The Ranch is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Ranch provides residential care for three people with learning disabilities. At the time of our inspection there were three people living at the service who had a range of needs such mental health diagnoses and learning disabilities.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen

The inspection took place on 11 January 2019 and was announced.

The service had 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 2008 and associated Regulations about how the service is run.

Risks to people were not appropriately recorded. There was no monitoring or analysis of accidents and incidents that had taken place to identify trends and reduce further risk. Care plans were not person-centred and did not include any detail around people’s end of life wishes or health diagnosis. Safeguarding procedures were not always followed and appropriate notifications were not made to the CQC and the local authority. People’s rights under the Mental Capacity Act 2005 (MCA) were not protected. The service did not follow the principles of the MCA and correct legal authorisation had not been sought to deprive people of their liberty.

Medicines had not always been stored at an appropriate temperature and people’s medicine profile did not include any information around allergies. There were no gaps in Medicine Administration Records (MARS) and protocols were in place for ‘as and when’ medication.

There was not a sufficient number of staff to meet people’s needs. Some staff did not receive adequate breaks between shifts. Recruitment practices were not robust. Staff were not up to date with their mandatory training. Staff told us that they were not receiving regular supervision and appraisals.

The service did not have robust quality assurance systems in place. Internal audits that had taken place had not identified the issues that we had during our inspection. The service had not notified the Commission of all reportable incidents. This included incidents where people living at the service had unexplained bruising.

People and their relatives were involved in the review of their care. However, this was not recorded in people’s care files. People were treated with kindness, respect and dignity. People and relatives told us they would feel comfortable raising a complaint if they needed to. People had a choice of foods, and their weight was monitored regularly. The premises was suitable to meet people’s needs effectively. People were able to personalise their rooms to suit their taste.

Staff and relatives felt that the registered manager and deputy manager were approachable. There was partnership working with a local day centre. Plans were in place to improve the service. However, the deputy manager felt they needed more staff to allow the time required to be able to implement these changes. We did not observe any pre-assessments as people at the service had been living there for many years.

People were being cared for by staff who were aware of and carried out safe infection control processes. People had access to a wide range of healthcare professionals, such as GPs, dentists and opticians. People were encouraged to take control of their appointments.

During th

This inspection was carried out on 24 May 2017.

The Ranch is registered to provide accommodation with personal care for up to three people. At the time of our inspection there were three people living at the service all of whom had a Learning Disability. People required minimal support with staff encouragement and prompting as they were able to attend to most of their own personal care needs.

At the last inspection in 31 May 2016, the service was rated Good, however, we found the service was in breach of Regulation 18 (1) (2) (e) of the Care Quality Commission (Registration) Regulations 2009 (Part 4). The registered person had failed to notify the Commission of a safeguarding incident in relation to a service user. During this inspection we found the service was now meeting this regulation.

A registered manager was 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 2008 and associated Regulations about how the service is run.

Staff and the provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were attended to by staff.

People and staff were empowered to contribute to improve the service. People and staff had regular meetings where they were able to put forward suggestions of how to improve the service. These were listened to and acted on. People, relatives and associated professionals had been provided with the opportunity to state their views about the care provided and how the home was run through an annual survey in 2016.

There was a set of values that included the aims and objectives, principles, values of care and the expected outcomes for people. This was displayed at the service. We observed staff putting these into practice.

Records of accidents and incidents were maintained at the service and the registered manager undertook monthly audits to identify any trends and took action as required to maintain the safety of people.

Further information is in the detailed findings below.

This inspection took place on the 31 May 2016 and was unannounced.

The Ranch is registered to provide accommodation with personal care for up to three people. At the time of our inspection there were three people living at the service all of whom had a Learning Disability. People required minimal support with staff encouragement and prompting as they were able to attend to most of their own personal care needs.

A registered manager was 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 2008 and associated Regulations about how the service is run.

The registered person had not notified the Commission of a safeguarding incident in relation to a person living at the service.

People told us they felt safe living at the service. Staff had received training in safeguarding people and were able to describe how they would report and respond to any concerns.

Staff had received training and supervisions that helped them to perform their duties. New staff received a full induction to the service which included training.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person’s best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way.

People were positive about the care provided and their consent was sought. People told us that staff treated them with respect and any help with personal care needs were done in private.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when they required.

People were supported by staff to have enough food and drink of their own choice. There were enough staff to ensure that people could undertake their activities and be supported with their assessed needs. Staff encouraged people to be independent and to do things for themselves, such as cooking and cleaning.

Documentation that enabled staff to support people, and to record the care and treatment they had received, was up to date and regularly reviewed. People had signed their care plans and were involved in writing and reviewing them. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

Staff showed kindness and compassion and people’s privacy and dignity were upheld. People were able to spend time on their own in their bedrooms. People told us they would be able to raise concerns and make complaints if they needed to.

Staff at the service worked in line with these provider’s values that ensured people received effective care. Staff were also aware of the whistle blowing procedures and would not hesitate to report bad practice.

Quality assurance processes were in place to monitor and improve the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We visited The Ranch to look at the care and welfare of people who used the service. We spoke to three people who used the service and four members of staff, including the registered manager. We observed the interactions between staff and the people who used the service.

All the people we spoke with said they liked living there. Staff were seen to interact well with people. For example by having conversations with them about how they were and the activities they had planned for that day. People appeared relaxed and happy.

People told us that they felt respected by staff. We saw that people were encouraged to maintain their independence, for example by preparing their own meals and drinks.

People who used the service and relatives had been involved in the planning of care. We saw that where risks of harm had been identified an assessment had been completed to protect the welfare and safety of people.

We looked around the house and saw that it was clean and tidy. People told us they were happy with the standards of cleanliness. There was a plan to replace the carpets in the house.

All the staff we spoke with felt supported in their role. New staff completed an induction process. This ensured they had the necessary skills to support the people who lived there.

Information about how to make a complaint was on display within the house. All the people we spoke with said they knew how to raise a complaint. They said that they had never felt the need to complain.

We spoke to three people who live at The Ranch, and with three staff (including the manager).

One person who lived there told us “If I need help staff are there.” Another person said “I love it here, staff help me a lot.” People were seen to interact positively with staff and were laughing and joking with them.

People we spoke with told us that their permission was asked before treatment or medication was given. People told us that staff helped them to understand decisions around their care and treatment.

We saw that people’s individual needs had been assessed with them, and ‘care protocols’ had been put into place. These detailed the support people needed in their daily lives. People told us they received the support they needed.

The people we spoke with told us they felt safe living at The Ranch and staff supported them. We saw procedures were in place which gave guidance to staff on safeguarding vulnerable adults. Staff were able to describe what action they would take if they suspected abuse was taking place.

We looked at records of recruitment and training and spoke with staff to check their understanding of the training they had undertaken. We found that training and recruitment were appropriate to meet the needs of the people living there.

People told us they had the opportunity to express their views about the service, and that the provider took action where needed.

People told us they were very happy at the home. One said “I can do a lot more than I did” “the staff help me with shopping but I do a lot for my self. I go to college and I have learnt to cook, I am a good cook now.” Another said that “we go out a lot, the staff are kind and they listen when I want to talk”. They said that they felt they the staff treated them with respect and respected their privacy. One said “they always knock on the door before coming in, I like that.”