Miranda House

Updated 2 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Miranda House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Miranda House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with seven people and three relatives about their experiences of care and support. We spoke with five members of staff, the registered manager and regional manager. We reviewed care records for seven people and various medication records. We also reviewed accidents and incidents, quality monitoring, complaints and compliments, medicines competence records, staffing rotas, health and safety records, three staff files for recruitment, safeguarding records and meeting minutes.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection

We continued to validate evidence found. We spoke with nine relatives and six members of staff on the telephone. We contacted four professionals for their views about the service. We reviewed dependency tools to calculate staffing and practice observation tools.

Updated 2 September 2022

About the service

Miranda House is a residential care home providing nursing and personal care for up to 68 people. The service supports people living with dementia, mental health conditions, adults under and over 65 years of age. At the time of our inspection there were 29 people using the service.

Accommodation was provided on two floors accessed by stairs and a lift. People had their own rooms and access to communal areas such as lounges, dining rooms and a conservatory. There was a secure garden accessed from the ground floor.

People’s experience of using this service and what we found

People had their medicines as prescribed. Staff had been trained to administer medicines and had their competency checked. When people were prescribed multiple ‘as required’ medicines for the same health condition, guidance for what medicine to give first needed to be clearer. The registered manager took action during our inspection and told us they would review the prescriber’s instructions with people’s GP’s.

At our last inspection we found high numbers of safeguarding incidents between people living at the home. At this inspection the numbers of incidents had reduced, and the provider was taking action to improve dementia care and support. A new dementia strategy had been produced and the provider was providing training, guidance and additional support to staff to improve dementia care.

Risks to people’s safety had been assessed and management plans were in place. These were reviewed by nursing staff regularly. Where needed additional monitoring records were in place which had no gaps in recording. Property and equipment were serviced and checked for safety on a regular basis.

The home was clean and smelt fresh. Cleaning schedules were in place for staff to make sure all the home was cleaned regularly. Staff were seen to be wearing personal protective equipment safely and staff told us they had plenty of stock. Staff were testing regularly for COVID-19.

People were supported by enough staff. The provider used a dependency tool to calculate numbers of staff needed. Some feedback we heard was that at times staffing was a challenge. The registered manager told us when staff called in sick at short notice it was not always possible to get agency staff. The provider told us they were reviewing deployment of staff to make sure they had the right staff role doing the right work.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Visitors were welcomed and there were no restrictions on visiting arrangements. Relatives were able to visit when convenient to them or if they wished they could book a visit in advance.

Staff enjoyed working at the home and people told us they felt safe and happy to be at Miranda House. Staff had training on safeguarding, and all told us they would report any concern.

Quality systems were in place and there were different levels of quality checks taking place. The provider had good oversight of the home and had improved ways in which learning was cascaded following incidents and accidents. Complaints received were logged and monitored by the provider until resolved.

Since the last inspection there had been changes in management both with the home manager and deputy manager. There was a new registered manager in post who was making changes to improve outcomes for people. Some staff did not appreciate the new management approach which had impacted on morale. However, we observed staff working together as a team and some staff told us they viewed the changes as a positive for the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 15 November 2021).

Why we inspected

The inspection was prompted, in part, due to concerns received about the provider’s approach to visiting, responding to concerns and risk of a closed culture. A decision was made for us to inspect and examine the concerns across a range of Caring Homes services.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.