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.

At our last assessment we rated this key question inadequate. At this assessment, the rating has changed to requires improvement. Whilst improvements had been made, these changes were yet to be embedded at the service. Leaders and the culture they created did not consistently support the delivery of high-quality, person-centred care. The provider was previously in breach of the legal regulation in relation to governance. Sufficient improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 54 (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, whilst 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.

Since the last assessment, the provider had made improvements in developing a shared direction and a positive culture. Leaders and staff were increasingly working in a way that reflected the values of transparency, equity, equality, human rights, diversity, and inclusion. Feedback from people and their relatives reflected a service that was improving, but where changes were still being embedded. A relative told us, “They are turning over a new leaf. It’s not expected to happen overnight. Will wait and see.”

Most staff were positive regarding the culture at the service. A staff member told us, “Everyone is so supportive. I have no hesitations working with any of them. It is such a friendly environment. Everything is going really well. We are working hard. Everything is going better since the new management is in post.”

At the last assessment we found the provider did not have capable, compassionate, and inclusive leaders. We found leaders did not have the required skill and knowledge to deliver a safe and effective service.

The provider had made improvements in leadership since the last assessment. There was a new manager in post, who was awaiting registration with the Care Quality Commission at the time of the assessment. We found them to be open and honest about the challenges the service had faced, and they had clear plans to drive improvement going forward. Staff told us they felt supported by leaders and appreciated the clear direction and positive example they set.

Most people and their relatives told us that they felt the service was improving and they felt that it was now well-led. However, not all relatives were aware of who the new manager was.

At the last assessment people did not always feel they could speak up and that their voice would be heard.

At this assessment, people and their relatives told us they knew how to raise concerns and were confident any issues that arose would be managed. A relative told us, “They always acknowledge my complaints when things are not done. They are dealt with.”

Staff told us they were assured that if concerns were raised internally the management team would take appropriate action. A staff member told us, “I feel listened to by the management team and can approach them with any concerns or suggestions.”

At the last assessment, we received mixed views from staff regarding how they were treated.

At this assessment, we found the service valued diversity in their workforce. Staff told us of an inclusive and fair culture amongst the staff team. A staff member told us, “The management is fine. The office has changed since the last inspection. Things are now a lot more professional.” Another staff member told us, “We are treated very fairly as a member of staff.”

At the last assessment, 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.

Since the last assessment, the provider had strengthened their governance arrangements by using the services of an external consultant. This support had enabled them to identify gaps and start to introduce appropriate systems and tools to improve management oversight. This work was ongoing at the time of the assessment and, whilst starting to produce positive results, was still in the process of being embedded. This meant some of the gaps identified during this assessment (for example, missing information in risk assessments) had not been identified by the provider’s own governance and auditing systems.

In response to concerns found at the last assessment, staff training compliance has improved considerably. However, there were still gaps in staff competency checks, supervisions, and spot checks. When we spoke with staff, they did not always demonstrate a full understanding of individual’s specific needs and health conditions. As such, work is still required to effectively embed staff knowledge and understanding in these areas.

Staff were positive about the changes being made at the service. A staff member told us, “Everything completely changed following the last CQC inspection 6 months ago. We now have e-MAR charts and we have Nourish. It makes things so much easier for us. There have been so many changes to policies. We now have online meetings, supervisions, and visits to the client’s home for reviews.”

At the last assessment, the provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people.

At this assessment, we found improvements had been made. Care records evidenced improved partnership working with a range of heath and social care professionals. Care staff told us they “worked well” with health professionals and felt confident seeking support if they felt unsure about anything.

At the last assessment, the provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome, and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Since this assessment, the provider had sought to improve the systems in place for recording incidents, safeguarding referrals, complaints, and concerns. However, work was still ongoing to ensure these processes were clearly embedded. Where incidents occurred or concerns were raised, the management team was able to verbally explain what action had been taken. However, this was not consistently documented in sufficient detail. In addition, there was limited analysis of this information for themes, patterns, and trends. This meant there remained missed opportunities to identify learning and drive improvement in service delivery.