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.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The registered manager told us they assessed new people to the service and those being discharged after a hospital stay. They said they always made sure the service could meet the person's needs, including the impact on others and staffing numbers. Records showed the assessment was documented and an initial care plan and risk assessments were completed. These were discussed with staff and added to when further information about the person was known. Staff confirmed this, with one staff member saying they always reviewed the person’s paperwork following the assessment.

There were regular assessments of people’s needs and care plans were reviewed monthly or as people’s needs changed. People, their relatives and involved health care professionals were invited to contribute to the assessments and care reviews where appropriate.

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.

People had their weight monitored in line with evidence-based guidance and records demonstrated dietary needs and dietary and fluid intake. This included any specific requirements such as texture or allergies. Catering staff were aware of this information and had been trained in the preparation of modified diets. They told us they attended weekly clinical meetings with registered nurses and were kept informed of any changes to dietary requirements.

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.

The registered manager told us there were systems to ensure all staff were kept up to date with people’s needs and key events of the day. This included leader’s meetings every morning and handover meetings at the start of each shift. A record of the meetings was maintained, and all leaders were expected to cascade any required information to their teams.

Staff were readily able to access information about the people they were supporting using a handheld device. Such information included care planning, risk assessments and associated care records. This ensured people did not need to repeatedly tell staff about their needs and preferences.

The service had good links with other health and social care professionals. The GP visited the service weekly, and other professionals could be called upon as required. This included speech and language therapists and the Care Home Liaison Team. Records were maintained following these consultations, and included any advice given.

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 systems to ensure oversight of people’s health. This included regular discussion with the GP, specialist nurses and other care professionals. People were supported to attend medical appointments, with staff arranging transport as needed.

Catering staff told us many people were at risk of losing weight due to their age and health conditions so full fat milk and fortified foods were used. They said milkshakes were promoted, and desserts were encouraged if people declined their main meal. Catering staff told us they would review people’s food and fluid monitoring records and make recommendations for improvement. Options to help people lose weight were available if needed.

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.

Relatives were positive about their family member’s care and said their health and wellbeing had improved since being in the service. This had included enhanced mobility and increased dietary intake. The registered manager confirmed this and said there were people who had rallied and were doing well after being admitted for end-of-life care.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Records demonstrated people had their capacity assessed in line with legislation, and overall, best interest decision making procedures were being followed.

Some people had legal authorisations to deprive them of their liberty, but all applications had been made in accordance with the Deprivation of Liberty Safeguards (DoLS). This ensured people’s rights were fully respected. Records demonstrated the registered manager maintained a tracker of all DoLS applications and authorisations, so all information was up to date.

We observed staff asking people for consent before undertaking any intervention. This included questions such as, “Can I help you with that?” and “Shall I move that so you can sit down?” Staff knocked on people’s bedroom doors and asked to be invited in before entering. One member of staff politely asked a person if they could assist them with their meal.

People were asked on their admission about their preference of being supported with their personal care by a male or female staff member. This was documented in their care plan and considered during the deployment of staff.