D.A.D. Toolkit

Meeting the communication needs people with a sensory impairment: a toolkit for CSCI Inspectors and managers and staff of care homes.

Introduction
Information for CSCI Inspectors
Communication
Equipment for Homes Managers and Staff
Access to Communication Support for Darlington, County Durham and Tees Valley
Contacts

Introduction

The Commission for Social Care Inspection ( CSCI) works on a local and national level. One of its roles is to register, inspect, assess and review all care services in each local council area. This includes private and voluntary care services and local council social services departments.

In November CSCI published the first draft of Inspecting for Better Lives , which sets out its ideas to modernise the way that social care services are regulated. Key to the review of the regulation services is the commitment from CSCI to consult and involve service users and carers, not just in the period of change, but at a wider level as part of the inspection process.

In July 2005 CSCI commissioned a piece of work - the Service User Involvement Project - using the skills and experiences of nine user-led organisations (one per CSCI region) to try out different ways of engaging service users locally in inspection activities. The aim was to give CSCI a range of mechanisms with which to seek the views of people who use social care services. Darlington Association on Disability (DAD) was approached to work with service users with a sensory impairment in the North East area.

DAD is a local voluntary organisation, led by disabled people. The organisation exists to promote independence and choice. It has been in Darlington for nearly 20 years, and has over 30 staff working on four sites. DAD has nine projects that provide support and services for disabled people, ranging from information, advice and direct services such as Shopmobility, to consultation and involvement.

Over a period of four months DAD worked with CSCI inspectors and managers and with deaf people and people with visual impairments to look at ways of improving communication between inspectors and service users in homes across the region.

By the end of this period DAD had:

Asked people with sensory impairments what difficulties they think people may have when living in residential and nursing homes.
Delivered Disability Equality Training to local Inspectors.
Organised 10 joint Inspection visits to residential/nursing homes where the Inspector was accompanied by someone with a sensory impairment.
Worked on removing some of the communication barriers that prevent inspectors from seeking the views of people with sensory impairments.
Developed an on-line Toolkit for Inspectors and Residential/Nursing Homes managers to use, which outlined ways of removing barriers to effective communication.

The Service User Involvement project is being evaluated by researchers from the University of Brighton. A copy of the full report, including recommendations for future planning is available from CSCI.

DAD is very grateful for the valuable work done by its User Involvement Project Visitors, who accompanied Inspectors on visits, and for the wider contribution made by the User Involvement Group, Stockton Blind People's Voice and officers from Darlington Borough Council's Physical and Sensory Impairment Team.

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Information for CSCI Inspectors

This section looks at guidelines for Inspectors before and during inspection visits.

Before visits

If possible find out

Is there is anyone at the Home with a hearing or visual impairment?
Do they have any communication support needs?
Are they likely to need a lip speaker, BSL signer, interpreter or other communicator?
Are they likely to want to access the comments cards in a different way?

Arrangements need to be put in place to ensure that communication support needs are met before the visit takes place. It is not appropriate to assume that a relative will be able to interpret on behalf of the service user. The service user may want to share information in confidence. The relative may put a ‘spin’ on information provided. Equally the relative should be able to feed in their own views independently without being asked to play a dual role.

For local Communication Support Services see the list of Contacts at the end of this section.

The manager of the home should provide guidance on when it may be better to interview someone in a quiet place to reduce background noise.

The standard Comments Card is not accessible to many people with visual impairments; large print versions may be more useful. See below for guidance on font sizes. The Inspector and Homes Manager may need to decide between them if independent assistance would be useful to an individual to complete a Comments Card.

During visits

It is important from the outset to be aware of people's impairments. A home for older people is likely to have quite a high proportion of residents with hearing or sight loss. Some residents will also be experiencing dual loss - that is loss of sight and hearing.

Capacity should be built into visits to give adequate time for seeking comments from service users with sensory impairments.

It may be more appropriate to hold conversations away from the main flow of people. There may be instances where it is useful to ask a member of staff to support communication; Inspectors should be aware however that this may not encourage the service user to be as open as they might be otherwise.

