

A clear therapeutic need for

room sharing may be taken into

account, though clarification will

be needed from the NCSC.

Treatment services should seek

clarification from their local

NCSC representative.

Services should also consider

alternative ways of ensuring that

the privacy of residents is

maintained, (e.g) through the

use of screens.

25.5iv …in short stay homes

for people who misuse

substances… up to four

people may share a

room…

A few services may lose a small

number of beds by limiting

room occupancy to a maximum

of four occupants.

Treatment services will need to

address this issue within

existing business planning

mechanisms.

Services should also consider

alternative ways of ensuring that

the privacy of residents is

maintained, (e.g) through the

use of screens.

27.2 …toilets are shared by

no more than three

people (by 1st April

2004).

27.4 Bathrooms (hand

basin and shower or

bath) are shared by

no more than three

people (by 1st April

2004).

For a number of services this

would lead to the loss of some

beds and raise significant cost

implications.

Residents in rehabilitation

spend only a limited proportion

of time in their rooms. Facilities

in communal areas should also

be considered when looking at

these standards.

Clarification is being sought on

whether strict compliance with

the 1:3 ratio will be enforced

where it is shown that residents

can readily access toilets and

bathrooms as and when

required.


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3.3 The needs and

preferences of specific

minority ethnic

communities, and

social/cultural or

religious groups catered

for, are recognised and

met.

This is a requirement with which

a number of services do not

fully comply at present.

However, compliance should be

attainable with careful planning -

although further guidance and

support is likely to be required.

Ethnicity, religious, cultural background and gender issues

17.2 Service users are

offered a choice of

suitable menus, which

meet their dietary and

cultural needs.

17.6 The preparation and

serving of food

respects service users’

cultural and religious

requirements.

As above, this is something with

which a number of services are

not fully compliant at present.

Services should become

compliant with these

requirements, although it is

likely to require careful planning

and involve cost implications.

18.7 Service users have

some choice of staff

who work with them,

such as staff from the

same ethnic, religious

or cultural background

or the same gender.

33.6 The staff team reflects

the cultural/gender

composition of service

users.

Once again, a number of

services are not fully compliant

at present - in particular in

relation to the issue of ethnic

and cultural diversity.

Services should become

compliant with these

requirements in due course,

although further guidance and

support is likely to be required

from the NTA and other bodies.

A separate NTA project to

assist services assess how they

deal with issues of diversity is

underway, and is expected to

be completed by the Spring of

2003. (See the NTA website,

www.nta.nhs.uk, for more

details on this and other NTA

projects).


2.2 Minor issuesThe consultation exercise identified a number of standards which one or more of the services

surveyed did not feel that they were currently compliant. A consensus suggested these could be

addressed relatively quickly and easily - although in some cases this would also require action by

other parties (e.g. local authorities, NTA and the NCSC).

11


Policies and procedures

Such documentation is an

important tool to ensure referrals

appropriate to individual

services.

Treatment services will need to

undertake reviews and where

necessary amend existing

documentation to ensure

compliance and usage by all

members of staff.

1.3 A copy of the most

recent inspection report

is made available to

service users and their

families.

This is a generally accepted

procedure in most organisations

but is not to be universally in

place.

Treatment services should

make this available.

1.1 The registered person

produces an up-to-date

statement of purpose

setting out the aims,

objectives and

philosophy of the home,

its services and

facilities, and terms and

conditions; and

provides each

prospective service

user with a service

users’ guide to the

home.

1.2 The service users’

guide sets out clear

and accessible

information for service

users including…

Some services do not

currently provide these

and others will need to

amend existing

documentation.

2.2 For individuals referred

through care

management, the

registered manager

obtains a summary of

the single care

management.…

assessment - integrated

with the [CPA] for

people with mental

health problems - and a

copy of the Single Care

Plan.

Not always provided by health

and social services. Where

provision is in place most

services already comply with

this requirement.

It is however, an expectation

that this information is supplied

on admission by the placing

authority, and may be monitored

by the NCSC where this does

not happen.

