Care @ Rainbow's End

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• 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

We assessed 6 quality statements in the effective key question and found areas of good practice. Since our last visit improvements have been made. People’s needs and rights were supported. Care and support for people was effective. People had their health, care, well-being, and communication needs assessed. Care plans were reflective of people’s support needs and reviewed in a timely manner. Staff were aware of people’s preferences and respected these. The Registered Manager had good knowledge of the Mental Capacity Act, including capacity and consent.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us that they had time to review care planning documents, so they could keep up to date with people’s changing needs. “We are given time to review care planning documents, to assess people’s needs and check for any changes. I do a monthly review and set goals for the resident I keywork. We make contact with family to give them an update or discuss any changes we have noticed with the residents needs and then make care plan changes.” Staff had good knowledge of how to support people’s needs, and what action to take if the person’s needs appeared to have changed. One staff member said, “if we notice changes, we inform the person's keyworker or the manager. We are notified of any changes to people’s needs through handovers, or messages through the nourish (an electronic system) and we then read the care plan. The Registered Manager told us, people’s needs are assessed and reviewed monthly or before if necessary.

A range of national assessment tools were used, to understand people’s needs and how best to support them. For example, staff had been provided with guidance on how to best support people who show signs of distress or agitated. Records showed there had been a reduction in incidents since our last visit because staff had effective information and followed people’s care plans. Staff had access to documents on how to support people. Where people’s needs changed, these care planning documents were updated so staff understood people’s changes in needs. For example, person’s mobility had improved, and the person’s care plan and staff were updated while awaiting a multi-disciplinary assessment to reduce the use of restrictive equipment. People’s communication needs were recorded and understood by staff. This allowed staff to communicate with people, to have a clear understanding of the person’s needs. For example, we observed staff using Makaton to communicate with a person. Makaton is a form of sign language. Staff completed daily care records which showed how they provided care and support in line with people’s assessed needs and care plans. The Registered Manager regularly reviewed care records to ensure they continued to meet people’s needs and preferences.

Staff knew about people’s health and social needs and preferences and gave them as much choice and control as possible. People’s needs were assessed. Relatives told us that they were involved in assessments. Relatives were confident that the staff team understood their loved one’s needs. One relative told us, “[Person] is non-verbal, expressive, and loud. [Person] can make noises. Staff know [Persons] moods and encourage [Person] to sign. [Person] can sign yes or indicate to what [Person] wants. Will put hands under things they want.” Another relative told us, “[Person] non-verbal and staff can understand [Person] basic needs when [Person] is hungry or needs a drink through [Persons] iPad. This is with them at all times. The staff have changed and updated the buttons on iPad to meet [Persons] needs. Staff are with [Person] at all times. They have an emotions board in the hall with eight faces as it is difficult to know how [Person] is feeling."

Staff understood how to deliver evidence-based care and treatment. Staff were able to explain what was important to people and supported people in line with best practice standards. For example, one staff member told us about a person on a modified diet, which differed with various food types. Levels were clearly detailed in the person’s care plan and accessible in the kitchen to ensure this person’s food was made appropriately in line with national guideline. Staff had good knowledge of tools that the service used, and how they impacted the care given. For example, one staff member explained who was at risk of malnutrition and the measures that were in place to manage the risks. The care plan told staff how best to support this. One staff member told us, “We have all the information in the care plan, and we follow their care plans. If I identified a risk or a change, I would let management know and contact the GP if needed.” Staff understood how to work with external health and social care providers, to provide support in the most effective way.

People’s nutrition and hydration needs were supported in line with current standards. Staff had identified people at risk and were monitoring how much food they were consuming. Where needed, staff had made contact with health professionals. Processes were in place to deliver evidence-based care and treatment. The electronic care plan system allowed staff to monitor people’s needs, for example, people’s weights, health condition changes and behaviours. Care plans provided clear information and guidance and were updated to inform staff if people’s care and treatment needs had changed. The management team and staff were working with a wide range of health professionals, such as occupational therapists, oxygen therapy nurses, social workers, and stoma nurses to ensure people were receiving appropriate care and support.

People received care and support that was evidence based and in line with good practice standards. For example, one person had a Speech and Language Therapist (SALT) plan that stated the person required their food to be modified, to use certain cutlery and to be supervised while eating to reduce the risk of choking. We observed staff following these guidelines.

The Registered Manager had made contact with all professionals involved in people’s care and support because they have not had the information they need to appropriately assess, plan, and deliver people’s care and support. For example, one person had specialised equipment that restricts them. The Registered Manager has made contact with all health professionals involved to arrange a meeting to work together to assess the persons support needs. One staff member told us, “We have just had a meeting regarding a person’s health care needs and had discussion regarding their improvements and looking at ways to reduce some health support needs,” Another staff member told us, “We have been working with day service to see if [Person] could go to college and do drama. We are working with other teams to make this happen for [Person].”