The following are indicators that the home has begun to address the needs of its residents who have sensory impairments:

Notes, forming part of the care plan, which describe the impact of the persons impairment. Information that a resident is “hard of hearing” or “partially sighted” is inadequate unless supplemented with details about how this effects their quality of life within the home, and indicates what can and is being done to support the resident.
Staff training and awareness raising at induction and ongoing in relation to sensory impairments and independence.
Clear, uncluttered corridors and rooms.
Colour contrasting on walls, floors, tables and table settings etc.
Good clear signs.
Chairs available in places to maximise vision for someone with a visual impairment.
Quiet areas, where someone with a hearing impairment can talk or watch television without background noise.
Access to a radio, ceefax, teletext, subtitles and/or audio description via digital television.
Equipment to assist with eating, bathing etc (see equipment).
Activities which can be adapted to someone with a sensory impairment.
General adaptations to the building such as flashing alarms, vibrating door bell, telephone amplifier/minicom, loop systems in communal areas, large digit clocks, large font size and/or colour contrast on signs.

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Communication

Communicating with people with a visual impairment

A visual impairment is generally defined as an eyesight problem that cannot be corrected by wearing glasses or contact lenses or by surgery .

Verbal communication

The following guidelines produced in consultation with the CSCI User Involvement visitors and Stockton Blind People's Voice, support good and effective communication:

Never approach someone suddenly.
Introduce yourself and anyone with you explain the reason for your visit.
Ask the service user where they would like you both to sit whilst you talk. Service users with some residual vision may like you to sit in a particular seat in relation to the light source.
Be aware of confidentiality. The service user may not be aware of who else, for example staff, other residents, who might be in the room.
The service user may not be able to access written information. Ask if they would like the information in an alternative format, e.g. Braille, taped, large print.

Written information/Text

Clear, well presented and easy to read text makes it more accessible to all, not just people with a visual impairment. As a general guide use a clear unfussy font such as Arial with a font size of 14 (as, for example, this text). Where possible, avoid italics, indentations, bullet points that vary in style and underlining as these all "clutter" the text. Use left justification on text. Large print should ideally be produced in a font size to suit the recipient; font size 18 is a useful starting point.

Aids such as magnifiers and colour-contrast equipment can also improve access to the written word.

Braille

Braille is a reading and writing system used by some people with visual impairments. There are between 20,000 and 25,000 people who use Braille regularly, and many more who use Braille labelling on signs, lifts etc. The letters of the alphabet and the numbers are formed from different combinations of a set of six dots arranged in two vertical rows of three, like a domino. A visually impaired person can interpret these dots when moving a finger along a line of Braille.

Audio-tape

Audio-tape is a popular method of accessing information, used mostly for leisure. A Dictaphone can be used to enable someone to make notes or respond to a series of questions.

Computers

Computer technology and software packages can enable people with a visual impairment to access printed information. A range of settings are available on Windows based computers in the Control panels under 'Accessibility Options' which allows the user to choose settings of screen colour combinations and font sizes. These can be configured to suit an individual's preferences. Options include magnification of text, altering the image, brightness and definition of text.

Many people with visual impairments have access needs relating to navigating the screen and locating particular items or events. This can be supported, along with speech recognition and screen readers by accessing a range of specialised software such as supernova.

Communicating with people with a hearing impairment or who are Deaf

The following guidelines produced by the RNID support good and effective communication:

Even if someone is wearing a hearing aid it doesn't mean they can hear you. Ask if they need to lipread.
If you are using communication support always remember to talk directly to the person you are communicating with, not the interpreter.
It is important to make sure you have face-to-face or eye-to-eye contact with the person you are talking to.
Make sure you have the listener's attention before you start speaking.
Speak clearly but not too slowly, and don't exaggerate your lip movements.
Use natural facial expressions and gestures.
If you're talking to a deaf person and a hearing person, don't just focus on the hearing person.
Don't shout. It's uncomfortable for a hearing aid user and it looks aggressive.
If someone doesn't understand what you've said, don't keep repeating it. Try saying it in a different way instead.
Find a suitable place to talk, with good lighting and away from noise and distractions.
Check that the person you're talking to can follow you. Be patient and take the time to communicate properly.
Use plain language and don't waffle. Avoid jargon and unfamiliar abbreviations .

