CQC report explained · a residential care home
What the CQC found at Toby Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors looked specifically at staffing and infection control. Staffing had fallen below the minimum level on two days in November 2021, but inspectors found sufficient staff during the visit and no evidence of severe impact on people.
- Effective?
- Good
- This question was not assessed in this targeted inspection.
- Caring?
- Good
- This question was not assessed in this targeted inspection.
- Responsive?
- Good
- This question was not assessed in this targeted inspection.
- Well-led?
- Outstanding
- Inspectors looked specifically at management and culture. Most feedback was positive, but one staff member said they did not always feel listened to by senior management.
What inspectors found, February 2022
Inspected but not rated; inspectors found staffing concerns were being addressed, but the full quality of the home was not assessed.
This was an unannounced targeted inspection on 14 and 22 December 2021. It followed concerns about staffing levels and the culture within the home. Inspectors spoke with people living there and staff, reviewed staffing records and care records, and observed the home and infection control practices.
Records showed that staffing had fallen below the provider's minimum level on 29 and 30 November 2021. Four staff were present on those days instead of the stated minimum of five. Inspectors found no evidence that people had been severely affected, although some external activities were cancelled.
By the inspection, staffing levels had improved and the home was recruiting more staff. Inspectors saw a calm environment, people supported in the community, and effective infection control measures. They also found that some staff did not always feel listened to by senior managers, and there was no registered manager at the time.
The home was inspected but not rated. This means the inspection looked only at specific concerns, rather than the full service. The previous ratings were Good for Safe and Outstanding for Well-led, but those ratings were not reviewed or changed.
Staffing had improved
Staffing levels had not fallen below the stated baseline during December 2021. The provider was recruiting new staff and using extra support when shortages occurred.
“Daily records for December 2021 confirmed staffing levels had not fallen below baseline levels and staff confirmed this.” from the report
Calm atmosphere
Inspectors saw a relaxed environment. People appeared comfortable with staff and were supported with walks, appointments and other activities.
“Throughout the inspection we observed a calm and relaxed environment.” from the report
Infection control
Inspectors were assured that the home had effective arrangements for infection prevention, personal protective equipment, testing and visits.
“We were assured that the provider was using PPE effectively and safely.” from the report
Open management response
Senior managers acknowledged the staffing problems and described steps being taken to recruit staff and provide additional support.
“The senior management team were open and transparent when we discussed the concerns with them” from the report
Staffing fell below the minimum
needs fixingThere were four staff present on 29 and 30 November 2021, below the stated minimum of five. Some external activities had to be cancelled on those days.
“Daily records showed on the 29 and 30 November 2021 there were only four members of staff present” from the report
Some staff felt unheard
minorAlthough most feedback about management was positive, one staff comment raised a concern about communication with senior managers.
“one staff comment highlighted other than the deputy manager, they did not always feel they were listened to by other members of the senior management team.” from the report
No registered manager
minorThe previous registered manager had left. An interim manager was in place while the provider recruited a permanent manager.
“The service did not have a manager registered with the Care Quality Commission.” from the report
- 01What staffing levels are in place now, and how do you cover sickness, non-attendance or cancelled shifts?
- 02Have any further shifts fallen below the minimum staffing baseline since the inspection?
- 03Has a permanent manager now been appointed and registered with the CQC?
- 04What changes have been made so staff can raise concerns and feel listened to by senior management?
- 05How often are residents' community activities cancelled because of staffing levels?
This was a targeted inspection of specific concerns about Safe staffing, Well-led culture and infection control; the other key questions were not assessed and the previous ratings were carried over. This explanation was written from the published report of 10 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2021
Inspected but not rated; inspectors found strong infection control arrangements after a COVID-19 outbreak, with some remaining issues around staff space and equipment.
This was an announced, targeted inspection on 5 February 2021. It looked only at infection prevention and control after an outbreak of COVID-19. Nine residents and 11 staff had tested positive at the end of December 2020.
Inspectors were assured about visitor checks, testing, shielding, social distancing, safe admissions and the infection control policy. Staff checked residents' temperatures, oxygen levels and cough status three times a day, with digital alerts if checks were missed.
Inspectors were only somewhat assured that personal protective equipment, the use of space and hygiene practices were fully effective. There was no separate staff break area, and a recommended pedal bin was not in place during the visit. The bin was put in place on 10 February 2021.
The service was inspected but not rated. This report does not provide an overall quality rating or ratings for all five areas of care.
Visitor safety checks
Visitors had their temperature taken and had to take a lateral flow test before entering. Staff also signed to confirm they had no symptoms and had not been in relevant contact with someone who was ill or positive.
“There were robust protocols in place for visitors upon entry, with temperatures taken and a requirement to take a lateral flow device (LFD) COVID-19 test before entering the home.” from the report
Regular health checks
Staff checked residents' temperatures, oxygen levels and cough status three times each day. The digital system sent an alert when a check was not completed.
“Staff checked people's temperature, oxygen levels and their 'cough status' three times a day, which was recorded on their digital care planning software.” from the report
Support for understanding
The home used easy-read posters and social stories to explain the pandemic and social distancing. This helped reduce one person's anxious and distressed behaviour.
“Easy read social stories had also been used to help explain the pandemic and the importance of social distancing” from the report
Action after the outbreak
The provider acted on most recommendations and arranged a professional deep clean. It also held regular discussions with staff about following guidance and good practice.
“The majority of recommendations had been actioned by the provider after the outbreak and the provider had also carried out a professional deep clean of the service on 7 January 2021.” from the report
No separate staff break area
needs fixingInspectors said the lack of a separate staff area could affect infection control. The local authority and the Clinical Commissioning Group were due to discuss this with the provider.
“One issue in the process of being reviewed was there was currently no separate staff area for them to take their break, which could impact the effectiveness of their IPC measures.” from the report
Pedal bin missing during visit
minorA recommended pedal bin was not in place when inspectors visited. The manager later sent photographs confirming that a bin had been added on 10 February 2021.
“There was a recommendation from the CCG IPC team regarding the need for a pedal bin in one area that was not in place at the time of our visit.” from the report
- 01Has a separate staff break area now been provided, and how is this reducing infection risks?
- 02Is the pedal bin now in the agreed area, and have all other infection control recommendations been completed?
- 03What are the current arrangements for relatives to visit after visits were suspended because of the outbreak?
- 04How are staff now checked for symptoms and contacts before starting work?
- 05How are residents supported to understand infection control guidance and social distancing?
This was a targeted inspection of infection prevention and control after a COVID-19 outbreak; the service was inspected but not rated and the other care areas were not assessed. This explanation was written from the published report of 5 March 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Toby Lodge
3 rated inspections over 2 years: the service has held its Good rating throughout.
- February 2022Inspected but not ratedcurrent ratingSafe: Inspected but not ratedWell-led: Inspected but not rated
- March 2021Inspected but not ratedSafe: Inspected but not rated
- March 2018Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Outstanding
- May 2017Goodstayed GoodWell-led: Good
- February 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- December 2013
Registered with the Care Quality Commission on 10 December 2013.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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