About the service:

• The service is in a rural setting, near to Mablethorpe in Lincolnshire.

• The service provides accommodation and personal care to people with mental health issues. The care home can accommodate 17 people in one building. At the time of our inspection there were 15 people living in the service.

People's experience of using this service:

• People were assisted to have choice and control over some aspects of their lives, though there were issues about some people’s ability to choose their own lifestyle.

• Heating levels were not always adequate to keep people warm.

• Audit processes were not comprehensively in place to ensure quality care. Questionnaires had not recently been supplied to people and their representatives for their views of the service.

• The service provided was safe.

• Most people told us that people liked living at the service.

• People were protected against abuse, neglect and discrimination. Staff members were aware of ensuring people's safety and acting when necessary to prevent any harm.

• Staff members knew people well and most people appeared to enjoy the attention from them.

• People's care was personalised to their individual needs.

• A registered manager was in place, which is a condition of registration.

• The service met the characteristics for a rating of "Good" in key questions except caring and well led, where it was rated Requires Improvement.

• More information is in the full report.

Rating at last inspection:

• At our last inspection, the service was rated "good". Our last report was published for the inspection of 15 March 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.

We inspected Alderson House on 15 March 2016. This was an unannounced inspection. The service provides care and support for up to 18 people. When we undertook our inspection there were 17 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection there was no one subject to such an authorisation.

Staff had taken an outstanding amount of care and preparation in finding out what people wanted from their lives and had supported them in their choices. This sometimes had taken a lot of weeks of preparation and setting up, but staff remained consistent in their approach and ensured the outcomes were what each person wished. They had used family and friends as guides to obtain information and accessed a number of different resources within the community. Staff had outstanding skills and an excellent understanding of the social, cultural, values and beliefs of the people at Alderson House.

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We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. And meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. Some people helped with the preparation of meals and setting tables for meals.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

People who used the service told us they were happy living at Alderson House. They told us staff listened to their problems and needs and acted in accordance with their wishes. One person told us, "Staff are there for me and what I want to do and need." Another person said, "Staff ask me what I want to do each day."

We looked at care plans which recorded people's assessed needs and specific risks. These had been updated on at least a monthly basis. People told us they knew staff kept notes on them and had their needs discussed. One person said, "Staff talk to me at all times about my care."

The records showed that people had been receiving their prescribed medication. The storage area was clean and tidy. Some staff had been trained to administer medication.and others were in training. People who used the service told us about their medication and how it was administered. One person said, "I prefer staff to keep my medicines locked away for me."

People who used the service told us there were sufficient staff on duty to meet their needs. One person said, "Staff are always around to take me shopping." Staff told us there were adequate numbers of staff to ensure they could meet people's needs.

The complaints process was on display and people who used the service told us they were confident any concerns would be investigated. One person said, "Staff will always listen to me."

As part of our inspection we spoke with a number of people who used the service. They spoke positively about the care and support they received. They told use they liked living in the home and confirmed that they were supported to make choices and decisions about the care they received.

Comments included, "I'm happy here", "I've got everything I need", "I know staff keep records on me" and "I feel safe here".

During the visit we spoke with visitors who expressed their satisfaction with the standards of care at the home. They told us the staff were good and they were kept informed of any changes.