Archived: Alpine Villa Residential Care Home

Alpine Villa provides care and accommodation for up to fifteen older people, some of whom are living with dementia. At the time of our inspection there were thirteen people using the service.

The home did not have a registered manager in place. 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.

Procedures were in place to manage and dispense people’s medicines safely. Medicines audits were also undertaken. Stock levels that we checked were correct. There were risk assessments in place to ensure that staff received guidance in how to support people safely. These were reviewed and updated accordingly when necessary.

Staffing levels were assessed to determine the number of staff hours required and we found there were sufficient staff to meet people’s needs. People told us they felt there were enough staff to meet their needs. Safe recruitment practices were in place and staff were confident in recognising potential abuse and what action they must take. Staff received support through supervision and training and felt supported by the management team.

Staff understood the principles of the Mental Capacity Act 2005 and care records were underpinned by the Act and enabled people to make decisions and be involved in their care and support.

People told us they had sufficient to eat and drink and had a varied and nutritious diet.

People received care which was responsive to their individual needs. People were able to follow their own preferred routines during the day, for example by getting up and going to bed when they wished. Staff worked with healthcare professionals to ensure that professional advice was sought when necessary.

Staff were kind and caring and treated people with respect. People were encouraged to maintain relationships with other people that were important to them.

There was a range of activities which people could take part in, both individually and as a group.

Staff reported feeling well supported and able to raise any concerns or issues. There were systems in place to monitor the quality and safety of the service. This included a programme of audits that included: medicines, the environment and people’s care plans.

This inspection was undertaken to assess compliance, as the timescales the provider had identified to achieve this, had elapsed. This inspection took place over three days: 29/07/14, 31/07/14 and 05/08/14 and was performed by two inspectors.

Due to people's complex dementia care needs, we were not able to gain any verbal feedback about the service they received. Information about people's experiences was based on observation and talking to a relative and staff.

We considered our inspection findings to answer 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. If you would like to see the evidence supporting our summary please read the full report.

Is the service caring?

Some staff were engaging and spoke to people in a caring and friendly manner. They spoke to one person in their preferred language, which was not English. These staff spent time with people, encouraging conversation and assisting independence in a positive manner.

Whilst there were some positive interactions, not all staff engaged well with people. One person was not supported with their agitation despite staff being in close proximity. People were not reassured, involved in their care or fully informed of what was taking place during care interventions. Some people spent large amounts of time asleep or unoccupied with the only interaction from staff being task orientated.

Is the service responsive?

The deputy manager had introduced an auditing system which had identified some issues which required attention. These issues formed various lists of work to be achieved which the deputy manager was working through.

The provider and deputy manager had addressed some issues of non-compliance we had previously identified. However, some areas remained outstanding. Issues which required immediate attention during this inspection such as excessive hot water from a hand wash basin, the renewal of the home's insurance cover and a rat in the garden were not addressed in a timely manner.

Staff were not consistently responsive to people's needs. Some people were not given the assistance to eat in a way which met their needs. Fluid intake was not consistently promoted and some people were not sufficiently supported to minimise their risk of pressure ulceration.

Staff had undertaken a range of recent training courses. However, the training covered mandatory areas such as infection control and first aid. Staff had not undertaken training in relation to people's individual health and care needs.

Is the service safe?

Improvements had been made to the environment to make it safer for people. Covers had been fitted to radiators so that people did not burn themselves on hot surfaces and a bathroom had been refurbished. A sluice had been installed, to enable safer procedures when dealing with waste and regulators had been fitted to hand wash basins in people's bedrooms. The regulators were to ensure the hot water was not unpredictable or excessively hot. However, whilst these improvements had been made, there remained issues which presented risks to people's safety. This included very hot water from a hand wash basin and an exposed hot pipe in the shower room, cleaning materials not securely stored and a pane of glass in the garden and decorating tools in a corridor.

The standard of cleanliness within the home had improved with less visible areas such as the underneath of the shower chair, bath seat and mats being free from debris. There remained some shortfalls with staining to some armchairs, dust on skirting boards and splashes to walls.

Staff had received up to date manual handling training. However, the techniques used to assist some people with their mobility, were unsafe. Some staff were hesitant in the use of the hoist and the manoeuvres were precarious, which increased the risk of harm. Staff were not gentle in their manner when placing the hoist sling around people.

Improvements had been made to the management of people's medicines. Staff followed safe procedures when administering medicines, which minimised the risk of error. A new trolley had been purchased to transport medicines more easily. However, this was not securely stored as it was not attached to the wall. In addition, the controlled drugs cupboard was not fit for purpose, as it could be locked.

Is the service effective?

Some staff member's handwriting within people's daily records was difficult to decipher so the records were not always eligible.

Care charts had not been consistently completed. This meant that the systems in place to monitor people's food and fluid intake, their bowel management and the inventions required to minimise the risk of pressure ulceration, were not effective.

