Ranmore House

Ranmore House is a care home providing care for up to five people. On the day of our visit five people lived at the service. The service provides support to people who have a learning disability and some who may challenge the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

We met and spoke to all five people during our visit. However, some people who lived at Ranmore House had some communication difficulties due to their learning disability and associated conditions, such as autism. Therefore, they were not able to tell us verbally about all their experience of living there. We spent short periods of time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. One relative who provided feedback said; “They (the staff) are brilliant with him.” One person said they ‘were happy’ living in the service.

People’s relatives said they felt their loved ones were safe with the staff supporting them. Systems were in place to safeguard people. Risks to them were identified and managed.

The support required with medicines was assessed, agreed and provided to people. Infection control measures were in place to prevent cross infection. Staff were suitably recruited. Staffing levels were flexible to enable the service to provide a bespoke service to people to meet their needs.

People were supported by staff who completed an induction, training and were supervised. The support required by people with health and nutritional needs was identified and provided. People were 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.

A relative said all the staff were kind and caring. Their privacy and independence were promoted.

Systems were in place to deal with concerns and complaints. This enabled people to raise concerns about their care if they needed to.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

People had staff support to access activities and holidays. This was flexible and provided in response to people’s choices. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs.

People were supported by a service that was well managed. Records were accessible and up to date. The service was audited, and action taken to address any areas identified that needed improving. A relative was complimentary of the registered providers and manager and described them as; “Very welcoming, keep me informed and encourage us to be involved in our son’s care.” Staff were committed to providing good outcomes for people.

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

Rating at last inspection

The last rating for this service was Good (Published 14 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 and associated Regulations about how the service is run. The registered manager was responsible for two locations and was working at the other location during our visit. The deputy manager was present for the duration of the inspection.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

People were protected from harm and had assessments in place for identified risks. The registered manager logged any accidents and incidents that occurred and put measures in place for staff to follow to mitigate any further accidents or incidents.

Staff supported people to keep healthy by providing people with a range of nutritious foods. People were supported to be involved in the menu planning and their shopping.

People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in a range of activities which were individualised and meaningful to them. People planned their day with help from staff and this was flexible depending on how people felt or what activities were available.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were undertaken in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People and staff interaction was relaxed. It was evident staff knew people well and understood people’s needs and aspirations. Staff were very caring to people and respected their privacy and dignity.

There were sufficient numbers of staff on duty to meet people’s needs and support their activities.

Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the home

Staff received a good range of training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the registered manager had good management oversight of the home.

The registered manager undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place to manage this.

Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas into the running of the home.

how the service is run.’

This inspection took place on 3 December 2015 and was unannounced.

The home was run by a registered manager, who was present on the day of the inspection visit. ‘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 and associated Regulations about how the service is run.

Risk of harm to people had not been consistently identified and controlled. Where risks had been identified these had been these were managed and reviewed.

People received their medicine as prescribed. All medicines were administered and disposed of in a safe way. We noted information relating to persons allergies had not been included in their MAR chart so the risk of harm could be missed by staff. PRN (when required) medicine did not have protocols in place.

Parts of the home were not well maintained and we saw broken tiles and a cracked window in the bathroom on the first floor. Some bedrooms did no promote people’s dignity and privacy as curtains had been pulled down and not replaced. The garden was not well maintained and required the rubbish to be cleared as this was unsafe for people who accessed the garden.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The act requires that as far as possible people make their own decisions and are helped to do so when needed. We noted one person should have had a best interest meeting to make a decision on their behalf which was not in place.

Where peoples liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the persons rights were protected.

There were sufficient numbers of staff deployed to meet people’s needs. Staff were appropriately trained to meet the needs of the people who lived at the service. Staff did not receive annual appraisals or formal supervision on a regular basis. Recruitment procedures were robust to ensure that staff had appropriate checks undertaken before they commenced employment.

People were protected from the risk of abuse. Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. The staff we spoke to knew of types of the different abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

People were encouraged and supported whenever possible to be involved in their care and had access to a range of health care professionals, such as the GP, district nurse, dentist and opticians.

People told us the food was good and there was lots of choice. We saw people had access to drinks and snacks at any time during the day or night. People were treated with kindness by the staff on duty.

People had individual care plans. They were detailed and updated regularly. We recommended some information in the care plans could be archived as this was several years old and not relevant to people’s current needs.

Staff told us the registered manager supported them in their roles. Relatives told us they had every confidence in the manager.

People were aware of the complaint procedures and relatives told us they would know how to make a complaint.

The registered manager had not maintained accurate, complete and detailed records in respect of people and records relating to the overall management of the service. The service did not have systems in place to record and monitor the quality of the service provided.

Accidents and incidents were recorded and acted upon to ensure people were kept safe whenever possible. People were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what we told the provider to do at the back of this report.

Our observations showed that people were supported with their personal care in a private way and in a way that promoted their dignity. People appeared very relaxed in the home and staff were observed to be caring and supportive in their approach.

We spoke with relatives of people and they told us that they were happy with the care provided and felt that their relative was safe and comfortable in the home. One relative said "I couldn't think of anyway that they could improve the care they already provide" and "It's not a home that people just live in, it's very clearly their home".

Relatives of people spoke very highly of staff and said they are "Extremely caring".

Relatives also told us that they found the management of the service to be very approachable and open to feedback or suggestions. They said the service was very responsive to any suggestions they made and felt that if they had the need to raise a concern then they were confident that the appropriate action would be taken.

We saw that the service had quality assurance systems in place to ensure that the care and support provided to people was effective and of a high quality.

We found that the provider had taken action to address the identified concerns around staff training so that people were protected from the risk of unsafe or inappropriate care.

We spoke with one person who used the service on the day of the inspection. They told us that they like living at the home. They said "Staff look after me" and "I can do what I want to and I choose when I do things". This was confirmed by our observations during the day as we saw that staff speak to people who used the service in a kind and respectful way. We saw that the environment was relaxed and some people who used the service had been taken out on the day of our inspection, to places they liked.

We also spoke to two relatives who gave us their views. They told us that the staff treated people as an individual and went out of their way to ensure that people had familiar items that surrounded them so they were relaxed. They also said that staff encouraged and promoted people's independence. One said "he's very happy there and loves the job he does each week" and "we immediately knew it was the right place and he settled immediately".

One relative told us that the home was "Always very clean" and this was confirmed by our observations on the day as we saw that staff had completed the cleaning duties for that day.