This inspection was unannounced and carried out on 30 January 2017.

The Retreat is a residential care home that provides care and support for up to five people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were four people using the service.

The service did not have 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service appointed a manager who commenced in post in January 2016. They had begun to address the issues needing urgent attention at the service as identified in our last inspection report. They had since left the service and the new manager appointed in September of 2016 had continued with the necessary improvements. This manager was not yet registered with the Care Quality Commission to manage this service, but is seeking registration. As well as The Retreat they are employed to manage another service within the providers group.

At our last inspection, the overall rating for this service was 'Inadequate' and the service was therefore 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, it 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.

Following the last inspection the provider gave us an action plan of how they intended to improve. We used this action plan to assist us with the planning of this inspection and checked the evidence we found, against the action plan. At this inspection we found significant improvements had been made but there was still some work left to do.

At this inspection, we found that the staff had increased in number on duty. They were supported with supervision and training and knew people well. We found there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The issues of fire safety had been addressed and the cleanliness of the service had been improved by the recruitment of a designated person to carry out cleaning duties. A system was now in place to ensure there were sufficient numbers of staff on duty to support people to follow interests and take part in social and activities. There were sufficient staff to enable people to go out into the community while ensuring there were also sufficient staff to support those who remained at the service.

Staff had received additional training with regard to meeting the specific needs of people as well as a range of other areas relevant to supporting people effectively.

There was an effective recruitment and selection process to check that potential new staff were suitable to work with people who used the service. Staff were receiving training and supervision.

Medicines were managed and stored safely and administered correctly to people. People were supported to maintain good health.

Staff had continued to develop positive relationships with people. They knew their individual care and support needs well and people were supported, where able, to express their views and choices. The service had applied the principles of the Mental Capacity Act 2005 and issues of capacity and consent had now been considered and recorded.

Other professionals had been consulted to work with the service to address people’s physical needs.

The system of audits had been further improvement. More auditing was taking place than at our last inspection but we were concerned about the overall effectiveness as the audits as these had not always identified issues, in particular tha

This inspection was unannounced and carried out on 24 March 2016.

The Retreat is a residential care home that provides care and support for up to five people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were four people using the service.

The service did not have 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service has appointed a new manager who commenced in post in January 2016 but they were not yet registered with the Care Quality Commission to manage this service. They have been employed to manage The Retreat and another service.

The overall rating for this service is 'Inadequate' and the service is therefore 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 enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There had been a lack of oversight of the service by the provider to ensure the service delivered was of good quality and safe. Opportunities to improve had not been taken which meant people’s safety and welfare were compromised. The provider did not have a robust and effective quality monitoring and assurance processes to identify issues that presented a potential risk to people. Thorough risk assessments had not been carried out routinely to identify risks in relation to the physical environment and fire safety; necessary maintenance work and fire precautions had not been taken to protect people from risk of harm. Cleanliness in the service had been neglected.

A system was not in place to ensure there were sufficient numbers of staff on duty to support people to follow interests and take part in social and therapeutic activity. There were not enough staff to enable people to go out and to support those who remained at the service. People were not supported to participate in meaningful activities and the service did not provide people with opportunities and support to access the community on a regular basis. The two staff members on shift had additional responsibilities that included cleaning and prep

Some of the people living at The Retreat had complex needs and were unable to speak with us. This meant that people were not able to tell us about their experiences. We saw from their facial expressions and body language that they were comfortable and appeared relaxed and happy. One person told us they liked living at The Retreat and enjoyed having friends visit.

We saw that staff treated people with respect and encouraged them to make choices and express their views. The service responded to people’s care and support needs in ways that they preferred.

There were robust systems in place to recruit staff safely and ensure they had the skills and knowledge to support people safely.

The environment at The Retreat was homely and people’s bedrooms were decorated according to their preferences. At the time of our inspection work was in progress to improve and modernise the building.

The Retreat was well managed and there were effective processes in place to maintain records, to monitor the quality of the service and to seek the opinions of people and their relatives.

We gathered evidence of people’s experiences by talking with people, observing how they spent their time and noting how they interacted with other people and with staff.

People living at The Retreat had close relationships with people in another home owned by the provider and visited a few times a week. One person was able to tell us that they liked visiting their friends.

Some people had complex needs and some were not able to speak with us but we saw that they smiled and appeared happy.

One person who lived at The Retreat told us about buying a Christmas present for a relative who they were looking forward to visiting. They confirmed they liked having their own things in their room.

The people living at The Retreat were unable to talk with us or had limited verbal communication. We saw through gestures, facial expressions or signs that people were well cared for and happy.

One person told us they were happy and also that they liked living there.

People who completed surveys as part of the home's quality assurance process had made positive comments about improvements to the service in the past year. These included Health or social care professionals, staff, relatives or others representing people living in the home.

Complimentary comments were made about the management of the home, people’s lifestyle, the relaxed atmosphere, staff training, the improved environment and the good standard of care.