Highams Lodge

We found the following examples of good practice.

• The service had a screening process for visitors when entering the building, including temperature checks and provision of personal protective equipment (PPE). As well as wearing a mask, all visitors were required to wear a disposable apron before entering the main communal areas and use a hand sanitiser, which helped to reduce the risks of spreading infection.

• People isolating were supported in creative ways to ensure they were able to continue to receive the support they needed and reduce the spread of infection. This included, providing meals to people in their rooms and supporting them to maintain their well-being through individual activities.

• Staff were supported to travel safely to and from work using a private minicab service, to avoid the use of public transport and reduce the risks associated with Covid-19 and spreading infection.

• Staff and people using the service took part in regular weekly testing for Covid-19. Additionally, staff carried out lateral flow testing twice a week, which enabled them to receive test results within 15-30 minutes. This helped the service to reduce the risk of spreading infection and allowed them to closely monitor and act immediately to ensure government guidelines can be followed where positive test results were discovered.

•The service conducted regular fogging cleaning (professional antiviral disinfectant sprayed using a fogging machine) to help manage infection of hard to reach areas and provide a safe living/working environment. Domestic staff were employed to carry out daily cleaning and sanitising of the communal areas took place. We observed staff cleaning the communal areas during our visit. This helped to minimise the risk of spreading infection.

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.

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.

Staff we spoke with were clear about what needed to be recorded when administering medication. There were no gaps in the MARs charts we checked and where people had refused, the reason for refusal was clearly stated.

We saw that care records were accurate and up to date and were held securely in files in a locked cupboard in the office.

At this inspection we found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The manager told us risk assessments and risk management plans had been reviewed and a new form had been introduced.

The provider responded appropriately to any allegation of abuse. We saw that where there had been incidents or allegations of suspected abuse the provider had notified the local authority, the care quality commission (CQC) and the police.

During the second visit on 16 May 2013 we saw evidence of people's current medicines, but when we looked at the medication administration records (MAR) for the fourteen people who lived in the home we saw that medicines were not always recorded appropriately.

Staff stated and records confirmed they receive annual performance appraisals where they discussed training and development. The manager sought feedback from people who used the service about individual staff as part of the appraisal process.

One person we spoke to told us they would not write down a complaint but go directly to staff if they have any complaints. They said sometimes staff would do something about it and sometimes staff would say why they could not but tell you what you should do yourself.