Platters Farm Lodge

Platters Farm lodge is a residential home that provides accommodation and personal care for up to 43 older people. At the time of inspection there were 31 people living at the service with a variety of needs. Needs included people living with dementia and with a physical disability. The home consists of 3 separate wings, each of which has separate adapted facilities. One of the wing’s provides specialist care for people living with dementia.

People’s experience of using this service and what we found

People in the service were kept safe from harm and abuse. People were cared for in a safe environment. Medicines were managed safely, and enough staff were deployed to keep people safe. The provider followed infection, prevention and control guidance.

The service assessed people’s needs before admitting them to the service. People were supported by staff who were adequately trained to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives told us the support they and their loved ones received was kind and caring. Staff encouraged people to be as independent as possible. We observed caring and compassionate interactions between staff and people.

People were receiving person-centred care and their communication needs were being met. Relatives told us they were able to visit and were happy with the process.

The registered manager worked well with other agencies to ensure joined up care for people. Effective audits were in place to ensure the quality of the service delivered by staff. Staff spoke highly of the management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 November 2020) covering two key questions safe and well-led).

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Platters Farm Lodge is a residential care home providing personal care for older people, people with physical disabilities and people living with dementia. The service accommodates up to 43 people across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. At the time of the inspection 34 people were living at the service.

People’s experience of using this service and what we found

People were cared for in a safe environment and all risks to people were identified and mitigated. People and relatives we spoke with were happy with the care they received and felt safe. One person said, “I am a nurse from years ago and know what to expect and I have to tell you, you can’t get better. The whole team are excellent, and I am very happy.” People and relatives told us they would recommend the service to others.

The provider had improved their quality assurance systems to ensure every detail of people’s care was monitored. Staff were happy in their roles and were motivated by an effective registered manager to provide high quality person-centred care for people. There was good communication with relatives and external professionals to ensure people’s needs were met and they achieved positive outcomes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 3 June 2019).

Why we inspected

This service has been rated requires improvement for the previous three consecutive inspections. We therefore undertook this focused inspection to follow-up on the repeated requires improvement rating and the risk this presents. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Platters Farm Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The proposed area for the designated care setting was for up to two units supporting up to 20 people.

We found the following examples of good practice.

• The provider had plans in place to identify and allocate a dedicated team of staff to the designated area.

• There were separate entrances and exits to the designated care setting which meant that staff would be able to access the area separately and avoid other parts of the home. The provider had considered the impact to other areas of the home and how to reduce the risk of transmission.

• There were separate staff facilities including a separate shower and changing room that was under construction on the day of the inspection; and there was a separate staff break room which allowed for social distancing.

• The care home was participating in the weekly testing of staff for COVID-19.

• The communal areas in the designated care setting were large enough to enable people to follow social distancing guidelines.

People’s experience of using this service:

Risks to people’s safety had not always been identified. A room containing hazardous items had not been secured to prevent unauthorised access. We made a recommendation about this.

Risks associated with flammable lotions and creams had not been considered which increased the risks to people in the event of a fire. We made a recommendation about this.

Risks associated with people's care and support had been identified. Plans were in place to ensure these risks were reduced.

The service was well led. The management team knew people well. The management team carried out the appropriate checks to ensure that the quality of the service had improved. The audits and checks were robust but had not captured the issues relating to risk management we had identified. This was an area for improvement.

The quality of care people received had significantly improved since the last inspection.

Medicines practice had improved. The management team continuously reviewed medicines practice, including records and storage to ensure people received their medicines in a safe way.

Recruitment practice had improved. The provider had carried out suitable checks to ensure staff were suitable to work with people.

Care planning and records had improved. The provider had introduced and embedded an electronic care planning system. This enabled all staff to know and understand people’s care and support needs.

There was a positive atmosphere at the service. People were happy, and staff engaged with people in a kind and caring way. People were busy when we visited, engaging in activities and (for those people staying at the service for rehabilitation) undertaking therapies to aid their recovery.

Staff were kind and caring and had the skills, learning and training they needed to support people. People were encouraged to increase their independence. The service supported people to maintain family relationships.

The environment had been improved to help people living with dementia moved about the service. The provider had improved signage and accessible information so people understood what options were available to them.

Please see more information in Detailed Findings below.

Rating at last inspection:

The last inspection was carried out on 05 and 07 December 2017. The service was rated Requires Improvement.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found that improvements had been made to the environment, medicines management and recruitment processes. Records and care planning had improved to evidence that the service was meeting people's health care needs. However, we also identified some areas which required improvement.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At the previous inspection on 01 and 03 November 2016 there were breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The provider and registered manager had failed to deliver care in a safe way. People’s safety had not always been suitably assessed. The provider and registered manager had failed to ensure that records were complete, accurate and stored correctly.

After the inspection the provider sent us an action plan on 03 February 2017 which detailed how they planned to address the breaches of Regulation. The action plan stated they had met Regulation 17 on 03 February 2017 and Regulation 12 would be met by the 06 February 2017.

Platters Farm Lodge is a care service providing accommodation and personal care for up to 43 people. The service provides care and support for older people and younger adults; and people with physical disabilities, sensory impairment and dementia. It also provides a day care centre which is not regulated by the Care Quality Commission. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 28 people were staying at the service. The service was split into three different units. One unit provided rehabilitation for people who had been discharged from hospital. One unit provided short stays such as respite care and one unit provided care and support for people living with dementia.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘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 service is run.

