Care Home: Chatfield Lodge

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What the care home does well People can be sure that their complaints and concerns are listened to because there is a complaints procedure that that they can understand. The Commission has not received any complaints about the service. The service offers people a clean, comfortable, and homely environment. What has improved since the last inspection? Overall information included in the Statement of Purpose has significantly improved. Good information is now available to people about the service. People now have care plans and risk assessments. The management team have developed a quick reference guide that includes important information about people who use the service for new and agency staff. All records are securely stored. The weekly activities programme for the current service users has been improved. A weekly menu has been developed and people are being supported to cook. All medicines are stored securely and labelled with full instructions for use. People are being given their medicines as prescribed. The management team have developed daily handover sheet. Staff have recently attended relevant training that will enable them to meet the needs of the service users. Staffing records have improved. People who use the service can be confident about the staff as checks have been done to ensure they are suitable to care for them. A new staffing roster system is in place. All visitors are now required to sign the book when they enter the service. The management team have developed a simple transparent system for recording peoples financial income, expenditure and balances. The registered provider and the deputy manager have been working together as a management team to meet the needs of the people who use the service. Improvements have been made in this outcome area. What the care home could do better: Care managers reviewed placements. As a result of these reviews one person has moved to another service. During this visit the registered provider told us that another person was moving out on Tuesday 24th of November.It has been established since the last key inspection that the remaining person is a member of the registered providers family. They are currently receiving a care package from a domiciliary care agency. The registered provider told us that they were in discussions with the local authority with the view to offering a care package to this person. The registered provider told us that they were considering their future options for the service. Their aim is to improve the service rating and admit new people. It is recommended that the registered provider keep the Care Quality Commission informed of any decisions made about the running of the service. Improvements have been made in personal and health care support outcomes, however the staff team require further training to make sure that peoples health care needs can be met. All staff who administers medication must attend training on the administration of medication. The service should obtain written evidence that staff supplied by agencies have received medication training before they are permitted to administer medication to service users at Chatfield Lodge. A signature from the pharmacist must be obtained when medicines are returned. The registered provider told us that they found the administrative aspect of running the service a challenge and an area where they needed to improve. They have been working with the deputy manager as a management team to improve the service and to meet the Care Quality Commission requirements. The deputy manager is currently taking a gap year from university and plans to return next year. The administrative aspect of the service has significantly improved. They told us that Croydon Councils Care Home Support Team had been very supportive, offering advice and training for staff. The registered provider must undertake from time to time such training as is appropriate to ensure that they have the experience and skills necessary for managing the service. The registered provider should complete the Registered Managers Award. 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:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: James OHara     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 32 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 0 6 2 0 0 9 5 5 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 32 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: one star adequate 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 for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Following the last key inspection, 18th of June 2009, ten Statutory Requirement Notices were served to ensure compliance and improve outcomes for people who use the service. We also made a referral to Croydon Councils Safeguarding Team regarding issues identified at that inspection. The Safeguarding Team has conducted a number of meetings under their serious concerns about a provider protocols. Croydon Councils Care Home Support Team has visited the service to offer advice, support and training for staff. We visited the service on the 12th of August 2009 to check whether the service had Care Homes for Adults (18-65 years) Page 5 of 32 complied with the Statutory Requirement Notices. We assessed that eight of the ten Statutory Requirement Notices had been met. Another two Statutory Requirement Notices were served. A CQC pharmacist inspector visited the service on the 3rd of November 2009 to check compliance. We have assessed that all of the Statutory Requirement Notices have been met. This inspection was carried out by two regulation inspectors. We spent three hours at the service and talked with the registered provider, the registered provider is also the manager of the service, and the deputy manager. Records and documents examined included risk assessments, care plans, activities, medication, staff recruitment and training and quality assurance. The deputy manager completed an Annual Quality Assurance Assessment to tell us about the service provided, how it makes sure of good outcomes for the people using it and any planned developments. