Rainscombe Bungalow

Rainscombe Bungalow provides accommodation and personal care for up to 6 people who have a learning disability and are autistic. At the time of our inspection, there were 6 people living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The provider had failed to ensure they met the principles of Right support, Right care, Right culture. People were not supported to live independent lives or access meaningful and person-centred activities. Risks were not being managed well and health care professional advice was not being followed in relation to people's care.

Right Care

People were not protected from abuse and neglect from staff. There were not always sufficient levels of staff deployed to ensure safety of care. There were not sufficiently trained or supervised staff to meet the needs of people. Incidents of anxiety and epilepsy were not always recorded in sufficient detail to look for trends and themes. Staff were not always kind and respectful towards people. People were not always given choices around their care.

Right Culture

There was a lack of management and provider oversight to review shortfalls of care to make improvements. The provider did not focus on people's quality of life, and care delivery was not person-centred. The provider and staff did not recognise how to promote people's rights, choices or independence.

Rating at last inspection and update

The last rating for this service was inadequate (published 31 May 2023).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has remained inadequate based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to people not being protected from abuse, safe care and treatment and the lack of trained and appropriately supervised staff. We also identified breaches in relation to the staff not being caring and respectful, lack of meaningful activities, lack of person-centred care and a lack of robust management and provider oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rainscombe Bungalow provides accommodation and personal care for up to 6 people who have a learning disability and or are autistic. At the time of our inspection, there were 6 people living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The provider had failed to ensure they met the principles of Right support, right care, right culture. This meant people who used the service were not able to live as full a life as possible and achieve the best possible outcomes. People were not protected against risks associated with their care. Health care professional advice was not always being followed in relation to people’s care.

Right Care

People were not protected from abuse from staff. There were not sufficiently trained or supervised staff to safely meet the needs of people. Incidents where people displayed their distress were not always recorded in sufficient detail to look for trends and themes. Staff were not always kind and respectful towards people.

Right Culture

There was a lack of management and provider oversight to review shortfalls of care to make improvements. The provider did not focus on people's quality of life, and care delivery was not person centred. Staff did not recognise how to promote people's rights, choice or independence.

Rating at last inspection and update

The last rating for this service was requires improvement (published 09 May 2023). At the time of this inspection we received additional concerns that related to the safe care of people.

Why we inspected

The inspection was prompted due to concerns received about people not being protected from the risk of abuse, concerns around safe staff levels and lack of robust management oversight. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed to inadequate based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to people not being protected from abuse, safe care and treatment and the lack of trained and appropriately supervised staff. We also identified breaches in relation to the staff not being caring and respectful, lack of meaningful activities, and a lack of robust management and provider oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rainscombe Bungalow is a residential care home providing personal care for up to 7 who have a learning disability or autistic people. The service is in a residential road with each person having their own bedroom and a shared kitchen, dining area and lounge. At the time of the inspection 7 people were living at the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it .

Right Support:

People were not always being given the opportunity to lead as fulfilling life as possible, although staff had started to consider how they could work towards this. Staff were being provided with training around the Right support, right care, right culture guidance to enable them to consider how they could transfer their learning into benefitting people living at the service.

Although people had good relationships with staff, staff had not always considered how they could help ensure people were provided with information relevant to them in a way they understood. There was little evidence to show people were involved in their care plans or given the opportunity to learn new life skills.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Although we found most restrictive practices followed the principles of the Mental Capacity Act 2005, we observed staff restricting one person’s movement without the necessary documentation in place. We have made a recommendation to the provider in this respect.

Staff were aware of their responsibility in relation to infection control and people were seen to follow good hand hygiene practices.

Right Care:

People were cared for by a sufficient number of staff who had been recruited through safe recruitment processes. However, we found some staff had not completed training that was relevant to the people they cared for. This meant staff may not have the relevant skills to ensure they always followed good practice. We have made a recommendation to the provider in this respect.

