This inspection took place on 7 December 2016 and was announced. We gave the provider 48 hours’ notice of our inspection because the location provides a domiciliary care service [care at home]; we needed to make sure that there would be someone in the office at the time of our visit. The service was last inspected in August 2015 and was meeting all the regulations.

Alpine House are registered to provide personal care. They provide support to two people living in their own home. People required support from the agency because they had either complex physical health needs or were living with a learning disability.

The registered manager was present during our 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 relatives of people using this service told us that they felt their relatives were safe when they were being supported by staff. Staff were aware of the need to keep people safe and follow the risk assessments in place. Staff knew how to report allegations or suspicions of poor practice. Relatives told us there were enough staff employed to ensure the care and support was reliable. Staff had been recruited appropriately and safely.

Relatives of the people who used this service told us that they were happy with the care and support provided by the staff. The staff we spoke with told us they had received adequate and relevant training to meet the specific needs of people they supported. Staff told us that they had received observational competency checks to ensure they were safe to undertake complex medical procedures. People were supported to maintain a healthy lifestyle.

Relatives described the staff who supported their loved ones as kind and caring. Staff who worked for this service understood the needs of the people who they supported. Staff supported people to make choices and decisions about the care they received through a variety of communication styles. People were supported by staff who respected their dignity and privacy.

Personalised care plans were in place to enable staff to provide care the way that people preferred. Staff had developed relationships with people they were supporting. Relatives felt that they could speak with staff about their concerns or complaints and that they would be listened to.

The registered manager with the support of the management consultant ensured there were some systems in place to ensure safe and appropriate support to people. However, the audits and monitoring in place had not identified that staff had limited knowledge of the Mental Capacity Act and what it meant for people who used the service. Whilst the provider consulted with relatives of the people who used the services to find out their views on the care provide the information received had not been analysed or used to drive continual improvement. Relatives were happy about the quality of the service that was provided to their loved ones by the consistent team of staff employed.

This inspection took place on 04 August 2015. We gave the provider 48 hours’ notice of our inspection to ensure members of the management team would be available at the office, and to ensure they could make arrangements for us to meet with and speak to staff.

We last inspected this agency in November 2014. At that time the systems in place to monitor the safety and quality of the service were not adequate, the agency was not well managed, people could not be confident that deprivations to their liberty would be identified or managed, and people were not always being supported by staff that had undertaken training relevant to their role. We used our regulatory powers to ensure that improvements would be made. The registered provider and registered manager took action and at this inspection we found that some of the required improvements had been made.

Alpine House provides support to two people living in their own home. People required support from the agency because they had either complex physical health needs or were living with a learning disability.

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.

The relatives of people using this service told us they felt their relatives were safe. There were always enough staff available to support people. The staff employed had been subject to recruitment checks and had received some of the training and support they required to work safely. Training for staff about the specific needs people experienced had not all been provided. Evidence that staff were able to apply the training they had received to their work were not available.

Staff we spoke with were able to describe a range of activities they undertook each day which ensured people stayed healthy. Staff described how they observed people’s feet and skin for signs of infection or sore areas for example when they were supporting them with personal care.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 (MCA) which applies to services providing care in the community. Staff we spoke with and the registered manager had a basic understanding of this subject and were being supported by a management consultant engaged by the registered provider to ensure they were meeting their responsibilities under the act. Records showed that consideration was given to people’s needs under the MCA in care planning.

The culture of the agency had been built around providing a caring service that met the very specific needs and expectations of the two people using the service and their families. Staff we met spoke enthusiastically about the people they were supporting, and in discussions were able to explain people’s needs, their preferences and were aware of important people in the person’s life.

Senior staff, supported by the management consultant engaged by the provider had visited each of the people using the service at their home. They had met with them and their family to determine what care and support the person required, and how they would like this care to be provided. This information had then been developed into a care plan, and shared with staff that were supporting the person. This ensured all staff were aware of the person’s needs and wishes. Staff we met were able to describe at length how they met the individual needs of the person they supported.

The registered provider had developed a complaints procedure. No matters of concern had been raised with either the agency or the Commission but the management consultant and registered manager were able to describe how any concerns received would be investigated and resolved. They described how the information would contribute to the development and improvement of the service.

The feedback from relatives of people using the service and staff was consistently positive about the management of the agency. People told us the management team were approachable, friendly and that they did what they said they would do. Professionals we spoke with told us that sometimes they had to chase or wait lengthy periods of time for information they requested from the manager.

The registered manager had used feedback from the last inspection to develop the service, and we found the action plan they submitted had been partially effective at achieving some of the necessary improvements. The registered manager and management consultant shared with us ideas they had to fully achieve compliance with the regulations and to further develop the agency building on their existing achievements.

This inspection took place on 05 November 2014 and was announced. We give providers of domiciliary care services 48 hours’ notice of our visit to ensure we are able to speak with people who use the service and the staff who support them.

We last inspected this service in February 2014. At that time we found the service was breaching five of the regulations we inspected. The agency had been improving slowly over time but had been non-compliant with Regulations since 2011. At this inspection we found that improvement had continued and that three of the five breaches of regulations we had previously noted had been fully met.

Alpine Care is a small domiciliary care service. It provides care and support for two people who live in their own home. The service has a manager registered with the Commission but we were informed this person is not in day-to-day control of the service and we have advised the registered provider’s nominated individual to apply to correct this. 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 registered provider’s nominated individual was operating the service with support from a private consultant.

