The inspection took place on 9 May 2018 and was unannounced. The last comprehensive inspection was in September 2017, where we found there were 10 breaches of the Health and Social Care Act 2008, (Regulated Activities 2014) regulations. We carried out a further focused inspection in December 2017 and found there were no improvements made.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions to at least good. At this inspection we found the provider had taken steps to address all of the breaches and significantly improved the quality of the service. We have made two recommendations in relation to ensuring procedures to evidence the robust recording of staff checks and for information about people’s consent to be more accurately recorded.

Calderdale Retreat 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 care home accommodates 81 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia, one of the units is for people who need nursing care and the other unit is for people who require residential care. At the time of the inspection there were 25 people living at Calderdale Retreat and the ground floor residential unit was unoccupied.

There was a registered manager who had been in post since January 2018. 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 had made some significant changes since coming into post and had made real progress to improve the quality of care for people through a clear action plan and targeted approach. All areas of the service provision had improved and actions had been taken to ensure there were no breaches in the regulations.

People were happy and well cared for, with their needs met in a person-centred way. We saw examples where people's health and well being had significantly improved since our last inspection. People's nutritional needs were well met and there was a good understanding of individual risks to people throughout the service. Medicines were well managed and there was good clinical oversight of people's health needs.

Care records were being improved to fully reflect people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Systems to recruit and induct new staff were in place although staff checks needed to be evidenced more clearly. Staff had clear direction and they were supported, trained and motivated to carry out their work. Communication had improved throughout the home and staff understood their roles and responsibilities. There were supportive relationships between staff and people in the home and there was a happy atmosphere with kind, caring and respectful interaction.

There was a newly emerging culture of openness and transparency, with good channels of communication between staff at all levels, people who used the service, relatives, visitors and other professionals in support of people's care.

Staff were involved and included in the implementation of new processes and systems to drive improvement in the service and as such they felt valued and respected. The registered manager had an oversight of the strengths of the service and the areas to improve and actively sought feedback from people, relatives, staff and other professionals.

We carried out an unannounced comprehensive inspection of this service on 18 and 20 September 2017. After this date we continued to receive concerns regarding people's care and the management of the home. We undertook an unannounced focused inspection of Calderdale Retreat on 18 December 2017. This inspection was done to check that improvements planned by the provider to meet legal requirements after our comprehensive inspection on 18 and 21 September 2017 inspection had been made or were in progress. The team inspected the service against three of the five key questions we ask about services: is the service well led, safe and effective. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Calderdale Retreat is a care home which provides residential, nursing and dementia care to people. The service is registered for up to 81 people. There were 31 people living at the home when we carried out this inspection. 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 care home accommodates people across three separate units, each of which have separate facilities. One of the units specialises in providing care to people living with dementia.

The home had an acting manager in post who was in charge of the home until a new registered manager was appointed. 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 continuing concerns in relation to the three key questions and therefore the service still was not providing safe, effective or well-led care and identified continued breaches in regulations. Although some minor improvements were evident, the key priorities for people's basic care needs to be met, had not been addressed sufficiently.

The management of risks to individuals was poor.

Care documentation was poorly or inaccurately completed and staff did not have sufficient access to key information about people's needs.

There was a lack of management oversight of risks, such as the analysis of accidents and incidents.

Staff lacked direction and clear leadership.

The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service remains 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 enou

Calderdale Retreat provides accommodation, personal care and nursing for up to 81 people. There were 35 people living in the home at the time of the inspection. This was the first inspection of the service since it registered in April 2017. We found multiple breaches of the regulations in relation to: person-centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, receiving and acting on complaints, good governance, staffing, fit and proper persons employed.

There was a registered manager named, but who was no longer 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 provider had enlisted the support of a care management company to oversee the running of the home and they were in the process of appointing a new manager.

There were no safe systems in place to ensure individual risks to people’s health and well-being were known and managed. People did not receive safe care and treatment and they were not protected from abuse and avoidable harm.

Staffing levels and deployment of staff did not ensure people’s care needs were met. Recruitment procedures were not robust to ensure those working with vulnerable adults were suitable to do so.

Staff did not know the fire procedures in the home or how to evacuate people in the event of an emergency.

Many staff had not received an induction or any training and supervision and they lacked the knowledge and skills of how to meet people’s needs.

Staff did not understand the impact of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). 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; there were no available policies and systems in the service to support staff practice.

People’s nutritional and hydration needs were not managed well.

Some staff interactions were kind and caring; other staff interactions were not so caring and people did not receive compassionate care. People’s dignity and privacy was not respected.

Care was not person-centred. Documentation relating to people’s care and support was not completed accurately or used to plan their care effectively and safely. People’s individual wishes were not respected and their basic personal care needs were not met. Many people remained in bed without good reason.

Complaints had not been managed well, although the new management team was taking steps to address this.

There was a serious lack of leadership and direction for staff, with no oversight of clinical risks or key issues for people’s care. Systems and processes for monitoring the quality of the provision were weak and there was no robust management of the service. At the time of the inspection there was a new management team installed and they had begun to produce action plans for improving all aspects of the service. However, it was too soon for us to assess the impact of this upon people’s care.

The overall rating for this service is ‘Inadequate’ and the service has therefore been 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, 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 enfo