Miramar Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The key question of Safe was rated Good at our last inspection and continues to be rated Good following this assessment. Staff knew people well and supported them to stay safe and independent. Staff knew how to recognise abuse and how to raise concerns. Staff told us they were supported by the management team and had received the training they needed to support people safely. However, during the assessment of this key question, we found concerns around the management of risk which resulted in a breach of regulation. We found there was no detailed guidance for staff to mitigate risk and processes were not always followed to learn lessons when things went wrong.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us when their loved ones had fallen, staff had taken appropriate action and called the emergency services when needed. They had been informed about any falls straight away and felt people were safe. One relative told us they had been involved in discussions about how to reduce the need for their loved one to go to hospital each time they fell because of their medication and this had been successful.

The registered manager explained to us how they used the provider’s systems to have oversight of all accidents and incidents. They used this information to look at possible causes and plan how to mitigate any risks. For example, several people had fallen and sustained injuries, including broken bones before our assessment. The registered manager told us they had reviewed and considered if people’s medicines had increased their risk of falling. People had been referred to their GP, physiotherapists and occupational therapists. The registered manager told us their analysis of the falls had not found any patterns or trends and the people who had fallen do not have a history of falls. Any learning points were shared with senior carers at daily meetings and disseminated to care staff for action. All the staff we spoke with understood how to prevent similar incidents occurring again. The registered manager understood their responsibilities under duty of candour and informed people’s relatives about any incidents or accidents and what was being done to keep people safe in the future.

There were processes in place to analyse accidents and incidents to identify patterns and trends, these had not been used consistently. Records showed there had been 71 accidents or incidents in the 3 month period January 2024 to March 2024, with some people falling regularly for example one person had fallen 7 times. The information had not always been used to develop strategies and reduce the risk of them happening again.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the service. One person told us, “It’s a lovely place and I feel safe. The staff are very nice. Of course, one or two are nicer than others but none of them is nasty. They are kind and helpful. I haven’t seen anything that bothers me.” Relatives told us, they thought staff supported people to remain safe. One relative stated, "Staff are very friendly and attentive. They talk to (relative) like they are part of the family there, they don’t make them feel as though they are there to be looked after."

We observed people were relaxed with staff and were comfortable to call staff and request for help or ask questions. Staff spoke to people in a respectful manner. They paid attention to people’s needs and supported people accordingly. The atmosphere was relaxed and friendly.

There were systems in place to report safeguarding concerns to the local authority. The management team had identified when concerns needed to be raised and reported them accordingly. They had worked with the other professionals including the local authority safeguarding team and the police to investigate any allegations of abuse. When people were at risk of being deprived of their liberty to protect them from harm, the registered manager had applied for Deprivation of Liberty Safeguards (DoLS) authorisations. These were kept under review and new applications were submitted as required.

Staff understood how to keep people safe. They explained to us the signs of possible abuse and the action they would take to keep people safe. This included informing their line manager, the registered manager and the police. Staff we spoke with were confident the management team and provider would act promptly to keep people safe.

People's care plans did not contain detailed guidance for staff to refer to that demonstrated how they were to manage potential risks to people's health and welfare. Some people were at risk of requiring rapid intervention by staff, including the use of emergency medicines. There was no guidance in place for staff to follow to ensure they were able to recognise when a person needed the medicines and what to do if the person did not respond . The medicine was locked away in a clinical room, whereas the person spent time in all parts of the building. There was a risk staff would not be able to access the medicine quickly enough. Some people could not express their anxiety or distress verbally and there was limited information for staff to refer to that informed them of people's individual triggers or what distraction techniques should be used. For example, additional staffing had been allocated to manage a specific risk but incidents had continued to happen, but the strategy had not been reviewed or guidance updated. Incident records showed there had been repeated incidents between people, which staff had not been able to mitigate. When people were at risk of falls, there was very little guidance for staff to manage the risks of people falling. Some people had illnesses or were prescribed medicines which could increase their risk of falls, this had not been identified in people's care plans. When management plans had been put in place, these had not been monitored to assess if they had been effective. For example, additional staffing had been allocated to manage a specific risk but incidents had continued to happen, but the strategy had not been reviewed or guidance updated.

