Rainscombe House

Updated 27 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 3 inspectors.

Service and service type

Rainscombe House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Rainscombe house is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. There was a manager in post who intended to submit an application to register.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 29 November 2023 and ended on 15 December 2023. We visited the location’s service as well as the office for the service on 29 November 2023 and 4 December 2023. The office is based at Rainscombe Bungalow which is next door to the house and also one of the provider’s care homes.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information the provider had sent us following our last inspection. This helped us to judge whether the improvements they had promised to make had happened.

We also reviewed the information we had received about the service since our last inspection. For example, notifications of incidents, accidents or safeguarding concerns.

We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed the care documentation for 3 people and looked at medicines information for people living at the service. We observed care interactions between staff and people. We spoke with 6 staff, which included the provider (who was also the nominated individual), area manager, the new manager, deputy manager and 2 care staff. We look at other documentation related to the running of the service, such as recruitment information, training and supervision for staff, audits and health and safety information.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Following our inspection we spoke with or received feedback from 2 care professionals, 1 person’s legal representative and 2 relatives.

We also requested additional documentation from the provider to assist us with analysing the quality of the service. This included evidence of actions taken since our last inspection, auditing carried out by external providers, training information and evidence of activities with people.

Updated 27 January 2024

About the service

Rainscombe House provides care and accommodation for up to 3 people with a learning disability and autistic people. People had a range of communication, care needs and abilities. At the time of our inspection there were 3 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.

We were unable to communicate with people directly due to their needs, instead we spent time observing interactions between staff and people to gain an understanding of the care people received.

Right Support:

We found not enough improvements had been made, staff continued to fail to focus on people’s strengths and promote what they could do. People were still not being supported with opportunities and experiences so they had a fulfilling and meaningful life. The provider had failed to improve enough to ensure that they met the principles of Right support, right care, right culture. People had limited access to individualised, person-centred activities which were important to them.

People were not always 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.

Staff understood people’s needs, but further work was needed to ensure people were always supported in a dignified and respectful way.

Staff enabled people to access health and social care support and they ensured people received the medicines they had been prescribed.

Right Care:

Staff were not always following professional guidance in relation to people, leaving people at risk of harm. People did not always receive kind and compassionate care as staff did not always protect or respect people’s privacy and dignity.

People’s care records were not always comprehensive or written in a way that was person-centred. Although some people used a form of sign language to communicate we did not observe staff using this to converse with them. There was a lack of evidence of people being involved in their care planning or decision making.

Improvements had been made to people’s living environment; however further work was needed to ensure people lived in a homely setting.

Although there were sufficient staff to look after people, we found occasions when the staff on duty did not have the appropriate skills for people’s needs. Staff were not sufficiently trained or supervised to ensure they were suitably qualified to provide a good quality of care.

Right Culture:

The provider had failed to take action to robustly address the concerns found at our last inspection. The care people received was not person-centred.

Safe recruitment processes were in place and the home was clean, however, not enough improvement had been made The provider did not have suitable processes and systems in place to ensure people, relatives and staff were involved in the running of the service.

Positive comments were received about the service from relatives and staff worked with external agencies to help improve people’s care.

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

Rating at last inspection and update

The last rating for this service was inadequate (report published 2 June 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made but the provider remained in breach of some regulations.

At our last inspection we recommended that the registered provider reviewed their staffing rotas to include a fully trained and competency-assessed staff member on shift able to administer medicines safely. We found the registered provider had not fully acted on this recommendation.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at our 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 unsafe care, staffing, medicines, and the lack of trained and appropriately supervised staff. We also identified breaches in relation to staff not respecting people’s dignity, a lack of meaningful activities and person-centred care, as well as a lack of robust management oversight.

Full information about CQCs 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 remains 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