Membership review for Options Roxby House
By – Date of visit:
The membership review is intended to reflect the experiences of the visitor who might be looking for a placement.
The review is subjective, consistent and impartial, representing the impressions of our team member on the day of the visit. It is a snapshot view only. The contents of this review are intended to cover some of the subjects and issues which an individual, their relatives or their placement officer might ask.
This review has been published with the written agreement of the home owner, or an authorised representative of the company.
‘A very impressive autism-focused provision which is showing a great commitment to adapting the environment and practice to the individual needs of a complex client group.’
Summary of findings
Roxby House appears to be a very impressive autism-focused provision which is showing a great commitment to adapting the environment and practice to the individual needs of a complex client group. Despite the overall size of the home there are no large dormitory type living areas; rather, lots of individual spaces and my observations during this visit suggested a setting where even the most challenging of needs are being met. A team of clinical experts is based on site including a Psychologist and Speech and Language Therapist and there is also an experienced training department.
Introduction
Roxby House is a thirty-bedded residential home for adults with autism and additional needs between the ages of 16 and 65. Within the 12 months following the visit this number would likely reduce to 29 beds due to a positive re-organisation of internal structure. The home is set in large grounds just off the A1077. It is around a mile and a half further out of Scunthorpe than Thorpe House, the other Options Group facility in the area. The needs of the individuals residing at Roxby are complex; the majority could be categorised as having moderate to severe autism with accompanying learning difficulties. Some individuals have additional mental health issues and there are also individuals with Prader Willi Syndrome and Pica.
Roxby House had an inspection from the Care Quality Commission in August 2013 with the service seen to be compliant in the following areas with no requirements -
- Standards of treating people with respect and involving them in their care
- Standards of providing care, treatment & support which meets people's needs
- Standards of caring for people safely & protecting them from harm
- Standards of staffing
- Standards of management
First impressions
Visitors should note to enter via the second gate if approaching from the direction of Scunthorpe. On the day of the visit I rang at the main gate and was asked to go through to reception on the left hand side of the main façade to reception by a member of staff and asked to sign in the visitors’ book upon arrival. I was soon met by Lesley Fisher, the Registered Manager. The reception area is clearly signposted and has comfortable seating. Lots of information about the facilities and ethos of Roxby House and The Options Group is on display including an ‘All about Roxby’ guide. Brochures were also available to read and to take away.
The Environment (External)
The Roxby site is very large (it is fenced on all sides); however, due to the spaciousness and abundance of trees and bushes this is barely noticeable. External lighting allows facilities away from the main building to be accessed late into the evening. Towards the centre of the site there is a small animal farm with chickens, guinea pigs, rabbits and chipmunks. Specialist workers support individuals to care for the animals and to work in the greenhouses and on the flower beds.
There are several raised beds throughout the site, some of which were themed and some which had a sensory element. To the rear of the site there is a vegetable plot and a number of greenhouses which were resilient to the strength of the gale force winds on the day of the visit. The spacious walkways around the site allow individuals to use bicycles/tricycles. Roxby House also has a sports hall and a small gym; there is a new specialist sports worker in place to deliver sessions.
The Environment (Internal)
Despite being minimal and functional on the whole, creating a low arousal environment, I noticed that since my last visit there were more pictures and paintings around the flats and residential units. Staff explained that these have been gradually introduced and that overall individuals have coped well with this addition. Staff confirmed that the maintenance team are second to none in terms of responding to requests for environmental adaptations and repair work is carried out very promptly. The design of the flats lends itself well to the management of behaviour allowing space for individuals to have time on their own to calm. In comparison, a more traditional residential unit with more communal living spaces has been split into individual flatlets and there are further plans to extend this design to remaining areas of Roxby House. Individuals still have the opportunity to mix together; however, it is managed in a way to allow the individuals themselves to choose when to have contact.
The Environment (Wider Environment)
Roxby House is set back from the road so traffic noise is barely audible. The site is surrounded by fields and open land on all sides.
Buses run regularly from an adjacent bus stop into Scunthorpe, although this service is only accessed by some individuals with support. Staff were now able to travel free of charge if they are supporting an individual thanks to a new local scheme.
Two young people currently living at Roxby House have vehicles through the motability scheme and there are also a number of other designated vehicles available. Risk assessments are undertaken to ensure every person is transported in a vehicle which is appropriate to their level of need taking into account elements of known behaviour. Staff must undergo a driving assessment before they can begin using the vehicles.
Any people going out and undertaking activities outside Roxby House are risk assessed based on their abilities, needs and the potential hazards in the wider environment. Roxby House has further established itself as part of the community with involvement in last year’s Winterton Float parade, as well regular open days.
Understanding Autism
Roxby House is an autism-specific facility, thus the level of focus on autism and associated behaviours is strong. The majority of individuals at Roxby House have complex additional needs, many with epilepsy and some with mental health concerns. It is clear through the training structure that significant effort is made to ensure staff are equipped with the knowledge to successfully care for each individual.
