We inspected Alpine Care Home on the 30 January 2017 and the inspection was unannounced. Alpine Care Home provides accommodation for up to 25 older people. On the day of our inspection there were 24 people living at the home. Alpine Care Home is a residential care home that provides support for older people living with dementia and other health related conditions. Accommodation was arranged over two floors with stairs and a lift connecting each level.

There was a registered manager in post. 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 our last inspection undertaken on the 5 April 2016 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to staffing levels at night; not adhering to the principles of the Mental Capacity Act (MCA) 2005 and failing to maintain accurate records. The provider sent us an action plan stating they would have addressed all of these concerns by June 2016. At this inspection we found the provider had made improvements and was now meeting the requirements of the regulations.

Staff were knowledgeable about people’s behaviours which might challenge and areas of care which might pose a risk to people. A range of risk assessments were in place and people’s ability to use the call bell was considered. However, people’s call bell risk assessment did not mitigate all the risks involved. For example, when someone remained in their room all day and they were unable to use the call bell, how often they should be checked upon was not recorded. We have made a recommendation for improvement.

People, relatives and staff spoke highly of the service. One relative told us, “It is excellent here. I would recommend the service and the manager is extremely approachable.” One person told us, “There is plenty of company, it's warm and comfortable and the staff are very nice and caring.” Another person told us, “I’ve been very happy here. I wouldn’t have stopped if I wasn’t happy.”

There were sufficient numbers of skilled, competent and experienced staff to ensure people's safety. People were cared for by staff that had a good understanding of adult safeguarding and who knew what to do if there were concerns over people's safety. People told us that they felt safe. One person told us "I feel very safe here.” There were safe systems for the storage, administration and disposal of medicines and people were supported to have their medicines safety and on time.

People's consent was gained and staff offered explanations before assisting people. Mental capacity assessments and deprivation of liberty applications had been undertaken to ensure that, for people who lacked capacity, appropriate measures had been taken to ensure that were not deprived of their freedom unlawfully. Staff understood the importance of enabling people to have choice and control within their lives.

Staff worked in accordance with people's wishes and people were treated with respect and dignity. It was apparent that staff knew people's needs and preferences well. Positive relationships had developed amongst people living at the service as well as with staff. One staff member told us, “No-one’s experience of dementia is the same so it’s all about catering to the individual. It’s down to us to show interest in people, let them know they are valued.”

Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the service. The registered manager had a range of tools that supported them to ensure the quality of the service being provided.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people w

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 peop

The inspection was carried out by one inspector over eight hours. There were 27 people using the service at the time of the inspection. The people living at the service were experiencing dementia which meant that they were not always able to tell us about their experiences. This report is based on our observations of the care and support people received, talking with people, relatives and staff and looking at records.

We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service safe?

People’s care was delivered safely and staff followed safe working practices. Staff understood how to protect people from the risk of infection and procedures were in place to minimise risk of infection.

The manager understood their responsibilities under the Mental Capacity act 2005 and Deprivation of Liberty Safeguards (DOLS). They had assessed that an application was needed for a person in order to ensure the home had taken appropriate measures to protect the person’s safety under DOLS guidelines.

There were systems in place so that events such as any accidents and incidents were tracked, and we saw evidence that any measures necessary to minimise them were promptly put into place.

Each person had a personal evacuation plan in place in event of fire at the service, and the fire risk assessment and contingency plan had been reviewed this year.

Maintenance work took place to make sure the building was safe for people to use and met their needs.

Is the service effective?

People’s needs were assessed before they moved into the home and then at regular intervals. This made sure that they received the care they needed. We saw evidence of people’s health improving since living at the home. Relatives told us health needs were well met.

The home liaised with health and social care professionals to make sure that people received the services they required.

Is the service caring?

Staff were patient and attentive towards the people who use the service. We observed good interactions between people and staff, and relatives told us that staff were kind and caring. Staff demonstrated a good understanding of the needs of people who were experiencing dementia and understood their individual support needs.

Is the service responsive?

We observed that staff were quick to respond if people were anxious or requested assistance. Relatives told us that the home responded quickly if people were unwell. Staff responded to people’s wishes and preferences, they consulted them about the running of the home and their individual needs.

Is the service well led?

There were effective quality assurance systems in lace and the manager and provider acted upon people’s comments. Improvements identified were acted upon. Comments from relatives included “The leadership is excellent, it is first class” and “They always call if there are any problems”.

At our inspection in May 2013 we found that three of the care plans we viewed stated that people’s weights should be recorded on a weekly and monthly basis. The last time the weights were recorded for these people were was in February 2013. This meant that people’s on-going health was not being monitored appropriately.

The provider sent us an action plan telling us how they would address this concern, this included all weights are to be recorded on the weight chart and recorded on the persons care plan. At this inspection we saw that all of the care plans viewed had up to date weight monitoring charts completed and that the care plans viewed contained malnutrition universal screening tool assessments (MUST).

