The Langford Centre

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

We assessed all eight quality statements. We rated safe as requires improvement because there were ligature risks from the sash style windows which had not been addressed since our last inspection. Environmental concerns were not always reported, and when they were reported, they were not always acted upon in a timely manner. Staff could not always access the firefighting equipment on Cooden ward.This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12.

People’s medicines were not managed well. For example, people who were prescribed high risk medicines such as clozapine did not have a clear management and escalation plan. The provider did not have a process in place to ensure people of child bearing potential and prescribed teratogenic medicines had appropriate risk assessments and oversight in place.People’s physical health was not always managed well. For example, staff were unable to locate the physical health monitoring forms for two patients who were administered high-dose antipsychotic medicines. This was a medicine that required additional physical health monitoring due to its side effects. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12.

The environment was not always cleaned to a high standard. There were cobwebs and dead insects in the de-escalation rooms and the communal toilets were dirty. This was a breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who used the service felt the provider managed incidents and complaints well and learned when things went wrong. For example, a carer informed us that the doctors and nurses contacted them to apologise following a medicine error. People said they could give their feedback about the service and felt supported by staff to do so. Staff encouraged and supported people to raise concerns, they felt confident that they would be treated with compassion and understanding, and would not be blamed, or treated negatively if they did so.

Staff managed people’s risk well including risks to themselves and others. Staff told us they ensured safety was a priority. They involved everyone including people using services and carers in decision making about the safety of the wards. When things went wrong, staff reviewed the incident and learned lessons to improve. Staff carried out debriefs after an incident with patients and reflective practice sessions with staff. Staff ensured patients were actively involved in incident reviews. Staff and leaders told us they tried to address people’s concerns in the first instance, and if they still wished to make a formal complaint, they supported them to do so by providing them with the complaint forms and guidance on how to complete them. Leaders ensured incidents and complaints were investigated. On most occasions, lessons were learned from safety incidents or complaints, resulting in improved care for people.

The provider completed surveys to get people’s feedback about their care and treatment and used the information from the surveys to drive improvement. There was a culture of safety and learning which was based on openness, transparency and learning from events that have either put people and staff at risk of harm, or that have caused them harm. The provider ensured that concerns about safety were listened to, safety concerns were investigated, and lessons were learned to continually identify and embed good practices. For example, following a complaint from a parent about restraint, of a person using the service, managers reviewed the incident and learned lessons including improving on staff’s prevention and management of violence and aggression (PMVA) and de-escalation techniques. Learning from incidents and complaints were discussed at handover and at staff one to ones and reflective practice sessions.

We received mixed feedback from people about their experience of the service. Whilst some people told us they did not feel well supported by staff on admission to the service, others felt staff were supportive and provided enough information about the services, their health, care, and support. Six out of 10 people we spoke with said that their care plans were not relevant to them, and they did not have much input into discussions about their medicines or treatment. Most people knew what their plans for discharge were and they told us staff discussed discharge plans at ward rounds. Some people felt their physical health was managed well. However, one person complained of tooth loss, but staff had not referred them to a dentist.

Staff told us that they took a joined-up approach to delivering care and treatment to patients. They collaborated with patients, staff, and carers, and with staff in other services when planning discharge or transfers between services. Discharge coordinators ensured that all barriers to people’s discharge, such as financial, health and social care needs were considered. For example, staff told us they worked closely with the local mental health trust and invited the community mental health teams to people’s ward rounds. Staff told us that they also worked with other services including substance misuse services to ensure people received the right support and treatment whilst in hospital. Staff told us they ensured they have a GP summary before a person was admitted.

While the provider had processes in place to manage people’s risk, this was not always effective. For example, staff had not taken appropriate action to address one person’s weight loss. There was no weight management plan or onward referral made. We raised this with the provider at the time of the inspection and they informed us that they had reviewed the person’s health records and were taking steps to address concerns about their weight loss.

Treatment plans for identified risks did not always contain sufficient detail to guide staff on how to support people. For example, one person’s record said that staff should implement deep vein thrombosis (DVT) prevention measures for pulmonary embolism, but it was not clearly recorded in the patient's notes what the prevention measures were.

People using the service could raise concerns when they did not feel safe, or when they had concerns about the safety of others. Although some patients reported that they had felt unsafe because they had been attacked by another patient on the ward.

