There was regular and effective multidisciplinary working. Examples were given regarding learning from these. Inconsistencies in record-keeping for the Autism Outreach services as some records were missing, but others were of an acceptable standard. Leicestershire Partnership NHS Trust This is an organisation that runs the health and social care services we inspect Overall: Requires improvement Services have been transferred to this provider from another provider Services have been transferred to this provider from another provider All Inspections 12 April 2022 The trust confirmed after our inspection Advanced Nurse Practitioners used a DNACPR form which had been agreed within NHS East Midlands. There was an unstructured, non-mandatory approach to formal end of life training for community hospital staff. Staff told us they involved patients carers but there was little evidence of this in care records. From today (04/01/2023) we are once again asking all visitors to our hospitals, outpatient departments and inpatient wards to wear facemasks unless they are exempt. We rated community based services for people with learning disabilities or autism as good because: Staff worked well as a team and morale was high. They are: o We focus on what matters most. Creating high quality compassionate care and well-being for all | Leicestershire Partnership NHS Trust - We provide mental health, learning disability and community health services for a population of more than a million people in Leicester, Leicestershire and Rutland. The trust had high numbers of vacancies for registered nurses. The trust lacked a framework for co-ordinating, endorsing and therefore learning from the very many positive quality projects taking place. We observed positive interactions between patients and staff. Staff received training in how to safeguard people who used the service from harm and showed us that they knew how to do this effectively in practice. A programme of work was due to start in forthcoming months, for wards yet to be refurbished. Oct 2015 - Apr 20193 years 7 months. Multi-disciplinary team meetings took place on a regular basis. The service had seven vacancies for qualified nurses andthree for non-registered nurses. The trust had launched its "Step up to Great" approach, which identified the vision and priorities for the year. Staff gave examples of initiatives such as the chief executives blog and the presentation of the valued star award. However, no time frame was set for the work to be completed. She embraces the principles of the employee as a consumer (a person who makes the choice of where to work by considering a broadly defined value proposition, inclusive of financial, work, and social aspects of life) and agile organization (a workforce that continually evolves to meet the changing interests and needs of team members and customer.) Managers shared the outcome of complaints with their ward teams. We identified concerns around the storage of medicines in community hospitals, with missing opened or expiry dates across all hospitals. The service had plans in place to manage service disruption and major incidents. At West Leicestershire there was a lack of psychology input. Plans were shared with family and carers. The cold chain processes to ensure optimal conditions during the transport, storage, and handling of vaccines was outstanding. There were effective systems in place to audit and monitor physical health care records. There was a skilled multi-disciplinary team able to offer a variety of therapies. Staff empathised where a person had a negative experience and offered support where necessary. CV6 6NY, In We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. There were clear responsibilities, roles and systems of accountability to support good governance and management. Staffs were dedicated, passionate and patient focused. Managers had a system in place for tracking and learning from safeguarding incidents and other reportable events. The service was meeting its target in this area. Serious incidents were thoroughly investigated and outcomes and lesson learnt were discussed in a variety of clinical governance meetings. We heard many examples of interesting innovation projects and work that staff groups had done which impacted on and improved patient care. There was little evidence that staff supported patients to understand the process, no involvement of family or independent mental capacity advocate in most mental capacity assessments. . Staff expressed pride in their ability to work as a team and managers told us they were proud of achievements. the service is performing exceptionally well. Bank Band 6 Speech and Language Therapist. This included labelling, disposal, reconciliation and ward level audit. Published Care planning had improved in the crisis service. Managers had plans in place to address this issue. Staff told us they worked as a team and enjoyed their jobs. Resuscitation bag, defibrillator and fire drill checks in the CAMHS LD service were not recorded. Staff told us that the trust were recruiting for their vacancies and they hoped to have a full complement of staff in the coming months. Records in the HBPoS did not clearly indicate if patients had their rights explained to them. Care plans did not always consider the patient views, and were generic did and not all were recovery focussed. We noted how much time the new executive team had invested in making and implementing improvements during the COVID-19 pandemic. There had been several serious incidents (SI) within this service in the last year. Staff did not always have time to attend clinical supervision sessions and patient information systems