Archived: Miramar

People’s experience of using this service:

¿ People were supported by staff that were caring, compassionate and treated them with dignity and respect.

¿ People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life history, and their communication needs. They used this information to develop positive, meaningful relationships with people.

¿ Risks of abuse to people were minimised because the service had robust safeguarding systems and processes. Staff demonstrated a good awareness of each person's safety needs and how to minimise risks for them.

¿ Regular health and safety checks were carried out. Environmental improvements, such as a stairlift to the second floor and a new shower had improved disabled access for people.

¿ People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. People’s health had improved because staff worked with a range of healthcare professionals and followed their advice.

¿ People were supported in the least restrictive way possible; the policies, systems and culture in the service supported this practice.

¿ People's concerns and complaints were listened and responded to. Accidents, incidents and complaints were used as opportunities to learn and improve the service.

¿ People, staff and professionals gave us positive feedback about the quality of people's care. They said the registered manager was approachable, listened and acted on feedback. Quality monitoring systems included audits, observation of staff practice and regular checks of the environment with examples of continuous improvements made in response to findings.

Rating at last inspection: Good. (last report published 6 April 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The inspection was brought forward by a few months to check safety improvements identified in 2018 had been implemented. At this inspection, the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see full report which is on the CQC website at www.org.uk

Miramar is registered to provide accommodation and personal care for up to 14 people. This includes people with mental health needs such as schizophrenia, bipolar disorder and autism and people living with addictions. When we visited, 13 people lived there with an age range between 45 and 96 years.

This inspection was to follow up if the required improvements had been made and ensure the provider had maintained standards in other areas. Since the last inspection we received an action plan from the provider which outlined the improvements being made. This included updating care records to include more comprehensive risk assessments and care plans. The registered manager had worked in partnership with the local authority quality assurance and improvement team to improve their quality monitoring systems.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this visit we found significant improvements had been made to people care records. Individual risk assessments had more detailed information about each person’s needs and measures being taken to reduce risks. They balanced risks with minimising restrictions to people's freedom. The provider had introduced electronic care records which were person centred and had more detailed information about each person’s needs. Significant improvements had been made in quality monitoring systems with evidence of ongoing improvements. Accidents and incidents were reported and included measures to continually improve practice and further reduce risks of recurrence. Regular maintenance and health and safety checks were undertaken.

The culture of the home was open, friendly and welcoming. People were relaxed and comfortable with staff who were attuned to their needs. Staff knew people well, understood their needs and care was personalised. They developed positive, kind, and compassionate relationships and treated people with dignity and respect.

People were supported by enough staff that provided skilled care at a time and pace convenient for each person. Staff spent time chatting with people and keeping them company.

Each person had a comprehensive assessment of their needs and care plans provided guidance for staff about how to meet those needs. Staff worked closely with local healthcare professionals such as the GP, community nurses and mental health team to improve people's health. Health professionals said staff were proactive, recognised changes in people’s health and sought advice promptly and followed their advice. People received their medicines safely and on time from staff who were trained and assessed to manage medicines.

People praised the quality of food and staff encouraged people to eat a well-balanced diet, make healthy eating choices and to exercise and maintain their mobility. People pursued a range of individual hobbies, activities and individual interests. For example, reading, music and singing, walking, bicycle rides and gardening.

People's rights and choices were promoted and respected. Staff understood the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards and sought consent from people for their care and treatment. Staff knew the signs of abuse and how to report concerns, including to external agencies. They had completed safeguarding training and had regular updates.

People received a good standard of care because the staff team were well led. The registered manager set high expectations of standards of care. Staff understood their roles and responsibilities, and felt valued for their contribution. They were motivated and committed to ensuring each person had a good quality of life. The registered manager used a range of quality monitoring systems such as audits of care records, health and safety and medicines management and made continuous improvements in response to their findings. The provider undertook regular quality monitoring visits and the registered manager addressed any areas for improvement identified.

