The Retreat is a ‘care home’. People in care homes receive accommodation and nursing or 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.

The Retreat can accommodate up to 14 people who have a learning disability, a mental health condition and/or dementia. At the time of our inspection 13 people were living there. People living at The Retreat had their own bedrooms, some with en suite facilities and had access to a shower and bathroom. They shared a lounge and a dining room. The grounds around the property were accessible. A shed in the garden had been provided for the use of one person living there.

The Retreat had 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 and autism using the service lived as ordinary a life as any citizen.

This inspection took place on 19 February 2019. At the last comprehensive inspection in October 2016 the service was rated as Good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At this inspection we found the service remained Good.

People’s care and support was individualised, reflecting their personal wishes, routines and lifestyle choices. They were treated with kindness and sensitivity. They had positive relationships with staff, who understood them well. Staff knew how to keep people safe and how to raise safeguarding concerns. Risks were assessed and encouraged people’s independence. Staff understood and respected people’s diverse needs. When people became anxious staff provided reassurance and supported them to manage their emotions.

People were supported by enough staff to meet their needs. Staff recruitment and selection procedures were satisfactory with the necessary checks being completed prior to employment. Staff were supported to develop the skills and knowledge they needed through a range of training and individual support sessions.

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. They made choices about their day to day lives. People and those important to them were involved in the planning and review of their care and support. They chose the activities they wish to take part in. People went carriage riding, used local transport, and went on day trips, to social clubs and to day centres. People were supported to keep in touch with relatives, friends and those important to them..

People’s preferred forms of communication were recognised. Staff were observed effectively communicating with people, taking time to engage with them. Good use was made of easy to read information which used photographs and pictures to illustrate the text. People had access to easy to read guides about complaints and activities.

People’s health and wellbeing was promoted. A weekly menu encouraged people to have vegetables and fruit in their diet. They helped to prepare and cook their meals. People at risk of choking had special diets and the support of staff to keep them as safe as possible. People had access to a range of health care professionals and had annual health checks. People’s medicines we

The Retreat is a residential care home providing individualised support for people living with a learning or physical disability. At the time of the inspection 13 people were using the service.

This inspection was unannounced and carried out on 11 and 12 October 2016.

There was a 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in April 2015. At that inspection we identified breaches of regulations. These were in relation to dignity and respect and sharing information with the appropriate authorities.

At this inspection we saw the actions they had told us they would take to improve these areas had been fully implemented and sustained over time.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. Family members said the management team were approachable.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they like to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people’s needs. Care plans were person centred to provide consistent, high quality care and support. Daily records were detailed and contained sufficient information for staff to read and support people effectively.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Staff, relatives and other professionals spoke positively about the registered manager.

We spoke with four people living at the home, observed care being provided and spoke with advocates, staff and a relative. One person told us “I like staff. They look after me”. We observed staff patiently supporting people to be as independent as they could be. We saw evidence that people were kept active and stimulated by staff.

One advocate told us the person was the “best looked after she has ever been”. Another advocate gave the service 30 out of 10 for the effort they put in to supporting people.

Staff and people all felt able to report a safeguarding concern if needed. People felt safe in the home. Medication was administered safely and people were appropriately consulted prior to administration. Storage and recording were appropriately completed.

Staff were positive about the training available to them. The manager monitored training needs through supervision meetings to ensure all staff were appropriately qualified. Advocates that we spoke with were very positive about the knowledge and skills of the care workers.

The provider sought feedback from a variety of people to ensure the service provided by the home was of a high standard. Survey responses included “excellent quality of high level care from staff who truly understand the client” and “general standard of the home if very good”. A number of quality review systems were in use by the manager to monitor service quality. The home was well maintained.

This inspection took place on 29 and 30 April 2015 and was unannounced. The Retreat is a care home providing accommodation and personal care for up to 14 people with learning disabilities. There were 10 people living at the service at the time of our inspection.

There was no 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. The previous registered manager had left the service. CQC had been notified and the manager’s registration cancelled on 11 March 2015. The provider’s business and development manager was managing the service. Recruitment was underway for a permanent manager who would apply to CQC to become registered manager.

People did not always receive a service that was safe. Safeguarding concerns were not always acted upon appropriately. Risks were assessed and individual plans put in place to protect people from harm. There were not enough skilled and experienced care staff to meet people’s needs. The provider carried out employment checks on care staff before they worked with people to assess their suitability.

The service was not always effective. Staff did not receive supervision and appraisal on a regular basis. People were supported by staff who had received the training needed to meet their needs. Staff understood their roles and responsibilities in supporting people to make their own choices and decisions. People received sufficient food and drink. People’s health care needs were met.

People did not always receive a caring and compassionate service. They were not always treated with dignity and respect because people’s stated preference regarding staff was not always adhered to. People were supported to maintain their independence.

The service responded to people’s needs and the care and support provided was personalised. Staff providing care and support were familiar to people and knew them well. People were involved in a range of activities both within the home and in the local community. The provider encouraged people to provide feedback on the service received. The service made changes in response to people’s views and opinions.

The service was well-led. The temporary manager provided good leadership and management. The vision and culture of the service was clearly communicated and understood by staff. The quality of service people received was monitored on a regular basis and where shortfalls were identified they were acted upon.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to keeping people safe and treating people with dignity and respect.

We have made a recommendation to improve the service provided to people in relation to staffing levels and staff supervision and appraisal.

You can see what action we told the provider to take at the back of the full version of this report.