Parkland Place Lancashire

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

Safe - This means we looked for evidence that patients were protected from abuse and avoidable harm. We rated this key question Good. This meant patients were safe and protected from avoidable harm. The service provided care and treatment in a way which made patients feel safe, supported, involved and listened to. Patients felt they were respected and treated with kindness, and compassion. They were treated as individuals and encouraged to be involved in their care and treatment planning. Staffing, processes, and equipment were in place to maintain the safety of the patients and to meet their needs. Staff engaged with patients in a kind, compassionate, and caring way. The environment, and equipment was clean, tidy, and well maintained. Information regarding the patient's care, treatment, and external resources available were displayed throughout the service.

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.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There was 1 serious incident in the 12 months preceding our assessment. This related to the death of a patient and was still under investigation at the time of our assessment.

All staff knew what incidents to report, how to report them and did so accordingly.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong.

Staff received feedback from investigation of incidents, both internal and external to the service. This was provided via team bulletins, team meetings and 1-1 supervision of staff where appropriate.

There was evidence that changes had been made as a result of feedback from incidents, for example, a patient had recently brought some contraband items into the unit. Staff had increased professional curiosity around patients coming into the building and how items might have been secreted. A policy was introduced whereby patients agreed to have any shopping checked when they returned to the building or if packages were delivered for them. Staff described being more vigilant following this incident.

Staff were debriefed and received support after a serious incident. Staff involved in the serious incident at the service had been offered lots of support including counselling, staff wellbeing service, the CEO of the organisation visited the day the incident occurred, and senior staff were on site following the incident to support staff.

The evidence showed a good standard. The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when patients moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. Patients needed to have a full assessment prior to entering detox with a thorough risk assessment carried out to determine if they were suitable for that environment. Patients deemed to be higher risk (mainly for physical health reasons) would not be admitted to Parkland Place but another detox unit under the same provider that had a doctor on site at all times.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge.

We scored the service as 3. The evidence showed a good standard. The service worked with patients and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving patient’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were provided mandatory training in safeguarding adults and safeguarding children at level 2 and at the time of our inspection the compliance rates were 100% and 96% respectively. Staff knew how to make a safeguarding alert and did so when appropriate.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies.

Staff followed safe procedures for children visiting the service. Patients did not typically have visitors whilst going through detox. However, if patients had young children, use of face time was used to keep in contact, and as a last resort, children could be brought to the unit to see patients under supervision of staff if patients were struggling without physically seeing their children. In these instances, staff would be present throughout the visit, and any concerns would be raised immediately.

There was no restraint used at the service. However, there were some blanket restrictions in place, including that patients were not allowed to bring their own food into the unit or go out whilst completing their initial detox. Drugs and alcohol were banned. Patients agreed to the rules of the unit prior to being admitted and did have a choice of units prior to deciding on Parkland Place.

Mental Capacity Act

60% of staff had completed training in the Mental Capacity Act. Staff that required training updates were already booked on training days at the time of our inspection. In addition, staff we spoke to had a good understanding of the Mental Capacity Act, in particular the five statutory principles.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

We scored the service as 3. The evidence showed a good standard. The service worked with patients to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well. They provided care to meet patient’s needs that was safe, supportive and enabled patients to do the things that mattered to them.

We reviewed 7 patient records during our on-site visit and found they all contained an up-to-date risk assessment.

Staff involved patients in care planning and risk assessment and this started prior to the patient’s admission on assessment visits. We saw that patients had an exit plan if they decided to or were asked to leave treatment unexpectedly, this detailed who to contact and what action to take, such as providing Naloxone if accepted.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties.

Staff enabled patients to give feedback on the service they received (for example, via surveys or community meetings).

Staff ensured that patients could access advocacy. Information on the advocacy service was displayed around the unit and explained to patients how to contact them for support.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff did regular risk assessments of the care environment.

Although the layout did not allow staff to observe all parts of unit, staff utilised regular checks of patients alongside blind spot mirrors to monitor patients safely.

Staff had mitigated the risks of ligatures adequately. There was a ligature risk assessment in place, and this was reviewed annually. Patients admitted to the unit were risk assessed around their mental health prior to admission and staff explained that if someone was an active self-harm risk or had a recent significant history, they may go to another unit that could manage this higher level of need. Staff were however conscious of the possibility of new risks emerging during the detox process and so ensured regular risk assessments were complete, and the environmental risks were managed accordingly with the use of observations, CCTV and staff knowledge of individual presentations.

The hospital complied with guidance on eliminating mixed-sex accommodation. The hospital was a mixed sex unit. However, patients had access to their own bathroom equipped with a shower, sink and toilet. Patients in the earlier stages of detox were nursed nearer to the staff office and as patients became more stable with less withdrawal symptoms they could move further away.

Staff had easy access to alarms and patients had easy access to nurse call systems. There was a new nurse call system that had recently been installed throughout the building, this was a more modern system than was previously in place and staff and patients told us that this was working well.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met patient’s individual needs.

There were no vacancies at the time of our on-site assessment. However, there were 4 members of staff who had recently been recruited (2 qualified staff and 2 support staff) and those staff were still in the onboarding process so had not commenced in post yet.

Sickness was 8.7% at the time of our on-site visit and turnover for the 12 months preceding the inspection was 30.43%.

Managers had calculated the number and grade of nurses and healthcare assistants required. The number of nurses and healthcare assistants matched this number on all shifts. The registered manager could adjust staffing levels to take account of case mix.

When necessary, managers deployed agency and bank nursing staff to maintain safe staffing levels. Where this was the case, agency staff were given an induction on their first shift which covered things such as who to contact in an emergency, a tour of the building and an overview of the patients in the service during handover. Whilst there was some use of agency staff, the agency staff had been working at the service for a number of years and knew the service well. We reviewed agency induction checklists as part of our inspection and found these to be in place for all staff who had worked in the 3 months prior to our inspection.

Staffing levels allowed patients to have regular one-to-one time with their named nurse.

Staff shortages rarely resulted in staff cancelling groups or activities.

The service was medically monitored, so a doctor was not on site at all times but was available 24 hours a day if a need arose. Nurses were on site at all times. The doctor visited the hospital on a Monday and a Friday to review patients and would always be on site for any new admissions that required oversight by a medic.

Staff had received and were up to date with appropriate mandatory training. This included manual handling, medicines management, legionella, PREVENT and safeguarding adults and children. All training was above 75% except for use of medicines for managing behavioural disturbance (71%), Mental Capacity Act (60%) and Autism Learning Disabilities (55%). Autism and learning disability training is a national requirement for all health and social care workers. The providers preferred online training provider did not offer this course, so they had sourced a platform to deliver this training to staff. This had resulted in some difficulties in staff accessing the training, but this was now resolved, and compliance was steadily on the increase, with the provider recognising the importance of this training and pushing for staff to complete as soon as possible. The mandatory training programme, was appropriate for the patient group using the service.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. Clean stickers were visible and in date.

All areas were clean, had good furnishings and were well-maintained.

Cleaning records were up to date and demonstrated that the environment was cleaned regularly.

Staff adhered to infection control principles, including handwashing.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met patient’s needs, capacities and preferences. They involved patients in planning, including when changes happened.

Staff followed good practice in medicines management (that is, transport, storage, dispensing, administration, medicines reconciliation, recording, disposal, use of covert medication) and did it in line with national guidance.

Staff reviewed the effects of medication on patients’ physical health regularly and in line with National Institute for Care and Excellence (NICE) guidance.

We reviewed 7 prescription charts for patients during our on-site visit. We found all records to be in good order with no concerns to raise.