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 guida

This inspection took place on 4 April 2017 and was announced.

At our previous inspection on 10 and 11 December 2015 a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to notifications.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Toby Lodge’ on our website at www.cqc.org.uk’

There was a registered manager in post at the time of our inspection. 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.

Toby Lodge provides care and support for up to 10 male adults with a learning disability and forensic history. At the time of our inspection they were providing support to nine people in the home, and one person was being supported in hospital.

At our previous inspection we found that the provider did not always notify the CQC of notifiable incidents.

At this inspection, we found that improvements had been made.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and had reissued the regulations to the registered manager and staff team with immediate effect. Notifications were discussed and monitored at management meetings.

This inspection took place on 10 December and 11 December. The first day of the inspection was unannounced and we told the registered manager we would return on the second day. At our previous inspection on 4 July 2014 we found the provider was meeting the regulations we inspected.

Toby Lodge provides care and support for up to 10 male adults with a learning disability and forensic history. All of the bedrooms are for single occupancy and at the time of this inspection the service was providing support to eight people.

There was a registered manager in post at the time of our inspection. 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 told us they felt safe living at the service and relatives confirmed this. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Staff also felt confident that any concerns would be investigated and dealt with.

People’s risks were managed and well monitored. The care plans included risk assessments which all staff could access via a digital device and any changes could be updated straight away. The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. There were sufficient staff so that people could be supported to go out and access the local community.

People received their medicines safely and staff had received training in the safe handling and administration of medicines, which was refreshed annually.

People were supported by staff who had the necessary skills and knowledge to meet their needs. Staff had completed an induction programme and received regular supervision from management. People consented to the care they received and staff understood their role with regards to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People were supported to maintain their health and well-being through access to healthcare professionals, such as GPs, social workers and the Community Learning Disability Service. The information provided from these appointments was updated into people’s care plans.

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.

People and staff were relaxed throughout our inspection. There was a warm and friendly environment and people told us they enjoyed living in the service. Staff put people at the heart of their work and focused on them and their needs rather than tasks. Positive relationships between people and the whole staff team had developed as staff displayed a kind and compassionate attitude towards people.

Staff were knowledgeable about the people they were supporting and respected their privacy and dignity, along with their cultural preferences.

People received personalised care and staff involved people, their relatives and health and social care professionals when reviewing their needs and how they would like to be supported. People were supported to follow their interests, take part in social activities and maintain relationships with relatives and friends that mattered to them. For example, during the inspection one person was supported to visit a relative.

The service had an accessible complaints policy and people and those who mattered to them knew how to raise concerns and make complaints. There were also surveys in place to allow people and relatives the opportunity to feedback about the care and treatment they received.

The registered manager had a visible presence within the service and was described by relatives a

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, response and well led?

As part of this inspection we spoke with all five people who lived at Toby House at the time of our visit. We also spoke with four members of staff and a member of staff at the NHS trust responsible for the treatment of one person who lived at the home. We reviewed records relating to the management of the home which included three care plans, daily care records and records about how the home monitors its own performance and quality of care.

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

Is the service safe?

There were enough staff on duty to meet the needs of people living at the home on the day of our visit. Staff working at the home had suitable experience to enable them to support people. We saw that the provider had carried out checks to ensure staff were of a suitable character. All the staff had undertaken safeguarding training which was refreshed regularly. Staff understood the risks involved in providing support for people and there were plans in place for dealing with other foreseeable emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. A number of people were subject to restrictions imposed under mental health legislation. Safeguards were in place to ensure people were protected from the risk of undue restriction on their liberty.

Is the service effective?

People told us that they like living at Toby House. One person said "it's good here; the staff really help me." The care plans we looked at showed that support was provided in line with people’s assessed needs. We saw that people were meeting their goals and making tangible progress towards their goals. Other professionals involved with the care of people living at the home spoke of improvements they had observed in people’s health, wellbeing and ability to care for themselves.

Is the service caring?

Staff spoke to people with courtesy and respect. People living at the home were comfortable in the company of the staff on duty on the day of our visit. Staff respected people’s individual personal and cultural needs and paid close attention to details important to individuals living at the home.

Is the service responsive?

We saw that staff were responsive to the needs of people living at the home and the choices they made. Staff helped to identify and arrange activities which helped address the needs of people on an individual basis. People were encouraged to make decisions about their own care wherever possible. Care plans were regularly reviewed and updated to take account of needs as they emerged.

Is the service well led?

The service was led by a manager who was actively engaged with staff and proactive in the care of people living at the home. There was a strong focus on devising bespoke care and support and there were effective systems of quality control to ensure the service provided effective care.