Archived: Miramar Care Home

During our visit we looked at four care plans, care records, incident and accident books, communication books, health professional records and spoke to all of the people living at the home except one who was out. The home also sent us a comprehensive action plan detailing what actions had been taken in response to our compliance actions and the safeguarding process. This has now been closed.

We were told there were 11 people were living at the home. We asked the registered manager and one of the providers if there was anyone who might not be well enough to see us, and they told us that there were two people who due to their mental health needs may become more unwell if we spoke to them.

People told us that they were happy with their care and that there were enough staff on duty. They told us about the equipment they used to help keep them healthy and independent. People described how their personal care needs were met and were clear about whom they would go to if they had a problem with their care. No-one raised any concerns about their care but said that if they had any concerns they would tell us.

There had been good improvements in the management and monitoring of safeguarding issues and staff were clear about the safeguarding process and how to identify, record and alert relevant bodies.

Care plans had improved and were well written in a personalised way, although some issues that would need monitoring were difficult to follow in the daily records as opposed to being clearly separated so that they could be evaluated. There were clear instructions regarding how staff were to meet people's needs to ensure that staff understood people's behaviour and were able to support people in an appropriate and consistent manner.

Our visit took place over approximately six hours with two inspectors on two of the days and gathered further documents on the third day. During our visits we looked at four care plans and the incident reports. We also looked at the daily records for four people using the service, training records, staff files for three staff, a quality assurance file, staff rotas, medication administration records for four people and the message book.

We were told there were 11 people were living at the home. We asked the registered manager and one of the providers if there was anyone who might not be well enough to see us, and they told us that there were two people who due to their mental health needs may become more unwell if we spoke to them. They told us two further people had gone out.

We met nine people individually during our tour of the home. With six people's permission, we spoke to them individually about their experience of living at the home. We met with people either in their rooms or in communal areas. One person we met was not able to comment directly on the care and support provided at Miramar.

People told us that they were happy with their care and that there were enough staff on duty. They told us about the equipment they used to help keep them healthy and independent. People described how their personal care needs were met and were clear about whom they would go to if they had a problem with their care.

However, we found from talking to the registered manager and staff and looking in depth at four care plans that safeguarding concerns raised by people living at the home and staff had not been identified as serious concerns, reported to the local authority safeguarding team or managed appropriately. This puts people living at the home at risk.

Although care plans were initially detailed and written in a person centred way we found that if a person's needs increased or changed, these were not monitored or recorded clearly. There were no clear instructions regarding how staff were to meet these increased needs. This led to needs not being met and people being put at risk. Important information about people's mental health needs was also not documented to ensure that staff understood people's behaviour and were able to support people in an appropriate and consistent manner.

Some people who use the service were not able to tell us clearly how they are involved in their decision making due to their medical condition but they were calm and happy to interact with staff and their body language was positive when asked how they were.

Care plans evidence that staff know about people, involving them and their relatives in finding out peoples' likes and dislikes and past experiences. This results in a person centred approach to care which is focussed on meeting peoples' needs as a whole person. We saw staff interacting with people in a respectful way, for example trying to encourage people to do activities which they like and enabling people to do things for themselves. Staff involve people at the home when doing jobs about the home or going on errands outside the home.

No-one spoken to had any problems with the meals or showed any negative signs when asked about food. Food was presented in an appetising and sociable way and there were condiments available.

Staff all said that they enjoyed working in the home. Most of the staff have been working at the home for many years and therefore know people living at the home very well. Staff said that 'we are very lucky here, the manager is really good and everyone is passionate about the job'. Due to the needs of people using the service there are not always enough staff to ensure that people are not at risk should the two staff on duty be busy. The manager recognised this issue and soon after the visit an extra staff member was put on duty at busy times.

Staff and the manager were able to describe how they managed individual peoples' needs in good detail and that they understood how to gently manage challenging behaviour and promote a homely atmosphere. Staff know how to protect people and keep them safe. Some records are not fully completed but the information is known by staff and the manager, such as fall audits, complaints/concerns and activities.

We found the home to be clean and there was ongoing maintenance to improve the bathroom facilities and update the older style building. Some areas present a risk to people who are not able to recognise dangers but the home responded well to addressing this immediately. The manager said that the home was having a new boiler in the near future but the home was very cold downstairs, in the lounge and the dining room particularly, due to Luke-warm, well-covered radiators and draft through the front door, which people living there mentioned. The manager addressed this immediately on the day of the visit.

Staff all said that they enjoyed working in the home. Most of the staff have been working at the home for many years and therefore know people living at the home very well. Staff said that 'we are very lucky here, the manager is really good and everyone is passionate about the job'.