Archived: Retreat House

• Retreat House is a care home for people with a learning disability who may also be living with a mental health need.

• At the time of our inspection there were three people living at Retreat House.

• The size of the home was within the good practice guidelines in Registering the Right Support. The provider had reduced the number of identifying signs and other indications it was a care home. Staff did not wear uniforms which might suggest they were care staff when coming and going with people.

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

People’s experience of using this service:

• People received a service that was safe, effective, caring and responsive.

• We found improvements were needed in how the home was managed.

• Improvements identified at our previous inspection had been made and sustained.

• People’s care and support was based on thorough, detailed and person-centred assessments and care plans.

• There were caring relationships between staff and people they supported.

• Staff involved people in decisions about their care and support.

• People’s care and support met their needs and resulted in good outcomes for them.

• There was a friendly, welcoming atmosphere in a comfortable and well-maintained environment.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Rating at last inspection:

• At the last inspection (published 4 October 2016) we rated the service good overall with requires improvement in the key area safe.

Why we inspected:

• This was a planned inspection to check the service remained good.

Follow up:

• We will follow up the areas for improvement identified in this report at our next inspection. We will re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.

The home 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.

We found people’s safety was compromised in some areas. Staff were trained and assessed as competent to support people with medicines. Medication administration records (MAR) confirmed people had received their medicines as prescribed. However there were no clear guidelines for staff to follow to support people with ‘as required’ (PRN) medicines.

Risk assessments were in place which minimised risks to people living at the home and fire safety checks were carried out. However the home did not have a business continuity plan in place for foreseeable emergencies.

People felt safe living at Retreat House and were very much at the heart of the service. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe. Relevant recruitment checks were conducted before staff started working at Retreat House to make sure they were of good character and had the necessary skills.

Staff received regular support and one to one sessions of supervision to discuss areas of development. They completed a range of training and felt supported in their job role.

People received varied meals, including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and helped them prepare and cook food of their choice.

Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a range of activities. Staff knew what was important to people and encouraged them to be as independent as possible. ‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service.

A complaints procedure was in place. There were appropriate management arrangements. Regular audits of the service were carried out to assess and monitor the quality of the service.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

The service helped people stay safe by ensuring people's care records showed how people had been involved in discussions about the support they required to keep themselves safe. One person accessed the community without staff support and there were procedures in place for the person to inform the service should they require support. The service had agreed with the person a timeframe for them to contact the person to monitor their safety.

We saw in training records that all staff had completed training in the safeguarding of vulnerable adults. Risks to people's health and safety had been assessed and management plans were in place to reduce these risks. Appropriate checks were carried out on staff before they began working with people.

Is the service effective?

The service met people's needs effectively by involving people in the planning and reviewing of their care. People's care needs had been identified through an assessment process. The care records included details of how each person wished to be supported, including their personal preferences. People spoke with their key worker and could identify activities they wished to try. We saw within the care plans where new needs had been identified and care plans had been changed to address these needs. Staff had received training to ensure they had the skills to care for people living in the home. Where appropriate, the service sought advice from appropriate professionals to assist with the care provided for people.

Is the service caring?

People were supported by a caring staff team, who were aware of their needs and how they wished to be supported. We looked at a quality survey carried out by the service in 2013. One response stated, "Staff are really helpful and involve me in decisions about what I want to do." We observed staff speaking to people in a respectful way and encouraging them to be as independent as possible.

Is the service responsive?

The service was able to respond people's changing needs and requests. For example, we saw in the comments book one person had asked for more one to one meetings with their key-worker. The manager told us this happened weekly and they had identified other staff the person could talk to as well. The manager told us about an incident that had occurred for one person. Following this incident staff received training specific to the needs of this person. The person's care plans were changed and emergency guidance for staff to follow were written.

Is the service well-led?

The provider and manager ensured the service was well led. Quality assurance systems were in place which included audits and checks carried out by the provider and manager. A weekly check of the service environment was carried out by the provider and manager. They checked care records to ensure they were reviewed and completed on a regular basis. We saw the people living in the home had completed an annual questionnaire about the quality of the service provided in the home. Comments from the survey were all positive. Where people had made suggestions or requests, the manager showed us how they had responded to their comments. Staff told us the management team were supportive and always available for advice and help. People living in the home were consulted about changes to the home, for example, decoration and choices of colours in communal rooms. A delegation list ensured all staff knew their duties on each shift and this was monitored by the manager and provider.

However, people were not always involved in making decisions about their care and support, and their wishes were not always respected. People who used the service were sometimes given insufficient information and support regarding their care or treatment. The provider acknowledged our findings and was taking steps to address concerns raised at the time of inspection.

Planning of care and support was not effective in meeting service users' individual needs and ensuring people's welfare. Risks to individuals were not fully and consistently assessed. However, the provider had identified similar issues internally and was taking steps to address concerns raised during inspection.

The provider's recruitment and selection processes ensured staff employed were suitable to provide care and support to vulnerable people. Staff training needs were clearly identified, and staff were gaining additional skills and expertise to better meet the needs of the people at the service. There were enough staff working to meet people's fundamental care and support needs.

We reviewed the care plan for the person living at the service and it was up-to-date and person-centred. We observed interaction between the person living at the service and the member of staff throughout the inspection. The staff member was polite and respectful, and there was a genuine warmth between them and the person in their care. Support was observed to be responsive to the person's individual needs.

There were effective recruitment procedures and staff employed had appropriate pre employment checks carried out prior to starting work with vulnerable adults. The service had procedures in place for safeguarding vulnerable adults. Staff had all received training in safeguarding vulnerable adults and followed appropriate local safeguarding processes. There were adequate systems for recording and responding to complaints.