This inspection took place on 16 August 2017 and was announced. We gave the provider 48 hours to make sure a member of the management team was available in the office to meet with us.

This was our first comprehensive inspection of this service since it registered with us on 19 May 2016. This service has been operating for 15 years and was previously registered with us at a different address. We inspected this service under their previous registration and we rated them good at our last inspection on 25 June 2015.

Rainbow Medical Services is a domiciliary care agency that provides personal care and support to people living in their own homes, many of whom were older people, some of whom were living with dementia. There were 63 people receiving services from Rainbow Medical Services at the time of our inspection.

Rainbow Medical Services provides nursing and care to support people who live across London. The services specialises in providing care to people who have complex health needs.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. However, two managers were in post who had both begun the process to register with CQC. One manager was a registered nurse who led on the clinical governance of the service, while the second manager led on operational oversight.

The provider managed people’s medicines safely. The provider had good systems in place to assess, monitor and improve the service. These included revising the recruitment system to ensure only staff who were kind and had a passion for caring for people were selected.

Improved recruitment systems meant the provider also experienced more positive outcomes relating to staff management. Recruiting staff who had the right attributes and interest in caring for people meant incidents of staff misconduct significantly reduced. The provider also had excellent systems in place to listen to staff, gather feedback and act on it to improve the service, with good systems in place to gather feedback from people using the service. The provider had a range of audits in place to check the quality of service including accredited award schemes to audit the service. The provider also had excellent systems in place to recognise and reward staff, which meant staff felt motivated to provide high quality care to people.

The provider identified risks to individuals and put robust risk management plans in place to guide staff in mitigating risks to individuals, incorporating guidance from external professionals. This meant risks to people were reduced. However, the provider did not always follow best practice in carrying out and recording risk assessments according to a five step procedure, but told us they would standardise and improve their processes. Care plans informed staff about people’s individual needs, and the best ways for staff to care for them.

People were supported by staff who were recruited following robust procedures to check they were suitable to work with them. There were enough staff deployed to meet people’s needs.

People felt safe when staff cared for them and staff understood how to respond if they suspected anyone was being abused, receiving training from the provider each year to refresh their knowledge.

Staff understood their responsibilities to provide care to people in line with the Mental Capacity Act 2005. The provider assessed people’s capacity to consent to their care and took measures to provide care in people’s best interests when they lacked capacity to consent.

The provider supported staff with a comprehensive programme of induction, training, supervision and annual appraisal. Staff were encouraged to complete