Miranda House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. 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 needs were met through good organisation and delivery.

This service scored 75 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

At the last assessment care records did not always demonstrate people received effective support to meet their needs. This had improved and care plans were now more personalised and records demonstrated people’s preferences were known and respected by staff. For example, if people preferred a shower, records showed this was happening. Staff were regularly reviewing care plans to make sure information was up to date. The service operated a ‘resident of the day’ system which meant people’s care plans were fully reviewed on a specified date. The provider was in the process of linking the care reviews with family input so that more personalised information about people could be sought. This was particularly important for people with dementia who might not be able to communicate their needs and preferences easily.

People confirmed they were encouraged to make their own decisions and do what they wanted to do. One person said, I make my own choices, staff don’t decide for me. I can choose when I get up, when I go to my room and what things I go to.”

We did find some care plans lacked some detail and contained some contradictory information. However, the provider and leaders were aware of this. Prior to our assessment, the provider quality team had also reviewed care records and identified some areas for development. Records of staff meetings showed this area had been discussed with staff and was an action on the service improvement plan.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People had access to a range of healthcare professionals and were supported to attend appointments, with staff maintaining records and acting on any recommendations. Care plans reflected professional advice, helping to ensure people's health needs were met.

Feedback from professionals was positive and highlighted strong partnership working. One professional told us, “I am confident people are safe living here. Staff use their own clinical judgement. We come weekly but they can ask for a review in between if they are concerned. They will contact us If someone is acutely unwell and they give us an up-to-date clinical assessment.”

The service offered nursing care and employed a registered nurse 24/7. This helped make sure people’s nursing needs were being met consistently. The deputy manager was a registered nurse and led clinical governance meetings. It was not clear what the clinical oversight would be when the deputy manager was not at the service. We discussed this concern with the provider as for some shifts agency nurses were being used. Whilst the deputy manager was at work, they supported agency nurses with clinical risks. The provider said they would review the oversight arrangements for clinical governance.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s communication needs were assessed. When people had specific communication needs, this was written in care plans. For example, a care plan for a person with poor hearing, described how staff should position themselves when speaking to them so that the person could lip read.

Records could be provided in various formats. The registered manager gave examples of how staff had used various communication methods to engage with people. For example, if needed staff had used white boards to write down communication for people to understand.

Some information around the service was pictorial and helped with way finding. For example, communal areas were clearly defined for their uses. Toilets and bathrooms had clear pictorial signs to inform people where these rooms were situated. However, some information was not pictorial, for example, menus on tables. Staff did use ‘show plates’ to help people choose their meal. This is where staff plate up the options and show people what they can have to eat. This is particularly good for people with dementia who might struggle to know what options are available. As menus were not pictorial, this may prevent people from reviewing the options earlier in the day and having more time to make decisions. We shared this feedback with the provider who said they would review menu information.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People said staff were good at listening to them which encouraged them to share their views about care and support. Comments included, “They [staff] genuinely listen to me if I want something or need to talk. [name of staff] is good at knowing when I have worries”, “Staff listen and things arrive if I ask for anything” and “Staff listen to what you say and if I have any worries, they listen to me. They do things to help you if you ask.”

There were regular ‘resident meetings’ which enabled people to share their feedback. One person said, “Carers and the manager come along to our meetings. They ask for suggestions about things like the food and the garden.”

The provider had a complaints process and people said they knew how to raise concerns if needed. Comments from people included, “I have never had to complain about anything major, little things get sorted” and “I have no complaints at all, I know they would act if I did though.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People’s needs were assessed before they moved to the service. When people’s needs changed, records showed staff referred people for specialist support and advice. If people needed support to attend appointments, staff were able to escort people and at times provide transport. Leaders also worked to remove any barriers for people by organising services to be available at the home. For example, chiropodist visited and various professionals from healthcare.

The environment was accessible, with wide corridors fitted with handrails and adapted toilets and bathrooms. All areas within the service and the garden were wheelchair accessible.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People’s care plans contained clear, personalised guidance that reflected their individual needs, preferences and protected characteristics. This supported staff to recognise and respect people’s communication needs, cultural backgrounds and religious beliefs when delivering care. Care plans provided detailed information to help staff meet people’s needs consistently, in line with their wishes, while promoting wellbeing, independence and quality of life. This included for example if people preferred male or female staff to support them with personal care.

Leaders had taken actions to make the service more dementia friendly. Changes in the environment had provided people with quieter spaces, clear signage and objects spaced around for people to pick up and engage with.

The registered manager said they regularly checked care records to make sure terminology being used was appropriate and respectful when recording care activity for different people.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the last assessment, people’s individual wishes for their end-of-life care were not clearly detailed in their care plan, and some people did not have any end-of-life care plans. People now had some details recorded about their wishes for future care and support. If people had specific wishes about being resuscitated, this information was clearly recorded. Leaders said this was an area of care planning they had tried to improve, however, more work was needed to obtain personalised wishes.

Care records showed staff had recorded when they began discussions with people and their families. However, some people had expressed a wish not to discuss the topic, which was clearly recorded. It was not always clear if staff had tried to revisit the subject at a later date. We discussed this with the management team and the provider.