This inspection took place on 4 and 12 July 2018. The first day of our inspection was unannounced, the second day was announced.

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 n

We inspected Prospect House Care Home on 22 March and 13 April 2017. The inspection was unannounced on day one. We told the provider we would be visiting on day two. The service was last inspected in October 2015 and met the regulations inspected at that time.

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.

P

The inspection took place on the 23 October 2015. It was unannounced. At the previous inspection in April 2014 the provider was fully compliant with the regulations assessed.

Prospect House is a purpose built care home. It provides personal care and support for up to ten older people. It is situated about six miles north east of York, in the small village of Gate Helmsley, where there are village amenities. There is a car park to the rear of the house and attractive gardens, with level access to the home. There were nine people accommodated when we carried out our inspection.

The registered provider is Debra Susan Boughen who is both the registered provider and 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.

People told us they felt safe living at Prospect House and the care we observed throughout our visit demonstrated a real person centred ethos. Person centred care puts people using the service and at the forefront. It is about viewing people as individuals.

The service had safeguarding vulnerable adult’s policies and procedures which were understood by staff. Staff received training in safeguarding vulnerable adults and they were clear of the process to follow should any aspect of poor care be observed.

Staff understood individual risks to people and worked with them to minimise these risks whilst also supporting them to remain as independent as possible. We saw that risk assessments were carried out on the environment as well as on individuals.

We observed warm and friendly relations between the people living and working at Prospect House. It was evident that a family environment was maintained. This was observed throughout our visit. People told us there sufficient staff.

Recruitment systems were robust and appropriate checks were completed before people started work. This helped to prevent unsuitable people from working with vulnerable people.

People received their medication as prescribed by their GP. The deputy manager agreed to record any carried forward medication on medication administration records (MAR) so that these could be more effectively audited.

The home was clean and there were no unpleasant odours noted during our visit.

Staff received induction, training and supervision to support them in their roles. They told us they received good support from the management.

Staff understood the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS are part of the MCA (Mental Capacity Act 2005) legislation which is in place for people who are unable to make decisions for themselves. The legislation is designed to ensure that any decisions are made in people’s best interests.

People told us they were able to make decisions and choices regarding all aspects of their lives.

People spoke positively of the food and said that they received a choice of tasty nutritious food.

Peoples health needs were monitored and advice from appropriate professionals was sought where necessary.

The premises were suitable and well maintained. People were able to personalise their rooms and their views were sought regarding the décor and furnishings at the home.

All of the people we spoke with spoke positively of the care they received. They told us they were treated with kindness and compassion and we saw this throughout our visit. They told us that staff respected their privacy and maintained their dignity at all times. This was reiterated in feedback from relatives.

People told us that the registered manager and staff responded to their needs. Each person had an individual care record which set out how they should be cared for. Care records contained very basic information and would benefit from review and update.

People told us that a range of social opportunities were available and said they could choose how to spend their time. Visitors said they could visit at any time and they told us how welcome they were made to feel.

The home had not received any complaints; however people told us that they could raise concerns if they needed to.

People told us that the service was well led. They told us that all of the managers were approachable.

We saw that meetings took place to seek people’s views and experiences. Quality surveys were also sent out on an annual basis.

People spoke of a positive culture and staff said that morale was good. People told us they liked living at prospect house.

A more formal auditing system may enable the registered provider to better reflect how they monitor the quality of care provided.

We gathered evidence against the outcomes we inspected to help answer our five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? The inspector gathered information from people who used the service by speaking with them during our visit to this service.

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.

People we spoke with said that they were informed about the service they could receive and were able to ask questions before they gave their consent to receive a service. A person we spoke with said “Everyone comes for a period of time. You are assessed and I assessed the home at the same time. I agreed to stay here willingly because it is so good.”

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 who use the service told us that they knew what the service could offer them and said they had consented to the service they received. We observed that staff respected people’s rights, privacy and dignity. One person said “I choose how I spend my time".

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".

People told us that they were well looked after and that they were happy with the care they received. People made comments such as "I would not be anywhere else and "It is a very nice place and a very good home" People told us that they had the "Freedom to do whatever you want"

People were also positive about the staff who looked after them. People made comments such as "Staff could not be better they are absolutely wonderful" and "Staff are very helpful, anything you want they will get it for you"

Everyone we spoke with told us that the food was 'very good'

People said they would speak to the manager if they did have a concern or a complaint.

We also talked with relatives who were visiting the home. They all spoke highly about Prospect House. They told us "This is an amazing home. The reason we choose it was it is a small home and it has stimulated a new chapter in my relative’s life"

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.