Ranis Healthcare Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance at the service.

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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities. Although the management team told us of their expectations for the service, there was very limited assurance on how this was monitored and discussed with staff. 

People and relatives consistently told us the service they received did not meet their expectations. The feedback for the management of the service was mainly negative. The provider did not have the processes in place to demonstrate they listened to and acted upon concerns, were open and responsive to suggestions and had systems to drive improvement.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

The service was not consistently well led. The management team did not ensure governance systems were effectively used, and they had failed to independently identify shortfalls in the service. Feedback from people and their relatives regarding the management team was overwhelmingly negative. One person told us, “It doesn’t feel well managed – the carers seem left to get on with it.” Another person told us, “I’ve never been asked how things are going – no contact from anyone in charge.” A relative told us, “Communication from management is dreadful…not responsive at all.”

People were unclear who was managing the service. A relative told us, “We don’t get much contact from management – it would be good to know who’s in charge.” Another person told us, “I don’t know who’s running things – I’ve never spoken to anyone from the office.”

People did not always feel they could speak up and that their voice would be heard.  One person told us, “They’ve never asked for my feedback, and I wouldn’t know who to speak to if I had something to say.” Another person told us, “I wouldn’t feel comfortable raising concerns- they don’t seem to listen anyway.” Concerns and complaints were not formally logged in sufficient detail. This meant there was often no clear audit trail demonstrating how concerns had been responded to, alongside action taken and outcomes. One relative told us, “No one has ever asked for my feedback, even after things have gone wrong…They seem to mean well, but there’s not enough awareness or follow-up."

Feedback from staff was mixed but most told us they were assured that if concerns were raised internally the management team would take appropriate action.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The provider had policies and procedures relating to equality, diversity and inclusion and staff had completed the relevant training. The majority of staff we spoke with told us of an inclusive and fair culture amongst the staff team.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance systems and processes in place were ineffectual and had not identified the areas of risk and concern found during this assessment. Leaders demonstrated a lack of understanding of their regulatory responsibilities. We identified numerous gaps in the completion of staff supervision, training and competency checks. This meant individual performance and development needs were not regularly monitored and addressed.

Quality assurance systems were not effective in ensuring people received a consistently good, safe service and were not effective in identifying areas for improvement. Provider oversight of care planning, risk management and the quality of care being provided was poor. Checks to ensure care was delivered as planned were not robust. For example, audits of Medication Administration Record (MAR) charts were not effective in identifying issues in a timely manner. We found instances where medicines had not been signed as given or refused on a regular basis. The management team were unaware of these issues until MAR charts were returned to the office at the end of the month. This meant potential missed doses of medicines were not identified and investigated quickly, placing people at risk of potential harm.

Management oversight of staff employed was poor. As part of the assessment, we requested a list of staff currently employed, alongside other records, such as the training matrix and rotas. We found instances of multiple staff allocated shifts whose names were not on the staff list nor other documents such as the training, supervision and spot check matrices. Despite several requests for information, the provider was unable to provide a clear answer regarding the number of staff currently working for them.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. The records we viewed and feedback we received did not demonstrate that the service worked in collaboration with people and staff when they raised concerns or shortfalls.

Feedback received from external stakeholders was variable. Information was not always shared with commissioners in a timely manner. However, a professional told us the provider worked well with others to ensure a positive outcome for people. They told us, “This multi-agency cooperation helped us navigate a difficult situation more effectively and ensured the service user’s needs remained central to the plan.”

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people.

Where incidents occurred or concerns were raised, these were not always followed up appropriately. Analysis of this information for themes, patterns and trends was not completed, and learning was not identified and embedded to drive improvement leading to similar incidents reoccurring. Where concerns were raised by people, their relatives and / or external professionals, there was a lack of learning and timely improvement.