The Triangle Care Home

The Triangle is a residential care home providing personal and nursing care to up to 25 people. The service provides support to older people some of who lived with dementia. At the time of our inspection there were 22 people using the service.

People’s experience of using this service and what we found

We had received concerns of staffing levels, poor care, lack of activities and inconsistency in leadership. We found, the home had been using different agency staff and this inconsistency was impacting on people’s care.

Staff were continuously busy and did not have time to have meaningful interactions with people. The activities coordinator had just left, and people did not always have access to activities of their choosing.

Risks to people were identified, however, they were not always managed safely. People’s risk management plans and care plans were not always up to date. Recommendations from the last fire risk assessment had not been acted upon.

The inconsistency in leadership was impacting on people’s outcomes and staff morale. There were 2 support managers who were managing the home at the time of the inspection and a new manager had just been appointed. The provider’s quality assurance processes were not always used effectively.

Following the inspection, the provider shared with us their improvement plan which they were working through to address the concerns we found.

People living at The Triangle told us they felt safe living in the home. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Medicines were managed safely, and people received their medicines as prescribed. Staff had the necessary skills to carry out their roles. Staff had regular training and opportunities for regular supervision and observations of their work performance.

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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the home.

Rating at last inspection and update

The last rating for this service was good (Published 10 April 2019)

Why we inspected

We received concerns in relation to staffing, people’s care needs, activities and management of the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

We have received an improvement plan the provider is working to make improvements and will request an updated action plan from the provider and have an understanding what they will do to improve the standards of quality and safety.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Triangle on our website at www.cqc.org.uk.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had sufficient stock of appropriate personal protective equipment (PPE) which complied with the quality standards.

Staff participated in various training sessions around infection control and using PPE. Staff's competency around infection control and PPE was checked regularly to prevent staff complacency. There were designated areas for donning/doffing PPE. There was signage all over the service on donning and doffing PPE and hand gel was visible in all required areas, including for visitors. We observed staff putting on and taking off PPE as per guidelines

A visiting suite had been created to safely facilitate relatives' visits on a pre-booking basis. A limited number of visitors was encouraged with consideration given to allow time for disinfecting the area in between visits. All visitors had their temperature taken and completed a lateral flow test for COVID-19.

On arrival to the service, infection control procedures were explained to any visitors and a declaration form completed which included the temperatures taken at the time. Visitors were provided and required to wear the appropriate PPE in line with government guidelines.

The provider used technology to maintain effective communication between people and their families. This included video calling and sharing updates.

The provider had robust systems to ensure safe admissions, including only allowing new admissions after a confirmed negative result of the Covid-19 test. The provider had also assessed the environment, with consideration given where to allocate people should they need to isolate.

An additional cleaning schedule had been introduced to ensure robust measures to reduce infection risks, including additional tasks such as cleaning of any regular touchpoint surfaces. The provider participated in the Covid-19 regular testing programme for both people and staff.

Impact assessments to ensure appropriate support for staff had been carried out, these included individual health conditions and personal circumstances. Staff had access to dedicated counselling and advice if they been affected directly or indirectly by Covid-19.

Additional, regular communication took place. This included a weekly update for people and their relatives to share the current 'Covid-19 status' of the service and any changes to the visiting policy. Also, a regular newsletter for staff with updates and thanks for their work and commitment to keeping people safe

People’s experience of using this service:

• The management team promoted an inclusive culture that ensured everyone was valued and respected for who they were. This resulted in people receiving person-centred care.

• There was a cheerful, homely atmosphere where staff treated people with kindness and compassion.

• People felt safe living at the service and were supported by staff who knew how to protect them from harm and abuse.

• The service involved a range of health and social care professionals that supported people to live healthier lives and to achieve their goals.

• Staff were well supported through effective training and supervision to ensure they had the skills and knowledge to meet people’s needs. Staff were knowledgeable about the needs of the people they supported.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service met the characteristics of Good in Effective, Caring, Responsive and Well-led. It met the characteristics of Requires Improvement in Safe.

Rating at last inspection: At the last inspection the service was rated Good. This report was published on 20 September 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Triangle is a care home providing accommodation for people requiring personal or nursing care. The service supports up to 25 people. On the day of our inspection there were 22 people using the service.

There was a registered manager in place. 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.

The registered manager was extremely positively regarded by people, relatives, health and social care professional and staff. Their inclusive, person-centred approach resulted in a service that put people at the forefront of all it did. There was a positive relationship between the registered manager and business manager who were both knowledgeable about their areas of responsibility and worked closely to achieve positive outcomes for people using the service. The management team looked at ways to continually improve communication with people and their relatives. They sought ways to obtain people’s views about the service. Feedback was used to continually improve the service.

There was a calm, cheerful atmosphere throughout the home and the inspectors were greeted positively by everyone. There were many caring interactions where staff showed genuine care and concern for people. People developed caring, meaningful relationships with staff and had made valuable friendships with each other. Staff treated people with dignity and respect. People's views were sought and valued.

People felt safe in the service. People were supported by staff who were knowledgeable about their responsibilities to identify and report any concerns related to the abuse of vulnerable adults. Care plans included risk assessments and where risks were identified management plans were in place to minimise the risk. Peoples' medicines were managed safely. The provider had recruitment processes in place to ensure people were supported by staff who were suitable to work with vulnerable people.

Staff were knowledgeable about Mental Capacity Act 2005(MCA) and supported people in line with the principles of the act. People were encouraged to make choices and choices were respected. Where people lacked capacity to make certain decisions a best interest process was followed.

People enjoyed the food and were given a choice at each mealtime. Individual dietary needs were identified and met. There were regular drinks and snacks made available. Where required people were supported to access health professionals to maintain and improve their health.

Staff were well supported and had access to training to improve their skills and knowledge. Staff had opportunities to access qualifications in social and health care to aid their development.

Care was personalised to each individual and staff were knowledgeable about people's needs. Care plans identified people's likes and dislikes and their preferences in relation to their care needs. There was a complaints system in place and people were confident to raise concerns.

There were effective systems in place to monitor and improve the quality of the service. The registered manager and business manager were knowledgeable about all aspects of the auditing processes and were responsive to any concerns found, which were immediately addressed.

One person told us that “This is a marvellous place.” Another person said, at a meeting, that the staff “understand my diabetes” and that they were “glad to be here”. During the same meeting, a family member said that “the staff I find are good”. Another relative said “I’ve got no complaints. They’re brilliant.”

People told us that they felt safe at the home. Their needs were met by a sufficient number of suitably qualified staff. The provider had a system in place to assess and monitor the quality of the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found that people were happy with the care that was provided. One person told us “the carers’ here are good, they take the trouble to get to know you individually and what you like". A relative told us “they look after him so well and make a fuss of him which is so important“.

We found that equipment in the home was safe and suitable. Staff were observed using hoists in accordance with risk assessments and individual care plans.

We found staff recruitment procedures ensured appropriately qualified and experienced staff were recruited. Pre employment checks were undertaken.

Staff were supported and trained to deliver good care. A relative told us “the staff here are very good, there has been an improvement and they seem to be well trained”.

We found there was an effective complaints system available. One person told us ”I know who to complain to, but I only need to comment on something and they come and resolve it or explain it to me".