Archived: La Retraite

La Retraite is a care home and was providing personal care to four people with an acquired brain injury at the time of the inspection. The service can support up to 10 people. La Retraite provides accommodation across two floors, with a lift and stairs providing access to both floors. People’s bedrooms had a medicines cupboard, wet room, toilet and a small kitchenette. On the ground floor, people had shared use of a kitchen-diner and lounge, there was also level access to an enclosed rear garden. The manager’s office was on the ground floor.

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

The provider could not be assured there were always sufficient numbers of suitably trained staff to administer medicines between 8pm and 8am.

A formula was being used to determine the numbers of staff deployed across the service. However, the formula calculated care in hours and did not consider people’s individual care needs and the skills and training staff needed to meet these needs.

The provider had worked with local staffing agencies and had improved the numbers of staff working in the home. Staff told us there had been improvements to staffing levels.

Rating at last inspection

The last rating for this service was Inadequate (published March 2020) when we identified seven breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 1 November 2019. At this inspection we found some improvements had been made, but further improvements were needed.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We have identified a breach in relation to staffing. This was because the provider could not be assured there were sufficient numbers of suitably qualified staff to administer medicines throughout a 24-hour period.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

La Retraite is a care home providing personal care to four people with an acquired brain injury at the time of the inspection. The service can support up to 10 people.

La Retraite provides accommodation across two floors, with a lift and stairs providing people with access to both floors. People had shared use of a kitchen-diner and lounge. The activities room was being used as an office space at the time of our inspection. People used an enclosed rear garden which was accessible by wheelchair. People’s bedrooms had a medicines cupboard, wet room, toilet and a small kitchenette. The manager’s office was on the ground floor.

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

People were not always protected from potential harm and abuse. Risk assessments had not always identified potential risks or included sufficient guidance for staff about how to lower the potential risk to people. We identified one person had an unexplained bruise to their face and the cause of this bruise had not been investigated or identified. We contacted the local safeguarding team about this. Analysis of incidents had recently been introduced and there was no analysis of accidents to identify themes and trends as a way of preventing a recurrence.

We observed kind and caring interactions between people and staff. People had not always been treated in a dignified and caring way, this was reflected in daily records we viewed. However, the incidents we identified had involved staff who no longer worked in the home.

Quality assurance systems had not been used effectively to identify concerns, errors and omissions we identified during the inspection. The manager was working to improve the experiences of people living in the home, this included working with a local care home to look at ways to improve the service. Notifications were submitted to the commission in line with requirements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s needs and choices were not always assessed in line with published guidance about best practice. When people required support to eat and drink sufficiently, guidance was not always available for staff. People were not always supported by staff who had received training relevant to their roles.

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

This service was registered with us on 24 January 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about risk management. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Well-led, Responsive, Effective and Caring sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to staffing, safe care and treatment, governance, person-centred care, the need for consent, safeguarding and recruitment.

We issued a warning notice in relation to regulation 18; staffing. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.