At Apple House care homes we strive to support residents to lead a healthy lifestyle and to be as independent as possible. We provide access to a programme promoting healthy living and wellbeing, with home cooked fresh food, regular exercise, and creative activities. This article outlines why it is important to give people with autism the opportunity to take part in creative activities and regular exercise.

Challenges for people with Autism

For people with autism, you may notice that they can have challenges in interacting in social situations as it can be overwhelming at times with direct verbal communication. We may not get a direct response or eye contact and we can wonder if we have been understood. So it may also be a struggle to build a relationship with them through words alone.

At times people with autism can have rigid mindsets as this may be their way of making sense of the world around them. So, therefore, change can be difficult as they feel reassured by a routine that gives them a sense of control. They may not always understand that a change in routine may be something beyond their carer’s or parents’ control. Such as the illness of a friend or a change in who supports them due to outside factors.  They may need help in regulating their emotions in response to these situations.

Sensory experiences

Jackie Edwards (2017) describes how people with autism may have difficulty making connections between their tactile, vestibular and proprioceptive sensory systems where they may be overactive or not active enough with how they interact with their environment.  For example, they may have a hypersensitivity to loud noise or bright light, may also be de-sensitised to tactile experiences. So, therefore, they would benefit from a sensory diet to improve sensory integration.

She advocates giving people with autism access to different sensory experiences to help improve concentration and attention. This in turn may help them to be able to regulate awareness of their surroundings more effectively as well as to help them relax and not feel overwhelmed, leading to increased socialisation and interaction, promoting less rigid thinking, creativity, and motor skills.

Benefits of exercise

At Summerwood we recognise the importance of exercise by helping our residents access their community, take part in physical exercises such as the gym and swimming, and helping with gardening, tending the vegetable patch etc.

According to Healy S, et al. (2018) research shows that for people with autism exercise can have a number of benefits:

• Reducing stereotypical behaviours or self-stimulating behaviours
• Improving social skills with sports that promote teamwork
• Helps to reduce weight gain or obesity
• Can increase a person’s attention as repetitive behaviours can decrease
• Exercise can reduce anxiety and improve the ability to regulate emotions, build resilience to anxiety-triggering situations
• Exercise can improve motor skills and coordination for people with autism

Benefits of creative activities

The creative arts is another important activity and we support individuals to participate in regular arts and music classes in the community and within Summerwood, their home.

Art can give a person a sense of control as they learn to adapt to the task in their own way. Drawing and painting can also help to improve and maintain fine motor skills. Creative arts can be an effective way to engage with the person in a non-pressurised way. Tactile art forms such as paint and clay also provide a sensory experience to fulfill the needs of the person to be able to balance their sensory experiences more effectively. Music can elicit interactive emotional responses and melodic rhythms can help them engage.

Arts and wellbeing

People with disabilities can be more vulnerable to mental health issues so we are aware that it is important to provide a way for people to communicate their emotions appropriately. Behaviours on the surface may arise due to an inability to verbally communicate how they feel. Behaviours thus can have a function so this highlights the importance of non-verbal communication and communication aids to help people communicate their needs.

For further assistance, creative arts therapy with a trained art therapist can be a way for a person to be able to express and/or regulate their emotions when words are difficult. It can also help to improve cognition and emotional regulation where the aim is to use the art materials or creative activity to access emotional wellbeing and to help a person learn to regulate their emotions and understand themselves within a safe and facilitating environment.

— By Andrew Wright, Support Worker, Summerwood Care Home, Hants (Previously Rated ‘Outstanding’ by CQC).

References and further reading

Draycot, C. (2013) Educating Autism – Art and Creativity to Engage an Autistic Child in the Classroom. The Art of Autism: Connecting through the Arts. https://the-art-of-autism.com/educating-autism-art-and-creativity-to-engage-an-autistic-child-in-the-classroom/

Edwards, J. (2017) The benefits of multi-sensory environments. Autism Journey Blog.

Healy S (2018) The effect of physical activity interventions on youth with autism spectrum disorder: A meta-analysis. Review article. Autism Research. 11(2) · April 2018.

Rudy, L.J (2017) How Does Art Therapy Help People With Autism? Very Well Health. https://www.verywellhealth.com/art-therapy-for-autism-260054

At the most basic level, stress is our body’s response to pressures from a situation or life event. Some common features of things that can make us feel stress include experiencing something new or unexpected, something that threatens your feeling of self, or feeling you have little control over a situation. [Mental Health Foundation]

In the following article, Jayne Jackson, registered manager at Apple House care home, writes an open and very insightful reflection on how stress plans can and do have a profoundly positive impact for a gentleman she supports:

Our care plans are person centred and very individual to each of the people we support.
I was looking at environmental risk assessments & policies for stress. This centred around how we could look after staff’s health and what they/we could do to help in their day-to-day working environment, which we know at times can be stressful.This prompted me to look at the people we support [in relation to stresss]. We looked at easy read documents and set up a meeting.

