Archived: Lakeside

Updated 31 December 2019

Lakeside provides care, treatment and support for patients on the autistic spectrum, and supports with mental health concerns, anxieties, or learning disabilities. The hospital has eight wards for patients who require rehabilitation to move on to residential or supported living. There were 30 patients receiving care and treatment at the time of inspection.

• Elstow 1 ward is a locked ward for up to eight females.
• Elstow 2, a locked ward, provides six beds for younger men (18-25 years).
• Elstow 3, a locked ward provides nine beds for men.
• Elstow 4 ward is a locked ward for up to eight females requiring intensive support.
• Elstow 5 ward provides eight beds for men. This is a locked ward for more stable patients stepping down.
• Cooper 1 ward provides seven beds for men. This is a locked male intensive care and admission ward.
• Cooper 2, a locked ward provides seven beds for men with a learning disability and autism with additional complex needs.

• Gifford ward provides 12 beds for women with diagnostic features of Emotionally Unstable Personality Disorder.

At the time of inspection, the manager was undergoing the registered manager process and a nominated individual was in post. Following inspection, the registered managers application was approved. Lakeside is registered to carry out the following regulated services:

• Treatment of disease, disorder, or injury.

• Assessment or medical treatment for persons detained under the 1983 Act.

Lakeside was previously known as Milton park Therapeutic Campus. The service changed its name in January 2018. The service registered with the CQC in 2005. The CQC has carried out 11 inspections since registering in 2005. The last comprehensive inspection was carried out in January 2019. Following the inspection, CQC rated the provider as requires improvement, we rated safe as inadequate, effective as requires improvement, caring and responsive as good and well-led as requires improvement.

Following the January 2019 inspection, we told the service that it must take the following actions:

• The provider must ensure that patients’ capacity to consent to treatment is reviewed regularly.
• The provider must ensure physical health care plans reflect patients current need and are adhered to.
• The provider must ensure that patients sign Section 17 leave forms and they are provided with information relating to their section 17 leave.
• The provider must ensure that accommodation and environment is appropriate for use. Ensuring it is clean, safe and the optimum temperature.
• The provider must ensure that rapid tranquilisation medicine protocol evaluation forms are being completed.
• The provider must ensure that their enhanced observation policy is in line with National Institute for Health and Care Excellence guidance and staff have access to regular breaks.
• The provider must ensure blanket restrictions are justified.
• The provider must ensure that long-term segregation daily review minutes are contemporaneous.
• The provider must ensure that three monthly independent reviews by an external hospital are being carried out for patients in long-term segregation in line with the Code of Practice.

The provider submitted an action plan following the January 2019 inspection and had addressed all concerns adequately prior to our current inspection. This included the closure of long-term segregation and patients had been reintegrated into the main stream provision within the hospital. Seclusion and rapid tranquilisation had also been discontinued. We have continued to monitor the provider with regular engagement and improvement meetings.

Updated 31 December 2019

This service was placed in special measures following the comprehensive inspection carried out in March 2018. Whilst we identified improvements during the comprehensive inspection carried out in January 2019, the provider remained in special measures due to insufficient improvement in the safe domain. As a result of this inspection, the provider is no longer rated as inadequate for any of the five key questions and has demonstrated improvements have been made. The decision has been made to exit the service from special measures.

We rated Lakeside as requires improvement because:

• Emergency grab bags contained some expired stock and some stock was missing. One emergency grab bag was secured with an incorrect tag meaning it could not be accessed quickly in an emergency. Defibrillation machines had parts missing or were not working and one staff member was unclear how to use them. Some wards did not have blood monitoring equipment or urine testing strips. wards that had blood monitoring equipment had not had it calibrated regularly. Emergency drugs bags were stored at ceiling height and some staff could not reach them. However, all issues were rectified during or shortly after the inspection.
• There were delays in signing off and closing incidents that had been reported using the internal incident reporting system.
• Although most care plans had been updated regularly, we found five care plans which had not been updated within the providers monthly timescale, this equated to 21%. One care plan had been reviewed within the providers timescale, but the review lacked detail. Some care plans contained several goals that could have been merged to make them less complicated for patients.
• Staff we spoke with knew the hospital had a freedom to speak up champion, but some were not sure who it was.

However:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
• 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 cared for in a hospital for people with a learning disability and/or autism and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• 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 wards 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.
• Staff spoke highly of the newly-appointed service director. Leaders knew patients well. Senior managers knew the names and individual personalities of patients. Staff felt respected, supported, listened to and valued.

Updated 31 December 2019