Miranda House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service since it registered with this provider. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

There was a clear pre-admission process in place to ensure comprehensive assessments were completed before people moved into the home. These assessments were carried out face to face and meant leaders could meet with people, understand their needs and preferences, and determine whether the service could support them safely and effectively.

If people used the service for respite short stays, they were also assessed each time they used the service. Records showed the service was working with people and their families to involve them in care reviews. We saw this had happened for some people and was being planned in others.

People said they had been involved in assessments. Comments from people included, “When I first came in, they wanted to know all about me. What I like and don’t like, my history and things like that” and “At the beginning, staff asked lots of questions to get the information they needed.” People also confirmed changes were discussed with them, and they were involved in their care reviews. One person said, “If anything changes, they tell me and we talk it through.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Nationally recognised tools were used to assess people’s risks and additional support was appropriately sought, such as specialist nurses and the speech and language therapy team. There were good links with external health professionals, and access to additional training and support was available through the provider’s training department.

The provider had developed staff knowledge and skills around wound care with additional training and support from their central quality team. When people sustained a wound, staff produced wound care plans including documentation and clear photographs. This helped leaders to monitor sizes of wounds which also recorded healing progress.

People had their weight regularly monitored. When people lost weight, records showed dietician support was sought, and people received fortified diets with additional snacks. Records showed people had enough to eat and drink.

Mealtimes were relaxed and inclusive. People were offered choices of food and had support from staff to eat and drink in a dignified discreet way. Leaders completed regular observations of the dining experience which helped identify any improvements that could be made.

People said the food was good and they had alternatives from main menus if they wished. People could share their feedback with the chef and share ideas for what they wanted to see on menus. Comments from people included, “The food is ok, I eat in the dining room, and I can eat by myself. There is a good choice off the menu, and the chef knows what I want” and “The food is really good. I have talked to the chef a couple of times; they will make you different things if you want.”

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff communication was effective with shift handovers and twice daily meetings. Staff we spoke with told us they were kept updated about people’s needs, even if they had been off work for some time.

Staff worked well with other health professionals and records showed advice was sought in a timely manner. The GP visited weekly and records showed other professionals such as the tissue viability nurse and care home liaison nurse were involved in people’s care when required. One professional told us, “The nurses and the carers are amazing in terms of how well they know people. They are very helpful. Any tests I ask for, or assessments required, they will do them. Sometimes they will even do [a urine test] before I arrive if they think someone might have a urinary tract infection for example.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

There were a range of health conditions being well supported at the service including diabetes, dementia, Huntingdon’s disease and mental health. People’s healthcare needs were assessed and care plans in relation to these were informative and personalised. For example, for people with diabetes, people’s target blood sugar levels were documented. The signs and symptoms of high and low blood sugar for staff to observe for was recorded. Records showed the guidance had been followed by staff.

People’s feedback confirmed staff had the knowledge and skills to support them effectively. One person said, “I have got [specific health condition]. Staff know all about it and how to look after me.”

Staff were aware of early signs of ill health and knew what actions to take. For example, the registered manager said if people started experiencing increased distress, staff checked people’s urine, checked for constipation and asked the GP to do blood tests. This helped identify any ill health prior to seeking other specialist support.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There was good oversight of people’s care and support needs. Monthly clinical meetings took place, and we reviewed the minutes of these. Minutes showed staff reviewed wounds, weight loss infections and falls for example. Action plans were in place and were monitored to confirm that actions had been completed. There was oversight of people’s weight and when required, food and fluid intake was monitored and supplements and fortified diets were provided.

Although people had been assessed for their mental capacity to consent to aspects of their care, the records we reviewed were of an inconsistent quality. Not all were decision specific and not all included detail of what had been discussed during best interest decision meetings or who had been involved in these meetings. We discussed this with the management team, and they confirmed this was an area for improvement they were aware of.

Staff had been provided with training on the Mental Capacity Act and understood the principles. We observed staff seeking people’s consent prior to supporting them. For example, we saw staff asking people, “Would you like to come with me for a coffee?” and “Where would you like to sit?” We observed staff knocked on people’s bedroom doors prior to entering. People said staff always asked their consent before helping them with any care. One person said, “The staff ask me first, always so polite. If I want to be private, I can close my door and be private. Staff respect that.”