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Inspection carried out on 30 June 2017

During a routine inspection

This inspection took place on 30 June 2017 and was unannounced.

L’Arche Kent The Rainbow is home for six adults with learning disabilities. It is part of a community run by L’Arche Kent, a charitable organisation. The home is a detached property in the city of Canterbury. Each person had their own bedroom decorated in the way they chose. One bedroom was on the ground floor and the other bedrooms were on the first floor. There were two lounges, a dining room, kitchen and an enclosed garden at the back that everyone had access to. The philosophy of L’Arche is that people with and without disabilities live together in a community, so some of the staff, called assistants also lived in the service and other staff worked different shifts.

The service was overseen by a registered manager with a team leader in day to day charge. 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.

At our last inspection in November 2015, the service was in breach of two of the regulations and was rated ‘Requires Improvement’. We issued requirement notices to make sure risk assessments were relevant and gave staff up to date guidance, to make sure the monitoring and auditing processes picked up inaccurate and out dated records, and to put a visitors’ book in place to make sure there was a record of who was in the building in the event of an emergency.

The registered manager sent us an action plan outlining how they would rectify those breaches. The registered manager and team had completed all the actions on the action plan and at this inspection all the regulations were met.

The registered manager had reviewed the audits system so that it was more effective. Regular checks of the environment had been carried out and there was a system of checking that records were up to date including: risk assessments, care plans, staff files, medication records and other records.

Plans were in place so if an emergency happened, like a fire, everyone knew what to do. Safety checks were carried out regularly throughout the building and all equipment was checked to make sure it was in good working order and safe to use. The visitors’ book was in place and a record was kept of when people were in the service and this was checked regularly.

There were effective systems in place to make sure people were supported to keep safe without being restricted. Risk assessments had been carried out and written up. Risk assessments were clear and detailed so that staff had the guidance necessary to protect people as far as possible from accidents or harm whilst still encouraging independence.

People looked comfortable in the company of staff and each other and expressed that they felt safe living at the service. There were clear processes in place to safeguard people and for staff to blow the whistle. The registered manager, team leader and staff acted promptly and appropriately if there were any concerns. Staff knew how to recognise and report potential abuse outside the organisation if necessary.

Potential staff were thoroughly vetted to make sure they were safe to support people. People had the time they needed to get to know potential staff before they were able to offer any support or work in the service. There were always plenty of staff in the service to support people and the registered manager kept staffing numbers under review.

Staff were enthusiastic in their roles and had received training to make sure they had the necessary skills to support people and provided person centred care. Each person had a care plan and a health action plan and these were kept up to date to give staff the guidance they needed to make sure people’s individual needs were met.

The Care Quality Commis

Inspection carried out on 23 and 24 November 2015

During a routine inspection

The inspection was carried out on 23 and 24 November 2015 and was unannounced. At the previous inspection in October 2013, we found that there were no breaches of legal requirements.

L’Arche Kent The Rainbow provides accommodation and personal care for up to six adults with a learning disability and there were five people living there at the time of the inspection. The philosophy of L’Arche is that people with disabilities live in a community. Therefore, some staff members also live in the home. The accommodation is over two floors, with one bedroom on the ground floor and the other bedrooms on the first floor. There are two communal lounges, a dining room and a garden to the rear of the home. .

The home was run by a registered manager. 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. However, the locality leader and not the registered manager were in day to day charge of the home. The locality leader was present at the home on a daily basis, organised staff rotas and training and was available to people who used the service and their relatives. The locality leader was responsible for managing the service and also part of the companies supported living scheme.

Assessments of risks to people’s safety and welfare had been carried out. However, some aspects of a persons’ daily life, such as the risks when they were out in the community, or swimming, had not been reviewed to ensure they contained up to date guidance for staff. There were clear guidelines in place for staff to follow for people whose behaviours may challenge themselves or other people. However, one of these guidelines directed to staff to lift a person off the floor which is potentially dangerous to the person and staff involved and against the person’s wishes.

Quality assurance systems were not effective. Shortfalls in risk assessments and had not been identified and action had not been taken to address shortfalls in care records which had been identified six months ago. The service was not proactive in gaining the views of relatives and stakeholders of the service. This meant that there was not a culture of continuous improvement in the home.

The home was managed on a day to day basis by a person who was not registered with the Commission to do so. The registered manager was office based, acted as a senior manager and only visited the home every two weeks. We have made a recommendation in relation to the day to day management of the service.

Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. The service carried out regular fire drills and checks of firefighting equipment to ensure it was in good working order. However, visitors to the home did not always sign the visitors book, and no visitors signed the book when they left the home. Therefore, there would not be accurate records of who was in the home in the event of a fire.

