We inspected the service on 6 November 2018. The inspection was announced. We gave the registered manager 24 hours’ notice of our inspection because the service is a small service where people and staff are often out and we wanted to be sure someone would be in.

Care at Rainbow’s End is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates seven people. On the day of our inspection seven people were using the service.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and their independence and participation within the local community encouraged.

At our last inspection on 3 March 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs had been assessed and planned for. These included risk assessments of activities people participated in such as horse riding and swimming. Risk assessments were reviewed monthly to ensure they reflected people’s most up to date circumstances. Staff followed the information in people’s risk assessments which ensured that people consistently experienced care and support that was safe.

People did not have any undue restrictions placed upon them and were encouraged to be as independent as possible. They were taught skills that increased their independence and which supported them to achieve longer term goals of living in their own homes.

There were sufficient suitably skilled and experienced staff to consistently meet people’s needs. Safe staff recruitment procedures were in place and used to ensure that only staff who met the services standards worked there. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence and protect people from harm.

People continued to receive an effective service. Staff received the training and support that was specific and relevant to people’s individual needs. People were supported with their nutritional needs. People were supported with their needs and accessed health services when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They had a very good understanding of people’s needs, preferences, and what was important to them. People’s independence was promoted and they were supported to make informed choices about their care and support.

People continued to receive a responsive service that was strongly focused on their unique individual needs. People’s needs were assessed and planned for with the involvement of the person and or their r

We carried out this inspection on 3 March 2016. The inspection was unannounced. Care @ Rainbows End (c@re) is owned and managed by Care @ Rainbows End Ltd. The service provides care and support for up to five people with a learning disability. On the day of our inspection four people were using the service.

The service did not have a registered manager in place at the time of our inspection. However the manager in post told us they were in the process of applying to become the registered manager but we had not yet received the application. 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.

People who used the service were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager shared information with the local authority when needed. Risks to people’s safety was assessed and reviewed regularly. Action was taken following any incidents to try and reduce the risks of incidents happening again. People received their medicines as prescribed and the management of medicines was safe.

Staffing levels were sufficient to support people’s needs and people received care and support when required. Staff were provided with the knowledge and skills to care for people effectively and felt supported by the management team

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were supported to eat and drink enough. Specialist diets were provided if needed. Referrals were made to health care professionals when needed. People who used the service, or their representatives, were encouraged to contribute to the planning of their care.

People were treated in a caring and respectful way and staff delivered support in a relaxed and considerate manner. Positive caring relationships had developed between staff and the people who lived at the home and different communication techniques were used to assist people to make their needs known.

People who used the service, or their representatives, were encouraged to be involved in decisions about the running of the service and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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 2008 and associated Regulations about how the service is run.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider wa

The inspection was carried out by one inspector visiting the premises. We spoke with family members and other professionals as part of the inspection process. During the inspection, the inspector addressed five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although the service currently had no applications to be submitted for a DoLS order, proper policies and procedures were in place. We saw the appropriate staff understood when an application should be made, and how to submit one.

The manager explained how they would follow the policy to ensure that a person’s liberty was not being restricted unlawfully. We saw from training records that most of the staff team had received training in Deprivation of Liberty Safeguards and the Mental Capacity Act 2005, which is legislation designed to help maintain the safety and rights of vulnerable people in care settings.

A relative commented, “When we leave [our relative] there we don’t have to give her wellbeing, safety or happiness another thought and, as a result, have been able to really relax and have a proper time of respite. [X] is always happy to go there and misses being there when [X] leaves.”

Is the service effective?

People were unable to tell us themselves about their experience of the service due to the complexity of their needs but family members told us they thought the service was effective in providing the care their relatives needed.

We spoke with family members of people who used the service for both long stay and respite care.

One person told us, “The home involves our family in reviews and assessments. Any problems, I can ring the manager or the owner.” Another relative commented, “The residents are encouraged to participate in activities to the maximum level of their abilities. They are involved in daily activities such as meal preparation and doing the laundry, giving a sense of independence which I consider to be very important. They get out and about which we feel is important for [X]”

We looked at care files and found the service effectively identified individual needs and based care and support programmes upon those needs. The staff respected the equality and diversity of the people who used the service by making sure the care, facilities and nutrition were provided individually to each person’s needs.

Is the service caring?

We saw staff supporting people in a caring manner and responded to individual needs in a patient and dignified way. We saw members of staff talking with people and using their knowledge of the individuals to respond to their wishes.

One relative told us, “The positives we have found are that Rainbows End has a very homely feel. Numbers are such that it feels like you are visiting family and, particularly so, as the owner and the staff are so welcoming and there is a warmth and understanding from all the staff we have had contact with. The rooms are just like being at home, none of the ‘hospital ward’ or ’care home’ type rooms.”

Is the service responsive?

The manager, owner and staff at the home met with people before they used the service to identify if the service could meet their needs. This process included consulting with family members and carers, as well as professionals such as doctors and physiotherapists to plan the best way of meeting people’s needs. This multi-agency approach then continued to support the ongoing care of each person at the home.

A member of staff told us they always consulted people to make sure the service was right for them before arranging for them to stay. A relative of a person who used the service told us, “We requested respite care for our relative at short notice due to a family emergency, and they were able to offer him care on the day we contacted them.”

Is the service well-led?

Other professionals who supported people living at the home told us the manager had made great efforts to improve the service offered at the home. Staff members reflected how they had benefitted from positive and supportive leadership within the service.

A relative of a person who used the service commented, “I have nothing but praise for the quality of Care@Rainbow’s End since our relative left our home. Any problems or issues are dealt with within 48 hours.”

Another relative told us, “The manager is very approachable and at the same time professional. When we first made contact they were extremely welcoming and took time to explain the set up at Rainbows End and encouraged us to visit or contact her whenever we wished.”

The staff provided thoughtful and compassionate care and knew the people who used the service well. New care plans were being implemented since our last inspection however, these did not give staff all of the information they needed to deliver care and support safely and confidently. The risk that people may not always receive safe and appropriate care were raised because there were not enough staff who were suitably trained to meet people's assessed needs.

There were systems in place to protect people from abuse or the risk of abuse and relationships between staff and the people who used the service were relaxed and friendly. However, more needed to be done to improve the communication systems to report abuse.

The environment was comfortable and spacious but risks had not been appropriately assessed and managed so that people were adequately protected. In addition, the registered provider needed to ensure that they met their obligations to report significant events to the Care Quality Commission.

There were five people living at Care@Rainbow's End when we visited. Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. We spent a period of time sitting with a group of people in a lounge. We were able to observe people’s experiences of living in the home and their interactions with each other and the staff. We spoke with visitors, care staff, management staff and the provider. We looked at care records and discussed quality monitoring systems.

We were told by one person who used the service that they liked living at the home. Visitors also told us that living at Care@Rainbow's End had been a positive experience for their relative. Our evidence supported what people told us. People who used the service were helped by staff who showed a clear understanding of the principles of person centred care and what this looked like in practice. The staff had the right competencies, knowledge, skills and experience to meet people's needs or we saw that arrangements had been made for them to develop these.