Lip reading

Most people lipread to some extent. Lip reading provides a way for people with hearing loss to maintain communication and receive information. Courses on lipreading are available throughout the country. Details are available from the RNID Communication page and following the links to Learn Direct. RNID have produced the following guidelines to make it easier for someone to lipread:

Find a suitable environment with good lighting, away from noise and distractions.
Sit or stand at the same level and three to six feet away from the lipreader.
Face the light, or your face will be in shadow.
Make sure the lipreader is looking at you before you speak.
Introduce the topic of conversation.
Speak clearly at a moderate pace, without raising your voice or over-emphasising your speech.
Use natural facial expressions, gestures and body language.
Keep your face visible. Do not put your hands near it or wear sunglasses, and do not turn away while you are talking.
Be prepared to repeat or rephrase something if the lipreader finds it difficult to follow you.
From time to time, check that the lipreader is following you.
Be patient and take time to communicate properly.

British Sign Language

British Sign Language (BSL) is the first or preferred language of around 250,000 Deaf people in the UK. Around 120,000 hearing people also use BSL. BSL is recognised as an official British language but it does not have any legal protection. This means that Deaf people do not have full access to information and services that hearing people take for granted, including education, health and employment. Deaf people feel strongly that they should and do have their own culture and community. For more information on Deaf culture and BSL visit the British Deaf Association website.

There are several colleges that provide courses in BSL. Most include deaf awareness as a precursor to taking level 1. It is important to remember that, like any other language, fluency takes time and a great deal of study. If asked for BSL interpretation CSCI Inspectors should commission interpreters with a level 4 signing qualification as a minimum.

Deaf blindness

The Department of Health defines people as deafblind "if their combined sight and hearing impairment cause difficulties with communication, access to information and mobility".

Deafblindness is also known as dual sensory impairment, dual sensory loss or multi-sensory impairment. Deafblind people may not be totally deaf and totally blind. The largest group of deafblind people develop hearing and vision loss as they get older. Deafblind people can access equipment and support to assist them to manage. There is also a deafblind manual alphabet, this involves finger spelling on the palm of the persons hand . Details on this are available on the Darlington Association on Disability website, follow the links to the report on Deaf and Hearing Impaired services or from RNID. For more information on deafblindness contact SENSE, Deafblind UK or RNID.

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Equipment for Homes Managers and Staff

Most residential and nursing homes provide a service to a wide group of residents and may only have a minority of residents with sensory impairments. During the User Involvement Project visitors were often asked about what was available to support the additional support needs for people living in residential and nursing homes. The following information provides an overview of what is available to support people with sensory impairments, and where to get further information.

Access to media

For information on Ceefax, teletext, subtitles, audio description, talking newspapers and books visit Darlington Association on Disability website and follow the links to the Information Guide section on Media.

For information on talking books and newspapers, Darlington and District Talking Newspaper Association provides a weekly audio tape (soon to be replaced by a CD) to anyone with a visual impairment or who would benefit from receiving news in an audio format.

For other local talking news services visit the Visual Impairment North East Services website and follow the links to your local town or area.

The National Library for the Blind (NLB) is a registered charity providing Braille, Moon and electronic books. It provides a free postal library service to blind and partially sighted people worldwide.

Aids for reading

For computer assisted technology contact Assisted Technology. For magnifiers and other equipment contact RNIB, Action for Blind People, your local Social Services Department or visit the Darlington Association on Disability website and follow the links to the Information Guide section on Equipment.

Aids for daily living

For non-slip mats for plates and trays, liquid level indicators, canes and other equipment for people with a visual impairment contact RNIB or Action for Blind People .

For equipment for people with a hearing impairment contact RNID Sound Advantage

For more information on where else to buy equipment visit the Darlington Association on Disability website and follow the links to the Information Guide section on Equipment.

