Rainbow Lodge is a residential ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service supports people with a learning disability or autistic spectrum disorder and can accommodate a maximum of four people. At the time of inspection, there were three people living in one adapted building. The service is run as a family home, with people living at the service as part of an extended family unit. Care is provided primarily by the provider. The provider’s family assist with the running of the service.

The inspection took place on 27 June 2018 and was announced. We gave 48 hours’ notice of the inspection visit because it is small service and we needed to be sure people would be in. At the last inspection, there were breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not thoroughly assessed, monitored and mitigated risks to the safety of people who used the service. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the safe and well-led domains to at least good. At this inspection, some improvements had been made to assess environmental risks and complete some training. However, the provider had not taken sufficient action to resolve the two breaches or improve their rating.

The care service has 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.

The provider is an individual ‘registered person’. 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 provider did not know what two medicines were prescribed for. This meant they did not know what effects the medicines should have and would not have known any side effects they may cause. Where people had medicine that was being regularly reviewed and gradually increased by a health professional these changes were not recorded on the medication administration records, to show the dose taken or evidence the medication was being given as prescribed. When people were assisted to manage specific health conditions, there was no care plan in place to identify how to support the person if their health needs changed. The provider did not document checks to make sure medicines were stored at a safe temperature.

There had been a delay of at least one year in DBS checks relevant to Rainbow Lodge being requested to help reduce the risk of unsuitable people working with vulnerable adults.

Where people had needs or made choices that could put them at risk, these were not formally assessed. This meant we could not be certain the provider had considered these risks or knew what course of action to take if concerns occurred.

Staff had completed some training, but had not covered important areas such as the Mental Capacity Act 2005 to inform their knowledge and understanding of how to support those living at the service to make decisions for themselves. When training had been done, the provider did not have a policy for when this should be renewed.

People’s backgrounds and needs were understood in detail. Care files did not always contain information the provider knew about people and were not always up-to-date.

The provider did not have current policies and procedures in place. Policies did not always reflect practices that were happening at the service.

The provider d

Rainbow Lodge is a residential care home in Scarborough. The service supports people with a learning disability or autistic spectrum disorder and can accommodate a maximum of four people. The provider is Ms Catherine Sleightholm. They live at Rainbow Lodge and are supported by members of their family (described as “staff”) in the running of the service. The provider's family did not live at the service. People who use the service live as part of an extended family unit. At the time of our inspection, three people had lived at Rainbow Lodge for more than 20 years and a fourth person had lived there for approximately eight years.

We completed this inspection on 6 June 2017. The inspection was announced. The provider was given 24 hours’ notice of our visit, because this is a small service and we needed to be sure that someone would be in when we visited.

At the last inspection in October 2014, the service was rated ‘Good’.

The provider is an individual ‘registered person’ and, as such, there is no requirement for them to have a registered manager for this service. 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.

During the inspection, we found that the provider had not robustly assessed environmental risks, for example regarding the need for radiator protectors or opening restrictors for windows. The service did not have a gas safety certificate. The provider did not have a clear system in place to determine and ensure appropriate recruitment checks were completed on people who ‘helped out’ at the service.

The provider did not complete training. We identified they needed to develop their knowledge and understanding around the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards as well as their responsibilities to safeguard vulnerable adults from abuse. The provider did not complete medicine management or first aid training despite often working alone and regularly supporting with medicines. We found further assessment was needed to determine whether one person who used the service was deprived of their liberty.

We found breaches of regulation relating to safe care and treatment and regarding the governance of the service. You can see what action we told the provider to take at the back of our report.

Despite these concerns, people provided consistently positive feedback about the service and we observed that people were happy, relaxed and content living there. The provider was observed to be kind, caring and attentive to people’s needs. It was the clear the provider knew people well and had established positive caring relationships during the significant period of time they had lived with the people they supported. People were treated with dignity and respect and supported to have choice and control over their daily routines. People were supported to engage in a wide range of activities of their choosing and to access their wider community. People enjoyed a varied social life and engaged in volunteer work. The provider supported and encouraged people to be independent.