Medicines were managed appropriately and staff received medicines training yearly. An area to consider for improvement is for staff to have their competency in giving medicines checked on a regular basis by staff who have received training in how to do so, in addition to yearly medication training.

Clear and comprehensive guidance was in place for staff about how to recognise and respond to abuse and staff knew how to put it into practice. Accidents and incidents were recorded and any learning from these events had been incorporated into people’s assessments of risk, in order to help keep them safe.

People’s health and dietary needs had been assessed and clear guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff were knowledgeable about people’s health care and dietary needs and the service liaised with a number of health professionals as appropriate.

Comprehensive checks were carried out on all staff at the home, to ensure that they were fit and suitable for their role. Staffing levels were flexible and reflected people’s assessed needs.

New staff received a comprehensive induction, which included shadowing more senior staff. Staff were trained in areas necessary to their roles and staff had completed some additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Staff showed that they understood their responsibilities under the Mental Capacity Act 2005. DoLS applications had been made for people who lived in the home to ensure that people were not deprived of their liberty unnecessarily.

Good positive relationships had developed with staff who treated people with kindness and compassion. Relatives were extremely positive about the kind, caring and supportive relationships that had developed between staff and people. Visiting professionals commented on the calm atmosphere in the home and enjoyed spending time at the service. Staff communicated with people using a variety of different methods to help them understand and respond to people’s individual needs and choices. People led active, busy lives and were fully involved in community life with L’Arche and the wider community.

Relatives said they had no complaints and would recommend the service as it integrated people into life in the L’Arche and wider community. Professionals said they enjoyed spending time at the home as it was calm and peaceful and one professional said they would place a relative at the home if they needed the care the service provided. Staff were aware of the aims and values of the service to treat people who used the service as equals.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 25 October 2013

During a routine inspection

We gave short notice to the service of our inspection so that they could let people using the service know that we were coming. This was because some people needed time to prepare for an unfamiliar person being in the house. There were six people using the service and we met, spent time with or spoke with four of them. People said or indicated that they were happy with the service. One person said “(Staff member) is really nice.” Another person said “Yes, I am happy here.”

People were taking part in activities in the community including swimming, visiting the library and shopping on the day of our visit. Others were relaxing at home. People were encouraged to be fully involved in the running of the service including taking part in the cooking and cleaning.

People told us about their recent holidays which were arranged to meet people’s individual needs and preferences. People’s hobbies and interests were supported and people had support to achieve the personal goals and aspirations.

People maintained good health because the service worked closely with health and social care professionals. The service responded well to people’s changing needs. The home was safe and well maintained and suited people’s needs.

Staff were supported and supervised and given the training they needed to provide a good quality service. There was enough skilled and experienced staff to meet people’s needs and staff engaged with people in a calm, respectful and reassuring manner.

The robust quality assurance and monitoring systems ensured that the service was safe. Checks were made on staff, as part of the recruitment process, to make sure that people were safe and supported by appropriate staff. There were suitable arrangements in place to ensure the service was properly managed.

Inspection carried out on 18 December 2012

During a routine inspection

We spoke with people who use the service, the manager and to staff members. There were five people using the service. We met and spoke with all of them and everyone we spoke with said or indicated that they were very happy living at Rainbow.

People looked happy and relaxed in the company of each other and staff. We saw that people took part in a range of community based activities that they enjoyed and were involved in the local and wider community. People had support to take part in household tasks and had the opportunity to go food shopping and prepare their own meals. Everyone was fully involved and included in the running of the service.

People told us or indicated that they felt safe and well looked after. People told us or indicated that they could express any problems to the staff who would listen and act. People said that they thought the staff were kind and caring. Staffing was planned around individual needs and activities.

People’s health needs were supported and the service worked closely with health and social care professionals to maintain and improve people’s health and well being.

Inspection carried out on 21 February 2012

During a routine inspection

People told us or expressed that that they were happy living at Rainbow. People were relaxing at home and had support to access and take part in a wide range of leisure and vocational activities.

The home was clean and homely and everyone we spoke to said or expressed that they were happy with their bedrooms and other facilities.

People told us or expressed that the staff were kind and helpful and that they felt safe.

Peoples’ hobbies and interests were supported and people had support to keep in touch with and visit their family and friends. Cultural needs were supported and respected. People were part of the local and wider community.

The service worked closely with health and social care professionals to ensure that people had the support they needed to remain well and healthy.

Reports under our old system of regulation (including those from before CQC was created)