Rainbow Care Services Ltd provides personal care and support to people living in their own homes in the area of South Nottinghamshire. At the time of our inspection there were 20 people receiving a care package.

At the last inspection, in April 2016, the service was rated Good with one breach of one Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was with regard to staff training. Following the inspection the provider sent us an action plan detailing the action they had taken to meet this breach in regulation. At this inspection we found that the service remained Good and the breach was met. Some continued improvements were required to ensure sustainability.

People continued to receive safe care. People were protected from avoidable harm and risks because risks associated to their needs had been assessed and planned for, and were regularly reviewed. People had not experienced missed calls and were informed if staff were delayed and staff stayed for the duration of the call. Safe staff recruitment processes were in place and there were sufficient staff employed and deployed appropriately. Where required people received support to take their prescribed medicines, some areas of improvement were required to ensure staff did this appropriately.

People had given consent to their care and support. Staff were aware of the principles of the Mental Capacity Act 2005. They had information to support them if there were concerns a person lacked mental capacity to consent to a specific decision about the care they received.

Where required, people received appropriate support with dietary and hydration needs. Some improvements had been made with regard to staff training. Some staff needed to complete refresher courses in some areas, which the office manager took immediate action to address. Staff received observational competency assessments of their work.

People continued to receive good care from the staff that supported them. People were treated with kindness, dignity and respect by a staff team that were knowledgeable about their individual needs. People were supported by a core group of staff that they were familiar with. People were involved in discussions and decisions about how they received their care and support.

People continued to receive a responsive service. People’s care needs had been assessed and planned for and were reviewed with the person. However, the management team had plans in place to improve their initial assessment of people’s needs. This was to ensure they asked appropriate questions that identified fully people’s diverse needs including decisions about their future care needs. Effective systems were in place to manage any complaints that the provider may receive.

The service continued to be well-led. The registered manager was no longer managing the service. The office manager was in the process of registering with CQC to become the registered manager. The management team and staff were aware of their role and responsibilities and were committed in providing people with the best care they could provide. People received opportunities to give their feedback about the service they received. Auditing processes were in place that monitored the quality and safety of the service people received.

This inspection took place on 07 April 2016 and was announced.

Rainbow Care Services provides care to people in their own homes. There were 27 people who used the service at the time of our visit.

A registered manager was in post and she was available during the 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 2008 and associated Regulations about how the service is run.

At the previous inspection on 25 June 2015, we found the provider had breached four regulations of the Health and Social Care Act 2008. We asked the provider to take action to make improvements to the areas of medicines management, staff knowledge and skills and good governance. We received an action plan in which the provider told us the actions they would take to meet the relevant legal requirements. At this inspection we found that improvements had been made in most areas, however, more work was required in the areas of staff knowledge, skills and relevant training.

Systems were in place to manage and monitor medicines safely. The provider had arrangements in place to identify the possibility of abuse and to reduce the risk of people experiencing abuse. Staff had some understanding about safeguarding and relevant training had been booked for staff to attend. Risks to people's needs had been identified and managed appropriately. People's needs were assessed and all documents completed. Staffing levels were sufficient to meet people's needs.

People felt staff were skilled and knowledgeable when they provided care. Staff training had not been fully completed as per the provider’s action plan dated October 2015. The Mental Capacity Act 2005 had been followed. Staff were aware of people’s capacity to consent to care and support, but staff had not received up to date mental capacity training. People’s nutritional needs were met. People were supported to have sufficient to eat and drink and maintain a balanced diet. People were supported to maintain good health and referrals were made to other healthcare professionals when required.

People developed positive relationships and received care from kind and respectful staff. People were happy with the care provided by their individual staff members. People were involved in decisions about their care. People’s dignity and privacy was respected.

People received care that was appropriate and relevant for their needs. People’s preferences about their care, routines and wishes were taken into consideration. People were listened to and knew how to raise concerns and complaints. People received relevant information to help them make appropriate choices about how they wanted to receive their care and support.

People were supported to express their views about the service and the care they received by completing a service questionnaire about how the service was run. People had access to an advocacy service, or appropriate information to support them to make informed choices. There were systems in place to monitor and improve the quality of the service provided.

Overall, we found shortfalls in the care and service provided to people. We identified one continuous breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 25 June 2015 and was announced.

Rainbow Care services provides care to people in their own homes. There were 25 people who used the service at the time of our visit.

There was a registered manager in post, but they were unavailable during our visit. A manager is required to register with us by law. 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 2008 (Regulated Activity) Regulations 2014 about how the service is run.

At the last inspection on 15 May 2014 we asked the provider to take action to make improvement to their recruitment procedures, and this action had been completed.

The provider did not have suitable arrangements in place to identify the possibility of abuse and to reduce the risk of people experiencing abuse. Staff had a variable level of understanding about safeguarding and had not received any up to date training. Not all risks were identified and managed appropriately. People’s care plans did not always reflect their care needs and risk assessments were not always completed.

Where the service was responsible for people’s medicines, people were at risk, as they did not always receive their medicines in a safe way.

