This inspection took place on 29 and 30 November 2016 and was unannounced.

Torrwood Care Centre is owned by Methodist Homes and is registered to provide nursing and personal care and accommodation for up to 82 people. At the time of our inspection there were 81 people using the service. The home is organised into three units: Beech House and Copper Beech providing care for people living with dementia and Oak House providing nursing care.

There is 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.

There were inconsistencies in the staffing arrangements specifically on Copper Beech. We observed a lack of staff availability to support people and provide assistance or prompting. There were periods when people became confused or unsettled and staff were not available to relieve this distress. However, in other parts of the home this support and availability of staff was present.

We have made a recommendation about reviewing the staffing arrangements.

People and relatives told us they felt safe in the home. One person told us “I feel safe here and know staff will help me if I need it.” One relative said, “There are good communications between family and the home. We have real confidence that we will be contacted if needed and consequently we sleep soundly without worrying.”

Staff demonstrated their knowledge of abuse and responsibilities to report any concerns about possible abuse. Staff were confident the registered manager would act to protect people if told of any such concerns. The registered manager had acted to protect people and responded professionally to any concerns or incidents, which placed people’s health and welfare at risk.

The registered manager had, as required, made applications under the Mental Capacity Act 2005 and obtained authorisations under Deprivation of Liberty Safeguards (DoLS) arrangements. Where people lacked capacity their rights were upheld and their health and welfare protected.

People told us they felt confident about staff having the necessary skills and training. One person told us "The carers are good and really know what they are doing and I can depend on them for anything."

People had access to community health services and their GPs when this was requested. Healthcare professionals we spoke with were positive about the care provided by the service. There were good relationships with outside professionals and people had access to specialist support and advice.

People told us they enjoyed the varied menu and always had a choice of meals. One person said, "The food is good and I always enjoy my meal." The service ensured people's nutritional needs were met and took action to address any concerns about people physical wellbeing and ensure they were able to have a healthy diet suited to their needs.

People spoke of respectful staff who recognised their right to privacy and upheld their dignity. People and relatives spoke of caring, courteous, professional and friendly staff. One person told us "I always feel staff treat me with respect and speak to me how I like to be spoken to." A relative said, "The caring is good and some of it is outstanding and (Name) has benefited from that."

People were encouraged to be as independent as possible. One person told us "I try and do as much as I can for myself staff know I want to and they let me get on with it as best I can."

There was a welcoming environment where people were able to maintain their relationships with family and friends. People and relatives told us there were no restrictions on visiting.

People felt able to voice their views or concerns about the service. There were regular meetings where people living in the home

There were comprehensive assessments and care planning of people's care needs. Where required specialist advice had been obtained to support the home in meeting complex needs. People told us they found staff caring and supportive. We observed staff supporting people in a sensitive and caring way.

The home's computerised medicines system provided a robust arrangement for the giving and auditing of medicines. However there were failures in relation to a lack of care planning to provide guidance as to the use of some PRN medicines. Records had not been completed to evidence the circumstances and appropriate use of "as required" PRN medicines.

We found that improvements had been made to the staffing arrangements of the home. This had resulted in care being more responsive and staff able to provide a more supportive environment particularly for people living with dementia.

We saw that there had been improvement in care records which evidenced the care being provided to people.

There were quality assurance and audits in place to look at the quality of care.

We visited this service as a result of concerns we had received which related to the planning and delivery of care and to look at staffing arrangements. This area had been the subject of a compliance action at our last inspection in July 2012. We found no evidence to substantiate the concerns we had received. We saw that care plans had been accurately completed reflecting the needs of people lived in the home. We saw that the completion of records needed to be improved.

People we spoke with had concerns about the staffing availability in the home. People told us that staff were always busy and that they did not always respond to requests for assistance in a timely manner. One person told us that they were not always able to have the care they needed when they chose. We found that staff did not feel there were sufficient staff on duty. This affected staff morale and their ability to fulfil their duties in a timely and efficient way. We found that no appropriate steps had been taken that made sure the staffing arrangements reflected the dependency levels of people living in the home. We saw that the provider had made efforts to make sure that staffing vacancies had been reduced.

We found some records we looked at did not accurately reflect the care needs and treatment of the individual.

Torrwood is organised as two units Beech House and Oak House. People in Beech House are living with dementia. Oak House provides primarily nursing care.

People told us that they were able to make some choices about their daily living at the home. One person told us “We can please ourselves up to a point. We all get into a routine.” We heard staff asking people if they wanted to receive care throughout the inspection.

Many people in the home were not able to tell us about the care they received. In Beech House we saw that people walked freely about the building. They looked clean and smartly dressed. One visitor told us they were pleased with the care their relative received. They said that the staff were “brilliant” and that their relative was relaxed and happy.They told us “he is a lot better now.”

