Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection Report The Chalet St. Asaph Type of Inspection Post Registration Baseline Date(s) of inspection 23 June 2016 and 24 June 2016. Date of publication 24 August 2016 Welsh Government Crown copyright 2016. You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk You must reproduce our material accurately and not use it in a misleading context.
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Summary About the service The Chalet is a care home. It is registered with Care and Social Services Inspectorate Wales (CSSIW) for 5 younger adults with learning disabilities to live there. CSSIW are in charge of checking and inspecting homes like The Chalet. We check that they provide good quality care and support. This report is to tell you what we found when we visited The Chalet. People living in The Chalet are known as students. Students attend Cambian Pengwern College. The Chalet is one of the community residential homes which is part of the college with the emphasis being on promoting independence within the home and community. The Chalet is owned by a company called Cambian Whinfell School Ltd. The company has a person, known as the responsible individual. Their job is to watch over the management of The Chalet. This persons name is Nadine Williams. Mark Wallis is the registered manager for The Chalet. Mark is responsible for managing the home each day. What type of inspection was carried out? Two inspectors went to visit students living in The Chalet. We went in the evening from 5pm until 8pm. We also went back the next day from 9am until 2.15pm. This was an unannounced baseline inspection. Unannounced means we did not tell anyone we were going to visit. Baseline means we looked at lots of areas - quality of life, staffing, leadership and management and the environment. For this inspection we: met with all 3 students who were living in The Chalet talked with and listened to: 2 students about what it was like living in The Chalet. Page 3
3 staff who worked there, the manager Mark and the college principal Tina Ruane. We also asked them about incident/ accident reporting, concerns and complaints, fire safety and infection control. we watched to see how: staff supported students. staff handled and stored student s medication. we gave out questionnaires: to the 3 students we met. All 3 were returned telling us what they thought about The Chalet. to the 3 staff we met. We also left questionnaires for the other staff working there. We did not have any returned to us. to parents and professionals (social workers). We did not have any returned to us. we looked at: 2 students care plans. A care plan tells staff about the support a student needs and wants. 2 staff files to see if the right recruitment checks had been made. staff training records to see what training staff have had. 2 staff supervision records. Supervision is where staff meet with their senior/manager for support. staff rotas to see how many staff were working at the home. the homes statement of purpose. This sets out what the home aims to do and the steps they will take to achieve this. we asked to see the service user guide. This tells students what services they can expect from The Chalet. We are aware that this is being reviewed for all the homes. a student showed us around The Chalet and the garden. What does the service do well? Before we visited The Chalet we had inspected Cambian Pengwern College. Care plans at the college did not have all the information they needed in them. When we visited The Chalet we saw that new care plans had been started. These were easier to read and included more information. They also showed Page 4
how students were being more involved in putting their own plans together. What has improved since the last inspection? This was the first inspection of The Chalet since it has been owned by Cambian Whinfell School Ltd. What needs to be done to improve the service? We found areas where improvements could be made: care plans said there were risk assessments in place to keep students safe. We saw them but they did not always match with the care plan. Information in 1 students care plan was not clear about their food allergy. the way in which students received medication did not respect their privacy and dignity. The right way to store medications was not always being followed by staff. records about incidents/ accidents or concerns/ complaints were not kept at The Chalet. We were told that these were sent to and kept at the college. Information needs to be clearly communicated with staff and students about any actions taken. the statement of purpose and service user guide do not contain the information they need to. These are being looked at by Mark and Tina. staff supervision sessions were not always being done every 2 months. The records we saw were not always completed fully. There were missed signatures and dates by the person carrying out the supervisions. staff inductions do not consider the Care Council for Wales (CCW) induction framework. This would help staff to understand working in social care services in Wales. training records given to us do not show that all staff have received all the training they need. This needs to be looked at so that all staff have up to date training. There should be an up to date record kept of all staff training. we were told that transport was not always available for students when they wanted to go out. This needs to be looked at. Page 5
we did not see that the home was being well maintained with repairs not being acted upon quickly enough. 3 student questionnaires said they did not have a lockable drawer or cupboard in their room. This should be looked at. the laundry room needs to be looked at to ensure that it is a safe place for students to be using independently. Staff were not always following the homes procedure on infection control. Following this inspection we have been given an action plan. This shows us what improvements have or will be made for The Chalet. Page 6
