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.

At our last assessment we rated this key question inadequate. At this assessment, the rating has changed to requires improvement. This meant that, whilst improvements had been made, some aspects of the service were not consistently safe. There was an increased risk that people could be harmed. The provider was previously in breach of legal regulations in relation to people’s safe care and treatment, the ways people’s medicines were managed, safeguarding, staffing and recruitment processes. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At the last assessment, the provider did not demonstrate a proactive and positive culture of safety. Known risks to people were not fully assessed and incidents were not consistently recorded and reviewed for learning.

Since the last assessment, the provider had made improvements to the processes in place for monitoring accidents, incidents, concerns, and safeguarding referrals. Staff told us they knew how to report and record any issues and were confident the management team would take appropriate action. People and their relatives told us that they had seen a positive improvement in how staff responded when concerns arose. The majority of people told us they felt listened to by the management team. However, whilst incidents or concerns were now followed up in a timely manner, outcomes and lessons learned were still not always identified and recorded. The management team acknowledged there was still work to be completed to ensure effective recording to enable patterns and trends to be identified. Processes were still being established and embedded to enable the service to effectively sustain a culture of organisational learning and continuous improvement.

At the last assessment, the provider did not work well with people and health system partners to establish and maintain safe systems of care. Records held by the provider failed to demonstrate there was adequate information for robust continuity of care.

At this assessment, the management team were in the process of reviewing all care plans and risk assessments. Where these had been reviewed, they generally contained detailed information to ensure people were supported safely. However, this work was yet to be completed for all people meaning some care plans and risk assessments continued to lack sufficient detail. This meant people remained at risk of receiving incorrect care, for example, in the event of a hospital admission.

At the last assessment, the provider did not have established and embedded systems and processes to help protect people from abuse. Staff were vague in their understanding of safeguarding processes and incidents were not followed up in a timely manner.

At this assessment, we found improvements had been made in the provider’s approach to safeguarding. The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately.

Staff had completed safeguarding training and knew how to report concerns both internally and to external bodies, such as the local authority safeguarding team. Staff told us they were confident to raise concerns and felt able to speak freely with the management team. A staff member told us, “I have received safeguarding training. If I had concerns, I would inform the police (where relevant) and the management team. I could also inform the local authority or CQC.”

We received positive feedback from people and their relatives. People told us they felt safe. A person told us, “Yes, I feel safe around the staff. They are careful and respectful. I would be comfortable to raise any concerns I have.”

At the last assessment, the provider had failed to work well with people to understand and manage risk. Staff were not providing safe care and people had been placed at risk of harm.

At this assessment, we found the provider had started to make improvements to how they involved people to manage risk. The management team were in the process of carrying out reviews with people and their relatives to update support plans and risk assessments. Where risk assessments had been reviewed these were much improved and contained relevant information to ensure people were supported safely. However, during the assessment we did identify some continued gaps in risk management and monitoring, where issues had not been fully addressed since the last assessment. For example, a person who had a diagnosis of epilepsy did not have an epilepsy care plan and risk assessment in place. In another example, the care plan for a person with diabetes did not contain clear guidance for staff around their specific role and responsibilities in relation to insulin administration. Both issues were fed back to the management team and records were promptly updated during the assessment.

Since the last assessment, staff had received increased training to ensure they were able to meet people’s health needs and manage the associated risks. However, the staff we spoke with during the assessment were not always aware of the specific risks and associated protocols in place for each person they supported. For example, staff were not always aware of who had epilepsy, was at risk of skin breakdown or who was prescribed anti-coagulant medication, even where they regularly supported individuals with these needs.

At the previous assessment, the provider did not always detect and control potential risks in people’s homes. At this assessment we found improvements had been made in how the provider ensured people were supported to remain safe at home. Where care plans and risk assessments had been reviewed, these now included assessment of any environmental hazards and plans for any mitigation required. Risks in relation to moving and handling equipment were now appropriately assessed and documented. All staff had received moving and handling training, but not all had received an assessment of their competency to use this equipment. The manager told us work to ensure all staff had received a competency assessment was ongoing. People told us they were supported in a safe manner. A person told us, “They [staff] use the hoist and are trained to do this. A couple of the carers have never been here before, but they know how to use the equipment.”

At the last assessment we found the provider did not ensure there were enough qualified, skilled, and experienced staff. The provider did not ensure staff received effective support, supervision, and development.

At this assessment, we found some improvements had been made but the impact of these changes was still being embedded. Staff training had now been completed on a range of topics and staff supervision, and spot checks had increased. However, there were still significant gaps in the completion of staff competency assessments, in key areas such as medication, moving and handling and catheter care. In addition, we found the staff undertaking these assessments had not always received suitable training to undertake this role. This meant we could not be assured they were always completed appropriately.

A staff member told us, “I have had lots of training. We have done a lot recently so now everything is up to date…it has been a lot of work.” Whilst most people and their relative’s felt staff were well trained, feedback in this area was mixed. A relative told us, they were “not sure if they [staff] have enough training.”

Analysis of the electronic call monitoring system demonstrated there had been improvements in the proportion of late calls. However, people and their relatives told us they were not consistently informed if staff were going to be late or who to expect. A relative told us, “They used to ring to say they were going to be late. It’s hit and miss. Last time there was no call.” The management team were aware of these concerns and had put measures in place to drive further improvements to punctuality and communication.

Recruitment records showed staff were recruited safely. This included identification checks, satisfactory references, full employment history, right to work verification and enhanced Disclosure and Barring Service (DBS) check.

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. Staff received training on how to manage infection risks and had enough personal protective equipment (PPE) for their use. Any issues identified were picked up through spot checks and talking to people and their family members and resolved quickly.

At the previous assessment, the provider failed to ensure robust systems were in place to enable people to receive their medicines as prescribed. Whilst we saw some improvement at this assessment, there were still some outstanding actions, which had previously been identified as required. For example, 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. In addition, we found for people who were prescribed creams to treat skin conditions, these were not always on the Medication Administration Record (MAR) charts. This meant there was not always a clear record as to when these creams had been applied. During the assessment, we observed the manager was responsive to feedback and took immediate action to rectify these issues.

Whilst all staff had recently had medicines administration refresher training, not all staff administering medicines had had their competency assessed. Where this had been completed, the member of staff carrying out the assessment had not always received appropriate training to undertake this role. This meant we could not be assured staff competency assessments were appropriately carried out to ensure all staff were administering medicines safely.

People and their relatives told us they were happy with how medicines were managed by staff. A person told us, “They [staff] give me my medication. It comes in blister packs. There have been no issues.”