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care managers reviewed placements. As a result of these reviews one person has moved to another service. During this visit the registered provider told us that another person was moving out on Tuesday 24th of November. Care Homes for Adults (18-65 years) Page 7 of 32 It has been established since the last key inspection that the remaining person is a member of the registered providers family. They are currently receiving a care package from a domiciliary care agency. The registered provider told us that they were in discussions with the local authority with the view to offering a care package to this person. The registered provider told us that they were considering their future options for the service. Their aim is to improve the service rating and admit new people. It is recommended that the registered provider keep the Care Quality Commission informed of any decisions made about the running of the service. Improvements have been made in personal and health care support outcomes, however the staff team require further training to make sure that peoples health care needs can be met. All staff who administers medication must attend training on the administration of medication. The service should obtain written evidence that staff supplied by agencies have received medication training before they are permitted to administer medication to service users at Chatfield Lodge. A signature from the pharmacist must be obtained when medicines are returned. The registered provider told us that they found the administrative aspect of running the service a challenge and an area where they needed to improve. They have been working with the deputy manager as a management team to improve the service and to meet the Care Quality Commission requirements. The deputy manager is currently taking a gap year from university and plans to return next year. The administrative aspect of the service has significantly improved. They told us that Croydon Councils Care Home Support Team had been very supportive, offering advice and training for staff. The registered provider must undertake from time to time such training as is appropriate to ensure that they have the experience and skills necessary for managing the service. The registered provider should complete the Registered Managers Award. 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 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 32 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 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this outcome area. Good information is now available to people about the service. No new people have moved in since the last inspection however all the procedures are now in place should they be needed. Evidence: Following the last key inspection, 18th of June 2009, ten Statutory Requirement Notices were served to ensure compliance and improve outcomes for people who use the service. We visited the service on the 12th of August 2009 to check whether the service had complied with the Statutory Requirement Notices. The Commission required the Registered Provider by 8th August 2009 to ensure that the Statement of Purpose was made available on request for inspection and each individual and their and representative. On the 12th of August 2009 the deputy manager produced an updated Statement of Purpose and told us that people who use the service and their representatives had access to the document. Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: The Commission required the Registered Provider by 8th August 2009 to ensure the Statement of Purpose accurately reflected the facilities and services which are to be provided. On the 12th of August 2009 the deputy manager showed us the Statement of Purpose. There was confusion as to the registration of the service as the Statement of Purpose had been completed under the heading of Unity Community Residential Care Home a limited company. During this visit the registered provider told us that they had contacted their representatives to clarify the situation. The service is trading as Chatfield Lodge and Unity Community is used only as an e mail address. The Statement of Purpose had been updated to reflect the facilities and services which are to be provided. The Commission required the Registered Provider by 8th August 2009 to ensure that all matters listed in the Schedule 1 are an accurate account of the information to be included in the Statement of Purpose. On the 12th of August 2009 we found that all information listed in Schedule 1 of the Care Homes Regulations was included in the Statement of Purpose. Overall information included in the Statement of Purpose has significantly improved. The Commission required the Registered Provider by 8th August 2009 to maintain in respect of each service user a record which includes the information and documents detailed in Schedule 3. On the 12th of August 2009 we found that two people who used the service had assessments carried out prior to moving into the service. When we arrived on the 12th of August 2009 the other person who lives at the service was being visited by two social workers from Croydon Social Services, they were carrying out an assessment. The registered provider produced signed and agreed contracts for all of people using the service, these contracts included terms and conditions and what they should expect to receive and pay for facilities and services provided. All other information listed in Schedule 3 of the Care Homes Regulations was available for inspection. Following the last key inspection we made a referral to Croydon Councils Safeguarding Team regarding issues identified at the inspection. The Safeguarding Team has conducted a number of meetings under their serious concerns about provider Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: protocols. An action agreed at the first serious concerns meeting on the 1st of July 2009 was that Croydon Councils Care Home Support Team would visit the service to offer advice and support. Another action agreed was that the three people living at the service would have their placements reviewed. Care managers visited and reviewed the placements. As a result of