Retreat Lodge is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Retreat Lodge accommodates up to seven people with a learning disability and/or autism in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. At the time of this inspection there were seven people using the service.

We undertook an unannounced inspection on 11 September 2018. At our last inspection in February 2016 we rated the service ‘good’ overall and for each key question. At this inspection we found the quality of service provision had deteriorated and the service was rated ‘requires improvement’. We also identified breaches of two legal requirements relating to safe care and treatment and good governance. You can see what action we have asked the provider to take at the back of this report.

A registered manager was 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.

There were not sufficiently robust procedures in place to review, monitor and improve the quality of service delivery. The provider had a system of monthly audits but these did not address all areas of service delivery and we found some key areas of service delivery were not appropriately checked, including medicines management, infection control and the quality of care records. We found the provider had systems in place to obtain feedback from people, relatives and staff, but there was not always sufficient action planning following this feedback to address any concerns raised.

Safe medicines management processes were not consistently adhered to, meaning we could not be assured that people always received their medicines as prescribed and accurate records were not always maintained about medicines administration.

The numbers of staff on duty per shift had recently been reduced. Staff felt the reduction in staff was not yet impacting on the quality of service people received but had increased the chance of people’s routines not being adhered to and the possibility of incidents occurring. The reduction in staff per shift had impacted on staff’s well-being, morale and stress levels. We recommend the provider uses staffing dependency tools to ensure the staffing levels are appropriate to meet people’s needs.

The provider was aware of safe recruitment practices including obtaining references from previous employers, checking employment history, criminal record checks, checking people’s identity and eligibility to work in the UK. However, we found these were not consistently adhered to and therefore we recommend the provider consistently adheres to safe recruitment practices to ensure all staff employed are suitable to support people.

Staff had received regular training and completed the provider’s mandatory training. Staff also received regular supervision and appraisals to ensure they had the knowledge and skills to support people. Staff were knowledgeable and adhered to key legislation including safeguarding adults’, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and infection control procedures.

Staff knew the people they were supporting. This included their individual preferences, as well as their routines, care, health and support needs. On the whole care records were in place that detailed people’s support needs and what was important to them. Care records also included a review of the risks to peop

The inspection took place on 17 and 18 February 2016, and was unannounced.

At our previous inspection of the service on 5 February 2014 the service was meeting the regulations inspected.

Retreat Lodge provides accommodation and personal care for up to seven people who have learning disabilities. There were seven people living in the home when we visited.

The service had a long serving 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.’

People felt safe using the service; they had sufficient numbers of trained staff present to support them. Recruitment procedures were safe and only thoroughly vetted staff were employed. The service had a staff training and development programme. Staff received appropriate training and support to enable them to meet people’s needs.

Staff worked with a range of healthcare professionals to obtain advice about how to support people with their healthcare needs. Staff were implementing care practices that reflected the advice received.

Staff were trained in safeguarding adults. Staff at the service identified risks associated with people’s care and were aware of how to manage these safely. The service ensured that people’s human rights were respected and took appropriate action to assess and minimise risks to people.

Staff demonstrated a good understanding of people’s needs. Staff treated people in a warm and caring manner showing regard for their dignity and individuality. Staff were attentive and responsive to people’s verbal and non-verbal communication; they provided care that took account of their individual needs and capacities.

Staff supported people with identifying goals they wished to achieve whilst using the service and supported them to progress towards them. Staff were aware of the importance of people engaging in suitable and enjoyable activities and leading fulfilling lifestyles. People were offered structure in their lives, opportunities and facilities at the home were good. People were encouraged and supported to participate in a variety of activities in the home and build links in the community.

People were cared for in line with the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). ‘Best interest meetings’ were held as required by the MCA in situations when people could not give consent, for example, for a medical procedure.

The service had systems to ensure the quality of the service was checked regularly and action was taken as necessary to ensure the standards of care were of a high quality. Appropriate action was taken in response to incidents with a view to preventing recurrence. Staff provided people with support, the opportunity and time to discuss any concerns or complaints they had.

We saw that staff took time to explain activities and the support they wished to provide before seeking peoples permission to provide care. Although people had limited verbal communication skills we observed they were able to indicate they understood the support choices available to them. One person we spoke with said, they (the staff) knock on my door, they always do. They ask me what meal I want, I choose.''

We observed that people received safe, appropriate care and support that met their needs and preferences. One relative we spoke with said, ''I don’t have to worry, the staff call me if there is a problem or want to know something but it’s not very often as they know him well by now.''

Prescribed medicines were stored securely and appropriately. We saw that staff had received training to administer medicines safely to people using the service.

We saw that there were effective recruitment and pre-employment checks undertaken to ensure people received care from staff that were fit and appropriately trained to do their job.

The provider had systems in place to ensure people experienced safe quality care and respond to any concerns they might have.

At the time of our visit there were two people using the service. One person was away for the weekend with their family. We spoke with the person who was using the service prior to their going out and being supported by staff in the community. People who use the service said they liked living at the home and being involved in different activities.

Staff were appropriately supported in their work and received regular training.

The environment of the home was maintained, with routine maintenance ongoing to ensure the home was safe for the people who use the service.

At the time of the site visit to Retreat Lodge there were no service users living at the home. However, the service is being maintained and is able to admit people at any time. Therefore the site visit focussed on the home's suitability to admit service users.