Park Lodge

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 for staff and leaders within the service and they provided care in a way that made young people feel safe. Staff were familiar with policies and procedures used to safeguard young people and to ensure the environment was kept safe. Where risks arose, the provider completed appropriate risk assessments to promote the safety of young people and ensured that all staff were aware of and understood correct procedures. The hospital promoted a culture where staff and young people were able to raise concerns, identify risk and learning was encouraged. Young people were actively encouraged to be involved in their care and treatment. The service used a safe staffing tool, and the wards were rarely short staffed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Young people told us they felt safe, knew how to raise concerns and staff within the service were responsive in dealing with issues. One family member told us that the manager was very approachable and was always available to listen to the views and concerns of both young people and their parents. Young people and their families said the service actively sought feedback on all aspects of care and did this on a regular basis. Parents and carers told us they were kept informed and were made aware if there had been any incidents. One parent told us that 'communication is very good and helps to reassure us in knowing that our child is being kept safe.'

Staff told us they felt able to raise concerns and gave examples of how they had been treated and supported in a proactive way. Learning from safety incidents was shared, and staff implemented learning into their work practices. Staff received lessons learnt through various forms and they attended a monthly team development day where lessons learned were discussed and reflected upon. Incidents and complaints were investigated thoroughly with outcomes and feedback given to all involved. There were regular patient safety, team and de-brief meetings to discuss incidents, complaints and lessons learnt. Staff were supported to speak up through regular staff feedback.

Staff and managers had good oversight of incidents within the service. We reviewed 4 incidents during the assessment. Staff had recognised incidents, reporting them appropriately and managers had investigated them thoroughly. They were discussed and reviewed in the morning risk meetings. The service held a team development day each week and all staff were allocated to attend monthly. The agenda for these sessions changed depending on the needs of the service but each development day involved reflective supervision, specific training sessions that had arisen from learning or were relevant to the young people at the service, group supervision and wellbeing support. Complaints from family and young people were investigated and resolved with actions put in place where required. We saw where feedback from family had resulted in change of process in how young people were searched on return from leave. This change had been implemented with feedback from staff and young people.

People told us they were actively involved in their care and discharge plans and they were always encouraged to attend meetings to share their views. People told us if they had concerns, they could raise these, and staff listened. Families were invited to meetings when consent had been given by the patient to share their views.

Leaders and members of the multi-disciplinary team were involved in reviewing and assessing referrals into the service to ensure the care and support available was suitable for the young person. Staff told us their opinions were valued and were able to share their views around patient care and risks. They gave examples of collaborative working to keep people safe while protecting their rights.

Partners said they had regular engagement with the provider in a variety of forms. They regularly attended multi-disciplinary meetings and other relevant care planning and review meetings. They told us the service was proactive and open to feedback.

Care records demonstrated that people were actively involved throughout their care journey. Young people and families were routinely involved in care planning and multi-disciplinary meetings. Patient voice was well documented in the patient's own words and records documented where young people had declined to give feedback on their care.

Young people said they felt supported by staff and felt safe. Families told us young people were kept safe in the service and that this was particularly important for young people who had been placed further from home. One family member told us 'I have complete trust in the staff.'

Staff were knowledgeable about safeguarding and knew how to raise a concern when required. They identified different forms of abuse, and the signs associated with these. Staff attended regular patient safety and safeguarding meetings where important information and lessons learned were shared.

Staff were observed having a caring and compassionate approach when engaging with young people. We observed staff supporting young people who required 1:1 observation in a relaxed and informal way while keeping them safe. Observation records were completed appropriately to reflect this.

There were effective systems, process and practices in place to make sure people were protected from abuse and neglect. Any potential safeguarding concerns were discussed in the morning risk meetings. The service worked closely with partners on safeguarding issues and ensured that relevant agencies were notified of any concerns. The provider had implemented a CCTV system which was monitored, reviewed and audited by an external party. All young people and their families were informed of the system and consent was gained. Leaders told us the system had been beneficial when reviewing incidents and concerns. Care records showed there was a clear understanding around mental capacity and best interest decisions. People were appropriately supported to know their rights and make decisions that were safe and in the best interests of the person.