these reviews one person has moved to another service. During this visit the registered provider told us that another person was moving out on Tuesday 24th of November. The deputy manager told us that this person has expressed that they were not happy with the planned move and they were contacting this persons care manager to discuss it. It has been established since the last key inspection that the remaining person is a member of the registered providers family. They are currently receiving a care package from a domiciliary care agency. The registered provider told us that they were in discussions with the local authority with the view to offering a care package to this person. The registered provider told us that they were considering their future options for the service. The registered provider told us that their aim was to improve the service rating and admit new people. It is recommended that the registered provider keep the Care Quality Commission informed of any decisions made about the running of the service. Care Homes for Adults (18-65 years) Page 12 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this outcome area. People now have basic care plans and risk assessments. Evidence: The Commission required the Registered Provider by 8th August 2009 to ensure all records as detailed in Schedule 3 are kept securely within the home. On the 12th of August 2009 we found that all records were stored in a cabinet in the office. The Commission required the Registered Provider by 8th August 2009 to ensure, unless impracticable, following consultation with the person and or their representative, put in place a written care plan that details how the service is to meet the health and welfare of the person using the service. On the 12th of August 2009 we found that all of the people who use the service had Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: care plans. These records were stored in a cabinet in the office. People who use the service and or their representatives had been consulted. However the care plans were very basic and did not include how care was to be delivered. For example care plans did not indicate when people needed the support identified in the care plans and there were no guidelines in place to support people who present challenging behaviours. There was a weekly time table of activities. We advised the registered provider that they had some information in different areas that could be pulled together to develop better care plans. During this inspection the deputy manager produced a new format for recording care plans. They were awaiting advice on the format from Croydons Care Homes Support Team. We looked at the format with the registered provider and the deputy manager and after discussion agreed that the format was an improvement on the previous care plan but could be simplified. The deputy manager told us that they would modify the new format. At the last key inspection we looked at two peoples files, we found a risk assessment form on one persons file. Although the form identified the risks to the person it did not indicate how the risk would be managed. The service did not have any procedures in place to manage these risks. The Commission required the Registered Provider by 8th August 2009 to ensure that unnecessary risks to the health and safety of people are identified and arrangements put in place to ensure that as far as possible these risks are eliminated. It was confirmed at the compliance visit on 12th August 2009 that the registered provider had not taken any action to review or make improvements to the risk assessments that were in place prior to the Statutory Requirement Notices being served. A further Statutory Requirement Notice was served on the 4th of September 2009 that the registered provider was required by 18th September 2009 to ensure that unnecessary risks to the health and safety of people are identified and arrangements put in place to ensure as far as possible these risks are eliminated. During this visit the registered provider and deputy manager produced risk assessments for the current person using the service. The risk assessments had a significantly improved. The risk assessments included the risk identified, the safeguarding measurement, an indication as to the level of risk and information on how the risk was to be managed by the staff team. The deputy manager also produced a quick reference guide for new and agency staff. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: The guide included the current persons profiles, risk assessments, the weekly menu, service users weekly activities, staffing rota, fire safety procedures, medication management, confidentiality, complaints, emergency crisis procedures and useful emergency telephone numbers. Care Homes for Adults (18-65 years) Page 15 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this outcome area. Appropriate arrangements are made so that people can have regular contact with their friends and families. Evidence: The deputy manager produced a weekly activities programme for people who use the service. This had improved since the last key inspection. The programme indicated what activities individuals took part in within the service and in the wider community. Currently one person attends a day centre once a week, attends a hairdresser and goes shopping. Other activities are mainly internal such as painting and drawing, doing crosswords and puzzles, listening to music or watching television. They are encouraged by staff to participate in life skills lessons at least twice a week. The life skills lessons include budgeting and domestic activities. This persons care plan indicates that they have regular contact with their son. