Ranger Home Care Ltd – Main Office

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation to consent.
 

This service scored 50 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider completed an audit of care plans. However, the quality of the audit was not demonstrated, and it was unclear what information was reviewed, and what changes were made as a result. We received mixed feedback about relatives being involved in care plan reviews. One relative said, “We get information by e-mail, they come round every 2 weeks to see how things are, we have team meetings every 8 weeks and they telephone me with updates.” Another relative told us, “No reviews, but they do ring to see how things are.”
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We found some people’s care plans with specific needs such as diabetes and epilepsy did not reflect detailed information or best practice guidance. One person with risk of hyponatremia did not have a detailed care plan and risk assessment around this specific condition. Hyponatraemia is a common electrolyte disorder defined as a serum sodium concentration below 135 mmol/L, indicating an excess of water relative to sodium in the blood. The lack of detail around this in the person’s care plan meant staff could not access clear guidance around fluid management and symptom monitoring. This placed people at potential risk of receiving unsafe and ineffective care.
 

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We found some concerns within people’s daily notes without evidence of action always being taken to ensure people received appropriate support. For example, 1 person was noted to have, “reddish line which look like wound inside skin on left leg.” However, we did not see evidence or an explanation as to how concerns such as this were always escalated appropriately to ensure teams worked well together, and across services where necessary.

The registered manager told us they ensured they worked with staff to ensure care was not task focused. They said, “We recruit the right person, some people are task focused, we find it can be cultural, it is about matching the carer to the right person. Through training, being on WhatsApp groups with families, sending in a domiciliary carer to see interactions, building relationships with families.”
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Care plans contained detailed information about people’s likes and preferences. People were supported with activities and exercise according to their individual needs and choices. For example, one person was supported to use their hydrotherapy pool, and another person was supported with exercising.
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Some people required blood pressure monitoring, or blood glucose monitoring. However, people’s care plans did not contain important information such as the person’s baseline observations, and what ‘safe ranges’ would be suitable for each person. This meant the provider could not demonstrate if people’s clinical observations were always safe, and in line with their individual needs to identify signs of deterioration. We requested information about people’s observations and readings; however, the provider told us these were recorded on paper and kept in people’s homes. This meant the provider was unable to always access and maintain oversight of people’s clinical conditions and observations. The provider did not demonstrate a robust approach to monitoring the effectiveness of people’s care, treatment and support and evidence action was taken to continuously improve it.
 

The provider did not tell people about their rights regarding consent or respect these when delivering care and treatment.

People’s rights were not fully protected when they needed covert medicines. There were at least 2 people receiving medicines covertly; this involves giving medicines to a person without their knowledge or consent. The provider’s policy noted they would ensure that staff did not administer medicines covertly, if people had capacity to make decisions about their treatment and care. However, the registered manager did not ensure appropriate care plans were in place for people receiving covert administration of medicines. There was a lack of evidence to demonstrate that regular reviews were taking place to ensure the covert administration was used for the shortest time. This meant people’s rights were not respected or upheld making the process potentially unjustified.

We reviewed the staff training matrix and found only 2 staff had completed mental capacity training. The provider did not demonstrate how they ensured all staff supporting people with and without capacity understood the Mental Capacity Act 2005, and to ensure people were receiving the appropriate support.