We last inspected this service on 26 July 2016. This inspection took place over two days on 9 and 20 August 2018 and was unannounced on the first day of our visit and announced for the second day. At our last inspection we found the provider in breach of Regulation 11 relating to consent to care and treatment. At this inspection we found the provider had made the necessary improvements to meet the relevant requirement.

Highams 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. Highams Lodge accommodates up to 15 adults in one adapted building. The service provided support to people with complex mental health needs and substance misuse issues within a therapeutic environment. This is a step-down service to prepare people with the necessary life skills before moving on to more independent living. At the time of our inspection 14 people were using the service.

The service did not have a registered manager in post. However, the manager was in the process of registering with the CQC to become the registered manager. 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.

People generally felt safe living at Highams Lodge, but at times felt unsafe due to the challenging behaviour of some people. At the time of our inspection we saw that the manager had addressed this and was working with other healthcare professionals to move people on to more appropriate accommodation.

Medicines were managed safely and people received their medicines as prescribed. People received care that was safe and safeguarding practices protected people from the risk of abuse. Staff were subject to the necessary checks before starting work.

Risk assessments identified risks and how these should be mitigated. Staff understood their role in managing and dealing with risks.

People using the service signed to give their consent to care and treatment. People are supported to maximise choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Medicines were managed safely and people received their medicines as prescribed. Systems were in place for recording and learning from accidents and incidents.

Systems were in place for logging and dealing with complaints and people using the service knew how to approach staff if they were unhappy with the service.

People’s cultural and religious needs were respected when planning and delivering care. Staff respected people’s sexual orientation and needs so that lesbian, gay, bisexual and transgender people could feel accepted and welcomed when receiving a service. People took part in a variety of activities and hobbies of their interests.

Staff told us the manager was approachable and listened to concerns. There were systems in place to monitor the quality of the service and obtain feedback from people using the service.

Staff received training and supervision to help them to effectively carryout their role. We have made two recommendations in relation to staff training in specialist area and compatibility of people admitted to the service.

Further information is in the detailed findings below.

This inspection took place on 26 July and was unannounced. At the last inspection of this service in December 2015 we found six breaches of regulations. This was because the service had not notified the Care Quality Commission of all safeguarding allegations, medicines were not managed in a safe manner, people’s physical health care needs were not adequately met, care plans did not include clear and measurable objectives for people, complaints were not always recorded appropriately and they did not have robust quality assurance and monitoring systems in place. We found all of these issues had been addressed during this inspection.

The service was registered to provide accommodation and support with personal care to a maximum of 15 adults. The service provided support to people with complex mental health needs and substance misuse issues within a therapeutic environment. Typically people used the service for a period of 18 to 24 months before moving on to a more independent setting. At the time of our inspection 12 people were using the service.

The service had a registered manager in place. However, they were on a period of extended leave at the time of our inspection and one of the deputy managers was acting up in the role of the manager. 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 service did not carry out mental capacity assessments where they managed medicines on behalf of people without their consent to do so.

We found one breach of 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.

The service had appropriate safeguarding procedures in place which staff understood. Risk assessments were in place which included information about how to support people in a safe manner. There were enough staff working at the service and robust staff recruitment procedures were in place. Medicines were stored, administered and recorded safely.

Staff were well supported and received regular training and supervision. No one using the service was subject to a DoLS authorisation and people were free to come and go as they chose. People were supported to eat a healthy and nutritious diet and had choice about what they ate and drank. People had routine access to health care professionals.

People told us they were treated with respect and in a caring manner by staff. The service promoted people’s independence and privacy and sought to meet people’s needs in relation to equality and diversity issues.

Care plans were in place which set out how to meet people’s individual needs. People were supported to engage in a variety of activities. The service had a complaints procedure in place and people knew how to make a complaint.

People and staff told us they found the management team to be approachable and helpful. The service had various quality assurance and monitoring systems in place. Some of these included seeking the views of people that used the service.

People who used the service told us that their care and support was tailored to meet their needs and they never felt it depended on staffing levels or the needs of others who used the service.

Two people told us that they let their care coordinators decide what was best for them as they trusted their decisions.

Most people who used the service said they did not always feel safe living Highams Lodge. Some people had experienced bullying from other people living in the home and most people said they were not confident in addressing this with staff.

One person said they would like to thank the staff that had looked after them during their stay at Highams Lodge and wanted people to know that there were staff there that were helpful and kind.

People who use the service gave us a range of opinions about the care they received. One person told us that they were very happy with the care and said, “The staff are wonderful”. Other people told us that they did not always feel safe or supported and one person said they did not always feel that they were treated with respect.

Staff spoken to said that people were enabled to take responsibility for their actions through the therapeutic structure of the service. People who use services however told us that this was not always enough to protect them from physical and/or verbal aggression when people became unwell.

We spoke to a number of people living at the home during our visit; all of whom were generally positive about their experiences since they arrived. We were told that people are allocated a key worker and a separate therapist. One person told us that they needed some practical assistance from staff regarding their daily living and that this was provided.

People spoken to told us they had clear goals and plans to help them increase their independence. These are designed to assist them in developing and/ or re-gaining the skills and confidence they need to move on to a more independent life style.

On our visit we saw people who live in the home involved in cleaning the communal areas of the building.

One person told that they are supported to keep their room clean and had recently been assisted to buy new sheets and pillow case for their bed.

We saw that staff worked with people in an appropriately friendly manner, seemed to have a good knowledge of people's needs and appeared to have formed good working relationships with them.

This inspection took place over two days on the 9 and 15 December 2015 and was unannounced. At our last inspection of this service in December 2014 we found there were five breaches of regulations. These related to staffing levels, cleanliness in the home, promoting people’s independence, assessing risk and food and nutrition. At this inspection we found the provider had successfully addressed these issues.

The service was registered to provide accommodation and support with personal care to a maximum of 15 adults. The service provided support to people with complex mental health needs and substance misuse issues within a therapeutic environment. Typically people used the service for a period of 18 to 24 months before moving on to a more independent setting. 12 people were using the service at the time of our inspection.

The service had a registered manager in place. 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.

Medicines were not always managed in a safe manner. The provider had not always notified the Care Quality Commission of safeguarding allegations. Support plans did not adequately address people’s physical health care needs and people did not have routine access to dental care. Support plans did not adequately set out how to develop and promote people’s independence. Accurate records were not always kept of how the service responded to complaints made by people that used the service. The systems for monitoring the quality of care and support provided were not always effective.

The service was found to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the end of the full version of this report.

People told us they felt safe using the service. We found there were enough staff working at the service and checks were carried out on staff before they commenced working. The premises were found to be clean and secure. Risk assessments were in place which provided guidance on how to support people in a safe manner.

The service was operating within the spirit of the Mental Capacity Act 2005 and people were able to make choices about their daily lives. No one was subject to a Deprivation of Liberty Safeguards authorisation. People were provided with sufficient amounts to eat and drink and were able to make choices about what they ate. Staff undertook training appropriate to their role and received support from management through regular supervision.

People told us that staff were caring and we observed staff interacting with people in a friendly and respectful manner. The service took steps to promote people’s privacy and independence.

People told us the service was responsive to their needs. People had access to both group and individual therapy sessions to help meet their needs around mental health issues. People were aware of how to make a complaint.

Staff and people that used the service spoke well of the registered manager and management team. There was a clear management structure in place at the service.