Lakeside View

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safety was a priority. There was a culture of learning and lessons learnt were shared with staff. Incidents and risk was reviewed regularly and measures were put in place to ensure staff and patients were kept safe. Staff were knowledgeable about safeguarding and worked closely with relevant external agencies to ensure they were notified of any concerns. Patients were encouraged to be involved in their care and treatment. There were enough staff to ensure patients were kept safe and wards were rarely short staffed. The environment was safe and clean although there was a plan in place to make improvements across the site which required refurbishment and redecoration. Improvements had been made related to infection prevention and control since our last inspection.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients said they felt safe and knew how to raise concerns if they needed to. Staff ensured that any concerns were addressed. Debriefs were available following incidents.

Staff told us that they felt able to raise concerns and gave examples of how they had been treated and supported in a proactive way. They said there was a culture of learning and lessons learnt were shared with staff. Staff received lessons learnt in team meetings, incident reporting, and emails. These were stored in the lessons learnt folder. All incidents and complaints were investigated thoroughly with outcomes and feedback given to all involved. Incidents and lessons learnt were discussed in morning risk meetings, team meetings, supervision and de-briefs.

Staff and managers had good oversight of incidents within the service. We reviewed 14 incidents during the inspection. Staff had recognised incidents, reporting them appropriately and managers had investigated them thoroughly. They were discussed and reviewed in the morning risk meetings, handovers and clinical governance meetings. Staff and patients received debriefs following incidents. Any incidents recorded on the provider’s incident reporting system were also copied into the patient care record, so all clinical staff had easy access to them which included lessons learnt. Managers cascaded learning about patient safety incidents from other Priory sites to staff, including actions and discussion points.

Patients told us they participated in their care and discharge plans and that they attended multidisciplinary meetings where they were able to give feedback. Patients told us they were able to share concerns and that staff listened, which prompted discussion about ways forward to make things better.

Managers told us that they assessed referrals into the service to ensure the care and support available was suitable for the patient. They gave examples of collaborative working and had developed positive relationships with external partners and commissioners.

We reviewed 9 patient care records. They demonstrated that patients were involved with care planning and risk management plans. Staff completed risk assessments for each patient on admission, although they were not always updated following all incidents. Staff ensured discharge planning was done safely and they collaborated closely with external partners such as community mental health teams and social services. Discharge coordinators from the NHS attended multidisciplinary team meetings. Patients wishes were reflected within the patient care records and considered. Across all the wards the average length of stay between June 2023 and November 2024 was 38 days. At the time of our inspection, there were 9 delayed discharges across the 3 wards. Managers told us they were due to delays in ongoing placements or accommodation. Staff completed 48 hour follow up following discharge to ensure patients were safe and copies of discharge summaries and care plans were sent within 48 hours to relevant aftercare services.

Patients said that they felt supported by staff and that they helped keep them safe. They said that they felt able to share any worries or concerns with staff.

Staff were knowledgeable about safeguarding and knew how to raise a concern when required and who to speak to if they wanted some advice. They were able to identify different forms of abuse and the signs associated with these. Staff attended morning risk meetings and handovers where essential information and lessons learned were shared.

Staff were observed having a caring and compassionate approach when engaging with patients.

There were effective systems, process and practices in place to make sure that people were protected from abuse and neglect. Any potential safeguarding concerns were discussed in morning risk meetings, handovers and clinical governance meetings. Safeguarding concerns were recorded within the patient care record. Staff collaborated closely with partners on safeguarding issues and ensured that relevant agencies were notified of any concerns.

Patients told us they felt safe and that staff supported them to manage risks. Patients told us items of risk were taken away from them when necessary although were returned when their risk had reduced. Patients participated in their safety plans which included early warning signs and inventions to help reduce the risk.

Staff recorded risks to each patient and acted to prevent or reduce risks, however not all risk assessments and care plans were updated following incidents. Staff attended a morning risk meeting each day, daily handovers and weekly multidisciplinary team meetings. The standard format reviewed items that could impact on patient safety; for example, admissions and discharges, staffing, incidents, environmental concerns, safeguarding, specific patient risks including nursing observations and physical health concerns. Any concerns around risk were disseminated to the wider staff team. Managers discussed incidents and risk within governance meetings. Staff were aware of guidance around restrictive practice and discussed patient restrictions in morning risk meetings. At the time of our inspection, blanket restrictions were in place on Swan ward in the kitchen area and at mealtimes. Staff told us that they made every attempt to avoid using restraint by using de-escalation and distraction techniques and restrained patients only when these failed and when necessary to keep the patient or others safe.

