Alpine House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems were in place to investigate safety concerns and events. However, these were not always used consistently and robustly to improve practice and reduce risks. The registered manager responded promptly and in detail to issues raised. However, these generally found no or very limited shortfalls with the service and did not always demonstrate an approach that explored areas for improvement and how lessons learnt from incidents were used to drive improvements.

Staff understood the importance of reporting any safety concerns and told us senior staff were responsive and supportive in dealing with matters raised. Relatives knew who to contact if they had any concerns about people’s care.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. There were some systems in place for the continuity of care, including when people moved between different services. Information was obtained from people, and others involved in their care, about people’s individual needs and risks to their safety. However, we experienced significant delays with the registered manager confirming what the most up to date record was for a person, reflecting their current risks and needs. For example, for several people whose care records we looked at as part of the inspection process, we were not made aware of all the relevant records in relation to risk management and safety during the inspection process. This meant the systems in place for ensuring continuity of care and continued oversight of risk through effective and timely information sharing were not always effective.

The provider told us since our inspection they have reviewed their systems, and have now centralised the records.
 

The provider worked with people and healthcare partners to understand what being safe meant to them. A safeguarding incident regarding poor treatment of a person was under investigation at the time of the inspection. During the investigation, it came to light that some information shared by a relative to a staff member had not been escalated to the registered manager in a timely way. The registered manager told the local authority, following this shortfall, they had reviewed their internal systems and procedures to ensure all concerns were escalated promptly to the management team. The local authority safeguarding team confirmed to us the safeguarding concerns were upheld. The registered manager did take appropriate action in relation to the staff implicated in the concerns.

The registered manager did investigate concerns brought to their attention. However, it was difficult to see how they had oversight of concerns. There was no overarching safeguarding matrix to enable the registered manager to track and monitor the progress of any safeguarding investigations, who the concerns had been shared with and the lessons learnt.

Staff told us they were confident that any concerns shared with the registered manager, would be dealt with. Some staff showed limited understanding of safeguarding procedures. Whilst they were able to tell us what safeguarding meant, when asked about different forms of abuse, they advised that abuse concerns would be dealt with by the management team.

Following our inspection the provider told us about a number of actions they had taken to improve their oversight of safeguarding. This included an internal review of reporting and safeguarding escalation protocols. Staff were reminded of their duty to report all safeguarding concerns directly and immediately. A centralised tracking system would be implemented to provide a more transparent and auditable overview. Additional refresher training and scenario-based learning had also been delivered to all staff to reinforce recognition of all abuse types and staff responsibilities.

We can confirm the above changes will be made to this section of the report. However, this change will not affect the scoring of the quality statement and the overall rating.
 

The provider had processes in place designed to enable them to identify and mitigate risks to people; however, these were not always effective. Some care records lacked detail about how people were supported with some health conditions and some care records lacked detailed about how specific risks would be managed. This included risks in relation to safe moving and handling practice. Whilst the records were clear about staffing levels needed and the equipment in place, the risk assessment was not always specific, or person centred about the needs of the person being supported. It did not include what the person could do for themselves with support, or if they suffered pain or other discomfort whilst being supported. It was not always clear or detailed how a person was supported through different moving and handling tasks. This included transitions from lying in bed to sitting up and moving into a position to use a walking aid.

A staff member told us inaccurate information about a person’s moving and handling needs. We raised this with the registered manager, and they told us this would be addressed, and further supervision and training would be provided.

A person’s care plan stated they were supported with all their meals by care staff and some additional risks in relation to eating had been identified by the registered manager and documented in the care plan. Staff informed us the care plan was not being followed, and the person could make their own choices about meal arrangements. We raised this with the registered manager who told us the person could make their own choices. Whilst acknowledging this, the care plan and risk assessment had not been updated to reflect this change, and the associated risks this person may be faced with had not been considered or assessed.

It was unclear how the provider kept information about people’s safety and risks robust and up to date. The core care plans and risk assessments, when reviewed by the registered manager, made no reference to additional addendum information, including additional risk assessments held by the provider.

Despite our findings there was no evidence that people had been harmed.

The provider identified and took steps to control potential risks in the care environment. The provider completed environmental risk assessments within people’s homes during their initial assessment to check if it was safe for staff to carry out care in a safe environment. This included checks around fire safety.

The provider had some systems in place to ensure there were enough qualified, skilled and experienced staff. The provider told us their system for monitoring care calls times, duration and staffing levels had identified no concerns. However, we found the provider’s systems were not always effective. People’s daily records showed the planned and not the actual time and duration of a call. We reviewed the provider’s planned and actual data and found a number of anomalies. For example, we found a high percentage of late calls for 3 people, calls not scheduled for 1 person and some calls where 2 staff should be allocated showing only 1 staff present for part of the call When we raised this with the registered manager, they told us the system can appear unclear and difficult to navigate and they were looking at replacing the system as a priority.

Most relatives and people we spoke with felt staff arrived on time. A relative told us, “Visits are within half an hour either way, which is acceptable. There are no problems at all, we love them! There is a main carer, if we need anything, they are there. There are 3 other regular staff, who we have got to know very well.” Another relative told us, “We had previous issues of too many changes of staff. When we asked for more consistency and explained the reasons why, we found the manager easy to work with and the matter was resolved quickly. The service is working smoothly, and we are very satisfied.”

Staff were recruited safely, with an induction process and training in place. Staff felt their training was sufficient to support them to carry out their roles and they told us they received regular supervision with the registered manager.

The provider assessed and managed the risk of infection associated with people’s care. People and relatives told us that staff attending their calls would wear appropriate personal protective equipment (PPE). A relative told us, “All is good with cleanliness, they use PPE, tidy up, I can’t fault them.” Another relative told us, “We raised a concern that staff weren’t using PPE all the time, or sufficiently. I phoned the manager, who was immediately very concerned to hear this, and it was rectified straight away.”

Staff confirmed the appropriate use of personal protective equipment (PPE) was monitored through regular spot checks by senior staff. Staff confirmed they had completed training and always had access to supplies of PPE. The provider had supplies of PPE stored at their office and these were accessible to all staff.

Some systems were in place for the overview of medicine management and were generally effective. Where support with medicine management was provided, a risk assessment was in place. Risk assessments gave some information about how the person may take their medicines, for example with a drink. However, they were not always specific and personalised about how the person would be supported to take their medicines safely, or any additional information in relation to time-specific medicines and storage arrangements.

Staff had received medication administration training and had their competency assessed.