Inspection on 01/08/05 for The Triangle Nursing Home

This inspection was carried out on 1st August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Triangle Nursing Home 10/06/08

The Triangle Nursing Home 06/06/06

The Triangle Nursing Home 25/10/05

The Triangle Nursing Home 20/01/05

The Triangle Nursing Home 19/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Triangle Nursing Home London Road Wheatley Oxfordshire OX33 1YW Lead Inspector Philippa MacMahon Unannounced 01 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Trianle Nursing Home Address London Road, Wheatley, Oxfordshire, OX33 1YW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01865 875596 01865 873992 Crown Nursing Homes Amanda Longford Care Home with Nursing 28 Category(ies) of OP; TI(E) registration, with number of places The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: On admission persons should be aged 60 years and over. The total number of service users must not exceed 28. Date of last inspection 20 January 2005 Brief Description of the Service: The Triangle Nursing Home is a purpose built home registered for 28 service users, built about 12 years ago. It is located in the village of Wheatley on the old A40 approximately three miles east of Oxford. The Triangle is home to 28 older people who require nursing care. The accommodation is provided on two floors. There are 26 single rooms and one shared room. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out between the hours of 9.30am and 12.30pm. The home was busy with residents going about their daily activities. The inspector was provided with a warm welcome, and assistance from the staff. Care plans were examined, and the inspector followed this through by talking to individual residents, staff and the visiting GP, in finding out if the care needs were being met. A significant amount of time was spent in talking to the residents, staff and visitors to obtain their views of the service provided. A tour of the home was undertaken to observe the upkeep of the premises and the grounds. Towards the end of this inspection the registered provider visited the home to break the news that the company had just been sold to Southern Cross, a large national provider. After many years of building up Crown Homes this was a hard decision to make and Mr Wilson took it upon himself to visit the homes and break the news in person. What the service does well: What has improved since the last inspection? Nothing was apparent to the inspector at the time of this visit. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Any person admitted to the home, whether for short or long stay, does not do so unless they have had an assessment of their care needs, and are assured that the home will be able to meet those needs. EVIDENCE: A sample of care plans was examined and each one had a pre-admission assessment form that had been completed and formed the basis of the care plans. The registered manager carries out all of the pre-admission assessments in the individual’s own home or the place where they are being cared for at that time. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10, 11. The care planning and delivery at the home is of a high standard. The home has a reputation within the local community for providing good care. All residents are treated with dignity and respect. The registered manager and her team have the experience and expertise to deal with residents at the end of their lives, and to allow them a dignified and peaceful death. Families and friends are considered by the registered manager to be as “extended family” and, as such, are included in any reviews or discussions as appropriate, with the permission of the person involved. The inspector recommends that the registered provider, and manager should look into the possibility of acquiring electrically operated nursing beds. EVIDENCE: The sample of care plans examined by the inspector gave a clear, up to date picture of the resident’s needs and how these would be met. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 10 One of the residents is someone who regularly comes into the home for respite care. This person has complex nursing needs and, by coming into the home periodically for “top up nursing” and to allow relatives to have a break, is able to remain at home. Discussion with the registered manager about providing for people with complex needs raised an issue that has occurred before, in that a lot of elderly people have electrically operated beds at home and find that when they come into the home it is difficult and uncomfortable for them to be hoisted to change position, and entails a certain loss of indepence. A visiting GP said that the care at the Triangle is very good, and the communication between the staff and the surgery is excellent. The majority of the residents are registered with this practice. Having observed the staff going about their duties it was apparent to the inspector that all the staff had a good understanding of the issues of privacy and dignity, such knocking on doors before entering a resident’s private room, and using the resident’s preferred term of address. There have been a number of deaths recently and the registered manager and her staff consider it is a privilege to nurse people at the end of their lives. Every support is offered to the family and friends at this difficult time. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The inspector did not make a judgement about this outcome as none of the outcomes were inspected. EVIDENCE: None of these standards were assessed on this occasion. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The inspector did not make a judgement about this outcome as none of the outcomes were inspected. EVIDENCE: None of these standards were assessed on this occasion. