The Care Quality Commission
  • Mental Health
  • Independent mental health service

The Lighthouse

Overall: Good read more about inspection ratings

282 Blackburn Road, Darwen, BB3 1QU 07891 940406

Provided and run by:
Associated Wellbeing Limited

All Inspections

17 January 2024

During an inspection looking at part of the service

Our rating of this service stayed the same. We rated it as good because:

  • 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. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
  • 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 and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward 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 supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • 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 planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Medicines were not always ordered in a timely way.
  • Staff did not fully understand and discharge their roles and responsibilities under the Mental Capacity Act 2005. They were unsure of good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
  • Internal meetings did not have set agendas and it was unclear whether previous actions had been completed.
  • Children felt that some agency staff and some new staff were not always keen to engage with them and were too hasty to apply restraint before fully utilising de-escalation techniques.
  • The service recently discharged a child to a service that was not fully OFSTED registered.
  • The service lacked adequate transport so that children could access community activities easily.

14 and 15 June 2023

During a routine inspection

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. The environment was safe and clean and had enough nurses, support staff and medical cover. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the young people and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The service included the full range of specialists required to meet the needs of the young people. Managers ensured that these staff received training, supervision, and appraisal. The staff worked well together as a multidisciplinary team and with those outside the service.
  • Staff understood their roles and responsibilities under the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
  • 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 planned and managed discharge well and consulted well with services that could provide aftercare.
  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Some young people were staying in the service longer than needed due to limited suitable accommodation in the community to move on to.

9 and 10 February 2022

During a routine inspection

Our rating of this location stayed the same. We rated it as requires improvement because:

  • Risk assessments had not been fully completed for all children. This meant that staff did not have all the necessary detailed information relating to children’s risks.
  • Safeguarding concerns had not been reported to the Care Quality Commission. This meant that there was limited oversight into safeguarding issues for external sources.
  • Not all child safeguarding concerns had been reported to the local authority. This meant that there was a risk of children being put at further risk of harm.
  • The service had blanket restrictions in place. There were no doors on children’s en-suite bathrooms, which staff said was to manage risk. Children’s privacy and dignity was impacted by this.
  • Children’s activity planners did not contain a full range of constructive activities and structure for children and staff to follow. There was no occupational therapy input to drive the quality of activities.
  • There continued to be gaps in the effectiveness of their governance processes. For example, systems and processes had not captured gaps in risk assessment provision and gaps within safeguarding practices and procedures. In addition, many policies and processes were new and had not been fully embedded into the service.
  • Independent child advocacy provision was limited. Independent advocates had not visited the service and links were weak. This meant that children did not have the opportunity to have their voices heard via a professional advocate.

However,

  • The ward environments were safe and clean. There was now a nurse call system available to children to summon staff if required. This system was now audible to staff who could respond. The wards had enough nurses and doctors. There had been an improvement in staffing levels. This meant there were now enough suitably trained staff on shift at all times to keep children safe. Staff managed medicines safely.
  • Staff minimised the use of restrictive practices. All physical interventions used by staff on children had been appropriately applied and met with national guidance. Policies and procedures had been updated to ensure that children who were high risk of requiring physical interventions would not be admitted to the service.
  • Staff developed holistic, recovery-oriented care plans. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. All staff had now received training in positive behaviour support.
  • The team included or had access to a range of specialists required to meet the needs of patients on the wards. However, there was no occupational therapist. Managers ensured that these staff received training, supervision and appraisal. Staff supervision was now of good quality and frequency. Staff described feeling supported. The staff worked well together as a multidisciplinary team and with those outside the service who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under Gillick competency and understood the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Children expressed that they felt involved in their care and that they understood the content of their care plans. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • Some of the governance processes had improved. For example, all necessary recruitments checks were now embedded in practice and that all staff were trained in physical intervention prior to working with children. Policies relating to the admission of young people over 18 years of age had been amended. Young people over 18 years of age were would not now be admitted to the service.

17 November 2021

During an inspection looking at part of the service

The Lighthouse is a four bed child and adolescent mental health unit based in Darwen, Lancashire. The service aims to provide step-down from child and adolescent mental health inpatient units as well as a placement for children to be admitted to during a crisis to avoid a hospital admission.

Following this focused inspection, we have rated safe as inadequate. There were large gaps in the service provision that meant the service was unsafe for children. We served The Lighthouse with a warning notice following this inspection. The provider is required to make improvements by 4 March 2022.

