Deloitte. Cent?b Sunrise Adult Training Centre Needs Assessment FINAL REPORT CONFIDENTIAL June 24, 2010 Table of Contents 1. Executive Summary 3 1. Introduction - Background, Scope and Objectives 3 2. Methodology 3 3. Findings Local Research 3 4. Best Practices 4 5. Recommendations 5 6. Next Steps 6 2. Introduction 7 2.1 Project Background 7 2.2 Project Objective and Scope 8 3. Methodology 9 3.1 Kick- Off Meeting 9 3.2 Data Sources 9 4. Findings ?Loca Research 13 4.1 Current State Analysis Facilities Equipment 13 4.2 Current State Analysis - Programs 17 4.3 Current State Analysis Specialists and Therapists 20 5. Best Practices 26 5.1 Definition 26 5.2 International Benchmarks of Adult Training Centres for Persons with Disabilities 26 5.3 Summary 32 6. Recommendations 33 6.1 Overview 33 6.2 Options Generation 33 6.3 Identifying Other Needs 37 6.4 Demand Forecast 40 7. Next Steps 44 8. Appendices 45 Appendix 1: Ongwanda - Facilities, Programs Specialists 45 Appendix 1: Ongwanada Facilities, Programs Specialists 46 Appendix 2: international Benchmarking Data Sources 50 Appendix 3: ASDAN Project Plan for Sunrise 53 Progression routes within ASDAN for Clients with Special Needs 56 Appendix - Towards independence Overview 57 2010 Deloitte. All Rights Reserved 2 1. Executive Summary 1. Introduction - Background, Scope and Objectives The Ministry of Education. Training and Employment ("the Ministry") engaged Deloitte to conduct an assessment of the needs of adults with disabilities in the Cayman Islands as a prerequisite to developing a facility design model and soliciting expressions of interest for the development of a new facility that would provide the requisite services and support to clients focusing on personal development through individual assessment, progress reporting, and towards independent living. The focus of the study was on the facilities, programs and specialists provided at the Sunrise Adult Training Centre ("Sunrise"). 2. Methodology 2.1 Kick-Off Meeting A Project Kick-Off Meeting was held on March 17, 2010 with members of the Ministry and Deloitte?s Consulting Team. At this meeting the project objectives, data gathering approach and confirmed project times were discussed. 2.2 Data Gathering Data was gathered through a variety of sources and processes. Deloitte conducted face-to-face interviews with a number of key stakeholders both internally and externally, and also held focus groups and used on-line surveys for data gathering purposes. Secondary data sources included a number of published reports which were supplied to us by the project steering committee from the Ministry. 3. Findings - Local Research 3.1 Current State Findings - Facilities Our review of the current Sunrise facilities revealed the following: 0 Location not ideal; . Shortage of space; 0 Craft Room I Program - not well utilized; 2010 Deloitte. All Rights Reserved 3 Number of restrooms is insufficient; Layout of the facility can be deemed a safety hazard; No dedicated area for recreational activities; Transportation all buses are not fully equipped; Occupational therapy room equipment inadequate; Life skills rooms inadequate equipment and space; Computer room insufficient adaptive equipment; hazard due to overcrowding; Employee facilities insufficient; and, Lack of covered parking or garage area. Our review of programs at Sunrise also revealed the following findings: ASDAN Curriculum not fully implemented; No formal structure to classes and training sessions; No measurable development plans; Limited creative programs at the centre; Limited outdoor activities; and, Insufficient access to occupational therapy rooms. Our review of specialists and therapists at Sunrise revealed the following findings: Staffing numbers inadequate as no backup support provided in periods of staff absence; Training - majority of staff do not have formal training in the areas in which they provide support; Role Definition staff uncertain of the role they are required to perform in providing support to persons with a wide range of disabilities; and, Specialist Roles staff not sufficiently trained to assist the clients in instances of seizures etc., therefore dedicated specialists are required on staff. Best Practices Definition: 2010 Deloitte. All Rights Reserved 4 ?a technique or methodology that, through experience and research, has proven to reliably lead to a desired result?; ?the winning strategies, approaches, and processes that produce superior performance in an organization. A best practice is the by-product of a successful end-result?e; and, "the methods and achievements of the recognized Ieader(s) in a particular field?. The following facilities were used as standards of excellence in our benchmarking exercise and were chosen based on their applicability to the needs of persons with disabilities in the Cayman Islands: 0 Lambs Farm, located in Libertyville, Illinois, USA . Ongawanada, located Kingston and Eastern Ontario, Canada 5. Recommendations Based on our research, Deloitte has provided two potential options for the Ministry based on the current and future requirements of an adult training centre for persons with disabilities in the Cayman Islands. 0ption1: Village Living Approach The village living option allows the clients the ability to interact with various support centres located throughout the Cayman Islands in order to participate in a varied number of services and programs offered by the various support centres and coordinated through a main central facility. The aim of the village option is to allow clients and caretakers the flexibility of gaining access to various facilities and programs, in some cases alleviating the concerns of distance travelling for clients to one central facility as support centres will be located throughout various districts in the Cayman Islands, and also allowing access to a wider range of service providers in the support areas they may require. 0ption2: Campus Living Approach The campus living option allows the client the ability to live, work and interact with other clients within one main dedicated area such as a campus setting. A central administration and coordination centre will conduct initial assessments, coordinate programs, and track the clients' progress through reporting provided by the various service centres located throughout the campus facility. b.htm , accessed 2005-10-10, Tribal Justice Information Sharing System 2 accessed 2005-10-10, 390.1 Glossary Terms and De?nitions from the Portfolio Management Framework. 3 accessed 2005-10-10, 2010 Deloitte. All Rights Reserved 5 6. Next Steps in identifying the needs of persons with disabilities in the Cayman Islands as a precursor to developing a facility design model and soliciting expressions of interest for the development of a new centre, the next steps required to move towards the implementation of a chosen option is as follows: 1. Project steering committee to review the final report and identify the option that best supports the needs of persons with disabilities in the Cayman islands and supports the Ministry's requirements. 2. Consideration of Option 1 will include the following: a. Review of the current services required by the proposed adult training centre and currently being offered in Grand Cayman; b. Research potential locations for development based on Government land and/or buildings available in Grand Cayman; and, 0. Identify proposed budget available for implementation of chosen option. 3. Consideration of Option 2 will include the following: a. Research potential locations for development based on Government land and/or buildings available in Grand Cayman; and. b. Identify proposed budget available for implementation of chosen option. 4. Creation of Design Brief outlining requirements to be presented to potential investors/developers. The Chief Officer to discuss development of brief with Deloitte project partner. 2010 Deloitte. All Rights Reserved 5 2. 2.1 Introduction Project Background The Ministry of Education, Training and Employment (?the Ministry?) engaged Deloitte to conduct an assessment of the needs of adults with disabilities in the Cayman Islands as a prerequisite to developing a facility design model and soliciting expressions of interest for the development of a new facility that would provide the requisite services and support to clients focusing on personal development through individual assessment, progress reporting. and towards independent living. The approach adopted by Deloitte incorporated a combination of both secondary and primary research methods. Our research methods focused on the following: Reviewing the operational management of existing local facilities and programs offered through focus group discussions and interviews with key stakeholders; Benchmarking international facilities and programs providing similar services; and, Consultation with various stakeholders including faculty of the Lighthouse School and Sunrise, parents and other relevant stakeholders. Our data collection efforts encompassed a combination of interviews, focus group meetings as well as short-form surveys. In addition to the Ministry, the key stakeholders consulted included: Faculty of the Lighthouse School and Sunrise; Current employees of Sunrise; Parents of disabled children and adults; Non-Governmental Organizations (NGO) and government agencies that provide support and programs for these facilities The Disabilities Committee); and, Other stakeholders that were identified in the project planning step. Taking into consideration the needs of these and various other stakeholder groups, we were required to present the Ministry with two options for development that will meet the needs of adults with disabilities in the Cayman islands. 2010 Deloitte. All Rights Reserved 2.2 Project Objective and Scope The needs assessment requested by the Ministry was to be conducted based on the perspective of current clients at Sunrise, parents of disabled children and adults, faculty of both Sunrise and the Lighthouse School, N605 and government agencies that provide support and programs for these and other stakeholders. The assessment focused on examining local existing facilities and programs offered; benchmarking of the current facility with other similar facilities and programs internationally; and consulting with various stakeholders including facuity of the Lighthouse School and Sunrise, parents, and other stakeholders. Our questions focused on the three main components of the operational management of the facility: 1. Facilities - assessed the condition of the facilities and the equipment avaiiable for use by the clients at Sunrise; 2. Programs - indicated the quality of the programs being offered to clients4 at Sunrise; and, 3. Therapists/SpecialistsIStaff - assessed whether the level of skills of the staff. and number of staff are currently providing adequate support to the clients of Sunrise. 4 Client refers to any persons attending and utilizing the services provided at Sunrise 2010 Deioitte. All Rights Reserved 3 3. Methodology Project Approach Project Situational Analysis Planning Assessment Action Plan Reporting . I ?A'lint: (371A.j'il: .1 m. 'l . 111'. l_ 't I he germ; :3 (i l_I ProjectManagementand Communication 3.1 Kick- Off Meeting A Project Kick-Off Meeting was held on March 17, 2010 with members of the Ministry and Deloitte's Consulting Team. During this meeting, the project objectives and deliverables were agreed upon, project assumptions and risks were discussed, and risk mitigation strategies were identified. The factors which were critical to the success of the project were discussed and agreed upon, and all project team members were required to sign Con?dentiality Agreements. 3.2 Data Sources A variety of sources were used to obtain information that would assist in identifying the current needs of persons with disabilities in the Cayman Islands. These sources are indicated as follows: 2010 Deloitte. All Rights Reserved 9 In order to identify the current needs of persons with disabilities in the Cayman Islands, Deloitte created two (2) online surveys targeted at parents of disabled children and adults attending the Sunrise Adult Training Centre or the Lighthouse School. The Deloitte team requested the assistance of the faculty from both the Lighthouse School and the Sunrise Adult Training Centre, to assist with encouraging the parents of individuals attending these facilities to complete the surveys. Parents of children attending the Lighthouse School were asked to complete the Deloitte survey by Mrs. Mac-Vicar, Principal of the Lighthouse School. The survey was launched on March 30, 2010 and two (2) responses were received. Deloitte administered this survey based on a request from the Director of Sunrise. In addition, another request was made to the parents of the fifty-seven (57) full time and part time adults attending Sunrise, by Mrs. Roberta Gordon, Director - Sunrise Aduit Training Centre, to complete a Deloitte survey addressing the needs of the current facility. The survey was launched on March 26, 2010 and thirteen (13) responses were received. The survey was designed based on four assessment areas that included the following: 1. General information on the survey participant; 2. Staffing level of skills and number of staff; 3. Facilities - condition of the facilities and equipment; and, 4. Programs quality of programs being offered at the facility. In addition to data gathered via the online surveys, Deloitte held one-on-one discussions with key stakeholders, and thus conducted interviews with staff currently employed at Sunrise. The interview questions were based on the four assessment areas addressed in the online surveys, including general information about the survey participant and three sections relating to the current state of Sunrise. The individuals interviewed by the Deloitte team were as follows: 0 Director of Sunrise Adult Training Centre - Roberta Gordon; 0 Deputy Director of the Sunrise Adult Training Centre - Bonnie Binns; 2010 Deloitte. All Rights Reserved 10 Principle of the Lighthouse School - Carla Bodden Mac-Vicar; 0 Chief Officer of the Ministry of Education. Training and Employment - Mary Rodrigues; and, a Minister of Education, Training and Employment - Minister Rolston Anglin. Once collected, the data from the interviews was analyzed by the Deloitte Team to assist in the needs assessment. 