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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
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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.
In the meantime, services
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
Standard Comments Action required
8
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.
In the meantime, services
should consider the current
ratio of trainee to non-trainee as
well as issues of supervision.
Training and workforce planning (cont.)
Standard Comments Action required
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.
Standard Comments Action required
10
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).
Standard Comments Action required
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
Standard Comments Action required
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.
In the meantime, services
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.
Standard Comments Action required
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.
5.1 The registered manager
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.
6.1 The registered manager
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.
Standard Comments Action required
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.
Treatment services to action. In
the meantime, a timetable for
implementation should be
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.
Treatment services to action. In
the meantime, a timetable for
implementation should be
developed.
Standard Comments Action required
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
implementation should be
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.
Treatment services to action. In
the meantime, a timetable for
implementation should be
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.
Standard Comments Action required
Standard Comments Action required
Standard Comments Action required
Service user, family and carer involvement (cont.)
Standard Comments Action required
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.
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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.
Waterbridge House, 32-36 Loman Street, London, SE1 0EE
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.
Waterbridge House, 32-36 Loman Street, London, SE1 0EE
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
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