Young people told us they felt safe, and staff supported them to manage risks. They told us the hospital was not restrictive and they had freedom to do activities that were purposeful and meaningful to them. The service was guided by a Lived Experience Panel and employed a Lived Experienced practitioner. Feedback from the lived by experience panel was embedded within all organisational decision making. For example, feedback from the panel and the young people had led to the service changing the language within some documentation to be more positive such as the use of safety assessment instead of risk assessment.

Staff knew about any risks to each young person and acted to prevent or reduce risks. Managers and members of the multidisciplinary team attended a morning risk meeting each day. There was a standard format which reviewed items that could impact on patient safety; for example, 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 on handover. Incidents and risk were reviewed within governance meetings and practices to reduce restrictive interventions had been implemented. Staff were knowledgeable about least restrictive practice and were able to share clear examples of where young people were empowered to take positive risks. Staff told us they made every attempt to avoid using restraint by using de-escalation techniques and restrained young people only when these failed and when necessary to keep the patient or others safe.

Staff completed risk assessments for each patient on admission and reviewed this regularly, including after any incident. Risk assessments were person centred and proportionate. Young people had positive behavioural support plans in place that had been written in collaboration with the young person and recognised their strengths and challenges. Plans were centred around the young person’s individual needs for example, meal support plans were individualised and identified clear guidance to staff on how best to support before, during and after meals. We reviewed incidents that had occurred within the service from May to August 2024. All incidents we reviewed were scored in terms of level of severity and reviewed by managers, with actions put in place where necessary. Themes were identified and contributing factors were also reviewed. Themes and risk around incidents were also included on the risk register. We reviewed restraints that had occurred within the service from May to July 2024. Most physical interventions were attributed to support young people at mealtimes. Documents that we reviewed showed appropriate actions had been taken to support young people and that plans were in place to ensure young people were supported appropriately.

The provider fully involved people to control potential risks within the ward environment. People were encouraged to comment on the environments in community meetings and specifically asked if they felt safe on the ward. People told us they felt safe on the ward, that the environment was safe, clean and well- maintained.

Staff were aware of the importance of completing safety checks of the environment and equipment. Where concerns were identified they were reported and acted on quickly. Staff told us that some doors within the hospital were quite loud when closing. Managers were aware of these issues and were taking action to reduce the impact of this on people. At the time of our on-site assessment, maintenance staff were present and addressing this issue. Leaders and staff told us significant changes had taken place within the environment to ensure that the layout was fit for purpose and met the needs of young people. For example, the hospital was split into three zones. Zone one was on the ground floor and was for young people with more complex needs and zones two and three were on the first floor. Zone one originally had three bedrooms, but the hospital had redesigned this space to ensure that there was a separate lounge area to support the recovery and safety of young people in their designated area.

All ward areas were clean, well maintained, well-furnished and fit for purpose. There were quiet areas on the ward, including a sensory room that had been developed and designed with young people. All doors and windows appeared secure with doors accessed using a key or fob. Cleaning and maintenance staff were visible during our assessment and were observed engaging with both staff and young people. Clinic rooms were fully equipped. Staff checked, maintained, and cleaned equipment that they used regularly. Separate rooms are available for Nasogastric Tube feeds and other treatments. All clinical equipment was clean and well maintained and most were in date. During the assessment we found some equipment and checks within the clinic that were out of date or not been completed. The blood glucose device had not been calibrated. The manager had oversight of this, and we saw documentation that it had been requested that this task be completed. This had been completed by staff and records were being completed. We also found 5 sets of specimen bottles had expired.

Staff completed and regularly updated thorough risk assessments of all ward areas and removed or reduced any risks they identified. Managers had completed and regularly reviewed ligature risk assessments. These clearly highlighted areas of risk and appropriate mitigations were in place to help reduce the risk level. We did not see individualised risk assessments for patient bedrooms however this had been identified within governance records and these were being developed by staff. Staff completed regular environmental and equipment audits and where areas of improvement had been identified an appropriate action plan was put in place.

Young people told us there were enough staff and they felt safe. People knew who their named nurse was and had regular 1:1 time with staff.