Action is required from both the

referral agent and the service

provider to ensure that this is

put in place.


should not accept referrals

unless such information is

available.

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Specific issues related to drug and alcohol treatment

2.5 Any potential

restrictions on choice,

freedom, services or

facilities - based on

specialist needs and

risk and/or required by

a treatment programme

- likely to become part

of a prospective service

user’s individual plan,

are discussed and

agreed with the

prospective service

user during assessment.

Any specified restrictions, such

as agreed participation in

treatment programme and

restricted access to family and

friends, must be based on the

treatment regime and any

reasoning clearly explained.

6.4 The plan describes any

restrictions on choice

and freedom (agreed

with the service user)

imposed by a specialist

programme (e.g. a

treatment programme

for drug or alcohol

misusers). Any

specified restrictions,

such as agreed

participation in

treatment programme

and restricted access to

family and friends, must

be based on the

treatment regime and

the reasoning clearly

explained.

See also 3. Restrictions on

choice, freedom, services or

facilities.

Further guidance will also be

required from NCSC as to

which restrictions are

considered acceptable. In the

meantime, services should

ensure all restrictions are

specified.

Services will need to review the

range of restrictions and make

these clear to service users and

purchasers in advance of any

referral.

They will also need to ensure

that service user Individual

Plans clearly detail all

restrictions.


13

Service user, family and carer involvement

3.7 The home confirms that

prospective service

users are informed

about independent

advocacy/self-advocacy

schemes throughout the

process of choosing a

home.

Compliance is dependent on

the referral agency, which would

be responsible for dealing with

issues of advocacy/self-

advocacy.

4.1 The registered manager

invites prospective

service users to visit the

home on an

introductory basis

before making a

decision to move there,

and unplanned

admissions are avoided

where possible.

4.2 A minimum half-day

(preferably including

overnight) visit to the

home is offered,

including an opportunity

for the prospective

service user (with

family, friends,

advocate, interpreters

as appropriate) to…

Many services do offer the

opportunity for an initial visit,

although it is rarely taken up.

Where a visit is thought to be

inappropriate for therapeutic

reasons, such decisions should

be clearly explained and

recorded.

Action is required from both the

referral agent and the service

provider to ensure that this is

put in place.


develops and agrees

with each prospective

service user a written

and costed

contract/statement of

terms and conditions

between the home and

the service user.


develops and agrees

with each service user

an individual plan,

which may include…

Most services stated that they

do produce both a

contract/statement of terms and

conditions, in addition to an

individual plan. However, many

reported that it would not be

possible for these to be drawn

up by the registered manager

in person.

Services will need to ensure

they do provide the required

documentation. Where

applicable, they should confirm

with their local NCSC

representative that some

flexibility will be permitted over

who would be entitled to act on

behalf of the registered

manager in this regard.

Any divergence from the

required standards should be

explained and detailed in the

individual plan.

Individual plans could be

signed by the registered

manager after they have been

drawn up.


14

Service user, family and carer involvement

5.3 Service users are

supported by family,

friends and/or advocate,

as appropriate, when

drawing up the contract.

5.5 The service user has a

copy of the contract,

which has been signed

by the service user and

the registered manager.

At present, not all services fully

comply with these requirements

- but could do so relatively

easily.

39.6 Feedback is actively

sought from service

users (with support from

independent advocates

as appropriate) about

services provided

through e.g. anonymous

user satisfaction

questionnaires and

individual and group

discussion, as well as

evidence from records

and life plans; and

informs all planning and

review.

39.4 The results of service

user surveys are

published and made

available to service

users, their

representatives and

other interested parties

including the NCSC.

This is not often done on a

formal basis at present but

should not be problematic to

implement. However, services

will need to develop appropriate

procedures to ensure full

compliance.

Treatment services to action.

In the meantime, a timetable

for implementation should be

developed.

Treatment services to action. In

the meantime, a timetable for

implementation should be

developed.

39.7 The views of family,

friends and advocates

and of stakeholders in

the community… are

sought on how the

home is achieving goals

for service users.