Staff understood how to protect people from identified risks. They consistently told us how risks, including choking, and falling were mitigated. For example, they described how people’s meals and drinks were prepared, in line with professionals guidance, to support them to swallow safely. Staff described to us the support they offered people to move around their apartments and the service. They told us they followed guidance in people’s care plans about the support they needed. All the staff we spoke with described how people’s needs fluctuated and how they supported them in different ways dependant on how strong people felt each day. Staff told us effective systems were in place to ensure they knew about any changes in people’s needs. These included hand over meetings at the beginning of each shift and being informed when guidance around how to meet people’s needs had not been met. Staff had access to this information at all times. All of the staff we spoke with were confident to support people to remain safe in an emergency. They all described the horizontal evacuation process, where they moved people to other areas of the building to protect them from harm.

Staff were involved in managing risks to reduce the risk of harm. We observed staff moving people from one place to the other using their mobility aids such as wheelchairs. Staff followed safety measures, they explained them to the person and encouraged them to follow the procedures. People had suitable equipment in place for safe transfers and mobilising. Where people had risk of choking, we saw they were supported to sit upright when eating and they were supervised to reduce any risk.

People and their relatives commented that they were involved in managing risks. One people told us that staff always used their transfer equipment when moving them and they explained what they were doing so they felt involved. One relative mentioned, [loved one] has had a couple of falls. Staff had ensured they got medical attention promptly and relatives were contacted immediately. Another relative told us, they had been involved with every decision so far, nothing had been changed without the family approving or being made aware of it.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were adequate staff around to support people. We observed care staff responding appropriately to people’s needs. Staff had time to stop and chat with people. Call bells were answered promptly and staff visited people in their rooms to check on them. People were not left unattended to in the communal areas.

The management team and staff explained how different areas of the service were staffed based on the needs of the people living there. Additional staff came on duty at 7am to assist night staff as some people liked to get up early. They told us staffing levels were kept under review to ensure there were always enough staff available to meet people’s needs. When people needed to have a staff member with them at all times to keep them safe, additional staff were deployed. Staff spent their time solely supporting the person. One person had additional staff support at the time of our inspection and the registered manager told us the person enjoyed the company of a staff member and this supported them to go out and join in activities at the service. The management team told us people were offered rooms in the area of the service where there needs could be met. When people’s needs changed any potential move needed were discussed and agreed with people and their family. This process was effective and staff told us they had time to spend with people and were not rushed. New staff told us they completed an induction, which included shadowing experienced staff before they worked alone with people. They told us staff had been very supportive and shared their experience with them and this has helped them develop the skills they needed. They told us they were completing the care certificate. Staff told us they completed annual e-learning in a variety of subject, including safeguarding. They also completed practical training in area such as moving and handling and first aid. Staff told us they had practiced evacuation processes, including the use of evacuation equipment. They told us they felt competent to support people to remain safe in an emergency.

There were effective systems in place to recruit staff safely. There had been checks completed on new staff including references from previous employers to establish they were of a suitable character to support people safely. New staff had received an induction, including time shadowing more experienced staff to learn about people's choices and preferences. Staff had received training and their competencies had been checked to make sure they were confident to support people safely.

People and relatives were mainly positive about the level of staffing within the service. One person told us, “There are plenty of staff around. When I buzz, they come quickly.” One relative mentioned, “Yes, there are enough staff. I have never seen when there are no staff around. I always see staff interacting with the residents.” One relative told us there seemed to be less staff on at the weekends, but they could usually find someone to help. There was always a head carer available. Another relative told us, " I feel there’s enough staff, there are some shifts where they are understaffed but they still do everything to make sure safety and wellbeing isn’t compromised."

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.