Care @ Rainbow's End

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• 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

We assessed 8 quality statements in the safe key question and found areas of good practice. Improvements had been made since our last visit. Staff were trained and supported to understand safeguarding and how to raise concerns. Staff understood their duty to protect people from abuse. Staff knew how and when to report any concerns they had to managers. Safety risks to people were managed well. The Registered Manager and staff assessed and reviewed safety risks to people. This meant people, health professionals, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. There were enough staff to support people with their needs. Staff received relevant training to meet the range of people’s needs at the service. Staff received support through staff meetings, supervisions, and appraisals, to support their continuous learning and improve their working practice. The Registered Manager was able to explain what recruitment checks are required for staff, to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service.

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 communicated well with the Registered Manager to review what was working well, and what could be improved at the service. There had been a reduction in incidents and accidents where staff were not using restricted practice such as restraint within the service. Staff told us this was because of the learning and training they had completed after the last CQC visit. Staff gave examples of how the staff team had learnt from incidents. For example, one staff member said, “after each incident we completed a de-brief to reflect and make changes if needed.” Another staff member told us, “I think with incidents and accidents we complete the debrief part and that has been beneficial to learn from and do things better. We also use staff meetings to learn from incidents.” The Registered Manager told us they review all incidents and accidents to see if any improvements could be made to reduce or stop the re-occurrence.

The Registered Manager had implemented new systems and processes since our last visit. There were clear processes to review and analyse accidents and incidents, to learn from them and make improvements. Staff were provided with the opportunity to reflect after incidents, to ensure learning and improvements could occur. Staff meetings and one-to-one supervisions allowed the management and staff to reflect on what was working well, and what could be improved at the service. There was a clear policy on the duty of candour. This policy guided staff to tell the person (or, where appropriate their advocate) when something had gone wrong. The Registered Manager was able to explain when to use the duty of candour.

The provider had learnt where things had gone wrong, and action was taken from the learning. This had a positive impact on people living at Care @ Rainbow’s End, because they had better outcomes from the care and support they were receiving. Relatives felt able to speak up if they had a concern. They also felt learning had been undertaken to improve the service since the last CQC visit. Relatives felt involved when changes or improvements were being made. One Relative told us, “Previous inspection (CQC inspection) pulled them up, more investment, more money now, care good and feels different. Would definitely recommend them to others.”

Staff had good knowledge of which health and social care professionals supported which people. Staff were able to explain when these professionals visited, and what type of support they offered. Staff knew how to monitor people’s health conditions to ensure timely referrals were made to other services. For example, a person had recently had a choking incident. Staff took immediate action and made contact with the person’s doctor and made changes to their diet until an assessment by a health professional was completed. This reduced the risk of choking again.

People’s information and support needs were effectively communicated to other services and health professionals. This meant people would receive the care and support in line with their needs and preferences. Relatives told us that communication between the care home, staff and other health providers was good quality.

Staff kept clear summary documentation on people’s holistic needs. If the person required a hospital admission, this document could go with them to the hospital. This meant hospital staff would have clear guidance on how the person liked to be supported. Where people required external health and social care support, documentation showed that suitable referrals had been made. For example, where a person’s mobility had improved, a referral was made to an occupational therapist to re-assess the persons mobility to remove the use of mobility aids and have a more independent life.

Partners told us they had seen evidence of the Registered Manager and staff liaising with several health professionals. This was through recording of appointments attended, where staff have been able to advocate and provide information to facilitate reviews. One partner told us, “The service has initiated contact with health professionals (GP’s, OT’s, Nursing teams, Case managers) to refer and request updated assessments and reviews of individual’s needs where they have identified possible changes in need or a need to review historical guidance. The service has been liaising with health professionals to seek additional training and support to facilitate safe care.”

Relatives told us they felt their loved ones were safe from abuse. One relative told us, “Small incident today with another resident as another person was sitting in their space on the sofa. [Person] pushed them away and staff noticed that they were not comfortable so dealt with it.” This meant staff were aware when to take action to ensure people were protected from further abuse.

The provider had clear policies and procedures in relation to safeguarding and whistleblowing and provided staff with training to ensure that they responded appropriately to any concerns. If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. Where incidents had occurred, there was opportunities for staff and people to review what had happened and ensure measures were put in place to prevent re-occurrence.

