About the service: Platters Farm Lodge accommodates up to 43 people. At the time of our inspection, 35 people were staying at the service. The service provides short term care and support for older people and younger adults; and people with physical disabilities, sensory impairment and dementia.

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.

The inspection took place on 05 and 07 December 2017. The first day of the inspection was unannounced.

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. Th

The inspection was carried out on 01 and 03 November 2016. The first day or our inspection was unannounced.

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 role

This was an unannounced inspection on 25 November 2014.

Platters Farm Lodge is registered to provide accommodation for people who require nursing or personal care. It is registered for 43 beds which include 20 beds for rehabilitation, and 23 respite beds. The rehabilitation unit aims to help people who have experienced ill health, disability, accidents or lost confidence to lead independent lives. The respite unit is a short term facility which gives carers a break and may be used when recovering from an illness. Some people who use the service may be living with dementia. Platters Farm Lodge also provides a day care centre which is not inspected by the Care Quality Commission (CQC). It is set in spacious, well maintained grounds and is situated within travelling distance of a train station and high street in Rainham. On the day or our inspection there were 18 people using the service – five were there for rehabilitation and 13 were there on respite.

The service is run by a registered manager who was present on the day of our inspection. 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. There was also a newly appointed manager who was in the process of registering with CQC and was taking over from the current registered manager.

Staff knew how to protect people from the risk of abuse. Recruitment processes were in place to check that staff were of good character and there were sufficient numbers of staff to meet people’s needs. People were supported safely to take their medicines. Staff were aware of the ethos of the home, in that they were there to work together to provide people with personalised care and support and to be part of the continuous improvement of the service.

People were at risk of receiving unsafe or inappropriate care arising from a lack of proper information because records were not accurate and not completed consistently.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. Assessments were completed and applications were submitted to the supervisory body in line with guidance.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Staff were caring and compassionate. Each person was allocated a keyworker who took the lead and co-ordinated their care.

People were provided with a choice of healthy food and drink which ensured that their nutritional needs were met. People’s physical health was monitored and people were supported to see healthcare professionals.

The design and layout of the service was suitable for people’s needs. There was wheelchair access and the building and grounds were adequately maintained. All the rooms were clean, spacious and well maintained. The provider had systems in place to monitor the quality of the service. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The inspection was carried out by one Inspector for over six hours. During this time we viewed all areas of the home; talked with 17 people receiving care in the home; talked with two relatives; and talked with 16 staff including the Training Manager, the Director of Human Resources, the Director of Care, and an agency support worker.

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.