EXECUTIVE REPORT FOR HOUSES 3 AND 13:
August 2013
Brackenridge Respite Services. Maddisons Road, Templeton,
Christchurch
Background:
Brackenridge Estate is a wholly owned subsidiary company of the
Canterbury District Health Board. It was established in 1999 to provide
residential accommodation primarily for residents who were being
transferred from Templeton Centre as that institution was being closed.
Fourteen homes were built in a new subdivision in Maddisons Rd,
Templeton. There are only Brackenridge owned homes on the estate.
Currently, as well as the residences on the Brackenridge Estate, the
service has a number of homes scattered throughout Christchurch. The
lease on the Brackenridge properties will expire in 2019, and it is the aim
of the agency by that date, to move from the current site into ordinary
smaller homes in the community in keeping with their commitment to
giving people lives of better quality.
The Respite care service is focussed on the houses at 3/150 Maddisons
Road, and 13/150 Maddisons Road, although two other houses currently
provide two respite care beds each. The two designated respite houses
can cater for a total of 12 children/young people at any one time, the
service has a waiting list for families who they currently do not have
capacity to provide respite service for. The responsibility for increasing
the number of respite beds available to families in Christchurch is out of
the hands of Brackenridge.
The service‘s mission statement is:
Supporting People to Create Great
Lives. The Respite service is but one aspect of services provided by
Brackenridge. It provides respite for children and young people with high
health and physical support needs and for children and young people with
high support needs. These services are provided on a rotating basis
throughout the year.
Currently fifty two children and young people make use of the respite
service that is provided by Brackenridge. It is important to note that the
reports produced in this evaluation are focussed on the Respite Service
and not about wider Brackenridge services. Although the Evaluation
Team spent some time in two other residences that provide a total of four
respite beds, the reports focus is on Respite care and we do not comment
on other aspects of Brackenridge’s services.
Significant Findings:
The Respite service provides service for children/young people in the
Canterbury area. Respite services are also provided by Mary Moodie
Respite and Chomondley Children’s Services. Laura Fergusson Trust
provides short term rehabilitation for young adults/adults with a variety of
neurological conditions. Numerous families told us that the service was
what enabled them and their children to survive. They were hugely
grateful to have access to the service, and appreciated that numerous
staff from the CEO downwards had worked exceptionally hard to make
the service available. Some aspects of the service were particularly
recognised. The fact that families can know up to six months in advance
when they will be able to access respite was a real bonus.
They also appreciated the efforts staff made to make the children’s
groupings as compatible as possible. It is important to bear in mind these
points when reading the reports.
Access to the service depends on the needs of the client and the
availability of beds, so despite efforts to provide a stable environment
there is a fairly regular change in the mix.
House 3
In House 3 the situation is complicated by the fact that two of the young
people live during a week in up to three different homes - time with Mum,
time elsewhere with Dad, and time with the respite service which itself will
have routine staff changes.
The Evaluation Team believes that a service model which consists of
taking up to six young people with challenging physical, behavioural or
health issues at the one time makes it almost impossible to adequately
meet the needs of the residents.
The residents are individuals with their own personalities and their own
learned behaviours. In a situation where children have challenging
behaviours it is essential that wherever they are – and this includes
school where many spend considerable time, there is a very high level of
consistency in managing their behaviours. With one child that can prove a
challenge but to then expect staff who also change frequently, due to the
roster, to be able to meet the needs of six different children at any one
time and the needs of over twenty different children in any one month is
understandably difficult.
With all these points in mind it was however disappointing for the team to
hear that families had a number of major concerns that need to be
addressed urgently.
Medication: Brackenridge has fairly standard protocols for the
administration of medication to people who live in the service, but the
current strategies in the respite service for ensuring the right medication is
taken at the right time need reviewing. We were told of children returning
home with their untaken medication, and of failures to give children with
high health needs appropriate medication. Where children move between
three living environments and attend schools/vocational placements it is
difficult at present to ascertain who was responsible for the failures, but
new protocols may need to be further developed for each individual to
ensure their safety.
