Inspection on 10/06/08 for The Triangle Nursing Home

This inspection was carried out on 10th June 2008.

CSCI found this care home to be providing an Good service.

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 06/06/06

The Triangle Nursing Home 25/10/05

The Triangle Nursing Home 01/08/05

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Triangle Nursing Home London Road Wheatley Oxfordshire OX33 1YW Lead Inspector Kate Harrison Unannounced Inspection 10th June 2008 12:15p X10015.doc Version 1.40 Page 1 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 The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 2 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 DS0000027186.V365612.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Triangle Nursing Home Address London Road Wheatley Oxfordshire OX33 1YW Telephone number Fax number Email address Provider Web 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 Chiltern Care Homes Limited (part of the Southern Cross Healthcare Group) Amanda Longford Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Terminally ill over 65 years of age (3) of places The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. The total number of service users must not exceed 28. Date of last inspection 6th June 2006 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 can provide accommodation for 28 older people who require nursing care. The accommodation is provided on two floors, and there are 26 single rooms and one shared room. The home has limited outdoor space. The weekly fees for this service range from £765 to £825, and more information about fees can be obtained by contacting the home. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection of the service was an unannounced ‘Key Inspection’ and took place over 5 hours during one day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home’s manager, through the Annual Quality Assurance Assessment (AQAA), and any information that we received about the home since the last inspection. We saw those areas of the home used by people living there and looked at records and documents relating to their care. We also looked at staff recruitment files and at training records, and we spoke with the registered manager of the home and with other staff members. We asked the views of the people who live in the home, staff members and of relatives we saw during the inspection, and their views are reflected in this report. We sent out surveys through the home, but we did not receive any replies. Several people were not able to communicate their views and we took time to observe how they were treated during the day. It was a thorough look at how well the home is meeting the standards set by the government and in this report we make judgments about the outcomes for the people living in the home. From the evidence we saw throughout the inspection visit and from comments received, we consider that the home would be able to provide a service to meet the needs of individuals of various religious, racial, gender or cultural needs, and with physical disabilities. What the service does well: People living at the home say that the care provided is good. One person said that the best thing about the home was the carers, that they ‘are sympathetic, firm and caring’. The home is involved in a national programme to improve the way people are treated at the end of their life, and some staff members have a special interest and additional training in the subject. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 6 One person said that she was ‘agreeably surprised’ by the quality of the food. People living in the home say they trust the manager to deal with any concerns and complaints arising. What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have their needs assessed before moving into the home, to make sure that the home can meet their needs. EVIDENCE: The home uses the company’s prepared documentation to carry out the preadmission assessments. The registered manager usually carries out the assessment before agreeing admission to the home, and obtains all the necessary information from social and health care organisations. We looked at a sample of the pre-admission assessments recently carried out and found these were completed appropriately. The AQAA information shows that a letter is sent to confirm that the home can meet the individual’s needs and the individual’s first four weeks at the home are seen by both parties as a trial period. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of the people living in the home are met by a caring respectful staff team. EVIDENCE: We looked at a selection of care plans, and saw that care plans were in place to meet the physical and social needs of the individuals selected. The home uses the organisation’s documentation to record care planning information, including risk assessment. The AQAA information states that there is easy access to NHS provision, such as a general practitioner, optician and chiropodist, and we saw from the care plans that this is the case. The home makes available equipment to meet the needs of individuals, such as pressure relieving equipment and hoists. Individuals praised the care team, one person saying that they ‘look after me well’. They told us that they were treated with respect and that as far as they could, the care team responded to their wishes. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 10 The home’s medication is provided by a well known pharmaceutical company, and a system is in place to make sure that the receipt, administration and disposal of medication is recorded. There are policies and procedures in place to guide staff members in managing the medication. We checked medication and saw that the records matched the medication seen. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home have some choice and control over their lives. EVIDENCE: The home employs an activities organiser, who has not been available to the home for long periods recently. The activity schedule shows that activities are provided on three days a week, and are a mixture of group and individual activities, but not all the scheduled activities take place. One individual said that activities were ‘disappointing’, and another said ‘very little entertainment’. One individual said that she liked it when entertainers came, as she would stay in the lounge, but that she usually stayed in her room otherwise. On the day of the inspection visit people sitting in the lounge had long periods of inactivity, with no interaction with others. We saw from the records that there were no entries regarding activities for several months for some individuals, but that entries had restarted for one individual the previous week. People at the home have limited outdoor space, and particularly because of this, the home needs to take action to improve the provision of group and individual activities. