The inspection took place on the 11 & 17 September 2018 and was unannounced. At the last inspection the service was not found to be in breach of any Regulations, and the service was rated as “good”.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Prospect House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate up to 56 people in one adapted building.

There was a registered manager in post working at the service. 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.

During the inspection we identified that people’s fluid charts did not reflect sufficient fluids were being given to them. However, we did not observe any signs of dehydration. Following the inspection, the registered manager confirmed that action had been taken to ensure fluid intake was appropriately recorded and promoted.

People’s medicines were administered as prescribed. We observed that PRN (‘as and when’) protocols were not in place to outline when these should be given, however these were put in place immediately after we raised this.

The service had been given the platinum award from the Gold Standards Framework (GSF). The GSF provides training and support to services across the country to promote best practice in end of life care. We spoke to a relative who commented very positively on the standard of care that had been provided to their loved one.

People each had a personalised care record in place which outlined important information to staff about the level of support people required. Information about their personal histories, likes and dislikes were also available to help staff get to know people.

People’s comments about staff were very positive. We observed examples where people were treated with kindness, dignity and respect. Throughout the inspection it was apparent that positive relationships had been developed between people and staff.

A good range of activities was available to people. This promoted social interaction and helped to prevent people from becoming isolated. People told us they enjoyed the activities that were available.

The environment was very clean, homely and people told us it was comfortable. Adaptations had been made to meet the needs of people living with a sensory impairment and those people living with dementia.

The service was working in line with the principles of the Mental Capacity Act 2005. This meant that people’s rights and liberties were being upheld.

People were protected from the risk of abuse. Staff had received appropriate training in safeguarding and had access to relevant policies and procedures.

Accidents and incidents were being monitored as required and action had been taken to protect people from these re-occurring.

Risk assessments were in place which clearly outlined the support staff needed to provide to people to protect them from the risk of harm.

Recruitment processes were robust and ensured that those staff employed were of suitable character.

Staffing levels were appropriate to meet the needs of people using the service.

Staff had received the training in a range of different areas. This helped ensure they had the skills needed to meet people’s needs.

Audit systems were in place

We spoke to three people who used the service as well as two relatives. Comments included:

"I have not been here that long but I have settled here and staff have helped with this"

"Staff are more than helpful"

"I have been told how to complain if I need to”

"I feel safe here and have no worries"

"I always get my medication and they never miss it out. They always tell me what I have been given and what it is for"

"I feel safe here, I can always ring my alarm and they will come to me"

"They are wonderful, one in a million"

"The care is good but sometimes the staff need to be told a few times before they adopt small personal touches"

"The provider is approachable and I know who to complain to if I need to"

"They do their best for my relative"

"They always involve me and let me know about how my relation is doing"

This visit found that the people who lived at Prospect House have their health and wellbeing maintained by the way the service identifies and reviews their needs as well as ensuring that the management of medication is safe. The provider has adopted systems for ensuring that concerns or comments can be passed on and acted upon. People are protected from harm and felt safe with the staff team. The staff team had the necessary experience, training, supervision and support to carry out their roles effectively.

Relatives of a person who had recently gone to live at the home told us “We are very satisfied so far”. They considered that communication had been good and they were urged to raise any concerns they might have. A person who lived at the home told us “They look after me really nicely, it has exceeded expectations”. We also saw letters that had been received from families of people who had lived at the home until recently. They had written:

“Prospect House is a credit to you all, there is a calm efficiency about the place.”

“We were always made to feel so welcome and in Mum’s last days the dignity and dedication shown to her and the compassion and understanding of our needs as a family is something we will always remember.”

“On my visits it was plain to see that you all not just cared for Mum but loved her as well.”

The home had six different sitting areas so people had a choice where to spend their time and some people preferred to stay in their bedroom. Bedroom doors were fitted with door knockers. For most people there was a picture of them outside their bedroom but for one person a note said that they did not wish to have a picture there and this had been respected.

Information was provided in the home's brochure and a service user guide. Regular newsletters kept people up to date with developments and events. The home’s complaints procedure was displayed in the entrance area and suggestions boxes had been provided for anyone to use.

Due to unforeseen circumstances we were unable to speak to any person living at the home during our unannounced visit.

However following our visit we had eventually managed to arrange and speak to a small sample of people living at the home via telephone.

We spoke to four people who told us they liked living there and advised they were happy at the home.They advised they had no concerns and felt that they had everyting they needed.

The Provider had developed various initiatives to get people involved with the development of their home and in the development of their care. They had recently introduced suggestion sheets asking people for positive and negative comments about the home which they intended to publish on their website. They had asked for live comments and suggestions that they felt would be useful to others. They had already received six detailed responses to date. Most people gave balanced views that were mostly positive. Some comments stated:

“Staff who are kind and caring.”

“Organisation who cares about their residents.”

”quality of care that is excellent in every way.”

“The building and rooms are well kept to a good standard.”

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester City before we visited the service. They had no issues of concern to report. The local authority had recently carried out a contractual monitoring check at the home in September 2011. The report was very positive and raised no issues or concerns needing further action or review.

We had also contacted the community infection control team for their comments about the home. They were positive about the homes management of infection control procedures.

We carried out an unannounced inspection of Prospect House on the 24th of August 2015.

Prospect House is a large detached property situated in the main street of Malpas village. It is very close to all of the local amenities. The home is registered to provide accommodation and nursing care for up to 48 people.

The service had 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.

People and their families who were able to told us that they were happy living at Prospect House and felt safe living there. They told us that staff were well trained, knowledgeable and very good at their jobs. People felt cared for and believed that care and attention by staff had helped them to progress and remain healthy.

People received care that was personalised and met their needs effectively. People had care plans which were person centred. This included an acknowledgement of their health needs but also placed emphasis on their social history and interests. We saw that care practice matched the information included within care plans. There were plenty of staff available to meet the needs of people who lived at the service. The registered manager and deputy managers regularly worked ‘hands on’ to ensure that people received care that met their needs. Good recruitment procedures meant that only staff suitable to work in the home were employed by the registered provider. There was evidence that staff were supported to attend external meetings in order to contribute and influence best practice in that area.

People lived in an environment that was clean, hygienic, well-maintained and designed to enable them to move independently.

The registered provider and staff have promoted excellent links within the community. They had been involved in making Malpas village a Dementia Friendly Community. Staff from the home have been involved with the dementia Café that Prospect House ran from the adjacent Church. After the inspection the registered provider informed us that Prospect House had won a Cheshire Community Pride Award in recognition for their work in this area. The registered manager and registered provider adopted an open and transparent style of management and sought the views of all concerned about how the standards of care in Prospect House could be maintained or enhanced. This has been done in an imaginative an innovative way. For example: pink and yellow slips were introduced into the home whereby anyone could raise an issue at any time. These were then addressed by the registered manager and/or the registered provider.

The registered provider and registered manager had used the five questions asked of services by the Care Quality Commission to guide staff practice and ensure a high standard of care was provided to people living at Prospect House.

The service had recently been awarded a beacon status by the Gold Standards Framework for Care Homes in 2015. The gold standard framework is geared towards those services providing end of life care to ensure better experiences for people.