Prospect House

Prospect House is registered to provide accommodation and personal care for up to seven people living with a learning disability. The care home accommodates people in one building. At the time of our inspection there were six people using the service.

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

Risks had been assessed and were being monitored, but some risks were not always prevented. Relatives had mixed views on their relative’s safety. Accidents and incidents were analysed but this process needed strengthening to ensure lessons were learnt.

A development plan was in place to address improvements in the service. Audits and monitoring systems needed to be further strengthened and embedded into practice.

Health monitoring records were not always suitably completed as required.

We recommend the provider takes appropriate action to strengthen communication to complainants as relatives felt communication needed improving.

Staff were trained in safeguarding and aware of what was reportable.

People were receiving medication as prescribed, but medication audits had not always identified shortfalls.

Staff were suitably deployed to meet people’s needs. Staff were receiving training and supervision. Staff were kind and caring. People were supported to access activities that were meaningful to them.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting was being better utilised to maximise people’s choice, control and independence.

Right care:

• Care is more person-centred and now starting to promote people’s dignity, privacy and human

rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff were being improved to ensure people using services led confident, inclusive and empowered lives

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

Rating at last inspection and update:

The last rating for this service was inadequate (published 10 April 2021) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Prospect House is registered to provide accommodation and personal care for up to seven people living with a learning disability. The care home accommodates people in one building. At the time of our inspection there were six people using the service.

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

Significant shortfalls were identified in the governance of the service. Systems were in place to check the service was working to the provider’s expected standards. However, where the checks had been completed, they were not effective and did not identify the concerns we had raised as part of this inspection. There was a lack of provider oversight of the standards at Prospect House.

People were not always kept safe. We found concerns with the safe management of risk for areas including people who show behaviour that may challenge others, eating and drinking, epilepsy and uncovered radiators.

People were not consistently kept safe from the risk of abuse or neglect.

Staff deployment was not sufficient to meet people's needs safely.

Infection control concerns were identified in relation testing, assessing risk and PPE.

Lessons were not being consistently learned and similar issues to those highlighted at other inspections, carried out by CQC and other organisations such as the local authority were found at this inspection.

Staff training was not effective as some staff did not have a good understanding of some people's needs and the support they would need, for example if the person was living with autism.

People's health needs were not accurately recorded and updated.

People were not supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were not always living meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that was appropriate and inclusive for them resulting in them in receiving poor standards of care. The provider submitted an action plan following our inspection giving details on how they intended to improve the standards at Prospect House.

Right support:

• Model of care and setting did not maximise people’s choice, control and Independence

Right care:

• Care was not always person-centred or promoted people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of staff did not ensure people using services lead confident, inclusive and empowered lives

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

Rating at last inspection

The last rating for this service was requires improvement (8 April 2020 last report published) At this inspection we found improvements had not been made and sustained, and the provider standards had declined further and the service is now rated inadequate. The service has remained rated either inadequate or requires improvement for the previous five inspections.

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safety and governance. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with safety, governance, staffing and safeguarding, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective, caring, responsive and well-led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, good governance, staffing and person-centred care at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

The overall rating for this service is ‘Inadequate’ and the service in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Prospect House is registered to provide accommodation and personal care for up to seven people with a learning disability. At the time of our inspection there were six people using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

People received safe care and many risks were identified well, although procedures for monitoring who was in and out of the home needed to be more robust. Staffing was organised to ensure people received the level of support they needed, and recruitment was in progress to develop a consistent staff team. Systems and processes were clearly identified in relation to supporting people with their medicines.

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 supported this practice. People gave their consent to care in line with current legislation. The service respected people’s human rights. Staff understood people’s individual communication needs and respected their wishes and preferences.

Staff received appropriate training and supervision. Staff communicated well with one another and they understood who they were supporting, with a clear management structure to help them in their work. Roles and responsibilities were more clearly defined and staff felt supported.

Staff were kind, patient and caring with the people they supported. People were treated with respect and their independence was encouraged. Prospect House provided a friendly, welcoming homely environment and people were happy.

Planned activities were in place for people and staff interacted with interest when people spoke about what they had been doing. Care plans were clear, concise and person-centred. Concerns and complaints processes were in place and the provider was considering ways in which people’s voice could be more clearly reflected.

