Prospect House Care Home

Prospect House Care Home is a residential care home providing accommodation and personal care to older people, some of whom may be living with dementia. The service accommodates up to 13 people in one adapted building. At the time of our inspection there were 12 people using the service.

People’s experience of using this service and what we found

People felt safe and were cared for by staff who knew them well. Although some areas of people's care plans would benefit from more detail to ensure all care needs were recorded, people were not affected by this and received good care.

Staff supported people to take their medicines as prescribed. The service was well supported by the local GP service to ensure people had access to appointments and that medication was regularly reviewed.

Management were regularly onsite, and people found them to be approachable. Concerns were acted upon quickly and staff felt well supported in their roles.

Systems were in place to review the safety and quality of the service. Some audits needed expanding to ensure oversight of all areas of care, however the manager worked quickly to update this during the inspection.

Positive feedback was received from people and their relatives about the standard of care. One person told us, “I’m definitely happy here, I can talk to anyone and this gives me a sense of security.” One relative said, “We have no concerns, the care is fantastic, [person's name] is very well looked after.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 4 December 2019).

At our last inspection, we recommended the provider review staffing levels and their deployment within the service. At this inspection, we found the provider had acted on the recommendation and improvements had been made.

Why we inspected

We undertook this focused inspection to review the previous rating. This report only covers our findings in relation to the Key Questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Prospect House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Prospect House Care Home provides residential care for up to 12 older people. Twelve people were using the service when we inspected.

People’s experience of using this service and what we found

People were at increased risk of harm, because staff did not always follow good practice guidance to reduce risks when managing people’s medicines. More robust audits were needed to identify issues and make sure safe practices were followed. We spoke with the provider about auditing recruitment records to ensure relevant information was documented.

The provider needed to develop their knowledge and understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to make sure they followed good practice guidance.

There was mixed feedback about staffing levels and the impact this had on the time available for staff to spend with people and to support with activities. We made recommendations about staffing levels and the support provided with activities.

Staff worked in a person-centred way. More detailed care plans and risk assessments were in place to guide staff on how to safely support people taking into account their individual personal preferences. People’s needs were reviewed and care plans updated if their needs changed.

People were supported by kind and caring staff who treated them with respect. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Staff offered people choices and promoted their independence.

People enjoyed the food provided and were supported to make sure they had enough to eat and drink. Staff worked with other professionals for advice and guidance on how to meet people’s needs. People were supported to access healthcare services when needed.

People felt able to speak with staff or management if they were unhappy or needed to complain. Staff told us they felt supported by the provider; they completed an induction and a range of training. The provider supervised staff’s performance and gave feedback, we spoke with them about more consistently recording these supervisions and appraisals of performance.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (report published 13 September 2018) and there was a breach of regulation relating to the governance of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations. However, the service remained requires improvement. This service has been rated requires improvement for three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Prospect House Care Home is registered to provide residential care for up to 12 older people. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service is a converted and extended house and accommodation is provided across two floors.

The provider is an individual ‘registered person’. 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. They were supported by a business manager and deputy manager in the management of the service.

At our last inspection we rated the service ‘requires improvement’ overall. There were breaches of regulation relating to the safety of care and treatment and the governance of the service. Following the inspection, we received an action plan setting out the action the provider planned to take to make improvements.

At this inspection significant improvements had been made in some areas, but there were ongoing concerns about the governance of the service.

Records were not well-maintained. Care plans and risk assessments did not always provide clear guidance about how risks should be managed. They had not always been updated as people’s needs changed. Records relating to accidents and incidents did not give a detailed account of what had happened and evidence how staff and the provider had responded to prevent a reoccurrence.

Audits had not identified that the provider’s gas safety certificate and servicing of hoists and slings had not been completed in a timely manner. We spoke with the provider about recording who took part in fire drills and timing evacuations to make sure they were completed safely.

Protocols were not always in place to guide staff on when to administer ‘when required’ medicines. Records did not evidence checks had been completed to make sure medicines were stored at a safe temperature. Recorded information about the amount of medicines in stock was not always accurate. The provider’s medicine audits were not robust enough to prevent the issues we found.

