Lakeside View

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. 

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.