Changes had been made in how the service was being led and managed. Staff reported improvements in how the service was run and they were confident further improvements would be made. Systems and processes with which to monitor the quality of the provision were being embedded.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published July 2019) and there were multiple breaches of regulation. The service has been in Special Measures since July 2019. 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 improvements had been made and the provider was no longer in breach of the regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; lack of choice and control. Staff often made decisions on people’s behalf but did not follow a formal decision-making process or record the decision. For example, staff made decisions autonomously about when people had snacks rather than following person centred guidance. Staff asked people to add their meal preferences to the menu but then cooked different meals.

People were not safe. Risks to individuals were not assessed and appropriately managed. Staff were using restraint but national guidance around safe restrictive interventions was not followed. Incident forms were not reviewed in a timely way by the management team. Medicines were not managed safely. Lessons were not learned when things went wrong. Some people did not receive the appropriate staffing support even though they had specific funding. The recruitment process was not always followed robustly. Some areas of the home looked clean, but others required deep cleaning.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Staff received training and supervision, but this did not equip them with the skills required to do their job well. People told us they enjoyed the meals and chose what they wanted for breakfast, snacks, light meals and supper. Records showed people had been seen by health professionals but there was no overview of people’s health and staff could not find out when people had last attended some appointments. People lived in a pleasant environment and had personalised rooms and access to a range of communal areas.

Staff and management did not always pay attention to detail, for example, laundering of clothes. People looked well cared for when we visited but relatives told us this was not always the case. Examples of people making choices and caring staff practices were seen on both days of the inspection. People enjoyed the company of staff who supported them. Staff explained how they ensured people had privacy, for example, giving a person time alone during personal care. However, listening monitors were sometimes used inappropriately which did not provide people with privacy.

People did not always receive opportunities to engage in person centred activities. Activities were not well planned although people told us they had enjoyed various outings. People’s support plans contained a lot of information but did not always reflect their needs. The provider did not have an accessible system for identifying, receiving, recording, handling and responding to complaints.

The service was not well led. The provider's quality management systems were not effective and did not identify areas where the service had to improve. The registered manager and provider did not demonstrate they understood their responsibilities and accountability. Opportunities for people who used the service, their relatives and staff to engage in the service varied.

The service has a history of providing poor quality care; it has only been awarded ratings of requires improvement or inadequate. We have previously met with the provider to discuss our concerns about the service.

Rating at last inspection: Requires improvement; not in breach of regulation (Published date: 26 May 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We referred our concerns to the local safeguarding authority and asked the provider to send us evidence of improvements and action points. This was used when decisions were made about our regulatory response.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

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

Prospect House provides care for up to seven people who have learning disabilities. At the time of this inspection seven people were using the service. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

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.

People felt safe living at Prospect House. We saw they were comfortable with people they lived with and staff who supported them. People told us they could talk to members of staff and the manager if they had any concerns. Relatives told us people received good care and they were complimentary about staff and the registered manager.

Staff knew people very well and had a good understanding of their routines and preferences. Care plans and risk assessments were personalised. They identified how people’s needs should be met and managed safely although some information, for example, people’s histories was brief. The registered manager said they continued to develop and improve records and documentation which would address any gaps. This included easy read documents to help ensure information was accessible to people who used the service. People enjoyed person centred activities at home and in the community.

Systems for ensuring people’s rights and choices were promoted had improved, and continued to be developed. This included changing staff practices around supporting people with decision making processes. People received a varied and nutritional diet and their health needs were met. People lived in a pleasant environment and accessed areas where they could spend time on their own or with others.

There were enough staff to keep people safe and staff received training and support to help them understand their role and responsibilities. Medicines were managed safely although storage of controlled drugs did not meet the required standard. The registered manager was responsive and took action promptly to address this.

We received positive feedback about the registered manager who was knowledgeable about the service. People were encouraged to share their views and put forward suggestions at meetings, individual discussions and via questionnaires. The provider had introduced more robust quality management systems. These were still embedding and needed time to evidence they were fully effective.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Prospect House provides care for up to seven people who have learning disabilities. At the time of this inspection six people were using the service. The service had a registered manager. 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.

There were enough staff to keep people safe. The provider did not have effective recruitment and selection procedures in place so appropriate checks were not carried out before staff started working at the service.

