The Care Quality Commission
  • Mental Health
  • Independent mental health service

Lakeside View

Overall: Good read more about inspection ratings

1 Ivydene Way, Willenhall, West Midlands, WV13 3AG (01902) 633350

Provided and run by:
Partnerships in Care Limited

All Inspections

23-24 September 2019

During a routine inspection

Our rating of this service improved. We rated it good because:

On this inspection we saw many improvements since our last inspection in September 2018. We saw improvements regarding the following:

  • The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However;

  • Wards were not always clean. A non-patient area on Finch Ward was cluttered and visibly soiled.
  • Staff on the wards did not always follow infection control procedures. Staff on Swan ward had not always recorded the temperature of food before serving.
  • Staff left sharps bins open and we found one oxygen cylinder unattached. Staff had left blood vials exposed on top of a clinic counter.
  • Some staff had been using an old document which imposed a blanket restriction on informal patients returning to the ward at a specific time.

26 -27 September 2018

During a routine inspection

We rated Priory Lakeside View as requires improvement because:

  • Governance systems at the service were not embedded to ensure continuous monitoring of quality and service improvement. We recognise that the provider had responded and acted upon concerns we raised during the focussed inspection for the two acute wards. However, on this inspection for the whole hospital we still found outstanding breaches and gaps in governance. The leadership at the hospital needs a period of stability and consistency to embed new systems and practices and to enable effective governance and to support to all staff.
  • The service had suitable premises and equipment but they were not always kept clean or well maintained. We found unclean wards, empty hand gel dispensers and emergency and medical equipment that had not been checked on a regular basis.
  • Staff did not always keep appropriate records of patients’ care and treatment. Care plans for patients on the acute wards were not personalised, holistic or recovery focused. They did not evidence agreed goals or discharge plans.
  • The service did not have enough staff with the appropriate qualifications, skills and training and experience. For example, the personality disorder pathway wards did not have enough staff suitably trained to provide the therapy patients had been referred for. There was high use of bank and agency staff and the vacancy rate across all wards was high at 21%.
  • All patients were subject to blanket restrictions which were disproportionate and not individually assessed.
  • The service did not ensure that patient care and treatment was designed to make sure it meets all the patient needs. There were minimal therapeutic and recreational activities available for patients on the acute wards. Patients told us there was nothing to do and there were no activities available in the evenings or weekends.
  • We were not assured that the service treated concerns and complaints seriously, investigated them and learned lessons from the results.
  • The service did not always actively seek feedback or action feedback from the people using their service. We saw many examples of the service not acting upon feedback in the community meeting minutes. There was a lack of information available to patients about how they could feedback in other ways.

However:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to safeguard patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The hospital had four safeguarding champions.
  • The service had good medicines management processes.
  • Staff undertook risk assessments and completed risk management plans with all patients on a regular basis.
  • Patients had good access to physical health care.
  • The service had an electronic system for recording and storing information about the care of patients. This meant that this information was available to doctors and nurses as patients moved between services.
  • Staff used the Mental Health Act and the accompanying Code of Practice correctly.

26 July 2018

During an inspection looking at part of the service

  • Governance systems at the service were not embedded or working to ensure continuous monitoring of quality and service improvement. Audits we reviewed  for care note quality, ligature point checks and cleaning of the service, in all examples requested there were significant gaps.
  • Risk assessments of patient need were not routinely updated following every incident or significant change to their wellbeing.
  • Bedrooms in use by patients were not always fitted with necessary security or observation facilities. We found that where anti-barricade systems were in place, staff were unfamiliar with their use and were unable to demonstrate how to operate them.
  • There was inconsistent use of the electronic record keeping system. Some senior medical staff reported that they were unable to access the system and instead documented their clinical entries using other staffs log in details, or had them typed up on paper and placed in a paper file.
  • We found limited evidence of the use of debriefs following significant incidents, or a process for sharing and learning lessons to reduce future risk. Staff reported that debriefs happened in isolation, followed an inconsistent format and were not routinely recorded.
  • Practices for the storage and dispensation of medication did not always ensure patient safety. We were given an example of a patient who had recently accessed the clinic room and obtained un-prescribed medication. We were not provided with any details of actions taken by the service or lessons learnt as a result of the incident occurring.
  • Blanket restrictions were in place across both wards. There had been no consideration of the use of individualised risk assessments to support patients access facilities for activities of daily living.
  • Morale amongst staff at the service was varied. Staff did not always wear the appropriate uniform and we were given examples where staff groups had chosen to work hours that were not in line with their contracts or the needs of the service.

