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Person-centred support for men with learning disabilities who have a forensic history

A look at what it takes for a care home to gain outstanding status from the Care Quality Commission

A look at what it takes for a care home to gain outstanding status from the Care Quality Commission


Low House in Country Durham is one of the homes that provides care for men
with a learning disability or autism with a forensic history

From the outside Highview House and Low House look like perfect places to take a well-earned rest from the stresses of everyday life.

But these are care homes, not holiday homes, albeit they are in semi-rural parts of County Durham in north east England.

Both homes are run by Resolve, a company set up more than ten years ago to provide care for men with a learning disability or autism who have a forensic history.

‘Meaningful activities’

The company stakes its reputation on providing person-centred care and providing ‘meaningful activities’ to service users. It seems to be getting it right judging by recent reports published by the Care Quality Commission (CQC) that rated both homes as outstanding overall following unannounced inspections.

1,087,100

Predicted number of people in England (2.16%) who have learning disabilities

Source: Public Health England (2016)

Now the company is in the early stages of planning a third home while preserving the high standards of care offered at its existing homes.

‘People come into our homes and they are staggered at how beautiful they are,’ says Resolve (Care Northern) co-director David King.

If homes resemble holiday cottages – Highview House is a former B&B, while Low House was a farmhouse – that could be deliberate.

Mr King, a registered learning disability nurse, says: ‘The men we work with have had more than enough bad things happen in their lives, so we try to provide them with the most caring, kind and compassionate staff support we can in a five-star environment.’

‘No service user has committed an offence while in our care’

David King, co-director of Resolve (Care Northern)

The homes aim to provide a high level of individualised care for a small number of service users – one home has seven and the other eight residents.


David King

Before being placed at one of the homes the men will have spent time being assessed at hospital.

Providing sanctuary

‘This period is helpful to them, providing almost a bit of sanctuary,’ Mr King adds. ‘All children, whether they know it or not, yearn for safety and for structure.

‘The chaps that we work with haven’t even had the awareness that that was what they needed, so the time in hospital where they undergo lots of treatment and do lots of courses gives them framework to their life.

‘Then when the clinicians feel that that has been done to an adequate degree, that’s when they start looking for community placements.

‘There’s not one punitive element in what we do,’ Mr King adds.

‘We are paternalistic in the way that we go about things, so that guidance and caring support is there to give them what they’ve yearned for for so long’

David King, co-director of Resolve (Care Northern)

‘What we try and do is provide them with a meaningful occupation, provide them with a beautiful environment to live in and surround them with great supportive staff.

‘We are paternalistic in the way that we go about things, so that guidance and caring support is there to give them what they’ve yearned for for so long.

‘The men come from dysfunctional, chaotic and abusive backgrounds. They have never had the role models that you would hope a child would have.

‘They’ve been in care or they’ve been subjected to harmful behaviours themselves. That affects their personality during their formative years. They haven’t had that moral compass imposed on them by parent role models.’

Moneymaking social enterprises 


Fill Ya Boots sauce – one of the
products made at Low House

Service users at Low House in County Durham have been growing their own fruit and vegetables’ – produce that not only finds its way onto their plates, but is also to be sold to the public.

This is thanks to a social enterprise recently set up known as Fill Ya Boots – ‘ya’ being Geordie for ‘your’, as Resolve (Care Northern) co-director David King explains. The men also sell wooden products they have crafted, such as wooden planters made from upcycled wooden pallets.

‘We’re just at the point of getting them sold now,' says Mr King. ‘We sat down with the lads and asked: “Do you think there’s somewhere else we could go with this?” After lots of discussions we created a social enterprise.

Significant change in status

‘We are making fudges, chutneys, jams and preserves from our own seasonal produce now.’

Working alongside a chef, service users have developed intriguing preserves, such as raspberry and liquorice jam, as well as Earl Grey and fig flavour.

It is hoped that these treats will lead to a significant change in status for the men who have set themselves an ambitious goal, says Mr King.

‘The men want to get to a point where they make enough money from the social enterprise and no longer have to rely on benefits.

‘They want to be trailblazers, saying “this is what we can do” so they can genuinely sense they are doing their bit.’

 

The Resolve approach to care

In both of its homes Resolve’s approach revolves around the following basics:

  • An in-depth pre-admission assessment.
  • Multi-agency involvement in care planning and risk assessment.
  • Practising an approach known as total attachment, a model of compassionate care that is based on British psychologist John Bowlby’s attachment theory, using a technique known as professional parenting.
  • Setting clear boundaries.
  • A knowledgeable, compassionate workforce.

Developing independence

In the CQC report on Low House, inspectors noted the care taken to develop independence: ‘People who used the service told us about how they could make choices and do what they wanted to do. One person told us: “It’s fabulous. The staff are out in the garden with us, helping us to do what we want to do.’”

A Low House staff member told inspectors: ‘It’s about what happens in the community as well. These men are now respected in the community. They are a credit to this place as much as it has benefitted them.’

Similarly, at Highview House inspectors found that: ‘People were supported to make decisions about their lives in a way which maximised their autonomy.’

Inspectors added that: ‘People who used the service received care and support from exceptionally well-trained and well-supported staff.’

The CQC also praised Resolve’s case management system, which uses a software package called Eclipse, produced by OLM systems. It can be accessed on mobiles and tablets so that staff can view and adapt service users’ electronic files wherever they are. ‘It’s so much easier than updating paper documents,’ says Mr King.

But perhaps the greatest testament to Resolve’s approach comes when Mr King says: ‘No service user has committed an offence while in our care.’

Exposing institutional abuse – the aftermath

In December 2012 the government announced plans to dramatically reduce – by 2014 – the number of people with learning disabilities in hospitals in the wake of the Winterbourne View abuse scandal.

The private 24-bed hospital near Bristol had been registered to assess, treat and rehabilitate people with learning disabilities and autism.

The BBC’s 2011 Panorama investigation, Undercover Care: the Abuse Exposed, had shown people with behaviour that challenges being bullied as well as physically and emotionally abused by hospital staff.

In the aftermath the hospital was closed and six members of its staff were imprisoned for abuse.

The Department of Health and Social Care missed its 2014 deadline for reducing the numbers in hospital that had been promised in its report Transforming Care: A National Response to Winterbourne View Hospital.  

The then care minister Norman Lamb described this as an ‘abject failure’. Figures published in July 2018 suggested that the March 2019 deadline of closing 35-50% of inpatient beds in England looked likely to be missed.

 

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