Partners had told us the Registered Manager had made contact with them to ensure people living at the service were receiving coordinated care and that everyone was working together to achieve the best outcomes for the people living at the service.

Some people attend college. People had a diary that went with them to and from college. This was updated by staff from both services to ensure relevant information was shared.

People received care, guidance, and information from a range of different staff, teams, and services. The management team had been working to ensure it is co-ordinated effectively. Care plans showed that all relevant staff, teams, and services are contacted to be involved in assessing and planning care, to ensure the delivery of care meets people's needs. People had a health action plan regarding their health needs and which health professionals were involved with their care and treatment. Since 2005, people with learning disabilities are supposed to have a health action plan. This was a single document for people’s health needs, with guidance on their current health conditions, treatment, and planned health care.

Health professionals and relatives were involved in people’s care planning. Staff were provided with clear guidance on how to support people. We saw evidence of staff improving people’s health. For example, a person who was living with diabetes had their medicines stopped and was now controlled through a healthy diet. Health records showed people being supported to attend routine health appointments such as, diabetes, annual health reviews, dentist, and opticians.

People were supported to access health services as needed. One relative told us, “[Person] has lots of medical care and appointments from Queens Respiratory, Diabetic and Epileptic Teams, staff support with taking [Person]. Doctor and Pharmacy had to change when [Person] moved there, and staff let me know how they get on.”

The management team and staff were aware of peoples needs and supported people to live healthier lives. One member of staff told us, “We have health action plans for each resident, and this has information on people’s health, dietary and well-being needs. We keep people active to ensure they are healthy. They have medicines reviews and health reviews with health professionals, and we follow their guidance.” Another staff member told us, “We make fresh home cooked food and have two options for the residents to pick from using photos. When the resident is given choices, we show them photos of different vegetables, so they can pick the ones they like. With [person] we support with going to gym. [person] goes swimming once a week. A lot of our residents like going for daily walks.”

The Registered Manager had implemented systems and processes to have an oversight of people’s care and support. Care plan audits were completed to review and monitor people’s outcomes. Where risks, concerns or errors had been identified action was taken. For example, people who require monitoring of their fluid intake to ensure they had enough to drink, had goals set on what they should have within a 24-hour period. The electronic recording system would alert staff and management if a person were not reaching their ideal goal, so action could be taken. Since our last visit we had saw an overall improvement to a person who was at risk of poor intake of fluids.

Since the last CQC visit improvements had been made to people’s outcomes. People were supported to learn new life skills and live a more independent life. For example, people were supported to be more independent with their continence care and were working to an end goal of not requiring the use of continence pads anymore.

Since our last inspection staff had made a huge improvement to people’s outcomes. Staff were knowledgeable about each person’s outcomes and how they were supporting them to make improvements to live a more independent and meaningful life. One staff member told us, “We have keyworker reviews so we can focus on their outcomes while they are living at Care @ Rainbow’s End to work on their personal goals and achievements.” Another staff member told us, “We set individual goals monthly and review these to see how the residents are getting on. [Person] we have been working on supporting to be more independent, and now [Person] has progressed to taking their laundry to the laundry room, putting it into the machine and now we are working on supporting them further to understand which settings to use.”

People’s human rights were respected, and The Mental Capacity Act 2005 (MCA) was followed for people who were deemed to lack capacity to make decisions about their care and treatment. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider had a policy and procedures in place to ensure that people’s human rights were protected and guidance to follow if they needed to deprive a person of their liberty. There were records to show DoLS applications had been submitted appropriately. The provider had made referrals to health professionals where restrictions had been imposed to people but felt there were not appropriate to the level of risk. For example, a person had a specialised chair for when they were eating their meals, the chair would restrict the persons movement due to them being strapped in. The person showed signs of not wanting to use the chair, so the Registered Manager made a referral to health professionals. The person has now been assessed as not requiring the restricted chair. During the on-site assessment we observed people making choices using their method of communication about what they would like to eat and drink.

Staff demonstrated a good understanding of consent to care and treatment. One staff member told us, “It’s very important that we get their consent. I make sure I get a clear sign from them to ensure that they are ok to have their personal care or medicines before I support them. Where residents are not able to make a decision a mental capacity assessment is carried out by senior or management.” Another staff member told us, “Make sure we still allow the residents to make the decisions they are able to. For example, what food they would like, what drink, when they would like to get ready for bed and making sure they are consenting.” The Registered Manager had a good understanding of The Mental Capacity Act and could explain how they had followed this where people could not consent to their care and treatment.

Where people’s capacity was in doubt, decision specific mental capacity assessments had been completed. Appropriate professionals and people who knew them well were involved in making best interest decisions.