The inspection took place on 31 July 2017 and was unannounced.

The last inspection took place on 2 and 3 August 2016 when we rated the service Requires Improvement. We found breaches of Regulation relating to safe care and treatment and good governance. We made requirements in respect of these. At the inspection of 31 July 2017 we found the provider had taken the required action to meet these breaches.

Torkington House is a care home for up to 32 older people living with the experience of dementia. There were 32 people living at the service at the time of our inspection. Some people were staying at the home for short stay visits. The provider also offered a day care service at Torkington House for some older people who lived in the community. The service is managed by Greensleeves Homes Trust, a charitable organisation providing care in 21care and nursing homes in England.

There was a registered manager in post. They had managed the home for 13 years. 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.

People who lived at the service were happy. Their needs were met and they felt comfortable and well cared for. Many people described the service as ''homely'' and ''a family atmosphere.'' Visitors were also happy with the care people received. They told us that the staff were kind, polite and had good relationships with the people who they cared for and their relatives.

People's needs were met. The staff had a good knowledge of individual needs and worked closely with other professionals to make sure health needs were met. There was an activities coordinator who organised social activities. The care staff also provided entertainment and supported people to pursue their leisure activities. People were free to move around the home without restriction. We saw that people used the garden and communal areas throughout the day of our visit. People's nutritional needs were being met. The catering staff had a good understanding of individual preferences and needs and catered for these.

People were cared for in a safe environment. The staff had assessed risks to their wellbeing and made sure they took action to keep people safe. People received their medicines as prescribed and in a safe way. There were procedures to safeguard people from abuse and to recognise and report any suspected abuse.

There were enough staff to keep people safe and they had been recruited in a way which made sure they were suitable to work with people. The staff received the training, supervision and support they needed. The staff felt well supported and enjoyed working at the service.

The service was well managed. The registered manager had a good knowledge of individual needs. The people using the service, staff and others liked the registered manager and felt supported and involved. There was an inclusive and positive culture where people were encouraged to share their feedback and experiences. There were systems to monitor, assess and improve the quality of the service. Records were appropriately maintained.

The inspection took place on 2 and 3 August 2016 and the first day was unannounced. The service was last inspected on 2 and 4 April 2014 and at the time was found to be meeting the regulations we looked at.

Torkington House provides accommodation and personal care for up to 32 older people. The service provides a service for older people who have a range of needs including dementia care needs. There were 31 people living at the service at the time of our inspection.

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.

Risk assessments did not provide up to date information in relation to individual’s risks when receiving care.

There was a policy and procedure in place for the administration of medicines and medicines were stored securely. However, people did not always safely receive their medicines and records staff kept were incomplete and did not fully evidence what action staff had taken.

There was a range of audits in place but these had not been carried out regularly or effectively to identify aspects of the service requiring improvement and therefore action had not always been taken to address issues.

People's capacity to consent to their care and treatment had been considered and assessed although it was not always clear why in some cases capacity assessments had taken place and when they had not. The registered manager had acted in accordance with the Deprivation of Liberty Safeguards.

We made a recommendation for the provider to seek national guidance on the Mental Capacity Act.

We found staff monitored people's nutrition and fluid intake but records were not always maintained accurately. It was not always clear when people's needs changed if staff had responded effectively.

We made a recommendation for the provider to seek national guidance on nutrition and hydration for older people.

Some care records reflected people’s health and social care needs. However, improvements needed to be made to ensure people's records always noted the support they needed to meet their current needs.

We made a recommendation for the provider to review how care records are written and audited to ensure records accurately noted people's current needs and if someone else had the legal power to make decisions on their behalf.

Although we found some areas that required improving, people and their relatives gave us complimentary comments about the service they received. People felt happy and well looked after. Staff knew people well and understood how to meet their individual needs. We observed positive relationships between staff and people at the service and their relatives.

There was a good range of activities on offer for people and people's right to take part or not was respected. These also took into account if people were living with dementia and what they responded to and enjoyed.

Staff had the training they needed to care for people. Specialist training was organised to ensure staff worked in a person centred way.

The environment was designed and used in a way which reflected people’s preferences and took account of their needs.