On occasion, anxiety levels of individuals can lead to outbursts which may require staff to physically intervene for the person’s own safety. The Options Group have developed along with PRICE (Protecting Rights In a Caring Environment) a bespoke autism intervention package which all staff are trained to use safely. All members of staff working at Roxby House are trained in the use of PRICE which can ultimately involve physical intervention to prevent individuals harming themselves or others. Options Group have worked with the PRICE organisation to adapt approaches which are compatible with individuals on the autistic spectrum focusing almost entirely on de-escalation.
The gradual changing of the environment to allow individuals more space on their own in individual flatlets has reduced the frequency of incidents.
In terms of communication, systems are developed which are tailored to each individual. Some individuals I met were using symbol-based communication and I looked at several systems based around widgets and pictures as I visited the individual flats. For some, these systems are too complex and simple objects of reference are used. There is significant input from Options Group’s own Speech and Language Therapist in developing systems and individual communication profiles.
Each individual also has a sensory profile which, again, is developed with Options’ own ‘in-house’ psychology team based at Roxby House.
Preparation for both admission and transition is rigorous and has become more so in the two years since I last visited. Staff will always visit the individual at their current placement or home setting and there has been increased involvement of the clinical team during this process.
Those individuals who are able to engage effectively and can express their views are encouraged to present their views at regular meetings. Individuals who are unable to engage in such a way have their ‘Keyworkers’ advocate on their behalf.
Each individual has a daily activity programme which takes into account their needs, potential and need for structure.
Health and Wellbeing
Every effort is made to ensure each individual living at Roxby House receives a balanced diet. Individuals that cannot express their wishes and tastes effectively rely on their Keyworker to make informed decisions on their behalf. Team leaders all possess a level 2 Food and Nutrition qualification.
Each individual has their own health and wellbeing file which is split into several sections. All people residing at Roxby House are accompanied to regular hospital, doctor and dental appointments. A lot of work is undertaken with individuals prior to these visits to reduce anxiety as much as possible. Roxby House has continued to maintain very positive relations with healthcare professionals. All staff receive training in the administration of medication and medication records are audited on a regular basis as part of the ongoing quality monitoring of the service which is overseen by Geoff Evans, the Head of Quality Improvement. No one currently living at Roxby self-medicates.
Individuals living in the home
Individuals living at Roxby House all have an autism diagnosis and complex additional needs, most have a learning disability. Lesley Fisher, Registered Manager, states that individuals coming into the service and new referrals appear to have more complex needs than two years ago when I last visited, with most displaying behaviour that challenges; most have non-verbal communication and some have additional mental health concerns, some requiring 2-to-1 support during waking hours.
Each person’s daily programme reflects their abilities, interests and capabilities. I witnessed several individuals during the visit engaged in a variety of activities, music workshop, and some were involved in food preparation and cleaning up after lunch in the café.
Staffing
No staff members are allowed to work at Roxby House until they have completed a Disclosure and Barring Service check. The induction period for staff members is thorough and autism-focused and, again, until this has been completed no staff member would be allowed to work with any individual living at Roxby. The training department has continued to run a staff induction programme at night school for interested people who may initially form part of the ‘bank staff’ until a position arises, thus negating the use of ‘unknown’ agency staff.
Although there is a new art worker and new sports specialist worker in post, the majority of team leaders and managers were still in place from the last time I visited.
I was given a copy of the staff handbook issued to new staff at the beginning of their time working at Roxby House which includes details around appropriate conduct.
Staff members have regular supervisions with a staff member senior to them to assess their work and set targets for the future. Supervisions are undertaken bi-monthly as a minimum.
Management of the home
Policies and procedures relating to the running of the home are located in the staff offices adjoining each flat and are available on the Options Group internet portal. I received a copy of the current ‘Statement of Purpose’ for my perusal. Policies had been overhauled recently with areas of best practice being shared across Options Group through the company portal as downloadable resources.
There is a system in place for debriefing staff after stressful incidents. Individual debriefs are also available; these are carried out by senior members of staff who were not involved in the incident or issue. There is also access to a counselling service.
The pre-assessment process that commences before an individual comes to stay at Roxby House now links straight in with the 6-monthly assessment areas, so progress can be directly monitored.
Risk assessments are reviewed as a whole on an annual basis; however, they can be updated regularly depending on any emerging behavioural issues.
I really liked the new colour-coded skills development sheet which allows staff to effectively log performance of individuals in key areas like ‘Flexibility and Imagination’ and link them to their individual skills portfolios.
Lesley Fisher, the Registered Manager, felt there were several things which made Roxby House a special and unique place - the ability to be flexible in catering for individual needs on a day to day basis; a prime example being if an individual was having such anxieties that would prevent them successfully engaging in an activity in the community, they would still be able to engage in the activity in the controlled setting of Roxby House so they would not lose the benefit and enjoyment of the activity itself. Lesley also believes the level of ongoing staff training mentioned in the previous section, particularly in terms of autism, is outstanding and, lastly, Lesley believes there is a real commitment to shape and adapt the physical environment to meet the needs of individuals.
Conclusion
Roxby House was seen to be a very impressive autism-focused home which is adapting the environment and practice to the needs of an increasingly complex client group. I would see this facility being an ideal placement for individuals who need a calm and therapeutic autism-specialised environment allowing them to live in their own personal space supported by a team of knowledgeable practitioners.
Visiting Officer - Craig Godding
Operations Director, Living Autism