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. The floor coverings in the main entrance hall are in a poor state of repair and it is recommended that consideration should be given to making good or replacing the flooring in the entrance hall and downstairs corridors. The sealed non slip flooring in the bathrooms and toilets is in need of repair and resealing to ensure that it is kept clean and hygienic. The communal outdoor space is not attractive, safe or appropriate for the residents to sit out in. It is recommended that consideration should be given to creating an outdoor space for the residents to enjoy during the good weather. EVIDENCE: Overall the home is clean and orderly, and the furnishings and décor are in good order and provide a warm and comfortable home for the residents. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 14 The resident’s individual rooms are comfortable, and residents have their own personal possessions around them that give the feeling of home. Those residents spoken to like their rooms, and are comfortable living at The Triangle. The floor covering in the entrance hall and adjacent corridors is worn and ill fitting and, in the inspector’s view, could cause a trip hazard. The staff also find it difficult to push the mobile hoist or wheelchairs across the uneven surface. The sealed floor surfaces in the bathrooms and toilets have a number of joins that are not sealed, and these areas are not clean. The grounds are well looked after but there is no designated appropriate sitting area for the residents to enjoy during the nice weather. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. The number and skill mix of the staff on duty at all times is appropriate to meet the care needs of the residents. Appropriate recruitment policies and procedures are in place. Crown Homes is committed to the training and development of all staff, and good systems are in place to support this. EVIDENCE: The inspector examined the staff rota and found that there are sufficient numbers and skill mix of staff on duty on each shift in accordance with the staffing statement previously agreed with the Oxfordshire Area Health Authority Inspection Unit. As this home is one of five owned by Crown Homes, the administration is managed centrally, and the inspector visited the head office to examine staff records and the recruitment practices earlier in the year, and found that they were in good order. The appropriate policies and procedures were in place. All staff receive induction training and there is a very comprehensive programme in place. Training is provided in-house by a senior nurse practitioner who also develops the training programme across the group. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35, 36, 37 and 38. The registered manager is very experienced and is very much a “hands on” manager, who shows strong leadership skills, and has a good team of staff supporting her. There are excellent administration systems in place to support the care provision at the home. It is recommended that a system of staff supervision should be implemented to support the good work that is achieved by the staff and to assist with the further development of their skills and knowledge. The nursing office is very dark and provides poor lighting for the staff to carry out their clerical duties and manage the medication system. It is a requirement that the lighting in this room must be improved to avoid any risk to the staff working in this area. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 17 EVIDENCE: The inspector observed an excellent professional discussion with the GP, and it was obvious that the GP held the manager and her professional judgement in high regard. The focus of the service provided is very much for the residents. As previously mentioned, all the administration is managed centrally, and the inspector observed at her visit to the head office previous to this inspection that there are good systems in place to safeguard the residents’ financial interests. There was evidence of excellent record keeping, in line with the company policies and procedures. The kitchen and laundry were found to be clean and in good order, and the staff are aware of all health and safety requirements. The fire log was examined and found to be up to date and complete. As yet the company has not implemented a formal system of staff supervision, although this happens informally on a day to day basis, but no record is kept. The nursing office has very poor lighting, especially the artificial lighting that is provided. All the paperwork and management of the medication system is carried out in this room. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 4 3 x 3 3 2 3 3 The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation 23(3)(a) Requirement It is a requirement that the lighting in the nursing office must be improved to avoid any risk to the staff working in this area. Timescale for action 30 09 05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 19 Good Practice Recommendations It is recommended that consideration be given to making good or replacing the flooring in the entrance hall and downstairs corridors. The sealed non slip flooring in the bathrooms and toilets is in need of repair and resealing to ensure that it is kept clean and hygienic. 2. 24 The inspector recommends that the registered provider and manager should look into the possibility of acquiring electrically operated nursing beds. The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 20 3. 25 It is recommended that consideration should be given to creating an outdoor space for the residents to enjoy during the good weather. It is recommended that a system of staff supervision should be implemented , to support the good work that is achieved by the staff and to assist with the further development of their skills and knowledge. 4. 36 The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Triangle Nursing Home H57-H08 S27186 The Triangle V235280 280605 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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