Miramar is registered to provide accommodation and personal care for up to 14 people who may have a learning disability, dementia or mental health needs. This includes supporting people living with addictions, schizophrenia, bipolar disorder and autism. When we visited, 11 people lived there with an age range between 44 and 95 years, and one person was in hospital.

The service had a registered manager who has been working worked across two registeredlocations, spending time at each service. However, these arrangements were about to change, which meant the registered manager would be working full time at Miramar in the near future. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff knew people well, understood their needs and care was personalised to their individual needs. However, people’s needs and some risks had not been fully assessed and care plans did not adequately describe how to support people. Care records were inconsistent and lacked sufficient detail about people’s care and treatment and about decision making. Where health needs were identified, detailed care and treatment plans were not in place to instruct staff how to meet those needs. This meant there was an increased risk people would not receive all the care they needed.

People were not fully protected because the quality monitoring systems in place were not fully effective. Although there were a variety of systems in place to monitor the quality of care provided, these did not identify the risk management improvements needed. However, there was evidence of making continuous improvements in response to people’s feedback, the findings of audits, and of learning lessons following accidents and incidents.

Staff worked closely with local healthcare professionals such as the GP, community nurse and members of the local community mental health team. Health professionals said staff sought advice appropriately about people’s health needs and followed advice.

Staff were aware of signs of potential abuse and knew how to report concerns. A robust recruitment process was in place to make sure people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to. The service had a written complaints process. Any concerns were investigated with actions taken to make improvements.

People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. People were relaxed and comfortable with staff that supported them. Staff knew what mattered to people, about people’s lives their families and their interests and hobbies. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes. People were involved in developing and reviewing their care plans.

There was a family atmosphere at the home. Although the home cared for people of very different ages, this had positive effects for several people who lived there. People spoke with fondness about people they had made friends with. Friendships had developed between people of similar ages and interests and also between people of very different ages.

Staff had undertaken training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty safeguards. People were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Where people lacked capacity relatives, friends and professionals were involved in best interest decision making.

People, relatives and staff said the home was organised and well run. The culture was open and honest. Staff worked well together as a team and felt supported and valued for their work.

The care environment had been improved to meet the needs of people living at Miramar, although further improvement to the rear outside space were needed.

We found three breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We found improvements were required in relation to the management of medication. At this inspection we found that improvements had been made in this area. However, improvements were still needed in some areas.

Everyone who lived at the home was able to give their consent to any care or treatment. However, the provider may wish to note that we found no records that showed people's consent had been obtained for the care and treatment provided to them by the service.

We looked at the care records for three of the people who lived in the home to find out how their health and personal care needs had been assessed, and how the home planned to meet those needs.

One person we spoke with told us staff were "all lovely". We discussed people's care needs with staff. They told us about people's needs and how they liked their care to be delivered.

People told us they thought the staff were "brilliant" and "very good". They said that they thought there were enough staff on duty to meet their needs.

We looked at three staff files which showed us there were effective recruitment procedures in place. People who lived at the home told us that weekly meetings were held where they could raise any issues. They said that any issues they had were quickly resolved and that "nothing was too much trouble" for the staff.

Prior to our visit concerns had been raised with us by the local safeguarding adults team. These concerns related to one person's care and treatment at the home. The matter had been investigated by the safeguarding adults team and the concerns had not been substantiated.

During our visit to the home we spoke in private with three staff, the provider, the manager and six of the people who lived there, about the care and support they received. We looked at some care records to see how people's care was planned and delivered. We saw evidence that care plans were regularly reviewed and updated as people's needs changed.

People that we spoke with all praised the staff, one person told us they "get on really well" with staff. Another person told us staff were "marvellous ' I feel lucky to be here". One person told us that staff were "very supportive" and another told us they were pleased they now had an area in the dining room where they could make their own drinks.

We saw that staff respected people's privacy. For example, people were offered help with their personal care in a discreet way.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.