Alpine Lodge

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• 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

We found two breaches of the legal regulations under this key question . We found concerns relating to the management of people’s medicines, infection control and the management of people’s individual risks. People’s risks were identified and mostly detailed in peoples plans of care. However, they were not always managed effectively. The provider had not ensured people’s medicines were managed safely. People had not been protected as much as possible from the risk of infection because the premises and equipment were not kept clean and hygienic. We also found concerns related to staffing. People, relatives and staff feedback told us there were not always enough staff on duty to meet people’s needs. The management team told us there was a high level of genuine sickness which was impacting on staffing levels. The provider was actively recruiting and interviewing applicants. Staff received training to ensure they had the skills to meet people's needs. However, we observed staff could be task orientated in their approach to care and support. This was particularly noted on the upstairs unit at mealtimes. Management told us some staff were being performance managed as they had identified the need for further support and training to ensure they were consistent in their approach to ensure people’s needs were met. The management team understood their responsibility to refer any safeguarding matters to the appropriate agencies. However, we were not fully assured staff would recognise and report people’s deterioration. We saw analysis, lessons learnt and review to ensure good practice regarding falls. However, staff were still not consistently following processes and guidance. This put people at risk of harm.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives expressed mixed views about the quality of care. Our assessment found elements of care did not meet the expected standards.

The management team told us they had responded to the concerns raised by the local authority, staff, and relatives. They were committed to learning and improvement of the service.

We saw analysis, lessons learnt and review to ensure good practice regarding falls had been completed. However, we found many concerns, most had been identified as part of the quality assurance process, but staff were still not consistently following processes and guidance putting people at risk of harm.

We received mixed views about the quality of care from people and relatives spoken with. Some people and relatives were generally happy whilst others felt the quality of care required improvement. Our assessment found elements of care did not meet the expected standards.

The management team told us they had responded to the concerns raised by the local authority, staff, and relatives. They were committed to learning and improvement of the service. Some staff spoken with did not feel listened to or their views valued.

Partners told us they could see improvements being made by the management team, but staff were still not embedding them into practice.

The management team had ensured positive relationships had been made with other healthcare agencies involved with people's care, to ensure they received effective care, support and treatment. Policies and processes about safety were aligned with other key partners who are involved in people’s care journey. However, our findings showed people’s plan of care was not always followed by staff. Putting people at potential risk.

Most people told us they felt safe. One person did not feel safe because they had to wait a long time for staff to respond to their calls for assistance. Relatives spoken with felt their family member was safe.

Staff told us they received training in safeguarding people and felt they had the skills to recognise and respond to concerns. However, we identified risks were not always managed effectively. We were not fully assured staff would recognise deterioration, which could mean people’s needs not being met and possible neglect.

Staff told us they would report any concerns to the management team but were concerned about the number of management changes. The peripatetic manager assured us they were taking action to address staff competencies and would take action.

There were safeguarding policies and procedures in place and the management team understood their responsibility to refer any safeguarding matters to the appropriate agencies. However, we were not fully assured staff would recognise and report people’s deterioration. Due to concerns found during our visit we submitted three referrals to the local safeguarding authority. The management team had been working with the ICB and local authority and were committed to making improvements. The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

People had individual risk assessments in place. However, people’s risks were not always managed effectively.

We looked at two people’s plans who were assisted to move by stand aids and hoists, we found no clear direction for staff. We also found examples where some people’s plans contradicted each other. When we questioned staff about a person each staff member gave us a different account of how the person was moved. Therefore, it was not clear if the person was moved safely.

We observed some people’s weight loss was not being managed effectively. For example, we observed people’s lunch experience and found some people were not being supported to eat or drink appropriately. Although people’s care plans detailed how people should be supported staff were not always following these plans. For example, we observed one person with a meal in front of them for over 15 minutes and no staff attempted to assist or encourage the person with their meal. The person’s care plan clearly detailed the support they required.

People’s risks were identified and mostly detailed in peoples plans of care. However, they were not always managed effectively. For example, risk of weight loss was not managed effectively. The care plans detailed actions to be taken but staff did not always follow these. People were not supported or encouraged to eat their meals, there were no records of what food had been served and eaten or how it had been fortified. There was no monitoring, review, or oversight of the risks. Some people’s moving and handling care plans required improvement to ensure there was clear guidance in place for staff to follow.

