The inspection took place on 30 October 2018 and was announced an hour before our arrival to ensure the registered manager was available to speak with us when we arrived.

Rainbow Care Solutions (Warwick) is a domiciliary care agency that provides personal care and support to people living in their own homes. Care staff call at people’s homes to provide personal care and support at set times agreed with them. At the time of our inspection 83 people received personal care from the service.

There was a registered manager in post. 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. The registered manager was also the registered provider.

We last conducted a comprehensive inspection of the service in January 2017, where the service was rated as ‘Good’ in every key question and overall. This inspection was prompted by information of concern received from members of the public and local authority commissioners, about the standard of care being provided. At this inspection we found senior staff had not identified and appropriately managed a safeguarding event. The event had not been referred to the CQC in a timely way. Recruitment processes had not initially identified some staff whose first language was not English may not be able to communicate effectively with people and meet their needs. It was not clear what level of understanding these carers had of the training they had received. We have rated the service as ‘Requires Improvement’ in the key questions of safe, effective and well-led and ‘Good’ in all other key questions. Therefore, the service is rated as ‘Requires Improvement’ overall.

Processes to monitor the quality of service were not always effective and improvements were required in the way events which called into question people’s safety were managed.

People found it difficult to communicate with some staff because of the standard of their communication skills and they told us staff were very busy. The registered manager was in the process of working with local authority commissioners to make improvements to the service, to ensure staff had the skills to provide effective care for people.

Staff understood their responsibilities to protect people from the risk of harm, however some staff had limited knowledge of local authority adult safeguarding procedures. Senior staff had not identified and appropriately managed a safeguarding event.

Staff worked within the principles of the MCA and supported people to have choice and control of their lives. People were supported to eat and drink enough to maintain a balanced diet that met their needs and preferences. People were supported to maintain their health.

Most people we spoke with felt cared for. Staff respected people’s right to privacy and supported people to maintain their independence.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed. People knew how to complain and had the opportunity to share their views and opinions about the service they received.

This inspection took place on 12 January 2017. Rainbow Care Solutions provides domiciliary care to people living in their own homes. At the time of our inspection, 82 people were supported with personal care.

This service was registered in September 2015 and has not been previously inspected. This is the first rating inspection.

The service had a registered manager. 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.

People felt safe with the staff who supported them. Staff received training to safeguard people from abuse. They were supported by the registered manager, who acted on concerns raised and ensured staff followed safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were mostly identified and staff were aware of current risks and how they should be managed. The registered manager used an electronic system of care planning and monitoring. Work was in progress to ensure risk assessments and care needs were correctly identified, recorded and followed.

Some people were administered medicines by staff who were trained and assessed as competent to give medicines safely. Records showed people’s medicines were given in a timely way and as prescribed. Checks ensured medicines were managed safely.

There were enough staff to meet people’s needs effectively, and people told us they had a consistent and small group of staff who supported them, which they appreciated. The registered manager completed thorough pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in their own homes.

People told us staff asked their consent before undertaking any care tasks. Where people were able to make their own decisions, staff respected their right to do so. Some people’s ability to make their own decisions fluctuated, but staff knew people’s individual reactions that showed them if people wanted to be supported or not. The staff team and the registered manager had a good understanding of the Mental Capacity Act.

People and relatives told us staff treated them with dignity, kindness and respect. People’s privacy was maintained and people felt comfortable when staff supported them with personal care needs. With the rare exception, people received care from staff of the gender they preferred.

People were supported to make regular choices and people said they were involved in making decisions that were suited to their needs. The registered manager sought regular feedback from people and made improvements to ensure they were proactive in improving the service people received. For example, people were supported and encouraged to build relationships with other people to improve people’s friendship with others and help reduce social isolation.

People saw health professionals when needed and the care and support provided was in line with what they had recommended. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. Some care plans were updated with the most recent information and were detailed, however, some improvements were required in risk assessments and in some care plans. The registered manager was aware of this and was working on ensuring all care records were updated. People were involved in how their care and support was delivered, as were their relatives.

People and relatives felt able to raise concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the registered manager, office and