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Values and Principles Underpinning the StandardsThe management and practice within a nursing home should create and maintaina caring and stimulating atmosphere where people are listened to and feelvalued, their rights are upheld and their cultural and religious beliefs arerespected. Living in the home should be a positive and beneficial experience. Inorder to achieve this, managers, staff and volunteers should have the followingvalues firmly embedded and demonstrated in their practice.Dignity and RespectThe uniqueness and intrinsic value of individuals is acknowledged and eachperson is treated with respect and their dignity protected.IndependencePeople have as much control as possible over their lives whilst being protectedagainst unreasonable risks.RightsIndividual and human rights are safeguarded and actively promoted within thecontext of services provided by the home.Equality and DiversityPeople are treated equally and their backgrounds, gender identity, sexualorientation and cultures are valued. The services provided by the home fit withina framework of equal opportunities and anti-oppressive practice.ChoicePeople are offered the opportunity to select independently from a range ofoptions based on clear, accessible and accurate information.FulfilmentPeople are enabled to lead full and purposeful lives, and to realise their abilityand potential.10

SafetyPeople feel safe in all aspects of their care and can expect that every service willemploy a zero tolerance of abuse, neglect, exploitation and harm and work to thehighest standards of safeguarding practice.PrivacyPeople have the right to be left alone, undisturbed and free from unnecessaryintrusion into their affairs and there is a balance between the considerations ofthe individual’s own and others’ safety.ConfidentialityPeople know that information about them is managed appropriately and will onlybe disclosed to others when this is in the interests of their welfare. Everyoneinvolved in the service respects confidential matters.11

AbbreviationsThis table shows the full wording of the abbreviations used in the standards.AHPAllied Health ProfessionalCNOChief Nursing OfficerDHSSPSDepartment of Health, Social Services & Public SafetyGAINGuidelines and Audit Implementation NetworkGPGeneral PractitionerHSCHealth and Social CareHSCTHealth and Social Care TrustLGBTLesbian, gay, bisexual and transgenderNIAICNorthern Ireland Adverse Incidents CentreNICENational Institute for Health and Care ExcellenceNIFRSNorthern Ireland Fire and Rescue ServiceNISCCNorthern Ireland Social Care CouncilNMCNursing and Midwifery CouncilPCCPatient and Client CouncilPHAPublic Health AgencyPSNIPolice Service of Northern IrelandRCNRoyal College of NursingRQIARegulation and Quality Improvement AuthoritySALTSpeech and Language TherapistSCIESocial Care Institute for ExcellenceSOPStandardised Operating ProcedureVBSVetting & Barring Service12

Before AdmissionIt is vital that at the pre-admission stage prospective residents, their relatives andrepresentatives have all the information they need to make an informed choice aboutmoving into the home. This is particularly important for those residents whosecapacity to make informed choices might be limited due to learning disability, mentalhealth issues or cognitive impairment such as dementia.The manager or other appropriate staff of the home should visit the prospectiveresident in their current location (which may be their home or in hospital) andundertake a pre-admission assessment. This also helps to establish communicationand relationships with the potential resident and their relatives as well as addressingthe emotional impact of the move.Life story work is considered fundamental to being informed about a resident’s lifeexperiences and so is integral to the assessment process. Where an individual lifestory book has already been prepared by families or another agency, it will providevital information on the resident’s life, skills and interests. By considering thismaterial, staff will be able to provide more empathetic person-centred care.The home must have clearly set out policies and procedures for emergency orunplanned admissions where it is not possible to have a pre-admission visit.The home must provide accurate information about the services and facilities it offersand be written in a way that can be easily understood by the reader. Informationshould be kept up to date and reflect the reality of what is delivered. Similarly,residents and prospective residents and their relatives must be given accurate,transparent information about the costs of living in the home – particularly any thirdparty or “top-up” payments required. People can only make the best decisions forthemselves and their families when they have the necessary accurate information.13

Standard 1 – Before AdmissionProspective residents (and where appropriate their relatives) have all theinformation they need to make an informed choice about moving into thehome. No resident moves into the home without having their needs assessedand been assured that these will be met.Criteria1. Prospective residents are given an information pack or residents’ guide whichsets out up-to-date information about the home and the services it provides.This information is written in plain English or in a language and format suitedto the prospective resident and contains the following: A summary of the Statement of Purpose; The aims, objectives and philosophy of the home; A summary of the services and facilities provided in the home; Where specialist care is provided (eg dementia, learning disability andpalliative care), the qualifications of the staff providing this care arespecified; The referral and admission procedures; The location and description of the home; The name of the Registered Manager and general staffingarrangements; The organisation, its structure and the name of the Registered Person; Accurate, accessible and transparent information on the home’s feesand charges to include arrangements for third party payments andchanges to fees; The arrangements for obtaining equipment required by the resident; The arrangements necessary for residents to bring their belongings tothe home (eg labelling, hygiene etc); The arrangements in place for residents who require treatment atoutpatients’ services or admission to hospital, including arrangements14