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 12 Although some private rooms have showers, currently only one bathroom is in use in the home, while another is awaiting repairs. Some individuals told us that this was a problem for them, as they cannot have a bath every day if they want one. One individual said that because she was not able to have a bath on the day allocated to her, she had to wait another week for her turn to have one. The manager explained that this is a short term problem as there are plans in place to improve the facilities. The call bell has a high pitched sound that can be intrusive, and the home is looking into improving the sound. Visitors are very welcome to the home, and are supported to have family celebrations at the home if they want to. People can bring personal possessions with them and they are encouraged to manage their financial affairs for as long as they want to. People at the home said that they liked the food, although some people said that the choice of evening meal was not very good. The home has recently started to introduce a new nutritionally balanced menu, and the new system is expected to improve the choice of evening meal. One individual said that her/his choice of meal was not respected on two occasions recently. This was discussed with the manager and the chef, who looked into the matter, and took action to make sure that it would not happen again. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are protected from harm and know that their concerns and complaints will be addressed. EVIDENCE: The home has a complaints procedure displayed at the entrance, and people told us they knew whom to approach if they wanted to complain. They said that the manager was approachable, and they trusted her to sort out any concerns. No complaints have been received at the home since the last inspection, and we have not received information about any complaints about the home. The home has a policy about safeguarding vulnerable people, and the manager knows what to do in the event of an allegation or suspicions of abuse. The manager, who has undertaken additional training in the subject, provides training to the staff team and to new staff members about safeguarding in the home. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place to keep the home comfortable and safe, and plans are in place to improve the bathing/showering facilities. EVIDENCE: We saw the communal areas of the home used by the people living there, and some private rooms. The requirement made following our last inspection about improving the standards of cleanliness in the bathrooms and toilets has been met. The home has a development plan to improve the environment, and has a maintenance system in place to manage day to day repairs, including a full time employee responsible for maintenance of the home. The carpet in some areas has been replaced. There are some areas upstairs where the carpet is not properly fitting, and may present a trip risk to staff members and to people living at the home. The manager is aware of the problem, and said that there are plans to make the carpet safer and to replace the carpet. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 15 There are plans in place to repair the assisted bath currently not in use, and the home’s development plan includes plans to add two shower rooms, so that the people living in the home have improved choice about personal care. The number of adjustable beds has been increased to 11, and there are plans to further increase the numbers to minimise risks to staff members and to individuals. The environmental health officer visited the home in March 2008 and was satisfied with the quality of the arrangements in place in the kitchen. There is a good system in the laundry room to manage the laundry needs of people living in the home, with a dedicated person responsible on duty five days a week. There is limited outdoor space, but the home has improved the area with seating and flower planters and improved access. The three recommendations made at the last inspection to improve the environment have been implemented. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 16 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at the home are cared for by safe trained members of staff. EVIDENCE: The home has a staff rota showing that a team of carers is available to meet the needs of the people living in the home over the 24 hours, including a registered nurse. People at the home said that the care provided was good. Staff members we spoke to said that they were satisfied with the training offered, and that they were supported to enrol on the National Vocational Qualifications (NVQ) programme. Of the 12 carers in the team 8 have achieved the National Vocational Qualification Level 2 in Care, and this means that the home has met the national minimum standard of 50 trained carers in the home. The home uses a matrix to record and track the training needs of the staff team, and the matrix shows that mandatory training is generally up to date. The matrix shows that most of the staff need to have training on Infection Control, and the manager said that this was in hand through a sister home, though no date was arranged as yet. The manager and senior care staff have a particular interest in palliative care, and are working to introduce an approved national programme of end of life care to the home. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 17 The home now uses the Skills for Care standard induction process for new staff members. We looked at three staff recruitment files to check that the home was following correct procedures to safeguard people living in the home, and we were satisfied that all the necessary information was available. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 18 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that steps are taken to keep people living at the home safe. EVIDENCE: The registered manager has been at the home for several years and expects to complete her Registered Manager’s Award in the near future. She completed the AQAA document accurately and is aware of what needs to be done to improve the home. All the requirements and recommendations from our last inspection have been met. She works well with senior managers in the organisation to report the home’s needs and to fulfil the home’s development plan. An annual quality assurance survey is carried out to see how the home is meeting the needs of the people living there, and includes the views of relatives. The home manages small amounts of petty cash for some people The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 19 living in the home, but is working with a well known bank to change the way this is done, so that people have more control over their affairs. The manager is the person responsible for health and safety in the home, and has attended a health and safety course. The home has a health and safety policy statement, and has systems in place such as contracts with appropriate companies to maintain the safety of the facilities at the home. The staff team receive training on health and safety topics, and there is an updated fire risk assessment in place to make sure that people living at the home are safe. The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 20 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 2 X 3 X 3 X X 3 The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Triangle Nursing Home DS0000027186.V365612.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000027186.V365612.R01.S.doc Version 5.2 Page 23 - 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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