At the last inspection, we rated safe as inadequate due to concerns about:

staff not being trained in restraint,

not having enough staff to safely restrain children

there was no nurse call alarm system

disclosure and barring service checks were not completed prior to employment

positive behaviour support plans were not based on functional assessments and contained negative punishment strategies

not all incidents involving the police were reported to the Care Quality Commission

We carried out this focused inspection of the safe key question only to see if the service had made the required improvements following safe being rated as inadequate in the March 2021 inspection. We did not inspect the other key questions at this focused inspection and the ratings for these remain the same:

Effective (requires improvement)

Caring (requires improvement)

Responsive (good)

Well-led (requires improvement)

The service was not safe for children and young people. The service did not have enough nursing and support staff to keep patients safe. From 1 September 2021 to 30 November 2021, there were 102 shifts out of a total of 182 shifts where staffing establishment levels were not met. Staff were also required to support a child in another property (an annexe – but considered as part of the Lighthouse) across the road. This meant the staffing ratios in both buildings were unsafe.

There was a high risk of children being exposed to avoidable harm. There were not enough staff to safely support children during incidents of restraint. If a child required two members of staff to support them, there was often not a third member of staff to care for the other children.

Managers did not comply with the incident reporting system and process. There was a significant number of police incidents that were not reported to the Care Quality Commission. The incidents related to children being reported as missing or behaving in a violent and aggressive manner towards staff.

Staff did not always adequately manage risks to patients. The service had admitted an 18 year old for two nights. We were not assured the risks of admitting the 18 year old had been assessed or managed at the time of admission. Documents relating to this admission had been created after the admission.

However,

Staff had received training in restraint prior to direct work with children, which was an improvement since the last inspection.

Staff and patients had access to nurse call alarms, which was an improvement since the last inspection. However, the volume on the nurse call alarm system could not be heard by staff required to respond. The service had received quotes to make repairs. There was a plan for the repair to be completed week commencing 10 January 2022.

The service had developed good positive behaviour support plans for children. They no longer contained negative punishment strategies and were now based on functional assessments.

All staff now had disclosure and barring service checks completed prior to starting employment. There was a system in place to cross reference each new employee with dates of employment and dates of DBS checks.

2 March to 3 March 2021

During a routine inspection

We have not previously rated this service. We rated it as requires improvement because:

  • Young people did not receive care and treatment in a manner that safeguarded them from potential abuse. Positive behaviour support plans were not based on functional assessments. Positive behaviour support plans contained strategies which included the use of punishments which were not in keeping with the therapeutic ethos.
  • Disclosure and barring service checks were not always conducted robustly. Staff had started employment without having the appropriate checks in place which ensured they could work with children as well as adults.
  • Restraint was not safe. Staff involved in restraint had not always undertaken the providers restraint training. This meant staff could potentially use different methods of restraint which could result in the young people being physically harmed.
  • Children and young people requiring assistance did not have a way to alert staff if they needed assistance quickly. Whilst hand held equipment was available in the unit to enable communication in an emergency, this was rarely being made available to the young people.
  • There was no target for staff supervision. This meant that there was not a measurable target for the service to work towards.
  • Staff did not use child friendly approaches with children and young people to engage them in decisions about their individual care and treatment. This meant children and young people felt uninvolved.
  • There were gaps in the governance processes that did not identify there were issues with disclosure and barring service checks and restraint training for staff.

However:

  • Infection prevention control measures had improved following prompting by the Care Quality Commission. Staff were now wearing masks and following national guidance.
  • Staffing at night had improved since the last inspection. Registered nurses were employed to work at night. This meant that children and young people had access to registered nurses at all times.
  • The service sought to ensure that children and young people had access to the appropriate therapies and treatment. Alternative therapies were sourced and funded by the service where necessary.
  • Community meetings were held regularly. Children and young people were asked of their opinions and changes were made based on their feedback.
  • The service had sought input from external bodies such as the Restraint Reduction Network, Safewards and was working towards Quality Network for Inpatient Child and Adolescent Mental Health Services accreditation.

5 May 2020

During an inspection looking at part of the service

This was a focused inspection on elements of the safe and well-led key questions only. Therefore, we did not rate the service. The service has not previously been inspected. We found the following:

  • There were no qualified nurses working at night. This meant that young people with complex needs might not have access to the professional support needed. There were no qualified nurses working in the hospital at night. This meant that children did not have immediate access to a qualified nurse.
  • Staff restrained children and young people using training models that were not consistent. This meant there was a risk of restraint not being done safely. The provider acknowledged that all staff should be trained to use the same techniques and has taken steps to address this.
  • Staff had not received the appropriate level of training to fulfil their roles. Staff lacked training in the Mental Capacity Act and Gillick competency and so did not always consider consent appropriately. Safeguarding children training was not completed to the required level of competence. There were plans for this training to be completed by the end of May 2020.
  • Our findings from the other key questions demonstrated that governance processes were in their infancy. Policies required improvements. There were plans to fully review policies and procedures and implement robust governance.
  • There had been a failure to notify CQC of safeguarding concerns and police contacts.

However,

  • The service managed patient safety incidents well. Staff assessed and managed risks to children, young people and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff understood how to protect children and young people from abuse and the service worked well with other agencies to do so.
  • The service had enough support staff, who knew the children and young people well. Staff had easy access to clinical information, and it was easy for them to maintain high quality clinical records.
  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff felt respected, supported and valued.