Hearing aids

For spare batteries, hearing tests and other services contact the Audiology Department at your local hospital.

Glasses

For information on local opticians who have accessible premises and/or who offer home visits contact your local Primary Care Trust.

General

Visual Impairment North East produces a directory of educational, medical, social and other services available to people with a visual impairment in the North East region. Their website lists contacts for local social and education services, support groups and medical services.

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Access to Communication Support for Darlington, County Durham and Tees Valley

Communication Service

Tees Valley and Durham Communication Service provides qualified/trainee registered BSL/English Interpreters & Lipspeakers for appointments/meetings. Notetakers may also be available. Organisations can contract with the service.

British Sign Language Interpreters

Tees Valley and Durham Communication Services provide a range of BSL/English Interpreters, Lipspeakers and other communication services to all deaf and hearing people living in the Tees Valley and Durham area.

North East British Sign Language English Interpreters have a website which provides contact details for over 20 interpreters.
RNID Video Interpreting Service provides sign language interpreters via videophone for short notice and/or short term assignments.

Lipspeakers

Darlington Association on Disability has a list of lipspeakers available in the Darlington/County Durham and Tees Valley area.

Braille translation, large print and tape

Stockton Blind People's Voice can transcribe information in a variety of formats including Braille, large print, floppy disc and CD.Charges include an hourly rate for staff time, a minimum cost per document and a rate per sheet of Braille.

Darlington Council for Voluntary Service have a Braille embosser which provides a direct transcription from the written word to Braille. Please note that the service is not able to check for accuracy. There is a charge for this service.

Darlington Borough Council Social Services Department Physical and Sensory Impairment Team can provide a transcription service at their Vane House office. This includes editing and proof reading documents. The service can also transcribe from Braille into print. Charges include a fixed charge per item and a rate per sheet of Braille.

The Hartlepool Blind Welfare Association produces Braille, tape & large print materials. Charges are available on application.

Darlington and District Talking Newspaper Association may transcribe suitable written information onto tape or CD. There is a charge for this service.

Darlington Memorial Hospital also has a facility to Braille documents for in-patients.

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Contacts

Action for Blind People
14-16 Verney Road
London
SE16 3DZ
Telephone : 020 76354800
Information & Advice Service National Helpline : 0800 9154666
Fax : 020 7635 4900
Email : info@actionforblindpeople.org.uk
Website : www.afbp.org.uk
www.afbp.org/information/advice/guiding.asp

Action for Blind People - Darlington
Vane House
Vane Terrace
Darlington
DL3 7AU
Telephone : 01325 388131

Action for Blind People - Middlesbrough
Garland House,
144-146 Borough Road,
Middlesbrough TS1 2EF
Telephone: 01642 233439

British Deaf Association (BDA)
1-3 Worship Street
London
EC2A 2AB
Telephone : 020 7588 3520
Fax : 020 7588 3527
Minicom : 020 7588 3529
Videophone : 020 7496 9539
E-mail : helpline@bda.org.uk
E-mail BDA North : dosign@tiscali.co.uk
Website : www.britishdeafassociation.org.uk

British Deaf Association North
13 Wilson Patten Street
Warrington,
Cheshire, WA1 1PG
Textphone: 01925 652529
Telephone: 01925 652520
Fax: 01925 652526
Videophone IP: 81.6.233.219
Email: emmac@signcommunity.org.uk
Website : www.signcommunity.org.uk

Commission for Social Care Inspection
33 Greycoat Street
London
SW1P 2QF
Telephone : 020 7979 2000
Fax : 020 7979 2111
Website : www.csci.org.uk

Darlington and District Talking Newspapers Association
c/o North of England Newspapers
PO Box 14
Priestgate
Darlington
DL3 9NQ
Telephone : 01325 465101

Darlington Association on Disability
20-22 Horsemarket
Darlington
DL1 5PT
Telephone : 01325 489 999
Fax : 01325 488 188
Minicom : 01325 245 061
Email : mail@darlingtondisability.org
Website : www.darlingtondisability.org

