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.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 62 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Feedback about the care delivered was mixed. Specific comments included “Staffing means meals are sometimes late” and “[Family member’s] clothing can occasionally appear slightly dirty.” Other relatives told us their family member was well cared for. They told us “Staff are kind and caring” and “[Name of staff member] has got good emotional intelligence”.

Care plans did not always reflect people’s individuality including their preferences. For example, one plan stated a person could be anxious and have low mood at times, but there was no information about potential triggers or what support was of benefit. Other information stated the person communicated in their own language, without detail of what this meant. The person’s care plan stated family was important to them, but there were no details such as names and where they lived. This did not enable staff to talk about their family in general conversation or use the information to provide reassurance.

Not all records were accurate as staff had not documented the occasions when we had requested support for people. Other records were not specific and included terminology such as ‘regularly’ and ‘assist with’. This did not provide staff with clear information about the person’s needs or support required.

Care records did not always demonstrate people received effective support to meet their needs. For example, records demonstrated one person who was incontinent, was not assisted to the toilet or to change their continence pad for periods of 8 hours or more. Another record stated a person had not been supported to have a wash for 12 days. The registered manager believed this information was not accurate as staff had probably forgotten to document some interventions. However, the records did not demonstrate these people’s needs were being met.

Other care plans such as the support a person needed to manage their diabetes were more detailed. This included the signs and symptoms of high and low blood sugar, and the action staff should take if this happened. Records demonstrated staff took appropriate timely action when people were unwell.

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 variety of professional support both internally and externally. People were seen regularly by the GP and staff called them between visits if needed. Staff supported people to attend healthcare appointments and arranged transport as needed. Staff maintained a record of any consultations with professionals. Any recommendations were documented and care plans showed people had been supported in line with the advice given.

Feedback from stakeholders regarding integration and continuity was positive. One professional told us, “I personally cannot fault the care staff at Miranda House. We have been working together for many years and have seen the ups and downs of the care home over the years. There are a handful of staff that have been there from the beginning, and I personally think they do a brilliant job and are always advocating of their service users and offering the best care.”

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

There was signage within the home to help people move around and orientate themselves more easily. The signs were clear and in colours aimed to help those with a visual impairment. People had their name on their bedroom door and there were photographs around the home to promote orientation and general communication. Events and social activities were well advertised on notice boards.

People’s communication needs had been assessed, and any aids people needed to assist with communication were identified within care plans. This included keeping people’s glasses clean and the need for staff to change batteries in hearing aids.

The registered manager told us documentation was available in formats related to people’s needs. However, plated meals to show people the lunch meal choices on offer were not automatically used. This did not enable people to make an informed choice without the anxiety around not understanding verbal descriptions. The registered managed told us they would address this with staff.

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 and their relatives told us they felt able to share their views, although one relative told us, “In my humble opinion, I shouldn’t have to shout about it.” They felt shortfalls should not occur, and then they would not need to be raised.

There were systems to encourage people, relatives, staff and other stakeholders to give feedback about the service. This included daily walkarounds by the registered manager and monthly ‘surgeries.’ These were dedicated times which ensured the manager or other senior members of staff were available to discuss anything people wished to raise. Posters around the service advertised a forthcoming cheese and wine evening. This had been developed to encourage social interaction, but also to promote relative’s attendance so more ideas would be shared.

There was a compliment and complaint policy, and a record of any concerns or formal complaints was maintained. The records demonstrated appropriate processes were followed to reach a positive outcome.

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

The environment consisted of 2 floors, each with their own lounges and dining room. All areas were level, so people did not need to negotiate any slopes or steps which enhanced safety. People could move around easily due to wide corridors and handrails, and there were assisted bathrooms with equipment to help people get in and out of the bath. A picture helped people locate key areas such as toilets and communal lounges.

The service had an enclosed garden, with various seating areas. The registered manager told us people regularly used the garden in the better weather.

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.

There was a minibus with disabled access which was shared between another service within the organisation. This meant people were regularly enabled to access their local community and groups such as the dementia choir and book club. The registered manager told us this was important and benefitted people’s wellbeing.

They said a summer fete was held and people and staff participated with the town’s carnival to promote inclusion. People were supported to attend church in accordance with their individual faith.

People were not 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.

People’s individual wishes for their end of life care were not clearly detailed in their care plan. Some people did not have any end of life care plans. This did not provide staff with the knowledge to support people effectively, in line with their preferences. There was no information about the person’s religious needs at the time of their deterioration or whether they wanted family or friends with them.

The registered manager told us it was the provider’s policy to only have end-of-life care plans, right at the end-of-a person’s life. However, this did not give people the opportunity to plan and discuss their preferences should an emergency occur when decisions needed to be made.

Records showed staff had received training in end-of-life care.