Staff knew how to protect people from abuse and how to make appropriate safeguarding referrals to the local authority and police. Staff ensured that carers and relatives were informed of any incident relating to the person using the service including when there was a physical and or medical intervention. Staff told us they always considered the least restrictive approach when caring for people who were distressed. They maintained people’s dignity and privacy when conducting searches when people returned to the ward. Staff knew and could describe when Deprivation Liberty Safeguards (DoLs) authorisations should be considered to protect the safety of patients. They informed us it was only used in the best interest of the person. Staff ensured people were appropriately supported when they felt unsafe or experienced abuse. For example, one person reported that the psychology team discussed coping strategies with them to keep themselves safe. Staff and leaders ensured people were supported to understand their rights, including their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010.

The providers training data demonstrated that staff had completed their mandatory safeguarding training. The data showed that 98% of staff had completed their safeguarding vulnerable adults training and 97% of staff had completed their safeguarding vulnerable children training.

People said they felt safe and supported to understand and manage their risks. People said they knew who to contact when they might be at risk of things going wrong or their health condition might be worsening.

Staff we spoke with knew the people they looked after well and could describe their risks. Staff told us that they worked with people to manage their risks and to keep them safe from harm. Staff told us they worked with people to manage their distress or emotions using the least restrictive approach. Staff told us they hardly restrained people, and restraint was only ever used as a last resort. Leaders reported no restraint in the last month.

The providers training data showedthat 86% of staff had completed their training in the prevention and management of violence and aggression, 85% of staff had completed their breakaway training and 99% completed the Use of Force Act training.

Staff completed individualised risk assessment for people, and they ensured there was an appropriate care plan for identified risks. For example, while some people were given access to long mobile phone charging cables, others were given shorter cables based on their individual risks. The service had a security and search policy which was based on individual risks. Staff worked with people to manage risks through good relational security.

People had a named nurse and a key worker who met with them weekly to discuss their care and support needs as well as any risks or concerns. The provider involved people in investigating and reviewing incidents.

People felt the environment was safe.

Staff and leaders told us that they considered how the environment could keep people safe from psychological as well as physical harm, for example, in relation to sexual safety and in relation to people’s sensory needs. Staff told us they considered people’s risks when identifying which bedroom they should use. Staff knew where all the high-risk ligature points were. They knew where the ligature cutters were, and they had received training on how to use them. Staff understood their patients well and kept them safe through relational security. Staff knew and understood how to respond to ligature incidents.

Staff did not always ensure that environmental concerns and risks were reported promptly and addressed. For example, there was a screw on the manager’s office door which was sellotaped in place with no plan to fix it. The provider informed us following the inspection that the screw had been removed.

The provider needed to improve how it managed environmental risks. There were no nurse call systems in people’s bedrooms on Arlington ward. One patient reported they could not easily get assistance from the nurse when their physical health deteriorated. Staff did not always complete individualised risk assessments for people using the communal bathroom. The provider completed a fire risk assessment in April 2024. All wards had firefighting equipment. However, on Cooden ward, staff did not have keys to the locks where the fire extinguishers were stored. This meant in the event of a fire, staff would not be able to respond appropriately. The provider informed us following the inspection that they had now provided master keys for the locks to the fire extinguisher cabinets on all wards. However, people with mobility problems had a personalised emergency evacuation plan in place. There were still several sash windows across the wards which were still potential ligature fixed points, and this was a requirement following our last inspection in June 2023.

People’s experience of staffing levels was mixed. While some people told us that there was enough staff on the wards to provide care and support, some people reported that they could not always go out to smoke cigarettes because staff were too busy. People said staff treated them like individuals and kept them safe. People said they were able to speak to the ward doctors if they had any health concerns. However, people said they were not always able to speak to their responsible clinicians outside of ward round days.

Staff knew the people they cared for well and worked hard to keep them safe. The provider shared their staff training data with us following the inspection which demonstrated that staff had completed their mandatory training.

The provider had plans in place to ensure that they could provide medical cover after hours and on weekends. The provider had an on-call managers and medical staff policy in place that set out the on-call arrangements including times and days each member of staff would be available, at the time of our inspection. For example, the protocol outlined that a consultant psychiatrist would be available between the hours of 5pm until 9am each day of the week including the weekends and bank holidays. The policy stated it would be the doctors decision as to whether they attended the hospital or not although there were instances where the doctor would be required to attend in person. However, at the time of our inspection the hospital manager informed CQC that the consultant psychiatrist on call was for advice only and in the event of a medical emergency staff are to dial 999 or attend an accident and emergency unit.