The two people using this service were unable to verbally tell us how they found the support they were receiving. During our inspection we met one of the people using the service and they looked content and relaxed with the service they were receiving. We spoke with the relatives of both people. They reported that they were extremely happy with the way the staff were supporting their relative. Family members told us that they appreciated that the same member of staff or a small dedicated team of staff supported their relative each day. Relatives told us this continuity gave them peace of mind and confidence that their family member would be cared for well.

Relatives told us they were getting the service they wished and hoped for. They described how their relative’s needs were being met and gave examples of how the person’s condition or their needs had remained stable or improved over time, which assured them that good care was being delivered.

The service was not being run in a way that would ensure risks to people’s safety would always be anticipated, identified or well managed. While we found no evidence that people had come to harm we did find that some staff had worked excessive hours. We found that there was a lack of clarity about the night time care needs of one person who had very complex health care needs, and that staff were not able to describe different types of adult abuse and what they would do if they witnessed or reported this. We had previously made a compliance action that required staff to undertake further training and assessment of their competency relating to healthcare they were undertaking. This had not been addressed. In these areas we identified that people may not always receive safe care.

People were receiving the support they hoped for from the service. We found staff had got to know the people they were supporting over time; however staff had not been well trained to meet the needs of the people they were supporting. Neither the registered provider’s nominated individual nor the staff we spoke with were able to describe their responsibilities under the Mental Capacity Act 2005. Although we found no evidence that this had impacted on people so far, this lack of knowledge would not ensure people always had risks to their liberty or human rights identified or that the appropriate action would be taken.

Staff we met showed compassion for the people they were supporting. Care was not always delivered in a way that was mindful of people’s privacy and dignity.

We found that people were receiving care that met their individual needs and wishes. Relatives were aware of how to raise concerns and there were systems in place to ensure people got feedback about the action the provider had taken.

The service did not have robust or established leadership and governance systems in place. Both the registered manager and registered provider’s nominated individual lacked the skills to run the service without support. They had sought support from an external management consultant. This had resulted in improvements to the smooth running of the service and the safety and quality of care for people using the service.

We carried out this inspection to see if improvements had been made following our previous inspection in July 2013. In February 2014 we found the service had improved although it remained non compliant in most areas we inspected.

The agency supports two people. Relatives of the people using the service told us," It is fine" and "I'm happy with the care. No problems at all." Relatives also told us they appreciated having the same care staff, and staff with whom they were able to speak with in their first language. We found the records of care, care planning and assessments were not adequate to reflect the needs of the people the agency was supporting.

Staff had received training in safeguarding. Staff records revealed that recruitment and pre-employment checks were unsatisfactory. This meant vulnerable people may not always be protected from unsuitable staff.

We found there were enough staff and that plans to develop a "bank" of staff were in place, which would provide staffing cover in event of emergencies.

Staff had received some training but required further training to demonstrate that they were competent to meet people's needs safely.

The agency had achieved some improvements and had further potential to improve if current plans to recruit senior staff and a care consultant were successful.

Records had improved but we found records for people using the service and staff were not all fit for purpose.

This is a small care agency and the agency’s office is not always open. We gave the agency two days notice of our visit to make sure there would be someone there when we visited. We visited the agency as part of our planned review and to follow up improvements needed from our visit in December 2012.

At the time of our visit to the care agency we were told that they were providing personal care to three people. We asked the agency to contact people so that we could speak to them about their views of the service they received. We were able to speak with one relative of a person who used the agency. We were told that one person did not wish to speak with us and that the agency had been unable to speak with the relative of a third person.

We spoke with a relative of a person who received care from Alpine House. They told us that they were very happy with the service and that the care was very good. They told us they always had the same carer, who arrived on time and who knew the person’s needs.

Surveys completed by people who used the service indicated they were happy with the care they received but we found that improvements were needed in most outcome areas that we looked at. We looked at quality and monitoring arrangements in place to drive improvements and minimise risks to the care and welfare of the people who used the service but found that these were not robust.

We carried out this inspection to check if any progress had been made to achieve compliance with regulations since the previous inspection in April 2013.

At the time of our inspection this service was supporting two people. We met with a person who used the service in their own home and spoke with relatives of both people who used the service. We were able to observe how one person was being cared for and noted that staff providing care treated them appropriately. People using the service received care which met their needs, but the planning of care and support was not well managed. Care plans and guidance was inaccurate and if followed by staff would, in the case of one person, put the person at risk.

Since our last inspection the provider had ensured that the majority of the staff had received safeguarding training, however the manager had not completed safeguarding training and was unaware of local authority procedures in respect of safeguarding vulnerable people. Staff advised that they would report safeguarding concerns to the manager for onward referral, but were not aware that the manager was not familiar with the procedures to be followed nor was she aware of the contact details.

Recruitment practices had improved and all appropriate checks and references had been undertaken. All staff had checks of their good character, skills and ability to meet people’s needs.

People received continuity of care from staff and when staff were unavailable the relatives of the two people receiving the service chose to provide the care rather than have different staff involved in provision of care.

The provider had introduced individual meetings with staff to ensure that were supported to provide safe care and support. The staff had opportunities to discuss their training and development needs at the individual meetings.

Arrangements for assessing the quality of the service provided were not effective. Monitoring of the care provided and records made by staff had failed to identify that on numerous occasions recorded information about care practices that was inaccurate. This meant that the provider had not protected the people who used the service from the risk of inappropriate care.

Records relating to care and support provided were altered on occasions sometime after care had been provided to remove detail of inaccurate reporting on the care given. Staff records were not accurate and staff altered people’s records. Written policies were not maintained and were not fit for purpose. Some policies and procedures produced for the service were inaccurate and misleading.