People had good relationships with staff and staff knew people well. Staff recognised people’s individuality and there was good guidance available in people’s care plans to help support staff’s care of people. People were shown care and respect by staff.

People were provided with the medicines they had been prescribed and staff recognised the need to keep people safe from abuse and protect them from the risk of harm. Staff supported people to see healthcare professionals when needed and ensured people were provided with sufficient food and drink to help them maintain good health.

Right Culture:

The provider had recognised the need to make changes in relation to opportunities for people and as such they had organised training seminars for staff. This included sharing the Right support, right care, right culture guidance and ensuring all staff undertook the required training in learning disability.

Despite the providers commitment to improve the service, we found people had been without curtains or blinds in their rooms for a long period of time. The provider had also failed to notify CQC of 2 safeguarding concerns which were raised in 2022, although both had been investigated and resolved.

Staff were happy working at the service and told us they felt supported and valued. They said they had the opportunity to meet with the line manager on a 1:1 basis and felt confident to speak up in staff meetings to air their views.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The rating at the last inspection was Good. Report published 8 January 2021.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to person-centred care. We have also recommended the provider improves their understanding of the Mental Capacity Act 2005 principles as well as support staff to complete all relevant training.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rainscombe Bungalow provides care and accommodation for up to six people with learning disabilities, autistic spectrum disorder and behaviour which may challenge others. People had a range of communication needs and abilities, which included body language and gesture. At the time of our inspection there were six people living at the service.

People’s experience of using this service:

People looked comfortable and relaxed with staff. One told us they enjoyed spending time with the staff particularly their key worker. Staff received safeguarding training and were regularly encouraged by the registered manager to raise with them any concerns they had.

People’s behaviours that may challenge were managed well to ensure people were kept safe and well. There was guidance around the service for people on what they needed to do if they were unhappy.

The service was clean and well maintained. Staff understood the principles of infection prevention control and wore PPE appropriately.

At the previous inspection the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. As this a targeted inspection looking at specific concerns, we did not look at this again and we had no concerns around this.

Right support:

• Model of care and setting maximises people’s choice, control and Independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human Rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

Rating at last inspection:

The last rating for this service was Good (published 17 October 2019).

Why we inspected:

We undertook a targeted inspection due to concerns we received that related to people being protected from the risk of abuse. We found no evidence during this inspection that people were at risk of harm from this concern. This report only covers findings in relation to safeguarding people from abuse and infection control.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively

The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner. We will continue to work with the local authority to monitor progress

Rainscombe Bungalow provides care and accommodation for up to six people with learning disabilities, autistic spectrum disorder and behaviour which may challenge others. People had a range of communication needs and abilities, which included body language and gesture. At the time of our inspection there were three people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service:

We spent time with people during our visits and observed their interaction with staff. Without exception feedback received regarding the service was positive. People’s relatives said that the service was of a high standard. People were cared for by genuinely kind and compassionate staff who were dedicated and committed to ensuring that people received the care they needed and live the lives they wanted.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The management and staff created a warm and relaxed environment and we observed a strong caring relationship between people and all grades of staff. Staff demonstrated a depth of compassion and empathy and genuinely cared for people they supported. Staff were highly skilled and had extensive training. They had the skills, knowledge and confidence to effectively support people with a high level of needs.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There were quality assurance systems in place to help monitor the quality of the service and identify any areas which might require improvement. Staff listened to feedback and reflected on how the service could be further improved.

The service was well led. The manager's values and vision were embedded into the service, staff and culture. The provider and registered managers were passionate and committed to developing a service where people received genuinely person-centred care. This was evident throughout our visit. Staff told us, ‘I feel very proud to be working [here] and be a part of the Rainscombe Bungalow team’.

The service was safe, with systems and processes which ensured that any concerns were reported to appropriate authorities without delay. There was a stable staff team. The service had high levels of staff retention due to the positive and supportive culture.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At our last inspection in September 2016 we rated the service good. The last inspection report was published 4 November 2016. At the inspection we found areas that required improvement. The provider had not maintained appropriate procedures in relation to people’s personal finances. Following the inspection improvements were made and conditions were imposed on the provider’s registration.

