Accomplish Group Support Limited

This service was placed in special measures following the comprehensive inspection carried out in March 2018. While there has been improvement overall there has been insufficient improvement in the safe domain and the service therefore remains in special measures. The service will be kept under review and where necessary another inspection will be conducted within six months. If there is not enough improvement we will move to urgent enforcement action.

We rated Lakeside as requires improvement because:

• There were some improvements needed to the physical environment. Cooper 3, the behavioural support unit for patients in long-term segregation was cramped, dark and tired. The floors in the bathrooms and communal areas were dirty and the unit needed refurbishment. Staff had not adequately carried out security checks. On Elstow 1 unit there was a strong smell of drains. Some bedrooms and bathrooms on Elstow 1 and Elstow 2 units were cold.
• On Elstow 2 unit, only one of the four patients on the unit had access to a key for their own room. This was not indicated in patients’ individual risk assessments or care plans to clearly justify this level of restriction.
• The provider’s observation policy did not follow National Institute for Health and Care Excellence guidance, which meant staff were spending longer than recommended observing patients.

• We found issues with paperwork including staff not completing required evaluation forms following rapid tranquilisation, some long-term segregation daily review notes had been cut and pasted from previous days and physical health care plans that did not reflect patients’ current needs and were not always being adhered to.
• Three monthly independent reviews of long term segregation by an external hospital were not being carried out.

• We found delays in reviewing patients’ mental capacity to consent to treatment and staff did not provide patients with information relating to their section 17 leave.
• Healthcare assistants did not feel involved or informed about outcomes from clinical governance meetings.

However:

• Staff completed ligature risk assessments annually or more frequently when needed. Staff completed patient specific fixed-point ligature risk assessments for each patient.

• Staff assessed the physical and mental health of patients within 48 hours of admission. Staff developed individual care plans which were reviewed and updated as needed. Care plans were personalised, holistic and recovery-oriented. Staff completed individualised positive behavioural support plans for patients. Staff had a good understanding of individual needs of patients. The hospital employed a practice nurse to manage patients’ physical health alongside the GP. A specialist dentist also attended bi-weekly.
• The hospital offered employment opportunities to eligible patients within the hospital grounds and had a recovery college based on site. Patients could take part in volunteering within the local community. Patients had access to the star centre, a multi-functional space for therapy groups and leisure activities. All patients were asked if they wished to have carers or relatives involved in discussions about their care.
• The hospital was taking steps to improve morale and staff retention. The management team had worked towards a cultural shift within the hospital and an opportunity to refresh the workforce with a successful recruitment process, which resulted in a higher than average turnover of staff. The hospital recruited a new team of unit general managers in September 2018, which improved staff morale and supported developing leadership within the hospital. Unit general managers felt valued, respected, rewarded and supported. Staff were passionate about the client group they were working with and reflected the providers values.