28th February and 1st March 2017

During a routine inspection

We rated Lakeside View as good because: 

  • There was a strong focus on keeping patients safe from harm.  There were a number of systems in place, for example, an alarm system to alert staff when there might be a problem. Staff were trained to use de-escalation techniques to avoid the use of restraint. Some staff were trained to use psychological therapies that explored managing difficult emotions with patients. Patients were reviewed regularly to consider changes in risks.  
  • Care plans were well written and involved all of those who played a part in the patient’s recovery. They were also adapted to meet the dynamic needs of the patients. The care plans evidenced encouragement of patients' independence.
  • Families and carers generally spoke positively about their experience with the service. They reported regular, good quality communication and saw improvements in patient well-being. 
  • There was ongoing recruitment of staff to meet the increasing number of patients admitted to the hospital. Staffing levels met the needs of patients and managers could be flexible in employing additional staff to support patients with greater needs.  
  • Patients had access to a consultant led multi-disciplinary team. The multi-disciplinary team were receiving evidence based training to support patients with personality disorders.  
  • Patients had access to activities that met with their individual preferences.  Patients could request resources to support them with their recovery.

However: 

  • Some staff did not know how to locate the pinpoint alarm system that alerted staff to assist in an emergency. We saw delays in responding in the event of an emergency that could have had an impact on safety.
  • Not all staff on the ward who worked directly with patients received specialist training in addition to the one and a half hour induction. Working in services for people personality disorder can be a challenge for staff.  Although reflective practice was offered, the uptake from staff was low.  Effective training and support helps staff manage emotional pressures arising from their work.
  • Staff received supervision that varied in frequency and quality.  Supervision notes looked at did not demonstrate that staff had the opportunity to reflect on their practice and enable professional development.
  • Agency staff were not in a position to access electronic information, this meant they were reliant on permanent staff members sharing information. This might mean they do not have all the necessary information to keep patients and staff safe. 

13 and 18 January 2017

During an inspection looking at part of the service

We found the following issues that the service provider needs to improve:

  • Staff did not follow the guidance in place to direct medical and nursing staff in safely administering intramuscular rapid tranquilisation. This meant that patients could be at risk of significant harm.
  • The multi-disciplinary team reviewed incidents. Incidents reported demonstrated high numbers of restraint and self-harm. Staff told us there was limited support and debriefs following incidents. Staff told us they did not always feel the learning from incidents were fully embedded.
  • Staff had not followed local protocols or provided documentary evidence of reviews when using restrictive interventions such as using safe wear clothing and bedding.
  • Patients provided information within their care plans to help staff know and understand their preferences. For example, to reduce distress and agitation. However, staff did not always use all the information contained within the care plans. This meant patients might experience unnecessary distress.
  • Staff and patients expressed that dignity was sometimes compromised. For example, patients had to request toilet paper and were allocated specific number of sheets. When staff assessed patient’s clothes as a risk, paper underwear was used; sometimes they ran out.
  • Lakeside View was a new service with new staff. Staff backgrounds varied and the majority of staff did not have experience of working on personality disorder inpatient wards. There were good staff inductions; however, personality disorder specific training was limited. There was a commitment to supervision but it was not consistent and the content of the sessions differed between those carrying out the supervision.
  • There had been a high number of bank and agency staff, which could adversely affect patient care, treatment, and safety.

However, we also found the following areas of good practice:

  • There were a number of safety systems on the ward to reduce the risk of harm to patients and staff. For example, a pinpoint alarm system so that staff could respond to emergencies. Managers had carried out environmental and ligature audits. Staff recorded incidents well.
  • There were risk reviews for individual patients and the implementation of risk management plans to keep patients safe. There were a number of methods in use to reduce the incidence of significant harm to patients. For example, the use of one to one observations.
  • Care plans were written and reviewed involving key people who played a part in the patient’s recovery. They were often adapted to meet the dynamic needs of the patients. The care plans evidenced encouragement of independence.
  • Families and carers spoke with positivity about their experience with the service. They were particularly impressed with the communication and support they received from staff at Lakeside View. All carers told us that they were impressed with the progress they had observed.