Group Living for Adults: Challenges and Quality Standards

Introduction (What you are going to cover in this document)

I am going to cover group living for adults.

There are various groups living for adults and each have a positive and negative impact. Group living can be beneficial for adults who are unsafe to live on their own and for individuals who are lonely. I will focus on residential care for group living. When individuals reach the stage where either they or their families have to decide it will be of their best interests to be moved into residential care, there are many factors that influence this.

Age

Mental capacity to make decisions
Safety factors/risks

Financial

Living in a group can pose problems as individuals are brought together, individuals may not always get on with one another due to their views, morals, background and general preferences. The difficulties is pleasing everyone and ensuring they all live amicably together.

The benefits in group living is having companionship/friendship and plenty of activities that they can attend with individuals they know and live with, still enabling them to have their own space and privacy if they so wish.

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Various group living:

Residential care
Elderly care complexes
Hostels
Supported living
Residential enables 24 hour care
Elderly complexes ensures they have a warden and activities if they so wish to join in, care provisions if they so wish

Hostels are temporary living

Supported living offers more choice and freedom, activities, meal provisions and warden input, where if needed they can have homecare provisions. Whichever an individual or their families choose they all have to promote a happy/safe environment for individuals, ensuring they meet standards set out for residential or group living provisions.

Every group living environment/care home has to meet standards set out by the government, these are monitored by CQC, GSCC and local authorities to ensure standards are met. Within group living the environment has to be safe, clean and ensure individuals wellbeing, while Promoting their independence and uphold their rights to human necessities. It is important that standards identify the requirements associated with leading and managing group living provision; it includes developing the physical environment, daily living activities and group activities in such a way that they support the achievement of positive outcomes for individuals. By respecting each individual and their individuality, making a setting that enables individuals choice, freedom and to be able to express themselves. Comfort and warmth, meal choices and variation, respecting cultures and backgrounds and focusing on their wellbeing, health and happiness.

Fitness for purpose: The regulatory powers provided by the CSA are designed to ensure that care home managers, staff and premises are ‘fit for their purpose’. In applying the standards, regulators will look for evidence that a home whether providing a long-term placement, short-term rehabilitation, nursing care or specialist service is successful in achieving its stated aims and objectives.

Comprehensiveness: Life in a care home/group living is made up of a range of services and Facilities which may be of greater or lesser importance to different individuals. In applying the standards, regulators ensure the service package offered by the care home contributes to the overall personal and health care needs and preferences of individuals and how the home works with others services / professionals to ensure the individual’s inclusion in the community.

Meeting assessed needs: In applying the right standards, inspectors will look for Evidence that the care home meets needs of individuals and that Individuals’ changing needs continue to be met. The assessment and service user plan carried out in the care home should be based on the care management. Individual care plans that meets and specifies their needs. Good residential care poses a variety of challenges, and requires high levels of expertise and creative ability from managers, staff and external supports. They need to be committed to enabling residents to take as much responsibility as possible for the planning and management of their own care. Managers should adopt a planned approach to meeting the needs and promoting the potential of individual residents, within a regime and culture for the unit, and groups within it, which provides the right balance of security, stimulation and scope for independence. ( Et al CQC website residential care)

Quality services: The Government’s modernising agenda, including the new regulatory framework, aims to ensure greater assurance of quality services rather than having to live with second best. In applying the standards, regulators will seek evidence of a commitment to continuous improvement, quality services, support, accommodation and facilities which assure a good quality of life for individuals It is important individual have rights to their own choices that include risks. The risks they take need to be evaluated to ensure the decision does not outweigh the risk to individual or others.

The difficulty within group living is what may be safe for one individual may not be for another, for instance one individual may be safe to come and go as they please whereas another may need supervision to go outdoors. This can pose a problem if fully independent individual leaves access door open or invite an unsafe party to go outdoors with them. There are risks associated with everyday living but ensuring everyone’s safety can be a challenge.