During our post-report meeting with Brackenridge management some of
the possible reasons for children returning home with medication were
discussed at length. We understand, at times, some children may arrive
with no medication, others have blister packs labelled with days which do
not match the days they are staying, e.g. Monday/Tuesday/Wednesday
may be the days they are in respite and the medication packs are labelled
Friday/Saturday/Sunday. It was also reported that not all families advise
Brackenridge of changes to medication or increases/decreases in the
dosage. Brackenridge assures us they communicate with the families
involved to try to avoid/eliminate the same issues being repeated,
sometimes successfully and occasionally without success.
Again the agency has taken steps to try and improve things –staff are
encouraged to self-report any mistakes so that systems can be improved,
but more work needs to be done.
Communication: The agency puts out regular newsletters and has
annual Family Information Evenings (held in September) with guest
speakers which has included families, and provides opportunity for a
forum type discussion apparently without much success. Families
acknowledged that because of the nature of respite care, they had limited
opportunities to share information with staff. Although communication
diaries exist, families reported that often there was little information in
them or else the staff who received them failed to pass on the family’s
requests/information to other staff. Brackenridge also appreciate the
information/comments sent to the respite houses by some families and
would like to encourage other families to do the same if they wish.
Several families in both Houses 3 and 13 have attended staff team
meetings to discuss any issues/concerns they had and or to provide
further information about their family member – these were always well
received by staff and beneficial for families and staff.
Challenging Behaviour: We were shown incident reports covering the
period of April to June.
The evaluation team was concerned at the number of incident reports
associated with the service. In House 3 the number of these reports
appeared to be high, even though we appreciate that there can be
additional challenges associated with a range of people using the service.
SAMS does not have the ability to compare the volume of incident reports
in this service with other similar services. However, at least two of the
evaluation team are very experienced, and their impression is that the
service has a greater number of incidents being reported that would be
usually expected. The evaluation team notes that they were informed by
families of two significant incidents, within this period, where there
appeared to have been no report logged. However subsequent to our
visit we have sighted both incident reports.
Clothing: It concerned the Evaluation Team that despite families’ efforts,
problems with clothing continued to be reported. Families reported good
clothes going missing, and receiving clothes that did not belong to their
child.
One family reported that they used to label all clothes meticulously but
gave that up as it did not seem to have any effect. Another family had
drawn up a very clear straightforward chart for clothes where staff simply
had to tick off clothes as they put them in the bag to go home.
However, some of the families’ other clothing concerns, like shrinkage,
were not dissimilar to the concerns of parents associated with other
service providers within the disability sector.
Staffing: The common factor in all these issues is that they all reflect how
staff perform their duties. The agency may have documentation stating
how medication should be checked, how clothing should be handled, and
how important communication is, but unless this is all put into practice
systematically the paper is in vain.
We were frequently told by a variety of people that the Respite homes
were the most difficult homes in the whole service to staff and that staff –
with some notable exceptions, were likely to remain there for shorter
terms than elsewhere. We were also told that a good proportion of staff
did not see their longer term future in this kind of work.
It was reported the service depended on a high percentage of casual staff
and that when there were no casual staff to fall back on the agency
sometimes had to call in Bureau staff to provide cover who would know
nothing about clients before they arrived, and may not have any expertise
in working with these challenging children.
The above information (in italics) was supplied by approximately 40% of
the families and 5 staff – not all of whom work in the two designated
respite houses. At our post-report meeting we were given the results of an
in-depth analysis carried out by the CEO which does not support the
statements. The Brackenridge staff turnover, across the whole
organisation, in the last year is 10.01%.
It appears a number of factors
may be contributing to the perception of a ‘changing staff team’. Two
areas we identified with the management team were:
The respite roster covers an eight day cycle and the staff roster in
one home covers seven days whilst the other home utilises a five
or six day staff roster. This exacerbates problems as staff have
fewer opportunities to get to know the children involved.
Staff who are also studying for formal qualifications. These staff
often move on when they have gained their degree.
Families may only meet some staff once or twice due to the
differing roster periods for children and staff. (see bullet point 1)
The service has a pool of casual/relief staff identified as being ‘respite care
trained’ who are the people used in the respite houses. Staff also work
additional shifts or swap shifts with other staff members. It is not common for
a Bureau person to be used.