Quality Of Leadership and Management Mark is the registered manager for The Chalet. Mark is also responsible for managing the other homes on site at Cambian Pengwern College. A senior learning support (SLS) staff member also works at The Chalet. They both make sure that the students living there are supported well by the staff team. We looked at the statement of purpose. This did not have all the information it needed in it. From visiting the college we know that all the information needed is not in these. We talked about this with Mark and Tina. They told us that they are making changes to them. They told us they would send us copies of these when they are finished. Students must have the information they need. This is so they are able to make decisions about where they live. We looked at 2 files for staff. This was to see how they had been recruited to work for the company. We found that the right checks had been made. Students living in The Chalet are being protected by the homes recruitment policy. We looked at a copy of the workbook staff must complete for their induction. We did not see that this followed the Care Council for Wales Social Care Induction Framework. This would help staff to understand working in social care services in Wales. We asked for staff training records to see what training staff had. This showed us that not all 11 staff had received all the training. For example only 3 out of 11 staff had training in person centred planning. Only 3 out of 11 staff had medication training. Following the inspection we were provided with further information that showed 9 out of 10 staff had completed medication training. There should be an up to date record kept of all staff training. There is a training plan for 2016. It is not clear what training staff from The Chalet are booked on. We looked at supervision records for 2 staff. Staff should meet with their senior/manager every 2 months. This helps staff to have the support they need to be able to do their job properly. We saw that both staff had supervisions in May 2016. We asked to see more records of other supervisions that they had. These forms did not show that staff were having supervisions every two months. The forms were not always being completed properly. Dates and signatures from the person carrying out the supervisions were missing. We were told by Tina that supervisions for all Page 7
staff would now be held every month. We looked at staff rotas. This was to see if there were enough staff to support students. This showed us that in The Chalet there are 2 staff in the morning. There are 2 staff in the evening. 1 staff member also sleeps in at The Chalet each night. When we visited in the morning 1 student didn t want to get up and go to college. Arrangements should be in place to provide enough staff to support them on occasions like this. We spoke to staff about reporting incidents and accidents. We were told that staff fill in a form and send it to the college. They did not know what happened next. We were told by staff that concerns/ complaints records were also sent to the college. Staff were unaware of any actions being taken. Information about any actions taken need to be clearly communicated with staff and students. Page 8
Quality Of Life When we visited in the evening we saw 2 students having a colouring party with their friend. Students said they enjoyed having friends coming over to spend time with them. They can also be invited to stay for tea. Students can use Skype to keep in contact with their families. They can also go on visits to see their families. A student told us about the activities they did both in and outside of college. They told us about the national catering competition final that they had entered in Birmingham. They received a certificate for this and their family went to watch them. The student had also been to Cardiff and received a trophy from another competition. This was for hanging baskets and planters. A student questionnaire said that there were not always enough activities. They suggested Disney movie nights and outdoor games like football and a trampoline. A student told us that if there was not a vehicle at the weekends they don t go out. They said they stay in and have chill out time at The Chalet. Staff told us that they sometimes struggle for vehicles at weekends. This needs to be looked at. We looked at new copies of care plans for 2 students. These were very different from the ones we had seen when we visited the college. They were much easier to read and for staff to follow. They included pictures and looked at what students should be achieving. They showed that students would be more involved in putting together their own plans. We looked at risk assessments for 2 students. These were not always the same as those referred to in their care plans. We saw that 1 student had an allergy to a type of food. Information about this was unclear in their care plan. This said that the student was allergic. It also said they didn t like it or it made them feel sick. We talked about this with Mark. Mark will make sure that all the right information is in the care plan and any other records. Care plans now have information in about any need to limit a student s freedom. This is known as Deprivation of Liberty Safeguards (DoLs). This may be needed sometimes to keep students safe. We spoke with Mark about making sure information about this is clear and easy to understand. Students and staff need to know what it means for them and the support that is needed. We were told that there is an advocate that students can speak to if needed. Page 9
We spoke to Mark and Tina about including this information in the new care plans. We were told that advocacy information would be added to all students care plans as well as any visits. We looked at the way students were being given their medication. We saw 3 students at different times going in to the medication room for their medication. This room was also used by staff that sleep in at The Chalet at night. The room was very small and it was difficult for staff and students to get in and out of easily. We spoke to Mark and Tina about this. They told us that they would look at how students could have their medication in other rooms where possible. This would respect student s privacy and dignity. Before we left individual medication cabinets had been ordered to make this happen. It was very hot in the room being used to store medication. We looked at staff recordings of the room and fridge temperatures. These records showed that temperatures were above what they should have been. We spoke with a member of staff who did not know what action they should be taking around this. Medication may not work properly if it is not being stored correctly. The fridge was not suitable for what it was being used for. We talked about this with Mark and Tina. We were told that following our visit there was a new fridge in place in another room. We looked at medication administration charts (MAR) which tell staff what medication students need. We saw that creams were being used for students. We did not see clear instructions for staff about where to apply the creams. We were told that body maps are now to be used to show staff where to apply creams. They told us that they had asked the local pharmacy to come and meet with them. This was so that they could get advice about how to keep medicines safely. We asked a staff member if they had information about medication. They told us they did not. We did see that there was a British National Formulary (BNF) book for staff to read. This can be used by staff to check what medications are for. The manager must ensure that staff have the required guidelines for handling medication. Page 10