3.2.3 Current State Focus Groups Another data collection method involved conducting focus groups to gain an understanding of and identify: . Key trends in current needs from the perspective of clients, parents, and staff; . Key issues of the facility, equipment, programs, and staff; and, . Opportunities for the Ministry to improve the current state. Focus group volunteers were requested through an open invitation to all parents at the Sunrise Adult Training Centre and the Lighthouse School. Focus group discussions were held with clients selected by the Director of Sunrise and all staff members at the centre to gain an understanding of their needs. Focus groups were also held with external stakeholders recommended by the Sunrise Adult Training Center Needs Assessment Project Steering Committee. Deloitte facilitated seven focus groups; each ran for approximately one hour. The focus group discussions centred on communicating the purpose of the survey and objectives of the Ministry in conducting such an assessment. and providing stakeholders the opportunity to share their insights. These were held as follows: March 25, 2010 0 Sunrise Employees 0 Sunrise Clients 0 Sunrise Parents March 30, 2010 0 Sunrise Clients . Sunrise Client Caregivers 2010 Deloitte. All Rights Reserved 11 0 External Stakeholders March 31, 2010 0 External Stakeholders 3.2.4 International Benchmarking In addition to our primary data collection efforts. Detoitte obtained secondary data through international benchmarking of other facilities providing a training environment that addresses the needs of persons with disabilities. Through our series of interviews, focus groups, and surveys, various facilities were identified for use in our benchmarking process. The chosen facilities were used in an attempt to gain an understanding of simiiar international facilities and programs. regional benchmarks, and industry best practices. The benchmark facilities referenced in this report were chosen over other recommendations and other facilities researched as these two models fulfilled the requirements for a new facility based on Deloitte's review of the current state and needs of Persons with Disabilities requiring the services from an adult training centre. In addition they were chosen based on recommendations provided by the Director of Sunrise. As noted in our report, although these facilities are much larger in terms of the number of clients they can accommodate. the services and programs provided can be taiiored to an appropriate structure for the Cayman Islands. The centres that were used for benchmarking purposes were as follows: 0 Ongwanada located in Kingston and Eastern Ontario, Canada . Lamb?s Farm - located in Libertyville, Illinois, USA (Please see Appendix A for a complete list of data sources consulted.) 325 Secondary Research Repon?s - Report of the Legai Sub-Committee for Persons with Disabilities, 17 February, 2009; The Office of the Complaints Commissioner Own Motion Investigation of Sunrise Adult Training Centre, June 30, 2008; . Deveiopmental Services for Persons with Disabilities Report by Brent Holt April 2008; and, . Report Recommendations for upgrading Sunrise Beverly Beckles, September 1999. 2010 Deioitte. All Rights Reserved 12 4. Findings - Local Research 4.1 Current State Analysis - Facilities Equipment The section below details key themes and findings regarding the current state of the facilities and equipment at Sunrise. 4.1.1 Location Sunrise is currently located on Powery Road in West Bay. The driving distance is approximately 20 - 30 minutes from George Town and this distance decreases the opportunity to take clients into town where they are able to interact with other people and develop socialization skills, an essential part of life skills training and interpersonal skills development are dependent upon having the opportunity to participate in these types of activities. Moreover, transporting clients to medical appointments or work in George Town is time intensive, and the location also limits specialists and therapists, with offices in George Town, time with clients. Additionally, Sunrise is not within close proximity to a full service emergency facility and is also located in an area that is isolated and historically has reported incidences of criminal activity. 4.1.2 Shortage of space Sunrise is a residential unit/single family house which has been converted in an attempt to meet the needs of persons with disabilities. Although renovations have been made to the facility to better serve and support persons with disabilities, there are limitations to the changes that can be made to this type of residential structure. The renovation limitations are due to the fact that building is rented and because it was not built with the intention of being used as a training centre for persons with disabilities. There are space limitations due to rooms that are small and hallways/doorways which are not adequate for people with disabilities requiring extra space to navigate the facility. For example, clients using wheel chairs and walkers have difficulty moving along the hallways and through the doonlvays. The small rooms limit the number of clients who can participate in specific programs. For example, only three persons can use the computer room concurrently and approximately four persons are able to use the life skills room per session. 2010 Deloitte. All Rights Reserved 13 4.1.3 Optimal capacity for current facility The table below depicts our observation of the current facility sections and its optimal capacity of clients. Craft room storage area 3 - 4 clients 3 0 Currently used as storage area Common areas TV room lunch 0 TV room 8-10 room . Lunch room 22 Computer room 3 - 4 clients 4 Life skills room 0 3 clients Occupational therapy room 0 2 clients (large room but due to 2 lack of equipment unable to accommodate more) . 4-5 clients 5 OPTIMAL TOTAL 22 4.1.4 Craft room (storage area) The current facility does not have sufficient storage space. Currently the craft room could accommodate three clients at a time but is being used for storage of food and supplies as the arts/craft program has been discontinued, according to the Director of Sunrise Adult Training Centre. Additionally, there are no lockers or personal storage areas for clients to keep handbags, personal valuables or learning equipment. 4.1.5 Number of restrooms is insufficient According to the Director of Sunrise, there are currently between thirty (30) and thirty five (35) clients who attend Sunrise each day and fourteen (14) employees at the facility. The facility was originally constructed as a private residence/singie family home and therefore the restroom facilities are not sufficient for the number of people that need to utilize them. There are currently four (4) restrooms, each with one (1) lavatory. One of these restrooms is for use by employees only and out of the remaining three (3) only one (1) is equipped for wheel chair access. Some of the clients use wheel chairs and require assistance with use of the restroom facilities which may take additional time, and results in a queue being formed by other clients outside the restrooms. 2010 Deloitte. All Rights Reserved 14 In comparison. Deloitte?s site visit to the Lighthouse School revealed that restrooms have been included in each program room with additional restrooms provided in general areas throughout the facility. 4.1.6 Layout of the facility is a safety hazard Sunrise consists of a number of small rooms and hallways and in the event of a fire, or a need to evacuate in an emergency, it would be dif?cult to evacuate quickly and efficiently due to the number of the clients who are not independently mobile. 4.1.7 No dedicated area for recreational activities Sunrise does not have an area specifically designated for recreational activities. The building is adjacent to the road and there is no designated area where outdoor activities can be regularly scheduled as part of the program and allow clients to participate in these daily activities. 4.1.8 Transportation buses are not fully equipped The current buses, which are used daily, are not all fully equipped with seatbelts. or for the transportation of people with disabilities. 4.1.9 Occupational Therapy room The Occupational Therapist operates out of the converted garage with minimal equipment. At this time, with equipment restrictions, only two (2) clients can be accommodated at one time in this room. Section 6.3.1 includes a list of recommended equipment that is necessary for the rehabilitation and/ or development of clients. There are also no private therapy rooms and it is not uncommon for two (2) clients to be given physical therapy side-by?side (one by the OT aide). This factor also relates to the issue that there is only one (1) Occupational Therapist on staff and clients do not have sufficient occupational therapy sessions. 4.1.10 Life Skills room The Life Skills room is small in size and has limited equipment which inhibits the client?s vocational training opportunities. 2010 Deloitte. All Rights Reserved 15 4.1.1 1 Computer room The computer room seats three (3) clients and there is minimal adaptive equipment in the room. The three (3) computers are however, equipped with touch screens for ease of use. There is also a computer in the Occupational Therapy Room that is equipped with an adapted mouse and keyboard. 4.1.12 The at Sunrise is cramped and difficult for persons requiring extra space to move around. Although there are weights and cardiovascular equipment, there is insufficient space to move freely or work with exercise balls, balancing balls etc. and the current environment poses a potential hazard for clients. 4.1.13 Employee facilities Sunrise does not offer a designated area for employees and specialists/therapists. There is no staff lunchroom, no storage area for special belongings and no meeting facilities or conference room. 4.1.14 Lack of covered parking or garage area The garage is currently being used as an Occupational Therapy room, and the buses park outside on the road. It is difficult to transfer clients from the bus to the building when it is raining as some clients? disabilities do not allow them to disembark the bus quickly to enter Sunrise. 4.1.15 Survey results The graphs below are a representation of the survey responses to questions relating to facilities and equipment at Sunrise. Do you believe the Sunrise Centre has adequate space to serve the needs of the clients? 100% 1002010 Deloitte. All Rights Reserved 1'5 Do you believe that the equipment at centre comparable with international standardsThe following comments and suggestions were recorded for the questions above: ?Facility should be in a central location" guardian of client at Sunrise. "The centre is clean but not well maintained. Equipment gets broken and there is no-one to repair it. Personal items taken there for my child have disappeared. An $8,000 DynoVox which I bought for my child was taken there, never used and then is taken care of at Sunrise and it is disgusting to see it all go to ruin" parent of client at Sunrise. 4.2 Current State Analysis - Programs The section below details key themes and findings regarding the current state of the programs at Sunrise. 4.2.1 Curriculum Throughout the course of Deloitte?s research, many stakeholders raised the lack of the implementation of ASDAN5 as an issue. The ASDAN framework has been recommended by a number of key external stakeholders and a proposed plan for implementation at the Sunrise center was provided by Mr. Clive Baker - Head of Curriculum, however to date there is no formalized structure for the consistent implementation of the ASDAN program plan (see Appendix for ASDAN Implementation Plan for Sunrise). 5 ASDAN ?Awards Scheme Development and Accreditation Network provides opportunity for learners to achieve personal and social development through the achievement of ASDAN Awards and Quali?cations, enhancing self-esteem. aspirations and individual contribution to local. national and global communities - ASDAN is an outcomes-based learning framework that focuses on setting and achieving objectives for learning and development. 2010 Deloitte. All Rights Reserved 1? There is currently no fully implemented curriculum that incorporates planned objectives towards a iong term development strategy for each client. Our recommendation of a formal curriculum and learning plan is supported by the 'Developmental Services for Persons with Disabilities' report by Brent Holt dated April 2008. The report reads as follows: the SEN code of practice requires for students who are 14 years or older, that lEP's must contain "documentation of a transition plan which includes post-secondary goals related to education, training, employment or independent living skills?, including required in-school and interagency supports in order to meet those goals. This applies uniformity to students served in mainstreamed and special needs days schools. 4.2.2 No formal structure to classes and training sessions We were provided with a ?schedule" by Sunrise administration, which lists the client name and matches them to an employee for approximately thirty minute intervals but does not detail the developmental goals to be attained during these periods. The schedule does not detaii the activities of the class and the administration of Sunrise does not maintain records of the expected outcomes of the class. Although Sunrise is operated on the school semester schedule, no quantifiable training plans for each semester were identified. Sunrise caters to clients with a wide range of disabilities but there are no individual development plans for different clients. Each client has a varying level of ability based on both their capabilities and disabilities but individual goals, training plans and curricula are not created. Consequently clients are not able to reach their full potential as they do not have a personal development plan geared towards their personal capabilities and training aspirations. 4.2.4 Lack of creative programs at the centre There is a lack of structured creative programs at Sunrise. There is no formal art program, even though client and parent focus groups indicated that this was a very beneficial and enjoyable program for clients. 2010 Deloitte. All Rights Reserved 18 In the past, Sunrise facilitated a craft program which allowed the clients to produce arts and crafts, and these were sold at the local craft market. However, it has been reported by the Director of Sunrise that the program has since been downsized. 4.2.5 Lack of outdoor activities Due to the limitations of the facility, not many outdoor activities are offered. Programs that include sports and physical activities would be bene?cial to the clients. However, it has been reported by the Director of Sunrise that clients do participate in basketball, aerobics and walking activities. 