The easy read document comprised general things to help lower stress/anxieties. We wanted our support plans to be personalised to suit the needs of the individual.

We worked with each person individually and discussed what we could do to help them stay settled and reduce their stress levels.

For one individual this was a massive achievement as in the past just discussing and writing information could cause him to experience high levels of stress.

We worked very closely over many years with the gentleman to help him learn to trust us. We use the phrase ‘it’s good to talk’ and this person now quotes this phrase.

This plan would not have worked for this person if they did not sign up to it.

He spent time with us, we listened to him, we built ‘his’ support plan. It is important that the person has ownership over ‘their’ plan. When he is feeling stressed we refer to the plan and this keeps it fresh in his mind. We all stick to the plan; this is key in keeping his well-being stable.

This plan cannot work without the individual being involved, it is not a paper exercise, it is a live tool.

The stress support plan runs alongside others that all interlink. He is now beginning to recognise when he is feeling troubled, or finding things difficult and, with our support, he is starting to work them out.
The individual works with us. We ensure he has time to reflect, to identify what is worrying him.

Breathing exercises, conversation and space are used; usually after 10 minutes he feels able to talk about what is happening. We must ensure that the person and staff have clarification that they have settled as this prevents further stress. A physical change can be seen within him – his body language and speech will return to pre-stressed levels, and he appears calmer. This is not just a one-off thing as this may happen a few times a day, or weeks may pass without presentation of stress.

Because of the trust we have built, continuity of the team and knowing and respecting the individual it could be said that he has a better quality of life. Sure, there are stressful days for him, we all have those, but learning to cope with them is what we support him to do.

I cannot tell you how proud I feel of him and the team; it is lovely to see the person more involved in day to day things, and by doing this it also helps him to have a renewed sense of purpose and to feel valued, staying focused forming part of his routine.

This individual wrote an additional support plan with staff which was linked to additional stress; he took it to a meeting with his psychiatric team and asked them to sign up to it which they did.

He then wrote to his link mental health team and asked to be discharged. We supported him in writing a letter and discussed the benefits, including self-esteem, that he would feel. His mental health team told us they never thought they would see they day this gentleman would be signed off [from their care].

This is a massive achievement for him!

Due to the hard work and commitment of my staff, their link team and the individual himself, he has stayed settled for over a year following years of mental health decline.

In our compliment folder, the person’s mental health team praised Apple House. They commented how well we had supported the person when they had deteriorated in their mental health and suffered episodes of depression and mania, they had never see this person doing so well. This was signed by the person’s community nurse. This person was told if they remained stable for the next year they would be signed off.

Jumping forwards a year, well its happened, he has been discharged!

We look forward to maintaining his wellbeing and will continue to encourage him to further develop and reach his personal goals.

— Jayne Jackson, registered manager, Apple House care home, Bournemouth.

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Pet therapy, or more correctly, Animal Assisted Therapy (AAT) is a type of therapy that involves animals as a form of treatment. The goal of AAT is to improve a person’s social, emotional, or cognitive functioning –Wiki.

In Apple House care homes, AAT is used as part of an holistic aproach to care and support.  Touch, social integration, sight, scent…the benefits of pet therapy are too numerous to list.  The smile on our residents’ faces as their fingers stroke a loving dog’s fur really, for us, sums the benefits up nicely.

Now well and truly into the new year, I thought I’d take a moment to reflect on the last year and what a year it was for us all!

Redcroft’s transformation began exactly twelve months ago when the foundations were laid for the beautiful new wing which has been used to its fullest since completion in early summer, with a comprehensive schedule of pop-up shows. Last year saw the creation of an accessible garden, patios and activity cabin. Perhaps most exciting of all was CQC’s recognition of the hard work of our Redcroft team with their award of an Outstanding for ‘Responsive.’

For Summerwood there was new wood flooring, sprucing up, and a full itinerary of adventures which took advantage of the home’s excellent location twixt forest and sea. We were incredibly proud of Carly, Deputy Manager, who was an award finalist and of John, Registered Manager, who joined us in Birmingham as finalist for a national award.

Apple House care home became even more accessible with a posh new stair lift. Most exciting of all was having the honour of accompanying Mr G, resident at Apple, to Birmingham to receive his National Finalist certificate. Here he is proudly displaying the engraved pocket watch he received to mark his achievement (shared with his kind permission)…

What will 2019 bring? Already the new year has seen further enhancement at Redcroft with a fabulous new kitchen and range cooker installed last week. At Apple House care home we are busy considering plans for a new conservatory to enhance our current dining provision and patio areas. Summerwood too will see some fabulous enhancements during the next few months.

