We carried out a review of the data available to us about Fielder Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Fielder Lodge, you can give feedback on this service.
Fielder Lodge is a women only high support unit providing support and accommodation to eight women aged 18 to 65 with extremely complex mental health needs. Partially designed by women who used the service, it provided a secure, therapeutic environment with eight self-contained flats and a respite flat, a communal kitchen and lounge, therapy room, and office area.
People’s experience of using this service and what we found
Fielder Lodge is a high-level support facility supporting extremely vulnerable women who had all previously spent much of their lives in secure hospital accommodation. Following the Hope and Recovery model of mental health support, the service was focused on providing exceptional standards of person-centred care and support.
All the women we spoke with told us they felt Fielder Lodge provided a safe and secure environment. They said that they had developed strong, meaningful relationships with the staff and built up trust and confidence whilst being supported. One told us, “I have trust in the staff, I know they will keep me safe. I never had trust in anyone, never did, but I know here they won't let me down."
There were safe recruitment systems in place. The service provided an all female staff team to ensure privacy and dignity were respected, quell anxieties, and provide empathy. Staff were highly motivated, resilient and skilled in their role. They had undertaken appropriate training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; People were respected and valued as individuals and empowered as partners in their care in an exceptional service.
The ethos of the service was totally focussed on meeting the needs and aspirations of each individual. Staff were highly motivated and offered care and support which was exceptionally compassionate and kind. Visiting professionals told us that staff were ‘amazing’ and, “Able to work with people to explore their issues in a sensitive and kind way." Staff showed empathy and had built open and honest relationships with the women they supported. They respected privacy and were mindful when sharing confidential information.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The women who lived at Fielder Lodge were fully involved in planning their care and had choice and control about how their care would be provided. A full transition period as each new person was admitted into the service allowed time to get to know people, understand their preferences and how they wanted their support to be delivered. Detailed support plans accurately captured personal preferences and histories, allowing staff to adapt the way they delivered support in a truly person-centred way. The service recognised and understood different cultures and backgrounds, and service delivery reflected people’s values and traditions.
People were very clearly at the heart of the service. The service was extremely well led by managers who were dedicated to providing a service which was responsive to need. The women living at Fielder Lodge were encouraged to support quality assurance measures and consulted in all aspects of their care and support. Effective reviews and audits helped to drive forward quality. Staff told us that they were proud to work in a service which provided a quality of life for women who would otherwise face a lifetime within a hospital setting.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Outstanding (Published 19 December 2016)
Why we inspected
This was a planned inspection based on the previous rating. Prior to our inspection we had received notification about two specific incidents. We reviewed these incidents during our inspection and are satisfied that the service responded and has subsequently made improvements to minimise the risk of any future occurrences.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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 professional approach. One person told us; “The staff are very supportive. I couldn’t have asked for more support. They’ve never given up on me. I can’t thank them enough.They’ve constantly been there for me.
The management and staff were clearly motivated to make the transition for people to the service as cohesive as possible. Staff provided six week non-funded support prior to people’s move to the service. Staff spent time with people on the ward, getting to know them, building therapeutic relationships, attending ward rounds and supporting people to visit the service and pick furnishings to make their flat their home.
People told us they had been involved in the planning of their care through the assessment and care planning process and at on-going reviews. Involvement of people who used the service was clearly embedded into everyday practice. There was a clear emphasis on people achieving their aspirations and staff were positive, motivated and focused on people’s successes to support their continued progression.
Health care professionals working with the service told us that Fielder Lodge was a high quality provider that was at the forefront of services when they considered placements. We were told that staff were exceptional at responding to people that required additional support and the service had achieved excellent outcomes with people.
People’s preferences and choices were fundamental in their care. Staff were innovative and suggested additional ways to embed these in their care, which people themselves might not have considered. People had developed in confidence because of how the staff cared for them.
When people were ready for stepping down, staff supported them through their transition. People were given practical support and people with lived in experience (peer support workers) would utilise their experiences to provide emotional support, advice and guidance throughout the person’s transition to new accommodation.
Management had recognised people’s sense of abandonment when progressing from the service and had developed the non-funded outreach service to provide continued relational security throughout this time.
The staffing structure in place made sure there were clear lines of accountability and responsibility. The vision and values were imaginative and person-centred and made sure people were at the heart of the service.
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.
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'.