The consultants worked part time on ward round days. The consultants did not offer the people a minimum of 20 minutes one to one time per week in line with NICE guidelines 2011 (Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services).

The provider reported they were fully staffed for all nursing and support worker roles and had not needed to rely on agency staff in the last three months. Staff received the support they needed to deliver safe care. There was a process in place to improve staff retention. For example, the provider had increased overtime rates for nurses. They were also considering a similar scheme for support workers. Recruitment, disciplinary and capability processes were fair and reviewed to ensure there was no disadvantage based on any specific protected equality characteristic.

People told us the wards were cleaned daily. People’s bedrooms were cleaned by the day cleaners. Staff supported people to do their laundry on scheduled laundry days.

Staff told us that they assessed and managed the risk of infection well. Staff said they reported any infection control risks promptly. However, on Cooden ward we saw that the environment was not always cleaned to a high standard, and this had not been reported or addressed by staff.

Staff did not ensure that the wards were cleaned to a high standard. For example, the communal bathroom and toilet on Cooden ward was dirty and there were cobwebs and dead insects in the de-escalation room. There was dust around the window frames in the communal areas. While there was air conditioning on Cooden ward, all the external windows were locked shut which meant there was poor airflow across the ward. At the time of the inspection, the air conditioning was off. We raised our concerns following the inspection and we saw that the provider had taken action to improve airflow the following day. The provider completed cleaning schedules, however, the schedules did not always reflect that the environment was not clean.

The were clear roles and responsibilities around infection prevention and control. The ward managers were responsible for completing the infection control audit on their wards. The most recent infection prevention and control audit was completed on 30th April 2024 on Fairlight, Cooden and Arlington wards which included room standard and hand hygiene standards. The audit reported no infection incidents or outbreaks during the reporting period. Information about the risk of infection was shared appropriately with relevant partners, including agencies, people using the service and visitors, for example, if there was a Covid-19 outbreak. However, the processes around infection prevention and control needed improvement because the ward environment was not clean, and the provider had not identified that this was a problem or taken action to address it.

We received mixed feedback from people about their medicines. Three of the ten people we spoke to who used the service reported that they were not always involved in decisions about their medicines, some people reported that the doctors and nurses discussed their medication and treatment with them. Some people told us staff were very responsive to meeting their physical health needs. For example, one person reported that when they were in pain, a nurse and the doctor offered them pain medicine. However, another patient reported that they were not given an option about their medication and the doctors had not clearly explained what the side effects were.

While staff told us they had received training on how to administer medicines safely, and that they had ongoing assessment to ensure they were competent in medicines management, staff did not ensure that medicines were managed well, and people’s physical health needs were always met. For example, people’s care plans did not contain information around the monitoring of high-risk medicines which could cause serious side effects. For example, clozapine can cause serious adverse effects such as heart problems. Staff did not ensure that the physical health of people was always monitored post rapid tranquilisation (RT) administration in line with national best practice. Rapid tranquillisation is the use of medicine to help calm a person who is extremely distressed and is at risk of harm to themselves, or possibly those around them. The side effects of rapid tranquilisation could include loss of consciousness, breathing difficulties, cardiac arrest and death.

The provider did not have processes in place to ensure people of child bearing potential and prescribed teratogenic medicines had appropriate risk assessments and oversight in place.

Staff on Cooden ward were unable to locate the monitoring forms for two patients who were administered high-dose antipsychotic medicines which required extra monitoring for side effects.

Across all wards only 95% of staff had completed the safe administration of medicines training.

The Mental Health Act (MHA) 1983 consent to treatment forms (Section 62s and T2s) on Cooden ward included physical health medicines that were not covered under the MHA 1983. Consent to treatment records were sometimes conflicting. For example, one patient record said they had insight into their illness and capacity to consent to treatment, but the doctor informed the inspection team that the patient did not have insight into their illness and therefore did not have capacity to consent to treatment. Staff on Fairlight ward said the consultant reviewed the physical health of patients prescribed high-dose antipsychotic medicines once a month.