Archived: The Retreat

The Retreat is a care home providing personal care for to up to five people who may be living with a learning disability. At the time of inspection, the service was supporting four people. The home accommodates people in one adapted building.

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 that 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 is appropriate and inclusive for them.

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

The registered manager had a good overview of the service and was actively involved in people’s care. There were effective systems in place to monitor the safety and quality of the care provided. People and their relatives were consulted about how the service was managed and developed.

Systems were in place to keep people safe from the risk of harm and abuse. People's needs were met by suitable numbers of staff who knew people well. Each person had a care plan containing relevant risk assessments and people received their medicines as prescribed. Staff supported people to keep the service clean which helped protect them from the risk of infection.

Staff were supported with training and supervision in order to support people with their assessed needs. Staff supported people to select their meals and helped with preparation and cooking.

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.

People using the service received planned person-centred care and support that was appropriate and inclusive for them. The service worked closely with other health professionals to ensure people's health needs were met.

The staff treated people with kindness and respect. People's privacy and dignity were respected, and personalised care was provided to meet individual needs.

People had support plans which were individual to them, information included their life histories, preferences, likes and dislikes and their support needs. The service had a complaints and compliments policy. People were support to pursue their choice of how they wished to live their life.

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 good (Published 18 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The Retreat is a residential care home that provides care and support for up to five people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were four people using the service.

The service did not have 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.

The service appointed a manager who commenced in post in January 2016. They had begun to address the issues needing urgent attention at the service as identified in our last inspection report. They had since left the service and the new manager appointed in September of 2016 had continued with the necessary improvements. This manager was not yet registered with the Care Quality Commission to manage this service, but is seeking registration. As well as The Retreat they are employed to manage another service within the providers group.

At our last inspection, the overall rating for this service was 'Inadequate' and the service was therefore placed 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.

Following the last inspection the provider gave us an action plan of how they intended to improve. We used this action plan to assist us with the planning of this inspection and checked the evidence we found, against the action plan. At this inspection we found significant improvements had been made but there was still some work left to do.

At this inspection, we found that the staff had increased in number on duty. They were supported with supervision and training and knew people well. We found there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The issues of fire safety had been addressed and the cleanliness of the service had been improved by the recruitment of a designated person to carry out cleaning duties. A system was now in place to ensure there were sufficient numbers of staff on duty to support people to follow interests and take part in social and activities. There were sufficient staff to enable people to go out into the community while ensuring there were also sufficient staff to support those who remained at the service.

Staff had received additional training with regard to meeting the specific needs of people as well as a range of other areas relevant to supporting people effectively.

There was an effective recruitment and selection process to check that potential new staff were suitable to work with people who used the service. Staff were receiving training and supervision.

Medicines were managed and stored safely and administered correctly to people. People were supported to maintain good health.

Staff had continued to develop positive relationships with people. They knew their individual care and support needs well and people were supported, where able, to express their views and choices. The service had applied the principles of the Mental Capacity Act 2005 and issues of capacity and consent had now been considered and recorded.

Other professionals had been consulted to work with the service to address people’s physical needs.

The system of audits had been further improvement. More auditing was taking place than at our last inspection but we were concerned about the overall effectiveness as the audits as these had not always identified issues, in particular that people’s care plans were up to date and accurate.

The complaints system had been rewritten and with the involvement of family members and advocates regularly visiting the service, had increased the choice and activities for the people using the service to enjoy.

The Retreat is a residential care home that provides care and support for up to five people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were four people using the service.

The service did not have 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.

The service has appointed a new manager who commenced in post in January 2016 but they were not yet registered with the Care Quality Commission to manage this service. They have been employed to manage The Retreat and another service.

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, 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 so that there is still 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 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. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There had been a lack of oversight of the service by the provider to ensure the service delivered was of good quality and safe. Opportunities to improve had not been taken which meant people’s safety and welfare were compromised. The provider did not have a robust and effective quality monitoring and assurance processes to identify issues that presented a potential risk to people. Thorough risk assessments had not been carried out routinely to identify risks in relation to the physical environment and fire safety; necessary maintenance work and fire precautions had not been taken to protect people from risk of harm. Cleanliness in the service had been neglected.

A system was not in place to ensure there were sufficient numbers of staff on duty to support people to follow interests and take part in social and therapeutic activity. There were not enough staff to enable people to go out and to support those who remained at the service. People were not supported to participate in meaningful activities and the service did not provide people with opportunities and support to access the community on a regular basis. The two staff members on shift had additional responsibilities that included cleaning and preparing and cooking meals.

The service did not have a pro-active approach to staff member’s learning and development needs in line with the provider's stated purpose and the needs of people using the service. Staff had not received training or refresher training in relation to caring for people with a learning disability which would enable them to develop the necessary skills to carry out their role and ensure their practice was relevant and up to date.

Staff had developed good relationships with people. They knew their individual care and support needs well and people were supported, where able, to express their views and choices. Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse.

However the service had not applied the principles of the Mental Capacity Act 2005 and issues of capacity and consent had not been considered in some circumstances. This had resulted in the inappropriate assessment which led to mismanagement of people’s money. Action by the new manager and staff has since been taken to remedy the situation.

There was an effective recruitment and selection process to check that potential new staff were suitable to work with people who used the service. This was followed and helped to ensure that only suitable staff were employed.

Medication was managed and stored safely and administered correctly to people. People were supported to maintain good health. They received continuing specialist help pertinent to their healthcare needs. They had prompt access to a range of healthcare professionals for routine follow up and when they became unwell.

We saw that staff treated people with respect and encouraged them to make choices and express their views. The service responded to people’s care and support needs in ways that they preferred.

There were robust systems in place to recruit staff safely and ensure they had the skills and knowledge to support people safely.

The environment at The Retreat was homely and people’s bedrooms were decorated according to their preferences. At the time of our inspection work was in progress to improve and modernise the building.

The Retreat was well managed and there were effective processes in place to maintain records, to monitor the quality of the service and to seek the opinions of people and their relatives.

People living at The Retreat had close relationships with people in another home owned by the provider and visited a few times a week. One person was able to tell us that they liked visiting their friends.

Some people had complex needs and some were not able to speak with us but we saw that they smiled and appeared happy.

One person who lived at The Retreat told us about buying a Christmas present for a relative who they were looking forward to visiting. They confirmed they liked having their own things in their room.