CQC report explained · a residential care home
What the CQC found at Miramar Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, October 2019
Miramar Care Home was rated Good; inspectors found safe, kind and well-managed care after significant improvements since the previous inspection.
This was an unannounced inspection on 14 and 15 August 2019. Two inspectors and an Expert by Experience spoke with 15 people, four relatives and 11 staff. They also checked care records, medicines records, recruitment files and management records.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safer recruitment, improved medicines management, suitable care planning and respectful support.
The previous inspection had rated the home Requires Improvement and found multiple legal breaches. Inspectors found that improvements had been made and that the home was no longer in breach of regulations.
Improved safety
Risk assessments, moving and handling guidance and falls reviews had improved. Staff took action when risks or safeguarding concerns were identified.
“Effective action had been taken to ensure risks to people were assessed and managed.” from the report
Medicines managed safely
Medicines records, guidance for medicines given when needed and checks on staff competence had improved.
“People received their medicines when they needed them.” from the report
Kind and respectful care
People told inspectors that staff were helpful, friendly and respectful. Staff supported people to make choices and remain as independent as possible.
“Staff treated people with kindness.” from the report
Good leadership
Inspectors found stronger management, better staff morale and regular checks to identify and address problems.
“Effective systems had been put in place to continually monitor the quality of the service and address any shortfalls.” from the report
Accurate care records
The home had changed its record system, trained staff and introduced daily checks. Inspectors found records were now accurate and up to date.
“Records about people and the care they received were accurate and up to date.” from the report
Call bell system still settling in
minorA new call bell system had been installed after concerns about response times. Inspectors noted teething problems, and staff had ordered easier-to-use handsets for some people.
“We have a new, better call bell system to use with larger buttons, although there are the inevitable teething problems” from the report
Mixed recommendation feedback
minorThe survey showed that not everyone would recommend the home. The provider had created an action plan in response to feedback, including call bell delays.
“63% of people said they would recommend the service.” from the report
- 01How well is the new call bell system working now, and have the easier handsets been provided to everyone who needs one?
- 02How do you check staffing numbers when people's needs or falls risks change?
- 03How are medicines given when needed, and how do you record their effects?
- 04How often are care records checked, and what happens if a record is incomplete?
- 05What actions were taken in response to the survey finding that 63% of people would recommend the home?
This was a comprehensive, unannounced inspection covering all five CQC questions, including the premises and care provided, and it checked progress after the previous Requires Improvement inspection. This explanation was written from the published report of 3 October 2019 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, January 2019
Rated Requires Improvement; inspectors found ongoing risks with medicines, staffing, care records and management oversight.
This was an unannounced focused inspection on 4 December 2018 and a further day on 5 December. Inspectors checked whether problems found at the previous inspection had been put right. They looked only at Safe and Well-led.
The home had made some changes, including reorganising people into units and improving some monitoring. However, inspectors still found unsafe medicines records, incomplete risk information, delays answering some call bells and gaps in staff recruitment checks.
Management systems did not identify all these problems. Care and management records were not always complete or well organised. The home remained rated Requires Improvement overall for the third consecutive inspection. The other areas were not inspected during this visit and their previous ratings were carried forward.
Protection from abuse
People were protected from abuse. Staff knew the types of abuse to look out for and felt able to report concerns.
“People continued to be protected from abuse. Policies were in place and available to staff.” from the report
Clean and maintained
Inspectors found the home clean and well maintained. Repairs were generally completed promptly.
“The service looked and smelt clean. Housekeeping staff carried out cleaning around the service as well as communal areas.” from the report
Staff support
Staff told inspectors that the registered manager was approachable and supportive. Staff also described working together as a team.
“All the staff we spoke with reported that the registered manager was approachable and supportive.” from the report
People's views
People had opportunities to give feedback. The new resident of the day process had led to activities and personal requests being supported.
“People and staff had opportunities for sharing their views. People's views had been listened to and acted upon.” from the report
Medicines records and doses
seriousRecords for creams, patches and some other medicines were incomplete or inconsistent. One person may have missed a pain relief patch, and inspectors could not confirm whether another person received insulin on one day.
“The failure to ensure the safe administration of prescribed medicines is a continued breach of Regulation 12 of the Health and Social Care Act 2008” from the report
Risk information
seriousSome people did not have up-to-date or detailed guidance about falls, moving equipment, diabetes or choking. This meant staff did not always have the information needed to provide safe care.
“Registered persons had failed to do all that is reasonably practicable to mitigate risks to people.” from the report
Delays with call bells
needs fixingSome people experienced long waits for call bells, especially at busy times such as meals and in the morning. Records showed waits of around 20 to over 30 minutes on some occasions.
“Call bell records evidenced some people often had long delays to receiving an answer to their call.” from the report
Weak management checks
seriousAudits and the improvement plan did not reliably identify or correct problems. Some deadlines had passed, and care records, food and fluid records were not consistently complete.
“The failure to establish and operated effective systems and processes to assess, monitor and improve the quality of the service.” from the report
Recruitment checks
needs fixingEmployment histories were not always complete, and gaps were not always explored. This meant the provider had not fully followed its recruitment procedures.
“The provider had failed to operate effective recruitment procedures.” from the report
- 01What changes have been made to make sure creams, patches, insulin and as-needed medicines are given and recorded correctly every time?
- 02How are risk assessments now kept up to date after falls and for people who need hoists, slings, diabetes support or modified food?
- 03What are the current call bell response times, especially during meals and in the morning?
- 04How do managers check that care records, food and fluid charts and medicines records are complete and accurate?
- 05Who is now leading the home, and how has the change in management affected staffing levels and staff morale?
This was a focused inspection of Safe and Well-led only; the other three questions were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 25 January 2019 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 Miramar Care Home
5 rated inspections over 4 years: the service has held its Good rating throughout.
- October 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2019Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- June 2017Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- March 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2013
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
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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