Allfor Care Croydon

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

The service was in breach of legal regulations in relation to person-centred care and need for consent.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some people felt the service assessed their needs appropriately, whilst others felt otherwise. Comments included, “I felt that the hospital staff had already decided what she needed”, “The manager came out and brattled on for ages, looked like she listened to our points but in the end the plan was all generalisations.” A relative told us they had to re-write the care plan and commented, “It (care plan) had no relationship to how I saw his (family member) needs and priorities, so I wrote it myself. The care plan is not thorough enough. There is no continuity of care.”

People’s care and support needs were not always assessed to make sure staff could care for them effectively. Initial assessment varied in quality some assessments captured detailed information about people's goals, lifestyles, and preferences, while others provided very minimum information.

We reviewed initial assessments completed for various health conditions, such as epilepsy, dementia, asthma, shortness of breath and stroke. However, no specific care plans were developed for these conditions. Without appropriate assessments plans, staff could not provide tailored support, manage these conditions, or identify when a person's health was deteriorating.

The service did not consistently create care plans that addressed specific issues common in certain groups, such as dementia in older adults or diabetes in some ethnic groups.

Although the registered manager stated the service had a dementia strategy, which aimed to provide person-centered care for people with dementia, this was not always put into practice. A review of care plans for people with dementia or cognitive impairment did not include information about how the condition affected their daily lives or what symptoms staff should monitor for as the disease progressed. This lack of detail made it difficult for staff to understand changes in behaviour and ensure people received prompt support from specialist health professionals.

Care plans were not always developed for people with poor skin integrity or diabetes. For example, a person's care plan noted they had poor skin integrity, but it only instructed staff to wash and cream their skin. There was no specific plan to guide staff on how to prevent pressure ulcers, including what signs to look for. Similarly, another person with diabetes had no care plan to instruct staff on how to effectively monitor and manage their condition.

We found care plans developed for people with a learning disability or autism were not always person centered. For example, a person's initial assessment noted their care, and communication should be conducted through "pictures or hand gestures" due to a speech impediment. However, this information was not transferred to their final care plan.

While the care plan did list the person’s hobbies, interests, and goals, it lacked a health/communication passport. This is a vital document that would have informed care staff and external agencies about the person’s health needs including how to interpret their unique cues, and the best ways to communicate with them. A communication passport would have helped ensure the person was seen and supported as an individual, not just a diagnosis. This oversight showed the service did not consistently follow national best practices and guidelines to ensure people living with a learning disability or autism and dementia received effective care.

The provider failed to review and update care plans according to its own standards. The ‘Care and Support Plan Policy – In-depth’ dated 1 April 2025 mandated formal reviews at least every three months. However, out of 11 care plans reviewed, 8 contained no records showing any review had ever taken place. Additionally, the service did not consistently date care plans, preventing people from being assured their care and support needs were current and relevant.

The service lacked clear documentation to demonstrate how staff contributed to positive changes in people's health, which is essential for tracking progress and proving care effectiveness. This issue was highlighted by a relative whose family member, initially supported in bed and catheter-dependent after a hospital discharge, was able to mobilise independently with a walking aid and no longer needed a catheter within 6 weeks.

Despite this significant recovery, a formal review of the person's care was not documented. While an undated new care plan was located outlining their current, improved support needs, the original care plan detailing their initial, acute circumstances was missing entirely.

This lack of clear, sequential documentation meant there was no evidence to track the person's progress, making it impossible to attribute their recovery to the care they received. This issue of ineffective monitoring and poor recording was a key concern addressed under the Well-Led section of the report.

The service demonstrated some efforts to support individuals in accessing health services. Our review of email correspondence with health and social care professionals showed examples of proactive communication, such as requesting GP and district nurse home visits, seeking assistance for medication management, and informing local authorities about hospital readmissions.

Despite these positive examples, we have identified in other sections of this report, the absence of person-centered care plans. This resulted in some people not being fully supported to live healthier lives. This showed that while reactive support was in place, the service lacked a consistent and proactive framework for promoting holistic health outcomes.

The provider failed to review and update care plans according to its own standards. The ‘Care and Support Plan Policy – In-depth’ dated 1 April 2025 mandated formal reviews at least every three months. However, out of 11 care plans reviewed, 8 contained no records showing any review had ever taken place. Additionally, the service did not consistently date care plans, preventing people from being assured their care and support needs were current and relevant.

The service lacked clear documentation to demonstrate how staff contributed to positive changes in people's health, which is essential for tracking progress and proving care effectiveness. This issue was highlighted by a relative whose family member, initially supported in bed and catheter-dependent after a hospital discharge, was able to mobilise independently with a walking aid and no longer needed a catheter within 6 weeks.

Despite this significant recovery, a formal review of the person's care was not documented. While an undated new care plan was located outlining their current, improved support needs, the original care plan detailing their initial, acute circumstances was missing entirely.

This lack of clear, sequential documentation meant there was no evidence to track the person's progress, making it impossible to attribute their recovery to the care they received. This issue of ineffective monitoring and poor recording was a key concern addressed under the Well-Led section of the report.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. Where people may need to be deprived of their liberty in order to receive care and treatment in their own homes, an application can be made to the Court of Protection (CoP) who can authorise deprivations of liberty. We checked whether the service was working within the principles of the MCA.

The service did not consistently adhere to the principles of the Mental Capacity Act (MCA) 2005. Mental capacity assessment forms often failed to specify what decision was being assessed (e.g., consenting to receive care and support). Staff incorrectly treated capacity as a global concept, using only one completed assessment for all decisions. This made the assessments illegal, invalid, and ineffective, as capacity is decision specific.

A critical failure was the lack of capacity assessments for key decisions. Specifically, no completed mental capacity assessments were found to confirm whether people lacked the capacity to make decisions about their medicines or to ensure medicines were being administered in the least restrictive way. This demonstrated a fundamental misunderstanding of the MCA's requirement for capacity to be assessed at the point of each individual decision.

The service subjected a vulnerable person to a potential unlawful deprivation of liberty. Bed rails were being used for a person who lacked the capacity to consent. The care record contained no evidence of a "Best Interests" meeting with relevant professionals or the person's representative to discuss and authorise this restriction, placing the person at risk.

Consent to care was collected initially but not consistently monitored or updated. In 2 care records reviewed, consent had not been formally recorded for over 12 months, with one record failing to be updated for over three years. This lapse meant the service could not be assured it was properly monitoring people's ongoing ability to give informed consent for specific care decisions, further undermining the application of MCA principles.