We inspected the service on 7 December 2017. The inspection was unannounced. Toray Pines Care Home is a ‘care home’. People in care homes receive accommodation, nursing and 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.

Toray Pines Care Home is registered to provide accommodation and personal care for 52 people. The service can provide care for adults of all ages. It can also care for people who live with dementia and/or who have physical adaptive needs. There were 48 people living in the service at the time of our inspection visit all of whom were older people.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 23 April 2015 the service was rated, ‘Good’.

At this inspection we found the service remained, ‘Good’.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. This included occasions when people became distressed and needed support in order to keep themselves and others around them safe. In addition, medicines were managed safely.

Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service and background checks had been completed before new care staff had been appointed. Furthermore, there were robust arrangements to prevent and control infection and lessons had been learnt when things had gone wrong.

Care staff had been supported to deliver care in line with current best practice guidance. People received the individual assistance they needed to enjoy their meals and they were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. In addition, confidential information was kept private.

People received personalised care that was responsive to their needs. As part of this people had been offered opportunities to pursue their hobbies and interests. In addition, the registered manager recognised the importance of appropriately supporting people who chose gay, lesbian, bisexual and transgender lifestyles. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Furthermore, suitable provision had been made to support people at the end of their life to have a com

Toray Pines Care Home with Nursing provides accommodation for up to 52 people who require residential or nursing care and also supports people living with dementia. There were 47 people living in the service when we carried out our inspection.

This was an unannounced inspection carried out on 23 April 2015. At the time of our inspection the service did not have a registered manager. 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 current manager had recently submitted their application to the commission. The manager was unavailable on the day of the inspection. However, a senior manager from the organisation was at the service.

We last inspected the service in July 2014. At that inspection we found the service was not meeting all the essential standards that we assessed. We found a breach in relation to the regulation which related to staffing levels.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection the registered provider had made referrals to the local authority, however, no one was currently subject to an active DoLS.

Staff knew how to recognise and report any concerns so that people were kept safe from harm and background checks had been completed before new staff were appointed. Staff helped people to avoid having accidents. There were arrangements in place for ordering, storing, administering and disposing of medicines.

Staff had been supported to assist people in the right way, including people who lived with dementia and who could become distressed. People had been helped to eat and drink enough to stay well. We found that people were provided with a choice of nutritious meals. When necessary, people were given extra help to make sure that they had enough to eat and drink. People had access to a range of healthcare professionals when they required specialist help.

Staff understood people’s needs, wishes and preferences and they had been trained to provide effective and safe care which met people’s individual needs. People were treated with kindness, compassion and respect. We saw examples when staff respected people’s privacy.

People were able to see their friends and families when they wanted. There were no restrictions on when people could visit the service. Visitors were made welcome by the staff in the service. People and their relatives had been consulted about the care they wanted to be provided. Staff knew the people they supported and the choices they made about their care. People were offered the opportunity to pursue their interests and hobbies.

There were systems in place for handling and resolving complaints. People we spoke with and their relatives were aware of how to raise a concern. The service was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. The manager and the registered provider assessed and monitored the quality of the service provided for people. The service had established links with local community groups which benefited people who lived in the service.

On the day of our inspection there were 47 people living at Toray Pines Care Home with Nursing. The inspection team who carried out the inspection consisted of two inspectors and an expert by experience. During the inspection the team worked together to answer five key questions, Is the service safe, effective, caring, responsive and well led.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The home had appropriate policies and procedure in place in relation to the Mental Capacity Act MCA (2005) and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. While no application had been submitted, relevant staff were aware of when an application would be needed.

There were enough kitchen, domestic and maintenance staff available to ensure care workers could focus on meeting people’s needs. People we spoke with told us the care workers available provided good care, however, they felt that there were not always enough care workers to ensure people were safe. We looked at staffing rotas and could see there was a reduction in the number of staff available between 2pm and 4pm. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

People we spoke with were happy with the care they received. Staff we spoke with could describe people’s care needs and this matched the information recorded in their care plan. One person said, “This is such a nice, clean place, everyone is friendly. Staff are very nice to me.” Another person told us, “I don’t think they could improve the service they give me.”

