Queens 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. Queens Retreat can accommodate three people. At the time of our inspection there were three people living there who have a diagnosis of mental health and/or learning disability. They live in a detached house in a street in the middle of Cheltenham. They each have their own bedroom, which they have personalised and share a bathroom, kitchen, lounge, dining room/conservatory. The garden is accessible and has patio furniture.

Queens Retreat has been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

This inspection took place on 25 July 2018. At the last comprehensive inspection in March 2016 the service was rated as Good overall.

At this inspection we found the service remained Good.

The service was responsive to people’s needs and highly personalised care and support was delivered which reflected people’s aspirations, hopes and routines important to them. The provider, registered manager and staff had developed a strong person centred working culture. Staff understood people really well, anticipating their feelings and emotions, treating them respectfully, with patience and sensitivity. People’s needs had been assessed and they were involved in developing their care and support with staff. They were fully involved in the planning of their care and making decisions about their lifestyle choices.

People’s independence was actively encouraged. They were provided with training to equip them with the skills and confidence to learn new tasks. People felt safe living in the home and using their local community without staff support. They enjoyed a wide range of activities which reflected their hobbies and lifestyle choices. People had been supported to participate in voluntary work and paid employment. People’s diversity was acknowledged and respected. Staff advocated on their behalf and promoted their rights and wishes.

People were supported to stay healthy and well. They chose and prepared their meals which reflected their likes and dislikes whilst promoting a healthy diet. Each person had a health action plan which described their health care needs. They had annual check-ups with their GP and regular reviews with another specialist healthcare professional. People’s changing health care needs were closely monitored. Staff supported them with compassion, sensitivity and reassurance through changes in their health care needs. People managed their own medicines.

People were supported by staff flexibly to ensure their individual needs were met. Staff had been through a satisfactory recruitment process. Staff felt supported in their roles and had access to refresher training to keep their knowledge and skills up to date. Staff were knowledgeable about people, their backgrounds and individual needs. Staff understood how to keep people safe and were confident any concerns they raised would be listened to and the appropriate action taken in response.

People were fully involved in changes about their accommodation and service provision. Their opinions and views were sought. They had agreed to move together to new accommodation in Gloucester. The registration of this home with the Care Quality Commission was in hand. Staff and managers listened to people and empowered them to make decisions. People talked with staff daily about any issues as they arose. The acting manager worked alongside staff enabling them to lead by example and to monitor the quality of care provided.

The provider had quality assurance proce

This inspection took place on 16 February 2016 and was announced. Queens Retreat provides care to people with a learning disability and mental health needs. Three people were living in the home at the time of our inspection. People had their own rooms and shared a living room and kitchen. The house was detached in its own grounds.

There was a registered manager in post, although they had been absent for over 28 days. An acting manager had been appointed in their absence. 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 and associated Regulations about how the service is run.

People received individualised care which reflected their individual preferences, routines important to them and aspirations for the future. Their past experiences and history had been considered when developing their care plans with them. Strategies had been put in place to uphold their rights, to give them the skills to stay safe in their home and the local community and to manage their feelings and emotions. People referred to staff as “counselling” them and helping them when they were anxious or worried. People had positive relationships with staff who treated them respectfully, sensitively and kindly. People enjoyed sharing lighter moments with staff.

People decided what they wanted to do and when. Staff support was provided if needed. People had a full and busy lifestyle pursuing hobbies and interests of their choice. One goal had been to go on an aeroplane and they did this going to Scotland. They liked to go on holiday to Devon and to theme parks. They were involved in their local community using the library, gym and swimming pool. They did voluntary work and helped out at a farm and a gardening project. People were empowered to be independent learning to manage their own medicines and becoming more confident in their local community. Staff reflected people had done “phenomenally well” and they were “proud of their achievements”.

People were supported by staff they knew well and who understood their individual needs. Staff had worked together as a team for some years and had kept their training and skills up to date to reflect best practice. They felt supported by the provider in their roles. They were helped to develop professionally and supported to talk through any fears or concerns they might have. Although there had been no new staff for some time, recruitment processes ensured new staff had the skills and character to support people. There were enough staff to meet people’s needs. Staff rotas were organised around people’s commitments and the support they needed to do these.

People were involved in reviewing their care and support and the service they received. They helped to write their daily records and were involved in developing their care records. They gave feedback to the provider regularly about the type of service they wished to receive. They had discussed moving house and plans were in place to move to their new home. They had been fully involved in this process; talking with social care professionals, choosing colour schemes and furniture. They told us, “This is what we really want”. Quality assurance processes included day to day monitoring of health and safety systems, audits by external organisations and people living in the home auditing “our practice and saying what works for them.”