People provided positive feedback about the food and were supported to ensure they ate and drank enough. The provider ensured people attended appointments with external healthcare professionals and appropriately sought advice and guidance to meet people’s health needs.

We observed sufficient staff were deployed to meet people’s needs. People were supported to take prescribed medicines. Care plans and risk assessments were in the process of being updated, but contained person-centred information about people’s care and support needs.

There provider listened and responded to feedback. People told us they could speak with the provider if they were unhappy about any aspect of their care and support.

The inspection took place on the 28 October 2014. It was a short notice announced inspection.

Rainbow Lodge is registered by Mrs Catherine Sleightholm to provide accommodation to persons who require nursing or personal care. Nursing care however is not provided. The home specialises in care for people with a learning disability and can accommodate a maximum of 4 people. It is a located in Scarborough close to amenities and with good transport links.

Rainbow Lodge is a family run concern and people who use the service live as part of the family unit. Mrs Catherine Sleightholm is the 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 using the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Decisions related to peoples care were taken in consultation with people using the service, their next of kin and other healthcare professionals which ensured their rights were protected.

Rainbow Lodge has been owned and operated by the same family for 21 years and three of the four people who live there have been there for those 21 years. The fourth person has lived in the home for six years. People living in the service have been treated as extended family and been involved in family events such as christenings, weddings and celebratory parties. This means that people who used the service are well known to the staff.

One member of staff (family) had completed training relevant to supporting people with learning disabilities. Other staff had identified this training in their development plan.

Staff were supported through good links with community healthcare professionals to ensure people received effective care relating to their diet and their ongoing healthcare needs.

There was a friendly, relaxed atmosphere at the home. People told us they enjoyed living there and one relative told us that staff were caring and compassionate. People were able to take part in activities that they enjoyed and they received support from staff if required.

Where people using the service lacked capacity to understand certain decisions related to their care and treatment, best interest meetings were held which involved relevant professionals such as; independent mental capacity advocates, health care professionals and social workers. Families were also involved in these meetings.

Rainbow Lodge is a small care home. The home does not employ any staff and all care is offered by the provider and family, all of whom have suitable checks in place to ensure they are safe to care for vulnerable people. (The family is referred to as 'staff' throughout the report though they are not employed.)

We saw that people were cared for with regard to their privacy and dignity and that they were treated with respect. People told us that the provider explained their care options to them and that they were involved in decisions about their lives. One person told us "X told me about my eye operation and I know what they needed to do. I agreed to it."

We saw care assessments and plans of care which included a consideration of risk. Risk assessments balanced the need to protect people against enabling them to live full and interesting lives. We saw that specialists had been consulted where necessary to ensure people had the benefit of expert advice.

The home had effective infection control procedures in place to protect people from the risk of cross infection.

Staff received updated training to ensure they were informed of current good practice. Supervision was informal in this family setting, however staff performance was monitored regularly through daily discussions.

We saw that the home had effective systems in place to monitor and review the quality of care.

Rainbow Lodge is a home where up to four people live as part of the family with private accommodation.

The home has cared for the same four people for a long time. We spoke with three of the people who lived at the home. All told us that they were enabled to take part in work and leisure activities as they chose. One person told us they enjoyed going out for walks and to ‘Brook Leigh’ day centre. Other people indicated that they enjoyed a full week of activity and social inclusion.

We spoke with the provider and her daughter. Both understood people’s care needs well, were aware of people’s changing needs and the risks associated with their care.

The provider was assisted in her role by several members of her family. All had received Criminal Records Bureau checks to ensure they were suitable to work with vulnerable people.

The provider and the staff employed did not have sufficient training to evidence they could meet people’s care needs safely.

The provider responded to people’s concerns and people told us they had confidence that any complaints would be dealt with quickly.

People living at Rainbow Lodge said that they liked the fact it was so small. They felt it allowed for a more personal level of support. They know and trust owner Catherine Sleightholm. They said they would be able to talk to Mrs Sleightholm if they were unhappy.