Ranis Healthcare Limited

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.

This is the first assessment for this service. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 33 (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 was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Whilst people’s needs were assessed upon the commencement of their support, they were not regularly reviewed. This meant people’s changing needs were not always identified. One person told us, “I’ve said I need more help, but nothing has changed.”

People told us they were not involved in the development of their care plans. One person told us, "No one ever asked me about my care plan - it just sort of happened." People's care plans did not reflect their needs and preferences. One person told us, "I feel I'm constantly telling them [staff] how to do things."
 

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. We identified limited use of recognised assessment tools.

Care plans did not always contain information about people’s specific health needs and how staff should support them. For example, a person had a diagnosis of epilepsy, but their care plan did not contain any information or guidance to staff as to how to respond in the event of a seizure. Another person had a diagnosis of diabetes, but their care plan did not outline to staff what to do in the event of high or low blood sugar levels. Another further individual had been assessed as requiring a Level 4 pureed diet, but this was not reflected in their care plan. This placed people at risk of harm.

The provider did not always work well across teams and services to support people. Some people’s care was delivered by a variety of different staff. This meant staff often supported them without understanding their needs, risks, or routine. People and their relatives told us communication between staff could be variable. One person told us, “I don’t think they always pass on the right information between shifts.”

We identified incidents where information was not proactively shared with external professionals in a timely manner. For example, a person was prescribed thickening powder for their drinks. This had been consistently refused by the person for a period of 5 months, but the provider had failed to seek medical advice, placing this individual at potential risk of harm.

Despite our findings, staff told us they worked well with other health and social care professionals such as community nurses, GP and social workers when needed. We received positive feedback from 2 professionals who had recently worked with the provider. One professional stated, “Their [staff] collaborative approach—working closely with myself, the occupational therapist, and other involved professionals—was key to ensuring continuity and quality of care.”

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

People’s care plans lacked sufficient detail in relation to individual health conditions including signs of deterioration and what action staff should take in response to these signs. Guidance for staff was either not available or generic and did not always reflect how the person was impacted day to day in relation to their conditions. For example, there was no information related to how people living with dementia might be impacted day to day and how staff could support them. One relative told us, “[The care staff] don’t seem to understand dementia well enough- I’ve had to explain it to multiple staff.”

People’s experiences were dependent on if they had consistent care staff. One person told us, “I don’t ever get to know them so it’s difficult to say how they manage with my healthcare as one will be different to the next.” A family member told us that they had previously had concerns regarding staff knowledge and understanding, in relation to their relative’s specific health condition. They told us their relative “didn’t feel safe” as staff “didn’t have a clue what they were doing.” However, they explained that once this had been raised with the provider the situation had improved due to the person now having consistent care staff.

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

People’s experiences of using the service told us they did not all result in a consistently positive outcome or that it met their expectations. This was because people were not consistently receiving care from people who knew them and their needs; had inconsistent care calls that caused them anxiety or because they did not feel listened to when they raised concerns.

People and their relatives told us that if people were supported by consistent care staff, outcomes tended to improve. For example, some people required their fluid intake to be monitored due to the risk of dehydration. One relative told us, “They give [family member] tea and water but don’t check that she’s taking them.” Another family member told us that they were concerned about their relative not having enough to drink. They explained that staff had recorded drinks as “given” when they had been made but not necessarily consumed. They stated, “I found out that [relative] wasn’t drinking it. [Relative] went into hospital because of it.” However, they explained that since a consistent care team has been put in place communication and monitoring had improved.

People had not always been empowered or included to make decisions about their care and support. The provider failed to evidence a robust system of regular reviews or effective feedback mechanism to enable them to understand people’s experience of the support received. Although staff had received training in relation to the Mental Capacity Act (2005) they were not consistently able to explain the main principles to us.

People’s consent to care was not always clearly documented within care plans. However, where required, Mental Capacity Assessments and Best Interest Decisions had been completed and documented. People and relatives we spoke with had no concerns regarding consent.