The inspection took place on 26 and 28 June 2017 and the first day was unannounced.

The last inspection took place on 1, 2 and 3 June 2016, when we identified breaches of Regulations relating to person-centred care, safe care and treatment and good governance. Additionally we made three recommendations in relation to the proper and safe management of medicines, access to the kitchen and that people using the service needed to be made aware of changes to policies and procedures, specifically that the front door was no longer locked.

The provider sent us an action plan dated 1 September 2016 detailing how they would address the issues raised at the inspection. During the 26 and 28 June 2017 inspection, we saw improvements to the service had been made.

Rainbow Lodge Nursing Home is registered to provide accommodation for up to 20 people with mental health need who require nursing or personal care. At the time of our inspection there were 13 people living at the service.

The provider is a partnership and one of the partners is the registered manager. 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 inspection on 26 and 28 June 2017, we saw that care workers knew how to raise safeguarding concerns and had received the relevant training on this subject..

Risk assessments and management plans were in place to minimise the risks to people using the service. Since the last inspection, the provider had made improvements to reduce the potential risks caused by people smoking. Incidents and accidents were recorded appropriately and action plans followed up to prevent reoccurrences.

There were a sufficient number of staff to meet the needs of people using the service and safe recruitment procedures had been followed to ensure suitable staff were employed.

Medicines were stored, administered and recorded correctly. Medicines procedures and policies were up to date.

Care workers had the skills and knowledge to meet people’s needs and were supported to maintain this through supervisions and appraisals.

Care workers understood they needed to obtain consent from people using the service and the provider followed the principles of the Mental Capacity Act (2005). People were supported to have enough to eat and drink.

People’s health needs were recorded and there was evidence they were referred to the appropriate healthcare professionals to maintain good health.

Since the last inspection, the provider had made adaptations to the service to meet peoples’ needs and improved the design and decoration of the home.

People we spoke with said they were happy with the care provided and we observed staff had a good knowledge of peoples’ needs and how to support them. People felt listened to.

People we spoke with said the staff supporting them respected their privacy and dignity.

People were involved in their care planning and we saw evidence of this in their care plans and reviews. Files were person centred and people’s preferences and wishes were recorded. This included individual activity plans.

People using the service knew how to complain and the provider addressed any complaints through the correct complaints procedure.

People using the service and staff found the registered manager and the provider approachable and responsive.

The registered manager had good links with the community and was aware of their responsibility of when to notify relevant bodies including the Care Quality Commission and the local authority of some events and incidents within the service.

The provider had effective quality management systems in place to monitor the quality of the service and reduce risks. Checks and audits were accompanied by action plans wh

The inspection took place on 1, 2 and 3 June 2016 and the first day was unannounced.

The last inspection took place on 7 and 8 September 2015, when we identified breaches of six regulations relating to person-centred care, dignity and respect, the need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment and good governance. Additionally we made one recommendation around the provider seeking and following advice and guidance from a reputable source, regarding activities provision for people with mental health needs.

The provider sent us an action plan indicating how they would address the issues raised at the inspection. Improvements had been made, but further improvement was required.

Rainbow Lodge Nursing Home is a nursing home registered to provide accommodation and personal and nursing care for up to 20 people with mental health support needs. At the time of our inspection there were 14 people living at the service.

The provider is a partnership and one of the partners is the registered manager. 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.

There was a no smoking policy inside the building. However some people who used the service smoked in their bedrooms which was a fire risk.

There were organised social activities but these were not suitable or meaningful for all the people who used the service.

Improvements had been made to the systems and processes used to monitor the quality and safety of the service and manage risk to people, however the systems were not always effective and presented a risk to keeping people safe.

Some practices around the handling and recording of medicines were not safe and this presented a risk.

We recommend that the provider ensures there are robust systems in place to ensure the proper and safe management of medicines at all times.

People were restricted access to the kitchen.

We recommend the lack of access to the kitchen is reviewed and appropriate risk assessments are put in place which justify this restriction.

Not everyone was aware they were able to leave the service whenever they chose to. They were specifically unaware that they could leave the service at night.

We recommend that people are made aware of the any changes in policy and procedure.

The majority of the medicines were administered and dispensed safely.

Risk assessments identified risk and directed staff to look at the care plans for further details on how to support people and minimise risks.

The service had a safeguarding policy and safe recruitment procedures in place to protect people from abuse.

Staff were supported through regular supervisions and yearly appraisals. Staff were sufficiently deployed and appropriately trained to meet the needs of the people using the service.

Health needs were being met through assessments, monitoring and support from the relevant professionals.

Staff were kind and caring.

People had person-centred care plans and we saw evidence that staff followed them to meet people’s needs.

People who used the service, staff and relatives told us the managers were approachable and they could raise concerns with them.

We found breaches in 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 the report.

