Bournemouth Rainbow Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment were effective.

The service used an electronic care planning system which meant changes to people’s care plans and risk assessments were easily accessible to staff. People’s communication needs were assessed and explained in their care plans.

We observed staff using people’s preferred communication methods when interacting with them.Staff we spoke with knew people well.

People’s care needs were assessed and reviewed regularly. However, we found some care plans and risk assessments did not always reflect people’s current needs, including their medicine requirements and the safe use of equipment. For example, 1 person’s risk assessment stated they required a rescue medicine in case their health deteriorated. However, the provider confirmed this was incorrect and the person did not require this medicine. This placed people at avoidable risk of harm as staff did not always have access to accurate and up-to-date information on people’s current needs.

The service supported people with food and drinks in line with their preferences. However, they did not always supply staff with accurate information on people’s needs.

People were referred to the Speech and Language Therapist (SALT) when required. SALT provided assessments of people’s swallowing or communication difficulties. SALT plans were kept in people’s homes and were easily accessible to staff. When asked, staff knew people’s swallowing or communication requirements.

Daily notes contained information about the food and drinks offered to people and how much they consumed.

However, we found some care plans contained incorrect information, for example, in relation to the nutritional supplement that was being used for 1 person. This person did not have necessary risk assessments in relation to their nutrition. Staff knew people well, however as the documentation in place was not always correct this placed people at risk of receiving care and support that did not fully meet their assessed needs.

The provider worked with teams and services to support people. However, they failed to have an effective oversight of delegated tasks which placed people at increased risk of avoidable harm.

Some medicines, such as injections, cannot be routinely administered by staff.We found 1 person was receiving daily injections under delegated tasks. A qualified professional can delegate the administration of these medicines to staff, if staff have the required additional and specific training and competency checks before undertaking these tasks. The provider failed to maintain contemporaneous record of this training and which staff had attended it. The provider failed to follow their policy to support staff with competency checks and supervision in relation to the delegated task.

Health and social care professionals were generally complementary about the service. An external professional told us, “The provider has worked well with professionals and family members, sharing information appropriately to support continuity of care and positive outcomes for the individuals they support.”

The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Staff supported people to attend their medical appointments. Records confirmed staff contacted healthcare professionals regularly.

However, we found significant shortfalls in the way people were supported to access healthcare services. For example, we found 1 person had not been referred to an external healthcare professional to have their equipment reassessed following an injury. Also records confirmed another person had been identified as requiring nutritional supplements and a higher calorie diet. This person experienced significant weight loss over a 6-month period. However, this was not identified by the provider at the time of the inspection, and no support from healthcare professionals was sought. This meant that people did not always receive timely access to appropriate healthcare support, placing them at risk of unmet health needs and potentially poorer health outcomes.Following the inspection, the provider requested a referral to a dietitian for one person and contacted external professionals to review another person's use of equipment.

The provider did not have an effective approach to monitor people’s care and treatment and their outcomes.

The service routinely monitored people’s care and treatment, however, the provider failed to act on the information gathered. For example, when required people’s weight was monitored. In response to our feedback, the provider created a weight loss risk assessment for this person. However, failed to act on the information gathered. This placed the person at increased risk of avoidable harm.

We found people were not always supported to manage their health and wellbeing effectively. For example, the provider did not always seek advice or support from healthcare professionals when required. This placed people at risk of deteriorating health and receiving care that did not fully reflect their current needs.

The provider had a system in place to regularly check people’s daily notes. Records showed bruising was recorded for some people, sometimes on regular basis. However, this was not identified by the provider and was not acted on. This placed people at risk of harm, as incidents were not recognised and investigated in a timely manner.

The service told people about their rights around consent.

People confirmed they were asked for their consent and offered choices.

Staff had received training in the Mental Capacity Act 2005 (MCA) and told us they respected people's choices and understood the importance of this.A staff member said, “I follow the Mental Capacity Act and their care plan. I act in the client’s best interests, explain what I am doing, respect their dignity, choices and encourage them to be involved where possible.”

People’s capacity was assessed in line with the MCA.

Where necessary, people with legal authority or responsibility can make decisions within the requirements of the MCA. The service had an effective system in place to ensure they had an overview of who could lawfully act on person’s behalf.