4.2.6 Insufficient access to Occupational Therapy programs As there is only one (1) Occupational Therapist on staff, clients do not have adequate occupational therapy sessions. According to the Director of Sunrise, one (1) client pays for private Occupational Therapy sessions, but most cannot afford this. 4.2.7 Survey results The graphs below are a representation of the survey responses to questions relating to programs at Sunrise. Do you believe that the Sunrise Centre has the right mix and number of programs 67respondents Yes No 2010 Deloitte. All Rights Reserved 19 What is your Level of satisfaction with types of programs offered at Sunrise30,Extremely Dissatisfied Satisfied Extremely Dissatisfied Satisfied Satisfaction Levels 4.3 Current State Analysis Specialists and Therapists The section below details key themes and findings regarding the current state for 'Specialists' at Sunrise. 4.3 1 Staffing There are currently fourteen (14) individuals on staff to provide direct support to the fifty-seven (57) full- time and part-time clients of Sunrise. The number of staff indicated has shown to be insufficient in providing support services to the clients in particular during periods when staff members are out sick. Clients are unable to receive their planned programs in these instances and are either assimilated into other programs activities, music playing, computer training) thus creating much larger groups where staff are unable to provide individual support attention, or clients are gathered into a common area to watch television and are again unable to participate in planned developmental programs. The currently filled staffing positions providing support to the ciients at Sunrise are as follows: Occupational Therapist (1) Assistant Occupational Therapist (1 Special Support Aide I Bus Warden (2) Adaptive Living Specialist (3) Assistant Adaptive Living Specialist (1) Adult Protective Service Worker - Vocational placement (1) 2010 Deloitte. All Rights Reserved 20 Assistant Adult Protective Service Worker 1) Bus Driver (2) Bus Warden I Cleaner (1) Receptionist (1) 4.3.2 Training There are currently only three (3) staff members with collegiate level education at Sunrise, and other staff members have been hired without the requisite knowledge, skills, and certi?cations required to adequately assist persons with disabilities. There are currently no formal training programs in place to acquaint staff with the correct methods required in providing support and care to the clients at Sunrise, and as a result no refresher training on new international methods available to provide care to persons with disabilities. One of the examples cited during the interviews and focus groups indicated that bus drivers need to be properly trained on the correct methods for assisting clients with mobility needs in and out of the buses. The current staffing qualifications for the related specialist areas that are available to support clients at Sunrise are as follows: Testing B.A. Special Ed. Life Skills Child Care Nursing High School Life Skills, Computer, Swimming High School [Working on GED Adaptive Equipment Occupational Therapy Vocational Placement B.A. Counselling Transportation Occupational Therapy High School Physical Education High School Vocational Placement Associate Degree Social Studies, Counselling Certification 2010 Deloitte. All Rights Reserved 21 4.3.3 Role definition in addition to the lack of training and requisite skills for staff there is also a lack of clear definition of the various support roles they are required to perform. Reponses to our interviews indicated that job descriptions are avaiiabie for the various roles, however feedback obtained from the staff at focus groups indicated that they are quite uncertain about the level and type of support they are required to provide to clients due to their varying levels of needs. in reviewing the list of disabilities being serviced at Sunrise, it has been noted that there are currently twenty five (25) clients requiring speech therapy, and twenty one (21) clients requiring physical therapy with the occupational therapist. Currently there is one (1) occupational therapist on staff with an assistant, to provide physical therapy to the twenty one (21) clients requiring support. As these clients may require daily therapy, the number of specialist roles is currently inadequate to support the needs of this group. in addition, there is currently no speech therapist on staff, however a visiting speech therapist visits Sunrise a few hours per week. Due to the varying disabilities of the clients and their use of medications on a daily basis to support their disabilities. there is a need to have a qualified nurse or medical practitioner on staff as feedback from the staff focus groups indicated that in the past they have experienced clients fainting and having seizures and staff do not feel that they have been provided with adequate training to provide the type of assistance the clients may require in these instances. Additionaily, the Director, Deputy Director and Adult Protective Service Worker (Vocational Placement) at Sunrise currently spends time on the phone corresponding with counsellors with the clients in the event of personal issues that trigger emotionai events. According to numerous stakeholders, there is currently a need for a dedicated counsellor on staff to support the emotional needs of the clients. The graphs beiow are a representation of the survey responses to questions relating to specialists and therapists provided at Sunrise. (9 2010 Detoitte. Ail Rights Reserved 22 Do you beliveve that the Sunrise Centre has the right combination of therapists? 90% 100you belive that the Sunrise Centre has a sufficient number of therapists on staff? 83% 100The following comments and suggestions were recorded for the questions above: "Absolutely not ?There are far too many clients for only one PT to deal with. Aides are filling in for therapists and this is unacceptable. Suppose they injure my child because they don't really know what they are doing. Fair warning it better never happen or there will be a lawsuit" parent of client at Sunrise. "They are not certified by local standards no improvements to clients" guardian of client at Sunrise. "All teachers should be qualified special education teachers. All therapists should be properly qualified therapists with degrees and 3 years experience working with disabled people. Administrators should handle staff instead of staff handling them. As it is now Sunrise is nothing more than a daycare centre for my child. The outings are good, but the clients should be learning SOME-THING during their days at the centre. Where is the music, arts, life skills and computer classes that they claim they teach? I never see any evidence of this? parent of client at Sunrise. 2010 Deloitte. All Rights Reserved 23 are not adequately trained. they need to be more patient and stop putting clients to watch TV. Much empathy is needed" parent of client at Sunrise. 4.3.6 Focus Group Themes and Survey Responses The responses obtained from both the focus group facilitations and the survey administration showed correlated themes between the staffing, facilities and programs as follows: Staffing: Common themes - Therapists I Specialists Survey resuits: . Of the responses received from parents of clients of Sunrise, eleven (11) or 92% indicated that Sunrise does not have the right combination of therapists specialists to adequately serve the needs of the clients. . Of the responses received from parents of clients of Sunrise, twelve (12) or 86% indicated that Sunrise does not have sufficient number of therapists on staff to adequately serve the needs of the clients. Focus Group feedback: . Client focus group Insufficient staff/teachers (would prefer one-on-one training) 0 Parent focus group Need additional specialists with training, and need speech therapist stationed at Sunrise. Facilities: Common themes - Space Equipment Survey results: . Of the responses received from parents of clients of Sunrise. thirteen (13) or 100% indicated that Sunrise does not have adequate space to serve the needs of its clients, both now and in the future. . Of the responses received from parents of clients of Sunrise, ten (10) or indicated that Sunrise does not have equipment that is comparable with international standards. (E) 2010 Deloitte. All Rights Reserved 24 Focus Group feedback: 0 Employee focus group - Current facility is overcrowded and rooms are too small, hallways are too narrow (clients have difficulty moving around especially those using wheelchairs). Computer room needs space with more special needs speci?c equipment. 0 Parent focus group Layout of the facility is not ideal to allow clients to move around easily. Programs: Common themes Types Number I Volume Survey results: 0 Of the responses received from parents of clients of Sunrise, ten (10) or 76% indicated that they are not satisfied with the types of programs being offered at Sunrise. 0 Of the responses received from parents of clients of Sunrise, nine (9) or 69% indicated that they are not satisfied with the number of programs being offered at Sunrise. Focus Group feedback: 0 Employee focus group Need a proper life skills program and curriculum. Sunrise has no plan, curriculum, progress reporting, training, and no personal client plans. 0 Parent focus group Need more programs at Sunrise. There is no real curriculum they keep promising ASDAN. Progress measurement assessment measures aren't really in place for adults and are not tracked as clearly as they are at the Lighthouse School. 2010 Deloitte. All Rights Reserved 25 5. Best Practices 5.1 Definition In defining the term 'best practice?, the definitions which can be applied universally across all sectors include the following: ?a technique or methodology that, through experience and research, has proven to reliably lead to a desired result?; "the winning strategies, approaches, and processes that produce superior performance in an organization. A best practice is the by-product of a successful end-result?; and, "the methods and achievements of the recognized Ieader(s) in a particular field?. The application of these definitions to adult training centres for persons with disabilities yielded a number of successful approaches to the operational management of these facilities, and as a result, such approaches are regarded as ?best practice'. 5.2 international Benchmarks of Adult Training Centres for Persons with Disabilities The best practice approaches to the operational management of adult training centres for persons with disabilities are shown to enhance the development and quality of lifestyle of the clients using these centres, and can serve as models for a new adult training centre for persons with disabilities in the Cayman Islands. Adopting a best practice approach to the implementation of a similar facility will require investment in three main areas: . Infrastructure the physical structure, size and layout of the facilities and the type of equipment provided for use by the clients for developmental and rehabilitative purposes; 0 Programs the learning curriculum that focuses on ongoing development and supports progress reporting of the clients; . Resources the combination of skills and specializations by the staff of the facility to adequately support the various needs of the clients. 6 W.tiiss.nethlossarv b.html, accessed 2005-10-10, Tribal Justice lnfonnation Sharing System 7 accessed 2005-10-10, 3901 Glossary Terms and Definitions from the Portfolio Management Framework. '3 accessed 2005-10-10. 2010 Deloitte. All Rights Reserved 26 Investment in these areas has shown to improve the quality of lifestyle as well as to effectively serve the developmental needs of the clients of these centres. One characteristic feature of the benchmark facilities researched for this project was that they serve as non-profit organisations for adults with developmental disabilities. A non?profit organization allows the community to become involved in the facility. Volunteering at designated non?pro?t facilities is also often an attractive option to the private sector, as this enhances a business's corporate image in terms of social responsibility and may also lead to government incentives. The benchmark facilities reviewed are as follows 0 Lambs Farm, located in Libertyville, Illinois, USA 0 Ongwanada, located in Kingston and Eastern Ontario, Canada In researching the operational management of the benchmark facilities indicated above, the aspects of the facilities that can be used to assist in effectively structuring a successful facility in the Cayman Islands include the following: 5.2.1 Organisation Structure The structure of these facilities allows for focus to be placed on the various services that are required by the clients of the facility. Although on a much larger scale than what is required for a facility in the Cayman Islands, the organisational structure of the Ongwanada facility (supports 600 clients), has clearly defined departments to focus on supporting the varied needs of the clients at the facility. However, it is important to note that based on the two (2) benchmark facilities reviewed, different roles may be required for a profit generating organisation versus a non-profit. Some of the service areas researched at the Ongwanada facility that can be applied to structuring a facility in the Cayman Islands include: Administrative and Community Services This department headed by an Associate Executive Director, oversees the human resources and support services functions. Finance and Support Services This department headed by an Associate Executive Director, oversees the financial services, nutritional services, and radiology services functions. 