Ranis Healthcare Limited

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 service. This key question has been rated inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulations in relation to people’s safe care and treatment, safeguarding, staffing, and fit and proper persons employed.

This service scored 34 (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 have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and lessons were not learnt to continually identify and embed good practice.

The culture within the service was not focused on safety and learning. Known risks to people were not fully assessed and insufficient guidance was provided to staff around how these risks should be mitigated and managed. Whilst incidents were recorded, action taken was not always clear and learning was not always identified. There was no analysis of accidents, incidents, concerns and safeguarding referrals for patterns and trends. This meant opportunities for learning and the chance to improve the service provided were missed. We saw evidence that concerns, regarding similar issues we identified, had been repeatedly raised with the provider, particularly around staff timekeeping, staff training and consistency of care. However, there was no evidence of sustained organisational learning to ensure improvements were made.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services. Care plans and risk assessments lacked sufficient information, which put people at risk of incorrect care being provided, for example, in the event of a hospital admission.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety.

Staff we spoke with were vague in their understanding of safeguarding processes. When we asked a member of staff what signs of abuse they should be aware of, they told us this was “not relevant” to their role. Where incidents occurred, these were not followed up in timely manner to ensure appropriate action was taken to keep people safe.

People gave us varied feedback regarding how safe they felt. Where people were supported by a consistent staff team who knew them and understood their needs, they generally felt safer. One person told us, “I don’t feel unsafe, but when I have to train them [staff] or can’t understand them, it does make me feel uneasy.” This view was supported by another person who told us, “I don’t feel safe when they [staff] don’t understand what they are doing.” A relative also told us, “I wouldn’t say I feel safe when new carers come in without knowing [relative]’s needs.”

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. This placed people at risk of harm as the provider did not do all that was reasonably practicable to mitigate risk.

People’s care records lacked detailed information to ensure staff were fully aware of risks and how to manage them. We identified people living with specific medical conditions or taking certain medicines did not have corresponding risk assessments in place to ensure staff knew how to safely meet their needs. We identified gaps in risk management and monitoring in relation to the following areas: bed rail use, choking and aspiration, asthma, diabetes, epilepsy, catheter care and skin integrity. There were also considerable gaps in staff training and competency assessments in relation to these areas.

People and their relatives fed back that staff were not always safely managing risks associated with their care. One relative told us, "Some of them [staff] clearly haven’t been trained enough – it’s not safe when you’re correcting catheter mistakes." The majority of staff supporting this person were not trained in catheter care and competency checks had not been completed. Another relative told us how they had to explain to staff how to move their family member safely and had to frequently remind staff to reposition them to prevent skin breakdown. When we asked to see repositioning charts for this person, they could not be provided to us. The provider put these in place during the course of the assessment.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services. Care plans and risk assessments lacked sufficient information, which put people at risk of incorrect care being provided, for example, in the event of a hospital admission.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

The provider failed to ensure all staff received appropriate training to meet the needs of people support in relation to specific health conditions, such as diabetes, epilepsy, catheter care, pressure care and dysphagia. Competency checks had not been completed, staff supervision was limited, and minimal spot checks were undertaken. This meant the provider could not be assured that staff were safely and effectively applying their learning when supporting people. People and their relatives told us that they did not feel staff were adequately trained to meet their needs. One person told us, “I don't think there is any training at all." Another person said, “Some come here because they haven’t had enough training, and I have to train them!”

Analysis of the electronic call monitoring system evidenced a high proportion of care calls were more than 15 minutes late and some were more than 45 minutes late. The provider told us this was due to the call monitoring system functionality being used incorrectly by staff. However, people we spoke with told us they frequently experienced late or missed calls and that communication with the office was poor. One person told us, “They can be very late, then do rush quite a lot and want to get away”, another person told us, “If they’re running late, they never let me know, and that leaves me feeling anxious and forgotten.”

Staff were not recruited safely. Where sufficient references could not be obtained for new employees, risk assessments had not been completed. We found the necessary police checks had not been completed for 1 member of staff. This placed vulnerable people at risk.

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 stated that staff generally used gloves and aprons and disposed of them appropriately after use. Staff had received training and told us they had enough personal protective equipment (PPE). A staff member told us, “We can get it from the office, masks, gloves, shoe covers, everything is available there.”

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The provider had failed to ensure robust systems were in place to enable people to receive their medicines as prescribed. We found where people were prescribed anticoagulant medicines, which increase the risk of excessive bleeding, no risk assessment had been completed to guide staff as to how to manage the risk. For people who were prescribed creams to treat skin conditions, there were no body maps in place to guide staff as to where this needed to be applied. This meant people were at risk of their skin integrity deteriorating, as staff did not have the information they needed to safely apply these creams. Staff had not received appropriate training and competency checks to administer medicines safely.

People and their relatives told us that support provided around medicines management was not consistently reliable. One person told us, “They [staff] do give me my tablets, but I feel like I have to double-check things myself.” One relative said, ““They give [family member] their medication but I am not 100% confident with it.” People and their relatives told us that late care calls also had an impact on medicines administration. One person told us, “I need my medication at 9am but they’re always late.” A relative said, “They do give [family member] their medication, but the timing isn’t always reliable."