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The other person is a member of the registered providers family. They are currently receiving a care package from a domiciliary care agency. Their weekly activities programme indicates that they attend a hospital out patients department three times a week. Other activities include walking, painting and drawing, doing crosswords and puzzles and reading or watching television. They are encouraged by staff to cook. On the 12th of August 2009 we checked food stored in the fridge and freezer against what was recorded on the weekly menu. People had what was recorded on the menu for lunch on the day we visited and all of food needed for the meals planned for that week was in stock. This was a significant improvement on the last inspection. The registered provider told us in the Annual Quality Assurance Assessment that people are actively supported in helping to plan, prepare and serve meals if they wish. All meals are well prepared and presented and all food preparation and handling activity in the kitchen follows good food hygiene practice guidelines. Meals also respect and reflect peoples cultural and religious preferences and requirements. Care Homes for Adults (18-65 years) Page 17 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this outcome area however the staff team require further training in order to make sure that people who use the service health care needs can be met. Evidence: The Commission required the Registered Provider by 8th August 2009 to ensure the proper arrangements for the recording of medications received in the care home. On the 12th of August 2009 we checked the medication administration and recording systems, however as a result of inaccurate recording and poor record keeping we were unable to undertake a reliable audit of service users medication. Following the compliance visit the Care Quality Commission served a statutory enforcement notice that the registered provider was required by 18th September 2009 to ensure the proper recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A pharmacist inspector from the Care Quality Commission visited the service on the Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: 3rd of November 2009. The pharmacist inspector looked at the medication records for both people using the service, at medication supplies and storage, at training for staff, and interviewed the registered provider. It was not possible to observe people being given their medicines by staff as neither of the people who use the service were at the home during the inspection. When we visited on 12th August 2009, the records and medicine supplies did not show that people living at the home were receiving their medicines as prescribed by their doctors. There were gaps in recording, an incorrect entry in a care plan indicating medicines had been given when they had not, and there were no records of administration for 3 days, August 6th, 7th and 8th 2009. The pharmacist inspector found that there had been some improvement, medication in stock corresponded with records, no medicines were out of stock, staff were now auditing medication records and medication supplies regularly, there were no gaps on medication records, and from inspection of medication records and supplies there was evidence people were being given their medicines as prescribed, however there were still some issues with entries made on medication records. The issues found were Handwritten entries on medication records had not been countersigned to ensure accuracy. Start dates on medication records were incorrect e.g. start date 14th October 2009 written on the record, however the actual start date is 01st November 2009. There was no signature from the pharmacist when medicines were last returned in September 2009. The quantity of medicines in stock at the beginning of the cycle has been recorded incorrectly e.g. 28 tablets recorded, but only 10 in stock. During this visit the deputy manager showed us a recently developed daily handover sheet. One section of the sheet, under the heading medication, included the name of the service user, the name of the prescribed medication, number of medications administered during the shift, number of medications handed over and any comments. The deputy manager told us that this would help with the management of medication. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The registered provider must obtain a signature from the pharmacist when medicines are returned. When we visited on 12th August 2009, we found that the level of errors with medication recording and handling indicated that staff were not trained appropriately. The registered provider supplied an improvement plan after the inspection which indicated that training in medication would be given by 31st October 2009. The pharmacist inspector found that there was no clear evidence that all staff who give medicines have had appropriate medication training. Some staff who give medicines are supplied by agencies who have not provided evidence of medication training. The registered provider told us that training in medication had been given by the Croydon Care Homes Support Team on October 7th 2009 however they could not explain clearly what this training involved, and there was no record that it had been given and who it had been given to as the certificates of attendance had not been received from the trainers. As the registered provider was not able to explain clearly what the training involved, this indicates they may not be able to assess the competency of staff in medication handling. The registered provider told us that the Care Homes Support Team have trained the staff team on medication and further training has been arranged on medication on the 16th of December 2009. The registered provider must ensure that all staff that administers medications attends training on the administration of medication. It is recommended that the registered provider obtain written evidence that staff supplied by agencies have received medication training before they are permitted to administer medication to service users at Chatfield Lodge. When we visited on 12th August 2009 we found that some medicines were not being handled safely as there were loose unlabelled tablets in a plastic container in the medication cupboard. The pharmacist inspector found that all medicines were stored securely and labelled with full instructions for use. Care Homes for Adults (18-65 years) Page 20 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this outcome area. People can be sure that their complaints and concerns are listened to because there is a complaints procedure that