2010 Deloitte. All Rights Reserved 2? Planning and Vocational Services This department headed by an Associate Executive Director, oversees the community and vocational services, community and social services, client information coordination, services, and community behavioural services. Residential and client services This department headed by an Associate Executive Director, focuses on services to more than twenty (20) community residences. The overall structure is headed by an Executive Director, and is managed by a volunteer Board of Governors. In order to support a facility that is structured to focus directly on the varying needs of the clients at the facility, disability specializations, along with the requisite staff qualifications and skills are instituted to ensure high standards of care at the facility. Some of the specialist areas researched at the Lambs Farm facility that can be applied to an adult training centre in the Cayman Islands are as foliows: The availability of specialists at these facilities is a significant factor that contributes to the development of the clients, and assists with servicing the individual needs of clients with varying disabilities. The following are specialist areas that contribute to the enhancement of the services being provided at the facility: Developmental Specialists Developmental specialists assist in the implementation of fundraising goals and strategies. This includes processing of donations and acknowledgement letters, assists in special events planning and implementation, and organizes and maintains central filing system. This is a highly visible position that interfaces with individuals inside and outside the facility and requires high energy level, excellent oral and written communication skills, time management skills to coordinate multiple projects at once, and can successfully solicit funding from foundations in the Cayman Islands. Behaviour Specialists This specialist is responsible for the design and implementation of behaviour programs, monitoring the status of behaviour programs, and training all staff to implement the behaviour programs. The qualifications required for this position includes a bachelor?s degree in social work, education or related field with a minimum of one year of experience working with persons with disabilities. Previous behaviour program management experience is preferred. 2010 Deloitte. All Rights Reserved 23 Health Services Specialists This specialist is responsible for the transportation of clients to/from medical, dental and ancillary appointments as well as other community locations. The specialist communicates to the health practitioner the needs of the clients and reports health appointment outcomes. The specialist must be able to physically assist clients when required. The qualifications required for an assistant in this area includes: High school diploma or equivalent, basic computer skills, valid driver?s license. 5.2.3 Programs Services In addition to the structure and specializations required at the facility, the programs or types of services provided to clients are a main component in ensuring clients are receiving a progressive and successful experience at the facility. The programs services researched that can be tailored to a similar facility in the Cayman Islands include the following: Residential Services A variety of residential options allows the clients varying levels of autonomy to suit their individual needs and lifestyles. Some of the residential options provided to special needs clients at both the Lambs Farm and Ongwanada facilities include: 0 Campus Group Homes: residents of the campus group homes learn community living skills in a supportive environment. Housekeeping and meal preparation tasks are shared among housemates with staff support. 0 Individual Apartments: To support independent living in a campus style environment, individual apartment units that include kitchen, living area and bedroom are provided. 0 Community Residences: Clients desiring a more independent lifestyle off campus reside in homes within nearby communities. These residences receive support from staff and have access to services. Day Support This program is available to residential and community clients who are twenty one (21) years and older. The program provides client-centred activities to ambulatory and non-ambulatory individuals with varying degrees of nursing, physical and behavioural needs. Daily activities are scheduled for this group include the following: hydrotherapy, physiotherapy, integrated community outings, sensory simulation and activities for daily living. Skills Training The skills training area offers basic skills training in daily living activities, communication, socialization, environmental awareness, and physical education. Activities emphasize community integration and 2010 Deloitte. All Rights Reserved 29 accessing generic services. Training is provided to adults with severe developmental disabilities with a dual diagnosis (developmental disability accompanied by a disorder). Social Work Services Social workers provide assessments and counselling to clients and families as well as referrals to appropriate services or agencies. In consultation with the client and family they can coordinate admissions and discharge, discuss placement and programming options, and contribute as part of an interdisciplinary team to individual planning. Vocational Services The services provided in this area include individual placement, employment solutions consulting, and supported employment programs that provide training and support for clients seeking and securing successful employment in the community. in addition, there are various areas within the vocational services group as follows: Career services centre This centre operates as an employment agency for all placements and is the hub of Vocational services. Career counselling, assistance in filling out applications, interview training, and referrals to work skills classes are offered through the Career services centre. Community employment program Individual placements in employment programs in the community provide challenging opportunities for the program participants. As a result, employment specialists provide on the job training and follow-along support. Training for employers on working with persons with disabilities is also avaiiable. Campus programs Vocational training sites for program participants are established to teach skills that are directly related or can be easily adapted to any industry. Training areas include food service, store stocking and maintenance, customer service. shipping and receiving, animal care and food production. Seniors program - For individuals who are no longer interested in working but wish to remain active, a retirement day program is provided. Activities include current events, arts and crafts, bingo, bike riding and other forms of exercise designed to slow down the effects of aging. The activities are designed to help ciients to maintain cognitive abilities. Services This service is a resource for staff, families and caregivers in responding to clients with emotional, behavioural, or learning problems that interfere with quality of life. Individual assessments are conducted and can contribute to the development of a behavioural support plan. Assessments are based on referral questions and may include cognitive functioning, long term planning, behaviour, attitudes, potential skill development, interests and other personality attributes, environmental 2010 Deioitte. All Rights Reserved 30 factors and relationships. While the department's roles are primarily consultative, counselling is provided to clients both individually and in small groups. Specialty Clinics seating clinics These clinics are conducted annually or as needed to assess and monitor the positioning and mobility needs of individuals who use a wheel chair. The seating clinic team includes a physiotherapist, occupational therapist and wheel chair technician working together with the individual and their caregivers. Custom seating is provided for those requiring special features. Rehabilitation Services Occupational therapy and physiotherapy consultation and treatment is provided to clients of the facility as well as others within the community. Specialized services/assessments include hydrotherapy, wheelchair seating, feeding and swallowing, prescribed exercise and positioning programs, mobility and prescription aids, activities of daily living, environmental modification and sensory stimulation. Consultation is also provided to staff regarding back care as well as lifting and handling techniques. Respite Care This service is provided on weekends to provide parents and other caregivers with occasional reprieve from their responsibilities. In addition, respite care is also provided in homes throughout the community during the week, and with host families. Community Behavioural Services A unique curriculum developed to teach individuals with developmental disabilities about relationships, sexuality, emotions, and social skills. Clients can progress three levels: Understanding Myself and Others (Basic), Responsible Sexuality and Personal Safety (Intermediate), and Decision-Making, Safety and Relationships in Society (Advanced). Parents and caregivers are closely involved in this process. This is an educational program and does not provide counselling or treatment for problematic sexual behaviours. Nutritional Services These services are provided by the resident dietician who assesses the nutritional requirements of each client as well as develops and monitors individual dietary plans for optimal health. Guidance is provided on menu planning, feeding techniques and food preparation and is offered to clients and caregivers at healthy eating clinics. Challenges faced by individual clients due to their disabilities are reviewed and addressed. The team providing these services include the dietician, the client's counsellors, an occupational therapist, and social worker. 2010 Deloitte. All Rights Reserved 31 5.3 Summary Although these best practice options for persons with disabilities are applied to much larger facilities than what may be necessary for the Cayman Islands, it is important to keep in mind that all of these types of facilities are serving the developmental needs of persons with disabilities in a community environment outside of their homes. Operating a facility that has a focused approach on delivering quality services to its clients as highlighted in the best practice facilities indicated has helped the clients to learn daily living skills. physical wellness and development of lifelong interests, as well as dealing with social issues and work skills to help support their continual development. 2010 Deloitte. All Rights Reserved 32 6. Recommendations 6.1 Overview in our review of the data obtained through surveying, interviews, focus group feedback and understanding best practices of the operational management of adult training centres for persons with disabilities, we propose two options for the implementation of a new adult training facility for persons with disabilities which will focus on providing services to adequately support the needs of the clients attending the new facility. It is important to note that these recommendations are based on insight from analysis of best practices at international facilities for persons with disabilities. In addition, the Ministry's objective of identifying the critical requirements for a new adult training facility were also taken into consideration in the formulation of these recommended facility options. Deloitte believes that the following recommendations have significant potential towards the development of an adult training facility for persons with disabilities in the Cayman Islands. 6.2 Options Generation Option 1: Village Living Approach The village living option allows the clients the ability to interact with various support centres located throughout the Cayman Islands in order to participate in a varied number of services and programs offered by these support centres, including private clinics, and coordinated through a main central facility. The aim of the village option is to allow clients and caretakers the flexibility of gaining access to various facilities and programs, and may also alleviate the concerns of distance travelling for clients to one central facility as support centres may be located throughout various districts in the Cayman islands. The village living option has a central coordination centre that houses the main administration centre responsible for coordinating the clients' access to the various services and programs being provided at different facilities with which it has an established relationship. Individual assessments will be conducted for clients at this main centre and progress reporting programs will be developed and reports will be requested from the various support centres. 2010 Deloitte. All Rights Reserved 33 In addition, the central coordination centre will house a resource centre facility that will provide the following services: Day support service - this service is provided to adult clients who are ambulatory and non? ambulatory with varying degrees of physical and behavioural needs. Daily activities are scheduled for clients including hydrotherapy, physiotherapy. community outings, sensory stimulation and activities of daily living. Nutrition services - provided by a dietician and offered to clients and caregivers to assess the nutritional requirements of each client and develop dietary plans based on their individual needs. The dietary plans developed will be distributed to the various support centres with which the client interacts. Guidance on menu planning and food preparation will aiso be offered to the clients and caretakers. services - resource program provided to staff, families and caregivers in responding to clients with emotional, behavioural, or learning problems that impact the quality of life. Rehabilitation services - occupational and physiotherapy consultation and treatment will be provided to clients registered at the centre and also to others within the community. Specialized service assessments may include hydrotherapy, exercise and positioning programs, mobility and prescription aids, and activities for daily living. The support centres are referred to as a village living setting due to the support provided through various homes and facilities throughout the community. The support centres that would be included in this village living setting are as follows: Residential Respite Care This facility is within a location that is structured in a home setting, and would provide parents and other caregivers with an occasional reprieve from their responsibilities. The scheduling and administration of the clients to this facility will take place at the central coordination centre with the actual service being provided at the home facility. Home Share - This support centre provides a service where host families share their home with an adult with a developmental disability. The scheduling and administration of the clients to this facility will take piace at the central coordination centre with the actual service being provided at the home share location. 