Care @ Rainbow's End

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 7 quality statements in the well-led key question and found areas of good practice. A new Registered Manager had been recruited since our last visit. Improvements had been made and the service was well-led. Management and staff understood their role and responsibilities. There were clear and effective governance, management, and accountability arrangements. The Registered Manager had clear oversight of the service and was able to identify areas of concern or improvement. Notifications were submitted to external organisations as required. Information was used effectively to monitor and improve the quality of care. Staff told us the new manager has made a difference in managing Care @ Rainbow’s End. Staff felt the manager had a strong leadership style and ensured people were receiving good quality care.

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.

The Registered Manager had implemented robust systems and processes to ensure people were receiving good quality care. For example, the Registered Manager carried out a daily walk around to identify any areas of concern or risks. The walk around consisted of checking the safety of the building as well as the wellbeing of the people living at the service. The provider and Registered Manager worked together to ensure that their vision, values, and strategies were in place and were developed in collaboration to ensure peoples support needs were met and relative’s views and external partners recommendations were gathered. For example, the Registered Manager and staff worked with the local authority to learn and make the necessary improvements. The Registered Manager worked hard and closely with people and staff to have a listening culture that promoted trust and understanding between them and people using and working at the service. We observed people, the provider, the Registered Manager, and staff working effectively together and in line with their vision and culture throughout our onsite inspection.

The management team had a clear plan that was shared with the staff team of their direction and culture, to make the necessary improvements to the service. The management team spoke positively about how the staff team took on the necessary changes and embedded best practice guidance to ensure people were supported safely. Staff told us they were aware and part of the shared direction. The culture within the home had improved and this has impacted positively on the people living at the home. One staff member told us, “The management have a clear vision and we regularly have meetings with the registered management. When the Registered Manager started, they set out the goals and visions, staff were given roles and responsibilities to drive improvement. For example, infection prevention and control, medicines, dignity, health and safety and the kitchen, each staff member has been given the responsibility of each task to ensure its in line with our policies. This has helped us so much to ensure we work within our values.”

The Registered Manager was capable and had the capacity to do their role. The Registered Manager had ensured the organisation’s vision and improvements were achieved and risks had been managed safely. The Registered Manager was alerted to a poor professional culture within the staff team and addressed this. All staff were issued the code of conduct policy where they had to read and sign to demonstrate they understood and would work in line with the policy. Throughout the on-site assessment the management team were visible and lead by example. We observed the management team work with integrity, openness and honestly. No new staff had started at the home; however, the Registered Manager was in the process of recruiting new staff members. The Registered Manager was able to explain safe recruitment.

Staff spoke positively of the Registered Manager and told us the service was well managed. They told us the Registered Manager had the skills and knowledge and this has had a positive impact at the service. The staff felt supported, and able to raise any issues or concerns openly. One staff member told us, “Management are really caring, supportive and the manager has made so much improvement to the home, it’s made the home better. Its also done wonders for our residents to have better outcomes.” Another staff member told us, “I feel like everyone has a lot more confidence in the new manager and feel listened to. They have put key policies in place and supported staff to understand them and put them into practice. The manager has also ensured safeguarding concerns have been dealt with appropriately and gone through it with us and makes sure staff are involved and this has developed us as a staff team because we are more aware. Since the new manager has started huge improvements have been made which has majorly impacted positively on staff and the residents. Residents have so many more choices now. The manager has previous experience and has been able to make the changes needed.”

Staff told us there had been a huge improvement with freedom to speak up since our last visit and the manager encouraged staff to speak up. Staff felt the new Registered Manager gave staff time and plenty of opportunities to speak up. When staff did speak up, staff felt action was taken. One member of staff told us, “I can definitely speak up, we have supervisions, or we can request one. I feel able to approach management if I have concerns. I have raised concerns, and these have been dealt with straight away.” Another staff member told us, “I feel, and I am able to speak up. Even on things I have disagreed on because we know the residents and the manager has listened and I had no come back. Since the Registered Manager has been here, I feel when I speak up, I feel we are listened to and being heard. We are not dismissed. Even our feelings. We are kept updated with anything we raise on what action has been taken. There is an open culture, and we are more encouraged to speak up.”

We observed a culture where staff and management acted with openness, honesty, and transparency. There were clear systems and processes in place allowing staff to raise concerns without fear. When concerns were raised the management team listened, investigated if needed and lessons learnt were shared with staff team. The Registered Manager implemented champion roles to empower staff and drive the required improvements. The champion role is where a staff member is trained in a particular area to share their knowledge with other staff and ensure the staff team are working in line with the organisations policy and procedures. For example, one staff member was an infection prevention and control champion, and they were responsible to the ensure staff where aware of the homes processes and completed audits to identify any areas of concern.

