Inspection on 15/06/09 for Chatfield Lodge

This inspection was carried out on 15th June 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chatfield Lodge 18/12/08

Chatfield Lodge 06/12/06

Chatfield Lodge 10/11/05

Chatfield Lodge 30/11/04

Chatfield Lodge 23/09/04

Similar services:

Ashlong House

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Delrose House Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chatfield Lodge 3 Chatfield Road West Croydon Croydon Surrey CR0 3LA     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: James OHara     Date: 1 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 43 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 43 Information about the care home Name of care home: Address: Chatfield Lodge 3 Chatfield Road West Croydon Croydon Surrey CR0 3LA 02086801395 02086861009 unitycommunityltd1@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Barbara Asiama care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia physical disability Additional conditions: For people who have a mental disorder and have a physical disability Date of last inspection Brief description of the care home Chatfield Lodge is registered to provide a service to adults who have mental ill health. The house is a small domestic-sized Victorian property, in an ordinary street close to West Croydon rail station, tram stop and bus services. It is particularly convenient for the numerous facilities that central Croydon has to offer. 1 8 1 2 2 0 0 8 5 5 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 43 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of this service is 0 stars. This means that people who use the service experience poor quality outcomes. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. The inspection was carried out by two Commission regulation inspectors. We spent six hours over two days at the service. We talked with two people who use the service, one member of staff and the registered provider. Limited records and documents examined during the inspection included the Statement of Purpose, needs assessments, care plans, risk assessments, activities, menus, Care Homes for Adults (18-65 years) Page 5 of 43 medication, staffing arrangements and training, health and safety and financial recording. We also spoke the registered provider about the requirements and recommendations set at the last key inspection. What the care home does well: What has improved since the last inspection? What they could do better: The service has not complied with a number of requirements set at the last key inspection. As previously stated the Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. A number of serious concerns where raised during this inspection about the safety of the people who use the service and about the running of the service. We made two referrals to Croydon Social Services Safeguarding Adults Team. As a result of these referrals the Safeguarding Adults Team coordinator has arranged for a serious concerns meeting. Croydon Integrated Adults Mental Health Service has informed us that they have suspended placements to the service until a there is a review and update from the safeguarding investigation. Concerns about the service were compounded by the absence of required records and documents availaible for inspection. For example the commission was unable to assess the adequacy of staffing in the home because no rotas were available. Nor were we satisfied about who actually worked at the service providing care. The service must make sure that peoples needs are fully assessed. People planning to use the service must have up to date and accurate information about the service. This would enable them to make an informed decision about whether or not the service can meet their needs. The service must make sure that identified risks to people who use the service must be properly managed. The service must make sure that people have care plans in place indicating how they would be supported by the service. The service must make sure that people are supported to take part in a programme of activities that reflects their individual interests. People must be given the opportunity to choose what they would like to eat. The service must make sure that peoples health care needs are being met. Care Homes for Adults (18-65 years) Page 7 of 43 Medication must be properly managed. People must be able to live in a clean, comfortable, homely and safe environment. The service must provide a record of who is working at the service. They must keep a record of visitors to the service. The service must make sure that all staff have files that include what hours they work and if checks have been done to make sure that they are suitable to care for the people that live there. The service must be properly managed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 43 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 43 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that the service can meet their needs because their needs are not being fully assessed. People planning to use the service should have up to date and accurate information about the service. This would enable them to make an informed decision about whether or not the service can meet their needs. Evidence: A requirement was set at the last key inspection that there must be a Statement of Purpose that reflects accurately the service provision. We asked the registered provider to show us a copy of the Statement of Purpose, after searching the office the registered provider told us that they could not locate a copy. They told us that an electronic copy was available on their computer but they could not access the computer as the battery in the key board had run out. Following the last inspection we requested that the registered manager send an improvement plan to the Commission. The registered manager sent us a Statement of Care Homes for Adults (18-65 years) Page 10 of 43 Evidence: Purpose along with the improvement plan. That Statement of Purpose does not accurately reflect the service provided. For example the Statement of Purpose cites the organisational structure of the service as having one manager, one deputy manager, one shift leader and four residential support workers and information about the experience and qualifications about staff was also inaccurate. The registered provider must ensure that the Statement of Purpose is made available on request for inspection by every service user and any representative of a service user. The registered provider must ensure that the Statement of Purpose accurately reflects the facilities and services which are to be provided for service users. The registered provider must ensure that all matters listed in Schedule 1 are an accurate account of the information to be included in the Statement of Purpose. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. The service is registered to support up to five people whose primary care needs on admission is mental disorder. There are currently three people living at the service. No new people have moved in since the last key inspection. A requirement was set at the last inspection that there must be full assessments of peoples needs prior to them moving in. At the last key inspection the registered provider told us that three people had recently moved in. Croydons Mental Health team had referred two people at short notice, one person moved in on the 8th of December and the other person on the 15th of December. The registered provider produced Care Programme Approach summaries from a care coordinator for these two people. The registered provider told us that they had used information from the summaries and their own assessments to draw up care plans. At the last key inspection the registered provider told us that the other person was a privately funded family friend. They told us that this person had mental health issues but was not sure of what their mental health condition was. This person had been offered a place without a mental health assessment or a Doctors report and the registered provider had not carried out an assessment. Care Homes for Adults (18-65 years) Page 11 of 43 Evidence: A requirement was set at the last key inspection that information from other health professionals must be obtained as part of the assessment process. The registered provider told us that they had now completed an assessment of this persons needs, the assessment indicated under important information a diagnosis of depression. The registered provider told us that they had made this diagnosis after talking to the persons family and had not sought the advice of other health professionals as part of the assessment. During a telephone conversation the day after the first site visit the registered provider told us that they would contact the persons General Practitioner for an assessment of the persons needs including a mental health assessment, the registered provider conceded that the person may not in fact have a mental health condition. They told us that they understood that if the person is not diagnosed with a mental health condition then this person should not be placed at a service registered by the Commission to support people whose primary care needs on admission is mental disorder. The commission is making further enquiries about the appropriateness of this service users placement and the services ability to meet their needs. The registered provider must maintain in respect of each service user a record which includes the information and documents detailed in Schedule 3. The registered provider must ensure all records as detailed in Schedule 3 are kept securely within the care home. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. A requirement was set at the last key inspection that the registered provider must make sure that people have a contract detailing terms and conditions and what they should expect to receive and pay for facilities and services provided. The contract should be agreed and signed by people at the point of admission. The registered provider produced contracts for two people who use the service, these contracts included terms and conditions and what they should expect to receive and pay for facilities and services provided. They told us that they were waiting for the privately funded persons brother to visit the service to support the person in agreeing and signing the contract. We are concerned that the registered provider has not made sure that all of the Care Homes for Adults (18-65 years) Page 12 of 43 Evidence: people who use the service have a contract. The registered provider must ensure that records as detailed in Schedule 4 are maintained in the care home. The registered provider must ensure that all records as detailed in Schedule 3 and Schedule 4 are kept up to date and available for inspection by any person authorised by the Commission. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. Care Homes for Adults (18-65 years) Page 13 of 43 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that they are properly supported or safe because care plans and risk assessments have not been developed. Evidence: A requirement was set at the last key inspection that there must be care plans in place which leads from a persons assessment of need. These plans must be reviewed at regular intervals. We looked at three peoples files. All of the files included needs assessments, one persons file included a weekly activities plan and records of occupational therapy sessions, two files included Care Programme Approach summaries. The Care Programme Approach summaries included detailed information on the persons needs and included risk assessments and crisis plans. The registered provider told us that they used information from Care Programme Approach summaries and their own assessment to draw up care plans for two people. Care Homes for Adults (18-65 years) Page 14 of 43 Evidence: The registered provider told us that the other person had a care plan drawn from the registered providers assessment however they told us that they had not sought the advice of other health professionals as part of the assessment or developing the care plan. When asked to produce a copy of this persons care plan the registered provider told us that there wasnt one. The registered manager sent us a copy of the services care planning form along with the improvement plan however these had not been fully completed for any of the people who use the service. Although the registered provider had carried out assessments there were no plans in place indicating how people would be supported by the service to meet their needs as identified in the Care Programme Approach summary. We are concerned that people who use the service do not have plans in place indicating how they would be supported by the service to meet their needs. The registered provider must, unless impracticable, following consultation with the service user and or their representative, put in place a written care plan that details how the service is to meet the health and welfare needs of the service user. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. A requirement was set at the last key inspection that each person must have individualised risk assessments in place. The risks to two people had been identified in their Care Programme Approach summaries. The registered manager sent us a copy of the services risk assessment form along with the improvement plan. We found a completed risk assessment form on one persons file, although the form identified the risks to the person the form did not indicate how the risk would be managed. The service did not have any procedures in place to manage these risks. There were no risk assessments in place for the other person who uses the service. We are concerned that the risks identified for people who use the service are not being properly managed. The registered provider must ensure that unnecessary risks to the health and safety of service users are identified and arrangements put in place to ensure as far as possible these risks are eliminated. The Commission is taking enforcement action to secure compliance and achieve better Care Homes for Adults (18-65 years) Page 15 of 43 Evidence: outcomes for service users. Care Homes for Adults (18-65 years) Page 16 of 43 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service could do more to make sure that people are supported to take part in a programme of activities that reflects their individual interests. People are not being given the opportunity to choose what they would like to eat. Evidence: On both of our site visits one person was observed sitting in the same chair in the lounge and was wearing the same clothes at each visit. On our second visit another person who uses the service was present. Their hair had not been brushed, their clothes were stained and they did not have any tights on underneath their skirt. One person told us that they attended a day centre one day a week. They told us that they sometimes go shopping and go to the hairdressers once a fortnight sometimes supported by staff, sometimes alone. The other person told us that they had an Care Homes for Adults (18-65 years) Page 17 of 43 Evidence: Occupational Therapy session once a week but they didnt do much else. Another person who lives at the service was attending an appointment at the hospital. A requirement was set at the last inspection that there must be a menu plan in place and a record of what food is prepared and served. Both people told us that they had mince, potatoes, lettuce and peas for lunch. They told us that they did not assist with the cooking, this had only occurred once before. They told us that staff buy the food and cook all of the meals. One person said the food was good, but you do not always get food when you want and so are hungry. We looked in the fridge and freezers. The fridge had two loaves of bread, some spread and an onion in it. Both freezers were frosted up, one freezer had a packet with a prawn dish in the other freezer had a packet of chicken pies and a packet of meat pies. There were other packets in this freezer, about four in all, but it was difficult to read what was on the label due to the ice. We did not see any fresh fruit or vegetables in the kitchen. The registered provider told us that they were defrosting the freezers so that they could be restocked. We looked at the menu displayed in the dining room, the menu did not reflect what people had eaten at lunch time; the menu was dated 28th June 2009. When we asked the registered provider for the current menu they told us it was the one on the wall but there had been a mix up with the dates. We asked the registered provider to provide previous menus and records of what people had eaten. The registered provider told us that they did not have any. We asked the registered provider for receipts for the food shopping, they produced some from a plastic bag however these were not dated so we could not establish when food had been purchased. The registered provider told us that they kept the receipts for each month then sent them off to an accountant. We agreed with the registered provider that it would be difficult for the accountant to record the services expenditure when receipts had not been dated. There were no other records of expenditure at the service We are concerned that records of food eaten by people who use the service are not being kept and people are not being given the opportunity to choose what they would like to eat. The registered provider must ensure that records as detailed in Schedule 4 are maintained in the care home. The registered provider must ensure that all records as detailed in Schedule 3 and Care Homes for Adults (18-65 years) Page 18 of 43 Evidence: Schedule 4 are kept up to date and available for inspection by any person authorised by the Commission. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. Care Homes for Adults (18-65 years) Page 19 of 43 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be sure that their health care needs are being met because there are no completed care plans or risk management plans in place. People can not be sure that their health care needs are being met because medication is not being properly managed. Evidence: A requirement was set at the last inspection that medication must be handled in accordance with current guidance. The homes policy must include sections on self medication and appropriate risk assessments should be in place. The registered manager sent us a medication policy and self medication risk assessment forms along with the improvement plan. None of the people who use the service administer their own medication. All of the people who use the service are registered with a General Practitioner. At the last inspection the registered provider told us that the privately funded person kept their medication in their bedroom. This person had moved into the service Care Homes for Adults (18-65 years) Page 20 of 43 Evidence: without a mental health assessment or a Doctors report. It was recorded in the last inspection report that the registered