2010 Deloitte. All Rights Reserved 34 0 Group Homes - At this facility, clients will learn community living skills in a supportive environment. Housekeeping and meal preparation responsibilities are shared among the housemates with staff support. Option 2: Campus Living Approach The campus living option allows the clients the ability to live, work and interact with other clients within a campus setting. A central administration and coordination centre will conduct initial assessments, coordinate programs. and track the clients' progress through reporting provided by the various service centres within the campus facility. In addition to the central administration centre, the campus facility will include a residential services centre which will coordinate and provide a variety of residential options for clients based on their individual needs. The types of residential services provided can include the following: . Campus group homes: Residents of the campus learn community living skills in a staff supported environment, where responsibilities such as housekeeping and meal preparation are shared among the housemates. . Individual apartments: individual apartment units complete with kitchen, living area and bedroom are provided to clients requiring independent living in a campus environment. . Community residences: located in nearby districts, provides residence living to clients requiring independent living off the campus facility. The clients receive support from the campus staff and have access to the services provided at the facility. Additional service centres or departments located on the campus site which will provide the required services and programs for clients include the following: Day Support Centre - provides daily scheduled activities that include physiotherapy, sensory stimulation and activities for daily living. Classes are centred on supporting the clients? personal goals, social and work issues and hobbies. Rehabilitation Centre - offering occupational and physiotherapy and treatment to campus clients and well as others within the local community. Vocational Services Centre - offering individual placement, employment solutions, and supported employment programs. Social and Recreational Services Centre - offers clients the opportunity to learn daily living skills, physical wellness and development of iifelong interests. Recreational activities may include use of a 2010 Deloitte. All Rights Reserved 35 gymnasium and physical fitness centre. Social hobby clubs and ?eld trips. activities may include clubs and group outings, choir, Community Behavioural Service Centre - provides assessment of the clients which can contribute to the development of a behavioural support plan. A curriculum may be developed by staff to teach small classes of clients about relationships, sexuality, emotions and social skills. Clients can progress through three levels - Basic (Underst anding myself and others), Intermediate (Responsible sexuality and personal safety), and Advanced (Decision making, safety and relationships in society). Option 1: Village Life Outsourcing functions Respite Care) to other facilities providing similar services on-island. Option 2: Campus Living All client activities (living, working, developmental programs and activities. and social I recreational activities) are located in one campus type facility. Allowing clients a more independent lifestyle. More cost effective option in terms of initial investment to deveIOp infrastructure to house the variety of service areas as the current facility can be used. Campus center allows more interaction of clients with each other through social, vocational and learning activities on a daily basis. Allowing clients become more acquainted with and comfortable among other clients. Allows the clients greater interaction with the general community. Departments dedicated to specialized services will allow clients greater periods of time with the specialists required. Speech Therapy. Occupational Therapy) Alleviates concerns of not having a centralized location as client can be accommodated at various facilities throughout the districts. Campus location could be placed in a central location near to emergency services (Fire, Hospital etc) thus curtailing the clients travel time from various districts. A Central Administration Centre responsible for and focused on coordinating client assessments, progress reporting and scheduling with the other facilities versus responsibility of coordinating client administration services as well as the coordination of daily services programs. Client support provided by staff at the main central administration centre as well as staff at the various outsourced facilities therefore offering a wider range of support to the clients. 2010 Deloitte. All Rights Reserved Disadvantages Disadvantages Clients will have to become acquainted with a More capital required at start up for development of greater variety of staff and various locations campus infrastructure. depending on the service they require. More staff will be required for this option. Greater need to move clients around to locations of specialized services. 6.3 Identifying Other Needs This section of the report focuses on potential requirements for a future facility. The information is based on data gathered through interviews, focus groups, surveys and best practice research. 6.3.1 Future Needs - Facilities Equipment Location There was consensus that a future location should be closer to the amenities that George Town offers including but not limited to the George Town Hospital, Dental Clinic. emergency services etc. At present some clients travel for two hours on the bus to reach Sunrise. A live-in facility and/or respite care facilities is needed and these could potentially be in the outer districts if a decision was taken to select the "village living? approach. Infrastructure Universal Design should be considered in the design of the facility. Universal Design is an approach to the design of all products and environments to be as usable as possible by as many people as possible regardless of age, ability or situation. The seven principles of Universal Design should be taken into account: Equitable Use; Flexibility in Use; Simple and Intuitive Use; Perceptible Information; Tolerance for Error; Low Physical Effort; and, Size and Space for Approach and Use. 2010 Deloitte. All Rights Reserved 37 More specifically the facility should be a spacious flat structure with wide hallways. The design needs to be created with special needs clients in mind and needs to be easily accessible for people in wheel chairs. Handrails are necessary not all clients/potential future clients are and/or will be independently mobile. Necessary amenities/facilities include: Private rooms that are dedicated to specific uses therapy] counselling; Spacious gymnasium where clients can move around easily and use equipment; Patio and/or outdoor recreational area and basic sports equipment; Indoor swimming pool for hydrotherapy; Training rooms that are dedicated to specific uses art studio, music room, library, computer room with adaptive input devises etc.; Adequate restrooms that are accessible for people with disabilities and people in wheel chairs and with shower/bathing facilities; Dedicated administrative area with offices, filing space, meeting facilities; Life skills area that is fully equipped with training equipment such as beds, kitchenette, dining area; Sensory room; Covered driveway i? garage area; Adequate storage space; Outside area for agricultural activities; In?rmary with full-time nurse - or medical centre; Dedicated vocational department; Chairs and tables that are specifically for people with disabilities and in wheel chairs; and Security cam eras. Recommended rehabilitation equipment includes: (Note: This information was provided by the current Occupational Therapist at Sunrise Training Centre) Treatment equipment 10 ft standard size parallel bars; Posture mirrors; Activity Table with cut-out; and, Adjustable mat platforms. Splinting tools 1 Heat gun; and, Rotary punch. 2010 Deloitte. All Rights Reserved 38 Exercise equipment Standard pulleys; Magnetic resistive exerciser; and, Dumbbell tower rack. Mobility equipment Gait training belts; and, Foot placement ladder. Balance training and conditioning Balance beam; Balance disc; Balance paws; Vestibular wedges; BOSU balance trainer; Exercise bands; and, Theraband individual exercise balls. Respite care and live in facility There is currently no respite care facility in the Cayman Islands. This service is requested to offer temporary relief to care takers for a few hours or a few days. This is also in keeping with international best practice. A live-in facility is also required as many of the clients are middle-aged and their care takers are aging. Through interviews and focus groups concern has been expressed, as there is a view that persons with disabilities are a vulnerable class of people who are susceptible to abuse and neglect. It is essential to have a facility which can remove these people from an abusive environment and/or allow them an opportunity to live independentiy. 6.3.2 Future Needs - Programs Formal curriculum and individual plan for each client In order to optimise client progress a future facility should make use of a formal curriculum or training framework that offers measurable progress objectives for each client. The ASDAN framework would allow for this. 2010 Deloitte. All Rights Reserved 39 Individual client assessments should be conducted and each client should be engaged in a program that is geared towards developing his/her personal skills and reaching his/her individual potential. This will act as both a good measurement tool for administration and motivational tool for clients. Potential creative programs to be implemented 0 Art program; . Music program; 0 Dance program; 0 Speech and drama; and, . Religious classes. Through our research it has become evident that the centre is in need of qualified, trained professionals who have experience working with people with disabilities. The following is a summary of required personnel at a potential future facility: 0 Qualified Occupational Therapists . Qualified Speech Therapist; . . Counsellors for addressing issues such as anger, grief and/or frustration; . Qualified Medical Nurse many of the clients are on daily medication and are also prone to seizures, ?ts, fainting etc; 0 Social Worker there are often cases of abuse within the homes of the clients; . Trained Adaptive Living Specialists; . Vocational Specialists; . Strong administration who has knowledge of persons with disabilities and is able to implement a curriculum; . Quali?ed and trained live-in employees for live-in/respite facility; and, 0 Kitchen and cleaning staff - the clients currently clean the centre, although this is an essential element of life skills it should be taught as part of a formal curriculum. 6.4 Demand Forecast We provide the following forecast as an example of what future demand could be. In order to forecast the demand for the services of an adult training facility for persons with disabilities in the Cayman Islands, we completed trend analysis using limited data available and applied a conservative estimate of the percentage of the population classified as disabled persons based on 1999 Census results, and applied '29 2010 Deloitte. Ail Rights Reserved 40 this estimate to the current population level to forecast the demand for the services at this facility as follows: 0 Resident population (1999) - 39,020 a Total number of disabled persons (1999) - 1,673 of resident population} 10% of this group (1,673) was used as a conservative estimate to be categorized as persons with disabilities requiring the support of the services provided at an adult training facility. This estimate was used as the term ?disabled persons' was not defined in the 1999 Census report and the number indicated above may have included all persons with disabilities both requiring and not requiring the support services of an adult training facility. Note: this example is subject to a number of variables and does not serve as a forecast of the possible future disabled population of the Cayman Islands. Current population estimate (persons with disabilities): Resident population (2008) - 57,009 Average growth rate - 3.5% Estimated resident population (2009) - 59.004 Estimated disabled population as per 1999 census - 4% 2,360* Persons with Disabilities 2009 Conservative estimate - 10% 236 10 year demand forecast: Disabled Population Estimate 350 300 100 Disabled Population :5 Estimate .r-l v-l 10yeartrend . 2010 Deloitte. All Rights Reserved 41 Disabled population estimate Table: 2009 59004 236 2010 61069 244 2011 63207 253 2012 65419 262 2013 67708 271 2014 70078 280 2015 72531 290 2016 75070 300 2017 77697 311 2018 80416 322 2019 83231 333 Deloitte was unable to accurately determine future demand, however, should the above example be used, a facility for adults with disabilities requiring the support of an adult training facility should be designed to accommodate the needs of 333 persons within the next ten (10) years. 6.5 Additional Considerations Skills review Through our research it has become evident that a new facility is required for persons with disabilities in the Cayman Islands, however a new centre will oniy be effective if it is staffed with knowledgeable, trained professionals who have expertise in the field of caring and developing peopie with disabilities. If a new centre is built we would recommend that a full organizational review be conducted along with a skills gap analysis of the current staffing complement. Strategic planning and vision The new centre would also need to clearly define its strategic objectives and mission and have a clear vision of what it aims to achieve. For example the facility needs to determine whether it is a training centre or a day care facility? Is the centre?s objective to groom clients into potential employees who can participate in the workforce or is the goal to provide a safe environment in which to develop socialization and interpersonal skills? If the centre is dual purpose do clients with varying levels of ability need to be separated? Should stricter entrance criteria be established? (El 2010 Deloitte. All Rights Reserved 42 Leveraging resources During our inspection of the Lighthouse School, it became evident that the necessary resources and specialists are available and practicing on island. A future centre should consider sharing resources with the Lighthouse School. We are aware that mixing adults, in large numbers, with children is not a practical solution, but if the adult centre was more centrally located it would be easy to transport individual clients to the site for therapy and/or have specialists from the Lighthouse School visit the future centre. 2010 Deloitte. All Rights Reserved 43 7. Next Steps In identifying the needs of persons with disabilities in the Cayman Islands as a precursor to soliciting expressions of interest for the development of a new centre, the next steps required to move towards the implementation of a chosen option are as follows: 1. Project steering committee to review the final report and identify the option that best supports the needs of persons with disabilities in the Cayman Islands and supports the Ministry's requirements. 