Raintree Care Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had developed a positive learning culture. The registered manager and staff understood the importance of reporting safety concerns. Systems were in place to support staff to report and record safety concerns and events when they arose. Any safety concerns or incidents that did occur were investigated.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The registered manager gathered information about people’s individual needs and wishes, and risks to their safety, prior to them receiving a supported living service from this provider. This information was used to develop person-centred care and risk management plans which were shared with staff to help them provide safe and appropriate care to people from the moment they moved into the providers supported living accommodation. Staff worked closely with all the relevant family members where applicable and external health and social care professionals and bodies to ensure care plans and risk assessments reflected people’s current needs and wishes.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were kept safe by the staff who worked for this provider. A visiting relative remarked, “My [family member] is kept completely safe by all the staff who support him at home.” Managers and staff understood how to safeguard people. They knew how to recognise and report abuse and were able to articulate how they would spot signs if people were at risk of abuse or harm. A staff member told us, “I’ve had safeguarding training and I know it’s my duty to tell the manager [registered], the local authority, the CQC, and the police, if necessary, if anyone we support is being abused or harmed.” Managers worked proactively with the relevant agencies, when a concern was raised, and took appropriate action to safeguard people from further risk, when this was required. An external care professional told us, “The registered manager is responsive, transparent, and knowledgeable about safeguarding procedures. Staff demonstrate an understanding of safeguarding responsibilities, and concerns are escalated appropriately.”

The service was working within the principles of the Mental Capacity Act 2005 (MCA). Staff understood people’s capacity to make decisions about their care and support using people’s preferred method of communication. Managers and staff had received Mental Capacity Act 2005 (MCA).

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Systems were in place to ensure risks people might face were routinely assessed, monitored and reviewed. People’s care records contained sufficiently detailed information for staff to follow to ensure risks they might face were mitigated, so far as possible, so people remained safe when taking part in activities of daily life. Managers and staff were fully aware of the potential risks people might face and the steps they needed to take to prevent or safely manage them. An external community care professional told us, “Staff manage risk exceptionally well. They have a clear understanding of the risks my client faces, including those relating to sensory overload, personal care and accessing the wider community. Risk assessments identify triggers and specific interventions staff need to implement to minimise these risks which include always taking a calm, structured and supportive approach.” Staff described how they balanced risk with independence, enabling people to undertake positive risks for themselves whilst remaining safe. A relative said, “Raintree Care always ensures that there is enough members of the staff present for my [family member] to spend time safely enjoying events in the wider community, such as trips to the gym, the local park and the seaside.” Throughout our site visits staff were always visibly present, attentive and aware of people’s whereabouts in each property and any changes that might indicate they needed additional support.

People had positive behaviour support [PBS] plans in place which ensured staff had access to all the relevant information and guidance they needed to prevent or appropriately manage incidents where people might become distressed. For example, staff were quick to politely ask people to leave a person’s bedroom when their non-verbal communication indicated they were becoming distressed because of overcrowding. A member of staff told us, “We work closely with other care professionals to continuously develop PBS plans we can all consistently follow which has really helped us reduce the number of incidents that occur here when a person becomes distressed.” Risk assessments and management plans were reviewed at regular intervals and updated according to reflect any changes in people’s needs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People told us the supported living accommodation their family members or clients lived in were comfortable and safe. A relative said, “My [family member] has a nice bedroom and ensuite bathroom which meets all his needs. The property has a nice, homely feel about it and there is plenty of communal space for people living there, their visitors and staff to socialise together.” In one property a learning disability friendly sensory room had been created as a positive behavioural support measure to help the person who lived remain calm. The properties were kept free from unnecessary slip or trip hazards and obstacles which enabled people to move safely around their home. The registered manager assessed potential health and safety risks people might face and plans were in place to mitigate risks posed by each property’s environment. Staff understood the importance of maintaining a safe environment for people to live-in. The properties were rented and safety systems and equipment were maintained and serviced at regular intervals by landlords who were responsible for ensuring the properties they owned remained in a good state of repair and safe places for people to live and work in. Staff told us they had clear guidelines available to help them deal with emergencies, including individualised plans to evacuate people in the event of a fire.

The provider did not always ensure there were enough staff working in each supported living property. Staff were qualified, experienced and received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were not always enough staff on duty at night to safely meet the assessed dependency needs of one person. We discussed these staffing arrangements with the registered manager who acknowledged having only one member of staff on duty onsite at night in this one property might not always be adequate to mitigate the assessed risk should, the person they supported become distressed during the night, which occasionally happened. The registered manager took immediate action to ensure 2 staff were now always on duty in this property at night in line with daytime staffing levels to minimise this identified risk.

The provider employed enough qualified, skilled and experienced staff during the day to ensure people received their care and support from staff who were familiar with their individual needs, preferences and daily routines. An external care professional told us, “The placement maintains adequate staffing levels to consistently meet my clients personal care requirements at home and in the community.”

Staff had not received any formal Makaton training despite care plans stating people used this method of communication. Makaton is language program that uses speech, signs and symbols to support people who cannot use words to communicate. We discussed this issue with the registered manager who acknowledged there was a gap in staff’s communication training. They agreed to ensure all staff received Makaton training within the next 3 months.

Staff received a mixture of e-learning and in-person practical and theoretical training and competency-based assessments which were relevant to their role and was routinely refreshed. An external care professional told us, “Staff demonstrate training and competence in autism awareness, sensory needs, de-escalation and positive behavioural support management.” A staff member added, “The training we receive is always relevant and is constantly being updated.”

Staff had ongoing opportunities to reflect on their working practices and to identify any further training, learning or support they might need. Staff had regular individual and group meetings with the registered manager and their fellow co-workers. An external care professional told us, “Staff are supported by an accessible manager [registered] and have ongoing supervision meetings with her. The registered manager monitors staff practice effectively.”

The provider operated safe recruitment practices and only suitable staff were employed to work at the care home.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The accommodation people lived in was kept clean. A relative told us, “The common areas and my [family members] bedroom are kept spotless.” Staff had received food hygiene and infection control training and knew how to prevent infections spreading. They had access to resources and equipment to help them reduce infection risks, which included adequate supplies of personal protective equipment [PPE].

The provider made sure medicines were safe, well-managed and met people’s needs, capacities and preferences. They always involved people in planning, including when changes happened.

Medicines stocks, balances and records showed people consistently received their medicines as prescribed. An external care professional told us, “My clients medicines are administered safely and correctly by well-trained staff. There are no reported medicines concerns.” People’s prescribed medicines were individually stored in securely locked medicines cabinets which reduced the risk of medicines errors occurring. Care records contained detailed guidance for staff about how people needed and preferred their prescribed medicines to be administered. Sufficiently detailed risk assessments and protocols for use were in place to guide staff including, 'as required' medicines. Managers told us the provider had signed up to STOMP (NHS program to - Stop The Over-Medication of People with a learning disability) and were actively working with external health care professionals to review prescribing practices and to reduce the use of behavioural modification medicines where possible in line with STOMP principles. Staff demonstrated good awareness of these principles with one staff member telling us, “We have been trained to understand ‘as required’ behavioural modification medicines must only ever be used as ‘last resort’ when all other strategies to deescalate a potentially harmful situation have been exhausted.” Staff had received medicines training and their competency to continue managing medicines safely was routinely assessed by the registered manager. There were regular internal audits of staff’s medicines practices, so any medicines near misses or errors would be identified and managed quickly.