Care @ Rainbow's End

Updated 18 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection prevention and control measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Care @ Rainbow’s End is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Care @ Rainbow’s End is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. For the purposes of the report, we refer to the provider who is also the registered manager.

Notice of inspection

This inspection was unannounced on 16 May 2023; we returned announced on the 17 May 2023 due to action we took. We then returned to follow up and continue our inspection on the 25 May 2023 due to continued concerns.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, including the provider's improvement action plan. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

People living at Care @ Rainbow's End were not able to discuss the care and support they received with us. However, we observed care and support being provided to them. We spoke with 5 staff members, including the provider, team leader, senior care assistant and care assistants. We also spoke with 2 relatives and 2 external professionals. We reviewed a range of records. This included care records of 5 people and their medicine records. We reviewed 4 staff files in relation to recruitment and staff supervision and records related to the management of the home. During the inspection we continued to liaise with the provider to obtain additional documents which we reviewed.

Updated 18 July 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Care @ Rainbow’s End is a residential care home providing personal care for up to 5 people with a learning disability. Accommodation is provided over two floors. A communal lounge, and Kitchen with a dining room are based on the ground floor. At the time of our inspection there were 5 people using the service.

People’s experience of using this service and what we found

Right support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests.

Mental capacity assessment had not been carried out robustly by the provider to ensure people were supported to have maximum control of their lives and supported in best interest safely; the policies and systems in the service did not support this practice.

The provider did not have effective processes or systems in place to safeguard people. to ensure they were safe from harm. Staff did not understand when a safeguarding needed to be reported to appropriate bodies.

People were not supported by staff who had been appropriately trained and were competent. People had not received their medicines safely.

Right care

People’s care plans and risk assessments did not cover their range of care and support needs. Staff were not guided to support people in line with legislation, good practice and their training. People had not been protected from harm and abuse.

The provider had not always provided staff with information and guidance to support people who were expressing distress and emotional distressed to ensure people had positive outcomes. Individual risks were not always assessed or managed well, and this placed people at risk.

Right culture

The service was not well-led. There was no effective governance system in place to monitor the quality of the service provided to people. The provider continued to fail to recognise risks and concerns in relation to health and safety, safeguarding, completing records and medicine management.

The provider continued to not follow recruitment legislation and ensure staff deployed had the right employment checks and skills to support people safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 December 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out our previous unannounced focused inspection of this service on 7 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent, and governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of safe, effective, and well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvements to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care @ Rainbow’s End on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to providing safe care and treatment, medicines management, infection control, safeguarding, consent to care, and management of the service at this inspection.

We took enforcement action 19 May 2023 and imposed conditions to the registration.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.