We reviewed 9 patient care records. All patients had a risk assessment and associated care plan completed on admission which was updated regularly, however not all incidents were recorded within these records. Out of the 14 incidents we reviewed, only 7 had been updated within risk assessments and associated risk management plans. Each patient had a safety plan which was completed with staff to record early warning signs and interventions staff should use to ensure the patient was kept safe when engaging in risky behaviour. One safety plan on Swan ward was not completed due to the patient being too unwell on admission, however, the patient had been admitted for 6 weeks and there was no record to suggest staff had further attempted to complete this. We reviewed observation records for 11 patients. There were no gaps in recording of observations however there was one occasion where an observation had been recorded for a patient who was on leave. Managers were informed of this while on site. Observation records detailed level of risk and gave guidance for staff on how to complete them. Most records reviewed documented patient interactions and presentation. Staff completed audits of observation records which identified any concerns with actions in place to rectify any issues. We reviewed leave paperwork for 12 patients. Staff completed a 5-point risk assessment for all patients prior to leave and completed all paperwork accurately. Staff were aware of the search policy and this was included in patient’s care plans. Staff were aware of any blanket restrictions on the individual wards and they were considered and assessed in governance and clinical meetings regularly with a view to reducing them as soon as possible. Each patient had a locker where their restricted items were stored which could only be accessed with staff supervision. Staff monitored and recorded patient physical health observations. Any physical health care conditions or risks were care planned.

People told us they felt safe on the ward, and the environment was safe and clean.

Managers had identified that there were areas of improvement required across the wards. A site improvement plan had been developed with plans to improve areas such as flooring, decoration, outdoor areas and gardens. Start dates for these works had not been confirmed and the site was waiting for finance and maintenance decisions. Staff completed hourly environmental checks and knew where blind spots and ligature points were situated across the wards. Where concerns were identified they were reported and acted on quickly.

The ward areas were clean but required refurbishment and appeared tired in places.

Staff completed and regularly updated thorough risk assessments of all wards areas and removed or reduced any risks they identified. Appropriate mitigations were in place to help reduce the risk level. Staff checked and calibrated medical devices and equipment. Any maintenance issues were discussed in morning risk meetings.

We spoke with 9 patients from all 3 wards. Most patients thought there were enough staff, however 2 patients on Swan ward did not.

Staff told us that overall, there were enough staff to keep patients safe and wards were rarely short staffed. However, they said staffing on Swan ward could feel short at times due to higher patient acuity. Staff said there were enough staff for patients to have 1-1 time and escorted leave and activities were not cancelled. Staff told us that they had received appropriate training, regular supervision and team meetings. Staff were up to date with their annual appraisals.

We did not observe any staffing issues whilst we were on site. We reviewed rotas and saw that shifts were filled.

The provider used National Institute for Health and Care Excellence (NICE) guidance to ensure wards were staffed safely. Managers ensured shifts were filled according to core numbers and they were rarely short staffed. The provider used bank and agency staff when required to ensure safe staffing figures. Agency staff were mostly block booked which meant they knew the service and the patients well. The hospital had recruited over their establishment for health care assistants and they provided cover across the wards wherever needed. Ward managers would cover shortfalls when required. There were 8 vacancies for qualified nurses. Managers had successfully recruited to them and successful candidates were waiting upon start dates. There was 1 vacancy for a consultant psychiatrist which a locum was covering. On 22 October 2024, 95% of permanent and bank staff were up to date with their required training.

Patients did not raise any concerns about infection control. They told us that the environment and their bedrooms were cleaned regularly.

Staff demonstrated a good knowledge of infection prevention and control. Staff completed hourly environmental checks so any concerns were picked up quickly and dealt with. Staff had completed mandatory training for infection control and audits took place regularly. Where issues were raised within audits, staff took appropriate action.

We observed ward areas to be clean, tidy and no issues were raised regarding infection control. Domestic staff were visible during the assessment.

At our previous inspection we found concerns related to infection prevention and control. We found improvements at this inspection. All bedrooms received a deep clean following patient discharges. Staff completed cleaning records and they were up to date. Infection, prevention and control was discussed in clinical governance meetings and progress on actions was monitored.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.