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

This inspection was carried out on 6th June 2006.

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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Triangle Nursing Home London Road Wheatley Oxfordshire OX33 1YW Lead Inspector Philippa MacMahon Unannounced Inspection 6th June 2006 09:30 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.V298454.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.V298454.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 triangle@schealthcare.co.uk 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.V298454.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 25th October 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 fees for this service range from £518 to £713.79. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09.30 and was in the service for 5¾.hours. The inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that the CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection. The inspector looked at how well the service was meeting the standards set by the government and has, in this report, made judgements about the standard of the service. A warm welcome and full co-operation was offered to the inspector throughout the inspection. The pre-inspection information sent out by the Commission had not been returned to the inspector so that additional information about the service and how it is meeting the needs of the residents was not available. The inspection is therefore limited to the site visit. The registered manager was not available until later in the day and the senior nurse in charge was very helpful to the inspector. A tour of the home was undertaken, care plans were examined and meeting the residents to see if the care plans gave a true reflection of their care needs and how these were being met followed this up. The inspector met with residents, staff, visiting professionals, relatives and friends to find out their views on how well the service is doing. Records required by regulations were examined, including staff files and the home’s policies and procedures. What the service does well: The home provides a comfortable friendly home that is very much a part of the village life. The nursing care provided is of a high standard. There is a very good working relationship between the local GP surgery, the GPs and district nurses. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 6 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 Triangle Nursing Home DS0000027186.V298454.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.V298454.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has an assessment of their care needs prior to being admitted to the home. This is always carried out by the registered manager. EVIDENCE: The manager carries out all pre-admission assessments. The sample of care plans examined all contained a concise assessment of all the individual’s care needs. The Triangle Nursing Home DS0000027186.V298454.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has a care plan in which their care needs are identified and the action required to meet them. The residents’ health care needs are met. EVIDENCE: A sample of care plans were examined and this was followed up by meeting with the individual resident to confirm that the care needs were being met. On each occasion the care plans gave a good reflection of the person, their care needs and how these would be met. The plans were reviewed on a regular basis, and the daily record reflected the care as set out in the individual care plan. Risk assessments had been carried out and appropriate actions put in place where needed. One of the residents has a complex wound and there is excellent joint working between the registered nurses, the GP and the district nurse who has a special interest in this area of expertise. Both the GP and district nurse told the inspector that the home’s nurses were excellent and very good at communicating with the surgery. Residents spoken to overall felt that the care provision was good and that the staff were kind and considerate. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents each have the opportuntiy to pursue their interest and take part in social and recreational activities should they wish to. The residents are offered a wholesome and nutritious diet. EVIDENCE: The inspector met with the activities co-ordinator who visits the home two days a week. There is an activities plan and this is displayed on a white board in the entrance hall. The home is holding a fete in a few days time and a number of residents were helping to sort out equipment from previous fetes in readiness. The activities plan includes bookings with entertainers once a month, quizzes, planting up of pots to brighten up the entrance to the home. and chair exercises. The co-ordinator meets with each resident and has one-to-one time to ensure that their needs are being met. Contact with local businesses has been very good and they have been generous in their support of the home. The Triangle is very much a part of village life and many of the residents are local people and are able to maintain their social links. Residents spoken to were looking forward to the fete and were enjoying helping the co-ordinator. A group of residents were taking part in a quiz during the inspection and were very enthusiastic in their participation. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 11 The home welcomes visitors at any time and a number were visiting at the time of this inspection. Those spoken to commented on how homely the home is and that they really enjoyed visiting. The local Anglican church provides communion once a month, and the Catholic church once a week. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural backgrounds. The inspector joined the residents for lunch and enjoyed a tasty meal that was well presented. The dining room was set up with colourful tablecloths and napkins, and there was a posy of fresh flowers on each table. The residents spoken to appreciated the meals and said that they are on the whole quite good. They also said that they were always given a choice, and could have snacks at any time. Fresh fruit is available if requested. The inspector met with the chef whose spoken English is very limited but he did appear to understand what he was being asked. The menus examined showed that the residents receive a wholesome and nutritious diet. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 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 the following standard(s): 16.18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an accessible complaints procedure in place. The residents are protected from abuse. EVIDENCE: The home’s complaints procedure is displayed in the entrance hall, and is contained in the service users’ guide. One resident spoken to expressed a number of concerns and issues that had been communicated with the manager and these had been dealt with appropriately. The registered nurse in charge said that all staff receive training in adult protection, and one member of the staff spoken to had a clear understanding of adult protection issues. The staff training files showed that training had taken place and it forms part of the induction training for all staff. The Commission has not received any complaints in respect of this home since the last inspection. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 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 the following standard(s): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained but is in need of redecoration and replacement of flooring in some areas. The standard of cleanliness in the communal bathrooms and toilets is poor. EVIDENCE: The inspector toured the premises and, overall, found that most areas were cleaned to a good standard. The residents’ private rooms were clean, homely and very individiual with their own posessions and pictures in place. However, the bathrooms and communal toilets were found to be in need of thorough cleaning, especially underneath the Parker baths and around the toilet pedestals. The toilet on the ground floor closest to the sitting room had an offensive odour. The nurse in charge told the inspector that the cleaner was on holiday and that the care staff were having to clean as well as carry out the care. It is a requirement that the bathrooms and toilets must be kept clean at The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 14 all times. The pull chord on the light in the toilet is very dirty. It is recommended that the manager should look into replacing pull chord switches in the toilets with a more hygienic, cleanable type of switch. The bathrooms and toilets contained various jugs and male urinals that are used for emptying catheter bags. In the ground floor bathroom there was also an old enamel bedpan on the floor that was full of dust and grime. It is a good practice recommendation that recepticals for emptying catheter bags should be cleaned and disinfected after use and stored in the sluice rather than the bathrooms and toilets. The carpet in the corridor on the ground floor is being replaced. The order has been processed and the manager is awaiting confirmation of the delivary date. There are plans to redecorate the communal areas of the home in a lighter, brighter colour scheme. The laundry was found to be clean and orderly and the laundry assistant was commended for the high standard care of the residents’ clothing. The grounds are limited in space to sit out or walk in safety. There are plans to redesign the garden area adjacent to the car park in order to provide a more pleasing enclosed area for the residents to enjoy. Colourful planters have been placed around the entrance to the home that have been planted up by the residents with the help of the activities co-ordinator. The lawns and flower beds were being tended to during this inspection. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers and skill mix of staff on duty at all times to meet the care needs of the residents. The domestic staff hours are not sufficient to ensure cover for annual leave and sickness. Staff training and development plans need to be developed. EVIDENCE: The staff rotas were examined and found to have sufficient numbers and skill mix of staff on duty at all times to meet the needs of the residents. There is a vacancy for a registered nurse that is being recruited to, and a further nurse is on maternity leave. In the interim agency staff are being employed to fill the shortfall. There is only one cleaner in employment at the moment, and when she is on annual leave the cleaning duties are carried out on an ad-hoc basis by all the staff. On some occasions the home is able to access help from other homes in the group but, on this occasion, there was no help available. It is recommended that the registered manager should look into the domestic staff hours and the workload, to ensure that there is sufficient cover for sickness and annual leave, so that care staff hours are not taken up with domestic duties. A sample of staff files were examined and these showed that proper recruitment procedures are in place, and that the necessary checks are carried The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 16 out for the protection of the residents, such as references, medical checks, registration with professional bodies and copies of birth certificates and passports. Criminal Records Bureau checks have been undertaken but these documents were not available as they were held centrally before the takeover of the new company in a discrete locked filing cabinet. The inspector had previously examined a sample of these documents in the last inspection year at the previous head office. The filing cabinet has not yet been found since the move and further checks are being carried out by the registered manager to enable a complete record to be held in the home. The nurse in charge told the inspector that training and development is offered and showed the inspector some of the training opportunities available to staff. She said that staff are encouraged to take part in any training offered. The new company is very committed to training and development of all staff and the company operations manager had met with the inspector previously and explained what the company’s expectations of the staff were. There was evidence of individual staff training in the staff files examined. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager of the home is very experienced and there are clear lines of accountability amongst the staff. EVIDENCE: The registered manager is a very experienced nurse manager who is undertaking the National Vocational Qualification Manager’s Award, and hopes to complete this in the near future. Both staff and residents spoken to hold her in high regard and feel they are in good hands. A visiting GP and district nurse also confirmed this. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 18 The company quality assurance systems are being introduced into the home and regular quality audits are undertaken by the manager and reported to the company operations manager on a monthly basis. The manager has a very open door style of management and residents, relatives and staff all said that they were able to take any issues to the manager and that she listens to them. Surveys to seek the views of the residents and relatives about the care provided have not yet been undertaken but are planned. Comment cards provided by the Commission have not been used on this occasion as the pre-inspection information required from the registered manager was not returned to the inspector prior to this inspection being undertaken. The fee invoices and payments are handled centrally, and there is a company policy that staff must not be involved in individual resident’s financial affairs. Small sums of cash are kept on behalf of residents for sundry items, and these are kept in the home’s safe in individual plastic pockets with all receipts and a record of all transactions made. The home’s maintenance log was examined and this included service documentation for the hoist, boilers, washing machines and dryers, electrical and gas supplies. These were found to be up to date. The fire log was examined and it was noted by the inspector that regular checking of the emergency lights had not been carried out for some months. It is recommended that the registered manager should discuss with the maintenance person who carries out the checks the reason for this omission and ensure that it is corrected. Other records required by regulation were found to be in good order and accessible to staff. The kitchen was found to be clean and orderly and the necessary checks required by environmental health are in place. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 19 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 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 2 3 3 X X 3 The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 20 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 OP26 Regulation 16(k) Requirement It is a requirement that the bathrooms and toilets must be kept clean and free from offensive odours at all times. Timescale for action 23/06/06 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. 2. Refer to Standard OP21 Good Practice Recommendations It is recommended that the manager should look into replacing pull chord switches in the toilets with a more hygienic, cleanable type of switch. It is a good practice recommendation that recepticals for emptying catheter bags should be cleaned and disinfected after use and stored in the sluice rather than the bathrooms and toilets. It is recommended that the registered manager should look into the domestic staff hours and the workload, to ensure that there is sufficient cover for sickness and annual leave, so that care staff hours are not taken up with domestic duties. It is recommended that the registered manager should DS0000027186.V298454.R01.S.doc Version 5.2 Page 21 OP21 3. OP27 4. OP38 The Triangle Nursing Home discuss with the maintenance person who carries out the emergency lighting checks the reason for this not having been carried out for some time, and ensure that it is corrected. The Triangle Nursing Home DS0000027186.V298454.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, 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 DS0000027186.V298454.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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