Highams Lodge

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not consistently met through the organisation and delivery of care.

Person‑centred care was not consistently delivered. Care planning was not always clearly structured, and systems used to monitor engagement and activity did not consistently demonstrate how care was adapted when needs changed. The service did not consistently support timely progression, and some people remained in the service for extended periods without clearly defined plans.

The service did not consistently support people to move on in a timely way. Records showed some people remained in the service for extended periods without clear planning or criteria to support progression.

Care did not always support consistent outcomes. There was variation in the quality and focus of key work sessions, and records did not always demonstrate that interventions were regularly planned, reviewed or adapted.

Processes were in place to record engagement, attendance and activity; however, these did not clearly demonstrate how information was used to plan care, respond to disengagement or adapt support.

However, the service offered a range of activities and opportunities for people to take part in the therapeutic programme. People described opportunities to contribute to day‑to‑day life in the service and engage in structured activities.

We have not awarded this service a score for Responsive.

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

Care planning was not consistently structured or maintained, and some records contained duplicated or incomplete sections. This reduced consistency in how staff were guided to deliver personalised care.

However, the service provided opportunities for people to contribute to daily life through community meetings and group activities. We observed a morning check‑in, a budgeting group and a community meeting where people shared views and contributed to decisions such as meal planning. People described activities that supported their interests and sense of autonomy, and some valued the therapeutic programme.

The service did not consistently demonstrate that care was maintained and adapted when people’s engagement changed. Records showed that attendance at some therapeutic groups was low, with some sessions attended by between 0 and 2 people out of approximately 12 people using the service at the time.

Where people did not attend sessions, records often noted non‑attendance but did not consistently demonstrate follow‑up, review or re‑engagement planning. This reduced assurance that staff adapted care to meet people’s needs or maintained continuity of therapeutic support.

Arrangements were in place to monitor engagement, attendance and therapeutic activity; however, these did not clearly demonstrate how information was used to plan care, respond to disengagement or adapt support.

However, people described mixed experiences of access to therapy, with some benefiting from consistent support and others describing gaps. Staff described a structured process where progress reviews took place approximately every 3 months, with input from a consultant psychologist. Staff also described maintaining contact with external teams where required to support people when their needs increased.

The service did not ensure people were routinely aware of independent advocacy. Of the 7 people we spoke with, 5 were not aware of independent advocacy or how to access it. At the time of inspection, the provider confirmed that advocacy arrangements were not in place but would be sourced for people.

However, people received day-to-day information about the service through community meetings, where staff shared updates about routines, activities and shared resources. People also had access to a shared digital communication board developed with staff, which provided updates about the service.

The service did not consistently demonstrate that it acted on concerns raised by people. Meeting records showed that people raised issues which were repeated over time, and records did not consistently show that actions were taken or followed through. This reduced transparency and accountability.

Records also showed duplication, which reduced clarity about what actions had been agreed and whether these had been implemented. The provider told us this duplication was due to an administrative recording error and said they would address this.

These issues made it difficult to track progress or outcomes from concerns raised.

However, the service provided opportunities for people to discuss concerns and give feedback. People described raising issues through meetings and day‑to‑day conversations and said they were able to share their views with staff. Meeting records showed that people raised a range of issues, including environmental concerns and shared resources, and that staff listened to these concerns.

People did not experience consistent or timely progression through the service. Records showed that some people remained in the service for extended periods. People we spoke with described lengths of stay ranging from 3 weeks to 4 years. In addition, information available at the time of the assessment identified that at least 1 person had been living in the service for over a decade. This limited opportunities for independence, delayed recovery and reduced access for others who may benefit from the service.

The service did not have clearly defined admission or exclusion criteria. Decisions about whether to admit people were made on a case-by-case basis. The registered manager told us they would not accept referrals involving people who required physical restraint or people with high physical care needs; however, there was no formal policy or documented guidance to support these decisions, which reduced transparency and increased the risk of inconsistent or inequitable access to the service.

Staff described referral screening processes and consideration of people’s needs alongside the service’s therapeutic approach when making decisions about admissions. While this supported a degree of flexibility, the absence of clear criteria limited assurance that decisions were made consistently and based on defined standards.

People did not consistently experience the same quality of support across the service. Care and treatment records showed variation in the quality of one‑to‑one key work between staff and people in 3 of the 4 records reviewed. In these records, key work sessions did not consistently include clear aims, reflection or identified next steps.

In 1 care and treatment record, there was limited detail recorded for a one‑to‑one session. This meant it was not always clear how support contributed to progress or how care was developed over time.

However, one‑to‑one key work sessions were delivered across the service.

Care and treatment records did not consistently evidence future planning that set out clear goals, timescales and review arrangements. Of the 8 relevant care and treatment records reviewed, only 4 included documented transition or move‑on planning. This reduced clarity about how people would progress or move on from the service.

The provider acknowledged this gap and told us plans were in place to ensure all people had a documented move‑on plan by the end of May 2026.

However, people described opportunities to build confidence and responsibility through involvement in shared projects and roles within the service. One person told us their future housing options were being discussed, including step‑down accommodation planned for the end of 2026. We also saw evidence of 1 person being supported to move into the community and into a self‑contained flat, with continued access to psychotherapy.