Alpine Lodge

Alpine Lodge is a care home providing accommodation, personal and nursing care to older people, including people living with dementia. The service can support up to 67 people over 2 floors and 4 units. At the time of our inspection there were 45 people using the service.

The home is purpose built with ensuite bedrooms and communal areas. The home has a secure garden accessible from the ground floor.

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

Overall, the feedback from people, relatives and external stakeholders was positive.

It was clear that although improvements had been made since the last inspection there were still some areas that required embedding or further improvement.

We have made a recommendation about records. Care records for people needed to be clearer and recordings more consistent.

We have made a recommendation about the oversight of medicines where are self-administered. More robust checks needed to be in place to ensure that people were receiving treatment as prescribed.

Incidents and accidents were recorded appropriately to ensure lessons were learnt. Staff understood safeguarding and whistleblowing procedures and stated they would report any issues immediately.

We observed staff interacting with people and found they responded to them in a timely way.

Effective systems were now in place to monitor and improve the quality of the service provided, to address cultural issues, and to expand on the involvement of people, relatives, and staff in how the service was run. However, we needed to see these embedded to show improvements developed and sustained.

The registered manager and senior management team were responsive to our inspection findings. We received updates on the day and following our inspection about what action they were taking to address any issues we had identified.

Recommendations

We have made recommendations about care records and record keeping and self-management of some medicines.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 December 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider keep staffing levels and staff deployment under review. At this inspection we found staffing levels were sufficient to meet people’s needs and keep them safe.

The last rating for this service was requires improvement (published 5 December 2022). The service remains rated requires improvement. The service has been rated requires improvement or inadequate for the last 4 consecutive inspections.

This service has been in Special Measures since December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alpine Lodge is a nursing home. It was providing personal and nursing care to 40 people at the time of the inspection. The service can support up to 67 people across four units. One of these units specialises in supporting people who live with dementia.

The home is purpose-built with en-suite bedrooms and communal areas. The home has a secure garden accessible from the ground floor.

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

There were clear signs of improvement at the service, which was reflected in feedback from people and external stakeholders. However, further improvements were still required.

Risk assessments had not always been updated to reflect significant changes in people’s care and support needs. People’s care records did not accurately reflect their needs. Some care plans had conflicting information and records were inconsistently kept.

People received their medicines safely and as prescribed. Systems and processes were in place to keep people safe.

The premises were clean and there was good infection control practice in place.

There was a friendly atmosphere at Alpine Lodge, and we saw people looked well cared for.

Staff were recruited safely. We identified some concerns about the staffing levels and deployment of staff during our inspection. We discussed this with the provider and an increase of staff was implemented so that people were kept safe and to meet their care needs.

Staff were receiving appropriate training, which was relevant to their role and people's needs.

Staff were supported by the management team and were receiving formal supervisions where they could discuss their on-going development needs. The provider had started to manage performance and poor cultural issues that was evident to ensure that improvements needed were not undermined.

People were supported to eat a healthy balanced diet.

Complaints and concerns were well managed. People were supported and encouraged to achieve positive outcomes.

The model of care helped to maximise people's choice, control and independence. People's bedrooms were personalised. The care people received was more person-centred and promoted people's dignity.

We did find some improvements had been made since the last inspection, however the service continued to be in breach of regulations. Governance and assurance systems was not fully implemented or effective to support continued improvement and ensure the service is meeting the requirements of the Health and Social Care Act

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

Rating at last inspection and update

The last rating for this service was inadequate (published 26 March 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Alpine Lodge is a nursing home. It was providing personal and nursing care to 43 people at the time of the inspection. The service can support up to 67 people across four units. One of these units specialises in supporting people who live with dementia.

The home is purpose-built with en-suite bedrooms and communal areas. The home has a secure garden accessible from the ground floor.

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

Aspects of the service placed people at significant risk. Since the last inspection the provider had improved governance systems relating to safeguarding, staff recruitment and the support staff received. However, not all issues from the previous inspection had been robustly addressed. Infection prevention and control continued to be inadequately managed and concerns around the lack of detail contained in people’s assessments and support plans was an ongoing provider action. Staffing arrangements sometimes negatively impacted the quality of people’s support. For example, during the inspection we observed delays to people’s morning routine as a result of staffing disruptions. We have made a recommendation about staffing. Accidents and incidents had started to be analysed and new systems were implemented to ensure staff were fully involved in discussions about lessons learnt to prevent recurrence. Medicines were mostly well managed, and people received their medicines in line with the prescriber’s instructions.