In many cases, such

consultation is limited but this

could be expanded.




developed.

10.2 Service users and their

families have access to

the home’s policy and

procedures on

confidentiality and on

dealing with breaches

of confidentiality, and

staff explain and/or

ensure service users

understand the policy.

At present, this information is

not always provided to families

and partner agencies but could

be done so relatively easily.




developed.


15

10.6 The home gives a

statement on

confidentiality to partner

agencies, setting out

the principles governing

the sharing of

information.

Ethnic, religious, cultural background and gender issues

11.4 Service users have

opportunities to fulfil

their spiritual needs.

A number of services do not

currently comply and need to

develop appropriate policies

and procedures.

Treatment services to action as

soon as possible. In the

meantime, a timetable for


developed.

Training and workforce issues

40.1 The home’s written

policies and procedures

comply with current

legislation and

recognised professional

standards, covering the

topics set out in

Appendix 3.

40.5 Staff are fully involved

in developing policies

and procedures, and

service users have

opportunities to help

in their formulation.

The majority of services have

most of these in place (and are

prepared to share them - see

under ‘documentation’ for

details) but few involve service

users and staff in consultations.

Recognised professional

standards are part of the NTA

workforce planning agenda. For

further details visit the NTA

website http://www.nta.nhs.uk.




developed.

Policies and procedures

33.8 Regular staff meetings

take place (minimum six

per year) and are

recorded and actioned.

Most, but not all, services are

currently complying and this is

generally recognised as good

practice.

Treatment services to action

immediately.

34.3 New staff are confirmed

in post only following

completion of a

satisfactory police

check, satisfactory

check of the Protection

of Children and

Vulnerable Adults and

UKCC registers.

This is not generally carried out at

present but is not expected to be

overly problematic to implement

once procedures for undertaking

checks are in place. (There may

be some difficulties for smaller

organisations with no appropriate

umbrella bodies to undertake

checks on their behalf).

Treatment services to action

with support and guidance from

the NTA. In the meantime, a

timetable for implementation

should be developed.




Service user, family and carer involvement (cont.)


3 Restrictions on choice, freedom, services or facilities

Under standard 2.5 the specific needs of individuals undergoing treatment are considered:

2.5 Any potential restrictions on choice, freedom, services or facilities - based on specialist needs and risk and/or required by a treatment programme - likely to become part of a prospective service user’s individual plan, are agreed with the prospective service user during assessment.

Standard 2.5 recognised that certain restrictions on freedom and choice are necessary in order to

provide substance misuse rehabilitation and treatment. The survey carried out by EATA asked

providers to identify any ‘restrictions on choice, freedom, services or facilities’ (in relation to any of the

other requirements in the standards), which they would need to apply in order to continue to provide

appropriate treatment and rehabilitation.

The list below should not be regarded as, in any way, definitive on this issue. Furthermore, any

restrictions will need to be ‘discussed and agreed with the prospective service user during

assessment’ and included in the service user’s individual plan.

The following standards may be considered inappropriate in terms of the treatment or therapeutic

regime that the service is providing. This may particularly be the case immediately post detox and

within therapeutic communities.

However, creative planning should enable services to become at least partially compliant - in

particular, in second stage rehabs and therapeutic communities. As stated previously, the onus is on

the service provider to supply reasons for non-compliance, such reasons should be discussed with

potential residents and clearly stated on individual plans.

16

Standard Comments

7.5 Service users manage their own

finances; where support and tuition are

needed, the reasons for, and manner, of

support are documented and reviewed.

This may be deemed to be inappropriate in the

early stages of treatment, immediately post-detox

and within therapeutic communities.

8.3 Service users have opportunities to

participate… in activities which enable

them to influence key decisions in the

home, for example: …ii) representation in

management structures; iii) involvement

in selection of staff and of other service users.

34.4 Service users are actively supported to

be involved in staff selection.

34.7 …service users are involved in [the]

review [of staff appointments].