for accompanying the resident and ensuring that their medical notesare transported with them; The general terms and conditions of living in the home; Information on bedroom accommodation and communal facilitiesavailable; Arrangements for personal property and valuables including insurancearrangements; The current programme of activities and events – including anyadditional costs; Arrangements for transport costs incurred in the resident’s care; The arrangements for resident involvement in the running of the home; The views of residents and their relatives on the quality of services andfacilities; The arrangements for inspection of the home and how to accessinspection reports; The arrangements for communication with families when the resident’sneeds may change and can no longer be met in the home; and The arrangements in place for termination of the accommodation.2. There are opportunities for prospective residents and their relatives to visit thehome at least once, meet the manager and staff as well as other residentsbefore making a decision about moving in.3. Prior to admission and in line with timeframes agreed by the commissioningTrust, an identified nurse employed by the home visits the prospectiveresident and carries out and records an assessment of nursing care needs.This assessment includes information received from other care providersincluding family members as appropriate. Any associated factors or risks aredocumented. A written record of the assessment and the decision as towhether or not the placement is appropriate is retained and made available onrequest to the resident or their representative.15

4. There are arrangements in place to ensure appropriate staff are available tocomplete the necessary assessments as quickly as possible to avoidunnecessary delays in hospital.5. Prior to admission (or as soon as possible after admission in the case ofemergencies) there is a record of the resident’s medical history; medicationshistory; treatments past and present; stage of illness; plan of care; andprognosis.6. The Registered Manager ensures that referral forms providing all necessaryinformation, including any risk assessment relating to the resident and thedelivery of their care and services are completed before admission. Referralforms include records of all discussions and decisions made. Documentsfrom the referring Trust are dated and signed on receipt.7. Aids or specialist assessed equipment are in place before admission.8. There are arrangements in place for responding to and ensuring appropriateplacement for self-referred residents. In cases of self-referral, the homeadvises the resident or their relative to contact the local Trust’s caremanagement service.9. For any unplanned admission, referral information is obtained or completedwithin two working days of admission. When referral information is notreceived, records are kept of requests made for it. Within a further two days,an assessment by an HSC professional takes place to determine the needs ofthe resident and the appropriateness of the ongoing placement in the home.During this period, the home makes a more detailed assessment as towhether the resident’s needs can be met on an ongoing basis in the home.16

Standard 2 – Individual AgreementEvery resident has an individual written agreement setting out the terms andconditions with the home.Criteria1. Each resident is provided with an individual written agreement that sets outthe terms of their residency. This agreement is made available in a formatand language suitable for the resident as required. The agreement isprovided in advance of the placement, except in the case of unplannedadmissions where it is provided within five working days of the admission.2. As a minimum, the agreement sets out: The date of admission and duration of stay (if known); The accommodation, services and facilities provided by the home(these are the general services and facilities agreed as part of thecontracting arrangements with the HSC Trust); What the individual can reasonably expect in terms of care andtreatment; The weekly fee (including any third party top-up charge); An accurate and transparent itemised list of all agreed services andfacilities over and above the general services and facilities; The individual charges for all the agreed itemised services andfacilities; the rationale for such additional charges; arrangements forthe payment of all agreed charges; and the minimum period of noticefor any change to the charges; The arrangements for any financial transactions undertaken on behalfof the resident by the home and the records to be kept (including,where appropriate, the details of any appointee and the records to bekept of this appointment); The general terms and conditions of residency with reference to any ofthe home’s relevant policies;17

The arrangements for the management of the resident’s valuables –including insurance arrangements; How the resident will be supported to be involved in the daily life of thehome; A copy of the complaints procedure; Signposting to independent advocacy services; The arrangements for regularly reviewing the signed agreement andthe circumstances when the agreement can be reviewed outside thesearrangements; The frequency of summary reports for persons staying for respite andrehabilitative care; and The notice period for terminating the agreement.3. The agreement should be in place before admission. Where this is notpossible, it must be in place within five working days of the date of admission.For residents admitted to the home on an unplanned basis, the agreementmust be signed within two weeks of admission.4. The terms and conditions of the agreement are in line with and do notcontradict or attempt to override the content of the Trusts’ regional contract forTrust-managed residents.5. The resident (or their representative) and the Registered Person sign theagreement prior to, or within five days of, admission. Where the resident ortheir representative is unable or chooses not to sign, this is recorded. Neitherthe Registered Person nor any staff member acting as an appointee or agenton behalf of a resident may sign the written agreement on the resident’sbehalf.6. The resident, their representative and (in the case of Trust-managedresidents) the Trust (in accordance with local arrangements) are given writtennotice of all changes to the agreement and these are agreed in writing.Where the resident is unable to sign or chooses not to, this is recorded.18

