Ranmore House is a privately owned home registered to provide accommodation and support for up to 5 people who have a learning disability, including autism or epilepsy. On the day of our inspection five people were receiving care and support.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager was responsible for two locations and was working at the other location during our visit. The deputy manager was present for the duration of the inspection.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

People were protected from harm and had assessments in place for identified risks. The registered manager logged any accidents and incidents that occurred and put measures in place for staff to follow to mitigate any further accidents or incidents.

Staff supported people to keep healthy by providing people with a range of nutritious foods. People were supported to be involved in the menu planning and their shopping.

People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in a range of activities which were individualised and meaningful to them. People planned their day with help from staff and this was flexible depending on how people felt or what activities were available.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were undertaken in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People and staff interaction was relaxed. It was evident staff knew people well and understood people’s needs and aspirations. Staff were very caring to people and respected their privacy and dignity.

There were sufficient numbers of staff on duty to meet people’s needs and support their activities.

Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the home

Staff received a good range of training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the registered manager had good management oversight of the home.

The registered manager undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred or the home had to close for a period of time, people’s care would not be interrupted as there were procedures in place to manage this.

Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

A complaints procedure was available for any concerns. This was displayed in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas into the running of the home.

how the service is run.’

Ranmore House is a privately owned service registered to provide accommodation for up to five people with learning disabilities. It is situated in a residential area of Banstead. At the time of the inspection there were five people living at the home.

This inspection took place on 3 December 2015 and was unannounced.

The home was run by a registered manager, who was present on the day of the inspection visit. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Risk of harm to people had not been consistently identified and controlled. Where risks had been identified these had been these were managed and reviewed.

People received their medicine as prescribed. All medicines were administered and disposed of in a safe way. We noted information relating to persons allergies had not been included in their MAR chart so the risk of harm could be missed by staff. PRN (when required) medicine did not have protocols in place.

Parts of the home were not well maintained and we saw broken tiles and a cracked window in the bathroom on the first floor. Some bedrooms did no promote people’s dignity and privacy as curtains had been pulled down and not replaced. The garden was not well maintained and required the rubbish to be cleared as this was unsafe for people who accessed the garden.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The act requires that as far as possible people make their own decisions and are helped to do so when needed. We noted one person should have had a best interest meeting to make a decision on their behalf which was not in place.

Where peoples liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the persons rights were protected.

There were sufficient numbers of staff deployed to meet people’s needs. Staff were appropriately trained to meet the needs of the people who lived at the service. Staff did not receive annual appraisals or formal supervision on a regular basis. Recruitment procedures were robust to ensure that staff had appropriate checks undertaken before they commenced employment.

People were protected from the risk of abuse. Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. The staff we spoke to knew of types of the different abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

People were encouraged and supported whenever possible to be involved in their care and had access to a range of health care professionals, such as the GP, district nurse, dentist and opticians.

People told us the food was good and there was lots of choice. We saw people had access to drinks and snacks at any time during the day or night. People were treated with kindness by the staff on duty.

People had individual care plans. They were detailed and updated regularly. We recommended some information in the care plans could be archived as this was several years old and not relevant to people’s current needs.

Staff told us the registered manager supported them in their roles. Relatives told us they had every confidence in the manager.

People were aware of the complaint procedures and relatives told us they would know how to make a complaint.

The registered manager had not maintained accurate, complete and detailed records in respect of people and records relating to the over

At the time of our inspection there were five people living at Ranmore House. All of the people who lived in the home had complex needs which meant they were not able to tell us their experiences of using the service; we therefore used our observations and spoke with relatives of people to help inform our judgements.

Our observations showed that people were supported with their personal care in a private way and in a way that promoted their dignity. People appeared very relaxed in the home and staff were observed to be caring and supportive in their approach.

We spoke with relatives of people and they told us that they were happy with the care provided and felt that their relative was safe and comfortable in the home. One relative said "I couldn't think of anyway that they could improve the care they already provide" and "It's not a home that people just live in, it's very clearly their home".

Relatives of people spoke very highly of staff and said they are "Extremely caring".

Relatives also told us that they found the management of the service to be very approachable and open to feedback or suggestions. They said the service was very responsive to any suggestions they made and felt that if they had the need to raise a concern then they were confident that the appropriate action would be taken.

We saw that the service had quality assurance systems in place to ensure that the care and support provided to people was effective and of a high quality.

We used a number of different methods to help us understand the experiences of people using the service, because people had complex needs which meant they were not able to tell us their views.

We spoke with one person who used the service on the day of the inspection. They told us that they like living at the home. They said "Staff look after me" and "I can do what I want to and I choose when I do things". This was confirmed by our observations during the day as we saw that staff speak to people who used the service in a kind and respectful way. We saw that the environment was relaxed and some people who used the service had been taken out on the day of our inspection, to places they liked.

We also spoke to two relatives who gave us their views. They told us that the staff treated people as an individual and went out of their way to ensure that people had familiar items that surrounded them so they were relaxed. They also said that staff encouraged and promoted people's independence. One said "he's very happy there and loves the job he does each week" and "we immediately knew it was the right place and he settled immediately".

One relative told us that the home was "Always very clean" and this was confirmed by our observations on the day as we saw that staff had completed the cleaning duties for that day.

People told us that they liked living at Ranmore House and chose to live there because it was small and friendly. They told us that staff were kind and respectful and nothing was too much trouble for them.

They told us that they are consulted about their care and how this is delivered. They are aware of care plans and are involved in reviews of care. They told us that they can invite people who are important to them to attend their reviews.

Relatives were satisfied with the care provided and are welcomed into the home at any time. There was good feedback about the food provided and people said that they enjoyed their meals.

Some people told us that they enjoyed the activities provided and that they are supported to access the facilities in the local community.

They also said that they enjoyed attending day centres for selected activities.