This inspection was carried out on 5 and 6 June 2018 and was unannounced.Miramar Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Miramar Care Home accommodates 122 older people and people living with dementia in one building. The service has 10 single bedrooms with en suite bathrooms and 69 apartments for one or two people. There were 60 people using the service at the time of our inspection. Most people using the service were able to tell staff how they preferred their care provided.
A registered manager was leading the service and was supported by a management team and the provider. The registered manager had been employed after our last inspection. A registered manager is a person who has registered with CQC to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At the last inspection on 2 May 2017, we asked the provider to take action to make improvements to the way the service was managed, including complaints management, acting on people’s views, the deployment of staff to meet people’s needs and how they supported staff to fulfil their role. We also required improvements were made to the way in which risk associated with people’s care and emergency situations were assessed and mitigated.
At this inspection we looked to see if the action the provider had taken had been effective. The company which owned Miramar Care Home had been sold to Avery Healthcare approximately four weeks before our inspection. They had not changed anything at the service in this time and had plans in place to make gradual changes with the registered manager and staff to improve the service.
The registered manager had made improvements to the service. However, further improvements were needed address the continued breaches of three regulations, including how risks to people were managed, how staff were deployed at busy times of the day and how people’s views were used to improve the service. We found two new breaches of regulation.
Action had not been taken since our last inspection to deploy more staff at busy times of the day and people continued to wait for long periods of time for the support they needed. People and staff continued to raise their concerns about this with the registered manager but action had not been taken to address them.
Staff, including nurses, had met with a manager since our last inspection to discuss their role, any problems they were experiencing or their personal development. However, these meetings were not held regularly. Nurses had not received clinical supervision to support them to maintain and develop their skills. Staff, including nurses, had been supported to complete the training they needed to fulfil their roles since our last inspection. Some staff held recognised qualifications in care.
People, their relatives and staff had been asked for their views of the service. These had not been reviewed and used to improve the service. For example, 12% of people had said they did not feel safe at the service but action had not been taken to address this. Checks and audits of the service had been completed but these had not identified the shortfalls we found during our inspection.
Assessments of people’s needs and risks had been completed and risks to some people, such as weight loss had been identified. Plans had been put in place to mitigate the risks but records of the action taken had not been maintained. Checks could not, therefore, be completed by staff and visiting health care professionals to make sure the planned care was always provided to people and was effective. Detailed information was now available to staff about people’s preferences and people told us staff provided their care in the way they preferred.
People’s medicines were not always managed safely. On occasions new medicines were not obtained promptly to begin to relieve people’s symptoms. The application of prescribed creams had not been recorded so staff could check they were being used as prescribed and were effective. Records of people’s ‘when required’ medicines were not always detailed and there was a risk that these would not be managed safely.
Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance to the service but it was not displayed on their website.
People received the care and support in the way they preferred at the end of their life. We have made a recommendation to support the provider to improve the planning of end of life care.
The registered manager supported staff to work as a team and staff were now motivated and felt supported. The registered manager and staff shared a vision of a good quality care.
Since our last inspection the provider had acted on advice from the local fire and rescue service to make improvements to the way people were protected in an emergency. These had been effective and staff had the knowledge and skills they needed to keep people safe in the event of a fire.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. The registered manager knew when assessments of people’s capacity to make decisions were needed. Information was available to people in a way they understood to help them make decisions and choices. Information about who had the legal power to make decisions about people’s health and welfare was now available to staff.
Changes in people’s health were identified and staff contacted people’s health care professionals for support. People were offered a balanced diet and food they liked. The registered manager had received, investigated and resolved people’s complaints to their satisfaction.
The required checks had been completed on staff before they had begun working with people including Disclosure and Barring Service (DBS) criminal records checks. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.
Staff were kind and caring to people and treated with dignity and respect. Staff knew the signs of abuse and were confident to raise any concerns they had with the provider. People were not discriminated against and received care tailored to them.
People had enough to do during the day, including activities to keep them physically and mentally active. The service and equipment were clean and well maintained. The building had been designed to meet people’s needs and make them feel comfortable and at home. People were able to use all areas of the building and grounds and were encouraged to make their rooms feel homely.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service like a serious injury or deprivation of liberty safeguards authorisation. This is so we can check that appropriate action had been taken. Notifications had been sent to CQC when required.
This is the second consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.