Rainscombe House

Rainscombe House provides care and accommodation for up to 3 people with a learning disability and autistic people. People had a range of communication, care needs and abilities. At the time of our inspection there were 3 people living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

We were unable to communicate with people directly due to their needs, instead we spent time observing interactions between staff and people to gain an understanding of the care people received.

Right Support:

We found not enough improvements had been made, staff continued to fail to focus on people’s strengths and promote what they could do. People were still not being supported with opportunities and experiences so they had a fulfilling and meaningful life. The provider had failed to improve enough to ensure that they met the principles of Right support, right care, right culture. People had limited access to individualised, person-centred activities which were important to them.

People were not always supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff understood people’s needs, but further work was needed to ensure people were always supported in a dignified and respectful way.

Staff enabled people to access health and social care support and they ensured people received the medicines they had been prescribed.

Right Care:

Staff were not always following professional guidance in relation to people, leaving people at risk of harm. People did not always receive kind and compassionate care as staff did not always protect or respect people’s privacy and dignity.

People’s care records were not always comprehensive or written in a way that was person-centred. Although some people used a form of sign language to communicate we did not observe staff using this to converse with them. There was a lack of evidence of people being involved in their care planning or decision making.

Improvements had been made to people’s living environment; however further work was needed to ensure people lived in a homely setting.

Although there were sufficient staff to look after people, we found occasions when the staff on duty did not have the appropriate skills for people’s needs. Staff were not sufficiently trained or supervised to ensure they were suitably qualified to provide a good quality of care.

Right Culture:

The provider had failed to take action to robustly address the concerns found at our last inspection. The care people received was not person-centred.

Safe recruitment processes were in place and the home was clean, however, not enough improvement had been made The provider did not have suitable processes and systems in place to ensure people, relatives and staff were involved in the running of the service.

Positive comments were received about the service from relatives and staff worked with external agencies to help improve people’s care.

For more details, please see the full report which is on the CQC website at www.cqc.org.

Rating at last inspection and update

The last rating for this service was inadequate (report published 2 June 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made but the provider remained in breach of some regulations.

At our last inspection we recommended that the registered provider reviewed their staffing rotas to include a fully trained and competency-assessed staff member on shift able to administer medicines safely. We found the registered provider had not fully acted on this recommendation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at our last inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has remained Inadequate based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to unsafe care, staffing, medicines, and the lack of trained and appropriately supervised staff. We also identified breaches in relation to staff not respecting people’s dignity, a lack of meaningful activities and person-centred care, as well as a lack of robust management oversight.

Full information about CQCs regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least Good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rainscombe House provides care and accommodation for up to 3 people with a learning disability and autistic people. People had a range of communication, care needs and abilities. At the time of our inspection there were 3 people living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were not supported in their independence, to achieve goals, make their own decisions or learn new life skills as staff were not following national guidance in relation to Right support, right care, right culture.

Although staff followed the principles of the Mental Capacity Act 2005, people were not supported to have maximum choice and control of their lives. However, staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not always supported by a sufficient number of staff, or staff who were aware of how to recognise potential signs of abuse and as such report these. People received the medicines they required. Medicines were stored neatly and safely.

Right Care:

People were not always treated with respect and dignity as the provider had removed window coverings from the ground and first floor windows.

People were not always cared for by staff who took time to engage with them and staff did not always follow people’s care plans in relation to their eating and drinking requirements. People were cared for by staff who did not always support them to follow good infection control practices.

Right Culture:

The provider had created a culture within the service which had resulted in people not receiving good quality, person-centred care. People and staff were not encouraged to get involved in the running of the service.

There was little evidence that guidance or training was being rolled out to managers and staff to help improve people’s lives. The provider worked with the GP and other external agencies in respect of people’s care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 25 April 2023).

At our last inspection we recommended that the provider make improvements to their recruitment processes. We found improvements had been made at this inspection.

Why we inspected

The inspection was prompted due to concerns received about people not being protected from the risk of abuse, concerns around safe staff levels and lack of robust management oversight. A decision was made for us to inspect and examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rainscombe House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to recognising and reporting potential safeguarding concerns, staffing levels, recognising risks to people, respect and dignity and good governance.

We have also made 1 recommendation to the registered provider in relation to medicines practices.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure the improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Rainscombe House provides care and accommodation for up to 3 people with a learning disability and autistic people. People had a range of communication, care needs and abilities. At the time of our inspection there were 3 people living at the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

Staff did not always support people with opportunities and experiences to learn to be more independent. People had limited opportunities to build skills and participate in individual activities. Staff carried out daily tasks such as cooking without always actively supporting people to take part.

People were not always supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff knew people well and we observed positive interactions. Relatives told us staff were kind and caring and their family member was happy they were living at Rainscombe House.

Staff enabled people to access health and social care support and they ensured people received the medicines they had been prescribed.

Right Care:

Some people's care records were not in line with the Accessible Information Standard and there was a lack of evidence of people being involved in their care planning.

Although people lived in a house that was suitable for their needs, due to its location, people were reliant on staff taking them out to activities or local towns.

Most staff knew and understood people well and staff demonstrated they understood people's communication needs. There were sufficient staff to look after people and staff recognise potential risks to people and took appropriate steps to keep people safe and free from harm.

Right Culture:

The quality assurance system had failed to identify shortfalls we found at the inspection. Recruitment processes were not robust and there was a lack of detail in some people’s care plans. The provider did not offer training and support to the staff team to ensure they had the knowledge to promote a quality of life for people that empowered them in particular people with a learning disability or autistic people.

