Torr Home

Torr Home provides nursing care and support for older people. The service is registered to accommodate up 60 older people and is separated into three units.

Torr house supports up to 24 people with nursing or residential care needs. The Belltor and Glentor units support up to 36 people living with dementia. Each unit has its own staff team, with one registered manager responsible for Torr house and another registered manager responsible for both the Glentor and Belltor units. At the time of our inspection there were 15 people living at Torr House, 12 people living in Belltor and 16 people living in Glentor.

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

People told us they felt safe and records showed staffing levels had improved since our last inspection. Necessary preemployment checks had been completed and rotas showed planned staffing levels had been consistently achieved.

The service continues to experience difficulties in recruiting additional nursing staff. As a result, a new lead care practitioner role had been introduced. These experienced members of care staff had received additional training to enable them to lead staff teams in each unit and manage people’s medicines with support and guidance available at all times, from a nurse based in another unit on site.

Medicines were managed safely, and cleaning products stored securely when not in use. Risks to people’s wellbeing had been identified and mitigated. Staff had a good understanding of infection prevention and control protocols and current COVID-19 guidance was being followed.

Staff had the skills necessary to meet people’s needs and new staff had received appropriate induction training.

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.

People were complimentary of the food and kitchen staff had a good understanding of people’s likes and needs. Staff were attempting to document the amount and food and fluids people consumed and we have made a recommendation in relation to this practice.

People and relatives were complimentary of the staff team who provided support when needed with compassion and kindness. People views were respected, and staff ensured people were protected from discrimination.

Staff were able to communicate effectively with people and care plans provided clear guidance for staff on how to meet people’s care needs. Activities were available in each unit, visitors were encouraged, and people were supported to maintain relationship that were important to them.

Significant management changes had been made following our last inspection. The provider’s Nominated Individual was now responsible for auditing, quality assurance and the services overall performance.

The registered manager for the dementia services was based in Glentor and staff in Belltor reported that they were isolated and lacked support from management. We have made a recommendation in relation to this issue.

The service worked collaboratively with involved professionals who reported significant improvements to the service’s performance since the last inspection.

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

Rating at last inspection (and update)

The last rating for the service was requires improvement. (Published 4 August 2021). At this inspection we found improvements had been made and the services’ overall rating is now good.

Why we inspected

We completed this comprehensive inspection to check that necessary improvements had been made in response to the issues identified at our last focused inspection.

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.

Recommendations

We have made recommendations in relation to procedures and systems for monitoring people’s food and fluid intake and in relation to the system in place to support staff based in the Belltor unit.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Torr Home provides nursing care and support for older people. The service is registered to accommodate 60 older people and is separated into two buildings.

Torr Home supports up to 43 people who have dementia, nursing or residential care needs and the Glentor Centre supports up to 17 people living with dementia. Both Torr Home and the Glentor Centre are run as two separate units and have separate staff teams. At the time of our inspection there were 28 people living at Torr Home and 17 people living at the Glentor Centre.

Torr Home is a not-for-profit charity made up of a Board of Trustees and a chief executive officer (CEO).

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

People told us there were not enough staff to meet their needs, which meant they had to wait long periods of time to be supported. This was impacting on their health and wellbeing. Staff also confirmed they felt emotionally pressurised by the lack of staff and told us they felt sad to not be able to provide people with safe, person-centred care.

People living with dementia were not always supported by staff who had the knowledge to meet their needs and essential training relating to the clinical management of people’s needs had not been completed by nursing staff.

People’s care records were not always reflective of the care and support they were receiving.

People and staff were not confident in the management and leadership of the service. There were ineffective systems in place to access, monitor and improve the quality and safety of the service.

Peoples feedback was not sought and acted on for the purposes of continually evaluating and improving the service.

During the pandemic an adapted system was not put in place for the Board of Trustees to obtain continued feedback from people and staff. Phone calls had commenced in April 2021, at the suggestion of the Commission.

Following the inspection, the CEO contacted the Commission to explain that they had reflected on the inspection findings and had spoken with the Board of Trustees. They spoke with transparency and told us they recognised immediate changes were needed to help facilitate improvement at Torr Home.

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

Rating at last inspection (and update) The last rating for the service was Good published on (23/09/2020). At this inspection we found improvements had not been made.

Why we inspected

We received concerns in relation to people’s nursing care needs, management of medicines, nursing competence, staffing levels and management and leadership. The concerns related to Torr Home and not the Glentor Centre.