Staff and managers told us the hospital was rarely short staffed and there were enough staff to support young people safely. Leaders were committed to ensuring staffing was safe and robust. They had over recruited health care assistants to ensure enhanced observations were always covered. There were vacancies within the multi-disciplinary team and nursing vacancies. Positions within the multi-disciplinary team had been filled and new recruits were due to start in September 2024. Recruitment was ongoing for nurse vacancies. Bank and agency staff were used to ensure safe staffing figures. Staff received appropriate training and regular supervision. Staff from specific specialisms received clinical supervision.

During the onsite assessment, no issues were observed of staffing issues. Rotas were viewed and shifts were filled.

The provider used a safe staffing tool to safely allocate staff on shift. Managers attended weekly resource meetings to review staffing numbers, deficits and annual leave and reviewed staffing according to clinical need or changes in observation levels each day in the risk review meeting. We reviewed rotas for August 2024 and all shifts were filled, with some agency use. Staffing figures were increased when needed, to accommodate the needs of young people. In the 6 months prior to our assessment, sickness rates were low at 1.5%. Overall turnover of staff was 2.5%. The provider had an overall vacancy rate of 5.8%. There were no vacancies for health care assistants. There were 3 full time equivalent (FTE) vacancies for qualified nursing staff. One of these vacancies had been filled at the time of assessment and recruitment was ongoing. The remaining vacancies were filled by locum agency nurses who were familiar and regular to the service. Managers had created a new role for a ward manager and a deputy ward manager and were in the process of recruitment. There was a full multi-disciplinary staffing team including a consultant, dietician, family therapist, social worker, occupational therapist and assistant, psychologist and assistant and activity coordinators. Vacancies had been filled for a 0.5 WTE family therapist, a 0.5 WTE social worker, and 1 WTE psychology assistant. These staff were due to start in September 2024. The mandatory training programme was comprehensive. The overall training completion rate for all staff was 96%. All courses except for fire marshall training had a completion rate of above 94%. Fire marshall training was 83%. The training matrix identified training was due in the next month and courses were planned for staff to attend. Staff had regular monthly supervision. This was completed as part of team development days and all staff were compliant. Staff received annual appraisals and those eligible were up to date.

Young people did not raise any concerns about infection control. They told us they felt safe in the environment and areas, including their rooms were cleaned regularly.

Staff demonstrated a good knowledge of infection prevention and control. Staff had completed mandatory training for infection control and audits took place regularly. Where issues were raised within audits, appropriate action was taken promptly by staff.

Areas were observed to be clean, tidy and no issues were raised regarding infection control. There was cleaning stations situated around the ward and domestic staff were visible during the assessment.

Staff completed regular environmental and infection prevention control audits. Appropriate action plans were in place where required.

People were aware of their medicines and staff discussed them with them.

Staff followed systems and processes to prescribe and administer medicines safely. Medicines reconciliation was completed regularly, and relevant observations were completed dependant on individual treatment plans. Staff reviewed the effects of each patient’s medicines on their physical health according to National Institute for Clinical Excellence guidance (NICE).

All clinic rooms and medicines fridges were clean, and staff had access to all appropriate equipment. Medicines were stored, managed and dispensed in line with national guidance including the management of controlled medicines. Staff had access to relevant patient medicines documentation, including information on patient allergies. We saw that single use syringes were being used on more than one occasion while supporting young people with nasogastric feeds. On discussion with the manager this was attributed to reusable syringes being in short supply nationally and were on order from their pharmacy. The provider had made attempts to source syringes from other suppliers and had not been successful. Leaders within the service were aware it was not best practice to reuse single use syringes, however due to the risks associated with some young people, decisions had been made to allow the re-use of single use syringes in some circumstances to prevent further distress to young people. Risk assessments outlined when this should occur and to ensure appropriate infection control processes were followed.

We reviewed 5 prescription charts. Systems and processes were used to safely prescribe, administer, record and store medicines. Authorisation documentation for Deprivation of Liberties, Mental Health Act 1983 and capacity assessment forms were in place with the associated prescription cards. Staff completed regular environmental, Infection Prevention Control and medication audits and where areas of improvement had been identified an appropriate action plan was put in place.