2. Considerations for Option 1: Village Living Approach a. Review of the current services required by the proposed aduit training centre and currently being offered in Grand Cayman; b. Research potential locations for development based on Government land and/or buildings available in Grand Cayman; and, c. Identify proposed budget available for implementation of chosen option. 3. Considerations for Option 2: Campus Living Approach 3. Research potential locations for development based on Government land and/or buildings available in Grand Cayman; and, b. Identify proposed budget available for implementation of chosen option. 4. Creation of Design Brief outlining requirements to be presented to potential investors] developers. The Chief Officer to discuss deveiopment of brief with Deloitte project partner. 2010 Deloitte. All Rights Reserved 44 8. Appendices Appendix 1: Ongwanda Facilities, Programs Specialists Appendix 2: International Benchmarking Data Sources Appendix 3: Implementation plan for ASDAN programmes at Sunrise Training Centre (provided by Clive Baker - Head of Schools Curriculum) Appendix 4: Sunrise Adult Training Centre survey Appendix 5: The Lighthouse School survey Appendix 6: Internal and External stakeholder interview questions (Q 2010 Deloitte. All Rights Reserved 45 Appendix 1: Ongwanada Facilities, Programs Specialists ONGWANADA About" Us 3 Directory Of Sorvlca Ari-it Frrterlwe 361.316 Betta-rm al Stevie; nines? c, Hanoi {nit CW and: Crescent. {we-rt? Sci-(ice Day woos-rt llorrzeshor lighten Rehab Centre Lebcwetow burr; ?n 1? Mint 5 Phorr'ez,? F's you. ur- se?e?e't 41o?:- Scrurl"n:c fer Wt 4??nt .oeaev . 9 a Ongwanada ONGWANADA About Us; .. Inns-"tow 0t 2 Add! Fri 'Jertrw Service amounty bar-3- no! 5oz" "es Curran? (Ira cm enacts {restart r'orn'v rey?icr (W "-uf-por' c?xsi? l?irm er; "can Lent: e. errx; Nit. more?: Ser r?cy rcd'cr i= :ervt?' L?v?jifl? 3 7- reinvent run:- Care Sc? Program Adulzs ?Zli?ls I: an Sec ?\?ovl marki?tv {it an Done SUPPORT, RESPECT, CHOICES Search Contact Us . login . Stat! Crescent Community Services Located at 114 Wright Crescent in Kingston Crescent Centre otters adults the opportunity to engage in meaningfu! activrlres oftherr chorce ectivrlies can be vocational (Le emplomrenl) or l'lOl'tv vocationaltre leisure artsvolunteer'rng) The emphasrs IS on integration and generic semces are accessed wherever possrme El Open to adults eighteen years or age or older demelopmentat disaoi ities who are interested in pursurng vocational or non-vocational goals Area served Kingston and area Hours Week-clays a ni to 4 Referrals Accepted rrom all sources including lamilres sell other agencies and aoroccites Relerrals wrlhin Ongwanada are made through the Indivrdual Support Plan Waiting period Because or the demand tor this service potential clients are encouraged to place their name on a waiting list while still attending school and belore reach-n9 the age 0! 18 The slalus of individual relerrals can he obtained lrom Karen Menzies Turner Coardinator -rocat anal and Communiiv Semces For l?i'lOlE information about this program nlease contact Ongwanadas Intake COOH?il?aiOf 3 613-548- 4417 EX. 3314 RESPECT, CHOICES -t Home search Contact Us Login Stalf lroncais Kinsmen Rehabilitation Centre The centre otters occupational therapy and physiotherapy consultation and treatment to clients lrom onqwanada as Inrell as in the community Specialized serviceslassessntenls inc'ude hydrotherapy. wheelchair seating feeding and swallowmg prescribed exercise and nosrtionino programs. mobility and prescription aids activities 0! dally Irving envtronmental modification and sensory stimulation Semces are offered out of the Ongwanada Resource Centre on Portsmouth Avenue. in indivadual homes schools and Car program areas Consultation is also provided to stall regarding back care as well as lilting and liar-idling techniques Semces are Open to all Origwanada clients as well as community clients With a developmental A order is requ-red tor comnrunrl, clients and commune) clients must pay a tee to access these services The program hours run Monday through Friday lrom 8'00 3 to 4'00 For more rnlormalion about this program. please contact Ongwanada's Intake Coordinator at 513-548; 4-117 ext 33? 2 Internet Protected Mode: Off 2010 Deloitte. All Rights Reserved lnieinet Protected Model Of! Wt" - 9391' ?.1095? ?3 at ,?Ongwanada ONGWANADA . SUPPORT, RESPECT, CHOICES ?1'0-rlili I F'mttittl Hu- ltlriiII 51th" I lrnilgirin I Services About Us a . Servrces I5 a resource tor Ongwanada stall lamilies and In responding to Directory of Services . clients With emotional ps .chlatnc behavioural or learning problems that rnterlere A?l?'l quality otlite am sewn the department undertakes indn'idual assessments and can contribute to the development of a behavioural support plan Assessments are based on reterzal questions and may include cognitive re: - . ?m yeehummd functioning tonglerm planning behatnOUl attitudes potential skill development interests and other Cranial-3?3" personality attributes environmental factors and relationships Crescent: Cum-nun? Selvrce Day Support While the department?s role is primarily consultative counselling is prmided to clients both Individually H?Mnsg?e and in small groups services is also active in training graduate students and Interns in Clinical P5 rchology Rehab Centre Laboratory Living ?Mth Others titration Set-.535 Pharmacy 5e: aces F.2?3r?rrci Treatment Home School Care Service- Sd'tool Program for milks Sl'?s Iratrmg Sic-cl:i Work Srecis?ty Cln-ts Don: I. lnternet 1 Protected Mode: Off INS. @0ngwanada If ital 'Z?Plge . ONGWANADA SUPPORT, RESPECT, CHOICES Honiel Search Contact Us login Stall I trangais Skills Training bout Us 3 Located at 114 Wright Crescent in Kingston. the Skills Training Area otters oasu: skills training in the activities or daily thing, communication. serialization. environmental awareness and physical education Training to improve is provided both individually and in small groups Activrties emphasrze community integration and accessing generic services irectorv or Services 3 Etigibitity. Open to adults with severe developmental disabilities including individuals with a dual diagnosis (developmentat disability accompanied by a disorder; Clients should be -iiterested in pursuing a non-vocational goal Referrals: Accepted lrom all sources including families. sell. other agencies and adrocates Referrals from within Ongwanada are made through the indim?oual Support Plan Hours: WeekdaysWaiting period: The program has space for thirty?five clients. Because 01 the demand for this sen-cc potential clients are encouraged to place their name on awaiting Iistwhile attend-n9 school and before reaching the age of 18. The status of individual referrals can be obtained from Karen Menzies - Turner. Coordinator. Vocational and Community Services For more inlormation about this program. please contact Ongwanada?s Intake Coordinator at 613 5-18 4417 ext 33? . _antemetIProtectedMode:0lt 4310096 2010 Deloitte. All Rights Reserved 47 ?Ongwanada ONGWANADA About In Directory Of Servicw lg air! F'rctetme 56 Ire Cca'munty Behammed Sew-{es {mm wary i am with Orgasm fresu?nt formal-:7 r2 iuwocl liar: estate raven Per-3'? Cent: 2 Lat-or no! Loam (h tithe-s Nutrition ?33:79 92' Pram :y Pw-zha? no; Saw-ctr. F'ogcw! term:- a 3m no; ?ixtvol In Adv-1'? this Wm iom? ice-claw (inst: Done . 5 .510-ols'1' SUPPORT, RESPECT, CHOICES Home I Search Contact Us Lupin I Staff Francois Day Support The Giver 21 Day Program located at the Onmvanada Resource Centre otters day programming to Ongwanadas Resrdential clients and community clients The program prondes client-centred to ambulatory and non-ambulatory individuals With varying degrees of nursing and behavioural needs Act'Mties are scheduled daily tor clients and Inoude physiotherapy integrated community outings senson stimulation and activities orderly The program runs on weekdays from September to June 8 30 a to 4 00 Adults 2! lrears of age or older living With a developmental disabilitv are etigaole tor the program For more untormataon about this program prease contactOngNanada's Intake Coordinator 31613 543 4417 ext 3314 2010 Deloitte. All Rights Reserved a Internet Protected Midigf: ".3109? 43 ONGWANADA ORGANIZATIONAL CHART I BOARD OF GOVERNORS I I EXECUTIVE DIRECTOR I R. w. Scaby 1.. I r. .v ?insular-do: I ?5:332:13? i urn-mm HelmAnum'rsm mm A COMMUNITYSERWCES 1 ma V1655 RBJDE-WL I PICS I Asocmh: Emmi? Dire-:0: Nahum Excrunv: 06mm Axum Fm?te 9W Am ?umlim Dimm John Fe: fern Collard Mania-Tum? Lind: Murray I I L.-- . ?mm? rim Scnica Comma-y a. Vac-Klan! Scrum Community Mam a Canada Wm Bail: Apnnd?ilm Kan-Ky mm 3 um mm: I Roma Dillon Kim um? I om: Rmu I I Cumuulixy Scn?lm - (Imam Tum m. Mum Occupational Nam Nutrition Scrum cuieu Scull RIM-hue Cunningham. Con: Drhbic McMulla Mm Simian I I - - I ?ame Sandman-um Cun Bum. Mum-l Sum-1h IP Jammie-dun! Dough: ?mm" i anus-u service: 4 Gto??G-?u?d i . Trudy Rawdin' I Kain Shower: PM CMM . . Dav: I Braid: 80cm Vim-um Graham. McKee-1:, Henry 8.. Pull Smith Jan: Skinner had: kaz -A - Cytogcar?u khan-nary Dr Juan: Holden 1. 191mm: Mull Education Program - anu- Mmh: Smith mum wmauau rum: I Wendy macaw Tm I thy haul-u (DEC) Tulane-I Home Suppul Sank-n h: lob m: i?w . Kathy Day It: hymn?. (hmpn?oul Thu-p), _l Iiydmhenpy l_ FulHqudi-am I I - I Ole-l I lo Cde ham-q Scnku I R: I. Canaan-11y Wu MI: Cullen I Stun: Am?n Service DI menu Prim Charla. Richard. Sydallun Liz ?lmr PM "do: Mink-Rune Community ?nd Shanilm Bucky. F?nb?h. Imam] I Mich-un?lmlupin Stn?lm i Mum-Lynn Hu? 1 I . I Comm-mml Sank-u Audit-y Andersen My vmnu Nam I ?lm! 13:01an Adult from Servin- . Wham (Rapids) Mm sun: Linc rm I cum: magma-y Debbi: Mouhm . I a cum: Fm I stud-nag I 13mm Haitian. Tmey William. Mantra: Madman! . gr lax-kc Trudy Sickle: -: Satin! Work Remsed Dabber 2009 Appendix 2: international Benchmarking Data Sources '5 Lamb: Farm Residential Services - Windows lntemet Explorer I i ?7 i A I Lr'v: Search 9 VI Q'l 4: #3 ?Lambs Farm Residential Services . I EB film - 'Pogl '15- Tools pcaptc: mil/r detrcfofmrcumf "fun-,1 - h- rlr'wrfuft'lrcs (a (cad fut'frt't'urg (10.1.: ll-l'l businesses a. special order our how you newsletter employment links to other Lamiu Form attractions ovcnu product: can help highlight: opportunltlos . resources lilsloryl lesumniml services vocational services vocational Wr'lrl-i router social and rearr-atlonal services Residential Services Lambs Farm otters avartety oi testdental ophons tor Program Participants both on the campus and in the community Intermediate Care Facility The Green-Field pros-mes retire meal-specific actmties promoting wellness and an actue Ilfeshle Staff are available 24 hours a day to prov-ole the level oi care rectu red by each resident Campus Group Homes Resrdenis oi the campus Group Homes Ieatn community ilL?l?g suits in a supportive environment Housei:eeplng and meal preparation are shared among the housemates wrih sta? support Individual Apartments The Stone Apartment Building ieatures indiudual apartment units complete with kitchen living area and bedroom tor those desiring Independent Irvmg In a campus enmronrnenl Community Residences Located In nearby communities these resuaences are home to those Program Panic-pants desmng a more independent litesryle otl campus ReSvdenls receive suppon from stall and have access to Lambs Farm senices 847.362.4636 - rm. ?245 Rockimd Road, Libertpuie lL 60048 - .. an; I'm I :mhc farm \1 vlnilr \Ian 9 int-met} Piucted Mejieiil? 2010 Deloitte. All Rights Reserved 5t] ?5 Lambs Farm -Vn?etionol Services Windows Internet Explorer {m at I, . imp- lambsfarm. org/aboutuslvoc_sen1ces A .1 tic. =4 ?lambs Farm-VocationalSemcu a up?. 7 -_vFiige .1 Tools I.focational Services include IndeuaI Placement Employment Solutions Consulting and Supported Employment Programs that provide training and support for those seeking and secunng succesle employment In the community as well as placement on campus In the busrness operations or other areas Career Services Center The Career Services Center acts as the ?employment agency' I?or all placements and Is the hub 01 the Vocational Services Career counseling In out applications intenn'ew training, and relerrals to work skills classes are altered through the Career Services Center. Located on campus the center also posts job opportunities and has a computer lab with internet access. tax services and reference materials tor those seeking employment Individual placements In community emplovment provide challenging opportunities tor Program PartICIpants. Lambs Farm employment specialists provide on-the-iob training and tollow-atong support Training tor employers on working with indivrduals placed is also available through our Employment Sotutions Consulting Program Using a team approach Supported Employment Programs meet the statl'Ing needs of local businesses by providing an enclave at two to eight workers along with a rep coach Job tasks are analyzed. training procedures are implemented and ongoing support is provided by the job coach on-s.te at the lacititgr Areas ot specialization include janitoriat tood service manulacturing and shippinglrecerving Campus Programs The . - and other areas serve as vocational training sites tar Program Participants and teach skills whim are directly related or can be easrtr adapted to any industry The business operations offer training in areas including lood service store stocking and maintenance customer service shipping and receiving animal care and food production They include the Country Inn Restaurant. Farmyard with Children 5 Attractions Pet Shop Thrih Shop and Aunt Mary's Country Store Bakery In addition campus training is provided through the support services department and administrative ottices In such areas as clerical work ian torial services. and grounds keeping Seniors' Program For those individuals who are no longer interested in working but want to remain active Lamps Farm otters a retire-hem day program Particrpants engage in a varieh ol activities like current events. arts and crafts Bingo althe local senior center. as well as bike rid.ng and othertorms ot exercise designed to slow down the etlects ol ag:ng ActiviI-es are designed to help Individuals to maintain cognitive abilities The goal ollhe Seniors Program is to help Panicrpants to have enjoyable and productive retirement years Located near the Lambs Farm campus the vocational Work Center provides training opportunities to indmduals who need a more structured worlr environment Workers undertai-e subcontractiobs such as assemb?; packaging sorting mailing services and m?t? a Internet 3 Protected Mode: Otf *t 100% '3 Lamb: Farm? Specializing in Hand Assembly and Production Servrces - Explorer I K. i t, a Lambs Farm - Specializrng In Hand Assembly 13?. Page 1 '3 Tools Vii?h?orihl \Vork'C'c'n tor" I EFFICIENT PRODUCTIVITY At the Lambs Farm Contract Packaging and Assemer Center our trained worldorce is ready to meet the production and ma ling service needs at your business Whether it's hand assembly packag ng. sealing or sorting we guarantee that your recerre Immediate attention and a qurck turnaround time Our detailed procedures include careful inspecli on or incoming components and outgoing tinished products QUALITY CONTROL When your busmess brings a project to the Lambs Farm Contract Packaging and Assembly center you can expect precise workmanship and a dedication to quality Our worlsorce iob coaches and supervisory start make sure each prerect adheres to the highest Industry standards Quality service at a competitive price is a simple goal but It Is a goal we are proud to achieve IMPECCABLE Our trained work. force and impeccable service have made us a leader in the field oi packaging and . assembly Our personal support dedication and commitmentlo quality make us your source to meetiour business 5 productvon needs A COMMUNAL WORKSPACE Our employees work in a clean sate communal workspace because at Lambs Farm Contract Packaging and Assembly we betreve that ellictency and quality are the byproduct of a happ. and headhy workforce OUR SPECIALTIES: PRODUCTION HandAssembly Sorting I Disassembir I. Stulling Coltatrng HeatSeahng Sealing I Labeling Bagging 0 Packing - Laundry MAILING SERVICES 6 LabelApptIcation a Cotlating 9 Folding Stuf?ng - Sealino Bone . . . . a Internetlprotect_ed Mode:_0ff_ 1100?. 