Positive comments were received about the service from relatives and professionals. Staff felt supported and they worked with external agencies to help improve people’s care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 21 December 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to person-centred care at this inspection. This is because the manager was unable to provide us with all of the necessary documentation in relation to staff recruitment and people were not being given the opportunity to live a full life with a range of opportunities.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rainscombe House provides care and accommodation for up to three people with learning disabilities, autistic spectrum disorder and behaviour which may challenge others. People had a range of communication needs and abilities, which included body language and gesture. At the time of our inspection there were three people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

We spent time with people during our visits and observed their interaction with staff. Without exception feedback received regarding the service was extremely positive. People received care and support from a dedicated staff team. Staff monitored people’s health and well-being, they genuinely cared for people they supported. The caring ethos of the service was evident.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Prior to moving to the service, people had experienced previous placements where incidents of challenging behaviour were reported to be very high. Since being at the service this had significantly reduced. People were engaged and occupied, their lives had been enriched, they were happy and settled.

The registered manager demonstrated a great deal of passion in advocating for the rights of people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There were strong caring relationships between people and all grades of staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At our last inspection in September 2016 we rated the service good. The last inspection report was published 18 October 2016. At the inspection we found areas that required improvement. The provider had not maintained appropriate procedures in relation to people’s personal finances. Following the inspection improvements were made and conditions were imposed on the provider’s registration.

Why we inspected:

We completed a planned comprehensive inspection based on the previous rating of Good.

Follow up:

We will review the service in line with our methodology for ‘Good’ services.

This inspection took place on 9 September 2016 and was unannounced.

We carried out an unannounced inspection of this service on 24 November 2015. During this visit we identified areas of concerns where the provider was failing to comply with the relevant requirements of the Health and Social Care 2008 (Regulated Activities) Regulations 2014 (the Regulated Activities Regulations 2014).

We asked the provider to take action to make improvements. The registered manager sent us an action plan that stated these actions have been completed. We undertook this comprehensive inspection on 9 September 2016 to review the improvements made and to see if they met the legal requirements. We identified no serious concerns during our inspection.

The home was run by a registered manager. However they were on leave on the day of inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. We were supported throughout the inspection by the deputy manager and a senior care worker.

The provider did not have a robust process that had ensured people’s finances were managed appropriately which is subject to investigation.

People and their relatives gave positive feedback about the service they or their family member received.

People appeared happy and at ease in the presence of staff. Staff had written information about risks to people and how staff managed these in order to keep people safe. There had been a reduction of incidents of people’s behaviour that may challenge since our last inspection.

People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted. Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises was safe and well maintained.

People and their families had been included in planning and agreeing to the care provided. People had an individual plan, detailing the care they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

People consented to the care they received. The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were not always involved in making decisions about their and choices offered to people were not always recorded. We have made a recommendation about this.

Staff had the specialist training they needed in order to keep up to date with care for people. Staff demonstrated best practice in their approach to the care, treatment and care people received.

People were provided with a choice of meals each day and where they wanted to eat, for example go out for lunch or have lunch at home. Facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical, religious or cultural needs were provided where necessary.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed some positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit.

People took part in community activities on a daily basis; for example trips to the shops. The choice of activities had been in place for a number of years. The deputy manager discussed ways of improving this. We have made a recommendation regarding people’s social activities.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. Relatives and visitors knew how to make a complaint. Complaint procedures were up to date. The policy was in an easy to read format to help people and relatives knew how to make a complaint if they wished. Staff knew how to respond to a complaint should one be received.

The registered manager had quality assurance systems in place, including regular audits on health and safety, medicines and care plans. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

People who used the service had limited capacity and no verbal communication so were not directly involved in this inspection visit.

We saw that everyone receiving a care package from the service had an assessment of their needs undertaken before a care agreement was offered. This was to ensure that people's assessed needs could be met and that the service had the staff with the relevant skills and qualifications to meet these needs.

We looked at three care plans for people who used the service. Care plans were based on the needs assessment that had been undertaken prior to admission.

We saw the service had adult protection policies and procedures in place known as safeguarding. These demonstrated how the provider identified potential abuse and prevented abuse from happening for the people who used the service.

There were sufficient numbers of bathrooms and toilets for the people to use. We found that some of these had been adapted to provide assistance for people that had been assessed with mobility needs.

The provider had an established quality assurance (QA) program in place. We looked at the provider's QA system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality and risk.

We saw that everyone receiving a care package from the service had an assessment of their needs undertaken before a care agreement was offered. This was to ensure that people's assessed needs could be met and that the service had the staff with the relevant skills and qualifications to meet these needs.

We looked at the care plan for a recent admission into the service. Care plan was based on the needs assessment that had been undertaken prior to admission by the registered manager. The detailed assessment was well designed and detailed. The service had received feedback that inferred that the detailed assessment had assisted the person to acclimatised to their new home .

People who used the service had limited capacity so were not generally involved in the care planning process.

We saw the service had adult protection policies and procedures in place known as safeguarding. These demonstrated how the provider identified potential abuse and prevented abuse from happening for the people who used the service.

The provider had an established quality assurance (QA) programme in place. We looked at the provider's QA system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality and risk

We observed people were able to exercise choice with regard to what they wanted to do or go within the service.

People were observed to be offered appropriate assistance from the member of staff on duty to enable them to access their chosen activities.

During our observations the people who used the service were happy to interact with member of staff and the manager.

The staff demonstrated a good knowledge and understanding of the people they were supporting.

There was clear records that indicated that each person or their relative/representative had been involved in the admissions assessment process.

People's values and human rights have been respected. The manner in which the member of staff spoke to people was respectful, but also warm and friendly.

People where seen to be supported effectively and respectfully by staff who were trained and supported by the provider.