People were cared for in an environments that was designed to meet their needs.

Staff told us they undertook environmental checks to detect and control potential risks in the care environment.

Equipment was available in different areas of the service for staff to access easily to support people who could not mobilise independently.

There were a range of environmental checks in place. Equipment checks were also undertaken to support the delivery of safe care. We found some equipment required cleaning. For example, shower chairs were rusty so staff were unable to clean them effectively.

People spoken with told us at times they had to wait for a long time for support. One person said, “I don’t feel safe here because you have to wait ages when you press your buzzer it is too long and sometimes it is two hours or sometimes one hour.” Relatives also raised concerns regarding agency staff as they did not know people. One relative said to us that when she asked agency staff about their relative, they said “Who is that?”

Staff told us there were not always enough staff on duty to meet people’s needs.

On the day of our visit a senior had called in sick. Staff cover was provided for the administration of medicines but then the staff member left. Staff were visible in communal areas throughout most of the day. However, we observed staff were not always present in the lounge/dining room on the upstairs unit. On one occasion we observed a potential choking incident and had to find staff. From our observations, it did appear there was enough staff on duty but the staff lacked effective deployment, support and direction.

There was a staffing dependency tool used, the staffing levels met the required amount. However, people, relatives and staff feedback told us there were not always enough staff on duty to meet people’s needs. The management team told us there was a high level of genuine sickness which was impacting on the staffing. The provider was actively recruiting and interviewing staff. Staff received training to ensure they had the skills to meet people's needs. However, we observed staff could be task orientated in their approach to care and support. This was particularly noted on the upstairs unit at mealtimes. Management told us some staff were being performance managed as they had identified the need for further support and training to ensure they were consistent in their approach to ensure people’s needs were met.

People were not protected from the risk of infection. Staff did not encourage people to wash hands or change clothes when stained and dirty. People were able to receive visitors in line with best practise guidance.

The management team told us there was a number of domestic staff absent due to genuine sickness so this had impacted on the standard of cleanliness at the service.

The service was dirty and not well maintained so could not be effectively cleaned. For example, we found chair cushions and mattresses, bath, shower and toilet chairs were not clean. Raised toilet seats and shower chairs were rusty so they could not be effectively cleaned by staff. Kitchenette areas were not clean, refrigerators were dirty and seals damaged, we found mouldy food in one refrigerator.

The provider had not ensured people were protected as much as possible from the risk of infection because the premises and equipment were not kept clean and hygienic. The audit tool used did not identify some areas that required attention. This was discussed at our visit and some improvements were made on the day but had not been picked up as part of the providers quality assurance systems.

Some people were prescribed medicines to be taken ‘when required’ or with a choice of dose. The protocols to support the safe administration of these medicines were either not in place or were not personalised. There was no information for staff to follow to assist them to decide the most appropriate dose to administer when there was a choice of dose. This meant people may not get their medicines consistently and at the time they were needed. One person did not have always have their diabetes managed safely because staff failed to follow their care plan property and they failed to act in a timely manner when equipment was faulty.

The registered manager and a senior manager explained the actions that had been taken before the assessment to reduce the number of medicines errors being made by agency staff. Staff told us the paperwork was more organised and easier to use. It was too early to assess if the actions had reduced errors being made. The managers were aware that staff did not always manage people’s medicines safely and staff did not always follow the medication policy or guidance properly. The managers explained what action they were taking to ensure people were given their medicines safely.

The information recorded on people’s medicines administration records was not always accurate or up to date which meant that they were at risk of not being given their medicines safely. The poor record keeping meant that staff could not know when it was safe to give doses of paracetamol or where to apply transdermal patches. The information about one person’s insulin was incorrect and could have led to a serious error being made. A few people required their medicine to be hidden in food or drinks to ensure they received the medicine they needed. There was no information available, from a pharmacist, for staff to follow as to the safest way to disguise each individual medicine. Medicines, including creams and injections, were not always stored safely or at the correct temperatures. Waste medicines were not stored securely in line with current guidelines.