CQC report explained · a nursing home
What the CQC found at Miranda House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, September 2022
Miranda House rated Good; inspectors found safe care and improved management, with some medicines guidance, staffing and staff morale issues to watch.
This was an unannounced inspection on 9 August 2022. Inspectors spoke with people, relatives, staff and health professionals. They reviewed care and medicines records, staffing information, accidents, complaints, safeguarding records and quality checks.
The home was rated Good overall. Safe and Well-led were both rated Good. Inspectors found that risks were assessed, records had improved, medicines were given as prescribed, and there were enough staff to support people safely during the visit.
There were still some issues. Instructions were not clear enough for some medicines given only when needed. Feedback about staffing was mixed, and some staff morale was low after management changes. The last inspection rated the home Requires Improvement in November 2021, so the overall position had improved.
Improved risk management
Risk plans had been reviewed by nursing staff and matched monitoring records and professional guidance. Inspectors found that earlier problems with inaccurate and conflicting records had improved.
“At this inspection we found this had improved. People had their own risk management plans which had been reviewed by nursing staff.” from the report
Safe medicines and infection control
People received their medicines as prescribed, records had no gaps, and medicines were stored safely. Inspectors were also assured about infection prevention and control.
“People had their medicines as prescribed. People had their own medicines administration record (MAR) which staff used to record administration of medicines.” from the report
Reduced incidents between people
The number of incidents involving people had reduced since the previous inspection. The provider had introduced a dementia strategy and extra training and guidance.
“Since that inspection incidents involving people had reduced. The provider was rolling out a dementia strategy in Miranda House and staff were being supported with additional guidance and training.” from the report
Good teamwork and atmosphere
Inspectors saw staff working together to meet people's needs. The home felt calm, and people and relatives described it as welcoming and kind.
“We observed good teamwork and saw staff working together to meet people's needs. The home felt relaxed and calm.” from the report
Improved oversight
The provider and home had several quality checks in place. Actions were monitored until completed, and learning from incidents was shared.
“Quality monitoring systems were also in place at home level. Staff and the registered manager carried out a range of audits to monitor quality and safety.” from the report
Unclear instructions for some medicines
needs fixingFor some people taking more than one medicine when needed for the same health problem, the records did not clearly say which medicine should be given first. The registered manager said this would be clarified with the GP.
“For some people on multiple 'as required' medicines types for the same health need, the guidance on the order of administration was not clear.” from the report
Staffing could be difficult at times
needs fixingInspectors saw enough staff to support people safely during the visit, but some relatives and staff said staffing became difficult when staff were off sick. The provider was reviewing how staff were deployed.
“We are running low on staffing anyways, when staff go off sick it makes things extra difficult.” from the report
Staff morale during management changes
minorSome staff said morale was low because of changes made by the new registered manager. The provider said this would continue to be monitored.
“Some staff we spoke with told us morale had been low amongst the staff. This was due to the changes being made by the new registered manager.” from the report
- 01How have you clarified the order for giving different 'as required' medicines for the same health need?
- 02What happens when staff call in sick and agency cover cannot be found?
- 03Has the management team now stabilised, and what have you done to improve staff morale?
- 04How are incidents between people living at the home monitored under the dementia strategy?
- 05Which quality checks are currently outstanding, and how are actions followed through?
This inspection focused on Safe and Well-led; the report does not give ratings for Effective, Caring or Responsive. This explanation was written from the published report of 2 September 2022 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, November 2021
Miranda House is rated Requires Improvement; inspectors found improvements in staffing, medicines and infection control, but safety records and management were not consistently reliable.
This was an unannounced focused inspection on 12 October 2021. Inspectors spoke with people, relatives, staff and health professionals. They reviewed care records, medicines records, recruitment files and management records.
The home was rated Requires Improvement for Safe and Well-led. Risks were identified and staff generally knew how to support people, but some records were inaccurate or conflicting. There had also been a number of altercations between people, some causing injuries.
There were enough staff, medicines records had no gaps, and infection control arrangements were found to be effective. Management had improved from Inadequate to Requires Improvement, but leadership had been inconsistent, there was no registered manager, and actions from feedback were not always recorded.
This inspection did not review Effective, Caring or Responsive. Those ratings were carried forward from the previous comprehensive inspection. The overall rating remained Requires Improvement.
Enough staff
Inspectors found enough staff to meet people's needs. Staff did not appear rushed and responded promptly to requests for help.
“At this inspection, we observed improvement had been made and people were being supported by sufficient numbers of staff.” from the report
Medicines
People received their medicines as prescribed. The medicines administration records checked had no gaps.
“Medicines were managed safely, and people had their medicines as prescribed.” from the report
Infection control
The home had testing, PPE, cleaning and visiting arrangements in place. Inspectors were assured that infection risks were being managed.
“We were assured that the provider was using PPE effectively and safely.” from the report
Improved reporting
Incidents were being recorded and reported more reliably than at the previous inspection. The provider was reviewing individual incidents and monitoring some clinical areas.
“Incidents had been recorded and action taken to address the immediate risk and/ or injury.” from the report
Inaccurate risk records
seriousSome records did not accurately show the action taken to reduce risks. Inspectors found gaps in repositioning records and conflicting information about choking risks.
“However, we observed that the provider could not always be assured the correct action had been taken as the records were not always accurate.” from the report
Altercations between people
seriousThere had been a number of altercations between people living at the home, and some had caused injuries. The provider was using specialist training and activities to try to reduce this.
“Whilst people and relatives told us people were safe, we observed there were a number of incidents where people had altercations with each other.” from the report
Incomplete clinical oversight
needs fixingOne clinical governance meeting wrongly recorded that there had been no altercations that month. This meant those incidents were not discussed as part of the home's clinical oversight.
“This was not accurate as there had been incidents, which meant these were not discussed as part of that clinical oversight.” from the report
Unsettled management
needs fixingManagement had remained inconsistent because several managers had been employed since the previous focused inspection. There was no registered manager, although an interim manager was in post.
“At this inspection we observed this had not improved as a number of managers had been employed since our last focused inspection.” from the report
Feedback actions not clear
needs fixingThe home had collected survey feedback, but inspectors could not see what action had been taken in response. The interim manager said this would be a priority.
“The results of the surveys had been received but we were not able to see actions taken in response.” from the report
- 01How will you make sure repositioning, choking and other risk records accurately show the action taken?
- 02What specific steps are being taken to reduce altercations between people, including the incidents that caused injuries?
- 03How will all incidents, including altercations, be included in clinical governance meetings and reviewed for further learning?
- 04When will a registered manager be appointed, and how will leadership remain consistent until then?
- 05What actions have been agreed from people's and relatives' survey feedback, and how will families be updated?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 12 November 2021 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 Miranda House
10 rated inspections over 6 years: the service has improved, from Inadequate to Good.
- September 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- June 2021Inspected but not ratedSafe: Inspected but not rated
- March 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Inadequate
- November 2019Goodup from Requires improvementSafe: GoodWell-led: Good
- December 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2018Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- August 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- November 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2016Inadequatestayed InadequateSafe: InadequateEffective: Inadequate
- March 2016InadequateSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- July 2013
Registered with the Care Quality Commission on 4 July 2013.
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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