Ensuring equipment, living quarters, and environment is kept safe and secure while promoting independence and choice. If a risk cannot be eliminated I would look at ways to reduce the risk, this way the individual is still in control but has measures in place to ensure their safety and the safety of others. Addressing risks with individuals and fully informing them why something is classed as a risk enables them to make an informed decision as to if they want to continue to take the risk, dependant on the severity. Working with individual and listening to how they deem or see something works, but if they are adamant and the risk out weights the benefits then measure have to be put in place.

The physical environment can promote wellbeing by having a nice homely atmosphere, allowing each individual to contribute to this. The lighting, warmth, setting, fixtures and fittings as well as what activities everyone enjoys and encouraging all parties to participate. By having a safe but nice environment it promotes wellbeing, by allowing and including individual to say what they like and dislike promotes inclusion. Encouraging them to participate in various activities gives stimulation and helps build friendships within group living. It is also important that the staff have good training and engage with individuals, that they remain friendly and impartial.

Choice is one of the main factors whether this be meals, settings, activities getting the right balance and promoting their independence and involvement. All this contribute to their wellbeing and happiness.

If the environment was a cold, damp, dark, with no opportunities for activities, there was no freedom of choice and made individual have set meals, toileting times and took their rights and independence away, I cannot imagine any individual would be happy and their wellbeing would decline.

Maintaining and the upkeep of furnishings and decorations are important, the cost of this can be substantial, with the right budgeting and setting aside of finances will help maintain this, that way the upkeep can be maintained and the finances will be readily available. Part of this reflects in the amount it will cost for individuals to live there. Another way is to hold charity/fundraising days. I believe you can have cut backs but still maintain quality assurance without delivering low quality surroundings. Part of this is looking after the environment, if the environment is of good quality to begin with individuals are more likely to maintain this and respect it as their home.

Not allowing items that need repairing to get to the stage where they are in repairable or unsafe. Ensuring electrical items and gas servicing is maintained, this is a legal requirement within group living environments.

Ensuring the environment is kept clean, safe and hygienic maintains it’s daily living requirements and reduces the risk of cross contamination. There has to be adequate space for each individual and the correct amount of staff ratio.

When making decisions regarding the environment it is important that the individuals who live there are included, they may want some of their own belongings, like a chair of dressing table. All of these things are important to them as without been given the choice they will feel as though it is not their home.

Each individual will have different taste, likes and dislikes, although this may prove difficult to please each one, if each one has some input they will feel included and are more likely to come together as a group to decide on what everyone wants.

This should include decisions down to cost, what furniture, fitments; decorations they feel are the most important and make their environment safe, the safety aspect needs to be looked at the same as comfort. Chairs that support individuals and offer the right height, wash ability etc.

Beds, dining room furniture, decor, plants, pictures, easy access between chairs. Ensuring the environment offers stimulation and relaxation.

Daily activities are an important part of group living and these also need to be agreed upon. Trips, bingo, sing-along’s, flower arranging, exercise classes, outdoor activities, gardening, vegetable plots and planting. By offering choice and ensuring daily activity times are adhered to, implementing an activities co-ordinator and ensuring staff encourage participation and inclusion of individuals and staff.

It is nice for individuals when family members attend and this should be encouraged when possible. The best times for activities tend to be afternoons and early evening times. By offering activities throughout the day enables all individuals to include themselves at some point or another.

Legislation states that individuals must have choice and ensure the activities are appropriate for age, genders, and cultures. The outcomes from these have to be achievable, ensuring individuals do not feel belittled or restrained.

Individuals must have the opportunity to exercise their choice in relation to: leisure and social activities and cultural interests;

food, meals and mealtimes;
routines of daily living;
personal and social relationships;
Religious observance.

The outcome must find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. interests are to be recorded in care plans and that they were given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities; particular consideration should be given to people with dementia and other cognitive impairments, those with visual, hearing or dual sensory impairments, those with physical disabilities or learning disabilities.