People told us they had been involved in planning their care to meet their needs. Records showed people had given written consent for care to be delivered in line with their care plan. Where people may not have been able to make decisions for themselves this was assessed in accordance with the MCA. Care plans recorded who needed to be involved when making a decision in the best interest of the person receiving care.

We saw people were protected against the risks of malnutrition. The provider monitored people’s weight and took action if there was a significant unplanned weight loss. Specialist advice was sought and taken to ensure people were supported to eat and drink safely. We saw people were supported to maintain a healthy weight with special diets and extra snacks.

People were offered a choice of meals on a daily basis and we saw people were supported to access alternative meals if they did not like what was on offer. Care staff helped people maintain their independence with eating by providing equipment such as plate guards and did not rush people through their meal.

Is the service caring?

We saw care staff treated people with respect and were aware of the name they preferred to be known by. Care staff showed an interest in people and were aware of their leisure activities and hobbies.

People told us care staff respected their privacy and dignity when providing personal care. One person said, ““Staff always respect me; they put me in the bath with a hoist. They close the curtains and put a screen around me when I need to go to the toilet or when I get washed and dressed. I wash my hands and face myself; they always give me a flannel to do it myself. I do what I can for myself.”

Is the service responsive?

The home had two activity co-ordinators to arrange daily activities for people. This ensured people had meaningful activities to occupy themselves. We saw people were reading the paper and completing jigsaw puzzles, the music was on and two people were dancing and enjoying themselves.

People were supported to make a complaint if they were unhappy with the care they received. People told us the provider was responsive to concerns they raised and took action to resolve the issue

Is the service well-led?

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. On the day of our inspection the home was being managed by an acting manager. This was a temporary measure until a permanent manager was appointed.

The service had a quality assurance system, records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

During our inspection of Toray Pines Care Home we spoke with people who lived at the home and friends and family who were visiting. One person told us: " I really can't call it. They have really looked after me and I feel very settled here". People we spoke with told us they felt involved in their care and we saw evidence of this in care records we looked at.

We found that care records were current and reflected the needs of people who lived in the home. Staff demonstrated a good understanding and knowledge of the care and support people required.

Safeguarding policies to protect vulnerable adults were in place and staff had undertaken safeguarding training.

The premises were well maintained and records showed that appropriate safety checks had taken place on systems and equipment to ensure the safety of people living in the home.

There was a recruitment procedure in place which ensured that only people suitable to work with vulnerable people were employed. Staff received a wide range of training which equipped them for their role.

There were regular on-going training sessions in place to ensure that staff safely delivered care and support to people.

There was an effective system in place to deal with any complaints or concerns people who lived in the home or their relatives might raise.

People we spoke with told us they were happy living at Toray Pines. The atmosphere in the home was relaxed. We saw some people were very happy and they told us that at times they enjoyed the fun and humour.

One person we spoke with told us, “I don’t know what it is about the place, I love it. The people are nice, they are very kind. I don’t want to go home.”

Another person said, “It’s an exceptional home. They make sure you have everything you need” and “I’m quite content and happy, I’m lucky to be here.”

We spoke with a relative who was visiting the home, they told us, “My husband’s being very well looked after, his needs are fully met. The staff keep me very much informed, the food is good and very varied. I have no concerns, I think the staff do a good job of looking after people who have dementia.”

Another relative we spoke with said, “My husband has been here for three weeks. He has settled in very well, no problems.”

People living in the home told us that they were satisfied with the cleanliness of the home and their bedrooms. Specific comments were, “It’s absolutely spot on” and “the cleaners are in here all the time, it gets on my wick I don’t know why they do it so often”.

Staff were able to describe how they cleaned people’s rooms. The chambermaid told us how she monitors the condition of bed mattresses, however, this did not include looking to check how clean they were.

Staff told us they had received infection control training and were regularly informed of any changes in practice.

We spoke with people who were involved in the laundry and found staff differed in their opinion of how laundry was managed.

The head chef described how kitchen staff followed good hygiene practices in terms of hand washing and cleaning of the kitchen areas.

We were told that all bathing areas and toilets had been recently refurbished and air dryers had been introduced to replace hand towels.