Brackenridge offers all staff an excellent range of staff training opportunities,
and we were able to examine the material used in short courses on behaviour
management. It was straightforward and practical, and the agency has also
invested a considerable sum of money in sending two senior staff to
advanced training at the Institute of Applied Behaviour Analysis in California,
and training three senior staff in Non Violent Crisis Intervention, as well as
their on-going attendance at mandatory refresher training programmes.
Commendable as these steps are, it is still a challenge for the agency to
effectively tackle the challenge of 52 young people – with diverse needs.
House 13
Medication: There were less issues with medication in this house. Specific comments are
included in the House 13 Evaluation report. The requirement relating to
medication in House 3 Evaluation Report covers all Brackenridge residential
services.
Clothing: One family told us how they pack the clothes for their child in
separate bags labelled for each day their child was away. However during our
visit we witnessed their young person come home without socks on a day
when there was still some snow on the ground outside. Whilst this could have
been determined as ‘lack of responsibility’ on the part of the Brackenridge
staff, as the young person ended their stay in respite that morning, it could
also have happened at school during the day.
Again with multiple venues/services being involved in the young people’s lives
it is unfair to attribute an incident to a single provider without due
investigation. We encourage Brackenridge to continue to reaffirm with staff
the need to be vigilant in caring for the clothes of the young person while they
are in respite care.
Again some of the families’ other clothing concerns, like shrinkage, good
clothes going missing, and receiving clothes that did not belong to their young
person were not dissimilar to the concerns of parents associated with other
service providers within the disability sector.
Staffing:
The above information (in italics) was supplied by approximately 40% of
the families and 5 staff – not all of whom work in the two designated
respite houses. At our post-report meeting we were given the results of
an in-depth analysis carried out by the CEO which does not support the
statements. The Brackenridge staff turnover, across the whole
organisation, in the last year is 10.01%.
It appears a number of factors
may be contributing to the perception of a ‘changing staff team’. Two
areas we identified with the management team were:
The respite roster covers an eight day cycle and the staff roster in one
home covers seven days whilst the other home utilises a five or six day
staff roster.
Families may only meet some staff once or twice due to the differing
roster periods for children and staff.
The service has a pool of casual/relief staff identified as being ‘respite care
trained’ who are the people used in the respite houses. Staff also work
additional shifts or swap shifts with other staff members to fill any
unexpected vacancy. It is not common for a Bureau person to be used.
The Evaluation team therefore recommends:
1. Medication
The agency undertake a medication review. (see requirement in House 3
Evaluation report)
2. Communication
That steps are taken to teach all staff the importance of communication, of
passing on information to other workers following them, and of reporting back
to families.
3. Clothing The agency develop robust models for ensuring proper handling of clothing
and ensure that staff practise these procedures.
4. Staffing
The agency undertake a review of how this service is staffed, and of how the
use of casual staff can be enhanced. The CEO reported he has already
changed the roster to ensure there is a very senior staff person on at the
weekends.
5. Model Review
The evaluation team notes that an Enabling Good Lives demonstration is
planned for the Christchurch area. We also note Brackenridge’s own
aspiration for people with disabilities, and the Ministry’s objectives in its “New
Model”, to see quality services that are beneficial to families and their disabled
children. We urge the agency and the Ministry of Health to examine best
practices in respite care and further develop approaches that are in keeping
with the Enabling Good Lives principles.
We are encouraged by wider moves in the sector to develop an approach to
“respite” that is more flexible and increases the choice and control individuals
and families’ experience. It is imperative that any change in the service does
not deprive families of essential respite. We appreciate that families have a
real and immediate need for respite options and services. Current services
are fulfilling an immediate need. However, we support moves to transition
towards an approach to “respite” that enables greater personalisation and
choice for individuals and families.
Brackenridge fully supports the Enabling Good Lives demonstration and
believes that respite provision for families in Christchurch can be provided in a
number of ways. However before any change to the current models of service
provision are made all families receiving respite services from Brackenridge
have the right to be fully consulted as to the type of respite they see working
best for them. There should be no changes to the current models of service
provision until this exercise is completed.