At the time of inspection there was a manager in place employed on a short-term basis, who had experience of working in services who needed to make improvements. The manager had made improvements to the provider’s audit systems. Engagement practices had also improved and a regular schedule of meetings with staff, residents and relatives were planned. Staff survey results had been analysed since the last inspection, and these highlighted a number of recurring themes around low staffing and low staff morale. As the improvements to audit systems and engagement practices were in their infancy, more time was needed to demonstrate improvements made were sustained and embedded. The provider told us they had appointed a new manager who was due to start shortly after the inspection and they would continue to work with the new manager, regulator and external stakeholders, to ensure the service improved to the standard of good.

The provider had made improvements to ensure people received a choice of food, and dietary requirements were known by staff. However, the use of menus and plated meal options to help people choose their meal was not consistently practiced by staff. Staff training and support had improved, and training compliance remained an ongoing focus for the provider. Improvements had been made to the environment to ensure there was suitable signage to aide orientation for people living with dementia. The provider had plans in place to address areas of the environment in need of re-decoration, such as carpets, which were showing signs of wear and tear.

People received good access to health professionals. People’s consent to care was recorded. 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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 31 December 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the provider had not made enough improvement and they remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safety, the provision of person-centred care, and good governance.

Please see the action we have told the provider to take at the end of the full report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Alpine Lodge is a nursing home. It was providing personal and nursing care to 58 people at the time of the inspection. The service can support up to 67 people across four units. One of these units specialises in supporting people who live with dementia.

The home is purpose-built with en-suite bedrooms and communal areas. The home has a secure garden accessible from the ground floor.

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

Risks were assessed but had not been reviewed so people’s safety was not managed and monitored. Infection prevention and control was not adequately managed. Systems, processes and practices were not embedded to ensure people were safeguarded from the risk of harm or abuse. Sufficient staff were not evident in all areas of the home and appropriate checks on staff recruitment had not always taken place. Accidents and incidents were not analysed so lessons could not be learnt to prevent recurrence. Medicines were mostly administered as prescribed, however improvements were needed to the management of some time-sensitive medicines.

There had been inconsistencies in the management of the home and a lack of effective leadership of staff to promote good quality care delivery. The provider's governance framework had not identified the issues found during our inspection. Issues identified at our last inspection had not been addressed. Residents meetings took place, as did some staff meetings. Surveys with people and staff had taken place, however these had not been analysed so their feedback had not been acted on.

People's needs and choices were assessed, however there was limited information about people's needs made available to staff. People did not always receive a choice of food. People who required a modified textured diet were not given a choice for their main meal. Staff were trained, however there was no evidence new staff members received an induction. The environment was not always suitable for people who lived with dementia. Information about choices was not always given in the most appropriate way to support people’s understanding.

We have made a recommendation about how the staff and environment could better support people who live with dementia.

People received good access to health professionals. People’s consent to care was recorded. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plans lacked detail about people as individuals. People did not always have appropriate end of life care plans. Complaints were not always logged.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 December 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the provider had not made enough improvement and we found they were also in breach of additional regulations.

Why we inspected

We received concerns in relation to record keeping, staffing and infection control. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 risk have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, responsive and well-led sections of the full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people’s safety, the provision of person-centred care, and good governance.

Please see the action we have told the provider to take at the end of the full report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the provider's registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Alpine Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care. The service can accommodate up to 67 people across four units. There were 58 people living at Alpine Lodge at the time of this inspection.

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

We found the arrangements in place to manage medicines so people were protected from risks associated with medicines required improvement.

The systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people had improved since the last inspection. However, we saw the system and processes in place to ensure people had an accurate and complete care plan required improvement.

At our last inspection we found safeguarding procedures needed to be embedded into service practice. We saw improvements had been made, but further action was required to ensure staff always reported incidents to the registered manager.

People and relatives spoken with did not express any worries or concerns. They were satisfied with the quality of care that had been provided. People had access to external health professionals to help promote good health and wellbeing.

There were robust recruitment procedures in place so people were cared for by suitably qualified staff who been assessed as safe to work with people.

At our last inspection we saw people were not always treated with dignity and respect. At this inspection the culture within the service had improved. During the inspection we observed staff giving care and assistance to people. They were respectful and treated people in a caring and supportive way. People and relatives spoken with described the staff as kind and caring.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

At our last inspection we found concerns about staff training. At this inspection we found action had been taken to ensure staff completed relevant training. The systems in place to ensure staff received regular supervision had improved, however some staff were still not receiving the number of supervisions stated in the provider’s supervision policy.

People made positive comments about the quality of food provided and told us their preferences and dietary needs were accommodated. People’s nutritional needs were monitored and actions taken where required. However, we found the pureed food provided to people required improvement.

At our last inspection there were limited meaningful activities for people using the service. At this inspection we found further improvement was required to ensure people were provided with meaningful activities.

The complaint process at the service had improved since the last inspection. There was a robust process in place to respond to concerns or complaints by people who used the service, their representative or by staff.

The service looked, on the whole, clean and regular infection control audits were undertaken by the senior staff. The registered manager told us the provider was planning to replace the carpet in one unit as it had malodours.

