Ranis Healthcare Limited

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service. This key question has been rated inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 36 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Care plans were not developed in conjunction with people and kept up to date. People told us that staff did not read care plans and as a result care was not always provided in line with their needs and preferences. One person told us, “The care plan should be there, but I don’t think they all read it properly.” Another person told us, “I don’t think they read the care plan properly – they always ask the same questions.”

People told us that whilst their basic needs were met, care was not particularly consistent, nor person centred. One person told us, “Sometimes I have to remind them how I like things done. There’s no real consistency- it feels like they are guessing at times.” Another person told us, “I can’t fully relax because I feel I need to monitor what they’re doing…They don’t always meet my needs clearly or consistently."

There were significant shortfalls in how the provider understood the diverse health and care needs of people, so care was not joined-up, flexible or supportive of choice and continuity. People and their relatives consistently told us of their concerns regarding the numbers of different staff members providing support and the impact that had on the quality of care provided. One family member told us, “I think it’s hard to build a good relationship with [relative] as there are always a string of different carers.” Another family member said, “[Relative] will have 4 different people in the same day and then another different 4 the next day.” A person told us, “No continuity of care. Different person twice a day, every day. I’ve asked for a main carer, and it doesn’t happen. I have to explain myself every time they come.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The provider told us that they sought to adapt information to meet people’s needs, for example, providing documents in large print. Whilst people’s communication needs were detailed within their care plans, people consistently told us staff did not always understand or listen to them which meant communication was often difficult. One person told us, “I don’t feel unsafe, but it would be easier if communication was clearer.” A relative said, “Language is difficult and [family member]’s hard of hearing and they never make allowances for it.”

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

People and their relatives told us when they raised concerns they were not always responded to effectively and changes needed were not always monitored and embedded. The service had no system in place to record, manage, investigate, and monitor complaints and concerns. They were therefore unable to demonstrate concerns were managed appropriately or used to make improvements to the service.

One relative told us, “No one seems to listen when we raise concerns…We’ve given feedback before, but nothing seems to change.” Another relative told us, “The manager never got back to me for weeks on end. They don’t ever call back. I tried to arrange a meeting, but they wouldn’t respond.”

The provider made sure that people could access the care, support and treatment they needed when they needed it. The provider was alert to potential discrimination and inequality that could disadvantage different groups of people in accessing care, treatment and support. The provider ensured people they supported were treated fairly and not discriminated against.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. The provider was able to give us some examples of where they had considered people’s specific cultural or religious needs. However, in the absence of regular monitoring and reviews, there were missed opportunities to document people’s individual needs and wishes in relation to their protected characteristics.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Care plans contained limited detail about people’s end of life wishes and preferences. Two people were being supported at end of life at the time of the inspection. Their care plans contained no specific details for staff regarding the best way to support these individuals nor how they should work alongside other professionals involved in their care. Staff had not received end of life training although the provider confirmed they were in the process of sourcing this.