Rainbow Living

On this page

• 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

People lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. There was an open culture where staff were encouraged to learn lessons to improve future practice. People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. People’s freedom was restricted only where they were a risk to themselves or others, as a last resort and for the shortest time possible. Staffing levels were safe. They were recruited safely and had the appropriate pre-employment checks in place before employment commenced. People were supported by staff who had received relevant and good quality training. This included training in the wide range of strengths and impairments people with a learning disability and or autistic people may have, mental health needs, communication tools, positive behaviour support, trauma-informed care, human rights and all restrictive interventions. The service had safe systems in place for appropriate and safe handling of medicines. Where shortfalls were identified during the inspection, the service acted responsively, making the necessary improvements.

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.

We visited 3 supported living projects and engaged with 6 people. We were able to speak with 4 people about the learning culture. Comments were mostly positive. The Expert by Experience contacted people by phone and spoke with 4 people and 5 family members. They felt able to raise concerns and found the service responsive to any concerns raised.

During the on-site visits we engaged with 9 support workers. They were all positive about the open culture within the service. They told us there was a culture of learning and the registered manager and the on-call system was very responsive. Clear and effective systems were in place to manage incidents within the service. We reviewed a selection of incident records from December 2023 and January 2024. There was a good level of detail and clear focus on reviewing and updating positive behavior support plans where required and debriefs after incidents were also recorded. Each incident included the option to report to the local authority safeguarding and the Care Quality Commission where required. Each incident was completed appropriately with good management oversight in place. The registered manager shared the outcome of a recent incident where shortfalls had been identified and actions taken to address the shortfalls. The service was open and transparent and quick to respond.

We received feedback from a local authority commissioner and 4 health and social care professionals. The feedback was positive about the care provided and we were told the service was quick to respond to any concerns raised. There were no concerns reported about any learning culture deficits.

The registered manager shared a recent safeguarding incident. There was a quick response to any shortfalls identified with actions taken to address the shortfalls.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We visited 3 supported living projects and engaged with 6 people. We were able to speak with 4 people about safeguarding. Comments were mostly positive, and people told us they felt safe. The Expert by Experience contacted people by phone and spoke with 4 people and 5 family members. The feedback was also positive except one person who had experienced hostility from another person. This was being managed appropriately.

Staff were supported through their induction and regular training to understand their safeguarding responsibilities. This included training to monitor and observe changes in behaviour, which may indicate whether a person is at risk or experiencing abuse or discrimination. We discussed safeguarding training with 9 support workers and checked their learning in practice. All staff had received training and understood what the different types of abuse are and understood when to report and all were confident managers would respond appropriately.

We observed positive interactions between 6 people and staff during onsite visits to 3 supported living projects. Staff were attentive to people’s needs and both people and staff were relaxed in their environments. We observed no concerns about poor care or any dignity issues.

The safeguarding and whistleblowing policy included how to raise concerns with local councils and the Care Quality Commission and also how to contact local independent advocacy services. The training matrix provided a record of staff attendance at safeguarding training and also training on the Mental Capacity Act and Deprivation of Liberty safeguards.

We visited 3 supported living projects and engaged with 6 people. We were able to speak with 4 people about their involvement in managing any risk involved in their care. Comments were mostly positive, and we received no concerns. The Expert by Experience contacted people by phone and spoke with 4 people and 5 family members. The feedback was also positive, and no concerns were shared about this issue.

We discussed care plans and associated risks with 9 support workers. They told us care plans reflected people’s needs accurately and guidance on how to manage any risks were clear. They reported no concerns. The use of physical restraint was managed safely and in the least restrictive way. Training on safe restraint provided to staff was certified by the British Institute of Learning Disabilities (BILD). There was a clear commitment to minimising the use of restrictive interventions. We reviewed 2 care plans specifically looking at how risk was managed. Care plans and positive behaviour support plans were person-centred and provided clear guidance on how to support people to manage any risks.

We engaged with 6 people during our onsite visits. Each person led active lives, dictated by what they wanted to do, and what they were able to do. We observed no concerns during our visits. We spoke with one person about how they were involved in managing a new risk and they were happy with the way it had been managed.

The service had clear processes to manage any restrictive practice. Positive behaviour support plans focused on supporting people to stay at baseline by understanding their triggers and implementing strategies to keep them safe based on lived experience.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We visited 3 supported living projects and engaged with 6 people. We were able to speak with 4 people about safe and effective staffing. Comments were mixed with 2 people telling us staff were kind and caring and one person expressing concerns about language barriers. The service manager was aware of this issue and explained international staff did not always understand slang and sarcasm, for example, and measures were being taken to address this as far as possible through supervision, induction and training. The Expert by Experience contacted people by phone and spoke with 4 people and 5 family members about safe and effective staffing. All the feedback was positive.

We discussed safe and effective staffing with 9 support workers. They told us they had enough skilled staff and the induction and training gave them the confidence to work safely. Training included autism and learning disability training and the provider had been working with the training provider to ensure the training was compliant with the legal requirement introduced by the Health and Care Act 2022.

We engaged with 6 people in 3 supported living projects during our onsite visits. Staffing levels met people's assessed needs and were at a level which kept people safe and enabled them to live fulfilling lives as they chose. The care we observed was warm and compassionate and people and staff new each other well. One observation in particular involved 2 people and 2 staff preparing dinner. The 2 people enjoyed the activity and the food and there was a really positive atmosphere throughout. We spoke to 9 support workers and were impressed by their commitment to their roles and with their knowledge.

There was a clear staffing structure in place and people had clearly defined roles. There was a consistent staff team in place and no agency staff were being used. Good systems were in place to induct and train staff and there were also good systems to ensure staff received regular 1-1 support and regular spot checks. Staff were recruited safely. Good systems were in place to ensure documentation was up to date. Where required all international staff had police clearance. All international staff were supervised and shadowed other staff until their police clearance was received.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s individual medicines needs were detailed in their care plans. Person-centred information was in place to support staff to safely give ‘when required’ medicines. Epilepsy care plans for people who have seizures were detailed and clearly stated how and when to give emergency medicines.

Managers told us staff had completed medicines training and had been assessed to ensure that they gave medicines safely. We were shown evidence of training records to confirm this. Managers told us medicines audits were completed at regular intervals to identify issues and drive improvement. Following the inspection, we received a detailed action plan addressing the shortfalls we had identified and evidence of the improvements that had been made.

Records showed that medicines were given at correct times and appropriate intervals were left between doses. Medicines were stored securely in properties. The reason for secure storage and the location was detailed in people’s care plans. We observed staff giving medicines in a safe and timely manner.

Systems were in place to ensure regular medicines were given as prescribed and recorded accurately, including controlled drugs. People’s allergies were recorded on medicines records. ‘When required’ medicines were not always added to the medicines records each month. There was a risk that they could get missed. However, there was no evidence that this had happened. Processes for applying and recording creams were in place. However, we found one person was not having their cream applied as prescribed. The service corrected this immediately post-inspection.