Miranda House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service since it registered with this provider. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff and leaders we spoke with were very passionate about the work they did and wanted to provide good care. Staff were aware of the provider values and expected care standards. The service had held an ‘appreciation week’ for the whole team. Staff wrote out cards about how other staff were working to the values of the organisation and placed them on a display board. Staff received prizes and gifts as a thank you and appreciation for their work.

Leaders were a presence at the service and created a culture of transparency. There was a clear line management structure, however, staff said they could approach any of the leaders for advice or help with anything.

Since the last assessment there had been a new provider registered. The service had support from the new providers central support teams with areas such as audits, training and general support. Staff said even though the transformation had been difficult at times, the provider had been supportive. One member of staff said, “Care UK have been good so far, there is lots of training available. The [quality manager] will often mention some new training they have seen online that might be good for us to do.”

Leaders and staff also said the new provider had made changes to improve the service. One member of staff said, “It's better now, it feels more stable and yes, I do think it's safe here. We have struggled to get permanent nurses, but our agency ones are regulars and know the residents really well.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

There was a registered manager in post and feedback about their approach from staff was very positive. Comments included, “[Registered manager] is very supportive; we work really well together. We plan the day together” and “[Registered manager] is so approachable, and [their] door is always open. [Registered manager] is always on the floor and happy to help.”

Staff said they had seen improvements in the environment and with the care since the registered manager had been at the service. One member of staff said, “[Registered manager] has made a massive difference, it is more organised.”

People and relatives said they saw the manager around the home and felt able to approach them at any time. Comments from people included, “The manager is ok, I have a good relationship with [them] and I can chat with [them] about anything”, and “I know the manager, [they] are really nice and I can talk to [them].”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Details on how to raise concerns was available in the staff room on notice boards. Staff also had this information in policies and via training. Staff said they knew how to raise concerns and felt able to approach senior leaders if needed. Staff also knew how to raise concerns outside of the service. The registered manager said as part of their daily walk around they regularly asked staff how they would speak up if needed. This helped leaders check the understanding of staff so that additional training or guidance could be provided if staff were unsure.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff were provided with training on equality, diversity and inclusion and the provider had a range of policies to provide staff with procedures for this area. Staff said there was equal opportunities at the service and they had not seen any discrimination. The registered manager said, “We are all here for the same reason, the staff know I don’t tolerate any bullying or negative comments. I think I am clear on having respect for each other, being kind to each other and being thoughtful.”

The service had done events about celebrating different cultures and staff were welcoming to all new staff.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The provider had governance systems which were now helping to identify and drive improvements. There was a weekly governance meeting which enabled the provider and all leaders at the service to review and discuss progress. Following their own audits the provider had produced an action plan which identified areas for improvements across the service. Weekly reviews and discussions helped monitor action taken and ensured the improvement was made.

Audits and quality checks were being completed regularly by different members of staff and management teams. This meant all departments were involved and aware of the importance of good governance. The registered manager completed a daily walk around which was recorded and included checks of various areas. They also completed an out of hours visits either at night or at a weekend which was a further check of care standards.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Leaders and staff worked in partnership with a range of healthcare professionals to make sure people’s health needs were met. This included the local GP surgery and a range of dementia specialist professionals. Leaders and staff were aware of the services available in the local area and referrals were timely and appropriate.

People confirmed they could see healthcare professionals when needed. Comments from people included, “If I say I am not very well, staff get the doctor in. Sometimes they know without me telling them” and “When I tell them I am not well, they get the nurse or the GP and the care staff do check on me.”

The service had many links with local organisations such as local churches, a dementia choir and schools. People were supported to engage with the community, and the community was welcomed into the service. Staff supported people to engage with community events such as the local carnival.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The registered manager said they were open to piloting and trialling any new ways of working if it improved outcomes for people. They kept themselves updated with various pieces of research and gave us examples of how some had been put into practice. For example, the service had moved their main meal of the day to an evening service. The registered manager said having read the research and tried this they had seen improved outcomes for people with dementia. People had improved sleep patterns and less distress in the evening. The service had worked with a local specialist dementia clinician piloting new medicines for people living with dementia.

Staff were encouraged to develop their skills and knowledge and further their practice by being supported to do work-based qualifications. Staff also had opportunities to be a lead in a subject that interested them. For example, a member of staff had become a moving and handling trainer, another was a lead for infection prevention and control. Care staff were given development opportunities to become senior carers and take more responsibility for areas such as medicines. The registered manager said, “Everyone has something they are very good at. The team empowers each other.”