This was an unannounced inspection carried out on 20 September 2016.

The service was last inspected on 26 August 2014 and was meeting all the regulations assessed at that time.

Fielder Lodge, is a not for profit, women only, high support accommodation. Fielder Lodge provides a therapeutic environment, psychological safety and containment to enable people to progress at their own pace, towards sustained recovery and independent living. Fielder Lodge had eight self-contained one bedroomed flats, along with communal areas including a lounge, dining room and large communal garden. The building had adaptations including a ramp and wide door frames to accommodate wheelchairs. There was a fully adapted bathroom and one fully accessible flat to accommodate a person with restricted mobility.

A respite facility was located on-site, a complimentary therapy room, offices and a meeting room. There was one entrance and exit route and an intercom system to the flats and to manage access to the building. People residing at the service had fob access to their individual flats and there was CCTV security on the perimeters of the service. At the time of the inspection there were seven people living at Fielder Lodge.

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.

The professional feedback we received regarding Fielder Lodge was extremely positive. We were told that Fielder Lodge was ‘a breath of fresh air’ and provided people with a sense of hope for their future.

Staff developed meaningful relationships with people which empowered them to proactively manage their own risks. This approach enabled people to feel in control and we saw it had resulted in positive outcomes for people.

Staff were creative and adapted their support in response to people’s changing needs to mitigate risks. People spoke highly of the support received and attributed their progress, enhanced sense of wellbeing and quality of life to the staff and support recieved.

We saw staff received comprehensive training which provided them with exceptopnal knowledge and skills. People received multidisciplinary input from a range of staff which included forensic community psychiatric nurses, social workers, occupational therapist and psychologist.

Staff told us they felt extremely well supported by management and received very good support through training, regular supervision and team meetings. Staff received psychology input to undertake formulation work, to equip them with the knowledge and skills to effectively support people. The psychologist also facilitated debriefing with the staff following incidents to ensure they were adequately supported.

People were at the heart of the service. The staff had achieved outstanding results based on people’s goals. People themselves told us that they had not believed their achievements had been attainable and attributed their success to the relationships and trust that had developed between themselves and staff. People were empowered to achieve their goals and live a fulfilled and independent life. People and staff worked in true partnership as equal partners with a focus on recovery principles and shared decision making. Recovery principles were embedded throughout the service design. A recovery coordinator was employed at the service to ensure recovery remained at the heart of care planning.

People and staff were encouraged to influence service change. Staff spoke of being given opportunities to explore and implement their ideas. People were at the heart of the service design, recruitment and quality monitoring.

Without exception, people receiving support praised the staff for their caring and pro

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 safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

Emergency fire procedures were displayed prominently on the walls at Fielder Lodge. Fire alarms were checked on a weekly basis and we saw people responding to a check on the day of our inspection. This helped ensure the safety of people who used the service.

There were robust recruitment procedures in place. Successful applicants were required to provide two references and a Disclosure Barring Service (DBS) check. When necessary, authorisation to work in the UK evidence was requested. We looked at two staff files and saw the required checks had been completed. These checks meant people who used the service had their health and welfare protected.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. On the day of our inspection, the manager told us no person who used the service was subject to a DoLS.

Is the service effective?

An advocacy service was available if people needed it, and if necessary, they were supported by staff members to access it. This meant people were provided with additional support if required.

We saw people underwent pre-admission assessments. People`s choices and preferences had been recorded and care plans were regularly reviewed which reflected a person centred approach to providing care. Consent forms, for example for the sharing of information, had been signed by the person. This meant people understood how their support needs would be met and had agreed with their care plans.

Is the service caring?

Staff had undergone training in relation to dignity in care which helped ensure support was provided to people in a dignified manner. One person we spoke with told us, "Staff continually encourage us to do things for ourselves and I think that`s right. If we need help though, they are there for us and that`s good to know."

We saw staff members spending time with people in communal areas of Fielder Lodge. We heard staff speaking to people in a patient and unhurried manner. People told us they appreciated the time and help provided by staff members.

Is the service responsive?

A complaints procedure was in place at the lodge and the manager showed us a tracking form which was also monitored by the quality assurance manager. A complaints and suggestion box was available in the reception area.

People had facilities which provided them with the opportunity to take part in activities, for example gardening, pool and art sessions. One person was working twelve hours a week and another person was considering doing some voluntary work.

Is the service well led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. We saw evidence of annual audit questionnaires which provided the opportunity for people to express their views in relation to how the service was provided.

Records were kept of GP and other professional visits and appointments. We were told this included crisis intervention teams and community mental health services. This showed a multi-disciplinary approach to providing care which helped ensure people received appropriate support when they needed it.

During our inspection to Fielder Lodge we visited the communal areas and were invited into one person’s flat. We saw that all areas were well maintained and regularly assessed to make sure they were safe.

People spent several months preparing to move to the service. During this time staff visited them and attended their ward rounds and review meetings. People visited the service and were able to have overnight stays so they were familiar with all aspects of the service when they moved.

We saw that risk assessments and risk management plans were in place. These were regularly updated. People also met with staff on a one to one basis weekly. All aspects of their recovery were discussed during these meetings.

New staff were being recruited at the time of our inspection. The provider told us there were usually enough staff available, but they were able to access agency staff at short notice if required.

There was a system in place to regularly assess all aspects of the service. Action plans were put in place where improvements were required.

The people we spoke with were positive about the support they received. Their comments included ““Staff don’t treat us like they’re better than us. They show respect”, and “I’d recommend other people to come here and start a new way of life. [The staff] make you see there’s more to life than hospital” and “The staff make time for you whenever you need a chat”.