CQC report explained · a residential care home
What the CQC found at Mirabeau
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2020
Rated Requires Improvement; inspectors found kind, personalised care, but staffing levels and service leadership did not always keep people safe.
This was an unannounced inspection on 30 January 2020. Inspectors observed care, spoke with people, staff, managers, relatives and health and social care professionals, and reviewed care, medicine, staff and management records.
The home provided personalised support for 10 people with learning disabilities or autism and complex needs. People were treated with kindness, involved in decisions, supported to be more independent, and helped with activities, food and healthcare.
The main concern was staffing. There were not always enough staff with the right skills, so care plans were not always followed and people were not always safely supported. The home had also not always been open and clear about how staffing levels were decided, and its checks on incidents needed improvement.
The overall rating fell from Good at the previous inspection to Requires Improvement. Effective, Caring and Responsive were rated Good. Safe and Well-led were rated Requires Improvement.
Personalised risk guidance
People had detailed assessments and clear guidance about the support they needed. Inspectors found this advice was based on good practice.
“People had personalised, high-quality, need and risk assessments and there was detailed guidance on the support people needed.” from the report
Kind and respectful care
Staff knew people well and treated them with compassion. Families gave positive feedback about the care and support provided.
“Staff knew people well and treated them with respect and compassion.” from the report
Choice and independence
The home had improved how it involved people in decisions and supported them to develop skills and independence.
“This was an area which had greatly improved since our last inspection.” from the report
Personalised activities and communication
Activities reflected people's interests and goals. Staff used different communication approaches to help people understand information and express their views.
“Staff were skilled at communicating with people and providing information in an accessible way.” from the report
New staff lacked key training
seriousSome new staff worked in high-risk situations before completing important training. Inspectors found this left them lacking confidence and knowledge about keeping people safe.
“some new staff had not yet gone on the training but were still required to work in high risk situations” from the report
Incident monitoring needed improvement
needs fixingThe home had several forms and systems for recording incidents, but it was not always clear what action had followed or whether people were being made safer.
“It was not always straightforward to see what actions had been taken after each incident” from the report
Communication about staffing
needs fixingThe provider was not always open and clear with professionals about how it decided staffing numbers and skill levels. The manager later sent information showing that communication was improving.
“Some professionals told us the provider did not always communicate openly about how staffing numbers were decided at the service.” from the report
Liberty restriction paperwork
needs fixingOne restriction on a person's liberty was not included in the relevant application. The manager agreed to resubmit that application and review others.
“one incident where the provider was depriving a person of their liberty and the detail of this restriction had not been included in the deprivation of liberty application.” from the report
- 01How many staff are planned for each shift, including overnight, and what happens when staffing falls below the required level?
- 02Which staff have completed training for supporting people with anxious or challenging behaviours, and how are untrained staff supervised?
- 03How will you make sure each person's care and risk plan is followed when staffing is under pressure?
- 04How are incidents and safeguarding concerns reviewed, and how will families be told what action was taken?
- 05How have you reviewed liberty restriction applications to make sure every restriction is recorded and legally authorised?
This was an unannounced inspection covering all five key questions; end of life care was not assessed because nobody at the home needed it. This explanation was written from the published report of 18 March 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2017
Mirabeau was rated Good; inspectors found safe, kind and personalised care, with improvements needed in involving people in decisions and monitoring external audit actions.
This was an unannounced comprehensive inspection on 27 April 2017. Two inspectors observed care, spoke with people, staff, managers, families and a health and social care professional, and reviewed care records, recruitment, training and quality checks.
The home supported up to 10 people with learning disabilities or autism and complex support needs. Inspectors found people were safe, medicines were managed properly, staffing was sufficient and staff had suitable training. People were treated with kindness and respect, supported to stay healthy and helped to take part in activities and maintain family relationships.
The home remained Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors recommended finding better ways to involve people in decisions about the home. They also noted that quality reports did not clearly show whether actions from external audits had been completed, although the manager had made the necessary improvements.
Managing risks
The home used detailed, personalised risk assessments and changed care plans when incidents showed that support needed to be different.
“Detailed and personalised risk assessments outlined required actions and guidance to minimise risk.” from the report
Skilled staff
Staff received induction, specialist training, supervision and appraisals. New staff were observed before working on their own.
“Training was provided face to face and included managing challenging behaviour through de-escalation techniques and other training tailored to people's needs.” from the report
Kind and respectful care
Inspectors saw positive relationships between staff and people. Staff supported independence, communication, dignity and personal choice.
“Staff knew people well and treated them with kindness, good humour and respect.” from the report
Personalised support
People had individual routines, activities and care plans. Staff used detailed daily records to understand what support worked for each person.
“Staff recorded daily activity in great detail and this information enabled staff to develop personalised care.” from the report
Health and wellbeing
People were supported with healthy lifestyles, food and drink, and timely referrals to health professionals.
“Staff supported people to maintain a healthy lifestyle and referrals to healthcare professionals, such as GPs and speech and language therapists, had been made in a timely manner.” from the report
People's involvement
needs fixingStaff and the provider made some decisions about the home, such as communal colours, displays and garden plants, without involving people who might have been able to take part.
“People were not enabled to make decisions about the way the service was run.” from the report
Accessible care plans
minorCare plans contained useful information but were often long and clinical. Inspectors found limited attempts to make some parts easier for people using the service to understand.
“People's care plans were vast and often written in a clinical way.” from the report
Tracking audit actions
needs fixingThe manager had made necessary improvements, but regular quality reports did not clearly show whether actions from external audits had been completed.
“The provider's regular quality assurance reports did not refer to any actions required by external audits which meant there was not a clear overview of whether these had been implemented.” from the report
- 01How are people now involved in decisions about the home, such as changes to communal areas, displays and the garden?
- 02How do you make care plans easier for people to understand and take part in?
- 03How do you record and check that actions from external audits have been completed?
- 04How do you make sure staffing levels remain sufficient for activities inside and outside the home?
- 05How do you support people who cannot communicate verbally to express their choices and concerns?
This was an unannounced comprehensive inspection covering all five key questions; the report also refers families to the previous report published on 27 January 2015 for more detail. This explanation was written from the published report of 8 June 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Mirabeau
3 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- March 2020Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 17 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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Most charge £1,020 to £1,260 a week. 25 can care for a couple. 10 years' experience on average.
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