Finally, we welcome new team members and look forward to our annual party next month. Here at HQ we are already plotting to make 2019 a year of fun for our colleagues and those whom we support.

–Jane Montrose, Managing Director.

CQC is the independent regulator of health and adult social care in England.  The inspection was unannounced and took place over two days on the 27^thFebruary and the 1^stMarch 2018.

Our teams have demonstrated their unfailing commitment to providing a high standard of care and support at Apple House.

We would like to share below some of the report’s findings and you can also view the full report HERE

Safe

We spoke with three people who lived at the home, all of whom were living full active lives. They all told us they were happy living at Apple House and were keen to be part of the inspection. No one had any concerns about safety and they made comments such as: “I am very happy here”, and, “This is a nice place to live”.

The registered manager had also taken steps to make sure people’s care was delivered as safely as possible as all aspects of people’s care had been risk assessed. The risk assessments showed that the service was not ‘risk adverse’, as people were supported to take calculated risks in meeting their objectives.

One person had been assessed as having memory problems; however, they were supported to maintain their preferred routine of going out in the evenings and arrangements were made to support them with this goal.

This person was also the in-house Fire and Health & Safety officer. They worked with staff and had their own picture format to work from. This helped them identify risks or hazards in the way that they could understand. They were supported by a member of staff and assisted with fire evacuations and monthly health and safety checks. The registered manager told us this has helped this person’s esteem by being valued and included in the safety of their own home.

The home had recently had an audit of their medicines’ management by their pharmacist.  The report showed good compliance with medicines guidelines.  The registered manager shared knowledge with their medication auditor as they did not know the risks to using paraffin emollients. They said they would feed the information, which was taken from NICE/ CQC and NHS guidance, back to their pharmacist team.

Effective

People were satisfied about how their care and support was managed at Apple House and fed back to us that their consent was always agreed before any changes to their routine. Health and social care professionals also commented positively about the support people received at the home.

The home had a small staff team who felt well supported by the registered manager as well as the directors of the company.

Records showed that staff had regular supervision meetings and annual appraisal meetings with the registered manager. In these meetings they reflected on their work, the people living at Apple House, as well as training and development needs.

People were mostly able to make decisions for themselves about various aspects of their care and support. The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 in relation to supporting people wherever possible to make their own decisions. People’s consent had been documented in relation to areas such as care and treatment, medication, sharing information with professionals and having photographs taken. People told us that their consent was always gained and that staff respected their decisions.

Where people lacked the mental capacity to make decisions about aspects of their care, staff were guided by the principles of the Mental Capacity Act 2005 to make decisions in the person’s best interest.

Care plans recorded that people had been involved and supported as far as possible in making any decisions. Best interest decisions had been made on the basis of the least restrictive intervention necessary. Staff had all had training in MCA.

Staff encouraged and supported people to eat healthily and to be involved in shopping, cooking and budgeting. For example, one person’s cookery folder showed how staff had worked with them. Real time photos had been used as visual prompts to help the person remember what actions were needed to complete the task.

Caring

People and health and care professionals all told of how supportive the staff were at Apple House.

We discussed equality, diversity and human rights with the registered manager. Staff had a good understanding about treating people as individuals and ensuring they were given choice and their preferences respected. Staff received training in diversity, equality and inclusion.

Staff we spoke with had very good understanding of people, how to support them and knew of their goals as detailed within care plans. Each person had a communication plan and staff knew how to communicate with each individual.

Staff were aware of people’s preferences and respected their choices. People’s records included information about their personal circumstances, likes and dislikes and how they wished to be supported. For example, care plans referred to people’s preferred routines and how they liked to spend their day.

Responsive

An advocacy worker who had been engaged to work with one person commented; “It is refreshing to meet such a dedicated staff who have such a strong bond with the residents. It is very clear that (person’s name) enjoys life at Apple House, and this is solely due to the professionalism and genuine warmth of the staff to the residents. Believe me, there are not many homes that I would endorse without a second thought.”

Each person had an up to date personal care plan. The plans detailed people’s needs and how they should be supported. The plans gave good information about the whole person; their health, social, spiritual and emotional needs and identified goals set with that person. The plans were up to date and shared with the people living at the home so that they were fully involved in planning what they wanted to achieve in the future. For example, the registered manager told us that staff at Apple House and family had worked with one person with a mental health condition to remain stable for the past 18 months. The professionals involved had agreed to sign a support plan the person had written with the help of staff. This person had also with support written their own support plan to lower their stress levels, demonstrating the service encouraged people to contribute to planning their care.