provider must move this persons medication to the locked cabinet in the office until an assessment is carried out to establish whether they are capable of self administration of medication. The registered provider told us that this persons medication is now kept in the cabinet in the office. The registered provider told us that they had now completed an assessment of this persons needs, the assessment indicated under important information a diagnoses of depression. The registered provider told us that they had made this diagnosis after talking to the persons family and had not sought the advice of other health professionals as part of the assessment as required at the last inspection. As previously stated in this report the registered provider told us that they would contact the persons General Practitioner for an assessment of the persons needs including a mental health assessment. We looked at the Medication Administration Records for all of the people who use the service. The service could not demonstrate that one individual had recieved their medication for a period of three days because the medication administration record sheet had not been signed. Other peoples records showed that the registered provider had signed the Medication Administration Records every evening since the 9th of February 2009. Records showed that one person had signed the Medication Administration Records every morning from the 9th of February 2009 to the 22nd of March 2009. The registered provider told us that this person had been an agency staff. Records also showed that one member of staff had signed the Medication Administration Records every morning from the 23rd of March 2009 to the date of this visit. We asked this member of staff if they worked at the service everyday and they told us that they did not. When we asked them if it was their signature on the Medication Administration Records they agreed that it was. When asked why the records had been signed everyday the registered provider did not offer an explanation however the member of staff said they signed every morning and were at the service daily. On our second site visit we observed pieces of a torn up Medication Administration Records on the floor and in the bin in the office. We asked the registered provider why the records had been torn up, they told us it was because a mistake had been made. We advised the registered provider that all documentation was required to be kept Care Homes for Adults (18-65 years) Page 21 of 43 Evidence: and that mistakes should be crossed out and signed. We collected these pieces of Medication Administration Records from the floor and the bin and asked the registered provider if we could take them away. The registered provider agreed and we gave the registered provider a receipt for the pieces of paper taken. These 28 day Medication Administration Records were dated to commence on the 9th of June 2009. Following our visit we pieced together the document and found that one medication had been signed as administered from the 9th of June 2009 to the 6th of July 2009 indicating that medication had been recorded as being administered weeks in advance. We are concerned that people who use the service may be at risk. The registered provider must ensure the proper arrangements for the recording of medications received in the care home. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. Care Homes for Adults (18-65 years) Page 22 of 43 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is now a complaints procedure in place that people who use the service can understand. Evidence: A requirement was set at the last inspection that there must be a complaints policy accessible within the home. The registered manager sent us a copy of the complaints procedure along with the improvement plan. The registered provider told us that the complaints procedure is included in the Statement of Purpose and a copy of the complaints procedure was given to people in their welcome booklets. The registered provider told us that she had not received any complaints about the service since the last inspection. The Commission has not received any complaints about the service. It was recommended at the last inspection that the registered provider obtain a copy of Croydon Councils Safe Guarding Adults procedure. This recommendation was not assessed during these site visits. It was recommended at the last inspection that the registered provider attend refresher training on adult protection. Training records indicated that the registered Care Homes for Adults (18-65 years) Page 23 of 43 Evidence: provider had not attended refresher training on adult protection. Care Homes for Adults (18-65 years) Page 24 of 43 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More could be done to make sure that people can live in a clean, comfortable, homely and safe environment. Evidence: All of the people who use the service have bedrooms with en suite facilities. There is also communal bathroom and a toilet. One person showed us their bedroom, the registered provider also came into the room. The persons room had a carpet that was not fitted and smelt of urine and was stained. The bed was an old divan, the mattress was grubby and dirty. The sheets and curtains were grubby and dirty looking. Furnishings were basic. The registered provider must ensure that the carpet in one persons bedroom is cleaned or replaced and properly fitted. The registered provider must ensure that one person is provided with suitable furnishings and that this furniture is kept in a good state of repair. The two other peoples bedrooms were suitably furnished and tidy. Care Homes for Adults (18-65 years) Page 25 of 43 Evidence: There is a dining room with a table and chairs and a lounge with comfortable furniture and a television, there is also a computer room that people who use the service can access if they wish and a staff room. Care Homes for Adults (18-65 years) Page 26 of 43 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that they are safe because the registered provider is not able to provide records of who is working at or visiting the service. It was not possible to establish who is working at the service, what hours they work or if checks have been done to make sure that they are suitable to care for the people that live there. Evidence: At the last inspection the registered