This comprehensive inspection took place on 14 May 2018 and was unannounced.

Alder House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Alder House accommodates up to 22 people with physical or sensory disabilities. At the time of our inspection, there were 20 people living at Alder House.

At our last inspection, we rated the service Good. At this inspection we found the evidence continued to support the rating of Good, and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager at the service. 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.

Why the service is rated Good.

People received care and treatment which was planned and delivered in a way that ensured their safety and welfare. There were enough staff to ensure people’s care and support needs were met. Staff had been recruited and employed after appropriate checks had been completed. People's medicines were managed safely and medicines were administered by staff who had received training to do so. There were systems in place to minimise the risk of infection.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). 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 support this practice.

People received a service which was responsive and centred around their needs. People's care plans provided clear guidance to staff on how people wished to be supported, and were regularly reviewed. The environment at Alder House was appropriately designed and adapted to meet people's needs.

Staff received training and structured supervision to enable them to acquire the skills and knowledge to meet people’s care needs. Staff were kind and caring in their approach with people. Staff treated people with dignity and respect and promoted people's independence.

People were supported to eat and drink enough, ensuring their dietary and nutritional needs were met. Staff worked effectively with other health care professionals to ensure people's health needs were met.

People were provided with the opportunity to participate in activities and pursue their hobbies and interests. There was an effective complaints procedure in place, and complaints had been dealt with in line with the registered provider's policy.

There were systems in place to continually monitor the quality of the service, and to drive improvements. This included people being encouraged to feedback about the quality of the service, and make suggestions for improvements.

Further information is in the detailed findings below.

This inspection took place on 25 January 2016.

Alder House is registered to provide accommodation with personal care for up to 20 people who have physical or sensory disabilities. There were 18 people living at the service on the day of our inspection.

A registered manager was 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.

Staff were knowledgeable about how to protect people from the risk of abuse and other areas where they may have been assessed as being at risk. Risk management plans were in place to support people to have as much independence as possible while keeping them safe. There were also processes in place to manage any risks in relation to the running of the service.

People received their medicines safely and had regular access to health care professionals. People were supported by staff who knew them well and were available in adequate numbers to meet people's needs. There was a good choice of food and drink and people who were at risk of not eating or drinking enough were monitored.

Staff used their training effectively to support people. The manager understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff were aware of their role in relation to MCA and DoLS and how to support people so not to place them at risk of being deprived of their liberty.

People received care that met their individually assessed needs and preferences. People’s dignity and privacy was respected and they found the staff to be friendly and caring. People were supported to participate in social activities including community based outings.

People received personalised care and staff knew them well. Relationships between people, relatives and staff were positive. Staff were caring and responsive. Care plans were clear, provided staff with guidance and were reviewed regularly. People were involved in the planning and reviewing of their care.

The service was well led; people knew the manager and found them to be approachable and available in the home. People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response. The provider and manager had systems in place to check on the quality and safety of the service provided.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information we had gathered to answer questions we always ask; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had been trained to understand when an application should be made, and in how to submit one.

The provider had safe and effective recruitment and selection procedures in place. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe working practice was identified and people protected.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People told us that they had been involved in writing them and that they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service. This enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with told us; “The staff are kind here and do as much as they can for us. Most importantly for me they really respect my independence and help me to retain this."

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were identified we saw that these were addressed. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home has its own adapted minibus, which helped to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. One person said that they had made a complaint and were satisfied with the outcome. We looked at how complaints had been responded to. We noted that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. We were therefore assured that the provider had taken steps to continually improve the service.

During our visit to Alder House on 03 October 2013 it was clear staff had a good relationship and communicated well with people who lived at the home.

People could spend time how they wished. Some chose to stay in their own rooms, others used the communal lounges, took part in activities or went out.

All staff members had been trained in the Mental Capacity Act. With the knowledge they had of the people they were caring for, this meant they knew what assistance a person would require to make a decision or give consent.

People told us they enjoyed the food at Alder House. One person said, "We get to choose the menus. I like the cakes best.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We visited the home to check whether actions had been taken to address the areas of non compliance we identified during our inspection visit on 26 September 2012.

We found that the required improvements had been made. The provider had an effective system in place to identify, assess and manage the risks to the health, safety and welfare of people using the service and others. We also saw that the views of people using the service were considered and acted on.

We spoke with one person who used the service. They confirmed that people using the service had the opportunity to express their views on the service and be involved in shaping the way it was provided. This was through involvement in meetings for people using the service, completing questionnaires and taking part in interview panels to appoint new staff.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke with seven people living at the home at the time of our inspection visit on 26 September 2012.

People we spoke with told us they felt well cared for and that they were happy living at the home. One person said, “The care is quite good here.” We found that people made choices about their daily lifestyles where they were able to and they were involved in making everyday decisions about their care. People’s diversity and individual preferences were respected and supported.

People told us they felt safe at the home. They spoke in a complimentary way about the staff working there. One person said, “Staff are very nice here, I do feel safe with them.” People also told us that they would feel able to tell someone if they had any worries or concerns and that they knew how to make a complaint.

We looked at records that would tell us about people’s care or show us that the service was well run in a way that kept people safe. Some of the records did not have all the information they needed to. They were not always clear or easy to follow.

People who used the service were able to attend meetings so that they could express their views about the home. They were also asked to give feedback in written surveys. We found that the provider did not always show clearly that people's views were listened to and acted upon.