Torr Home provides care and support for older people. The service is registered to accommodate 60 older people and is separated into two services. Torr Home supports 43 people who have nursing or residential care needs and the Glentorr Centre supports 17 people living with dementia. At the time of our inspection there were 51 people living across both services.

There was a registered manager in post. 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.

Prior to our inspection we had received concerns people were not adequately supported with their nutrition and did not always have access to a drink. We had also been told risks associated with people’s skin were not being managed effectively and referrals to external health care professionals were not always made promptly. So we looked at these concerns as part of our inspection.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

People told us they felt safe and that there was enough staff to meet their needs. Staff, had been recruited safely, people received their medicines as prescribed, infection control processes were in place to help reduce the spread of infection, and risks associated with people’s care were managed appropriately.

People told us staff had the right training to meet their needs, and staff demonstrated through their interactions with people, how they put theory into practice. Nursing staff undertook clinical training and received supervision to help maintain and develop their nursing competency. People told us they liked the meals, and staff understood how to support people correctly with their individual nutritional needs. People had access to a variety of external health and social care professionals to help maintain their health and wellbeing.

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 design of the service helped to support people’s individual needs and promoted their ongoing independence.

People told us staff were kind, staff knew people well, spoke fondly of them and showed through their interactions that they cared. People told us staff respected their privacy and dignity. Staff told us how they helped to support and encourage people to make decisions and to be involved in their own care. People, who were at the end of their life, were cared for by staff who understood the importance of respecting people’s wishes and choice. Nursing staff were responsive to people’s changing medical needs to help ensure they were comfortable and not in unnecessary pain.

People were supported in an individualised way. People’s social needs were recognised and catered for. People were encouraged to share their views and to complain when they were not happy. People’s comments were listened to, and used to effectively to make changes within the service.

People lived in a service which was well-led. The registered manager encouraged a positive culture, and led by example. Governance systems which were in place to help monitor the overall quality of the service were in place. But the registered manager recognised that some of these quality checks needed strengthening, and she told us she would be taking immediate action.

Further information is in the detailed findings below.

The service provides accommodation, personal care and nursing care for up to 60 predominantly older people. At the time of our inspection there were 43 people using the service. The service consists of Torr home a nursing and residential care home and The Glentor Centre a specialist unit for up to 16 people living with dementia.

The service had a registered manager who was also a nurse. The registered manager was based in Torr Home but was responsible for the overall leadership of both units. 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 and associated Regulations about how the service is run.

The service’s systems for recording the administration of medicines were not robust and therefore potentially unsafe. Medication Administration Records included gaps and where hand written additions had been made these had not been appropriately checked. Personal Items including jewellery and money had been stored inappropriately within medicine storage cupboards..

The staff team were well motivated but were lacking some skills and knowledge as they had not received appropriate training. The service did not have appropriate systems for the management of staff training needs and staff had not been provided with appropriate formal supervision.

Staff were unclear on local procedures for the safeguarding of adults and when asked were unable to locate contact information for the safeguarding authority.

People were well cared for and relaxed and comfortable in the home. Staff and managers knew people well and provided support with compassion. People told us, “the staff are very friendly” and, “I knew immediately this was the place for me and I’ve never regretted it. It’s very comfortable and the staff are very good”.

Care records generally were up to date, and provided staff with sufficient detailed information to enable them to meet people’s care needs. Daily records of care provided were detailed and accurately recorded details of care provided and activities people had engaged with.

The service’s risk assessment procedures were designed to enable people to take risks while providing specific guidance to staff on the support people required in relation to identified risks.

People enjoyed the varied range of activities available within the home and regular trips to local attractions. People told us, “There’s always something on in the afternoon” and staff said, “I am proud, we do good activities here”.

The service was clean, well decorated and odour free. In the Glentor Centre motion sensors were used to control lighting in corridors and communal areas. These arrangements were inappropriate as lights were regularly turned off by these sensors when people were sat in the lounge.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

During our visit we spoke with nineteen people who lived in the home, thirteen members of staff, three visitors and the registered manager. We visited the main house and the Glentor Centre which is a separate house within the grounds of Torr Home. We were joined by an Experience by Experience during the visit to the main house.

We examined care files belonging to four people in the main house and two people in the Glentor Centre. One person using the service said “The staff listen to me and are respectful”.

We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. One relative said “It was hard not to worry when mum moved in, but it’s been wonderful”.