Quality Of Staffing We looked at how staff were supporting students. Staff were seen to be kind and caring towards students. We spoke with staff and it was clear that they knew the students well. Students also told us they liked the staff that supported them. We saw that the relationships between staff and students were warm, caring and friendly. We saw a member of staff providing students with positive encouragement. A friend had come to visit but was feeling a little anxious. The staff gave them reassurance. Instead of leaving they stayed and enjoyed the rest of the evening with their friends. We saw that students were being supported by staff to be independent. A student was laying the table for the evening meal. The next day they offered us a cup of tea when we arrived. They told us they did the hoovering and cleaned around the home. Staff told us that students are supported to be involved in planning the food menus. Students then do the food shopping with staff support and also help prepare their meals. Page 11
Quality Of The Environment The Chalet provides a homely place for students to live in. We did find that work needed to be done to improve The Chalet. We saw that there were 2 lounges for students to use. 1 lounge is mostly used for socialising and watching television. The other lounge had a computer, drum kit and trampoline in it. There is a large kitchen/ dining area. We saw a person laying the table for their evening meal. Staff and students sit together to eat their food. 1 student was happy to show us their bedroom. We saw that their wardrobe door was broken. They showed this to Mark. He said he would get it fixed. They had their own personal items in their rooms to make them more homely. 3 student questionnaires said they did not have a lockable drawer or cupboard in their room. This should be looked at. We went into the back garden. There were tables and chairs and a swing seat. Fence panels were not all stained the same colour. There was a missing gate and panels where you could see old items/ rubbish being stored. This area needs to be improved. Students should have a nice area where they can spend time outside The Chalet. Following our visit we were told that the fence panels would be replaced and painted green. The garden would be tidied up and the trees cut back. The garden furniture had either been removed or would be painted. When we were in the garden we also noticed the outside of the home needed some repairs. We saw a large crack at the top of the home by the roof. Paint work at the bottom of the home also needed repainting. We talked to Mark about this. When we visited the second day we spoke with the person responsible for maintenance work. He told us that they were there to look at all the jobs that needed doing. This included jobs both inside and outside the home. He told us about the workmen that would be coming to carry out the work. They said they would send us the plan to look at. Following out visit we were told that student s bedrooms and shared spaces would also be updated, repainted and made personal. We looked at fire safety. When we visited we were told they were not expecting to have a fire drill. There was a record book for visitors, students and staff to sign in case there was a fire. 1 person had a plan on how they would need to be supported by staff. This was to make sure that they left the home if there was a fire. We were told by Mark that students and staff practice fire drills and these can be carried out anytime including at night. Page 12
We saw books which showed fire alarm tests were done weekly. Fire drills were done as and when needed. We looked at how the home tries to stop or reduce the risk of infections. There is a policy and procedure for staff to follow to manage infection control. We saw that did not always follow this. We saw that there were colour coded mop buckets with mops. These were out in the back garden. We asked a member of staff what rooms these were used for. They said one was used for the kitchen and one was used for the bathroom. They did not know which one was which. We have been told there is now information for staff in the laundry room. This tells them about the use of colour coded mops and buckets. We went into the laundry room. Although this was a big space it was not being used as well as it could be. There were no work tops or shelves for students to sort out their clean laundry. There was no where for students to wash their hands in the room. We asked if there were gloves and aprons available in the room. We were told that these were kept upstairs. Students living in The Chalet are encouraged to do their own laundry. We saw that the washing powder said irritant on it. We know that students living in The Chalet can have sensitive skin. We talked about this with Mark. We have been told that they will look at the laundry room. This is to see how they can make it better for students to use. Page 13
How we inspect and report on services We conduct two types of inspection; baseline and focused. Both consider the experience of people using services. Baseline inspections assess whether the registration of a service is justified and whether the conditions of registration are appropriate. For most services, we carry out these inspections every three years. Exceptions are registered child minders, out of school care, sessional care, crèches and open access provision, which are every four years. At these inspections we check whether the service has a clear, effective Statement of Purpose and whether the service delivers on the commitments set out in its Statement of Purpose. In assessing whether registration is justified inspectors check that the service can demonstrate a history of compliance with regulations. Focused inspections consider the experience of people using services and we will look at compliance with regulations when poor outcomes for people using services are identified. We carry out these inspections in between baseline inspections. Focused inspections will always consider the quality of life of people using services and may look at other areas. Baseline and focused inspections may be scheduled or carried out in response to concerns. Inspectors use a variety of methods to gather information during inspections. These may include; Talking with people who use services and their representatives Talking to staff and the manager Looking at documentation Observation of staff interactions with people and of the environment Comments made within questionnaires returned from people who use services, staff and health and social care professionals We inspect and report our findings under Quality Themes. Those relevant to each type of service are referred to within our inspection reports. Further information about what we do can be found in our leaflet Improving Care and Social Services in Wales. You can download this from our website, Improving Care and Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW regional office. Page 14