The Care Quality Commission
  • Care Home
  • Care home

Archived: Rainbow Homes London Limited

Overall: Inadequate read more about inspection ratings

23 Hoop Lane, Golders Green, London, NW11 8JN (020) 8458 8288

Provided and run by:
Rainbow Homes London Limited

Important: We are carrying out a review of quality at Rainbow Homes London Limited. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

02/09/2015

During an inspection looking at part of the service

The company Rainbow Homes London Limited operates this one care service that is registered with the Care Quality Commission. The services provided at this care home include for people with mental health conditions or substance misuse problems, and is primarily aimed at younger adults. The care home is for up to six people. There were three vacancies at the time of our inspection.

We carried out a comprehensive inspection of this service on 10 December 2014. We found eight breaches of legal requirements, which put people using the service at significant risk of receiving inappropriate or unsafe care. You can read the report of this inspection, by selecting the 'all reports' link for this service on our website at www.cqc.org.uk

We took enforcement action against the registered provider as a result of the findings of that inspection.

We undertook this unannounced comprehensive inspection, of 02 September 2015, to check on the progress the provider had made to address our concerns from the previous inspection, and to check on the standard of care people using the service were receiving.

There was no registered manager in post on the date of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. A new manager had been appointed. They had applied for registration as manager of the care home; however, this process had not been completed. They were not present during out inspection visit.

Whilst we found evidence to demonstrate that some of our concerns had been addressed, we found breaches of 12 legal requirements because improvements were insufficient and further concerns were identified. This continued to put people using the service at unnecessary risk of receiving inappropriate or unsafe care.

The improvements made at the service were mainly in respect of the approach of staff who we found to be more caring and positive towards people than previously. Staff communicated better with people, and there was a positive, inclusive and empowering culture at the service. As a result, people using the service were more relaxed, and those we spoke with praised the services provided.

However, a staff information handover took place with a person using the service present. This compromised the person’s dignity and the privacy of information about other people using the service.

There remained risks to people’s health, safety and welfare as a result of the service’s approach to people’s individual health, safety and nutritional needs and risks. The advice of relevant healthcare professionals such as dietitians was not always promptly sought in response to risks such as significant weight change, and where advice was provided, timely care planning and action did not always take place in response.

People’s individual risk assessments and care plans were not comprehensive or kept up-to-date to reflect people’s current needs. Monthly progress reviews did not consistently monitor and evaluate all goals set up in people’s care plans. This put people at risk of receiving care and support that was not appropriate or did not meet their needs.

There were improvements to medicines management; however, there remained risks to people being supported to receive their medicines safely.

Some fire safety equipment was not properly maintained, and there was a lack of recent fire safety checks, which meant that fire safety risks were not being safely managed.

People’s health, safety and welfare were compromised due to a range of ineffective processes for assessing, monitoring and taking action to address risks and quality shortfalls. Records, particularly for the care and support of people, were not always accurate or complete. There was overall poor governance at the service.

Recruitment procedures had not been operated effectively to ensure that staff members were of good character, because appropriate references were not in place. Systems and processes to prevent abuse of people were not being effectively operated because whistle-blowing procedures were not properly established.

The support, supervision and training of staff was not appropriate to enable them to carry out their care and support duties effectively. Staff lacked sufficient training on meeting the needs of people using the service in respect of nutrition and mental health needs, and they were not receiving regular supervision.

Whilst the service was not unlawfully depriving anyone of their liberty, the provisions of the Mental Capacity Act 2005 were not being followed in full at the service, as people’s capacity to refuse some specific support that might reasonably be seen as in their best interests had not been assessed.

We had not been notified as required of a change of company director and two separate police visits to the service, and we found that the required display of the rating from our previous inspection was not occurring. This undermined our confidence in the management of the service.

We found overall that people using the service continued to be at risk of receiving inappropriate or unsafe care. We found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009.

Following this inspection we continued with our enforcement action. The action we took was to serve a notice proposing to cancel the registration of the provider. Due process was followed and we served a Notice of Decision to cancel the provider’s registration which meant that Rainbow Homes London Limited was closed by the Care Quality Commission on 18 December 2015.

