Toby Lodge

Updated 10 February 2022

The inspection

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. This was a targeted inspection to check whether the provider had met the requirements of the specific concern we had about safe staffing levels.

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.

Inspection team

This consisted of one inspector.

Service and service type

Toby Lodge 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.

The service did not have a manager registered with the Care Quality Commission. A registered manager is a person, along with the provider who are legally responsible for how the service is run and for the quality and safety of the care provided. The previous registered manager had recently left and there was an interim deputy manager in place whilst the provider looked to recruit a permanent manager.

The provider informed us after the inspection on 7 January 2022 they had seconded a member of the senior management team to be an interim manager whilst the recruitment process was underway.

Notice of inspection

This inspection was unannounced. The provider knew we would be returning on the second day of the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed the previous inspection report and sought feedback from the local authority. We also reviewed the information of concern that had been shared with us via our contact centre which triggered this inspection. We used all of this information to plan our inspection.

During the inspection

We met and had introductions and general conversations with all of the people who used the service.

We spoke with seven staff members. This included the interim deputy manager and two members of the senior management team. We also spoke with four support workers.

We reviewed a range of records related to staffing levels in the home. This included samples of staff rotas and shift planner records for November and December 2021, daily and weekly service reports and email correspondence related to staffing in the home. We also reviewed samples of daily records that had been completed on the provider’s digital care planning system.

We carried out observations throughout the inspection in relation to IPC procedures, staff awareness of best practice and reviewed signage that was displayed around the home. We also sat in and observed a resident meeting that took place on the first day of the inspection.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We reviewed policies and quality assurance records related to IPC within the home.

We had follow up correspondence with two directors on the 15 December 2021, one of them being the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We provided formal feedback to the nominated individual and senior management team via email on the 23 December 2021, who responded with their comments on 12 January 2022.

We provided our c

Updated 10 February 2022

This comprehensive inspection took place on 6 and 7 February 2018 and was announced. At the last comprehensive inspection in December 2015 the service was rated as Good.

Toby Lodge 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. Toby Lodge accommodates 10 male adults in one building across four floors, with each person having their own bedroom with en-suite bathroom. There was also a communal living room/dining room, kitchen and access to a small courtyard. At the time of the inspection the care home was supporting 10 people who had a forensic history with mental health conditions and a learning disability.

There was a manager in post at the time of our inspection who was also a registered manager at another service managed by the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People and their relatives felt comfortable approaching the management team, who had a visible presence throughout the service. Staff felt valued and spoke positively of the open and honest working environment and the support they received from management, which led to a strong sense of teamwork across the whole team.

During a period of refurbishment at the home people had been supported to stay at a holiday home to minimise the negative impact it could have had on their day to day lives. People enjoyed the experience and staff spoke positively about the support from management during this period.

People’s risks were managed safely and care records contained appropriate and detailed risk assessments and emergency plans. Staff had a good understanding of how to manage behaviours that challenged the service and worked closely with health and social care professionals for advice and guidance.

People and their relatives told us they felt safe using the service and staff had a good understanding of how to protect people from abuse. It was discussed regularly with people who used the service and all staff were confident that any concerns would be investigated and dealt with immediately.

People who required support with their medicines received them safely from staff who had completed training and been observed in the safe handling and administration of medicines. Staff completed appropriate records when they administered medicines and these were checked daily by staff to minimise medicines errors.

Staff had access to training to support them in meeting people’s needs effectively. New staff shadowed more experienced staff before they started to carry out care tasks independently and received regular supervision from management. They told us they felt supported and were happy with their input during the supervision they received.

People received support to make choices about their food and drink and staff were aware of nutritional needs relating to people’s culture, religion and medical needs.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and authorising applications. Best practice information was available in an easy read format to help explain the process to people who used the service.

People had regular access to healthcare services and staff were aware when people’s health and medical appointments were due. Health and social care professionals confirmed they were always updated if people’s health conditions changed or needed any further guidance and support.

People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. We observed positive interactions between people and staff throughout the inspection and saw people felt comfortable in the presence of the whole staff team. We saw that staff treated people with respect and kindness, respected their privacy and promoted their dignity and independence.

People were supported to follow their interests and staff were proactive and encouraged them to take part in a range of activities to increase their health and well-being and reduce social isolation. People and their relatives were involved in planning how they were cared for and supported. Care records were person centred and developed to meet people’s individual needs and discussed regularly during key work sessions.

The provider had an accessible complaints procedure in place which was regularly discussed with people and relatives knew they could speak with staff if they had any concerns. There were surveys in place and monthly residents meetings to allow people the opportunity to feedback about the care and support they received.

There were effective quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. The management team followed a daily, weekly, monthly and annual cycle of quality assurance activities and learning took place from the result of the findings.