43.6 Service users are involved where

possible in the business and financial

planning and monitoring of the home.

Residents remain in treatment for only relatively

short periods and, as such, it would not be

possible to fully comply with these requirements.

However, creative planning should enable

services to become at least partially compliant -

in particular, in second stage rehabs and

therapeutic communities.

17

12.1 Staff help service users to find and keep

appropriate jobs, continue their

education or training, and/or take part in

valued and fulfilling activities.

12.3 Staff help service users find out about

and take up opportunities for further

education, distance learning, and

vocational, literacy and numeracy training.

12.4 Staff help service users to develop

employment skills, and to develop and

maintain links with careers advice

services, local employers and job centres.

12.5 Staff help service users find out about

and take up opportunities for paid,

supported or volunteer jobs/therapeutic

work placements or work-related training

schemes.

While such requirements would normally be met

in second stage rehabs and the later phases of

treatment within a therapeutic community, these

would not be appropriate to the early, post-detox,

stage of treatment.

However, arrangements for aftercare should be

put in place which may take into account other

non-treatment needs.

12.2 Service users can continue to take part

in activities engaged in prior to entering

the home, if they wish, or re-establish

activities if they change localities.

14.2 Service users are encouraged &

supported to pursue their own interests

and hobbies.

Some restrictions would need to be applied in

this area, particularly in relation to activities,

interests and hobbies associated with substance

use. Restrictions would also be required to

ensure that hobbies and interests did not

interfere with the service user’s involvement in

the treatment process.

14.3 Service users have a choice of

entertainment brought in to the home.

Some restrictions would need to be applied,

particularly in relation to material that might

undermine the treatment process e.g. films or

music glamorising drug use.

14.4 Service users in long-term placements

have as part of the basic contract price

the option of a minimum seven-day

annual holiday outside the home.

This only applies in the long-stay sector - but would

run counter to the requirements of on-going

treatment and could lead to an increased risk of

relapse (especially in the early phases of treatment).

14.5 Group trips are planned and chosen by

users who share the same interests.

Restrictions would need to apply to the choice of

trip, (e.g) visits to public houses, especially early

in the treatment cycle. Any such excursions need

to be agreed and supervised by staff.

15.2 Family and friends are welcomed, and

their involvement in daily routines and

activities is encouraged, with the service

user’s agreement.

15.3 Service users choose whom they see

and when; and can see visitors in their

rooms and in private.

15.5 Service users can develop and maintain

intimate personal relationships with

people of their choice, and information

and specialist guidance are provided to

help the service user to make

appropriate decisions.

Restrictions would need to apply to visitors,

especially in the early stages of treatment, in

order to prevent disruption to the treatment

process and possible smuggling of illicit

substances. Many facilities consider intimate

personal relationships during treatment to be

counter-therapeutic, particularly between

residents.

Restrictions on visitors would need to be clarified

in each individual care plan.

Standard Comments

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15.4 Service users have opportunities to meet

people and make friends who do not

have their disability/illness/addiction.

This would be unlikely to be appropriate in the

early, post-detox, stage of treatment - where the

key focus is on service users’ facing their

addictions and working with others with similar

problems to help overcome their dependency.

16.2 Staff enter service users’ bedrooms and

bathrooms only with the individual’s

permission…

16.4 Staff do not open service users’ mail

without their agreement.

26.4 Service users’ bedrooms are lockable.

Staff use an override device only as

indicated by a service user’s risk

assessment.

26.2 Service users’ bedrooms include…

lockable storage space.

A number of services indicated that they need to

have the right to insist on inspecting residents’

rooms and belongings where they have good

reason to suspect that illicit substances might be

stored or have been brought in to the house.

Attention is drawn to Section 8 of the Misuse of

Drugs Act 1971, which requires managers to

take steps to prevent the supply or use of

controlled drugs on their premises.

16.7 Service users choose when to be alone

or in company, and when not to join an

activity.

17.5 Service users can choose where and

when to eat, and whether to eat alone or

with others including staff.

