Archived: Rainbow Lodge

Rainbow Lodge is registered to provide care and accommodation for up to four people with learning disabilities and/or autism. At the time of our inspection three people were living at this service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

Everyone spoke positively about the service. People were relaxed in their own home and responded well when staff interacted with them. Staff listened to people and offered support to achieve their goals when this was needed. The service demonstrated positive outcomes for people which reflected the principles and values of Registering the Right Support. This included supporting people to make their own decisions and choices to maintain independence and control of their lives. People’s life experiences were improved by staff accessing the right support at the right time, to maintain positive outcomes for people’s health conditions. This had a positive impact on people’s wellbeing and mental health. People had opportunity to access work placements and gain new skills through social interactions and activities.

Improvements had been made to ensure safe recruitment practices were followed. The systems in place supported staff to safeguard people from abuse or harm. Risk assessments had detailed guidance for staff to mitigate potential risks. Clear processes were in place to record, analyse and learn from accidents and incidents. Medicines were managed, stored and disposed of appropriately.

Care plans were person-centred and tailored to meet people’s needs. People’s preferences and religious beliefs were explored and documented.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. People were provided with information they needed and were encouraged to be involved in all aspects of their care. Staff knew the importance of asking for people’s consent before delivering care and support to them.

Staff attended regular refresher training, supervision and staff meetings.

People were encouraged to eat healthy foods to ensure optimum nutrition. They had access to kitchen facilities to prepare their own food and drinks when they were able to. Some people were involved in preparing meals and setting the dining tables.

People and staff spoke positively about the manager. Everyone advised the manager had a proactive approach to addressing any concerns they might have; people were confident to discuss issues with them. Audits had been completed to analyse and improve the quality of the service. In addition, the provider extensively worked alongside other key organisations such as the local authority. The changes made had impacted positively for people living at the service.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with, or who might have, mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. At the time of our inspection the service did not use restrictive intervention practices.

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 31 August 2018).

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service supports people with a learning disability or autistic spectrum disorder and can accommodate a maximum of four people. At the time of inspection, there were three people living in one adapted building. The service is run as a family home, with people living at the service as part of an extended family unit. Care is provided primarily by the provider. The provider’s family assist with the running of the service.

The inspection took place on 27 June 2018 and was announced. We gave 48 hours’ notice of the inspection visit because it is small service and we needed to be sure people would be in. At the last inspection, there were breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not thoroughly assessed, monitored and mitigated risks to the safety of people who used the service. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the safe and well-led domains to at least good. At this inspection, some improvements had been made to assess environmental risks and complete some training. However, the provider had not taken sufficient action to resolve the two breaches or improve their rating.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The provider is an individual ‘registered person’. 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 provider did not know what two medicines were prescribed for. This meant they did not know what effects the medicines should have and would not have known any side effects they may cause. Where people had medicine that was being regularly reviewed and gradually increased by a health professional these changes were not recorded on the medication administration records, to show the dose taken or evidence the medication was being given as prescribed. When people were assisted to manage specific health conditions, there was no care plan in place to identify how to support the person if their health needs changed. The provider did not document checks to make sure medicines were stored at a safe temperature.

There had been a delay of at least one year in DBS checks relevant to Rainbow Lodge being requested to help reduce the risk of unsuitable people working with vulnerable adults.

Where people had needs or made choices that could put them at risk, these were not formally assessed. This meant we could not be certain the provider had considered these risks or knew what course of action to take if concerns occurred.

Staff had completed some training, but had not covered important areas such as the Mental Capacity Act 2005 to inform their knowledge and understanding of how to support those living at the service to make decisions for themselves. When training had been done, the provider did not have a policy for when this should be renewed.

People’s backgrounds and needs were understood in detail. Care files did not always contain information the provider knew about people and were not always up-to-date.

The provider did not have current policies and procedures in place. Policies did not always reflect practices that were happening at the service.

The provider did not use a formal audit system, which meant we could not see that a full range of checks had been made across the service to identify where actions and improvements were needed.

The provider had informal systems for staff communications and people and relatives raising any concerns or complaints. Records did not evidence that people were consulted and involved in the running of the service.

There were breaches of regulation relating to safe care and treatment and the governance of the service. You can see what action we told the provider to take at the back of the full version of this report.

