Alpine Care Home provides accommodation and personal care for up to 30 people. The service supported older people and those who were living with dementia. Facilities were available for people with mobility difficulties. The service was provided across two floors in a detached house. This inspection was carried out on 05 April 2016 by three inspectors. It was an unannounced inspection. There were 16 people using the service at the time of the inspection. At our last inspection on 17th June 2015 we issued three warning notices and six requirement notices in relation to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan detailing the improvements they would make and confirmed they would be meeting the requirements of the regulations by 30 November 2015. This inspection was carried out to follow up on compliance with these notices.
There was not a registered manager in post. A registered manager is a person who has registered with the 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. A new manager had been appointed and had started work in the service in November 2015, but they had not applied to be registered. We received their application for registration following our inspection.
We found that the registered provider had met the requirements detailed in the warning and requirement notices and had made significant improvements to the culture of the service and the care people received. However, we found three further breaches of regulation at this inspection.
Sufficient numbers of staff had not been deployed at night to ensure people were safe, particularly in the event of an emergency in the service.
The principles of the Mental Capacity Act were not consistently applied in practice. People had not always been asked for their consent, for example to alarm mats that alerted staff to their whereabouts, and where people were unable to consent an assessment of their capacity to do so had not always been completed. This placed people at risk of staff making assumptions about their ability to make their own decisions.
The registered provider had not ensured that accurate and complete records were always kept about the care provided to ensure people’s needs were met. They had also not ensured that accurate and complete records were kept for the effective running of the service.
You can see what action we told the provider to take at the back of the full version of this report.
People and their relatives told us that improvements had been made to the service since our last inspection. One relative told us, “The atmosphere feels so much more relaxed now” and another said, “Visiting is so much nicer now.” Another person told us, “It’s amazing the work they have done.”
Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.
There were thorough recruitment procedures in place to ensure staff were suitable to work with people.
Medicines were stored and disposed of safely and correctly. Staff were trained in the safe administration of medicines, however, there was a lack of guidance for staff about when they should administer medicines prescribed to be used ‘as required’.
The premises were clean and the risk of the spread of infection was appropriately managed and minimised.
Staff were knowledgeable and skilled in meeting people’s needs. They had the opportunity to receive further training specific to the needs of the people they supported. All members of staff received regular one to one supervision sessions and had an annual appraisal of their performance. Staff felt supported in their roles and were clear about their responsibilities. This ensured they were supported to work to the expected standards.
The service was well maintained and the manager had begun work to ensure it was decorated in a way that met the needs of the people that used it. Improvements had been made to the layout of the premises. The use of signage helped people find their way around. The lift was difficult for people to use and some found it noisy and frightening. We have made a recommendation about this in our report.
The staff provided meals that were in sufficient quantity and met people’s needs and choices. People were happy with the quality and range of food they received. Staff knew about and provided for people’s dietary preferences and restrictions. Where people were at risk of dehydration staff ensured they were frequently offered drinks and monitored their fluid intake.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.
People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.
People had positive experiences which were created by staff that understood their personalities and took time to chat with them and provide assurance. Staff were kind and caring in their approach toward people. Staff clearly knew people well.
Staff treated people with respect and ensured their privacy was maintained.
People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to attend reviews that were scheduled. The service responded in a timely way to changes in people’s needs.
Clear information about the home, the facilities, and how to complain was provided to people and visitors.
People were involved in the planning of activities that responded to their individual needs. A broad range of activities was available to keep people occupied and stimulated. The planning of activities took account of latest research on dementia care, for example the use of doll therapy and reminiscence activities.
People received a personalised service. Staff understood how to plan care that took account of people’s individuality.
The manager had begun to make effective use of systems for monitoring the quality and safety of the service and making continuous improvements. The registered provider and manager had introduced changes that had impacted on the culture of the service to ensure it better reflected the registered provider’s vision and values. This ensured a more personalised service for people, however the manager acknowledged that this shift in culture would take time to fully embed into practice. We have made a recommendation about this in our report.
People’s views were sought and listened to. Relatives and residents meetings were held monthly and people told us their ideas and views were taken seriously.
The manager provided clear and confident leadership for the service. Staff felt supported in their roles and were clear about their responsibilities. The manager was open and transparent in their approach.
The manager kept up to date with any changes in legislation that might affect the service and carried out audits to identify how the service could improve. They acted on the results of these audits and made changes to improve the quality of the service and care.