Inspection on 04/09/07 for Rainbow

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rainbow 26/10/06

Rainbow 24/03/06

Rainbow 06/10/05

Rainbow 17/03/05

Rainbow 07/09/04

Rainbow 26/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rainbow 5 Victoria Road Canterbury Kent CT1 3SG Lead Inspector Wendy Gabriel Key Unannounced Inspection 4th September 2007 09:15 Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rainbow Address 5 Victoria Road Canterbury Kent CT1 3SG 01227 455745 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) rainbowlarche@tiscali.co.uk L`Arche Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: Rainbow is a care home providing personal care and accommodation for 5 people. It is operated by L’Arche which is an international community, within which are homes for people with learning disabilities. L’Arche Kent is the owner of Rainbow. The acting manager has applied to be registered. The home is located close to Canterbury city centre with all of its amenities. The house is a large semi detached property. All the residents have single rooms. There is an enclosed garden to the rear and car parking facilities to the side. Some of the staff are permanent but others come from many different countries to be part of the community within the home and within the area for a specific period of time. Staff and residents are known as Members of the community, some of who are Core Members. The terms staff and residents are used for the purpose of this inspection report. Up to date information about the home, including the last inspection report, will be made available on request. Fees are in the range of £580.00. - £771.61. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the unannounced inspection the Inspector met the acting manager and a member of staff and, briefly, two other members of staff and two residents who were just leaving for their day centre activities. Other residents had already left for their day activities. Communication was limited but one resident very kindly showed the Inspector his own bedroom. Other bedrooms were not viewed as the residents were out at the time. An accompanied tour of the rest of the premises was taken. The acting manager pointed out areas that had been identified for redecoration and reflooring. Some records were viewed and cross-referenced with others to verify care practices. Some information was taken from the previous inspection report regarding the on-going staff training programme that has not altered since that time and from the annual quality assurance assessment provided by the home. The annual quality assurance assessment is a new document that gives the provider the opportunity to fully record different aspects of the homes practices. This is a legal document. One requirement was made regarding medication storage for an otherwise sound medication administration system. The acting manager agreed to this and recommendations were made for some minor repair and outside rubbish clearance. Previous recommendations had been met. The home presented as a very homely and ‘family’ orientated environment. There was evidence in all areas of pictures and handicraft made by residents. What the service does well: Guidance for staff regarding equality and living in the home is descriptive and clearly written. Both the statement of purpose and service users guide are written from the point of view of residents and clearly describes life in the home. This is good practice. Environmental risk assessments and fire assessments are fulsome and very straightforward. Privacy is an important part of life in the home and bedroom doors have locks. One resident was seen to be in control of his own key. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the opportunity to visit the home and receive information to enable an informed choice to be made. Prospective residents know that their individual needs and aspirations will be assessed. EVIDENCE: The acting manager stated that there had been no new residents for approximately 10 years, one person had been with L’Arche for about 25 years. There is an organisational procedure to admit new residents to the home. Assessments would be made of prospective residents and visits to the home encouraged to meet the people who live there. Admission to the home is via a local or health authority. The home has a statement of purpose and a service users guide for use by prospective residents. These documents are clearly written from the perspective of residents. The detailed service users guide states that English is to be spoken when in the presence of another person as speaking another language “excludes them from your conversation and you from their gifts”. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents know their assessed needs and personal goals will be recorded and that they are consulted on and participate in choices in the home. Residents know that they will be supported to make decisions and to take risks to maintain as independent a lifestyle as possible. EVIDENCE: Individual care plans and personal profiles are kept regularly reviewed. Guidelines are clearly written regarding assessed needs, in some cases these have been enhanced with a pictorial explanation for a preferred behaviour from residents. This is thoughtful practice. Where possible, reviews and information is also signed by the individual resident. Residents can have access to their own plans on request. Individual risk assessments are clearly written to aid staff enable residents to be as independent as is possible. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 10 Personal profiles include detailed information including reference to Health care professionals. Reports from day care staff help build a picture of each individual and are used as information at reviews. House meetings take place once a week and residents discuss issues such as menus and outings for the coming week. Daily recording is in ‘go between’ books and information includes residents’ own input about how they feel that day. This is good practice. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities for socialising and day care provision offers a variety of stimulating activities. Residents benefit also from a menu that they help choose and that considers dietary needs. EVIDENCE: Residents go to day care four days a week and each has a day in the home where they undertake housework, shopping or animal care. Day care can be at one of four centres, one is more craftwork orientated and swimming, dancing and exercise is available, another has the garden workshop where some produce is provided for the house. There is a farm where animals are cared for and there is opportunity for horse riding and the last is the Fountain Therapy Project where massage, art and therapy takes place. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 12 Evenings are more relaxed for residents and include preparation of their evening meal, listening to music, watching tv or going to their own rooms if they wish. The evenings are spent with the staff who live in the home. The home has a quiet room or chapel for regular prayer meetings. This is part of the ethos of LArche. There are two main holidays a year, in the summer and at Christmas. This year during the summer the venues for different people were Poland, London, Broadstairs and France. People may take other, individual holidays throughout the year if they wish. A member of staff said that the home has its own vehicle and regular outings are undertaken and are chosen by the residents. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and their health needs are identified and met. Residents are protected by the homes medication procedures but these will be improved by more robust storage. EVIDENCE: There was written evidence of the involvement of Health care professionals for individuals. Care plans include details of personal support. The home has a rule that female residents have female staff undertaking personal care and male residents have male staff undertaking their personal care. The acting manager said that there was enough staff to ensure this was always observed. There is a policy for how to deal with a death in the home. The acting manager said that health or behavioural changes would be referred to the appropriate Health care professionals. Medication administration procedures were appropriate. But a requirement is made for a suitable medication cabinet to be provided for the main medication Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 14 and for a resident who, although not self medicating, keeps their medication in their own room. This is made to improve security. All staff may administer medication once they have been trained. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse and their views are listened to and acted on. EVIDENCE: Residents have opportunities to raise concerns at regular, weekly house meetings and to their reference person. The home maintains policies and procedures for dealing with complaints, adult protection, restraint, bullying and whistle blowing. There is a policy for dealing with aggression towards staff. A book is kept for recording complaints. The acting manager confirmed that there had been no complaints made since the previous inspection. The acting manager and a member of staff were very clear about actions to be taken should abuse be suspected. The member of staff said the acting manager was very approachable and staff would not feel worried about telling her of any concern they may have. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents will benefit from some improvements to the environment. Residents benefit from a clean and comfortable home. EVIDENCE: An accompanied tour of most of the premises was undertaken. One resident very kindly showed the Inspector his own room and used his own key to unlock the room. All bedrooms have locks. Some bedrooms were not viewed as the residents were out. The acting manager pointed out various areas that have been designated for redecoration this year including new flooring to the kitchen, laundry and pantry. The kitchen units are showing signs of wear and tear and are to be replaced as well as the cooker. The living room is to have new flooring and be repainted. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 17 The paintwork on the stairs and in some areas of the hall needs repainting as it is chipped in places. Some re grouting and tile repair could improve the upstairs bathroom, although generally it was a clean and attractive room. Since the previous inspection new carpet has been laid in the hall, stairs and landing areas. Storage in the cellar is to be reorganised to ensure dried foods are not close to stored cleaning items where they may pick up the chemical smells. Staff are to ensure that storage does not rest on an electric flex used in the cellar. The garden has been maintained and meets the recommendation made at the previous inspection. The health and safety officer is to view the possibility of re paving the garden path. The driveway to the side of the home has a disorganised pile of broken wood, possibly from a fence panel and is to be cleared for safety. A commode was in the garden after being loaned out to neighbours and is to be removed. The unhinged top and general state of it was pointed out to the manager who said it was not used. The home is comfortable and homely, in keeping with a family home. The fire officer has audited the fire safety risk assessment. The health and safety officer for the home does a monthly ‘walkabout’ to audit the general state of the home. The acting manger said this brings a ‘fresh pair of eyes to the home’. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment, staff training and supervision benefit the residents. EVIDENCE: A member of staff confirmed that regular training is undertaken in the home including NVQ3. Induction includes basic understanding of the ethos of the home regarding the welfare of the residents who live there. Two staff records were viewed and these confirm induction training, references, supervision and annual appraisals are undertaken. The acting manager stated that after a period of time a new member of staff is assessed by the manager and by residents who are encouraged to give their own assessments. CRB and POVA checks are held at the administration office on another LArche site in a nearby village for security and data protection. Staff roles are clearly written and guidelines for living as part of the community enhance the lifestyle of the residents. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 19 In the mornings there is a male and a female member of staff on duty, when the residents leave for their day activities a member of staff stays in the home for cleaning duties. A member of staff does office duties in the afternoon and afternoon and evening there is a male and a female member of staff on duty. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well run home and their health and safety is promoted. EVIDENCE: The manager has worked at the home for several years and has applied to become registered. Maintenance records are in date. Fire safety records are in date and include, the fire officers’ confirmation that the homes assessment of fire risks is suitable. There are written procedures available for different aspects of the health and welfare and safety of the residents. The home also provides guidelines and a Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 21 policy for staff including regarding equality seriously; part of which states that ‘we aim at equality in relationships where the distinction between carer and cared for is not emphasised.’ The Inspector was pleased to have been introduced to residents and staff as soon as she entered the home and was pleased to note that there was no distinction between staff and residents shown. Staff training is via a rolling programme and includes NVQ 3 as well as the mandatory subjects. Environmental risk assessments clearly identify areas and appropriately inform staff on how to deal with the assessments. Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X X 3 3 Rainbow DS0000023531.V346364.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement A secure storage facility is to be provided. Timescale for action 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA24 YA24 Good Practice Recommendations Minor repair and redecoration to be undertaken and the driveway cleared. Cellar storage is to be reorganised including avoiding electrical leads. 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