Miranda House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

This service scored 50 (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 did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

There was a poster on a noticeboard related to ‘Alice in Wonderland’, which contained a phrase that did not promote compassion or people’s dignity. The registered manager told us they had not identified this but would take it down immediately.

The quality of interactions between staff and people living at the service was mixed. For example, one staff member repeatedly spoke louder and louder to a person every time they could not be heard. The staff member then leant over in front of the person’s face to reach their ‘good ear’. This did not promote dignity and was an intrusion into the person’s personal space. Other interactions were more positive. This included a person who was anxious and asked a member of staff if they could follow them. The staff member responded positively by saying, “Of course, come with me.”

There was positive feedback about the staff from people and their relatives. Specific comments included “Staff are fantastic, so kind”, “The staff are great. I can’t fault them” and “The girls are excellent.” One relative told us their family member was supported with dignity, respect, and compassion.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

However, each person had a keyworker and there was a ‘resident of the day’ system, which worked well. This enabled a different person each day to have their care and preferences reviewed by a member of staff from each department. These systems ensured more individualised interactions and enhanced relationships between people, their relatives and staff.

Some staff recognised people’s individuality particularly regarding food preferences and entertainment choices. This included one staff member identifying a person was not eating their lunch. They offered them a dessert instead, which was successful, and a second helping was eaten. The staff member told us “[Person] definitely has a sweet tooth and whilst it’s not ideal, they’ve at least had something inside them. They might eat more later.”

During the afternoon on the second day of the inspection, musical entertainment was arranged. Staff were aware who would like to join in with the activity, and there was positive involvement. This included people singing and dancing with each other and with staff.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

On the first day of the inspection, no organised activity had been arranged for people. This meant people were unoccupied and sat for most of the time without interaction. People received a choice of the lunchtime meal, but some people could not easily understand the choices available to them. This meant they could not readily make a choice of what to have. Others were given a selection of sandwiches without being asked what they wanted and people were not offered a choice of drink.

However, on the second day of the inspection, people were offered a choice of social activity. Many chose the musical entertainment which they enjoyed. Other interactions were more positive and included one person who said they would really like some eggs after they had finished their breakfast. This was arranged and the person said, “Thank you sweetheart", to which the staff member replied, “No problem, enjoy your breakfast."

There was information within care planning to help staff promote people’s independence. This included any mobility aids people used, and what aspects of their personal care they could do themselves. One plan described how a person could wash parts of their body but needed staff to help them with areas they could not reach.

People were encouraged to have visitors without restrictions in communal areas or the privacy of their own room. Some relatives assisted with care interventions such as assisting their family member to eat.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Not all staff responded appropriately to people’s distress. For example, one person was speaking loudly, anxious and walking around the lounge, but staff directed them to an armchair and left the room. They did not attempt to find the cause of the person’s distress by asking them if they were thirsty, in pain or needed the bathroom for example. The person immediately got up and presented as they had previously, which demonstrated their immediate need had not been addressed.

Another person was tangled in their bed sheet and told us they were cold and thirsty. We informed a staff member of this, who assisted the person to their armchair. The interaction with the person was minimal although they said they would get them a hot drink. This did not materialise, and the person had returned to lie on their bed, without any covers on them. The same staff member later sat in a lounge but did not interact or promote individual opportunities for people. This did not promote involvement or maximise people’s wellbeing.

Staff assisted another person with their continence in a timely manner, and call bells were answered quickly.

The provider cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

The registered manager told us they cared about the staff and did what they could to support them. This included informal support through general conversations and more formal systems such as supervision sessions and meetings with leaders. They said they would adjust staff member’s working rota if requested and a phased return was offered following long-term sickness.

The registered manager told us they had a firm but fair management style although expected everyone to be accountable for their actions. Staff gave us positive feedback about the registered manager. One staff member described them as “Lovely and very accommodating.”