We saw people and staff have positive relationships. There was an open culture of communication and we saw no evidence that people were at risk or fearful of the staff team. We observed people were free to complete their own routines and live their lives as they wished. Some people would be at risk if they did not have continuous supervision and control, where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards (DoLs). These safeguards ensure people who cannot consent to their care arrangements in a care home are protected if those arrangements deprive them of their liberty.

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns were not being responded to. One staff member told us “Safeguarding is when something is wrong, and a person is at risk of abuse or harm. I would go to management to report anything and if I didn’t feel action was taken, I would report it to the local authority safeguarding team and/or CQC.” Another staff member told us, “The ultimate thing is keeping people safe and protected, if I felt there is safeguarding, I would make sure the resident was safe, report it to the manager, if I felt it was the management I would go to CQC. I would also whistle-blow if I had to”. The Registered Manager understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe. Staff knew where to find the safeguarding policy. They were aware of the policy guidance and knew how to follow it to keep people safe from potential abuse.

Staff were able to tell us how they delivered person-centred care and treatment to people, this meant people’s risks were managed due to people’s individual needs being met. Care plans and risk assessments were up to date which meant staff had up-to date information to support people safely. One staff member told us, “We have risk assessments to follow to ensure we manage risk and if we are out in the community, we always risk assess where we are going to ensure we keep people safe.” The Registered Manager told us about their ‘keyworker system.’ Each person had a staff member who would ensure their risk assessments and care plans were reviewed and updated accordingly.

Relatives told us that their loved ones were not always able to verbally communicate their needs. However, they felt staff understood people’s communication methods and knew their needs well to support people to keep them safe. One relative told us, “Non-verbal but they can communicate with him.”

We saw people were supported safely. One person could become distressed. We saw staff were quick to respond to this person and offer support that reduced their agitation. This meant the person was kept safe as their distress did not escalate.

People’s needs were clearly documented in their care plans, so staff had clear guidance on a person’s mental, physical, and social needs. Staff knew how to support people to manage risk. For example, staff were provided with clear guidance on how to use positive distraction techniques to support people who showed signs of distress or agitation. Records showed that staff had followed people’s care plans, resulting in positive outcomes. People’s communication needs were clearly recorded. This allowed staff to understand people’s needs/wishes and support them to stay safe. There were clear processes in place for how to respond to an emergency. Staff had clear evacuation processes to follow, and these processes considered the unique needs of people. Staff had received training on how to support people’s individual needs. Some people at the service could become distressed. Staff had received training on how to support people when they became agitated.

The provider had made adaptations to ensure the home was safe. For example, fire guards had been fitted on doors. Fire guards are used to hold a door open but would release in the event of a fire to keep people safe. Relatives felt the environment was managed safely. One relative told us, “Feels like a home away from home. Safe and secure here.”

We observed a hot water pipe exposed and a potential burn risk to people. We raised this with the management, and they took immediate action. Since our on-site visit the pipe has been boxed in. The home was safe in the event of a fire. Corridors were clear of any blockages, allowing people to follow easy to read escape routes. Staff had access to fire-fighting equipment. Windows were unable to be opened wide. This safety feature prevents people from falling or climbing out and is in line with guidance from the Health and Safety Executive.

The environment was not always kept safe, by regular checks and maintenance. Systems were not in place to ensure the water quality was maintained to reduce the risk of waterborne bacteria, like legionella. Since our on-site assessment, the provider had booked an external contractor to complete a legionella water check. We saw there had been regular checks to ensure the home was safe in the event of a fire. For example, by checking the alarm system daily to ensure its in good working order.

Staff knew how to monitor the safety of the environment, and where to report any maintenance concerns. Staff were confident that the building was well maintained to keep people safe. A staff member said, “We have our weekly checks, for example weekly fire checks and we have been completing regular fire drills. We have risk assessments in place for cleaning products. We now have a lot better system and processes than we did before to ensure we are doing the health and safety checks.” The management team described a clear process for monitoring the safety of the environment. For example, the Registered Manager documented their regular checks around the building and explained how they action identified concerns. We saw that any areas they had picked up, had been resolved to keep people safe.

We saw there were enough staff to provide support to people safely. Staff were deployed effectively around the building, to provide timely support to people. We saw staff were suitably trained to complete their roles. Staff used their training to respond effectively to people’s needs.

Relatives told us there were enough staff, and any needs were responded to quickly. One relative told us, “Not a large turnover of staff so they are all familiar with each other. There is enough staff for the residents and at least 3 there. How many depends on different times. Someone is always with [Person], making tea, sitting with other residents and staff keep an eye on all of them at all times.” Relatives told us staff were well trained and knew how to meet their loved ones needs.