As a result, we undertook a focused inspection of Torr Home to review the key questions of Safe 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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

We visited both Torr Home and the Glentor Unit during our visit. We found all areas in the service to be clean. There were appropriate procedures in place to ensure any infection control risks were minimised. High contact areas were cleaned regularly throughout each shift and cleaning procedures had been reviewed and updated.

The service had good stocks of Personal Protective Equipment (PPE) and had purchased additional equipment including higher specification masks, visors, scrubs, and arm and hair coverings for use in the Glentor Unit due to the current outbreak there.

The registered manager kept up to date with appropriate training in infection control. Staff were following up to date infection prevention and control guidance to help people to stay safe. The registered manager had arranged for all staff to receive training on the appropriate use of PPE and additional on-line infection control training had been made available to the staff team.

Cleaning and infection control policies and procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection.

Glentor was currently closed to visitors due to a Covid outbreak. Torr Home visits were by appointment only with a Covid test and full PPE offered when appropriate, for example if someone was considered end of life care. In addition, WIFI internet was available throughout the service and staff regularly supported people to make video calls to friends and relatives.

People and staff were being regularly tested in accordance with current guidelines. Appropriate admission procedures had been developed and anyone moving into or returned to the service from hospital were tested and then cared for in isolation.

People in the Glentor Unit were isolating in their bedrooms due to the current outbreak. People in the main house, Torr Home, were able to access the service’s communal areas if they wished but most people were choosing to spend most of their time in their rooms. People were complimentary of the service and the staff team their comments included, “They do look after me well, I have no complaints” and “They are all very nice and kind.”

The registered manager communicated regularly with people, staff and relatives to make sure everyone understood the precautions being taken, and how to keep people safe. The registered manager ensured people living in the service, and staff, had access to additional support, including one-to-one meetings and contact by phone, to offer any emotional support needed.

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 up to 43 people who have nursing or residential care needs and the Glentor Centre supports up to 17 people living with dementia. At the time of our inspection there were 48 people living across both services.

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

People told us they felt safe and happy in the service. Some people said there had been a time recently where they had felt unsettled and the culture in the service was negative, the registered manager and provider addressed this and now the atmosphere was improving. Incidents and safeguarding concerns were investigated and notified to us. Staff knew how to identify and report concerns.

Staff and people fed back that in the Torr Home unit there were often agency staff that weren’t familiar with their needs working and staff seemed rushed. After the inspection the registered manager had adjusted staffing levels to include one extra staff member to support with breakfast, personal care and lunch time. Staff were recruited safely.

Infection control processes were robust, and the service was clean and well maintained. The service had checks and processes in place for staff and visitors to mitigate some of the risks associated with the spread of infection and the coronavirus pandemic.

Medicines were managed safely but we did identify some areas for improvement around recording of cream application, description of ‘as and when PRN’ medicines protocols, and auditing processes for medicines. This had been addressed by the end of the inspection.

The registered manager was visible in the service and staff said they felt supported. Although the service had several aspects of a good well led service, there were some areas for improvement that needed to be addressed. Quality checks were in place for all aspects of care provision and where issues had been identified action was taken. However, some improvements needed to be made to the auditing of medicines.

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. Some relatives were upset they had not been able to see their loved ones in the Glentor unit due to restrictions on visiting because of the coronavirus pandemic. After the inspection we were told arrangements had been made for relatives to safely see their family members whilst still ensuring infection control and prevention processes were observed.

We made two recommendations around the auditing of medicines management and monitoring the culture in the service.

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

Rating at last inspection

The last rating for this service was good (published 29 September 2017).

Why we inspected

We received concerns in relation to the management of medicines, staffing levels and safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good.

We have found evidence that the provider needs to make improvement in some areas, but that people were not placed at avoidable risk of harm. Where needed the provider had taken appropriate action to mitigate some of the risks that had been identified prior to the inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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.

During our visit we spoke with six people who lived in the home, seven members of staff, the registered nurses in both the main house and the Glentor Centre, and the registered manager. We examined care files belonging to five people who lived in the home.

People told us they were "perfectly happy" and the staff were "good as gold". Recently staff had been "very busy" and staffing was "a bit topsy turvy". We found that there were insufficient staff on duty in the main house during the evening which meant that people did not always go to bed at the times they preferred.

We looked around the home and found that it was clean, hygienic, and there were no offensive odours. The staff followed the correct procedures in relation to infection control by, for example, ensuring that hoist slings were not shared by people who lived in the home to eliminate any risk cross contamination.

We found that staffing levels in the Glentor Centre were sufficient to meet people's needs, that there were suitable arrangements to ensure that people were enabled to give consent to their care and treatment, and that records were detailed enough to ensure people received safe and appropriate care.

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.