18.4 Times for getting up/going to bed, baths,

meals and other activities are flexible.

Treatment programme requires that residents

participate fully in all treatment activities and

would be unable to accommodate this level of

flexibility in the day-to-day routine. This should be

clearly written into the individual plan.

26.2 Service users’ bedrooms include…

space for… [a] computer …, [a] TV

aerial point, and telephone point (or

access to a cordless telephone handset

for use in the room).

A number of services have stated that they

would not want residents to have computers and

TVs in their rooms as residents are encouraged

to spend time engaging with peers rather than

isolating themselves in their bedrooms. This is,

for instance, contrary to some approaches run as

therapeutic communities and should be clearly

written into individual plans.

26.3 Service users can bring and/or choose

(or are helped to choose) their own

furniture and can decorate and

personalise their rooms subject to fire

and safety requirements.

A number of services suggested that this was

impractical in treatment settings - particularly in

the short stay sector and where residents are

required to share a room.

Standard Comments

4 Preparing for inspectionThe National Care Standards Commission took over responsibility for registration and inspection of

registered care homes from local authorities and health authorities in April 2002. Inspections can be

announced or unannounced and services will generally be inspected twice per year. Prior to an

announced inspection, a pre-inspection questionnaire will be sent to the service manager

approximately two weeks in advance. The following sections will assist preparation for inspections

and completion of pre-inspection questionnaires.

The inspection is intended to ensure that the home is fit for its stated purpose and meets national

minimum standards. Inspections are expected to be carried out in a consistent fashion across the

country. Except in cases of clear gross negligence putting residents at risk, inspectors will work with

services to ensure that standards are met.

Inspectors will seek to examine all records, talk to staff and service users and generally observe how

services operate. To be fully compliant with the standards, services will need to have in place a

range of tools and documentation (e.g. service user guides, assessment and planning tools) and a

comprehensive set of written policies and procedures.

Services should be prepared for an inspection at any time. It is recommended that services ensure

required documentation is easily accessible, clearly states level of compliance and exact reasons

where compliance is not thought to be appropriate or is in the process of completion.

The audit and planning process should be carried out by a multi-disciplinary team of staff, involving

representatives of each of the service’s operational areas. It is also recommended that multi-facility

agencies conduct this exercise locally for each of their facilities individually.

Before carrying out this process, services should first read the other sections of the implementation

support pack - including the report on the findings of the initial survey of providers and the section on

materials (which includes a checklist of required materials and contact details of organisations which

already have these in place and are prepared to make them available to other services).

4.1 Self-audit and planningTo assist services meet the required standards, the following documents have been produced and

are included in the pocket of this document, and available online at www.nta.nhs.uk:

• Policies and procedures checklist

• Tools and documentation checklist

• Staff qualifications and development

• Summary of areas of non-compliance table

• Implementation pro-forma

4.2 Policies and procedures checklistServices are required to have written policies and procedures in place covering each of the topics

listed in Appendix 3 of the standards, (except where they are clearly not relevant to the service

concerned). It is suggested that services use the checklist to indicate which of the policies and

procedures they have. Where policies and procedures are not considered applicable to that service,

reasons should be clearly stated in the comments box. Where a service is still in the process of

completing certain policies and procedure documents, this should also be stated in the comments

box with a proposed date for completion.

The completed checklist should be retained alongside a comprehensive set of policies and

procedures to aid the inspection.

19

4.3 Tools and documentationTo be fully compliant with the standards, services will also need to have in place a range of tools and

documentation (e.g. service user guides, assessment and planning tools).

It is suggested that services use the following checklist to indicate compliance with documentation

requirements. Where documents and tools are not considered to be applicable to that service,

reasons should be clearly stated in the comments box. Where a service is still in the process of

completing certain documents or tools, this should also be stated in the comments box with a

proposed completion date.

The completed checklist should be retained alongside a comprehensive set of documents to aid

inspections.

4.4 Staff qualifications and developmentEach staff member and their supervisor should complete the enclosed pro-forma and ensure it is kept

up to date through regular supervision. The completed form should be retained by the staff member,

kept with their personnel records, and be available for inspection.

