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 leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider was in breach of the legal regulation relating to good governance.

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 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.

The registered manager told us the main aim of the service was to promote people’s rights and provide a good standard of care. This included good engagement opportunities with the local community. Records demonstrated the vision and culture of the service was disseminated to staff through role modelling, meetings and training.

There was an open culture, and focus was given to the development of staff and their career progression. This included promotion and champions of an area such as infection prevention and control. The registered manager told us they strongly believed in empowering staff and valuing their contribution.

Staff told us they enjoyed working at the service. One staff member said, “I leave here every day knowing that I've done the best I can."

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.

and knew people and staff well. They said they had an ‘open door’ policy and encouraged people, relatives and staff to raise anything which was concerning them. One staff member told us “[Name of manager] has made a significant positive impact since her arrival.”

The registered manager was supported by senior managers and a quality team who regularly visited the home. There were other departments such as a recruitment and finance team. This enabled dedicated work roles and shared learning, which improved practice. Leaders had an ongoing action plan to further develop the service but had not identified shortfalls we found at this inspection.

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

There were systems to encourage staff to raise any concerns they had about safety or poor practice. This included a whistle blowing policy and opportunities to speak to senior managers when they visited the service. The registered manager told us they met with staff regularly and aimed to create a culture of learning and transparency.

Staff told us they were confident in raising any concerns and felt they would be listened to and taken seriously. They had confidence the registered manager would address any concerns they had.

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.

The registered manager told us they had a very diverse team, including different ages, gender, experience and ethnicity. Some members of the team were very established and had worked at the service for many years, whilst others had just commenced employment.

The registered manager told us the team worked well together, without discrimination. Records demonstrated staff had completed mandatory equality and diversity training. They did not raise any concerns about inequality in the workplace.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Shortfalls found during this inspection had not been identified within the auditing processes. This included shortfalls with person-centred care planning, medicine administration, the management of distressed behaviour and some agency staff’s training. The lack of some staff’s engagement with people and their use of poor techniques to move people safely had also not been identified or addressed. This demonstrated a lack of management oversight and did not provide assurance all staff were fully competent in their role.

The registered manager told us they would discuss these shortfalls with staff and ensure improvements were made. They were disappointed with the shortfalls in staff practice as this was not their experience or expected practice. The registered manager told us these shortfalls would be added to the home’s action plan and addressed. This plan was ongoing and regularly reviewed by senior managers to ensure actions were being completed in a timely manner.

There were a range of auditing systems to assess the quality of the service. These included provider visits, evening and night checks and heads of departments auditing their area of work. People’s care was reviewed within daily handover and clinical review meetings, and the registered manager reviewed any overdue interventions which were highlighted on the electronic care planning system. All checks were part of an overall schedule, which demonstrated the frequency expected, and the different topics to be assessed.

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.

The registered manager and staff told us they worked closely with various health and social care providers and positive relationships had been built. Partners confirmed this. Specific comments included “We tend to work well together, and the system works very well,” and “I have found that the home has been very accommodating during our visits and we are involved in organisation of people’s care. They will call us if they need to run anything by us and we are usually kept up to date of any changes there may be.”

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 told us how they had developed the service since being in post. They had worked closely with staff to achieve this and confirmed the service had improved significantly. The registered manager told us there was always more work to do, so improvement was ongoing. Areas improved were described as the environment, personalised care, social activities and the culture. They said this in turn had improved the home’s reputation.