Staff spoke positively of the improvement that had been made since our last visit. They told us they have felt empowered to raise concerns and ideas which has resulted in positive changes to improve the service and created a more inclusive culture. One staff member said, “I feel all the staff are treated fairly. When changes are made, we are all included and have a discussion and everyone’s points are discussed.” Other comments from staff included, “We are all included and equally treated. Management makes sure we work in line with policies and procedures now. For example, the management made us all read the code of conduct at work to ensure that we work professionally. We have a staff member who has a health condition and is supported.” Another quote was, “I feel my human rights are protected, and my wellbeing. If staff are off sick, we now have return to work meeting which is beneficial.”

Management and staff had completed Equality, diversity, and inclusion training. Staff had access to the care homes policies and procedures. The Registered Manager felt improvements needed to be made in this area and ensured staff had read the polices and signed to show they understood them, so they knew their rights and professional boundaries at work. The Registered Manager was aware there was a poor inclusion culture within the service and worked with staff to change the culture. We saw improvements had been made, and staff were more confident and felt involved. Where needed, the management team had made reasonable adjustments to support staff with health conditions to enable them to continue their role safely. We saw a respected culture and people’s differences were accepted and they were supported by a staff team who understood them.

Processes and systems had improved since our last visit. The Registered Manager implemented a range of effective audits and monitoring tools to identify concerns, risks, and areas where improvements where needed. The audits provided the management team with an oversight of the service. For example, there were audits in place to check care planning records, medicines, health and safety, infection prevention control and incident and accidents. The management team had empowered and upskilled the staff team to complete the audits with support and oversight of the management team. The Registered Manager completed daily walk arounds to check people were supported appropriately and check the cleanliness and safety of the building. There were compliance checks to review staff training to ensure staff had completed the required training. The provider had emergency contingency plans in place should there be an event that could affect the running of the service.

Staff spoke positively regarding the improvements that had been made by the new manager. Staff felt there was more of a structure and organisation within the home, and it was clear regarding roles and responsibilities. Staff felt more empowered and knowledgeable about completing audits. They were able to explain what action they had taken when they had identified concerns when auditing. One staff member told us, “There is more management oversight, and audits are now being completed and the staff management completed them know what they do. Using the electronic system helps, because the audits pop up the day they need to be completed and it will highlight it’s not been completed. The system helps to ensure the audits are completed on time and action is taken where needed because you have to complete what actions are required and the audit cannot close until the action is complete.” The Registered Manager told us they have implemented a wide range of audits and worked with the staff team to understand how to complete audits and what to do when risks, concerns and issues were identified.

People were supported to access the local community and be involved in local events. People were supported to have joined up care and support from other partners to ensure they had better outcomes and could access services that provide specialist care. For example, people living at the service had specialised equipment for their legs to support with independent walking. The staff team and health professionals shared key information and worked together to support people to be more independent with their mobility.

The local authority told us, they were happy with the progress the service had made following their support and assurance visits. People had access to other professionals according to their individual needs. People were supported to access community facilities such as local shops, pubs, and social events. On the day of the site visit we saw all the people living at the service out within the local communities. Two people were supported to go to karaoke and out to lunch with two staff. One person was out visiting their family and two people were at college.

Staff supported people to pursue their interests and hobbies. Staff had also worked with other partners to make the necessary improvements. One staff member said, “we take the residents to local youth clubs, so they get to meet local people and catch up with people they went to school or college with and they enjoy catching up with them.” Another staff member told us, “We have been working with the local authority contracts team to support the improvements that needed to be made. We don’t now dread them coming in because we are now working together and sharing information to ensure better outcome. For example, we have worked together improving the resident’s weekly activity planners.” The management team told us they worked openly with a range of professionals to ensure they made the necessary improvements and to ensure people received the care and support they needed to meet their health and social needs.

The management team had put measures in place to ensure that there was an open culture. They had worked openly and transparently with other professionals. For example, they worked closely with the local authority and told them they could complete their visits unannounced for them to be assured the service was safe. There were systems and processes in place to work collaboratively with all relevant partners. Information and data were shared openly, and the staff and provider were transparent. For example, when incidents or accidents had occurred the information was shared openly with the local safeguarding team if needed.

The provider had arranged for a series of audits and reviews to be carried out since our last visit by an external organisation to ensure improvements had been made and sustained. The feedback from the visits was used to make the required improvements. Improvements had been made since our last visit. The management team had a robust action plan to ensure actions were completed and sustained. There is a learning culture to ensure that the management and staff team learn from when things go wrong. We saw meeting records that showed learning was shared with the staff team to ensure staff had clear and up to date information and guidance when changes were made. The provider had moved from paper records to an electronic system. We saw this had made improvements to the quality of people’s care planning, risk assessments, daily notes, audits, and storage of people’s information.

Staff told us moving to an electronic recording system from paper records had made improvements to care planning and auditing. It has also assisted with having an oversight of the service. One staff member told us, “We have moved onto an electronic system for care planning and audits it’s made a huge difference and improved the quality of recording information and ensures we complete tasks and audits in a timely manner but also ensure action is taken because the system will not let you close a record until actions have been completed.”