People using the service were not protected against the risks associated with the administration, use and management of medicines.

People told us they felt safe and staff understood safeguarding procedures and their responsibility to report concerns. They were confident the management would team would respond appropriately.

People’s care had been assessed, planned and delivered. However, because support plans and risk assessments were not updated the information did not reflect people’s current needs. People’s care records showed they had accessed a range of health professionals.

Staff told us they were trained and felt well supported by the management team and colleagues. However, we found staff did not receive appropriate supervision to enable them to carry out their duties they were employed to perform.

The provider had trained staff around the requirements of the Mental Capacity Act, however, they did not understand what they must do to comply with the Mental Capacity Act 2005 because they were not acting within the law.

People were generally positive about the service they received and we observed they were comfortable in the presence of staff. Relatives told us they were satisfied with the service provided. They said the service was well managed and they had regular contact with the registered manager. Staff we spoke with provided positive feedback about the management team.

We saw people lived in a well maintained, clean and tidy environment. Checks were carried out to make sure it was safe, however, we found the gas safety certificate had expired; the registered manager said they would ensure this was addressed promptly.

The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not implemented. A system was in place for managing complaints. The service had not received any formal complaints in the last 12 months; they had received three compliments.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These related to safe care and treatment, employment of staff, meeting the requirements of the Mental Capacity Act 2005, supporting staff, person centred care and governance arrangements. You can see the action we have told the provider to take at the end of this report.

Prospect House is registered to provide accommodation and personal care for up to six people who have a learning disability. The home has a kitchen, dining area and two lounge areas on the ground floor. There are six single en-suite rooms; two of these rooms have shower facilities. There is a communal bathroom and communal shower room on the first floor. The home has a well maintained garden area and is also within easy walking distance of the local amenities.

The service had a registered manager. 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 manager was on annual leave at the time of inspection and deputy manager was in charge.

We saw safety checks and certificates that were all dated within the last twelve months for items that had been serviced and checked such as fire equipment and gas safety. We did see a record to show the electrical safety certificate was next due September 2017; however a current certificate was not available. No testing for legionella was taking place and water temperatures were showing low which could make bathing and showering uncomfortable.

Staff we spoke with knew how to administer medicines safely and the records we saw showed medicines were being administered and checked regularly. Protocols for when required (PRN) medicines were kept with the care plans, these should also be kept with the medication administration records.

Accidents and incidents were monitored and analysed each month to see if any trends were identified.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. At the time of inspection there were five people subject to a DoLS authorisation. Staff demonstrated a clear understanding of DoLS.

People were supported to maintain their health through access to food and drinks. People using the service enjoyed healthy eating.

The service was clean and tidy and staff had access to personal protective equipment (PPE). The service was having building work done which would provide an extra downstairs bedroom. The building work was being managed so there was little disruption for the people who used the service.

People had access to a variety of activities either on a one to one basis or in a small group.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service. There were sufficient staff to provide the support needed and staff knew people’s needs well. Staff had regular supervisions and appraisals to monitor their performance. Staff received regular training in the areas needed to support people effectively and were suitably trained to manage behaviours that challenge whilst ensuring people’s rights were protected.

People and relatives we spoke with were positive about the support they/there relative received. Throughout the inspection we saw people being treated with dignity and respect.

People had access to advocates and independent mental capacity advocate (IMCA’s).

We found care plans to be person centred. Person centred planning provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person. The service was working on gaining accreditation from the National Autistic Society.

The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.

The service had an up to date complaints policy. The last complaint received was in July 2014.

The registered provider carried out regular checks to monitor and improve the quality of the service.

Staff felt supported by the registered manager.

Feedback was sought on a regular basis from people and their relatives on the quality of the service.

People who used the service had regular meetings. Staff meetings took place approximately every other month but were not well attended. The deputy manager said this was now being discussed in supervision and staff would be expected to attend at least three a year.

The deputy manager understood their roles and responsibilities, and felt supported by the registered provider.

We met and spoke to most of the people who lived at the home and observed how people who used the service were being cared for. We spoke to four staff including the home manager and the operations director. At a later date we had a phone call discussion with a service user's relative. We also attended a scheduled staff meeting, examined three care plans, three staff files and inspected the home's records.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The relative and staff felt the people who lived at Prospect House were safe. We inspected the staffing rota set by the manager and saw that there was sufficient number of skilled and experienced staff to provide the one to one care needed to ensure that people's needs were being met.