2010 Deloitte. All Rights Reserved 51 7" Lambs Farm? Social and Recreational Programs - Windows Internet Explorer RE [m ?kxl i I I A Live Search iv? - .2 It. . 3 lambs Farm-Social and Recreational Programs - r-i" E) Pig! .3 pcapl?c hw?v?n inn.?- (a (cat! pulsrumft'q [irt'fr?uly (tire?.1: Wm! tl? iabout businesses 8- epeciru order our how you lnowslorter employment links to other Ilambs Farm attractions ovonte products can help highlights opportunities resources residential services vocational servrces vocational work ccntorI social and recreational services Sncial Rr'cr minim! Sacral and Recreational services at Lambs Farm locus on helping those served learn daily living skills. physical wellness andthe development of Irtetong interests Recreation Many Program Partitipants take part in individual and team sports as well as training tor the Special Olympics The Founders Burlding located on the Lambs Farm campus. holds a regulation-size gymnasmm and trtness center The ?Healthy Larnos' and programs encourage to term good exerCIse and nutrition habits QUEST Day Program: The QUEST Day Program provides opponunrlres for Program Pa?icipants to pursue their personal goals with classes centering on daily living skills social issues wort: skills and hobbies Activities A wide variety 01 social admires are altered inmugh the QUEST Day Program and other areas at Lambs Farm including specral intereslclubs and group outings Actmties Include chorr hobby clubs. camping and ?eld trips Click here to ?nd out how to volunteer in this area 847.362.4636 I-m ., -- 142-15 Road. Liberty'nile 11.. 600-13 . Located attire Intersection oft-94 and Route ?6 Lilith Furl? rim]: Map - 9 Internet 1 Protected Mode: Off Dims 2010 Deloitte. All Rights Reserved 52 Appendix 3: ASDAN Project Plan for Sunrise Implementation plan for ASDAN programmes at Sunrise Training Centre (SRC). Provided by Clive Baker - Head of Schools Curriculum Introduction The Award Scheme Development and accreditation Network (ASDAN) is an international accrediting body. It is a not for profit organization, and represents one of the largest cooperatives of educators in the world, operating in many countries. ASDAN programmes already operate at John Gray High school and Lighthouse school. ASDAN programmes utilize portfolio based, competency assessment and certification. Aims of ASDAN at SRC . To provide a framework of activities through which personal, social and independence skills can be developed and accredited regardless of the severity of disability . To promote a culture of success Rationale Currently clients at SRC receive no formal recognition for their achievements within the education programme provided. ASDAN will enable clients to receive accreditation for their successes and will enable progress within the programme to be measured. ASDAN programmes, by nature of the portfolios produced will also enable evidence collation and record keeping to be enhanced. It will also provide a focus for further training of both clients and staff. Implementation 0 The programme will be implemented for all clients 0 The clients will al start on the Towards Independence programme taking the mandatory starting out unit (which is personal portfolio) and the unit Everyday Living . They will progress through at different rates according to needs and will then be offered a further challenges reflecting personal choice, resources available, and appropriate challenge . Start of implementation May 1st 2009 Monitoring and Evaluation . SRC will be registered with ASDAN and will conform to its published guidelines on monitoring and evaluation in the scheme handbook . Mrs. Bonnie Moxam will be the ASDAN coordinator, Assistant coordinator 2010 Deloitte. All Rights Reserved 53 The whole staff team will meet weekly to discuss client progress in the scheme 0 A weekly timetable of the clients programmes will be published 0 A portfolio of evidence will be continuously assembled and stored at the centre Stakeholder involvement . Parents and Guardians have been very supportive when initially contacted. Further meetings need to be scheduled to enable them to give their opinions on implementing ASDAN programmes . Assuming we have their support and implantation occurs regular meetings to feed back on client progress and share portfolios will be scheduled Initial materials required for each client a Registration forms 0 Ring binders (3 hole) 0 Sheet protectors 0 Subject dividers . Student workbook starting out 0 Student workbook Everyday Living 0 Stickers showing level of support Materials for centre 0 Digital camera 0 Video camera . Filing cabinet (x2) 0 Printer ink 0 Teacher manual Suppon Local expertise is available at Lighthouse schooi, particularly Mrs. Olga Gourzong and Ms Carolyn Powell. Mr. Clive bake at the DES and Mr. Nat King at JGHS are also ASDAN trainers Overseas support is available through the ASDAN network our nearest centres are in Jamaica and we have existing links with centres in the UK. It is strongly advised that, after some months of implementation, that we bring over an ASDAN trainer from the UK. The trainer would be available as a resource for ASDAN programmes for SEN clients across the continuum of care. 2010 Deloitte. All Rights Reserved 54 Draft Timeline 14/02/09 Activity Deadline Who is involved Outcome Resources required PHASE 1 Implementation plan 25/2/2009 Clive Baker. Brent Clear strategic plan Time. copying Holt, Roberta for implementation Minimal cost to GordonJ SRC staff SRC Code of Practice 16/2/2009 As above Clear policies for Time, copying admissions criteria, Minimal cost to Supporting policies 1/9/2009 policy. criteria SRC for eligibility of provision, health and safety policy. reporting and recording policy Staff stakeholder consultation 2/3/2009 As above Staff support for Tl Time - one day Mapping of modules to SRC Published Copying programme timetable/scheme of Refreshments work of SRC provision Parent/Guardian stakeholder 3/4/2009 As above Parent support for Tl Time - one consultation evening Copying Refreshments Ministries approval 30/4/2009 of Approval of ASDAN Copying and accreditation and associated costs Centre registration 1/5/2009 ASDAN SRC becomes an Registration - coordinator accredited centre fees Start Towards independence 1/5/2009 SRC staff Clients are Time recognized and Student accredited for their materials achievements within Copying the ASDAN Transport . - framework Tuition ASDAN training with overseas 30/6/2009 SRC staff, LHS All staff trained in Tl Flights trainer staff accommodation . Per diem 2010 Deloitte. All Rights Reserved Progression routes within ASDAN for Clients with Special Needs .. . . mW-2010 Deloitte. All Rights Reserved 56 Towards Independence Overview What is it? Towards Independence provides a framework of activities through which personal, social and independence skills can be developed and accredited for those with severe (SLD) and profound multiple learning dif?culties (PMLD). Who is it for? . Post-16 students (so there is a progression route from Key Stage 4) . Students with severe (SLD), moderate (MLD) and profound multiple learning difficulties (PMLD) Towards Independence can be undertaken at schools, colleges, residential homes, day and care centres and across government and private provision. Structure Towards Independence will be used to accredit the existing SRC programme, not to replace it. However opportunities may well be found to extend the existing programme by accessing Tl modules. Towards Independence offers formal recognition for small steps in achievement towards a larger goal. Modules can be used separately and accumulated to build a record of personal achievements. There are almost 50 modules to choose from, and the first of these - Starting Out - is mandatory. This module enables learners to be helped to recognise achievements and plan targets and challenges, which can then be developed through further modules. The modules can be divided into themes (NB: Many of the modules can fit into more than one themed area). Creativity*; Making Pictures; Performing Arts; Creative Studies Photography/Multimedia; Pottery Ceramics; Printing; Sound. Music" Everyday Living*; Independent Living; Meal Preparation Cooking; Money; Using Transport The Environment; Current Affairs; Popular Culture; The World Around Us*; The Wider World Physiotherapy"; Residential Experience Challenge; Sport Leisure/RecreationISport Leisure*; Sports Studies; Water Skills; Yogacise; Using Leisure Time Personal Development] Knowing About Myself; Citizenship; Relationships; Multi-sensory Independent Living Skills Cultural 2010 Deloitte. All Rights Reserved 5? Citizenship/PSHE Experiences"; Coping With People; Getting Ready To Go Out; Getting To Know A Group; Myself and Others*; Self Advocacy; Out In The Community; Recognising And Using Everyday Signs Vocational Training/Experience; Going To College; Horticulture; Personal Safety; Practical Workshop; Using a Computer; Using Work Related Work Awareness; World Of Work*; Time Management Self Organisation; Animal Care (including Horse Riding and Stable Management); Business Enterprise indicates modules particularly accessible for learners with PMLD. Additionally. there is an opportunity to record students' achievements by allocating a Level/National Curriculum reference to their work, as and when this is appropriate. ASDAN has also produced additional resources for recording 'P'/Milestone achievements in Literacy and Numeracy. These might be appropriate for out less challenged clients. Levels of Support are used to show how the learner has achieved the activity. They show individual progression and differentiation between learners. These are: No Help 0 Spoken/Signed Help 0 Gestural Help . Physical Help a Sensory Experience 0 Experience Recorded Assessment Following internal verification, centres are required to register candidates for external moderation four weeks prior to a regional Preparatory Network Moderation Meeting. The meeting provides a forum to receive information on national developments and updates, share good practice and moderate candidates' work. Progression routes There are opportunities for progression from Towards Independence to Workright or the Certificate in Life Skills, an approved Entry Level qualification. at Entry 1. (See above) How much does Tl cost? Centre Guidance and Resources: ?32.90 Starting Out Candidate Folder and book: ?5.80 Additional modules: ?3.50 each Candidate certification: ?3.90 2010 Deloitte. All Rights Reserved 58 Appendix 4: Sunrise Adult Centre survey Ezoomerang' Ministry of Education, Training and Employment - Sunrise Adult Training Centre Needs Assessment Created: March 23 2010, 3:14 PM Last Modified: April 27 2010, 7:06 AM Design Theme: Basic Blue Language: English Button Options: Labels Disable Browser ?Back" Button: False Ministry of Education, Training and Employment Sunrise Adult Training Centre Needs Assessment Page Heading The Ministry of Education, Training and Employment has engaged Deloitte to conduct an assessment for a potential future adult training centre. We will be reviewing the Sunrise adult training centre as a starting point for the future facility. Your responses to these questions would allow The Ministry to identify areas of opportunity and/or improvement which can be used to better serve the needs of people with disabilities in the Cayman Islands. We thank you for your valuable comments and feeback! Page 1 - Heading GENERAL The questions in this section will allow us to obtain a general profile of the various individuals groups that have a direct relationship with the clients of the Sunrise Adult Training Centre. Page 1 - Question 1 - Choice - One Answer (Bullets) Please indicate which of the following categories do you belong to? Client - Sunrise Adult Training Centre Parent - Sunrise Adult Traning Centre Client Guardian - Sunrise Adult Training Centre Client Student - Lighthouse School Parent - Lighthouse School Guardian - Lighthouse School Employer of Sunrise Adult Training Centre Client Other, please specify 2010 Deloitte. All Rights Reserved 59 Page 1 - Question 2 - Choice - Multiple Answers (Bullets) Please indicate the details of your disability or the disability of the person you have a relationship with at the centre. Cerebral Palsy Speech Mental and Learning Behavioral Attention Deficit Disorder Autism Blindness Deafness Cayman Cerebellar Ataxia (Cayman Disease) Physical disability Other, please specify Page 1 - Heading STAFFING (EMPLOYEES) The questions in this section will allow us to assess whether the level of skills of the staff, and number of staff at the centre are currently providing adequate support to the clients of the Sunrise Adult Training Centre. Page 1 - Question 3 - RatingScale - One Answer (Horizontal) Please indicate how responsive is the Centre in providing information and responses to your questions. rF a i r6 0 dExcel-luent Page 1 - Question 4 - Yes or No From your experience with the Sunrise Adult Training Centre, is there sufficient administrative support at the Centre? Yes No Please provide additional comments to explain your answer. Page 1 - Question 5 - Yes or No From your experience with the Sunrise Adult Training Centre, do you believe the Centre has the right combination of therapists specialists to adequately serve the needs of the clients at the facility? Yes No Please provide additional comments to explain your response. It? 2010 Deloitte. All Rights Reserved 60 Page 1 - Question 6 - Yes or No From your experience with the Sunrise Adult Training Centre, do you believe the Centre has a suf?cient number of therapists on staff to adequately serve the needs of the clients at the facility? Yes 0 No 0 Please provide additional comments to explain your response. Page 1 - Question 7 - Open Ended - Comments Box Please indicate any gaps you believe there are in terms of the staffing at the Sunrise Centre. potential needs for specialists/therapists - please specify the skills these individuals should have) Page 1 - Question 8 - Open Ended - Comments Box Please provide any additional suggestions you may have on the staffing complement at the Sunrise Centre. Page 1 - Heading FACILITIES The questions in this section will be used to assess the condition of the facilities and the equipment available for use by the clients at the Centre. Page 1 - Question 9 - Yes or No Do you believe that the Sunrise Centre is currently in a safe and convenient location for the users of the facility? Yes No Please include comments to explain your response Page 1 - Question 10 - Yes or No Do you believe that the Sunrise Centre has adequate space to serve the needs of it's clients. both now and in the future? Yes No Please provide additional comments to explain your response. 