Toray Pines Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a clear shared direction, with the provider’s values and vision displayed in staff areas and included in the staff handbook. Staff were aware of these values and described working as a team, feeling able to speak up and raise concerns, and understanding the home’s focus on dignity, independence and good communication. Team meetings, handovers and senior staff groups helped reinforce a consistent culture, and staff said the management team were approachable and supportive, which helped create a positive and open working environment.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Some relatives expressed concerns they were unaware of who the current manager was due to some recent changes. One relative said, “I don’t [know the registered manager] at the moment. There have been a couple of managers that have left close together.” However, relatives who did know, spoke highly of them. One relative commented, “I know the manager and she is good. She is approachable.” The registered manager was knowledgeable and was supported by the deputy and head of care to improve the quality of the service. Their knowledge of people’s needs was strong and showed they were aware of what was happening in the home. Staff described the management team as approachable, supportive and always available when advice was needed, saying they felt able to raise concerns and speak openly with leaders. Leaders ensured staff received training, supervision and clear handovers, and they worked closely with staff to help them feel confident in their roles, contributing to a positive and inclusive culture focused on improving care.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

There were systems and policies in place to support staff to speak up, including a whistleblowing and freedom to speak up policy. Staff told us they felt comfortable raising concerns and said they would go to the registered manager or senior staff if they had any worries. They described the management team as approachable and supportive, and said they felt able to speak openly and knew concerns would be listened to.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff said the home promoted fairness and equal opportunities, and they felt listened to and respected as individuals. Recruitment processes included checking proof of identity and completing DBS checks, helping ensure staff were safely and consistently appointed. Staff reported that training was made accessible, with options for face-to-face or online learning, and they were paid for attending training on days off, supporting equal access to development. Staff also described collaborative team working, open communication and feeling able to speak up or use the whistleblowing policy if needed. The provider made reasonable adjustments, such as flexible working arrangements, to support individual needs.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There was a clear and effective governance structure in place that helped drive good standards of care. The service used the provider’s governance pathway, which set out daily, weekly and monthly oversight processes to monitor safety, quality and risks. These systems worked together to give leaders a consistent overview of the service and ensured that issues were identified, acted on and followed up, supporting sustainable improvements in care.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The home had strong partnerships within the community and created opportunities for people to stay connected. A Dementia Café was in place to support both people living in the home and those in the wider community. Staff worked with local organisations, including nearby schools and SEND groups, to bring multi-generational activities into the home. The service also took part in local events, such as hosting a trick-or-treat activity at Halloween, which helped people maintain links with their community and created meaningful shared experiences.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The home actively promoted learning and innovation and took part in several research programmes to improve evidence‑based care for people living in care homes. It was part of the ENRICH programme and engaged in multiple studies, including research on personalised music to support people living with dementia and projects exploring care‑home priorities and good practice. Staff also contributed to wider learning through initiatives such as hosting community‑based “world café” discussions as part of an additional research study. These opportunities helped the service stay up to date with emerging evidence and supported continuous improvement in care.