When supporting others in the implementation of daily activities it is important they treat individuals with dignity and respect. That they encourage inclusion and allow individuals to do as much as possible for themselves. They also need to respect individuals who do not want to be included in group activities and mealtimes. Some individuals may prefer to eat in privacy, by respecting their rights, choices and preferences. Some individuals may need more support than other, for instance if playing bingo they may not be able to mark the numbers off or see the card properly. Supporting these individuals is important for their wellbeing and to enable them to participate. Ensuring staffing levels are adequate so that workers are able to encourage and assist active participation without causing undue stress to staff members or residents.

Each individual has the freedom of choice, this should be respected. An individual may not want to join in a certain activity but no others, for instance exercise or stimulation classes, All of these need to be specified in the care plan for each individual. By getting feedback and involving everyone in the decision process I can implement activities for everyone. Certain activities may need to involve numerous risk assessments to reduce risks but still allowing the individual to safely participate. Systems put in place will ensure all questions relating to each individual are clear and precise and cover all aspects of their needs, preferences and choices. No assumptions should be made and neither should anyone be forced to participate in anything they do not want to.

Reviewing daily activities is important as individuals may become bored and activities become stagnant, less stimulating over time and frequency. When individuals participate a log should be made of how they participated and what level of participation was involved, these go into the care plans and activity log sheets. A quiz for instance may be easier for some but hard for others, by ensuring all levels are catered for by dividing classes or varying quiz questions for different groups. Reviews are made weekly when activities are organised for the week ahead, circumstances may arise that require a daily review. If new individuals become home members or the dynamics change.

Positive group livings are established by ensuring individuals are supported to remain independent, given choices. By ensuring staff remain happy and supported in supporting individuals. Listening to individual’s preferences, choices and needs and maintaining a calm, warm and welcoming environment. The decoration, cleanliness and staff all play a huge part in ensuring a positive atmosphere/establishment.

Group living can promote positive outcomes for individuals due to the fact they are with other likeminded individuals, socialising each day, stimulating and building new relationships. They can be monitored more closely compared to living alone in the community. Friends and groups encourage each other and they have access to constant support. By living in an environment that is focuses on quality care whilst encouraging individuals to remain independent.

Through group activities individuals are less likely to see a goal as a hurdle, it is more enjoyable as a group and tends to forget they are actually working towards a goal or find it easier as a group, having support encouragement from others. If an individual has mental health issues and tends to become depressed and withdrawn, we are able to work towards a positive outcome within a group living environment by supporting them to socialise, less likely to become withdrawn, there is more support available for them. If an individual tends to have frequent falls due to the fact they neglect to use a walking aid, through group living the risk could be reduced by the constant reminder/prompting to use a walking aid and monitoring of their wellbeing and current health conditions. Group living can have a positive impact on individuals if the right conditions and support is readily available.

Each individual is encouraged and supported to maintain relationships by activities, group talks and staff members interacting with them. When individuals build relationships this is maintained by seating and setting but not to the point that it disinclines others or creates a divide. Creating divides creates problems, therefore this should be discouraged. Creating an open warm caring environment starts with the staff and generally flows towards residents, encouraging individuals to accept and understand other individuals they live with. Having days out, meetings and group talks and activities encourages individuals to build relationships and maintain them, by dealing with problems and issues as and when they arise, fairly and openly.

When conflicts arise they should be dealt with fairly and non-judgemental. Looking at each individual’s aspect of how they view and how they feel, by encouraging resolve and not allowing conflict to cause divides or non resolutions must be adapted. A conflict arose where 2 individuals who had previously been very close friends argued when it came to mealtimes; one was unable to sit by the window due to her dislike of watching people walk past whilst she ate her meal. The other loved sitting by the window, neither of them had explained to each other their reasons. By getting both of them together after speaking to each individual first we were able to come to a resolve and they were more understanding of each other’s needs and choices. By seeing this they both sat where they wanted and built further relationships with other residents.

It is important to have working schedules and patterns in group living so that individuals have continuity of care. Assigning workers to groups of individuals and ensuring staffs are not over worked is also imperative to not only their wellbeing but the wellbeing of the residents. There are times when schedules will affect residents such as mealtimes, activity times and times when staffs need to attend team meetings. Fill care plans in and ensure the home is running smoothly. It is at these times that I need to ensure staffing levels are adequate and residents are still tended to. By having a good rota structure, staff that is reliable and choosing the best times that suit not only staff but also the residents. You cannot make individuals go to the toilet at the same time or have meals at set times. Baths and other necessities that individuals need, this would be institutional abuse, therefore maintaining good staff levels and been prepared for unforeseen circumstances are so important, this will contribute to the smooth running of the home and environment.