Why we inspected:

We completed a planned comprehensive inspection based on the previous rating of Good.

Follow up:

We will review the service in line with our methodology for 'Good' services.

This inspection took place on 20 September 2016 and was unannounced.

The home was run by a registered manager and they were present throughout our inspection. ‘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.

The provider did not have a robust process that had ensured people finances were managed appropriately which is subject to investigation.

People and their relatives gave positive feedback about the service they or their family member received. People were very happy.

People said that they felt safe and they appeared happy and at ease in the presence of staff. One person said; “The staff look after me here.” People benefited from a safe service where staff understood their safeguarding responsibilities. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. People who experienced conditions such as epilepsy had protocols in place for staff to ensure they remained safe during times of seizure activity.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted.

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe. The premises provided were safe to use for their intended purpose.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed.

People said that they consented to the care they received. The home was meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People said that they were involved in making decisions about their care as much as they wanted to be. However we noted that all documentation was typed similarly and not personalise to meet each person’s needs.

Staff had the specialist training they needed in order to keep up to date with care for people. Staff demonstrated best practice in their approach to the care, treatment and support people received.

People were provided with a choice of meals each day and where they wanted to eat, for example go out for lunch or have lunch at home. Facilities were available for staff to make or offer people snacks at any time during the day or night. Specialist diets to meet medical or religious or cultural needs were provided where necessary.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed some positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit.

People took part in community activities on a daily basis; for example regular clubs. The choice of activities had been in place for a number of years. The registered manager discussed ways of improving this. We have made a recommendation regarding people’s social activities.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to. The policy was in an easy to read format to help people and relatives know how to make a complaint if they wished. Staff knew how to respond to a complaint should one be received.

The provider had quality assurance systems in place, including regular audits on health and safety, medicines and support plans. The registered manager met CQC registration requirements by sending in notifications when appropriate. We have made a recommendation about this. We found both care and staff records were stored securely and confidentially.

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what relatives of people who used the service and members of staff told us, what we observed and what we learnt from the records we looked at. We talked with two of the staff, a deputy manager and the registered manager. Records we looked at included three care records, staff training records, management audits and the service's quality assurance documentation. Following the inspection we spoke by telephone with relatives of two people who lived at the home. This was because opportunities for our meaningful engagement with people who lived at the home were limited.

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

Is the service safe?

All staff were up to date with training about safeguarding vulnerable people. Staff we spoke with had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues.

Care plans recognised the benefits of supporting people to take risks in life experiences in and out of the home, and assessed how risks were to be managed to support them to do so. Risk assessments routinely considered issues of vulnerability to various forms of potential abuse. Risk management strategies covered how to keep people safe, for example by one-to-one staff support in the community and appointee arrangements for overseeing access to and use of money.

Is the service effective?

Staff and management were proactive in researching leisure and learning opportunities in the community. The service had two vehicles for community access. People went out daily for rides, walks and use of cinemas and eateries.

Care and support plans showed people's diagnoses and reasons for being placed in the home. Care plans included a health action plan. Staff we spoke with said the care plans underpinned the care and support people received. They had time to read them and knew how to access information. They received a handover of updating information, together with delegated responsibilities, each time they started work. Records showed evidence of close liaison with external care managers and health professionals. The home used body maps to show clearly where any mark or injury was observed, but these were not being used to track progress of treatment.

Two people with relatives who lived at the home told us they were informed about care plan reviews, invited to take part and informed of outcomes. Both said their respective relatives' had shown improved physical and emotional wellbeing as a result of living at the home. They said staff kept them informed about, and asked their opinions on, any health changes, including changes to medicines.