People and their relatives we spoke with felt safe with the staff that cared for them although some expressed concerns about staff skills and knowledge. Inductions had taken place, but staff supervision was not up to date. There were gaps in staff training.

People’s nutritional needs were met. Staff supported people to have sufficient to eat and drink and maintain a balanced diet.

People were happy with the care provided by their individual care staff. They told us the staff were kind and respectful at all times. Staff we spoke with told us they had clear values to ensure people were treated with dignity and respect.

People were able to express their views by completing a service questionnaire about how the service was run, but there were no plans in place to identify any action required to be taken if and when issues were raised. People did not have access to an advocacy service, or appropriate information to support them to make informed choices. There were no systems in place to monitor and improve the quality of the service provided. Systems were not robust enough to highlight concerns.

Overall, we found significant shortfalls in the care and service provided to people. We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with people who use the service who said things like, “Yes I’m very happy with my care plan. There’s no need to change it.” and, “I really gel with her. It’s embarrassing [to have a shower], but we can have a laugh about it.” However, we found that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare.

We spoke with relatives of people using the service who commented positively on the staff with one saying, “Anything we’ve asked them to do, they do.” Another said, “They’re very good at providing the right personalities to work with my wife.” However we found that people were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People using the service and their relatives told us that they were generally happy with the staff who provided care. We found that people were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We spoke with people who use the service who said things like, “I would fill out a survey, but I’ve not been asked.” and, “You’re the first one that’s ever asked what it’s like. There’s no surveys. No meetings. The people in the office are faceless.” We found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We found there was not an effective complaints system available.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used telephone interviews and home visits to people who use the service and to their main carers (a relative or friends) to gain views about the service.

We visited six people in their own homes and spoke with 15 other people by telephone to obtain their views and gather evidence of their experience of the service. In addition, we spoke with three management staff, one senior care worker and four care workers. Nottinghamshire County Council, who commissioned part of the service, shared information with us from their annual quality audit.

The majority of the people we spoke with told us the care they received met their needs and was provided by staff who were competent and respectful.

One person told us, “They asked me at first how I’d like to be called." Another person said, “They do things as I like it done.”

Some people who used the service were unclear about the procedure for making a complaint and no one had received information on abuse. The majority of people who had complained were satisfied their concerns had been addressed, "Efficiently and promptly."

The inspection team who carried out this inspection consisted of one inspector. During the inspection we looked at evidence to answer five questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and staff told us.

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

During our visit we spoke with three people who used the service, two relatives and six members of staff including the registered manager. At the time of the inspection there were 48 persons using the service.

Is the service safe?

People who used the service said they felt safe with the people who cared for them.

We found the provider had commenced reviews of care and had updated the care plans to ensure people were safe and their individual needs were met.

Records showed that Disclosure and Barring Service checks had been completed prior to staff starting work. The manager told us they had a system in place to ensure the checks were up to date. This meant the provider took steps to ensure that staff were safe to work with vulnerable adults

Is the service effective?

We saw systems were in place for the manager to monitor staff training and ensure it was up to date.

We spoke with three people who used the service who told us they were happy with the service they received. Two of the people said, “They [the staff] are very good.” Another person said, “I am more than satisfied with the service I receive. I have had different companies over the years and these are the best.”

We spoke with four staff who had good knowledge of people's needs. They explained the care and support each person who used the service required and how they ensured the support was effective.

Is the service caring?

People who used the service told us they were happy with the care provided. They were complimentary about the staff and they told us the staff attended to their needs they also said staff were caring and respectful.

We spoke with two relatives of people who used the service. One relative told us they felt the staff cared and supported their family member very well.

We spoke with three people who used the service. They all gave positive feedback regarding how staff cared for them. One person said, “They understand what I need.” Another person said, “We [the staff and I] have good conversations and they are very professional.”

Is the service responsive?

We saw recorded personal safety and risk assessment had been completed. One person was a risk of aggressive behaviour. We saw the triggers had been identified and there were instructions for what staff should do if an outburst should occur.

We saw regular checks were taken for one person’s blood glucose. It was identified the person was responsible for their own medication, which was listed on the care plan to identify what medicines they were taking. However, although it was identified what medical condition the person suffered from and appropriate risk assessments had been undertaken there were no instructions for staff to follow should the person suffer from high or low blood sugar. The manager supplied us with this information following our visit.

We found the provider had a complaint system in place, they respond and record concerns raised as per their own complaints policy and procedure. This meant the service was responsive when addressing complaints.

Is the service well-led?

We saw the recruitment procedure in place, but they were not robust enough to ensure the right people were employed. Staff files had not been audited in January 2014 as stated in the provider’s action plan 2014.

We saw evidence to demonstrate new recruits had been enrolled on an eight week induction programme.

The provider undertook spot checks and staff observations to ensure staff were performing correctly.

Policy and procedures were in place, however they required updating.

People we spoke with told us they had noted improvements to the way the service was run. One person said, "They use to have problems, but it is much better now."

We saw different audits were undertaken to measure the quality of the service and to ensure the service was run well. Satisfaction surveys were sent out to gather people’s views and opinions.