Changes to schedules are made when staff members who possibly do better at certain times of the working day to others. For instance one staff member whose shift patterns are late but they appear to be able to encourage individuals to participate in activities or certain activities. Then they would be moved. By knowing my staffs strengths and weaknesses I am best able to place them in shifts that are organised around activities, days out or other requirements. Another instance is a certain individual may become accustomed to a certain staff member and prefer them to bath her/him.

All of these things need to be taken into account when rota’s/schedules are being prepared. Meal times, activity times and such alike will need more staffing. Evening and bedtimes also require staffing levels to be adequate. If schedules/rota’s are looked at properly and ensuring there is sufficient levels for unforeseen circumstances/having a contingency plan in place helps and if good communication is made with staff then these can easily be resolved.

Ensuring staff have a good development plan and supporting staff in training and knowledge is so important. This ensures staffs do not become stagnant in progression/ knowledge. In house training is beneficial so that staff can address current issues with current residents. However sending staff on training courses will also be just as beneficial, but training is a requirement that needs to be maintained. Staff have to be trained in the right areas:

NVQs, Moving and handling, POVA, Medication, Health and safety, First Aid amongst others. By supporting staff in training and ensuring there is room for progression within the workforce staff retention and further progression will have a knock on effect for residents, ensuring the best care practises that are up to date.

Whilst it is good for care staff to build a relationship with residents it is important they maintain professional boundaries. I support them in doing this by maintain professionalism at all times, I ensure I deal with any concerns appropriately and if needed involve family members of the individual.

By explaining to individuals the reason we are supporting them and why relationships need to remain professional between workers and residents is for their best interests so that both staff and residents are able to make the best decisions without emotional attachments. Obviously there will always be a level of attachment but by maintaining a professional one, individuals are less likely to ask staff for things or to help with needs that are not within their remit or put either party at risk of say abuse, neglect Etc.

The last thing anyone wants is a worker or staff member to get attached to the level where either party feels obliged to do something and then keep secrets. This puts both parties at risk and does not give a good example to others. By setting our clear professional boundaries to staff and toward residents helps maintain clarity, I give examples of why it is important to maintain these and the risks should these not be maintained. Supervisions and appraisals all go towards this process and these are regularly maintained for the benefit of staff and business.

Residential care is not a cheap option. Because it caters for those with complex disabilities, a high degree of dependency needs for intensive staff support and supervision, or for high levels of professional skill and expertise. It must be properly resourced to be safe and effective; this is not to say that residential care may not be the most economical way of providing proper support for some groups of people with extensive or complex needs. But care on the cheap will generally be bad care, and will often do more harm than good. Residential care requires adequate funding, and a clear framework of quality controls and quality assurance to ensure high standards of service and practice. I have a responsibility to see that the residential service is well-managed and staff at all levels properly equipped through training and development programmes for the task they have to do.

A framework of external regulation, registration and independent inspection is essential, including the General Social Care Council, if the public is to have confidence in the standards of care, conduct and practice competence provided. Providing a positive group living environment starts with the management of the home and maintaining this environment, staff training and interaction. By ensuring and training staff to encourage choice, preferences and encourage the residents to remain as independent as possible, ensuring adequate monitoring of staff, supervisions and appraisals remind staff to adhere to care practises.

A short summary of what you have written or the conclusions you have come to: I have come to the conclusion it is imperative for the individuals whom live in residential care to remain as independent as possible. That they are involved in the decision process of their care, daily activities and the home environment.

The boxes will expand to fit as much as you want to type in them. When you have finished first go back and proof read what you have done, checking for spelling, punctuation and grammar errors. Then read it through with the criteria next to you and show, by putting the criteria number in the end column, where you have covered the criteria.