The registered manager and provider had an overview of the service. The registered manager and provider identified any areas for improvement and planned changes to the service to ensure it provided high-quality care. However, we found some systems and processes need to be more robust.

Rating at last inspection:

At our last inspection in September 2018 Alpine Lodge was rated requires improvement and we found five breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of four of these regulations. This service has been rated requires improvement for the last three consecutive inspections.

Enforcement

We found a continued breach of Regulation 17, (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk. Please see the action we have told the provider to take at the end of this report.

Alpine Lodge is registered to provide accommodation for up to 67 older people. Accommodation is provided over two floors, accessed by a passenger lift. Communal lounges and dining areas are provided. On the day of the inspection there were 49 people living in the home.

Our last inspection at Alpine Lodges took place in 10 August 2017. At that inspection, we found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 9; Person centred care, Regulation 12; Safe care and treatment and Regulation 17; Good governance. Following the last inspection, the registered provider sent us an action plan detailing how they were going to make improvements.

During this inspection, we checked improvements the registered provider had made. We found the registered provider had made some improvements but there were repeated breaches in regulations 12, Safe care and treatment and 17, Good Governance. We also found further breaches in Regulations 13, Safeguarding service users from abuse and improper treatment, Regulation 16, Receiving and acting on complaints and Regulation 18, Staffing, because staff did not receive appropriate support training, supervision and appraisal as is necessary to enable them to do the jobs they are employed to do.

This inspection took place on 25 September 2018 and was unannounced. The meant the people who lived at the home and the staff did not know we would be visiting.

There was no registered manager in post at the time of the 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 a 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 home manager had commenced employment the day of the inspection. Changes within the management team had impacted on the performance of the team. The provider had put in interim management arrangements in place to support the operations and the ongoing improvement of the service. We found from talking with staff this led to confusion about who was in charge.

We received mixed views from people about the support provided to them. Some people and their relatives spoke very positively and told us they felt safe and their support workers were respectful and kind. Other people had concerns about their experience of living at Alpine Lodge.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and records we reviewed confirmed staff had safeguarding training. However, issues we identified during the day did not support this.

Staff we spoke with told us they felt things had been difficult because of the changes in management and because different managers had told them different things to do. However, staff told us, “Things are getting better.”

We looked at the arrangements for the management of medicines. We found medicines were recorded, administered and stored accurately and in accordance with instructions. However, we found that some PRN protocols needed more detail. PRN protocols are to guide staff on how to administer those medicines safely and consistently.

We have made a recommendation about the recording of some medicines.

People were aware of the complaints procedure; however, we saw where concerns had been raised these had been not always been dealt with appropriately or in a timely way.

Activities were provided, however these were not well advertised and displayed for people to see. Further improvements and additions to the activity programme were needed.

People had access to a range of healthcare professionals to help maintain their well-being. A varied diet was provided. However, it did not always consider dietary needs and preferences so people's health was promoted choices could be respected.

Staff told us that supervision took place, however records we reviewed confirmed that staff had not always received appropriate supervision and appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We found care plans were in place and had been updated since our last inspection. We found for the most part people's needs had been identified. However, records we looked at confirmed risk assessments had bot always been followed to protect people from harm. Accidents and incidents were not always recorded and analysed to identify patterns and trends.

Systems in place to monitor the service had not been completed consistently. The quality and safety audits in place had not always been effective. For instance, the shortfalls that we found at this inspection had not been identified by the registered provider's monitoring systems.

Alpine Lodge is a care home providing nursing care for up to 61older people, some of whom were living with dementia. The home is located in Stocksbridge, in the North West of Sheffield. The home is a purpose built two-storey building. All bedrooms are single occupancy and have en-suite facilities. On the day of our inspection there were 59 people living in the home.

The home had a registered manager. 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.

Our last inspection at Alpine Lodge took place on 1 December 2015. The home was rated as Good. At that inspection we found the home to be in breach of one regulation for safe care and treatment. This was because some people's risk assessments lacked detail, did not reflect all of the relevant risks,

or had not been updated to reflect changes in their needs. A requirement action was given for this breach in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found improvements had been made relating to risk assessments. However sufficient improvements had not been maintained to meet all regulations.

The majority of people who used the service and their relatives spoke positively about their experience of living at Alpine Lodge. They told us they, or their family member, felt safe and were happy. Only one person we spoke with told us they did not want to live at the home and they were not happy there.

We looked at the arrangements for the management of medicines. We found medicines were not always recorded, administered and stored accurately and in accordance with instructions.

Staff recruitment policies and procedures helped to ensure the right people were employed which helped to keep people safe.

Sufficient numbers of staff were provided to meet people's needs, although current staffing levels meant staff did not have much time to spend with people, other than to provide the necessary support and care.