Staff were clear about the actions they would take should they have any concerns about people's care or safety.

After we looked at the care records for people, we spoke to staff about the care given to them, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine if they were able to make particular decisions.

We saw that Torr Home had a complaints procedure available and documentation of complaints that had been investigated.

We made an unannounced visit due to concerns raised about the care provided. These were that the home was short staffed resulting in people being left in wet beds, people being made to get up very early in the morning, staff not using correct equipment for moving and handling people, people's dignity not protected and lack of supervision and observation of people in Glentor.

During our visit we spoke with three care workers, the registered nurses in both the main house and Glentor, the cook, and the registered manager. After our visit we spoke on the telephone to two social and healthcare professionals who had visited the home recently or commissioned services for people living in the home. We did not speak to people using the service because we arrived early in the morning and people were either in bed or we were not able to communicate effectively with people due to their dementia.

We looked around the home and found that it was clean and hygienic indicating that continence needs were met. Our discussions with the staff in the main house, and our observation of their practice, showed that there were sufficient staff on duty, and they had received training, so that they understood people's needs and how best to meet them.

We examined care files belonging to two people who lived in Glentor and found that staffing levels were insufficient to meet people's needs and that record keeping was not detailed enough to ensure people received safe and appropriate care.

The Inspection took place on 8 & 9 & 10 September 2015 and was unannounced. The service provides accommodation, personal care and nursing care for up to 60 older people. At the time of our inspection there were 60 people using the service. The service consists of two separate services, Torr home, a nursing and residential care home and The Glentor Centre a specialist unit for up to 17 people living with dementia.

The service had 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 2008 and associated Regulations about how the service is run.

At our inspection in December 2014 we found breaches of legal requirements. The provider sent us an action plan which explained how they would address the breaches of regulations. At this inspection we found all actions had been completed.

We observed people and staff were relaxed. There was a friendly and calm atmosphere. We observed people and staff chatting and enjoying each other’s company. Comments included; “The staff are very good and caring.” People, who were able to tell us, said they were happy living there.

People had their privacy and dignity maintained. We observed staff supporting people and showing kind and compassion care throughout our visit.

People, relatives and healthcare professionals were very happy with the care provided to people and said the staff were knowledgeable and competent to meet people’s needs. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives. One person said; “My son and daughter are very happy with my wife and myself being here. They looked around Plymouth and found this to be the best and I think they are right. It is very good here. From the moment I walked in here I felt relaxed and at home.”

People were protected by safe recruitment procedures. There were sufficient staff to meet people’s needs and staff received an induction programme. Staff had completed appropriate training and had the right skills to meet people’s needs.

The registered manager had sought out and acted upon advice where they thought people’s freedom was being restricted. This helped to ensure people’s rights were protected. Applications were made to help safeguard people and respect their human rights. Staff had undertaken safeguarding training, they displayed a good knowledge on how to report concerns and were able to describe the action they would take to protect people against harm. Staff were confident any incidents or allegations would be fully investigated. People who were able to told us they felt safe.

People had access to healthcare professionals to make sure they received appropriate care and treatment to meet their health care needs such as GPs and Physiotherapist. Staff acted on the information given to them by professionals to ensure people received the care they needed to remain safe.

People’s medicines were managed safely. Medicines were managed, stored, given to people as prescribed and disposed of safely. Staff were appropriately trained and confirmed they understood the importance of safe administration and management of medicines.

People’s risks were considered, managed and reviewed to keep people safe. Where possible, people had choice and control over their lives and were supported to engage in activities within the home and in the community where possible. Records were updated to reflect people’s changing needs. People and their families were involved in the planning of their care.

People were supported to maintain a healthy, balanced diet. People told us they enjoyed their meals and we saw mealtimes were not rushed. One person said, “The food is very good-Excellent”, and “My request for mushy peas when we had fish was met in a week.”

People’s records were comprehensive and detailed people’s preferences and care needs. People’s communication methods were recorded. Records contained detailed information about how people wished to be supported. Records were consistently updated to reflect people’s changing needs. People and their families were involved in the planning of their care.

People, staff and visiting healthcare professionals confirmed the management of the service was supportive and approachable. Staff were happy in their role and spoke positively about their jobs.

People’s opinions were sought formally and informally. There were quality assurance systems in place. Audits were carried out to help ensure people were safe, for example environmental audits were completed. Accidents and safeguarding concerns were investigated and, where there were areas for improvement, these were shared for learning.