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Inspection carried out on 19 September 2017

During a routine inspection

We carried out this unannounced inspection of Place Farm House on 19 September 2017. We previously carried out a focussed inspection at Place Farm House on 3 November 2016. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to the management of medicines.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. We found improvements had been made in the required areas. We found that the service was providing good care. The overall rating for Place Farm House is ‘good’.

Place Farm House provides accommodation for up to twenty older people, some of whom are living with dementia and who may need support with their personal care needs. On the day of our inspection, there were 19 people living at the service. The service is a large property situated in Patcham, East Sussex. It has a large communal lounge, dining conservatory and gardens.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it.

People were supported to maintain good health and had access to health care services. Accidents and incidents were recorded and analysed and people told us they felt the service was safe. People remained protected from the risk of abuse because staff understood how to identify and report it.

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People felt staff were skilled to meet their needs and provide effective care. Additionally, people enjoyed taking part in meaningful and appropriate activities in the service.

People were encouraged to express their views. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs continued to be met and they reported that they had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team and this was observed throughout the inspection.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. People and staff found the management team approachable and professional.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Inspection carried out on 3 November 2016

During an inspection to make sure that the improvements required had been made

We undertook an unannounced focused inspection on 3 November 2016 due to information of concern we had received with regard to medicines management and insufficient heating to keep people warm. We looked at the key question: Is the service safe? This report only covers our findings in relation to this area.

Place Farm House provides accommodation for up to twenty older people, a majority of whom are living with dementia and who may need support with their personal care needs. On the day of our inspection there were sixteen people living at the home. The home is a large property situated in Patcham, East Sussex. It has a large communal lounge, dining conservatory and gardens.

The provider, who also owns another home in the South of England, had taken ownership of the home in September 2016. The management team consisted of a registered manager. A registered manager is a ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

People had support with their medicines from trained staff. When asked about their access to medicines, people told us, “We are all well looked after, we get our medicines on time, they’re never late” and “They’re on the ball they are with that, they’ve never forgotten it”. However, there were concerns with regard to people’s access to ‘as and when required’ medicines. One member of staff, who had not undertaken medication training, worked night shifts on their own. Provisions had been made to ensure other staff, who had undertaken medication training, administered medication in the evening before their shift ended and in the morning when their shift began, so that the member of staff working the night shift did not have to administer medicines. However, for people who required medicines on an ‘as and when required’ basis at night there were no provisions in place to ensure a suitably qualified member of staff was available to provide these. As a result people may not have had access to medicines when they needed them.

Records showed that there had been a high number of occasions when medication had not been signed for in the Medicine Administration Records (MAR). This raised questions as to whether people had not been given their medicines or if staff had failed to sign the MAR. When asked about the gaps in the MAR the registered manager explained that this had not been recognised. Therefore there was a risk that people had not been given their medicines and that appropriate actions to ensure their well-being, such as contacting their GP, had not been undertaken.

The management of medicines, with regard to ensuring people had access to medicines and that appropriate actions were taken in a timely manner, were areas of concern.

Concerns had been raised that it was not always warm enough in the home. Most people told us that they felt the home was warm and our observations confirmed this. However, some people said that they sometimes felt cold. When asked about the temperature of the building, the registered manager explained that the heating used to be on constantly and that they were now trying to align the inside temperature to changes in the external temperature. They explained that they were constantly reviewing the temperature in the home and would adjust and increase the temperature if the weather turned colder or if people told them that they were cold.