We saw staff interactions between people and staff that were kind and respectful. We observed that when staff moved people or assisted them with their meals they were skilled and gentle.

This inspection took place on 16 and 17 June 2015 and was unannounced.

Torrwood Care Centre is owned by Methodist Homes and is registered to provide accommodation for persons who require general nursing or personal care. The home is organised into three units. Beech House and Copper Beech unit providing care for people living with dementia. Oak House provides care for people with nursing needs. At the time of our inspection there were 74 people living in the home.

There has been a registered manager in post since December 2014. 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.

Staff demonstrated a good understanding of the nature of abuse and their responsibility to report any concerns about possible abuse. However there was inconsistent understanding of how staff could contact outside agencies under the providers whistle blowing policy.

There had been improvement in the recruitment and retention of staff. This was confirmed by staff who told us there was more consistency and continuity of care because of improved staffing arrangements. We noted the staffing arrangements on Copper Beech unit did not  meet people’s needs. This meant potentially people’s needs were not always being met in a safe and responsive manner.

Whilst there was generally good arrangements for the management and administering of medicines there was a failure to follow the service’s policy about administering medicines covertly i.e. without the person’s knowledge or agreement.

From our observation of staff we saw people being supported and responded to in a caring and respectful manner. One relative described the staff as “All very caring and friendly”. However from our SOFI there were interactions which were neutral in that staff did not always fully engage with people. Whilst there were a majority of positive interaction there was a significant level of neutral and negative interaction.

There were inconsistencies when making decisions on behalf of people who lacked the capacity to make informed decisions. Whilst some decisions had been made following best practice, whereby relevant parties were involved in the decision making process, this had not always been the case for all the people at Torrwood.

Care plans did not always provide up to date or accurate information about people’s care needs.

There was a quality assurance system in place which audited the care arrangements in the home. However they had failed to identify how some records were not accurate and did not have the necessary information for staff about people’s care needs.

People told us they felt safe with staff who were “Friendly” and “Staff you can trust”. Relatives were confident people were kept safe and told us how staff were able to provide safe care.

Risk assessment had been completed so staff had the necessary guidance to prevent risks to people’s health and welfare. Some people could present behaviour which could challenge staff or people living in the home. There were care plans in place which identified actions staff should take in response to such behaviour. Staff had received specific training about how to respond to people’s behaviour and how to help to reduce anxiety or distress associated with people who are living with dementia.

The appropriate action had been taken to protect people’s rights in relation to placing restrictions on people’s liberty through the use of legal powers. Staff had a good understanding of how to ensure people were enabled to make choices about their daily lives and routines.

Staff received formal one to one supervision and training so they had the necessary support and skills to meet people’s care needs. The service had a significant number of volunteers who provided support to people assisting with meals and activities. Volunteers had received an induction and training as part of their role.

People and relatives told us there was a good choice of meals available. One person said “I really enjoy my food here. If there is something I don’t like I can always get something else.” There were arrangements to ensure people’s nutritional needs were met. However this could possibly be improved for some people by looking at how meals were served taking into account people’s dementia. Where concerns had been identified people were referred to the appropriate specialist or healthcare professional so they could receive the necessary support in meeting their care needs effectively.

People had access to a range of healthcare professionals such as physiotherapist, tissue viability nurse and chiropodists so their healthcare needs could be met.

People were not always able to verbally express their views or say what they wanted. Staff told us how had always tried to give people a choice verbally if possible. They noted how people responded and the behaviour they displayed. This enabled staff to recognise how people were feeling. Relatives were given the opportunity to inform staff about the particular care needs of their family member. They also attended care reviews to discuss if people’s needs were being met or if the care provided needed to change.

Relatives told us how they felt staff had a good knowledge and understanding of the people they supported and cared for in the home. One relative told us how the use of medicines (to reduce anxiety) had dramatically reduced since their relative had moved to the home.

Care plans were informative in providing information about people’s personal histories, interests and preferences. This helped to provide a range of activities which suited people’s personal choices and interests.

Relatives were confident of voicing any concerns or making formal complaints. There was evidence that complaints had been dealt with in a positive way and improvements made where this was needed when complaints had been upheld.

There was positive feedback from staff and relatives about the approach of the registered manager. People told us she was friendly and approachable. Staff said they felt they were well supported and their views were listened to with opportunities through staff meeting to voice their views. Staff said they had a good understanding of what the registered manager wanted to achieve in providing a quality service. The registered manager said they wanted to provide a dementia friendly and person centred service.

Relatives meetings had been held and relatives told us they were “Good” as it provided an opportunity to “Hear what was happening in the home.” Questionnaires had been issued to people living in the home and they had a high rate satisfaction with the care provided.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.