Rance Healthcare Services Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Where concerns had arisen, the registered manager and nominated individual had worked with people, relatives and professionals to resolve concerns and make any improvements. Staff told us learning was shared with them during 1 to 1 meetings and through staff communication channels. One staff member said, “We let the management know if anything goes wrong, they ask if there’s anything they can improve.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s needs were assessed prior to them receiving care. Staff told us they had access to guidance about people’s needs when they first started supporting them. The registered manager told us care plans were developed and more detail was added as staff got to know people and understand their needs. People’s care plans were regularly reviewed and updated where their needs had changed to ensure care met their current needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and relatives told us they, or their family members felt safe when receiving care and support. One relative said, “Yes, they are doing care safely. [Person] is given personal care and helped to wash and dress. They are pretty good. I can’t say anything bad about them.”

There were systems in place to ensure any concerns for people’s safety or well-being were recorded and escalated as required. Staff were trained in safeguarding and knew how to identify concerns for people’s safety and how to report any concerns. One staff member told us, “I know who I would speak to, there’s [registered manager] or the field care supervisor. Or I could contact the local authority or CQC if I felt I needed to.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and relatives spoke positively about how risks were managed. One relative shared, “[Person] is transferred from upstairs to downstairs from bed using a slide sheet to a chair, then to the stairlift to her wheelchair downstairs. They [staff] did a risk assessment for transfers, always [transferred] by 2 carers. They may bed wash or shower her, it was also risk assessed. No falls or urine infections. She has [medical condition], they apply creams on her dry leg skin upwards. She wears pressure stockings and the carers know how to put them on. The carers behaviour is a “can do” attitude. It’s all about [person] rather than their schedule.”

The registered manager completed risk assessments which staff used to provide safe care. Staff we spoke with were aware of people’s risks and could describe how they were supported safely. Risk assessments were in place for areas such as mobility, eating and drinking, sore skin and safe transfers. Records showed people’s risks had been reviewed where there had been any changes which ensured people received care that met their current needs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The registered manager and field care supervisors carried out assessments of people’s homes to ensure the environment and any equipment used was safe. One relative told us, “It’s extremely safe. [Person] has no mobility and they use lifts, hoists and a commode. Their supervisor has checked their use of equipment. They share any concerns with me.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives told us there were enough staff to support them safely. One relative said, “I get the same carer Monday to Friday, on weekends I get 2 others and I know them all.” and, “Oh yes, they are always on time, including weekends. One night they got stuck in traffic and phoned me to let me know, but they do turn up.” Another relative commented, “There’s no issue on staffing level concerns, carers know my son. When new staff come in, they come prior to get know him. Ninety-nine percent of the time they arrive on time. They are flexible to change times if we have to go to hospital.”

Staff had received training relevant to their role and told us they felt well equipped to support people safely. Relatives gave positive feedback about staff skills and knowledge. One relative said, “I do think they are well trained. They have a stable team. But a new carer did start, and the supervisor trained her and showed her how to use the equipment.”

The registered manager told us they matched people with staff to support the development of a strong working relationship between people in receipt of care and the staff team. The provider had carried out relevant pre-employment checks to ensure staff were safe to work with people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People and relatives spoke positively about the management of Infection Prevention and Control (IPC). One relative told us, “The hygiene standards are excellent. They are always changing gloves and wash their hands, they put PPE (Personal Protective Equipment) on and wear a mask all the time. They also put shoe guards on. The waste goes in a bag, like a nappy bag and it all gets put in the bin outside.”

Staff told us they had access to PPE and contacted the management team if they were running low. There were systems in place, which staff followed, to reduce the risk of cross infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines records did not always reflect the difference between daily medicines and those prescribed for use 'as required'. Some Medicine Administration Records (MAR) showed discontinued medicines had been administered due to recording errors. We discussed this with the registered manger and nominated individual who took immediate action to address the concerns. Following the inspection, they shared with us the actions they had taken and explained how changes would be monitored to ensure they were effective.

Despite these recording concerns people told us they were happy with the support they received with their medicines. One relative said, “Yes, carers give [person] medicines, he can swallow them. I know they record on their app, his meds are in a dosette box. They also use barrier creams. There’s been no recent changes in his prescription. They give him pain relief if he needs it, no problems with medicines.”