provider had allowed a member of staff to start work at the service prior to obtaining a Criminal Record Check or seeking Protection of Vulnerable Adults clearance. An immediate requirement was served that all members of staff employed to work at the service must complete a Criminal Record and Protection of Vulnerable Adults Check before commencing employment. The registered provider was advised that this member of staff could not work at the service until they obtained the above clearance. The registered provider told us that they immediately contacted an employment agency to recruit staff to cover the service on a temporary basis until the member of staff obtained their Criminal Record Check and Protection of Vulnerable Adults clearance. The member of staff has since obtained a Criminal Record Check and returned to work at the service. Care Homes for Adults (18-65 years) Page 27 of 43 Evidence: When we visited on the 18th of June 2009 we found a piece of paper on the office floor with a persons name on it, this indicated that the person would be absent on some dates in May. We asked the registered provider who this person was. They told us that it was an agency staff employed by Croydon Social Services to visit the privately funded person to support them with bathing. When we asked the registered provider to produce a staffing roster they told us that they did not have one and that there was no record of this person visiting the service. We requested copies of the previous three months rosters, these were also not available. The registered provider told us that the agency staff comes from an outside agency to care for one person, they told us that they did not think the agency staff had anything to do with the service and did not believe that agency workers should be on the roster. We are concerned that people who use the service may be at risk because the registered provider has not kept a record of all visitors to the home, including the names of the visitors. We asked the registered provider if we could take the piece of paper we found on the office floor away. The registered provider agreed and we gave the registered provider a receipt for the piece of paper taken. The registered manager sent us a copy of a staffing roster along with the improvement plan. The roster indicated that the registered provider was supported by two members of staff. The roster only included the first names of the staff. The registered provider told us that one of these staff was an agency worker. The registered provider also told us that an administration person worked at the service one day a week. When asked to produce the administration persons file the registered provider told us they could not find that persons file. The registered provider was asked to produce time sheets or invoices for the agency staff, they told us that the accountant had copies of the agency staffs time sheets and that staff are paid by cheque. A member of staff present at our second visit told us that they did not have wage slips. The registered provider told us the name of the agency they used for care staff. However when we contacted the agency they had no record of providing care staff to the service since December 2008. The registered provider produced a file for one member of staff. The file included a Criminal Record Check, copies of the persons passport and driving licence, proof of address, a completed application form for Unity Community Care Homes, two references, training records, a development plan and one supervision record. The file Care Homes for Adults (18-65 years) Page 28 of 43 Evidence: did not include a contract or job description. We asked the registered provider for a copy of the member of staffs contract. The registered provider and the member of staff had a conversation about the contract, there appeared to be some confusion as to the whereabouts of the contract or even if the member of staff had a contract. It was very difficult to establish what staff worked at the service, what hours they worked or be satisfied that adequate pre employment checks had been undertaken. When we spoke to two people who use the service during our second visit about staff that worked there they recalled the names of the registered provider and the member of staff present and the names of three other people they said worked there however they had not heard of the staff whose name appeared on the duty rota provided by the registered provider along with the improvement plan. The registered provider and the member of staff present told us that they did not know the people that the people who use the service mentioned. We spoke the member of staff they told us that they had worked at the service as a support worker since December 2008 and also provided occupational therapy sessions to one people who use the service on a Thursday. They told us that they were completing an NVQ level 3 in Care and hoped to complete NVQ level 4 in the future. As previously stated in Personal Healthcare and Support standards of this report the member of staff told us they signed medication records every morning and were at the service daily. A requirement was set at the last inspection that there must be a roster in place to demonstrate who will be meeting care needs. This requirement has not been met. We are concerned that people who use the service are not being properly cared for because there is not enough staff to look after them. The registered provider must ensure that records as detailed in Schedule 4 are maintained in the care home. The registered provider must ensure that all records as detailed in Schedule 3 and Schedule 4 are kept up-to-date and available for inspection by any person authorised by the Commission. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. The member of staffs file included details of training attended. They had completed an NVQ level 2 in Care, attended training on first aid in June 2008, food hygiene and Care Homes for Adults (18-65 years) Page 29 of 43 Evidence: moving and handling in October 1998 and arts and crafts and sports and games training April 2003. We asked the registered provider for the services training records, the registered provider produced a Chatfield Lodge training record sheet that included only one entry for the registered provider in 2004. We are concerned that people who use the service are at risk because the registered provider and staff are not properly trained. The registered provider must ensure that they and all staff attend training on food hygiene, moving and handling, first aid, medication, safeguarding adults, health and safety and fire safety. Care Homes for Adults (18-65 years) Page 30 of 43 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be sure that their needs are being met because the service is not being properly managed. Evidence: A number of serious concerns where raised during this inspection about the safety of the people living there and about the running of the service. We made two referrals to Croydon Social Services Safeguarding Adults Team. As a result of these referrals the Safeguarding Adults Team coordinator has arranged for a serious concern about a provider planning meeting to be held. Croydon Integrated Adults Mental Health Service has suspended placements to the service until a there is a review and update from the safeguarding investigation. Concerns about the service were compounded by the absence of required records and documents availaible for inspection. The registered provider was not able to produce care plans detailing the arrangements for meeting peoples care needs, risk assessments, menu plans or a record of food provided, staff rotas, staff files and Care Homes for Adults (18-65 years) Page 31 of 43 Evidence: details of anyone else employed to provide care, visitors records, a legitimate insurance certificate and some medication administration records had been destroyed. The registered provider must ensure that all records as detailed in Schedule 3 and Schedule 4 are kept up to date and available for inspection by any person authorised by the Commission. The Commission is taking enforcement action to secure compliance and achieve better outcomes for service users. The registered provider is also the registered manager for the service. The registered provider has included in the Statement of Purpose that they were working towards or attempting to maintain the following qualifications Registered Mental Nurse, State Registered Nurse, State Enrolled Nurse and the Registered Managers Award, to be completed. However we could find no evidence to confirm that the registered provider was a State Registered Nurse. It was difficult to establish who owns the service. The front of the Statement of Purpose has a motif with Unity Community Residential Care Limited written underneath. The registered manager told us that the service is owned by a company called Unity Community Ltd. The registered manager is registered with the Commission as the responsible individual, they told us Unity Community Ltd is providing care to the people that live there and that they manage the service for Unity Community Ltd. Unity Community Ltd is not registered with the Commission as a care provider and we found documentary evidence that Unity Community Ltd was in the process of being dissolved by Companies House. We noted that a new company called Unity Community, Chatfield Lodge Ltd, had been incorporated in March 2009. The registered provider told us that they were not aware that this company was active. We served a Police and Criminal Evidence Code B notice to the registered provider and removed a number of documents from the premises. We are concerned that the service is not registered. The Commission may take enforcement action against the registered provider. The Commission was contacted in writing by the registered providers insurance company informing us that they had cancelled the insurance cover for the service with effect from the 22nd December 2008 leaving them with no insurance cover in place. Care Homes for Adults (18-65 years) Page 32 of 43 Evidence: They told us on the telephone that they had sent out an insurance certificate to the service in December 2008 however this was no longer valid. They told us that they had written to the registered provider in March 2009 informing them that that they had cancelled the insurance cover because they had not received payment. We asked the registered provider for the services insurance cover. The registered provider handed us an insurance certificate and told us that the service was insured by that company. We called the company on the certificate who again confirmed that the insurance cover had been cancelled and the certificate was invalid. The insurance company was contacted on the 19th of June, they told us that they had received a payment from the registered provider but were waiting for the payment to clear. The insurance company was contacted again on the on the 24th of June 2009, they told us that they started providing insurance cover for the service with effect from the 24th of June 2009. We are concerned that people who use the service and staff were left at risk because the registered provider had failed to procure insurance cover for the service. We served a Police and Criminal Evidence Code B notice to the registered provider and removed the certificate. The Commission may take enforcement action against the registered provider for failing to provide insurance cover for people who use the service and staff between the 22nd of December 2008 and the 24th of June 2009. The registered provider was asked to provide any bills in relation to council tax or water services, they could not produce these. The registered provider produced bills relating to electric, gas and telephone. The gas bill indicated that the gas supply was due to be disconnected the day after our visit. The registered provider told us that they had made payment arrangements with the gas company and the gas would not be disconnected. We asked the registered provider to provide us with information regarding the financial status of the service. The registered provider told us that their accountant dealt with all of the services finances. We asked if the accountant was available to bring this information to the service. The registered provider tried to contact the accountant by phone but got no response. Following this inspection the Commission wrote to the registered provider requesting information on the financial viability of the service. It is the Commissions intention to Care Homes for Adults (18-65 years) Page 33 of 43 Evidence: undertake an assessment of the financial viability of the service, review the services financial position in relation to the