Inspection on 04/01/06 for Rainbow House (Holiday Centre)

This inspection was carried out on 4th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rainbow House (Holiday Centre) 22/01/08

Rainbow House (Holiday Centre) 12/06/06

Rainbow House (Holiday Centre) 04/05/05

Rainbow House (Holiday Centre) 27/10/04

Rainbow House (Holiday Centre) 13/07/04

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Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

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Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Rainbow House (Holiday Centre) 15 Hooks Hill Road Sheringham Norfolk NR26 8NL Lead Inspector Mrs Lella Andrews Unannounced Inspection 4th January 2006 11:15 Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 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 House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 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 House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rainbow House (Holiday Centre) Address 15 Hooks Hill Road Sheringham Norfolk NR26 8NL 01263 823170 01263 825560 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) BREAK Position Vacant Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9), Physical disability (9), of places Physical disability over 65 years of age (9) Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Those accommodated with a learning or physical disability may be under the age of eighteen years. No unaccompanied child under the age of five may be accommodated. No unaccompanied individuals may be accommodated during the weeks set aside for family groups. 4th May 2005 Date of last inspection Brief Description of the Service: Rainbow House is owned and managed by the BREAK organisation which is a charity based in Norfolk and provides a variety of services to children and adults. Rainbow House (referred to throughout the report as the “Centre”) is a large detached house situated in a residential area of the seaside town of Sheringham. To the front of the Centre is a large, heated indoor swimming pool and an enclosed garden. The Centre provides holiday stays for children and adults with a wide range of disabilities. The bookings are arranged so that there are either groups of children or groups of adults staying at any one time. The service users are referred to throughout the report as “guests”. The Centre has progressively reduced the registered number of places, initially to twelve (12) and then from April 1st 2005 to nine (9). This enables all guests to have a single room. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and took place between 11.15am and 4.30pm on Wednesday 4th January 2006. The Inspector spent time talking to two of the staff on an individual basis and to two staff and one of the guests on a more informal basis. Some records were inspected and the communal areas of the Centre were seen during a brief walk around the building. This Inspection focused on following up the requirements and recommendations made in the last Inspection report. The organisation has recently appointed a new Manager who has only been in post for two months and is currently going through the process to become the Registered Manager. The Manager was present for the feedback at the end of the Inspection. There were three guests staying at the Centre on the day of the Inspection. What the service does well: What has improved since the last inspection? The ongoing programme of redecoration has continued with improvements made to the activities room and to the bedroom on the second floor. Staff have been recruited during the last six months and so agency staff are now rarely used. This situation improves the consistency of the service provided to the guests. Staff are now receiving formal supervision from the new Manager which gives them an opportunity to discuss their role and ongoing development within the team. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 6 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. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 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 House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Once the review of the Statement of Purpose is complete then the documentation available about the Centre will provide good information to prospective guests In some circumstances there is still a need for additional guidance to be available to staff in order for them to be able to meet the guests needs effectively EVIDENCE: The Service User Guide is provided in the form of a laminated booklet which contains symbols and photographs as well as simple sentences about the service provided at the Centre. This can be sent to prospective guests and their relatives/carers and there is also a copy in each of the bedrooms. The organisation has also put together an interactive guide to the Centre which can be accessed on a personal computer. Requirements have been made for the last three years about the need for an accurate Statement of Purpose and this document finally contains the necessary information. The actual format of the document is still being worked on but the information is now in one place. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 9 The guests application forms contain the assessment of individuals needs. These are completed by guests, parents or carers and a request for updated information is sent prior to every stay. The quality of the information contained on the application can be varied and staff often have to contact relatives/carers for further details. Even then, the information may still not be detailed enough to provide an adequate care plan from which the staff are guided about how to meet individual needs. Whilst it is understood that some guests do live a long way from the Centre it is recommended that the organisation considers enabling the Manager to meet prospective guests to undertake a detailed assessment prior to their first stay whenever possible. This would enable a much more detailed assessment to be undertaken and give the Manager an opportunity to observe how the guests needs are met at home. It may also be reassuring to prospective guests to meet at least one member of staff prior to their stay at the Centre. The need for accurate assessment information at an early stage is very important as the bookings for the Centre are made based partly on the dependency assessments undertaken by the Manager. This assessment can be difficult to carry out when information is not detailed enough. Staff said that whilst the planning of the mix of guests has improved there is still plenty of room for improvement as there have recently been some difficult mixes of guests. The organisation has recently appointed a new bookings administrator who has spent time at the Centre as part of her induction. It is hoped that this will improve the situation. The involvement of the Manager in the bookings process is very important as the staff team have a good understanding of the needs of guests who have stayed at the Centre previously. It is required that the mix of guests is improved so as to ensure that individual needs can be met. Following a comment made by relatives prior to the last Inspection it was recommended that guests are offered the opportunity to discuss any issues in private when they first arrive at the Centre. Although this has not actually taken place the Manager intends to make changes to the office on the ground floor so that this room can be used when guests arrive. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 The care plans and risk assessments still do not contain enough detailed information, in some cases, to ensure that guest will receive support in a consistent and appropriate way EVIDENCE: The care plans were seen for the three guests currently staying at the Centre. The application forms for the basis for the care plan and a general risk assessment is undertaken prior to the guests stay. Additional information can be added to the records when the guests arrive and the current formats used means that this can lead to information being kept in several places within the overall records and can also be confusing. One of the guests records had a lot of information added to it on the day that he had arrived and this was unclear and could possibly cause confusion about how to meet his needs. One of the guests records contained a body chart which stated that the guest had some spots but there was no record in any other part of the care plan to indicate what action had been taken, what the outcome was or even if the spots were still present four days later. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 11 The requirement is repeated in this report for there to be clear guidance to be provided to staff so as to enable them to meet guests needs in a consistent and effective way. Two of the care plans seen contained very basis risk assessments of the older style that the organisation used to use. One of the guests records contained a new style risk assessment. These are better than the older forms as a general risk assessment but there is still a need for detailed individual risk assessments for those areas identified as being of high risk. Therefore, this requirement has not been met. The guests records are no longer being kept in one handover book and more consideration is given to confidentiality when staff make notes in the handover book. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were measured on this occasion EVIDENCE: N/A Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were measured EVIDENCE: Although none of these standards were measured the Inspector did look at the medication policy and procedures to see if the requirement to include a policy relating to the use of homely remedies has been met. This has not been met and so the requirement is repeated within this report. It was noted that medication errors are now being recorded and monitored by the new Manager. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The written procedures relating to the protection of vulnerable adults and children need to be made more clear. Staff are aware of the procedure to follow in the event of an allegation being made EVIDENCE: It is required that the procedures relating to the protection of vulnerable adults and children are reviewed to ensure that they provide clear guidance to staff about the role of the Adult Protection unit. Staff recently evidenced that they are aware of the action to be taken following an allegation and the situation was dealt with appropriately. Staff are aware of the whistle blowing procedure. Two of the newer members of staff have recently attended training relating to child protection and all staff will be receiving adult protection training during the forthcoming training fortnight. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The Centre provides a comfortable, clean and safe environment for guests to enjoy their holiday EVIDENCE: The Inspector was shown the activity room which has been decorated since the last Inspection. This has been decorated in a style which is suitable for both children and adults. The requirement for the bedroom on the second floor to be redecorated and have new flooring has been met. This room is now much more attractive and homely. The Inspector was told that the curtains will shortly be put up in addition to the net curtains already in place. The Centre was clean with no unpleasant smells. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 36 The staffing situation has greatly improved with the recruitment of permanent staff and less reliance on agency staff Although a two week training programme is provided to the staff team each year there is a need to ensure that new members of staff receive appropriate training EVIDENCE: Staff said that the staffing situation has greatly improved as four permanent members of staff have been recruited in the last six months and a “bank” of staff is being developed to provide cover for holidays and sickness. Staff said that agency staff have not been used at the Centre for several weeks. This situation has improved the pressures that staff were feeling during the last Inspection when the staffing situation was very difficult. However, the use of volunteers from overseas whose English is not very good is still causing some difficulties. The organisation is currently reviewing the whole staffing structure of the Centre and so this area will be looked at in more detail once this has been completed. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 17 The training records were not seen on this occasion. The organisation have arranged a two week staff development and training programme which takes place at the end of January. This includes some mandatory training but focuses much more on team building and staff attitudes and values. During the Inspection it was clear that there are some difficulties within the team which the forthcoming team building will address. The Inspector was told that training has not been provided adequately to staff who have started work in the last six months. They have not all received the appropriate mandatory training, such as induction, moving and handling, fire safety. It is required that all staff receive induction and other training to enable them to carry out their role effectively. The requirement made for formal supervision to be provided to staff is now being met as the new Manager has undertaken to carry out all the supervisions in the short term so that she can get to know staff individually. Staff said that they have received supervision and that they can also approach the Manager or Deputy Managers for informal support as and when they need it. The personnel records were not seen during this Inspection and so the requirement made relating to these will be checked during the next Inspection. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The health, safety and welfare of the guests in general, is promoted and protected although improved risk assessments will assist with this EVIDENCE: The Inspector looked at a range of records relating to the maintenance of fire safety equipment. These are up to date. The records of fire drills show that these have only recently started to take place regularly. Weekly checks are carried out on the fire alarm. Evidence of electrical equipment and the various hoisting equipment having been checked for safety was seen also. The Inspector saw and heard evidence that showed that staff acted appropriately during a recent problem with the gas provision. Staff should be commended for dealing with this situation well despite initially being given poor advice and then having a problem with the company employed to carry out the work. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 19 The organisation has Health and Safety policies and procedures and training is provided although the Inspector was informed that not all staff have received appropriate moving and handling training. The organisation has a member of staff based at the administration office who is responsible for Health and Safety matters across the organisation. Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rainbow House (Holiday Centre) Score X X X X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000027335.V249931.R01.S.doc Version 5.0 Page 21 yes Are there any outstanding requirements from the last inspection? 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 2 Standard YA2 YA6 Regulation 12 (1) 15 Requirement It is required that the mix of guests is improved so that the needs of individuals can be met It is required that the care plans contain detailed guidance for staff with regard to meeting individual guests needs THE PREVIOUS DATE OF 30TH JUNE 2005 WAS NOT MET It is required that risks are recognised and assessed appropriately with clear written guidance available to staff to ensure that the risks are managed effectively THE PREVIOUS DATE OF 30TH JUNE 2005 WAS NOT MET It is required that the medication procedure contains information relating to the use of “homely” remedies. THE PREVIOUS DATE OF 5TH JUNE 2005 WAS NOT MET It is required that the adult and child protection procedures are updated to provide accurate guidance to staff It is required that all staff receive appropriate induction and mandatory training DS0000027335.V249931.R01.S.doc Timescale for action 28/02/06 28/02/06 3 YA9 13 (4) 28/02/06 4 YA20 17 28/02/06 5 YA23 13 (6) 31/03/06 6 YA35 18 (1) 28/02/06 Rainbow House (Holiday Centre) Version 5.0 Page 22 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 Refer to Standard YA2 Good Practice Recommendations It is recommended that the Manager visits prospective guests to undertake an assessment prior to their first stay Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Rainbow House (Holiday Centre) DS0000027335.V249931.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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