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 people’s safety and how people were to be supported to reduce those risks. We saw people engaged in a range of activities and were supported to maintain an active healthy lifestyle. Staff provided people with a balanced diet and were aware of people’s dietary requirements. Staff liaised appropriately with other health and social care professionals and accompanied people to healthcare appointments.
Staff supported people to maintain relationships with their families and there were no visiting restrictions in place. Staff respected a person’s privacy and treated them with dignity. Staff were respectful of people’s culture, religion and sexuality.
A complaints process was in place and relatives felt comfortable speaking with the registered manager if they had any concerns.
The registered manager submitted statutory notifications to the CQC about key events that occurred at the service as required by their registration. The provider clearly displayed their CQC rating so this was available to people, relatives and visiting professionals.