People were happy and relaxed at the service. They could access indoor and outdoor spaces at the home and had privacy when they wanted it.

Relatives told us they felt their family members were safe. The provider was aware of any accidents and incidents which had occurred in the home and had taken immediate action when accidents had occurred.

People and relatives spoke enthusiastically about the food offered at the service. People were given varied meals and had access to drinks and snacks throughout the day.

When people needed to see a doctor this was arranged promptly.

People received emotional support when they needed it, including if they were anxious or upset about past events. The provider understood the relationships that mattered to people and supported them to maintain these. People participated in activities which reflected their interests.

People’s communication needs were understood, but the provider was not familiar with accessible information guidance. We made a recommendation about this.

We completed this inspection on 6 June 2017. The inspection was announced. The provider was given 24 hours’ notice of our visit, because this is a small service and we needed to be sure that someone would be in when we visited.

At the last inspection in October 2014, the service was rated ‘Good’.

The provider is an individual ‘registered person’ and, as such, there is no requirement for them to have a registered manager for this service. 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.

During the inspection, we found that the provider had not robustly assessed environmental risks, for example regarding the need for radiator protectors or opening restrictors for windows. The service did not have a gas safety certificate. The provider did not have a clear system in place to determine and ensure appropriate recruitment checks were completed on people who ‘helped out’ at the service.

The provider did not complete training. We identified they needed to develop their knowledge and understanding around the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards as well as their responsibilities to safeguard vulnerable adults from abuse. The provider did not complete medicine management or first aid training despite often working alone and regularly supporting with medicines. We found further assessment was needed to determine whether one person who used the service was deprived of their liberty.

We found breaches of regulation relating to safe care and treatment and regarding the governance of the service. You can see what action we told the provider to take at the back of our report.

Despite these concerns, people provided consistently positive feedback about the service and we observed that people were happy, relaxed and content living there. The provider was observed to be kind, caring and attentive to people’s needs. It was the clear the provider knew people well and had established positive caring relationships during the significant period of time they had lived with the people they supported. People were treated with dignity and respect and supported to have choice and control over their daily routines. People were supported to engage in a wide range of activities of their choosing and to access their wider community. People enjoyed a varied social life and engaged in volunteer work. The provider supported and encouraged people to be independent.

People provided positive feedback about the food and were supported to ensure they ate and drank enough. The provider ensured people attended appointments with external healthcare professionals and appropriately sought advice and guidance to meet people’s health needs.

We observed sufficient staff were deployed to meet people’s needs. People were supported to take prescribed medicines. Care plans and risk assessments were in the process of being updated, but contained person-centred information about people’s care and support needs.

There provider listened and responded to feedback. People told us they could speak with the provider if they were unhappy about any aspect of their care and support.

We saw that people were cared for with regard to their privacy and dignity and that they were treated with respect. People told us that the provider explained their care options to them and that they were involved in decisions about their lives. One person told us "X told me about my eye operation and I know what they needed to do. I agreed to it."

We saw care assessments and plans of care which included a consideration of risk. Risk assessments balanced the need to protect people against enabling them to live full and interesting lives. We saw that specialists had been consulted where necessary to ensure people had the benefit of expert advice.

The home had effective infection control procedures in place to protect people from the risk of cross infection.

Staff received updated training to ensure they were informed of current good practice. Supervision was informal in this family setting, however staff performance was monitored regularly through daily discussions.

We saw that the home had effective systems in place to monitor and review the quality of care.

The home has cared for the same four people for a long time. We spoke with three of the people who lived at the home. All told us that they were enabled to take part in work and leisure activities as they chose. One person told us they enjoyed going out for walks and to 'Brook Leigh' day centre. Other people indicated that they enjoyed a full week of activity and social inclusion.

We spoke with the provider and her daughter. Both understood people's care needs well, were aware of people's changing needs and the risks associated with their care.

The provider was assisted in her role by several members of her family. All had received Criminal Records Bureau checks to ensure they were suitable to work with vulnerable people.

The provider and the staff employed did not have sufficient training to evidence they could meet people's care needs safely.

The provider responded to people's concerns and people told us they had confidence that any complaints would be dealt with quickly.