10 December 2014

During an inspection looking at part of the service

This unannounced inspection took place on 10 December 2014. Rainbow Homes London Ltd provides accommodation and support with personal care for people who have mental health needs. There were four people living at the home when we visited. They shared a house and each person had their own bedroom with ensuite bathroom with a shared kitchen, lounge and garden.

After inspections in January and April 2014 we asked the provider to take action to make improvements to cleanliness and infection control, nutrition, safety and suitability of the premises and how the quality of the service was monitored. Following those inspections the provider sent us an action plan on 4 August 2014 to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made and found they had not all been completed.

At the time of our inspection on 10 December 2014 the service did not have a registered manager in place, however the provider appointed a new manager in August 2014 who had submitted an application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider

People told us they were happy at the service. However, our own observations and the records we looked at did not always match the positive descriptions that some people had given us.

Feedback about the service from health and social care professionals was mostly negative. They had concerns that staff did not always have the skills to look after people’s changing needs.

Staff we spoke with did not always know how to support people they were caring for, we saw that staff were not up to date with training and were not supported by the manager and the provider to allow them to better understand and meet people’s needs.

Although staff understood what abuse was they did not understand who they should contact outside the organisation to report concerns.

Recruitment records we reviewed of all five staff were inadequate. Although the provider had systems in place these were not always followed. Therefore, staff who were employed may not be fit to work with people. Staff were not supported by the provider and were not up to date with important training.

People were not always supported to keep good health and have access to health care professionals. We saw people who were at risk of malnutrition were not always supported effectively by staff.

The provider had a complaints procedure in place but we were unable to review this when we visited as the documents had been misplaced. However, people we spoke with told us they knew how to complain and staff told us they would support them to do so.

Systems were not in place for monitoring quality at the service. During the inspection the manger was unable to provide documents demonstrating that monitoring had taken place and told us these had been destroyed or were missing. Documents that were available to view were often not fully completed and updated.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of this inspection, we served a notice proposing to cancel the registration of the provider. You can see what action we told the provider to take at the back of the full version of this report.

30 April 2014

During an inspection looking at part of the service

We returned on the 30 April 2014 to review the warning notice served on the provider at our last inspection on the 27 January 2014. At that inspection we saw the registered manager and the provider did not have suitable nutritious food in sufficient quantities to meet people's needs.

The inspection was led by a Care Quality Commission (CQC) Inspector joined by a dietician; a specialist in the area of nutrition. We observed people and staff preparing and having their lunch, reviewed menus and talked to people and staff. As well as checking there was enough nutritious food available for people to eat, and that food was being stored correctly.

Although we did see some improvement in the storage of dry food, the provider and registered manager had not ensured other foods were stored correctly to avoid contamination (Food Safety Act 1990). Staff did not have all the ingredients available to make meals as recorded on the menus on the day we visited. We saw that food was not presented in an appetising way. People did not have access to a variety of snacks and drinks of their choice through the day and night.

We are considering what further enforcement action to take following evidence of continued non-compliance with the warning notice served at the last inspection.

27 January 2014

During an inspection looking at part of the service

We returned on the 27 January 2014 to review the non-compliance from our inspection on the 24 October 2013. At that inspection we saw that although the provider had systems in place to monitor the quality of the service these had not been effective. They had not identified risk to health and safety and welfare of the people by having incomplete and out of date individual care plans and risk assessments.

At this inspection we saw that the provider had updated all the care plans and risk assessments for people who lived at the home. These were available in paper form for staff to view. We reviewed the daily care records for people and saw these reflected information in peoples care plans.

We observed people who were at the home at lunch time and spoke with four people about the meals and snacks available to them. People who lived at the home had mixed views about the food, some said 'it's not too bad,' others said, 'it's best not to complain it will just cause trouble,' and others said it was 'terrible.'

We looked at most areas of the home including three of the five bedrooms. We saw that these had not been cleaned. For example, in all three bedrooms we saw dust, rubbish and sometimes cigarettes butts behind people beds. In all the bedrooms, peoples personal belongings were covered in dust such as photos and all light switches were greasy and dirty.The provider had not taken steps to provide care in an environment that was adequately maintained.