stated aims and objectives of the home and to ensure that service users accommodated are safeguarded. A requirement was set at the last inspection that there must be appropriate fire safety systems in place. The existing fire alarm system needs checking to make sure it works. The registered provider produced evidence that an engineer had checked the fire alarm system. Fire records showed that the fire alarm system is checked weekly and regular fire evacuations are carried out. Care Homes for Adults (18-65 years) Page 34 of 43 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 There must be a full 15/05/2009 assessment of peoples need prior to them moving into the home. This will make sure that need is identified and the home can demonstrate that it is able to plan how to meet an individuals need. 2 2 14 Information from other 15/05/2009 health professionals must be obtained as part of the assessment process. This will make sure that that all needs are appropriately identified and planned for. 3 5 5 Each person who lives in the 15/05/2009 home must be provided with a contract that details what the service provision is and what is included in the fee. This will make sure that people are aware of what the weekly fee covers and what monies will be required for extras. 4 34 19 There must be a clear recruitment procedure in place and necessary checks carried out. This will make sure that staff 15/05/2009 Care Homes for Adults (18-65 years) Page 35 of 43 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action are recruited in a safe manner and people are not placed at risk of harm Care Homes for Adults (18-65 years) Page 36 of 43 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The registered provider must ensure that the Statement of Purpose is made available on request for inspection by every service user and any representative of a service user. This is a Statutory Requirement Notice. So that people can make an informed decision about whether the service can meet their needs. 10/08/2009 2 1 4 The registered provider must ensure that the Statement of Purpose accurately reflects the facilities and services which are to be provided for service users. This is a Statutory Requirement Notice. 10/08/2009 Care Homes for Adults (18-65 years) Page 37 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people can make an informed decision about whether the service can meet their needs. 3 1 4 The registered provider 10/08/2009 must ensure that all matters listed in Schedule 1 are an accurate account of the information to be included in the Statement of Purpose. This is a Statutory Requirement Notice. So that people can make an informed decision about whether the service can meet their needs. 4 2 17 The registered provider must maintain in respect of each service user a record which includes the information and documents detailed in Schedule 3. This is a Statutory Requirement Notice. So that there are the necessary records and documents to demonstrate how the health and welfare needs of service users are met. 5 2 17 The registered provider must ensure all records as 10/08/2009 10/08/2009 Care Homes for Adults (18-65 years) Page 38 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action detailed in Schedule 3 are kept securely within the care home. This is a Statutory Requirement Notice. So there are records available for the commission to inspect and assess the care provided to people who use the service. 6 6 15 The registered provider 05/08/2009 must ensure, unless impracticable, following consultation with the service user and or their representative, put in place a written care plan that details how the service is to meet the health and welfare needs of the service user. This is a Statutory Requirement Notice. So that people who use the service can have plans in place indicating how they would be supported by the service to meet their needs. 7 9 13 The registered provider must ensure that unnecessary risks to the health and safety of service users are identified and 05/08/2009 Care Homes for Adults (18-65 years) Page 39 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action arrangements put in place to ensure as far as possible these risks are eliminated. This is a Statutory Requirement Notice. So that the risks identified for people who use the service are properly managed. 8 17 17 The registered provider must ensure that records as detailed in Schedule 4 are maintained in the care home. This is a Statutory Requirement Notice. So there are records to demonstrate how the service is managed and how people who use the service are safeguarded. 9 20 13 The registered provider must ensure the proper arrangements for the recording of medications received in the care home. This is a Statutory Requirement Notice. 05/08/2009 10/08/2009 Care Homes for Adults (18-65 years) Page 40 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that people can be sure that their health care needs are being met. 10 25 23 The registered provider 30/09/2009 must ensure that one person is provided with suitable furnishings and that this furniture is kept in a good state of repair. So that people can live in a clean, comfortable, homely and safe environment. 11 25 23 The registered provider must ensure that the carpet in one persons bedroom is cleaned or replaced and properly fitted. So that people can live in a clean, comfortable, homely and safe environment. 12 35 18 The registered provider must ensure that they and all staff attend training on food hygiene, moving and handling, first aid, medication, safeguarding adults, health and safety and fire safety. So that people can be sure that staff are competent and have the skills and abilities to support them in meeting their needs. 30/10/2009 30/09/2009 Care Homes for Adults (18-65 years) Page 41 of 43 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 13 37 17 The registered provider must ensure that all records as detailed in Schedule 3 and Schedule 4 are kept up to date and available for inspection by any person authorised by the Commission. This is a Statutory Requirement Notice. So the commission can inspect the records that will demonstrate how the service is managed and service users safeguarded. 10/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 42 of 43 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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