At this inspection people told us they felt safe and they had care from kind and caring staff. People told us that the service was not always responsive to their needs but they felt it was well led.

At this inspection we found that registered persons had not met Regulations 12 and 17 as stated in their action plan. We also found a further two breaches of Regulations.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always complete and accurate.

People's care plans detailed most of their care and support needs. However, care plans had not been updated to reflect each person's current needs or specific healthcare needs. Some people had not received care as detailed in their care plan.

Risk assessments were in place to mitigate the risk of harm to people and staff. These had not always been updated when people’s needs had changed. Medicines had not always been well-managed or stored securely.

Appropriate numbers of staff had been deployed to meet people's needs. Staff had attended training relevant to people's needs and they had received effective supervision from the management team.

People had choices of food at each meal time which met their likes, needs and expectations. Food choices were not available in an accessible format. The management team took action to produce a pictorial food menu.

Activities took place in the service. People staying for rehabilitation found they had more activity and stimulation than those staying for respite care and short stays.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had systems in place to track and monitor applications and authorisations.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

People were supported and helped to maintain their health and to access health services when they needed them.

Maintenance of the premises had been routinely undertaken and records about it were complete. Fire safety tests had been carried out and fire equipment safety-checked.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time.

People and their relatives had opportunities to provide feedback about the service they received.

Compliments had been received from relatives.

People and their relatives knew who to talk to if they were unhappy about the service. The complaints procedure was available around the service and each person had a copy in their rooms. Complaints had been effectively managed.

People and staff told us that the service was well run. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Platters Farm Lodge is registered to provide accommodation for people who require nursing or personal care. It is registered for 43 beds which included 20 beds for rehabilitation, and 23 respite care beds. The local authority and community health trust commission the beds within the service. The service provides care and support for older people and younger adults; and people with physical disabilities, sensory impairment and dementia. It also provides a day care centre which is not regulated by the Care Quality Commission. There were 26 people staying at the service on the day of our inspection. Although the service only provided short term care for people, there were six people who had been living at the service for a long period of time. The registered manager had been liaising with the local authority and community health trust to find a permanent placement for these six people as the purpose of Platters Farm Lodge was to provide short term care and support only.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘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 service is run.

At our previous inspection on 25 November 2014 we found a breach Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this related to accuracy of records. At this inspection we found that some records had not improved.

People gave positive feedback about the service. People felt safe and well cared for.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments had not always been reviewed and updated when people’s health needs changed. Records were not always complete, accurate and stored securely.

People were not always protected from potential abuse by staff trained in how to safeguard adults. Four staff we spoke with did not understand their responsibilities in reporting abuse, this put people at risk of harm. We made a recommendation about this.

There were enough staff deployed to meet people’s needs. However people who lived with dementia were left in one area of the service for short periods whilst staff carried out tasks. We made a recommendation about this.

The environment did not meet the needs of people living with dementia and those that were disorientated because the service was new to them. Some doors had dementia friendly signs to help people find the bathroom or toilet, other doors did not. We made a recommendation about this.

People who stayed at Platters Farm Lodge on a short term basis had suitable care plans in place. There were six people who were staying at the service on a longer term basis. Their care plans did not list their life histories, personal histories, likes and dislikes. We made a recommendation about this.

The provider had a complaints policy and procedures which included clear guidelines on how and by when issues should be resolved. It did not contain the contact details of relevant external agencies, such as the local authority and Local Government Ombudsman, who people could go to if they were not satisfied with the provider’s response. Additional guidance for people about how to complain was available in communal areas of the service.

The provider followed safe recruitment practice. Gaps in employment history had been explored to check staff suitability for their role.

Equipment and the environment had been maintained. The service was clean and smelt fresh.

Staff had received training relevant to their roles. Staff were supported and encouraged to complete work related qualifications.

The provider’s business continuity plan was not specific to Platters Farm Lodge. Key information had not been completed that would ensure people’s care could continue safely if access to Platters Farm Lodge was no longer available.

Staff had a good understanding of the Mental Capacity Act 2005. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had submitted Deprivation of Liberty Safeguards (DoLS) applications for some people. The tracking system that the registered manager had in place to monitor DoLS was not robust, they made changes to this during the inspection.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People’s views and experiences were sought through surveys.

There were quality assurance systems in place. The registered manager and provider carried out regular checks on the service. Action plans were put in place and completed quickly.

Staff told us they felt supported by the registered manager. Health and social care professionals gave us positive feedback about the management of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that people were involved in discussing their care and rehabilitation in so far as they were able to take part in this.

People said that the staff were 'wonderful', 'amazing', "very kind," "friendly" and "patient." They said that they looked after people very well.

We saw that the home provided suitably nutritious food and varied menus. People thought that the food was 'excellent.'

We found that medication was managed in a safe way and had reliable processes in place.

We saw that staff interacted well with people and met their needs. Permanent staffing was being supplemented by agency staffing.

The manager was on extended sick leave, but the leadership of the home was being managed by team leaders on a day to day basis. The team leaders were supported by Directors from the company. On-going monitoring processes were in place or were being implemented.

We found that records were generally up to date and were stored appropriately.