Alpine Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 wer

This inspection took place on 10 August 2017 and was unannounced. This means prior to the inspection people were not aware we were inspecting the service on that day. The inspection was prompted in part as a consequence of information of concern sent to Care Quality Commission (CQC) and emerging risk identified by the CCG (Clinical Commissioning Group) and Sheffield local authority. The information shared with CQC indicated potential concerns about the management of risk in the service.

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

The inspection took place on 1 December 2015 and was unannounced. Our last inspection of this service took place in November 2013 when no breaches of legal requirements were identified.

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 ma

We found people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

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.

People all spoke very positively about Alpine Lodge. They told us they were happy with care at the home, liked all the staff, thought the service was kept clean and enjoyed the food which was served. Some people’s comments captured included, “staff all nice”, “it’s a very clean home”, “absolutely brilliant home, I can’t fault it” and ”fantastic care.”

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.

People told us that overall they were happy living at the home and satisfied with the level of service provided.

Individual comments included

“It’s smashing here”.

“The staff are kind and caring”.

Due to some people’s communication needs we used informal methods of observation during the site visit. We sat with people in the lounges, observed care practices ,and saw how staff and people interacted with each other.

Throughout the observation we saw all staff treat people with dignity and respect by using a positive, friendly and kind approach.

We spoke with Sheffield Local Authority, Contracting, Commissioning and Safeguarding and they told us that they had recently visited Alpine Lodge and had not identified any concerns at the home.

Some people who lived at Alpine Lodge had some conditions that meant we had difficulty talking with them. Other people were able to express their views clearly, others we were not able to verbally communicate with. Due to people’s communication needs we used informal and some formal methods of observation throughout our inspection visit.

The formal observation tool we used to observe people in this inspection was a ‘Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who use services for a period of up to an hour and recording their experiences at regular intervals. This included people’s mood, and how they interacted with staff members, other people who use services, and the environment.

Through our formal and informal observation we saw that staff made efforts to include people in conversations. Staff also encouraged people to communicate with each other and provided some social activities on a group basis to enable this.

Throughout the observation staff were seen to treat people with respect and courtesy. The inspector also observed staff being very warm and patient with all people who use the service. Staff frequently used touch when communicating with people and this seemed to provide comfort to people.

Staff spoke clearly and at a steady pace with people.

They encouraged people to be active in their own care and activity. Staff asked if a person would like assistance before providing it.

People told us that overall they were happy living at the home and satisfied with the care and support they were receiving. People said:

“It’s nice here.”

“The staff are very nice.”

“It’s alright here.”

“They (staff) look after me really well.”

“It’s lovely here.”

Relatives said that they were very satisfied with the support provided to their loved ones and were always made to feel welcome at the home when they visited. Individual comments included:

“Staff are smashing and so is the care.”

“It’s a good place here. The care is good and I have no worries leaving my husband when I go home after visiting him.”

“I’m really pleased with the home.”

“We as a family have no complaints whatsoever about Alpine Lodge.”

Relatives and people praised the amount and frequency of social activities organised and available for people.

One health care professional told us that they visited the home at least twice a week.They said they felt the standard of care delivered by staff was generally very good and they were happy with what they had seen and heard on visits to the home. They added that staff knew people very well and were fully aware of their health needs. They said they were asked to see people at the home appropriately and in a timely manner.

We found in the main that staff members through interaction and care treated people with respect, dignity and maintained their privacy.

Some concerns were raised over some staff’s actions whislt providing care that did not uphold one person’s privacy and dignity.