About the service: The Triangle is a care home that was providing personal and nursing care to 21 adults at the time of the inspection. Seven beds in the service were for people leaving hospital with the aim of returning to their own home.

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 inspection took place on 30 August 2016 and was unannounced. At our previous inspection 20 August 2015 we found there were insufficient staff deployed to meet people's needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection on 30 August 2016 we found improvements had been made and there were sufficient staff to meet people's needs in a timely manner.

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.

We carried out our inspection on 20 August 2015. This was an unannounced inspection.

The Triangle is a care home providing nursing care for up to 25 people. On the day of our visit there were 22 people living at the home.  

At this inspection the service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated regulations about how the service is run.

The home manager had recently left and the operations manager was supporting the deputy manager in the day to day running of the home whilst a registered manager was recruited.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate referrals had been made to the supervisory body.

People were positive about living in the home and were complimentary about the deputy manager and staff team. Staff were kind and caring. We saw people laughing and enjoying interactions with staff and the atmosphere throughout the home was positive.

There were not always enough staff deployed to meet the needs of people living in the home. Staff felt supported but did not always have access to regular supervision.

Staff had not always completed training to give them the skills and knowledge to meet people's needs. This included training in the Mental Capacity Act 2005 (MCA). We have made a recommendation about MCA.  

People's needs were assessed and where there were risks these were assessed and managed.

Quality assurance systems had identified issues found during the inspection and action was being taken to improve.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke to six people who use the service, five relatives and four staff members. We reviewed documents including care plans, risk assessments, and daily records of care. We observed that people were treated in a dignified, respectful way. People made choices in their care and their families were involved. We attended a meeting for residents and relatives which confirmed this.

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 involved in making decisions about their care. One relative told us “they discussed the care; I visited and knew this was the right place”. One person told us “they told me what they could offer me here”.

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".