We inspected Miramar Nursing Home on 25 August 2016. This was an unannounced inspection. The service provides care and support for up to 28 people. When we undertook our inspection there were 25 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, due to mental health issues.

There was no registered manager in post. The manager was in the process of submitting their application to CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 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. At the time of our inspection there was no one subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information.

People had a choice of meals, snacks and drinks. Meals could be taken in dining rooms, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

When we visited this home we spoke with four people who lived at the home, three members of staff and the manager and looked at three care plans.

Our inspection team was made up of only an inspector on this occasion. We were seeking answers to our five questions; Is the service caring ? Is the service responsive ? Is the service safe ? Is the service effective ? Is the service well led ?

If you want to see the evidence supporting our summary please read the full report.

Is the service safe ?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure the managers and staff learnt from events such as accidents and incidents. This reduced the risk to people and helped the service to continually improve. The home had policies and procedures in relation to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Staff had been trained to understand when an application should be made and how to submit one. This meant people would be safeguarded as required.

The environment was safe and clean. Staff had liaised with the local health and safety officers and the fire brigade when new safety measures had been installed on the stairs.

Recruitment practice was safe and thorough. Safety checks had been completed on all staff prior to their commencement of employment. This was to ensure they were safe to work with adults at risk.

Is the service effective ?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People's health and care needs were assessed with them, and they were involved in writing their care plans. Specialist mobility and equipment needs had been identified in care plans where required. People said they had been involved in writing them and they reflected their needs.

Is the service caring ?

People were supported by kind and attentive staff. We saw the staff showed patience and gave encouragement when supporting people. People commented, "Staff are kind to us" and "I like the staff they help me each day."

People who used the service completed questionnaires which asked them a variety of topics. They told us they could voice their opinions at meetings and could speak with any staff.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive ?

People completed a range of activities in and outside the service. In some cases people required to be escorted and this had been recorded in their care plans.

The provider had responded quickly to a falls incident. They had assessed the situation and put measures in place to ensure the stairs were safe to use.

The provider kept us informed throughout the year of any serious incidents and accidents which had occurred. They told us what action had taken place and measures which had been put in place as lessons learnt from incidents.

Is the service well-led ?

The service worked well with other health and social care professionals. They asked for advice when necessary and included them in reviews of people who used the service.

The service had a quality assurance system in place. Records showed when they had identified risks. Shortfalls had been addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding about the ethos of the home. This ensured people received a good quality service at all times.

During our inspection we spoke with eight people who lived at the service and two of their relatives by telephone. We also met and spoke with four staff members and the nurse in charge. We spoke with the registered manager by telephone.

People told us they enjoyed living at the Miramar and valued the care and support they received. One person told us, “It’s brilliant here.” Another said they got, “Plenty of very good support.”

People told us they felt safe and knew how to raise concerns or worries. One person said, “If I have a complaint I tell them.” A relative told us they trusted staff would speak to the manager if they had concerns. Another was reassured because staff “let them know if there are any issues”

We noted people were involved in planning their own care and were consulted in relation to meals and daily activities. We saw that when requested, care and support was delivered promptly and with courtesy. One person told us, “Staff “show me respect, I feel it.”

We saw that medication was managed and administered safely and the provider planned, organised and evaluated the service to ensure care was delivered safely and to a good standard.

Records showed where decisions were made for people in relation to routine care and important health and welfare issues, those decisions were discussed and considered with families and health care professionals. We noted however that people’s consent was not always asked for decisions which affected them and the assessment process for deciding whether people required care providers to make decisions for them was not clearly documented in care records.

As part of our inspection we spoke with a number of people who used the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed that they were supported to make choices and decisions about the care they received.

Comments from people using the service included, "I feel safe here", "Staff speak nicely to me" and "It's a nice place to live."

During the visit we spoke with visitors who expressed their satisfaction with the standards of care at the home. They told us the staff were good and they were kept informed of any changes.

We carried out this review because we had concerns that this service had not been visited since the last inspection which took place on 22 April 2008.

When we undertook a visit to Miramar care home people who lived at the home told us they were happy with the care and support that they received.

One person said, “Been to the shop, I go out when I want and I like living here.”

Another person told us that, “I have lived here for a long time. I like it and am hoping to move out sometime in the future.”

One person who had recently moved into the home told us, “They came to see me before I moved in. Being near the sea sold it to me. The care is good, I have my own telephone in my room and I speak to my family every day.”