Highams Lodge

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people experienced positive outcomes overall, and feedback from people confirmed they benefited from the support provided.

People’s needs were assessed prior to admission, and staff demonstrated a clear understanding of trauma, psychological distress and relational approaches. This supported the development of therapeutic relationships and helped people to engage with the service.

The service delivered a range of therapeutic interventions aligned with its clinical model. People described benefiting from therapy, including improvements in emotional regulation and reductions in self-harm. Staff worked collaboratively and liaised with external services to support continuity of care when needs increased. The service supported people to access physical healthcare and undertook reviews to consider goals, progress and development.

However, some aspects of assessment and monitoring were not always applied in a structured or consistent way. Records did not always capture all relevant information, including trauma history and substance use, which reduced clarity in some areas of care planning and limited the ability to anticipate changes in need.

The service did not always review or adapt therapeutic input where engagement reduced. This meant that some people experienced gaps in therapy, which could affect continuity in their recovery.

Care information was not always organised or accessible, which at times made it harder for staff to coordinate care effectively. Systems to monitor physical health and outcomes were in place, but these were not always recorded or used in a consistent way to demonstrate progress over time. The service did not use structured outcome tools to evidence outcomes consistently, which limited its ability to evidence outcomes in a systematic and comparable way.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

Records did not always capture all information required to support care planning. Trauma history and formulation were incomplete in 3 care and treatment records. Formulation is the process of bringing together information about a person’s experiences, history and current needs to understand what may be contributing to their mental health and how best to support them. Where this was incomplete, there was reduced clarity about triggers, patterns of behaviour and appropriate support strategies, which meant staff may not have fully understood the factors influencing a person’s mental health or how best to support them in a consistent way.

Care and treatment records did not always reflect people’s stated gender identity, and equality monitoring information was not consistently recorded. This reduced assurance that people’s protected characteristics were fully recognised and considered when assessing needs and planning care.

Substance use risk was not always assessed or updated in 2 care and treatment records. During the inspection, we smelt an odour that staff also identified as cannabis, which indicated that smoking was taking place onsite. Staff told us they would follow this up with the person involved. The absence of up-to-date assessment and review of substance use reduced assurance that potential risks, including the impact on mental health or safety within the environment, were understood and managed.

Risk assessments varied in depth between records, which reduced consistency in how people’s needs were assessed and recorded, and limited assurance that staff had clear and complete information to guide care.

However, care plans were generally well structured, holistic and reflected people’s involvement, which supported person-centred care. People described arriving with complex needs and valued staff understanding of trauma and psychological distress, which supported engagement and a sense of being understood. The service had systems to assess people’s needs before admission and understand the support required. Staff described referral screening and assessments that captured mental health history, risk, engagement and therapeutic need. Care and treatment records showed comprehensive assessments for most people, including mental health, trauma, physical health and wider social factors.

People described valuing the therapies on offer, including approaches that helped them understand their needs and triggers. Some people said this supported them to develop coping strategies when they felt distressed.

The service offered a range of therapeutic interventions aligned with its clinical model. This included psychosocial groups, reflective community meetings and individual psychotherapy.

However, care and treatment did not always demonstrate a consistent approach to maintaining engagement in therapy. Records showed variation in attendance and engagement, with some people experiencing gaps over extended periods of time.

In 2 care and treatment records, people had not attended one‑to‑one therapy sessions. Records captured non‑attendance but did not include clear follow‑up or re‑engagement planning after repeated missed sessions, which reduced continuity in therapeutic input and progress.

People described staff responding quickly when incidents occurred and supporting access to external services when needed. This helped maintain people’s safety.

Staff described working collaboratively within the service and received regular communication through handovers, supervision and informal discussions.

We observed a handover and saw staff share information about people’s day-to-day presentation, appointments and overall wellbeing. Staff liaised with external services when people’s risks increased, including emergency services and community mental health teams.

People described staff supporting access to physical healthcare, such as attending hospital appointments. Staff supported people to manage their ongoing physical health needs, including completing physiotherapy routines and using mobility equipment where required.

The service monitored people’s progress through reviews and care planning; however, none of the 4 care and treatment records reviewed included evidence of outcome measurement or tools to track progress over time. This limited the provider’s ability to measure progress in a consistent and objective way.

Care and treatment plans showed that people’s progress was reviewed. People described benefits from therapeutic input, including improved emotional regulation and reduced self-harm. Staff described reviewing progress through three‑monthly reviews and using therapeutic measures such as Adverse Childhood Experiences (ACE) scores.

People described experiencing more freedom and fewer restrictions than in previous placements, including choice in daily routines and movement. This reflected the community-based model of the service, where people were supported to live with greater independence and autonomy.

Staff training included the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Care and treatment records showed staff obtained consent from people whilst caring for them and before sharing information with others. Several care plans reflected people’s understanding of and consent to their care.