There were enough staff on duty to meet people’s needs and they had been suitably recruited.

The staff worked with other healthcare professional to assess and meet the healthcare needs of people who used the service.

There was an appropriate complaints procedure and people knew how to make a complaint.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to risk assessment and recording, medicines management and auditing.

You can see what action we told the provider to take at the back of the full version of the

During the inspection we spoke with eight people using the service, five relatives and six members of staff to find out about the service provided.

People's needs were assessed and care plans developed that ensured people's needs were met effectively. People's healthcare needs were monitored and met with the support of healthcare professionals. People who spoke with us said they were happy with the care and support they received at the home. One person said “the consideration for healthcare is very high” and “it really is glorious here”. Another said “they always support you to attend any hospital appointments”.

People said they liked the food and could choose what they wanted to eat.

The home was well maintained and health and safety checks were being carried out to ensure the premises were safe.

There were adequate numbers of staff to meet people's needs effectively and staff told us that there were always enough staff on duty. Comments we received about staff included us “I am looked after extremely well, the staff are very, very good. They are considerate, they do everything in a moment” and another said “everyone is very friendly”.

There was an effective complaints management system in place. People told us they were confident to raise any concerns they might have.

We spoke with fourteen people living at the home, three relatives and eight members of staff, which included the manager. All the people we spoke with told us they were happy and well looked after. The said that staff were “kind”, “caring” and that they were “well looked after”.

All three relatives we spoke with confirmed they were satisfied with the care and support provided. One relative said “the consideration and kindness here is remarkable. They (staff) are marvellous, warm, friendly and this is an exceptional home”.

People said they felt “safe” at the home and would report any concerns. Relatives said they could raise concerns with the manager and were confident to do so. People told us that improvements had been made to the service following their feedback.

We looked at the care records of three people, spoke with seven people, five relatives and ten members of staff.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People using the service told us they felt safe and that they were cared for individually. Assessments carried out by the staff ensured that people’s needs were identified and met. Risks were assessed and reviewed regularly to ensure people’s individual needs were being met safely. People were involved in making decisions about their care and how they wanted to be cared for. Staff had undertaken training on the Mental Capacity Act 2005 and were aware of their responsibilities in relation to Deprivation of Liberty Safeguards. People were supported to take their medicines in a safe way. Recruitment practices were robust and being followed. Policies and procedures for safe working practices were in place to assess and monitor that the service was prioritising people’s safety. Two relatives we spoke with said “my family member is safe and secure here, when we are leaving we have no worries”.

Is the service effective?

People received effective care from staff that were trained and supported by the manager. Staff spoke confidently about holistic care and treating each person as an individual. People we spoke with said that staff monitored their condition and where necessary sought the assistance of other healthcare professionals. People told us they were happy, well cared for and treated with respect. People we spoke with told us that they were provided with clear information which helped them understand the care and treatment choices available to them. People were involved in assessments of their health and care needs and in writing their plan of care, so they understood the information they included.

Is the service caring?

The service was good and caring. This was confirmed by all the people and relatives we spoke with. Staff respected peoples’ privacy, dignity and their right to be involved in decisions and make choices about their care and treatment. Care plans we viewed detailed people’s individual preferences, so that staff knew people’s individual wishes. People told us that staff were caring and compassionate. Comments we received from people included, “I am very happy with the care here”, “the workers here are marvellous” and “I have never known such care, this is genuine care, they do things that make a difference. The individual care is so good”.

Is the service responsive?

People’s needs were reassessed on a regular basis and we saw the service responded to any changing needs. For example, we saw where a person had lost weight the staff had responded by contacting the GP and arranging input from a dietician. People told us they enjoyed the activities on offer and the home catered for their individual preferences. Two relatives we spoke with said the staff had responded confidently when there was an emergency situation with their family member.

Is the service well-led

Governance arrangements were in place and staff were clear about the values of the organisation. Staff spoke confidently about caring for people in a holistic and safe manner.The home had a registered manager who was experienced and knew the service well. People using the service, staff and relatives we spoke with said the leadership of the service was excellent and it was a good place to work. Staff felt well supported to raise any concerns and said they were always acted on.