10 November 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by three adult social care inspectors, and an Expert by Experience who used telephone interviews to gather feedback from people’s relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Torr Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there were two registered managers in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed the information we had received about the service since the last inspection as part of the planning process. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also reviewed the action plans and other information the provider had submitted following the last inspection.
During the inspection
We met and spoke with twelve people who lived at the service and two relatives who were visiting. We also spoke with nine care staff, two nurses, a housekeeper, two cooks, one of the registered managers and the nominated individual. We also spoke with ten relatives by telephone to gather their feedback on the service’s current performance.
We looked at records relating to people’s care. This included seven care plans, medicine administration records (MARs) and a section of accident and incident records.
We also asked the service to send us records relating to the day to day management of the service, such as call bell records, staffing rotas, quality assurance audits and safety documentation. This information was reviewed in detail after the site visit. We spoke by telephone with both registered managers and the nominated individuals until the inspection process was completed on 20 September 2022.
10 November 2022
About the service
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.
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.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.