A CHILD and adolescent mental health unit remains as 'requiring improvement' following its most recent CQC inspection, which took place due to whistleblower raising concerns relating to the safety of the service.

The Lighthouse, which opened in January 2020, is a four bed child and adolescent mental health unit based in Darwen, aiming to provide a 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.

At an Care Quality Commission (CQC) inspection in March 2021 the service was found to be in breach of five regulations, was rated as 'requires improvement' and a requirement notice was issued.

Then, a focused inspection was conducted in November 2021 in relation to the 'safe' area, and a warning notice was issued, with the CQC maintaining the 'requires improvement' rating.

It told the provider the service must ensure there are enough competent and trained staff available on each shift to keep children safe after finding that on 102 shifts out of 182, staffing levels were not being met.

At the same inspection a requirement notice was issued which required all police incidents were reported to the CQC.

MORE: Darwen young people's unit 'unsafe for children' as latest CQC report demands improvements

During the most recent inspection, which took place on February 9 and 10, officials found the majority of the previous breaches of regulation, including the warning notice, had now been met.

However, in the inspection report, dated April 20, officials noted risk assessments had not been fully completed for all children, which meant staff did not have all the necessary detailed information relating to children’s risks.

There were safeguarding concerns that had not been reported to the CQC, and not all child safeguarding concerns had been reported to the local authority either. This meant there was a risk of children being put at further risk of harm.

The service was also found to have blanket restrictions in place, as there were no doors on children’s en-suite bathrooms, which staff said was to manage risk, however the CQC found this impacted on children’s privacy and dignity.

There continued to be gaps in the effectiveness of the governance processes and many policies and processes were new and had not been fully embedded into the service. Children also did not have the opportunity to have their voices heard via a professional advocate.

The report stated: "At the time of this inspection, we were still reviewing the requirement notice issued in relation to failing to notify the Care Quality Commission of police incidents.

"We also issued a further breach of Registration Regulation 18 relating to the failure to report safeguarding concerns to the CQC.

"The provider also owns another property across the road which had been used to accommodate children and at which staff had provided care and treatment prior to the last inspection.

"This property is not registered separately and following the last inspection, we informed the provider we considered this building to be an extension of The Lighthouse.

"We were concerned about the safety and suitability of this building and informed the provider we would inspect it as part of our next inspection.

"However, the provider had since changed the use of the building to a private rented property. This meant we were unable to cross the threshold at this inspection."

Despite these shortcomings, the CQC did find the ward environments were safe and clean, the use of restrictive practices were minimal, staff developed holistic, recovery-oriented care plans and of the three children inspectors spoke to, all stated they felt involved in their care and were aware of the content of their care plans.

The report stated: "The service now had more staff on each shift to carry out any physical interventions safely than at the previous inspection.

"Staffing ratios had been increased and these were being met.

"The service received a warning notice in December 2021 regarding having enough staff to carry out physical interventions safely.

"We saw evidence of improvements being made and the warning notice being met."

As a result of the inspection, the CQC said the provider must ensure all children have a risk assessment completed on admission and that this is updated following any incident.

They must also ensure there are robust structures in place for reporting and capturing safeguarding concerns and that they are acted upon promptly, with any safeguarding concerns reported to all relevant external agencies including the Care Quality Commission.

Additionally, the provider must ensure risk is managed on an individual basis and consider the impact having no en-suite doors has on children’s privacy and dignity. 

A spokesperson for Associated Wellbeing, which runs The Lighthouse, said in February that since the report in November, the service had gone through a company restructure.

The spokesperson said: "New directors have taken over the running of the company, the Lighthouse has a new registered manager and a new staff team who are absolutely committed to improving the CQC rating for the young people who use our service."

The manager and deputy manager have therefore only been in place for around four months.

A further inspection will be carried out at a later date to ensure any improvement requirements have been acted upon.