The inspection took place on 1 May 2018 and was unannounced. This was the first inspection since the service was registered with the Care Quality Commission (CQC) on 5 July 2017 and therefore, the first time the service has been rated Requires Improvement.

Alderson House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. Alderson House supports up to 32 people, some of whom may be living with dementia, have a physical disability or a sensory impairment. At the time of the inspection, there were 20 people who used the service.

The service 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.

A small number of people had not received their medicines as prescribed. This was due to errors in staff calculating when specific pain relief patches were due and on one occasion when staff were unable to locate a medicine. There were some minor recording issues and clearer guidance was needed for staff when people were prescribed medicines on a ‘when required’ basis.

This was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

The provider had a quality monitoring system that ensured areas of the service and care provision were audited so improvements could be made and lessons learned. A new electronic recording system had just been introduced, which staff were not completely familiar with. This had meant some records such as food intake monitoring could be improved. Staff described the culture of the organisation as open and management as supportive and approachable.

Staff had received training and had procedures to guide them in safeguarding people from the risk of harm and abuse. In discussions, staff were clear about how they would escalate concerns and which agencies they would contact for advice.

Staff had completed assessments with people to identify risk areas and the steps required to minimise risk. Some risk areas had been overlooked and this was mentioned to the registered manager to address.

People’s health and nutritional needs were met. Records showed people had access to a range of community healthcare professionals for advice and treatment. These included dieticians when people lost weight and required additional support. The menus provided varied meals with choices and alternatives. People told us they liked the meals provided to them.

The staff supported people to make their own decisions and choices when they were able. When people were assessed as lacking capacity, staff consulted with relevant people when decisions were made on their behalf. The provider worked within mental capacity legislation to ensure deprivation of liberty applications were made.

People told us the staff had a kind and caring approach, and they respected their privacy and dignity. Staff asked people’s consent prior to delivering care. People could remain at Alderson House for end of life care if they chose this option.

There were activities for people to participate in but these could be improved. As they were currently provided by care staff, the provision could be disjointed when they were called away for personal care tasks. Recruitment was underway for an activity coordinator, which will resolve the issue.

Staff were recruited safely and checks were carried out before they started work in the service. There were sufficient care staff on duty to meet people’s needs. There were a