Mirabeau

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.

When we last visited the service it was rated good.

At this inspection we found the service remained good.

People were supported to stay safe and staff were provided with detailed guidance to effectively minimise risks to people’s safety. There were sufficient, safely recruited staff to meet people’s needs both in the service and out in the community. Medicines were safely administered by appropriately trained staff.

Staff were well supported and received specialist training to meet people’s individual needs. Staff supported people to maintain good health and wellbeing and enabled them to access other health and social care professionals when required. People were able to choose what they ate and drank in line with their preferences.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. Management and staff understood their responsibility in this area. Staff were committed to ensuring all decisions were made in people’s best interest.

Staff knew people well and treated them with kindness, good humour and respect. There was advice in place to enable staff to communicate with people and support them to make decisions about the care they received.

Care at the service was highly person centred. Detailed assessments had been carried out and personalised care plans were in place. Staff carried out on-going observation and recording which was analysed to ensure support met people’s individual needs. People were supported to have an active and enjoyable life and to maintain communication and relationships with family members. There was a complaints process in place and the manager welcomed feedback and open communication with families.

The manager promoted stable leadership and a calm, positive atmosphere which benefitted people who used the service. People were not enabled to make decisions about the way the service was run. We have made a recommendation about greater involvement of people. The provider had systems in place to check the quality of the service and made improvements, where necessary.

Further information is in the detailed findings below.

We found that the provider had systems in place to maintain the safety and welfare of service users. The service provides staff with specilaised training to ensure the safety of people with specific medical needs. The service provided people with appropriate levels of nutrition and hydration and encouraged people to drink during the spell of hot weather.

We found that the service had appropriate arrangements in place to protect people from the risk of abuse. Staff received regular training on safeguarding vulnerable adults and people with learning disabilities. The provider had appropriate arrangements in place for the use of physical interventions and restraint and monitored all incidents closely to ensure people were protected from the risk of inappropriate restraint.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff, the clinical psychologist and the area manager. The provider ensured the operation of the service continued uninterrupted in the absence of the registered manager.

We found that there was a sufficient number of staff on duty to provide care. The service was recruiting additional staff at the time of our inspection and did not use agency. Staff received regular supervision and an annual appraisal.

We observed people being cared for by staff during our visit. People who used the service shared their views through gestures, facial expressions and body language wherever possible. People were engaged in a range of activities, relaxed and comfortable with staff and people around them.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The service was well supported by the provider through extensive training for staff, clear policies and procedures, and regular refurbishment and maintenance.