that they can understand. Evidence: As previously stated following the last key inspection we made a referral to Croydon Councils Safeguarding Team regarding issues identified at the inspection. The Safeguarding Team has conducted a number of meetings under their serious concerns about a provider protocols. Croydon Councils Care Home Support Team has visited the service to offer support and the Safeguarding Coordinator has met with the registered provider to discuss the serious concerns. Following the last key inspection ten Statutory Requirement Notices served to ensure compliance and improve outcomes for people who use the service. We visited the service on the 12th of August 2009 to check whether the service had complied with the Statutory Requirement Notices. Eight Statutory Requirements were assessed as being met. Two further Statutory Requirement Notices served following that visit. Following a visit from the Care Quality Commissions pharmacy inspector on the 3rd of November 2009 and this inspection all of the Statutory Requirement Notices have been assessed as being met. During this visit the registered provider told us that they had not received any Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: complaints about the service since the last inspection. The registered provider and the deputy manager showed us the complaints procedure was included in the Statement of Purpose and the services welcome booklet. The Commission has not received any complaints about the service. The registered provider and the deputy manager told us that they and the other staff are due to attend training on the protection of vulnerable adults and the deprivation of liberty safeguards with the Care Home Support Team on the 9th of December 2009. Care Homes for Adults (18-65 years) Page 22 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this outcome area. People live in a clean, comfortable, and homely environment. Evidence: People who use the service have bedrooms with en suite facilities. There is also communal bathroom and a toilet. 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 can access if they wish and a staff room. We visited the service on the 12th of August 2009 we observed that the back garden was in a poor state. At this inspection we observed that the garden had been tidied up. The registered provider told us that they had also laid grass seed in order to make it more presentable. Care Homes for Adults (18-65 years) Page 23 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made in this outcome area. Staff have recently attended relevant training that will enable them to meet the needs of the people who use the service. People can have confidence in the staff because checks have been done to make sure that they are suitable to care for them. Evidence: We made a judgment at the last key inspection that people using the service could not be sure that they were safe because the registered provider was 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 worked or if checks have been done to make sure that they are suitable to care for the people that live there. On the 12th of August 2009 we looked at the registered providers, a care worker and the deputy managers files. All of the files included completed application forms, Criminal Records Bureau checks, references, proof of identification, contracts, passports, recent photographs, job descriptions, health checks, supervision records and a record of training. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: On the 12th of August 2009 the deputy manager also showed us the roster, this was completed for each month. The roster was difficult to follow as it only had an end date, it did not include the full names of staff or the names of agency staff or the agency that provided them. The deputy manager showed us timesheets for four different agency staff indicating when they had worked at the service. We cross referenced these with the roster, this indicated that agency staff had worked these shifts, but the roster did not include their name. We advised the registered provider and the deputy manager to complete a weekly roster that would give them more space on the page to include all of the above information. During this visit the registered provider and the deputy manager showed us the new rosters. These were completed on a weekly basis and included the full names of staff, the names of agency staff and the agency that provided them. The registered provider and the deputy manager, who is the registered providers daughter, another daughter of the registered provider and one member of staff cover all of the shifts at the service. The registered provider told us that as the service may shortly be looking after one person the staffing levels may need to be adjusted. As previously stated Croydon Councils Care Home Support Team have visited the service to offer advice and support. The registered provider told us that the Care Home Support Team have trained the staff team on person centred planning, understanding risk assessment, medication and care plan auditing, communication, record keeping and incident reporting, skin care, understanding Schizophrenia and managing challenging behaviour. Further training has been booked with the Care Home Support Team on understanding depression, the protection of vulnerable adults and the deprivation of liberty safeguards. Staff had also attended training on health and safety, food hygiene and manual handling. Further training was planned for the Control of Substances Hazardous to Health and medication. The registered provider and the deputy manager showed us a copy of the Code of Practice for Social Care Workers and told us that all staff have been provided with a copy. One member of staff has completed an National Vocational Qualification at level 3 in care. The deputy manager told us that they are currently undertaking the same qualification. Care Homes for Adults (18-65 years) Page 25 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider and the deputy manager have been working together as a management team to meet the needs of the people who use the service. Improvements have been made in this outcome area. Evidence: The Commission required the Registered Provider by 8th August 2009 to ensure that records as detailed in Schedule 4 are maintained in the care home. This requirement was assessed as met at the compliance visit. On the 12th of August 2009 the deputy manager showed us people who use the services finance records. They had developed a system were people who use the services financial records were kept on the homes computer. Receipts were kept for peoples spending in separate envelopes. Although they had improved recording it was difficult to inspect as it was not all together. We advised that they develop a simple transparent system for recording peoples income, expenditure and balances. During this inspection the registered provider told us that one person had moved out. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: The deputy manager told that Croydon Social Services were the appointee for another person and showed us new cash transaction books that recorded their income, expenditure and balances, however they had not been used and it was unlikely that they would be used because this person was moving out. The remaining person is a member of the registered providers family. The registered provider told us that they were trying to open a post office account for this person. The registered provider and the deputy manager told us that they would ensure that any new people would open a bank account, have cash transaction books and make sure that they had a lockable cabinet and tin in their bedrooms. On the 12th of August 2009 we observed that there was record of visitors in place however not all visitors to the service had been recorded. The registered provider told us that despite the Statutory Requirement Notice on records that the District Nurse and domiciliary care workers were not signing in and they had taken no action to remedy this. We advised that all visitors including agency staff should sign the visitors book when they come into the service. During this inspection the registered provider showed us the visitors book and told us that they had made sure that all visitors signed the book when the entered the service. The Commission required the Registered Provider by 8th August 2009 to ensure that all records as detailed in Schedule 3 and 4 were kept up to date and available or inspection by any person authorised by the Commission. On the 12th of August 2009 we found that all information requested in relation to Schedules 3 and 4 were made available for inspection. The deputy manager had ensured that all records requested by both inspectors were made available without delay. However the registered provider was unable to locate the statement of bank accounts into which peoples money is paid held. When the registered provider was asked for these she stated they had removed them from the premises and taken them to her home address. However in light on all the other matters put in place and maintained this requirement was considered to have been met. The registered provider told us that they are a Registered Mental Nurse, State Registered Nurse and a State Enrolled Nurse. The registered provider told us that they excelled when it came to caring for people Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: however the administrative aspect of running the service was a challenge and an area where they needed to improve. They told us that they and the deputy manager, who is the registered providers daughter, have been working together as a management team to improve the service and to meet the Care Quality Commission requirements. They told us that Croydon Councils Care Home Support Team had been very supportive, offering advice and training staff. All of the Statutory Requirement Notices have been assessed as being met and overall the administrative aspect of the service has significantly improved. The deputy manager is currently completing a National Vocational Qualification at level 3 in care. They told us that they were taking a gap year from university and planned to return next year. The registered provider told us that they had partially completed the Registered Managers Award but because of work commitments decided not to continue with the qualification. The registered provider and the deputy manager agreed that it would be of benefit to the service for the registered provider to complete the Registered Managers Award. It is recommended that the registered provider completes the Registered Managers Award. The registered provider must undertake from time to time such training as is appropriate to ensure that they have the experience and skills necessary for managing the service. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 29 of 32 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 20 18 The registered provider 19/02/2010 must ensure that all staff that administers medications attends training on the administration of medication. To ensure the competency of staff in medication handling. 2 20 13 The registered provider must obtain a signature from the pharmacist when medicines are returned. To ensure that there are proper arrangements for the recording of medications returned to the pharmacist. 26/02/2010 3 37 10 The registered provider 31/08/2010 must undertake from time to time such training as is appropriate to ensure that they have the experience and skills necessary for managing the service. Care Homes for Adults (18-65 years) Page 30 of 32 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 the registered provider can gain the skills necessary for managing the care home. 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 1 1 It is recommended that the registered provider keep the Care Quality Commission informed of any decisions made about the running of the service. It is recommended that the registered provider obtain written evidence that staff supplied by agencies have received medication training before they are permitted to administer medication to service users at Chatfield Lodge. It is recommended that the registered provider completes the Registered Managers Award. 2 20 3 37 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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