This inspection took place on 20 March 2018 and was unannounced. At the last inspection in July 2017 we found the provider was in breach of six regulations which 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. At this inspection we found they had taken action and were no longer in breach of these regulations.

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.

At the last inspection we rated the service as requires improvement and found the provider was in breach of one regulation which related to their governance arrangements. At this inspection we found they had improved their water temperature checks and legionella testing which were identified as shortfalls, however, we found significant shortfalls in other areas and the service has been rated as inadequate.

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

The inspection took place on 5 July 2016.

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

On the day we visited we gathered evidence and inspected against six outcomes to help answer our five key questions; Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

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 found the provider had addressed all the issues raised at the last inspection.

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.

We spoke with three people who used the service. They made the following comments:

“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.

We spoke with two people who used the service. People told us the staff treated them well. One person told us; “They’re good here.” Another person said; “Staff look after me when I’m not well.”

People told us there were things to do. One person said they enjoyed going to the local pub. We asked one person whether they were aware of their care plan. They told us they were aware and said they could input into this.

People told us they felt safe living at Prospect House. One person said; “I do trust staff.” Another person we spoke with told us they would speak to the manager if they were unhappy with anything at Prospect House.