This inspection helped answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of our findings based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People living in the home were treated with dignity and respect by the staff that supported them. We received a number of positive comments, a care worker said "this is their home, they have to be comfortable" and a person living in the home told us "it’s nice here."

Staff told us what action they would take if they saw abuse taking place and where to find the correct contact information and procedures. One staff told us “it is their home, they need to feel safe."

Staff carried out a range of health and safety checks to ensure people were kept safe. Records showed that fire drills were carried out and people had their personal emergency evacuation plans.

Where there were risks associated with people's health, these were assessed and appropriate action plans put in place. For example, the procedure for the control of legionella disease in the bathrooms had very detailed instructions for staff on minimising the risk.

Is the service effective?

People living in the home were involved in the care planning and review process. Annual care reviews involved the person living in the home and they contributed towards their review. This helped ensure that support was person centred and reflected the needs of each individual. One person using the service told us “I wanted to fly in an aeroplane and we went up in one this year.”

Staff told us that communication was good in the home, so that staff would be aware of any particular issues relating to individuals. Staff told us that changes to people’s needs were discussed at handover.

Staff confirmed they had regular and informal supervision. A member of staff told us “I have supervision; and the owner is warm and approachable”.

Is the service caring?

The people we observed during our inspection reacted positively towards staff. We saw a lot of non -verbal communication between people and the banter with staff brought smiles to people’s faces. One person told us “I like the staff.”

We noted that staff were regularly asking people to make choices. We heard staff asking “Ok are we ready to go now, or shall we leave it for a minute?” One person did not want to go swimming so staff asked the person what they would like to do instead.

We made observations of people receiving the support they needed, in line with their care plan. One person was encouraged to discuss his fears of dental treatment and this information appeared in his support plan.

Is the service responsive?

We saw that the service worked well with other healthcare professionals. For example, one person had recently had involvement with a speech and language therapist. We saw from the care records that a GP and a dentist were contacted when staff had concerns about a person's health.

The way people expressed their likes and dislikes had been recorded so that staff could understand people's wishes. The likes and dislikes people told us about appeared in their support plan and showed that the service treated people as individuals.

People could make choices. We regularly heard staff asking people to make a choice. One staff asked a person "are you ready to go to the shop; shall we have coffee?”

We saw that accidents and incidents were recorded, analysed and action taken to reduce the chances of it happening again. This provided opportunity to identify any learning points and put any required action plans in to place.

Is the service well led?

We saw there were systems in place to monitor the quality and safety of the service. This included gathering the views of people living in the home. We saw there were plans to make possible changes to the accommodation and people were asked for their view and their responses were recorded in detail.

The home received regular visits from the registered provider who also worked shifts in the home. The registered provider regularly reviewed documentation and made changes where it was required.

The registered provider explained how the service worked hard on selecting staff which were suitable for meeting the needs of people using the service.

The records which we asked for were made readily available for us and the registered provider could supply the evidence which we requested to see. This showed that the registered provider was fulfilling her role and responsibilities to manage the service effectively.

During our visit, we spoke to staff and to all three people who used the service. We also looked at all three care files and other documents held by the provider. The atmosphere within the home was very friendly and warm and felt like a family home. The three people who used the service have lived there since childhood and therefore know the staff very well. Any decisions that needed to be made were made by the three people who live there with the support of staff.

We looked at the care files for the three people who used the service. We saw that each person had comprehensive care plans and risk assessments in place. A range of activities were available such as bowling, swimming and holidays. Staff encouraged people to participate in any activities they wanted to as well as developing their independence.

Medicines were administered safety by training staff. The registered manager also told us that the staffing ratios changed depending on the needs of the people who used the service.

We spoke to all three people who used the service. They all had nothing but positive things to say about the home and the staff and their comments included. “The staff look after us properly and feed us really well”. “There is nothing that we can’t do, the staff support us all the time and they do a good job”. “We make all the decisions in the house”.

We looked at the care files and spoke to each person using the service. During our visited we observed excellent interaction and communication between the staff and each person who used the service. We noted this communication to be very friendly and approachable and yet respected each person as an individual. The staff had worked with the three people living in the home for a long time. As a result, they knew each person very well and were able to provide continuity of care which was a benefit to each person.

Each person seemed well cared for and happy. They all told us what they liked to do and how well the staff supported them to do what they wanted to do. Each person was keen to tell us how much they liked the food and that where possible they helped with the cooking. Each person told us that they were well cared for and that the staff were nice. The people told us the staff had been looking after them since they were children and as a result they all knew each other very well.

People who lived in the home told us they were well supported and enjoyed living there. We were told that staff and management treated them with dignity and respect and they were able to discuss issues or concerns.

People said they felt safe and protected and knew how to complain if the need arose.

We were told that people were supported to develop their independent living skills and their leisure activities

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Staff were well supported by the management, undertook regular training appropriate to their work and received regular supervision.