Some people who lived at Rainscombe Bungalow had histories of presenting behaviours that other people could find challenging. We found behaviour management planning was based on maximising people's opportunities to express themselves positively, and to have choice and individual support in how they lived their daily lives. A letter from a person's relative said after admission to the home, the person's 'challenging behaviours were quickly diverted'staff are confident, experienced and relaxed with (them)'.

Is the service caring?

We saw gentle, caring interactions between staff and the people who liveding atin the home. Staff gave explanations of choices available to people and allowed time for responses. Two staff we spoken with expressed a strong view that their role was to support people to feel at home and to live the life of their choice. They told us there were always enough staff to meet people's needs. A person's relative told us the staff demonstrated respect for people's dignity by being attentive to their appearance and cleanliness. Daily records showed people experienced individual support to engage in identified preferred routines and activities

Is the service responsive?

Staff were supported in delivering care by an organised training programme, which included autism awareness. All but one of the staff had achieved relevant qualifications. Staff received monthly individual supervision every month. Records demonstrated a consistent approach that supported staff in identifying and meeting the needs of people living in the home.

There was evidence of effective liaison between the home and outside health and social care services. Care records showed specialist advice and care directions were incorporated into care plans and were followed by staff. External care management reviews gave the service feedback and discussion about the quality of care and support it provided for people living there. Where a person's relative had raised a query through the annual quality survey, this had been investigated and followed by further communication from both the home and the provider.

An annual survey of people living in the home, their relatives and the staff provided information the provider used to inform developmental planning for the service. Relatives we spoke with said staff and management were very responsive to comments and requests.

Is the service well-led?

The provider was well known to staff and relatives of people who lived at the home.

The quality of environment for people in the home received ongoing attention. We saw shortfalls were quickly referred to the provider's maintenance department for repair or replacement. There were daily schedules and checks for ensuring all areas of the home were cleaned to a good standard.

Monthly staff meetings covered care and operational issues. Staff we spoke with said they felt management listened to their views and kept them well informed of developments and plans. They felt a strong identity as a team working together.

We have not revisited Rainscombe Bungalow as part of this review because the provider Mitchell's Care Homes Limited were able to demonstrate that the service was meeting the standard without the need for a visit.

This is what we found: The provider had confirmed that the trip hazards identified from poorly replaced flooring after repairs to the front entrance was replaced. The walls that were found stained, dirty, scuffed and damaged have been repaired appropriately. The service have ordered and are awaiting the final fitting of new and appropriate floor coverings for all public areas within Rainscombe Bungalow.

We saw that everyone receiving a care package from the service had an assessment of their needs undertaken before a care agreement was offered. This was to ensure that people's assessed needs could be met and that the service had the staff with the relevant skills and qualifications to meet these needs.

We looked at five care plans for people who used the service. Care plans were based on the needs assessment that had been undertaken prior to admission. People who used the service had limited capacity so were not generally involved in the care planning process.

We saw the service had adult protection policies and procedures in place known as safeguarding. These demonstrated how the provider identified potential abuse and prevented abuse from happening for the people who used the service.

There were sufficient numbers of bathrooms and toilets for people to use. We found that some of these had been adapted to provide assistance for people that had been assessed with mobility needs.

The provider had an established quality assurance (QA) programme in place. We looked at the provider's QA system and found that there was a range of monitoring processes in place that enabled the provider to respond to issues of quality and risk.

We observed that staff spoke to people in a friendly and respectful way. We found that people were involved in making decisions and their right to respect, dignity and privacy was respected.

We observed that staff had a good understanding of people's needs and their means of communication and they had a good knowledge of their needs and preferences.

We found that people were supported by sufficient numbers of staff. Staff told us that they received a lot of training. Staff were visible throughout this inspection and they provided people with good levels of support and they spent time engaging and interacting with them. A person who used the service said that there was always enough staff to support them.

Staff told us they receive regular supervision and an annual appraisal. One member of staff told us that they received regular supervision. They continued to state that the "supervision and support" had got "considerably better" since the provider had reorganised the management of the service. Another member of staff told us that they felt fully supported and valued by the manager and the organisation.