People had access to a range of healthcare professionals to help maintain their well-being. A varied diet was provided, which took into account dietary needs and preferences so people's health was promoted and choices could be respected.

Training provision was good and staff received regular supervisions and appraisals. Staff were clear about their roles and responsibilities and how to provide the best support for people.

People who used the service and their relatives said they were well looked after. People liked the staff and there was mutual respect between people, their relatives and the staff team.

Assessments of people’s care did not include all of their needs, including health, personal care, emotional, social, cultural, religious and spiritual needs.

Activities were provided, however these were not well advertised and displayed for people to see. Further improvements and additions to the activity programme were underway.

People were aware of the complaints procedure but said they had not used this as they were happy with the service they were provided with.

The registered provider and registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys, audits and care reviews. We found these had not been effective in ensuring compliance with regulations and identifying areas requiring improvement and acting on them.

The registered manager was working in partnership with other professionals to improve the quality of the service.

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

Further information is in the detailed findings below.

Alpine Lodge is a care home providing nursing care for sixty-one older people. Within the home is a twenty-bedded unit for people with dementia. Alpine Health Care Limited owns the home. The home is located in Stocksbridge, in the North West of Sheffield, opposite a school and within walking distance of shops and the bus route. The home is a purpose built two-storey building. All bedrooms are single occupancy and have en-suite facilities. At the time of the inspection there were sixty people using the service.

There was no registered manager at the time of the 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. The provider had appointed a new manager, who had started work in the home around six months ago. The manager told us they were preparing to apply to become registered.

People said they felt safe and the staff we spoke with had a clear understanding of safeguarding people from abuse, and of what action they would take if they suspected abuse. The way staff were recruited was safe and thorough pre-employment checks were done before they started work.

The individual plans we looked at included risk assessments, which identified most risk associated with people’s care. However, some people’s risk assessments lacked detail, did not reflect all of the relevant risks, or had not been updated to reflect changes in their needs.

We found there were enough staff with the right skills, knowledge and experience to keep people safe. The manager was undertaking a review of the staffing levels and deployment in order to make improvements in this area, as there was a lot of pressure on staff to meet people’s needs at busy times.

People’s medicines were managed and administered safely.

Staff were provided with appropriate training to help them meet people’s needs. This included appropriate training to help them to respond positively when people displayed behaviour that challenged.

We found the service to be meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and the staff we spoke with were aware of the Act. There was a need to further develop some of the assessments, records, and the practice in some areas, and the manager was taking action to address this.

People were supported to maintain a balanced diet. The people we spoke with told us they liked the food and were happy with the choice of meals.

People were supported to maintain good health, have access to healthcare services and received on-going healthcare support. We found that people had received support from other professionals and appropriate healthcare services when required.

People’s needs were assessed and care and support was planned and delivered in line with their individual support plan. We saw staff were aware of people’s needs and the best ways to support them. The manager and all of the staff we spoke with and saw supporting people, had a caring approach and treated people with respect and dignity.

People’s individual plans included information about their family and others who were important to them and they were supported to maintain contact. We saw that people took part in activities and events in the home and in the local community, and people told us they were happy with the activities on offer.

People who used the service, their relatives and staff told us the manager, although relatively new, was very approachable and responsive. They were pleased that the manager had introduced regular meetings with them, and had made improvements to the service.

People told us that they were happy living at the home and satisfied with the care and support they received. Their comments included, 'Wonderful staff, really good here, I can't grumble at all,' 'I've no worries at all,' and 'Staff are marvellous, all of them.'

Relatives we spoke with said that they were happy with the care their loved one received. They told us, 'We're very happy with the care, we know he is being looked after,' 'No problems at all, if I did I would go straight to the manager, she would sort things,' 'The care here is good, staff are very good at keeping us up to date with how she is doing,' and 'There is always lots going on [activities] to keep him occupied, all the staff are lovely.'

We found, during our SOFI observation, that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people.

People had equipment in place to support them in meeting their needs, for example, hoists and wheelchairs.

The provider had an effective recruitment and selection procedure in place to ensure that staff were appropriately employed.

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had been maintained.

During our observations of how people were supported, we saw some examples of good communication skills by some staff that utilised eye contact and touch to engage people who used the service. However, we did see some practices by staff where they did not engage or communicate with people effectively.

We spoke with relatives who were visiting the home and they confirmed that they were very happy with the care provided. They told us, "the staff are very friendly, they keep us informed with what's going on', 'mum seems so relaxed since she has started living here' and 'the staff are very good, mum always looks really well cared for when we visit.'

We found that people's needs were identified in care plans. Records showed that people and their relatives had some involvement in the care planning process.

Medication records checked were up to date and regular audits of medication systems were undertaken.

We found that relevant training and support was provided to staff.

All of the people and their relatives we spoke with said they had no complaints or concerns about the home.