Recruitment records were not always well-maintained. Records did not clearly evidence how new staff had been assessed as competent before starting work. The provider did not have a supervision and appraisal policy. Other policies and procedures, such as the safeguarding policy, were brief and lacked detail.

The provider’s audits were not robust enough to identify and address the concerns we found. This was the second consecutive inspection where the service has been rated requires improvement overall. The failure to maintain complete and contemporaneous records and adequately assess, monitor and improve the quality and safety of the service was a continued breach of regulation relating to the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe. People were protected from the risk of abuse and avoidable harm by staff who were trained to recognise and respond to safeguarding concerns. Enough staff were deployed to meet people’s needs.

The environment was clean and tidy. Health and safety checks were completed to monitor the safety of the home environment.

Staff completed a range of training courses and told us additional advice, guidance and support was available when needed. We received positive feedback about the effective care staff provided. Staff supported people to make sure they ate and drank enough and we received positive feedback about the food. Staff worked with healthcare professionals to make sure people’s needs were met.

Staff supported people to make decisions and care records showed staff considered people’s mental capacity. We made a recommendation about record keeping in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and obtaining copies of any Powers of Attorney in place to confirm these are valid.

The service had been adapted and ‘dementia friendly’ signage was in place to help people find their way around the home.

Staff were very kind and caring. They supported people to maintain their privacy and dignity. People told us staff listened to them and respected their decisions. There was a friendly and inclusive atmosphere within the service and people laughed and joked with staff, this showed us they valued staff's company.

Staff provided person-centred care to meet people’s needs. They knew people well and understood how best to support them. Staff worked closely with people, their families and professionals to make sure people’s needs were met.

Support was available for people to engage in regular and meaningful activities. The provider had a system in place to gather and respond to feedback about the service.

People consistently told us the service was well-led. Staff told us they felt supported, relatives told us the service was homely, there was effective communication and their relatives were well cared for.

Prospect House Care Home is a large property which has been extended and renovated to accommodate up to 12 people. The service is accommodation for older people who require personal care and is close to the village amenities.

The home had a registered manager in place who was also the registered provider. 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 registered provider did not have robust systems in place to ensure all hazards were known and to reduce the likelihood of harm occurring. For example; fire doors were locked creating a barrier to people exiting swiftly. This meant the quality and safety of the service could not be assured. The registered provider did respond to points that were raised on day one of the inspection to improve safety.

Staff knew people’s preferences and how to support people in a safe way. Care plans did not contain a thorough assessment of people’s needs or detailed risk assessments to ensure staff had all the information they required to support people safely in the way they preferred.

The registered provider responded to our feedback on day one and had started to implement better systems when we visited on day two of the inspection. There was also an on-going improvement plan in place following the inspection, which the registered provider had kept us up to date with.

Staff told us they felt supported by the registered provider and that the training they had received had made them feel confident to fulfil their role. We saw in the records we checked that staff had received an annual appraisal to help them understand their performance and plan their development. Systems to evidence individual staff support through supervision were required. We recommend that the registered provider implement systems to evidence individual staff supervision. Following the inspection the registered provider gave us information to confirm staff had received training.

On day one of the inspection medicines systems did not include all areas of good practice. By day two the system had been changed and we felt it was safe overall. We made a recommendation that the registered provider continued to review their policy and practice to incorporate all best practice guidance.

There were systems and processes in place to protect people from the risk of abuse. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

People told us there were enough staff on duty to meet people’s needs and we observed this was the case. We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive and patient and observation of the staff showed they knew people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

People’s independence was encouraged and their hobbies and leisure interests were supported well. We saw there was a plentiful range of activities available and people who used the service told us they enjoyed them.