4.5 Summary of areas of non-complianceAs part of the self-audit process, services will need to go through each of the standards, and record

areas of non-compliance - the attached ‘summary of areas of current non-compliance’ table might be

helpful in this regard.

[Please note - it is important that this process is carried out carefully and thoroughly and all areas ofnon-compliance are identified - including those which might be expected to be covered underparagraph 2.5 and those which also require action by other parties].

4.6 Implementation planning proformaWhere there are clear areas of non-compliance, it is suggested that organisations complete the

enclosed implementation planning proforma, detailing who is responsible and the different milestones

necessary for compliance.

[Note - this exercise should be carried out for every area of non-compliance - including those whichmight be expected to be covered under paragraph 2.5 and those which also require action by otherparties. Also - any restrictions which services intend to apply under paragraph 2.5 will need to beratified by the NCSC. They must also be agreed with service users at assessment and be included intheir individual plans].

It is recommended that service managers check with their local NCSC representatives to ensure that

each of their plans will meet the commission’s requirements (though this might not be necessary

where the plan envisages full compliance, with few difficulties, in a very short time-frame).

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5 Sources of further informationNational Treatment AgencyThe National Treatment Agency (NTA) was created by the Government on 1 April 2001 with a remit to

increase the capacity, quality and effectiveness of drug treatment in England.

National Treatment Agency, 5th Floor, Hannibal House, Elephant and Castle,

London SE1 6TE Email: [email protected] www.nta.nhs.uk

Tel: 020 7972 2214 Fax: 020 7972 2248

EATAEATA is a membership organisation with over 140 members, most of which are voluntary and

independent treatment providers. Our members provide over 60% of community-based residential

treatment, much of the UK’s structured day care treatment, almost all of the UK's prison-based

programmes and a significant proportion of lower threshold services.

Waterbridge House, 32-36 Loman Street, London, SE1 0EE

Email: [email protected] www.eata.org.uk

Tel: 020 7922 8753 Fax: 020 7928 4644

DrugScopeDrugScope is a national drugs charity that helps support the work of drug agencies through research,

library services and the development of quality and best practice advice to DATs and others.


Email: [email protected] www.drugscope.org.uk

Tel: 020 7928 1211 Fax: 020 7928 1771

Alcohol ConcernAlcohol Concern is the national agency for alcohol misuse, working to reduce the incidence and

costs of alcohol-related harm while increasing the range and quality of services available to people

with alcohol-related problems.


Email: [email protected] www.alcoholconcern.org.uk

Tel: 020 7928 1211 Fax: 020 7928 4644

The National Care Standards CommissionThe National Care Standards Commission is a new, independent public body set up under the Care

Standards Act 2000, to regulate social care and private and voluntary health care services throughout

England.

From 1st April 2002, the NCSC was vested with responsibility for the registration and inspection of

services - replacing the existing system of inspection by local authority and health authority

inspection units.

National Care Standards Commission, St Nicholas Building, St Nicholas Street,

Newcastle upon Tyne, NE1 1NB

Tel: 0191 233 3600 Fax: 0191 233 3569

Email: [email protected] www.carestandards.org.uk

Shared resourcesMany of the services that took part in the initial pilot and other organisations have gathered a range

of written materials and are prepared to make them available to other services. Contact EATA if you

would like to discuss with similar organisations the possibility of sharing resources. [Please note,however, that EATA can not provide a guarantee about the quality such materials].

National Treatment Agency

5th Floor, Hannibal House

Elephant and Castle

London SE1 6TE

Tel: 020 7972 2214

Fax:020 7972 2248

[email protected]

www.nta.nhs.uk

All NTA publications and updates on our activities are available on www.nta.nhs.uk.

November 2002

Design: Moore-Wilson www.m-w.co.uk

Documents

National minimum standards for care homes for …1].pdfNational minimum standards for care homes for younger adults and adult placements Guidance on compliance for residential drug