Mirabeau

Updated 18 March 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by an inspector and a specialist advisor who was a learning disabilities nurse.

Service and service type

Mirabeau is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection we gathered and reviewed information we held about the service, including information we had received from the provider. The provider is required to notify us of deaths and other incidents that occur within the service, which enable the Commission to monitor any issues or areas of concern.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections

Shortly before our inspection we attended a meeting arranged by the local authorities organisational safeguarding team to discuss recent incidents at the service. This meeting was attended by a number of professionals and provider representatives.

We used all of this information to plan our inspection.

During the inspection

We focused on speaking with people who lived at the service and observing how they were cared for. Where people at the service had complex needs, and were not able to talk with us, or chose not to, we used observation to gather evidence of people's experiences of the service.

We spoke with seven members of care staff and the area manager, registered manager and deputy manager. We also attended a meeting where a number of clinical staff were meeting with care staff.

We reviewed a range of records. This included four people’s care records and medication records. We looked at two staff files in relation to recruitment and staff supervision and reviewed a variety of records relating to the management of the service.

After the inspection

We had contact with three family members for their view on the service. We had feedback from four health and social care professionals. We continued to seek clarification and further information from the provider.

Updated 18 March 2020

About the service

Mirabeau is a care home that provides care and support for up to ten people who have a learning disability or who are autistic and have complex support needs. At the time of our inspection there were ten people using the service, seven people lived in the main building and three people in a linked annexe called ‘The Garden Room.’

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Although the service was registered to accommodate more people than current best practice guidance, we found this did not have a negative impact on people’s quality of life. The size of the service was mitigated by the building design which included an annexe. The care home also blended well with other neighbouring residential properties.

People’s experience of using this service and what we found

Before our inspection we had concerns raised with us that there were not enough staff to meet people’s needs. When we inspected, we found the provider had started to address recruitment and retention, however they had not always ensured there were enough staff on duty to keep people safe.

There were detailed and personalised needs and risk assessments which provided excellent advice to staff, based on good practice guidance. Due to lack of adequate staffing, the care plans were not always followed as required.

The registered manager was committed and understood risk, however they had not had the resources to respond to the concerns with staffing levels. The provider was working with the local authority to address concerns; however, improvements were required to ensure open and clear communication about how the service decided on the numbers and skill levels of staffing . Staff recorded incidents and accidents. The provider was addressing how they monitored this information to ensure effective action was taken to keep people safe.

There had been improvements in the administration of medicine which demonstrated the service had learnt lessons when things went wrong. The provider ensured people were protected from the risk of infection and lived in well-maintained accommodation.

Staff were extremely motivated. There was a high-quality training programme which prepared staff well to meet people’s complex needs. However, some new staff had not yet attended key training, which left them unprepared for their role and lacking in confidence.

In response to recommendations at our last inspection, the service had introduced new measures to increase people’s independence and involvement in their care. Staff knew people well and communicated skilfully with people and promoted their views and choice. Feedback from families was positive about how caring staff were. Families and representatives were involved appropriately in people’s lives and decisions. They felt able to complain and be confident their concerns would be addressed.

Staff worked well with health and social care professionals to meet people’s needs. Meal times were personalised around people’s preferences and timetables. Staff provided the necessary support to meet nutrition and hydration needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The registered manager agreed to review their applications to deprive people of their liberty to ensure they included all areas of possible restriction.

Support was personalised and reflected people’s changing needs. Staff supported people to develop their skills and set achievable, person-centred objectives. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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

Rating at last inspection

The last rating for this service was good (published 8 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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