A recent safeguarding investigation had led to the provider making appropriate staff and service changes. We attended a staff meeting where the needs of the person who used the service were discussed. The staff also had feedback by the Operations Director and Home Manager on the completed investigation. They were also reminded that their personal responsibilities towards the people who lived at the home could not be negated whatever the circumstances and advised about when they should seek guidance. The Operations Director told us that the information pertaining to the people involved, who had now left their employ, was being prepared to send to the Disclosure and Barring Service.

Is the service caring?

The people who lived at the home were encouraged to be self-caring and empowered by staff to be involved and as independent as possible in making decisions about the activities they undertook during the week. We observed the interactions between staff and people who lived at the home to be unhurried, friendly, cheerful and sensitive. The relative told us that the home was "very good" and that when they had any concerns no matter how small they were always addressed. One person told us that the home was "alright', another person told us that they "liked" their room and showed us a list of what they wanted to buy.

Is the service effective?

Prospect House had been adapted and upgraded to provide a number of living and activity areas, one of which was to become a sensory room. There was a large communal kitchen dining area, a laundry and six individual rooms with en-suite facilities, two of which had a shower. There was also a large wet room that was used by the people who lived at the service who did not have a personal shower. The garden was being improved and adapted to increase its use by the people who lived at the home

There was a key worker system in place and people who used the service had their health and care needs assessed and planned with them, their relatives, their social worker and a specialist nurse. The relative said the food was of "very good quality" and we observed the people who lived at the service enjoying a communal evening meal. They were encouraged to shop and cook for themselves during the day and specialist dietary needs had been identified and people had their weight monitored and recorded weekly.

Is the service responsive?

The people who lived at Prospect House had complex medical, emotional and communication needs that could lead to behaviours that challenged the service. We observed the staff to be calm and confident when interacting with the people who used the service. We saw that records were kept with regard to how staff dealt with behaviours that challenged the service of the people who lived at the home, the interventions they deployed and the time taken to return people to a calm state. We saw records of planned training and the Operations Director also said that the staff were trained to monitor and deal appropriately with planning alternative strategies to change people's activities to divert and redirect them when they became distressed and agitated.

Is the service well-led?

The Home Manager was newly appointed to post and was in the process of registering with the CQC; in the meantime the Operations Director was overseeing the service. The Manager was very enthusiastic and eager to make improvement in the environment for the people who lived at the service including working towards gaining accreditation by the Autism Society. Some responsibilities had been devolved to staff for certain aspects of these changes with the intention of empowering them in their role. Whilst the pace of change had not always been appreciated, nevertheless the Manager had the support of the relative and all the staff we spoke to.

You can see our judgements on the front page of this report.

We spoke with the registered manager and deputy manager who told us of the improvements that the service had made in relation to meeting people's nutritional needs.

The deputy manager discussed two people's care plans with us. We were shown that people now had a nutritional care plan and risk assessment in place. People were weighed on a weekly basis and were referred to a dietician when needed. The deputy manager told us that the majority of staff had received nutrition and diet training. The training certificates confirmed this.

We found people were protected from the risks of inadequate nutrition and dehydration.

'I'm alright actually. I can eat what I want. I have a choice.'

'I do like living here. I like the food. I like pancakes.'

'I got some rock from the seaside.'

We spoke with a Community Nurse from the Community Learning Disability Team who told us from their experience they found that people and their relatives were involved in decisions about their care.

One relative we spoke with confirmed that their relative, who used the service, was involved with making decisions about their care. The relative told us they were kept involved 'most of the time' and found Prospect House to be 'very good.'

We looked at outcome 21 to follow up the compliance action we made at the last inspection. We saw that improvements had been made by the provider in relation to the care records of people who used the service and in relation to the staff records.

We found there were enough staff to meet people's needs and that staff had enough time to support people in the way they wished. We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

However, where a person had been identified as being at risk of poor nutrition, we found there was no care plan or risk assessment in place to show how the risk would be managed or how a person would be supported to eat and drink sufficient amounts for their needs.