7. A minimum of four weeks’ notice is given for the introduction of new charges,together with a statement setting out the rationale for such an increase.8. Any changes to the individual agreement are agreed in writing by the residentor their representative. The individual agreement is updated to reflect anyincreases in charges payable. Where the resident or their representative isunable to or chooses not to sign the revised agreement, this is recorded.9. Charges are levied in accordance with current DHSSPS guidelines on thecare assessment process1.1The DHSSPS guidance can be accessed 9

Standard 3 - Informed ConsentEvery resident is presumed to have the mental capacity to consent to or refusecare or treatment. Residents are involved in decision making in line with theDepartment’s guidance on consent, treatment and care.Criteria1. There are written policies and procedures on obtaining valid and informedconsent. Policies and procedures are in line with the DHSSPS guidance onConsent, Treatment and Care2 and with relevant professional guidelines.2. Residents and their relatives (when appropriate) are effectively involved inmaking decisions about their treatment and are provided with informationabout the implications of the treatment and any options available to them.The information is presented in plain English and in a format that isaccessible, including alternative languages, according to the individualcommunication needs of the resident.3. Residents are given information so that they are clear about what is involvedin the procedures for their treatment and care.4. The process for “best interest” decisions when an individual does not havecapacity is documented within the case record. This includes records ofdiscussions with representatives as well as multi-disciplinary professionalsand outcomes for the resident. Any such intervention is the least restrictiveoption. Records show evidence of the options considered, human rightsimplications, safety needs and outcomes for the resident.5. Residents and their relatives are signposted to independent advocacyservices as required.2DHSSPS guidance on Consent, Treatment and Care can be accessed at:http://www.dhsspsni.gov.uk/public health consent20

Standard 4 – Individualised Care and SupportEach resident’s health, personal and social care needs are set out in anindividual care plan which provides the basis of the care to be delivered and isre-evaluated in response to the resident’s changing needs.Criteria1. An initial plan of care based on the pre-admission assessment and referralinformation is in place within 24 hours of admission. A detailed plan of carefor each resident is generated from a comprehensive, holistic assessment anddrawn up with each resident. The assessment is commenced on the day ofadmission and completed within five days of admission to the home.2. All residents have a named nurse who has responsibility for discussing,planning and agreeing the nursing interventions necessary to meet residents’assessed needs. This is done in partnership with the resident and theirrelatives and includes their values and preferences in terms of physical safetyand promoting independence and how emotional, social and psychologicalneeds will be met alongside the physical and other healthcare needs.3. Where a resident does not already have a life story book, staff develop onewith the involvement of families and carers as appropriate. The informationcontained within the life story book informs the resident’s care and how bestto engage with them.4. The care plan clearly demonstrates the promotion of maximum independenceand rehabilitation and takes into account advice and recommendations fromrelevant health and social care professionals. The plan is shared with otherhealth and social care professionals as necessary and appropriate.5. The care plan records evidence of the involvement of the resident and theirrelatives in the development and review of care plans, incorporating the21

decisions made, the agreements reached and the information which wasshared.6. The care plan is written in a suitable format and so as to be accessible to andunderstood by the resident and their relatives. Copies of the care plan areshared with the resident and arrangements are in place to ensureconfidentiality is not compromised by this sharing of the plan. Where theresident has agreed, copies of the plan are shared with relatives asrequested.7. Re-assessment is an ongoing process that is carried out daily and atidentified, agreed time intervals as recorded in care plans.8. All nursing and social care interventions, activities and procedures areappropriate to the resident’s individual needs and supported by currentevidence and best practice guidelines as set by both national and localstandard setting organisations and professional bodies.9. In accordance with NMC guidelines3, contemporaneous nursing records arekept of all nursing interventions, activities and procedures carried out inrelation to each resident. The outcomes of such actions are recorded. Anyvaria

The Care Standards for Nursing Homes aim to improve the quality and consistency of care for people living in nursing homes. They also provide further detail on the criteria for registration and inspection set out in the Nursing Homes Regulations (Northern Ireland) 2005. Article 38 of the Health and Personal Social Services (Quality Improvement and