29 November 2013

During an inspection looking at part of the service

We carried out this inspection to check whether the provider had complied with a warning notice served in relation to the service, following an inspection on 24 October 2013. At that inspection we found that risk assessments and care plans were not in place for one person who had spent more than seven weeks in the home. Risk assessments and care plans for most people had not been updated for more than a year and did not always reflect people's current needs.

During our inspection on 29 November 2013 we found that improvements had been made. Care plans and risk assessments were in place for people who use the service. These had been updated recently and mostly addressed people's current needs. Although one person's care plan had not been updated following a multi-disciplinary review of the person's care needs, we saw that action had been taken to meet the person's needs as identified by the health and social care team caring for them.

24 October 2013

During a routine inspection

On the day we visited the home we spoke with two of the five people who use the service. Although one was happy living in the home the other was not and told us 'there is nothing to do here and no activities I like doing.'

The service was clean and hygienic and there were systems in place to reduce the risk of infection. There were appropriate arrangements in place to ensure people received the medication they were prescribed. People told us they received their medicines when they expected to. Staff recruited to work in the service underwent checks on their suitability before they began work.

However, we found that risk assessments and care plans were not in place for one person who had spent more than seven weeks in the home. Risk assessments and care plans for most people had not been updated for more than a year and did not always reflect people's current needs. Staff showed limited understanding of some people's needs.

There was a system in place to assess and monitor the quality of service that people received but this was not always effective. Risks to the health, safety and welfare of people using the service from incomplete and out of date individual care plans and risk assessments had not been identified despite regular visits to the home by the provider.

12 October 2012

During an inspection looking at part of the service

We carried out this unannounced inspection to check if the provider had complied with warning notices we served, and a compliance action we made, following an inspection of the service in August 2012. On this visit we found that care plans reflected people's needs and people who used the service were taking part in activities. One person told us they had been supported to go swimming several times a week.

Nutritious food was being provided for people. The manager monitored the quality of service provided and appropriate records were maintained.

14 August 2012

During an inspection looking at part of the service

We spoke with two of the four people who used the service. Both told us they were happy living in the home and one described it as 'a pleasurable experience'. The other person told us they enjoyed caring for their pet. However, there was a lack of meaningful activities provided for people both within and outside the home. A person we spoke with described themselves as virtually "housebound" and said they wanted to go out more and participate in more activities.

We found that care plans were not updated in line with reviews of people's care needs, which meant there was a risk that their needs were not being met. Meal menus showed that a choice of suitable or nutritious food was not always offered to people in the evenings to meet people's need for a healthy diet. Records kept about people were sometimes inaccurate. As a result people who used the service were not protected against the risks of unsafe or inappropriate care.

18, 24 May 2012

During a routine inspection

We made visits to the service on 18 May and 24 May 2012. On our first visit we spoke with two of the four people who lived in the home. Both people said they liked living in the home and were happy with the way they were treated by staff. One person told us, 'I'm OK. I wouldn't want to change anything'. Staff were described as 'helpful'. People told us there was no weekly plan of activities but they went out from time to time and participated in group activities in the home. People who used the service met regularly with staff to discuss the running of the home.

When we visited the home we found that people's care plans were not available to staff and could not be located promptly. Staff were not always aware of the content of people's care plans. The staffing rotas were also missing when we visited and rotas subsequently provided to us were found to be inaccurate. As a result no assurance could be provided that sufficient numbers of staff were available to meet people's needs. Staff training records were inaccurate and the provider did not have suitable arrangements in place to ensure that people were being cared for by staff who had been trained to provide care safely and to an appropriate standard. Nutritious meals were not always offered to people in the evenings. Consequently people were not protected from the risks of inappropriate nutrition.

23 June 2011

During a routine inspection

People who used the service told us that they were happy living there. They liked the staff and said they were 'friendly'. People went out to a local day centre, for walks and to the shops and chose the activities they wished to participate in. One person told us she was able to keep pets. Staff involved people who lived there in drawing up the meal menu and everyone told us they enjoyed the food.