At our inspection in May 2013 we found that the registered person was not always ensuring that people were experiencing safe care that met their mobility needs. The provider sent us an action plan telling us how they would address this concern, this included details of how accident forms will be kept in the persons care plan, where actions carried out can be clearly seen. The care plans inspected have been completely reviewed and is clear in relation to the mobility needs of people who use the service.

We found that care plans inspected had been completely reviewed and were clear in relation to the mobility needs of people who use the service.

At our inspection in May 2013 we found that there were not always enough qualified, skilled and experienced staff to meet people’s needs. The provider sent us an action plan telling us how they would address this concern, this included how the registered person would deploy staff to ensure there were enough staff available at all times, for example at meal times. We found at this inspection that there were enough staff to meet people’s needs.

At our inspection in May 2013 we found that the provider was not able to demonstrate that people were made aware of the complaint process. This was because the policy was not presented in an accessible format and that the complaint procedure had not been followed. The provider sent us an action plan telling us how they would address this concern, this included a new easy to understand format with timescales and response times.

At this inspection we found that the registered person had reviewed their complaints policy and that they had produced the complaints process in an easy read format that could be understood by people who used the service, or their relatives and visitors.

We found that the premises and grounds were well maintained and clean.

The majority of people who used the service had dementia or other complex mental health needs which meant they were not able to tell us their experiences of using the service. We therefore used our observations to help inform some of our judgements.

This inspection was to follow up on the findings from our previous inspection of 7 February 2013 to ensure that appropriate action had been taken by the provider to address our concerns. We asked the provider to send us a report of the changes they would make to comply with the standards they were not meeting.

We found people who used the service, staff and visitors were protected against the risk of unsafe or unsuitable premises.

We also carried out a routine inspection to look at other essential standards of quality and safety were being met.

We found that people were involved where possible in the planning of their care and that where they were unable to contribute, their relatives had been involved.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found there were not enough qualified, skilled and experienced staff to meet people’s needs.

We looked at the home’s complaints system and found that the provider did not have an effective complaints system available.

The majority of people who used the service had dementia or other complex mental health needs which meant that they were not able to tell us their experiences of using the service; we therefore used our observations to help inform some of our judgements. We found that people were involved where possible in the planning of their care and that where they were unable to contribute their relatives had been involved. We were able to observe that people who had dementia were experiencing a good quality of care and interaction from the staff group. The provider had taken steps to safeguard people. Staff had received both training and supervision and there was enough staff to meet people’s needs. The provider was monitoring the quality of the service they provided which included questionnaires, regular audits and holding meetings. We received some positive comments about the accommodation and facilities provided at the home. We viewed some areas of the premises however that needed to be improved upon to ensure they were safe and in kept in good repair. In addition, decor and some items of furniture were aged, damaged and tired in some areas. Shared bedroom accommodation lacked the facilities to always protect people’s privacy and dignity. The manager was unable to demonstrate that all window restraints used in the home protected vulnerable people from any potential for harm.

The inspection was carried out on 17 and 18 June 2015. It was an unannounced inspection.

The service provides personal care and accommodation for a maximum of 30 older people. There were 26 people living there at the time of our inspection, many of whom were living with dementia and additional needs such as mobility difficulties and sensory impairments. Some people were receiving end of life care. Some of the people living in the service were able to express themselves verbally, others used body language.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

At the last inspection in August 2014 we found no concerns. During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We are taking enforcement action to ensure the provider achieves compliance.

People were not kept safe from abuse and harm as staff did not respond appropriately to incidents of abuse and did not have accurate contact details for reporting these. People were at risk of unsafe practices to help them move around the home as staff did not follow moving and handling best practice.

People were not protected from the risk of the spread of infection as the homes décor and furnishings made effective cleaning difficult.

The provider followed safe recruitment procedures to ensure staff working with people were suitable for their roles. However, staffing levels were not based on people’s needs and did not promote their safety and wellbeing.

Medicines were not always stored safely and some necessary checks had not been made. Some records showed that topical medicines had not been given.

Staff did not have the necessary skills and knowledge to ensure they could meet people’s diverse needs. Staff had not received the supervision and support they needed to enable them to carry out their roles effectively.

People were not protected from undue restriction as staff did not understand the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Meal times did not take account of individuals needs and some people’s fluids were not effectively monitored.

People received medical assistance from healthcare professionals including district nurses, GPs, chiropodists and the local hospice. However, staff did not consistently follow guidance regarding people’s health needs.

The premises did not meet the needs of people living with dementia and mobility difficulties.

Some staff were not kind or compassionate in their approach. Staff did not always listen to people or treat them with respect. Staff did not always respond or know how to respond, to people’s distress.

People were not given information in a way they could understand.

People did not always receive a personalised service as some staff did not know people well enough to care for them in a way that met their needs and preferences. People’s preferences and social needs were not always respected even when known. Activities did not meet the needs of people living with dementia and additional needs.

People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed and their involvement encouraged.

The service was not well led. The service had recently been taken over by a new provider having been in administration for the last three years and quality assurance systems had not been effective in recognising shortfalls in care and quality. We found a number of areas of poor practice during our inspection that had not been identified by the management.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.