CQC report explained · a residential care home
What the CQC found at The Ranch
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Risks, medicines, fire safety and infection control were managed well, although staffing vacancies created a risk if there was unexpected absence.
- Effective?
- Good
- People's needs and choices were assessed and reviewed. Staff had relevant training and supervision, and people were supported with healthcare, nutrition and decisions about their care.
- Caring?
- Good
- This question was not inspected during this visit. The overall rating used ratings from the previous inspection for questions that were not covered.
- Responsive?
- Good
- This question was not inspected during this visit. The overall rating used ratings from the previous inspection for questions that were not covered.
- Well-led?
- Good
- The manager had introduced quality checks, updated care plans and improved communication with people, families, staff and professionals. People were involved in decisions and feedback was acted on.
What inspectors found, March 2022
The Ranch was rated Good; inspectors found safer, kinder and better-organised care, with some staffing and maintenance risks still to watch.
This was an announced focused inspection on 25 February 2022. One inspector spoke with people living at the home, relatives, the manager, a staff member and other professionals. Records, medicines, recruitment, training, care plans and quality checks were also reviewed.
The home was rated Good overall. Safe, Effective and Well-led were all rated Good. Inspectors found that risks and medicines were managed safely, staff were trained, people's care plans had improved, and people were supported to make choices and take part in activities.
The rating improved from Requires improvement at the previous inspection in 2019. The provider had completed an action plan, and inspectors found the home was no longer breaching the regulations identified at that inspection.
There were still vacancies, creating a risk if staff were unexpectedly absent. Inspectors also noted that some areas needed repainting and carpets needed replacing.
Safer care and medicines
Risks were assessed and staff had clearer guidance about how to manage them. Medicines training and competency checks were in place.
“People's medicines were managed safely. Staff attended medicines training and their practice was assessed before they were signed off as competent.” from the report
Choice and independence
People were supported to make day-to-day choices, pursue their interests and access activities in the local area.
“Staff supported people to have the maximum possible choice and control over their lives.” from the report
Improved care planning
Care plans were rewritten and were described as personalised and reflective of people's physical and mental health needs, wishes and aspirations.
“People's care plans were personalised, holistic, and reflected their needs and aspirations, included physical and mental health needs.” from the report
Responsive management
People, relatives and staff said the manager listened to them. The home used meetings and surveys to gather views and acted on requests.
“We saw evidence that the registered manager and staff acted on people's feedback.” from the report
Staffing vacancies
needs fixingThere were vacancies at the time of inspection. The manager was working extra hours and an agency was available, but inspectors identified a risk if staff were unexpectedly absent.
“there was a risk that staffing resources would not be sufficient to cover any unplanned staff absence, such as sickness.” from the report
Maintenance work
minorInspectors noted that some areas needed repainting and that carpets throughout the home needed replacing. The provider had agreed to include this work in the annual budget.
“Some areas need repainting and change of carpets throughout the home is needed.” from the report
- 01How many staff vacancies are there now, and how will you cover sickness or other unexpected absence?
- 02What progress has been made with repainting and replacing the carpets?
- 03How often are risk assessments, care plans and medicines arrangements reviewed and updated?
- 04How will my relative be involved in decisions about their care, activities and daily routines?
- 05How do you check that staff have the training, supervision and competency needed for my relative's particular needs?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and the overall rating used ratings from the previous inspection for those areas. This explanation was written from the published report of 22 March 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2019
Rated Requires Improvement; inspectors found kind and responsive care, but serious weaknesses remained in safety, staff training, mental capacity decisions and management checks.
The inspection was unannounced and took place on 2 October 2019. Two inspectors spoke with people, staff and relatives. They reviewed care plans, medicines records, incident records, policies and audits.
People were described as safe by relatives and treated with kindness and dignity. They were supported with food, activities, family relationships and developing independence. However, risk records were sometimes inaccurate or undignified, some areas were dirty, and staffing did not always allow for personalised care.
The home did not always follow the Mental Capacity Act. Staff training, supervision and medicine competency checks were incomplete. Records and quality audits were not reliable enough. The report identified four legal breaches. The overall rating stayed at Requires Improvement.
Kind and respectful care
People and relatives described staff as kind. Inspectors observed caring interactions and found that people's privacy, dignity and independence were respected.
“People and relatives informed us that staff were kind and caring towards them.” from the report
Support for independence
People were helped to make choices, learn practical skills and take part in everyday activities. This included supporting one person towards living more independently.
“Therefore, they had been given the necessary skills to be able to live in the community independently.” from the report
Meaningful activities and relationships
People were supported to attend education and activities that mattered to them, and to keep in touch with family and friends.
“People were supported to take part in activities and educational courses that were meaningful to them.” from the report
Food and involvement
People had access to fresh food and were involved in choosing menus, shopping and cooking. Their nutritional needs were met through a varied diet.
“People were supported to maintain a healthy diet.” from the report
Inaccurate risk information
seriousSome risk assessments did not explain clearly what staff should do, and others described risks inaccurately or in an undignified way. Emergency and missing-person records were also not always correct.
“People's safety could not be assured in an emergency.” from the report
Mental capacity and liberty decisions
seriousMental capacity records contradicted each other and best-interest decisions did not always involve the right people. A DoLS application was made for someone who could leave the home safely without support.
“The failure to follow the principles of the Mental Capacity Act 2005 meant that people's rights were still not protected.” from the report
Staff training and supervision
needs fixingMany staff were not up to date with training. Supervision was not regular enough, appraisals were not being completed, and first aid training was delivered online without practical skills training.
“Staff were not up to date with training.” from the report
Weak management checks
seriousQuality audits had not been completed since the previous inspection, so the provider could not show that problems had been identified and addressed. Care records also contained limited or out-of-date information.
“Quality audit records had not been completed since our last inspection.” from the report
Cleanliness
needs fixingInspectors found some areas were unclean and unhygienic, including parts of a bathroom floor. Worn and ripped sofas were also noted, although replacement sofas were provided after the inspection.
“We observed some areas of the service were unclean and unhygienic.” from the report
- 01What has been changed since the inspection to make risk assessments, emergency evacuation plans and missing-person information accurate?
- 02How do you check that every staff member who gives medicines is competent and that medicine stock records are complete?
- 03How are mental capacity assessments and best-interest decisions now checked, and how are relatives involved when appropriate?
- 04What training, supervision and practical first aid support has each staff member completed?
- 05What quality audits are now being completed, and how do you make sure care plans contain current, person-centred information?
This was an unannounced inspection covering the overall service, including the premises and care provided, and all five CQC questions. This explanation was written from the published report of 13 December 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Ranch
5 rated inspections over 6 years: the service has held its Good rating throughout.
- March 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Requires improvement
- April 2019Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Inadequate
- June 2017Goodstayed GoodWell-led: Good
- July 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2014
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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