People were enthusiastic to share their experience of the home and were happy for this report to reflect the full lives that they were able to enjoy because of the support and assistance of the staff.

Each person had varied, differing interests and the staff had worked with people to ensure people individuality was respected.

Well-led

The home was well-led by the registered manager who had worked at the home for many years. The directors of the company also took an active part in supporting the registered manger and people living at the home. They visited the home at least once a month to support the registered manager and also to review the performance of the service.

The company was a finalist in the National Learning Disabilities and Autism Awards 2017 for Employer of the year and also for 2018. The award for 2018 was in relation to the ‘Breaking Down Barriers’, which celebrates and recognises an individual or organisation who has worked to make sure people get clear information and are able to contribute their views and experiences.

One of the directors had been awarded ‘Director of the Year’ and had also been a finalist for a lifetime achievement award with a local initiative recognising women’s achievement in business. The Managing Director and the Director of Operations gave a seminar presentation for Westminster briefing, one of Europe’s leading political information, public affairs and policy communication specialist. This service feeds into the House magazine, the weekly business publication for the houses of parliament.

The registered manager had sought feedback from staff members with questionnaires asking about their working life. This was in addition to the support, supervision and appraisal given to all staff. The registered manager gave feedback in an open letter to the team to motivate and inspire the team.

— CQC

We would like to extend our warm congratulations to Jayne Jackson, Registered Manager at Apple House care home, and her team, for their hard work and total dedication to the individuals they support. What an amazing CQC report and a very well deserved rating of Good!

— Romaine Lawson, Director of Operations, Apple House Care Homes.

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“Care homes differ from other workplaces because they are not only places of work but are also homes for their residents. It is therefore important that they are pleasant places where the freedom and dignity of residents is respected, and where everyone’s health and safety is sensibly and effectively managed.” — HSE, Health and Safety in Care Homes, 2nd Edition.

“D, C and J were quite enthusiastic about the Health and Safety quiz and did their best to impress everyone with their knowledge. Some questions were a piece of cake for them, while others turned out to be a hard nut to crack! Fortunately, consultations were allowed and the spirit of co-operation proved stronger than the thrill of rivalry.

At the end of the day it’s all about team work at Apple House! Eventually, the collective effort paid off and the team passed the quiz with flying colours. This was a fun and informative house meeting, just like they always are. :-)” — Milosz, Deputy Manager, Apple House Care Home.

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How are Apple House care homes helping those we support to understand the written information that pertains to them in order to help in their decision making and choices?

A picture paints a thousand words.  This is so true, don’t you think?  At Apple House care homes, we utilise a variety of communication methods alongside the written word or, sometimes, instead of.

‘Easy read’ means that we make our fonts clearer, larger, and we add symbols or pictures alongside the words.  What we say is said simply, it makes the points without the fuss.  We use ‘easy read’ to help people understand their medication, to prepare for appointments such as the dentist, health check ups and residents’ meetings.

Our primary goal is to make all of the information that forms a part of all our lives, into a format that is useful and relevant on an individual basis.  That said, ‘easy read’ is not a tool that we develop by ourselves as care providers.  As with all communication, it has to be a two-way street.

This means that we work in partnership with the person with learning disabilities to ensure that they are involved in creating a working tool that they understand, that it is meaningful to them.

— Jane Montrose, Managing Director, Apple House Care Homes.

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The Apple House Ltd Approach:

The world of management and strategic planning can be full of jargon-based terms and phrases, which can take the core meaning away from readers who want to see the direction and aims a company wants to work towards.

While it is crucial that our company has a clear strategic plan from directorship level, the methods which enable this plan to work through an operational route are key to achieving the common goal. This planning stage will assist the company forward through an ever-increasing demanding economy and climate.

For our Company, the aim is to protect the homes of the people we support and the jobs of the people whom we employ throughout our services.

An infographic is used to give an overview of our Operational Goal Planning.

–Romaine Lawson, Director of Operations, Apple House.

Summerwood is a specialist residential home for up to 8 adults with learning and physical disabilities, who may also have complex needs and/or needs associated with the autistic spectrum.  Summerwood offers extremely flexible accommodation which can be utilised as either a stepping stone to more independent living or for a high needs service.  We now have available one delightful en-suite first floor bedroom with garden view.

Located in Ashley, a small hamlet close to the thriving town of New Milton, the home is close to the New Forest National Park and beaches of Barton-On-Sea, Highcliffe and Lymington.  The house itself is situated within walking distance of local bus services to Bournemouth, Southampton and other places of interest.  Also close by are local shops, churches, green spaces, pub and hairdresser/barber.

For further information, please telephone John, Registered Manager, on: 01425 839687