The registered provider had an effective system in place for responding to people’s concerns and complaints. People were regularly asked for their views. People said they would talk to the registered provider or staff if they were unhappy or had any concerns.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection, in relation to the safe care and treatment and governance systems in place. You can see what action we told the provider to take at the end of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection. We spoke with people who used the service and with a relative. We also spoke with the staff that supported them and we looked at records the service held.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People are treated with dignity and respect by the staff. People we spoke with told us that they felt 'at home' and felt safe at Prospect House Care Home. Staff understood what action they must take to ensure people were protected from abuse. There were effective safeguarding systems in place to help protect people.

The providers monitored the service provision. This included learning from events such as accidents and incidents. There had been no complaints received. This ensured that the quality of the service was being effectively monitored and where necessary, improved.

Recruitment processes were thorough. No staff had been subject to disciplinary action. The provider had policies and procedures in place which helped to inform all staff and to protect the wellbeing of all parties.

Is the service effective?

Advocacy services are available to people, at present no one required this support. It is available upon request if a person required this.

People's need are assessed before admission and this assessment is ongoing. People are cared for by a small group of dedicated staff who know people's needs well. This ensures that people's needs are met and provides continuity of care.

The providers take action to ensure any issues are dealt with quickly and thoroughly. They pride themselves in supplying a service which ensures people's individual preferences, likes and dislikes are known and acted upon. This ensured people were satisfied with the service they received.

Is the service caring?

People are supported by kind attentive staff, they had time to be able to sit and talk with people. We saw that staff treated people like members of their family. This ensured that the service was effective and highly regarded by people living at the home and their relatives. People said 'It is wonderful here. It is the best place in the world. The care staff are so nice they really look after me.' and 'I love it here. I would not want to be anywhere else.'

People using the service are asked for their views on a daily basis by staff and the providers. Relatives were also asked for their opinion and they too were welcomed and kept well informed.

Is the service responsive?

People had a range of activities provided for them which they could choose to take part in if they wished. Staff knew people's social preferences and helped people to enjoy their social life in the home and with family and friends. Events are held which relatives are invited.

There were robust systems in place to deal with a complaint. People told us they knew how to make a complaint. No complaints had been received. This was because the providers and staff spoke with people and their relatives regularly to gain their views. Any small issues were acted upon which helped to prevent the need for people to make a complaint.

Is the service well led?

The service worked well with other health care professionals and services to make sure people received the care they needed in a joined up way.

Quality assurance systems were in place. Staff and the providers took great pride in delivering a quality service to people. The quality of the service provided is constantly reviewed and where necessary, improved.

Staff are clear about their roles and responsibilities. They told us they would not want to work anywhere else because the providers cared about their residents and their staff. The ethos of the home was to provide an excellent service and to ensure that people living there were supported to live the life they chose, to the full.

We saw that people had individualised care records in place. Risks to people's health and wellbeing had been considered. This helped staff understand and meet people's needs. Everyone we spoke with said they were very happy with the care and support provided.

People's nutritional needs were assessed and continued to be monitored. Food being served looked appetising. People could eat wherever they preferred. We received the following comments about the food: 'The food is delicious.' and 'Periodically we discuss meals, they take my advice. The presentation of meals is quite good. Whenever I need something I get it.'

During our visit we saw that there was enough skilled and experienced staff to meet people's needs in a timely way. This was confirmed by people we spoke with and by staff. One person said 'They (the staff) are there when you need them. They are amazing.'

People told us they received the care and support they wanted to receive and could live the life they chose. People said 'They ask me what help I need" and 'Whatever staff are doing they leave off and come to look after you".

People we spoke with said they were satisfied with how their medications were dealt with by the staff. One person said 'I get my medication when I need it. The staff know what they are doing".

Robust recruitment processes were in place to make sure that people were looked after by staff who were suitable to work in the care industry. People we spoke with said 'I cannot praise the staff enough. The care staff take me out they are fantastic". Another person said 'I would not want to be anywhere else the care staff are wonderful all of them".

People living at the home told us that they would speak to the manager if they had any concerns or wanted to make a complaint. People spoke highly about Prospect House and said they had no complaint to make. One person said 'If I was not happy with anything I could say 'I do not like that'. They always ask us what we think. It is wonderful here".