2010 Deloitte. All Rights Reserved 31 Page 1 - Question 11 - Yes or No In your opinion, is the centre generally clean and well maintained? Yes No Please provide additional comments to explain your response. Page 1 - Question 12 - Yes or No Do you feel that the equipment at the Centre is comparable with international standards for equipment at other similar facilities? Yes No Please include additional comments to explain your response. Page 1 - Question 13 - Open Ended - Comments Box Please indicate whether there are any specific changes in the facility you would like to see in the future. Page 1 - Heading PROGRAMS The questions in this section will be used to assess the quality of the programs being offered to clients at the Centre. Page 1 - Question 14 - Yes or No Do you believe that the Sunrise Centre currently has the right mix and number of programs for the clients? Yes No Please provide additional comments to explain your response. Page 1 - Question 15 - Rating Scale - One Answer (Horizontal) How satisfied are you with the different types of programs currently being offered at Sunrise? Extremely Dissatisfied Extremely Satisfied 0 2010 Deloitte. All Rights Reserved 62 Page 1 - Question 16 - Rating Scale - One Answer (Horizontal) How satisfied are you with the number/volume of programs being offered at SunriseExtremely Satisfied Page 1 - Question 17 - Open Ended - Comments Box Please indicate whether there are any other changes you would like to see at the Sunrise Centre in the future. Page 1 - Question 18 - Open Ended - Comments Box Please indicate whether there are any other similar centres locally or regionally which can be used as a benchmark for the Sunrise Adult Training Centre. Page 1 - Heading To type in your initial question, click Edit. Insert adds a new question either above or below this one. Thank You Page 2010 Deloitte. All Rights Reserved 63 Appendix 5: The Lighthouse School survey Zzoomerang' Ministry of Education, Training and Employment - Future Needs Assessment Created: March 29 2010. 1:08 PM Last Modi?ed: April 27 2010, 7:06 AM Design Theme: Basic Blue Language: English Button Options: Labels Disable Browser "Back" Button; False Ministry of Education, Training and Employment Sunrise Adult Training Centre Needs Assessment Page 1 - Heading The Ministry of Education, Training Employment has engaged Deloitte to conduct an assessment for a potential future adult training centre. As parents at the Lighthouse School and stakeholders in the special needs community we would welcome your ideas and suggestions on this topic. Page 1 - Heading GENERAL The questions in this section will allow us to obtain a general profile of the various individuals I groups currently using the Lighthouse School, and intending to use an adult centre upon graduation. Page 1 - Question 1 - Choice - One Answer {Bullets} Please indicate the time frame in which you expect your child to graduate from the Lighthouse School. 1 year 2 years 3 years 4 years 5 or more years Page 1 - Question 2 - Choice - Multiple Answers (Bullets) Please indicate the details of your child's special needs. Cerebral Palsy Mental and Learning Behavioral Attention Deficit Disorder Autism Blindness Deafness 2010 Deloitte. All Rights Reserved 64 Cayman Cerebellar Ataxia Physical disability Other, please specify Page 1 - Question 3 - Yes or No Upon graduating do you plan to move your child to an adult facility such as the Sunrise Adult Training Centre? if not, what are your plans for their care after Lighthouse School? Yes No Page 1 - Question 4 - Choice - Multiple Answers (Bullets) If the answer to the above question was "Yes" will the person be attending the facility full-time or part- time. Full-time Part-time Page 1 - Heading STAFFING (EMPLOYEES) The questions in this section will allow us to assess the specialists required at a potential adult training centre. Page 1 - Question 5 - Choice - Multiple Answers (Bullets) What therapists specialists does your child currently use at the Lighthouse School? Occupational Therapists Speech Therapists Counselors Art Therapists Vocational Coaches Life Skills Coaches Other, please specify Page 1 - Question 6 - Choice - Multiple Answers (Bullets) What therapists specialists will your child need in order to achieve maximum results in the future? Occupational Therapists Speech Therapists Counselors Art Therapists Vocational Coaches Life Skills Coaches 2010 Deloitte. All Rights Reserved 65 Page 1 - Question 7 - Open Ended - Comments Box Are there any therapists specialists that you think would be beneficial to the development of your child that are not typically employed in the Cayman Islands? Page 1 - Question 8 - Yes or No Would you use formal transition assistance if it was offered for the move to the new facility? Counseling, Individual Needs Assesments, etc.) Yes No Additional comment Page 1 - Heading FACILITIES The questions in this section will be used to assess the expectation of the facilities and equipment that will be required by the future clients at the centre. Page 1 - Question 9 - Choice - Multiple Answers (Bullets) What area of Grand Cayman would you suggest to be the safest and most convenient location for the future clients of an adult facility? George Town Savannah Bodden Town East End North Side West Bay Red Bay Other, please specify Page 1 - Question 10 - Choice - Multiple Answers {Bullets} Which of the following services would you most like to see at the potential future facility? Laundry services Routine personal care Hygiene assistance Hot meals and snacks Social service needs Assistance with groceries and shopping Residential/live-in facility Respite/Iive-in facility is) 2010 Deloitte. All Rights Reserved 68 Outdoor activities Other Page 1 - Question 11 - Choice - Multiple Answers (Bullets) What equipment is necessary in order to best develop the skills and abilities of your child? equipment Occupational therapy equipment Specific learning tools Art equipment Musical instruments Computers/Computer training Other Page 1 - Question 12 - Choice - Multiple Answers {Bullets} What will be required in order for your child to move safely and comfortably around the facility? Wheelchair ramps Hand railings Automatic doors Other Page 1 - Question 13 - Open Ended - Comments Box What, if any, equipment or accessibility features are currently offered at the Lighthouse School that you would like to see offered in an adult care facility? Page 1 - Question 14 - Yes or No Do you believe that there is a need for a live-in facility in the Cayman Islands? Yes No Additional Comment Page 1 - Question 15 - Yes or No Would you like the facility to provide transportation? Yes No 2010 Deloilte. All Rights Reserved 6? Page 1 - Question 16 - Open Ended - Comments Box What types of features would your child require in order to utilize the transportation service? Page 1 Question 17 - Open Ended - Comments Box Please indicate any other features you would like to see in the facilities of an adult care centre. Page 1 - Heading PROGRAMS The questions in this section will be used to assess the need for different programs in the centre. Page 1 - Question 18 - Open Ended - Comments Box Are there any specific programs or curricula currently offered at the Lighthouse School that you would like to see continued at an adult care centre? ASDAN, Art therapy, etc) Page 1 - Question 19 - Choice - Multiple Answers {Bullets} What specific programs/classes do you believe would be beneficial for your child during their future adult care? Art classes Craft classes (weights and cardiovascular) Musical therapy Recreational therapy Spons Other, please specify Page 1 Question 20 - Yes or No Do you believe that coordinated work/vocational programs should be implemented for those whom are able? Yes 2010 Deloitte. All Rights Reserved 66 No Additional Comment Page 1 - Question 21 - Open Ended - Comments Box Do you know of any centres either regionally or internationally that can be used for benchmarking purposes? Thank You Page 2010 Deloitte. All Rights Reserved 69 A- -endix 6: Internal and External Stakeholder Interview Questions Internal Survey General What is your relationship with the Sunrise Adult Centre? How long have you been involved with this facility? What are you responsible for according to your performance agreement/contract? What additional tasks are you performing, that are not included in your performance agreement/contract? What is asked of you in your performance agreement/contract that you are not able to carry out? How many direct reports do you have? Can you give us an idea of the Centre is structured? How is the centre currently funded What is the annual budget? Is this sufficient? Does the lack of funding hamper the service provided? Who do you rely on to provide services to you within government? What is your opinion of the level of service provided? What are the main challenges issues affecting your centre? mpioyees of the Centre Do you believe that you have sufficient administrative support? If not how does this hamper the effectiveness of the centre? 2010 Deloitte. All Rights Reserved 7'0 Do you believe that you have sufficient staff (therapists etc) in place? If not, what changes would you like to see? Do you have the budget to send the current staff to required training etc as well as maintain the required level of staff on employed? Do you believe that the centre currently has adequate facilities to serve their clients well? What are the main issues or pain points regarding the facilities? What would you like see change? Do you believe that the Sunrise is placed in the optimal location on the Island? Do you believe that the current facility has sufficient space? Do you have the tools required to serve your clients? Are tools and equipment modern and on par with international standards? Do you believe that Sunrise currently has the right assortment and volume of programs on offer to its clients? Programs Offered If not, why? 2010 Deloitte. All Rights Reserved 71 What changes would you like to see going forward? What aspects do you think the centre is excelling in? Do you know of any similar centres in the region or internationally that could be used as best practice benchmarks? 2010 Deloitte. All Rights Reserved 12 What is your relationship with the Sunrise Adult Centre? A endix 7: External Surve Questions How long have you been involved with this facility for? Who is your key contact at the Centre? What types of interactions do you typically have? Is the Centre generally responsive to requests? Do you believe the Centre has sufficient administrative support? mployees of the Centre If not how does this hamper the effectiveness of the centre? Do you believe that the Centre has suf?cient staff (therapists etc) in place? If not, how does this affect the level of service provided? What changes would you like to see to the complement of staff/ therapists at the Centre? Do you believe that the centre currently has adequate equipment 2010 Deloitte. All Rights Reserved 7'3 and facilities to serve their clients well? What are the main issues or challenges regarding the facilities? What would you like to see change? Do you believe that the Sunrise Centre is placed in the optimal location on the Island? Do you believe that the current facility has sufficient space? Are tools and equipment modern and on par with international standards? Programs Offered Do you believe that Sunrise currently has the right assortment and volume of programs on offer to its clients? If not, why? What changes would you like to see going fonlvard? What aspects do you think the centre is excelling in? Do you know of any similar centres in the region or internationally that could be used as best practice benchmarks? (Q 2010 Deloitte. All Rights Reserved 74 Deloitte. 2010 Deloitte 8. Touche Deloitte refers to one or more of Deloitte Touche Tohmatsu. a Swiss Verein. and its network of member ?rms, each of which is a legally separate and independent entity. Please see for a detailed description of the legal structure of Deloitte Touche Tohmatsu and its member ?rms. Deloitte provides audit, tax, consulting. and ?nancial advisory services to public and private clients spanning multiple industries. With a globally connected network of member ?rms in 140 countries, Deloitte brings world-class capabilities and deep local expertise to help clients succeed wherever they operate. Deloitte's 165.000 professionals are committed to becoming the standard of excellence. Deloitte?s professionals are uni?ed by a collaborative culture that fosters integrity, outstanding value to markets and clients, commitment to each other, and strength from cultural diversity. They enjoy an environment of continuous learning, challenging experiences. and enriching career opportunities. Deloitte's professionals are dedicated to strengthening corporate responsibility. building public trust, and making a positive impact in their communities. 2010 Deloitte. All Rights Reserved 75