Darlington Council for Voluntary Service
Church Row
Darlington
DL1 5QD
Telephone : 01325 266888
Fax : 01325 266899
E-mail : enquiries@darlingtoncvs.org.uk

Darlington Social Services
Access and Contact team
Central House
Gladstone Street
Darlington
DL3 6JX
Telephone : 01325 346200
Fax: 01325 346474
Minicom : 01325 360862

Darlington Social Services
Physical and Sensory Impairment Team
Visual Impairment Service
Vane House
Vane Terrace
Darlington
DL3 7AU
Telephone : 01325 388131
E-mail : janet.taylor@darlington.gov.uk

Darlington Primary Care Trust
Dr Piper House
King Street
Darlington
DL3 6JL
Telephone : 01325 364271
Fax : 01325 746112

Deafblind UK
National Centre for Deafblindness
John and Lucille van Geest Place
Cygnet Road
Hampton
Peterborough
PE7 8FD
Telephone : 01733 358100
Fax : 01733-358356
Minicom : 01733 358858
Website : www.deafblind.org.uk

The Hartlepool Blind Welfare Association
Avenue Road
Hartlepool
S24 8BB
Telephone : 01429 272494

Inclusive Technology Ltd
Gatehead Business Park
Delph New Road
Delph
Oldham
OL3 5BX
Telephone : 0 1457 819790
Fax : 01457 819799
E-mail : inclusive@inclusive.co.uk
Website : www.inclusive.co.uk

National Library for Blind People
Far Cromwell Road
Bredbury
Stockport
SK6 2SG
Telephone : Customer Services 0161 406 2525
Other enquiries : 0161 355 2000
Fax : 0161 355 2098
E-mail : Customer Services reader.advice@nlbuk.org
E-mail : General Enquiries enquiries@nlbuk.org
Website : www.nlb-online.org

North East British Sign Language/English Interpreters
E-mail : first@language.freeserve.co.uk
Website : www.northeast-bslenglish-interpreters.co.uk

Royal National Institute of the Blind (RNIB)
105 Judd Street
London
WC1H 9NE
Telephone: 02073 881266
Helpline: 0845 7669999
Fax: 02073 882034
Minicom :
E-mail : helpline@rnib.org.uk
Website: www.rnib.org.uk

Royal National Institute for Deaf People (RNID)
19-23 Featherstone Street
London
EC1Y 8SL
Telephone : 02072 968000
Helpline : 0808 8080123
Fax : 02072 968199
Minicom: 02072 968001
E-mail : information@rnid.org.uk
Website : www.rnid.org.uk

RNID Sound Advantage,
1 Metro Centre,
Welbeck Way,
Peterborough
PE2 7UH.
Telephone : 01733 232607
Fax : 01733 361161
Minicom : 01733 282020
E-mail: solutions@rnid.org.uk
Website : www.rnidshop.com

RNID Video Interpreting Service
Telephone : 08707657 446
Fax : 020 72968069
Minicom : 0870 7657446
E-mail : vis@rnid.org.uk

Sense North
Rodney Clark Resource Centre
Leeds Road
Robin Hood
Wakefield
WF3 3BG
Telephone : 0113 2059500
Text : 0113 2059502
Fax : 0113 2059502
E-mail : northenquiries@sense.org.uk
Website : www.sense.org.uk

Stockton Blind People's Voice
27 Yarm Road
Stockton on Tees
TS18 3NJ
Telephone : 01642 803590
Fax : 01642 803591
E-mail : Christine.durnion@blindvoice.co.uk

Tees Valley and Durham Communication Service
Central House
Gladstone Street
Darlington
DL3 6JX
Telephone : 01325 346731 (Voice)
Textphone : 01325 468504
Fax : 01325 346457
SMS : 07903 926564
E-mail : tvdcs@darlington.gov.uk

Visual Impairment North East
52 Linskill Terrace
North Shields
Tyne & Wear
NE30 2EW
E-mail : directory@vine-simspecs.org.uk
Website : www.vine-simspecs.org.uk/directory.htm

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