There were clear processes to ensure there were enough staff. The rota’s showed staffing levels had then been arranged accordingly. Staff had received suitable training to do their role. The management team ensured there was always suitably skilled staff working. Once staff were trained, there were clear ongoing processes to assess their competency. If needed, further support and training was then given to improve staff skills. If staff were not providing the expected level of care, there were clear processes to monitor and improve their performance. There were safe recruitment processes in place. No new staff had started since our last visit however the Registered Manager could explain their process and systems to ensure safe recruitment. The Registered Manager had completed Disclosure and Barring Service (DBS) checks. These check the police database for convictions or warnings that may impact the staff members safety to work with people.

Staff spoke highly of the training and support provided to them. They explained how it had supported them to be more effective in their roles. A staff member told us “The training is good; I have completed the electronic learning which was effective. I completed some really good training to support people with challenging behaviour. This training has helped so much and had positive outcomes for people.” Staff told us there was enough staff during the week, nights, and weekends. They also told us that management are always contactable. Staff told us they had regular opportunities to meet their manager on a one-to-one basis for supervision. These meetings gave them the opportunity to feedback about their experiences and request further guidance/training if needed. “We have one-to-one supervision; we have one or two every month. Anything I have ever mentioned in my supervisions or staff meetings, action has always been taken.” The provider and the Registered Manager told us they didn’t use any tools to determine staffing numbers. Staffing numbers was based on people’s commission support, but they often staffed over them hours to ensure people have the support and care they needed. Staff had completed appropriate training. The Registered Manager told us when they started in their post they really focused on training, “I am proud of the training staff have completed and have 94% compliance, this is a massive difference to when I started.”

There were clear processes and policies, to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak.

The home was clean and hygienic. We saw that staff had access to personal protective equipment (like gloves) throughout the home. This allowed them to support people in a hygienic way. We saw the kitchen was managed in a hygienic way to ensure people did not get food-borne infections.

Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. This protected people from the spread of infection. One member staff told us, “We wear PPE during personal care and during cleaning.” Staff had received food hygiene training; they were able to explain what actions they took to reduce the risk of food-borne infections. One person said, “I have completed e-learning for food hygiene.” There was a clear process and system to ensure the service was clean. A staff member told us, “We have daily bedroom checks; this is to check people’s furniture and equipment is clean and safe. Each week every bedroom is deep cleaned, we move all the future and deep clean. We ensure communal areas and bathrooms are cleaned daily. We have a checklist to follow to ensure all cleaning tasks are completed. We have a member staff who is the infection control champion they complete a weekly audit too.”

Relatives told us that the home was always kept clean. One relative told us, “Place is cleaner than it was previously. Things better organised with deep cleaning of [Persons] bedroom when [Person] goes out. Staff will move furniture and really clean the room.”

Staff were able to explain how they supported people to take their medicines safely. One staff member said, “We check medicines against the medication records. When we administer, we make sure we explain to the resident what medicines they are taking. We sit with the residents to ensure they have taken them, and they are feeling ok.” Staff knew who to report medicine concerns. For example, if a person declined their medication, the staff understood where to document this, and which health professionals to contact. One staff member told us, “We ensure we follow everyone’s care plan, and if they declined their medications, we give a change of face, and go back after a little while. If the resident still refused, we would record it on the medication records, contact the doctor, keep a close eye on the resident and monitor if they are continuing to refuse, then more action will be taken. We have to also complete an incident form to show the resident has declined their medication.”

Relatives told us that they were involved in reviews of their loved one’s medicines. Relatives felt that staff were well trained to support people with their loved one’s medicines safely.

Staff had received training on how to administer medicines safely. The Registered Manager had assessed the staff’s competency to ensure they were following best practice. However, the Registered Manager completing the competency assessments had not been competency assessed themselves. So, we were not assured that these assessments were effective. The Registered Manager was aware of this and told us they were organising additional training for the management team to be competency assessed. Staff kept clear records of when they had given prescribed medicines. We saw medicines were given as prescribed. Medicines were stored in a locked area, to prevent people accessing them unsafely. Staff did regular checks of the amount of medicine in stock. This ensured that suitable stock levels were always in place, and more medicine could be ordered from the pharmacist as needed. Some people required ‘as needed’ medicine and staff had clear written guidance on how this should be administered. For example, one person required pain relief medicines. Staff had clear guidance on what symptoms the person would show and how much dosage should be offered.