We spoke with the provider, the deputy manager, one other member of staff and five people who use the service. We found that people were involved in decision making about their daily routines and the care and support they received from staff. When we asked people about their experiences in the home they made comments such as, "I'm happy here", "I am keeping well" and "I like the food and the patients (the other people who live in the home)".

We found that people's needs had been assessed and a care plan developed to ensure that these needs were met by staff. Risk assessments were in place and care records had been reviewed and updated as people's needs changed. We observed staff interacting positively with the people using the service.

The environment was maintained to an adequate standard and any maintenance issues were addressed promptly.

There were adequate numbers of staff available to ensure that people's needs were being met effectively.

There were satisfactory arrangements in place for managing complaints about the service.

We visited the service because we had received information that the service might not be complying with essential standards of quality and safety. In particular concerns were raised about neglect, poor quality food, financial exploitation, the condition of some areas of the environment and a lack of managment support for staff.

We spoke with the provider and deputy manager, three other members of staff and five people who used the service. We observed positive interactions between staff and the people living in the home. People told us that they were supported by staff and one person said, "they treat me well here". Another person talked about house meetings that were held every Tuesday and said, "I can air my thoughts, say what I like, what I don't like and they (staff) listen".

Care records contained information about people's dietary needs and their likes and dislikes in relation to food. The menus included a choice of breakfast foods, a main lunchtime meal and a selection of lighter evening meals. One person said, "I always enjoy the food here". Another person said, "they (staff) let you go in the kitchen and make something if you want to have something different".

We found that arrangements were in place to manage the risks posed by people smoking in the home and fire safety.

Staff told us that they were supported by the management when incidents took place in the home.

The records in the home contained sufficient detail, were in order and up to date.

We talked with the provider, the manager and deputy manager of the home and three other members of staff. We also spoke with four people who live at the home about the care they received and spoke with a relative who visited the home on a regular basis.

People told us that they were happy at the home and felt looked after. One person told us that “It's quite good here, it's got a good atmosphere” and another when talking about the staff said “I get on with them, they're good people”. We found that people's privacy was respected and their views listened to and people were encouraged to be involved in the local community and supported to observe their religious beliefs. A relative who was spoken with also said that she was happy with the care provided at the home and said "staff work with people at their own pace".

We saw that people's care needs were assessed and risk assessments were in place but these did not always contain enough detail to inform staff how to meet all of a person's care needs. Systems were in place to ensure that people's welfare was promoted and protected and any concerns reported and responded to promptly. Staff were also aware of their responsibilities in relation to ensuring people's safety in the home.

We saw evidence that appropriate recruitment checks were being completed to ensure the suitability of staff. We also saw evidence of appropriate quality assurance and monitoring systems.

The inspection took place on 7 and 8 September 2015 and was unannounced. The last inspection of the service was on 1 March 2014 and there were no breaches of Regulation identified.

Rainbow Lodge Nursing Home is a nursing home registered to provide accommodation, personal and nursing care for up to 20 people with mental health support needs. The provider is a partnership and one of the partners is the registered manager. At the time of our inspection there were 15 people living at the home.

There was a registered manager in post. 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.

People were not always safe. We found that fire safety arrangements were not being followed and this placed people at risk in the event of a fire.

The service did not have effective arrangements for the management of medicines to protect people against the risks associated with medicines.

Risk management arrangements were not robust and this placed people at risk of receiving inappropriate or unsafe care.

The provider had arrangements in place for safeguarding people, however not all the staff were aware of the procedures for keeping people as safe as possible when suspected abuse was reported. Safe recruitment practices were carried out.

People told us there were enough staff on duty to meet their care needs. However, the duty rotas were not up to date and did not detail how some staff were deployed and the hours they worked.

People told us that they experienced some restrictive care practices, such as not being able to have a drink after a certain time, not being able to go out a night and not having access to parts of the home during the night. People had not agreed to these restrictions and the provider had not recognised that these care practices were restrictions on people’s liberty. People’s ability to consent to their care and treatment had not been assessed in accordance with legislation.

People did not receive effective care because the providers did not keep up to date with good practice guidance for supporting people with mental health needs. People did not receive care and support as detailed in the providers Statement of Purpose.

People’s health needs were not always monitored or managed effectively and they were at risk of not having their health needs met.

People were not always treated with dignity and respect and their privacy was not always respected.

People were not always given care in a personalised way which met their individual needs.

People were not offered or supported with activities that were meaningful to them, met their preferences and allowed them to broaden their life experiences.

There was a lack of management leadership and a lack of systems to check on the quality of care, which meant people were at risk of receiving care which was not appropriate to their assessed needs and did not follow best practice.

People lived in an environment that was well maintained and clean.

Staff received induction, training, supervision and appraisal to help them to carry out their roles.

People received enough suitable food to meet their preferences and needs.

People were asked for their feedback on the service through regular resident meetings, annual surveys and keyworker meetings. Staff worked in partnership with other health and social care professionals in managing people’s mental and physical health.

We found several 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 the report.