Care plans did not always reflect people's changing needs and the support they required. Some records gave conflicting information which increased the risk of unsafe or inappropriate care. There was no information about some interventions such as the application of dressings or the management of pain or health care conditions such as constipation.

Is the service well led?

The provider/registered manager lived on the premises and was involved in the home on a daily basis. The deputy manager was responsible for the day to day management of the home. They were due to go on maternity leave two weeks after our inspection. A member of staff had been recruited to cover the deputy manager in their absence.

Some improvements had been made to the service since our last inspection. However, some shortfalls remained and other new issues were identified. Whilst formal staff supervision had been introduced, unsafe or inappropriate care was not being identified. The provider had not ensured that risks to people's safety had been effectively addressed. It was of concern that the provider confirmed that they were compliant with our Essential standards of quality and standards, despite widespread non-compliance being evident.

We found staff did not administer medicines in a safe manner and people were not always supported in a way which met their needs. There were aspects of the environment which impacted upon people's safety and less visible areas were not clean. Staff had not undertaken updated training related to their role and there were no formal systems of staff supervision. Not all records were up to date, in place or sufficiently detailed.

We issued a compliance action for each of the six outcome areas to ensure the provider made improvements. The provider sent us an action plan, which detailed the work they would undertake to address the shortfalls. The action plan gave a number of timescales, which were not timely. The deputy manager told us they felt they needed this amount of time due to the amount of work involved. We asked for an updated action plan and said we would visit before the provider's timescale had elapsed, to ensure progress.

At this inspection, we looked at four of the six areas of non-compliance. We noted improvements were being made although as detailed in the provider's action plan, compliance had not as yet been reached.

People had clean clothing, manicured nails and freshly brushed hair. People were relaxed in their environment and within the vicinity of staff. People were appropriately supported to eat, although they were given lunch at 11.15 in the morning.

Improvements had been made to the safety of the environment. Radiator covers, water regulators and restrictors to the windows on the first floor had been fitted. However, window restrictors did not meet current guidelines. Devices approved by the fire officers enabled fire doors to be held open. A new sluice room was being installed and a bathroom was being refurbished.

A range of training courses had been arranged for staff to update their knowledge and skills. Staff had completed subjects such as manual handling, infection control and safeguarding vulnerable people. Other courses were scheduled for the coming months.

Less visible areas continued not to be clean. This included bed frames, commodes and the underneath of a raised toilet seat. Cleaning substances were left unsecured in one person's en-suite facility.

People spent time in their bedrooms or one of the communal lounges. Staff were always in the vicinity of people yet we saw limited interactions took place. People were not always supported in a way which met their needs. Documentation gave limited information about people's health care conditions and how they were to be supported.

Staff did not administer people's medicines in a safe manner. One staff member gave a person's medicines to another staff member to administer. This is known as 'double dispensing' and increased the risk of error. Another person was given their medicines but staff did not ensure they had taken them.

Carpets, the surfaces of furniture and toilets were clean. Areas less visible were not. This included the underneath of the bath seat, hoist bases, extractor fans and light pull chords. The laundry was chaotic and not clean. Laundry systems significantly increased the risk of infection. Infection control audits had not been undertaken.

Consideration had not been given to how the environment could be improved upon for people with dementia. There was limited signage and no use of colour or points of reference. Two fire doors were held open inappropriately with a chair. Window restrictors which were in place on the first floor did not minimise the risk of people falling from a height. Some windows on the first floor opened completely and were not fitted with restrictors. The water from the hand wash basins in two toilets was very hot to the touch. Individual temperature regulators were not fitted. Systems were not in place to monitor the temperature of hot water. Radiators in some people's bedrooms were not fitted with covers. There were no assessments to minimise the risk of people scalding themselves from the hot surfaces.

Some staff had undertaken recent training in catheter care and skin care. Records showed the majority of training had been undertaken in 2012 or before. Staff had not completed training in key areas such as the Mental Capacity Act 2005, medicine administration or behaviours that challenge. There was no formal system to identify staff's training needs. Staff supervision was undertaken on an informal rather than a formal basis.

Some records such as the medicine administration records were clearly maintained. Other records were not in place or up to date. Care records identified people's basic care needs yet there was some lack of clarity and subjective language within documentation.

We found people within the home were treated respectfully by staff who worked to maintain their independence and dignity, through offering individualised support.

Everyone who lived in the home had a person-centred care plan that clearly identified needs and how they would be met. People were able to contribute to their care plans if they were able, as were representatives and relatives.

Staff in the home also work closely with other professionals in community health service and within mental health services.

The home ensures that the nutritional needs of people who use the service are met by providing good quality food and drink, including choices that suit all.

There were sufficient numbers of staff employed in the home to offer the level of care required by people who used the service. The staff had suitable qualifications and training.

There were systems in place to monitor the standards of care within the home. At the time of the review the home was participating in a national quality improvement programme.