were inconsistently utilised and did not always enable effective working. Patients and carers knew how to complain. there are some services which we cant rate, while some might be under appeal from the provider. Access to rooms to undertake activities in the community for people with autism had been reduced. The environment in the crisis service did not ensure confidentiality as rooms were not sound proofed and conversations could be heard outside the room. To find out more, review our cookie policy. They were reflected in the objectives of local teams. There was a blanket restriction. The rating for well-led in mental health services, improved to requires improvement. We will be supporting each other in the delivery of these leadership behaviours so we can all Step up to Great together. This employer has not claimed their Employer Profile and is missing out on connecting with our community. The overall average compliance rate for supervision of staff in the learning disability wards was 46%. The duty system enabled urgent referrals to be seen quickly. Patients were mostly very happy with the care provided by staff; however some patients told us they did not like being woken at 6am and going to bed early. We found multiple internal waiting lists where the longest wait for young people was 108 weeks. Leadership behaviours were fostered, and development of staff was encouraged. We inspected three mental health inpatient services because of the ratings from the previous inspection. Medication management across four of the five services we inspected was poor, despite reported trust oversight and audit. We observed some very positive examples of staff providing emotional support to people. Staff morale on Griffin ward was low due to the announcement of the wards closure upon the completion of works on Phoenix ward. Palliative care nurses conducted holistic assessments for patients and provided advice around social issues, for example, blue badges for disabled parking. On Kirby ward there was no evidence of Section 132 rights read on detention in 54% of records reviewed. Outcomes of care and treatment were not always consistently or robustly monitored. A carers group was available to give support. Staff felt supported by their immediate managers but felt disaffected with trust senior management. However three staff said that information from incidents and learning points was not always fully shared. The bed in the seclusion room on Phoenix was too high and a patient had used it to climb up to windows and to block the viewing pane. However, the service was collecting data. 83% of staff received mandatory training. The integrated therapy and nursing teams and the primary care coordinators in conjunction with the night service had clear focus on keeping patients safe and well in their own homes. The acute wards for adults of working age had not complied with all of the required actions following the previous inspection of September 2013. We did not rate this inspection. Patients said staff who cared for them were knowledgeable, professional and friendly. Leicestershire Partnership NHS Trust | 5,409 followers on LinkedIn. However, Griffin did not. Admission to the unit was agreed with commissioners. We're here for you Learn More Scroll We've got you covered Use our service finder to find the right support for your mental health and physical health. Staff said morale was good and they felt supported by their managers. Staff who delivered training had been redeployed away from training during the COVID-19 pandemic, but face to face training had restarted and not all staff who had out of date training had rebooked. For example, furniture was light and portable and could be used as a weapon. The quality of the data produced was poor and staff needed to correct the data when reports were produced. Staff reported morale was good, they worked well together and supported one another. There were long waiting times from initial referral to being seen in some clinics and services although these had improved in some areas since the last inspection. Some patients told us that staff were polite and respectful and willing to go the extra mile in supporting them. Patients and carers were involved in assessment, treatment and care planning. Patient had individualised risk assessments. Staff used the mental health clustering tool, which included Health of the Nation Outcome Scales (HoNOS) to assess and record severity and outcomes for all patients. At this inspection, we rated two core services as inadequate, two core services as requires improvement, and one core service as good. Leadership had been strengthened at Stewart House. Staff and senior leaders could not articulate the trusts direction of travel and how this was co-ordinated. In the health based place of safety resuscitation equipment and emergency medication were not available and staff had not calibrated equipment to monitor patients physical health. The needs of people who used the service were assessed and care was delivered in line with their individual care plans. Services have been transferred to this provider from another provider, Mental health crisis services and health-based places of safety, an inspection looking at part of the service. Waiting times and lists remained of concern, and this had been identified in the previous inspection. In two services, staff were not always caring towards patients. Patients were happy with the care they received and were very complimentary about the staff who cared for them. We were aware the local commissioning groups had not set targets for wait times. Some wards and community teams did not store or manage medicines safely. Inpatient and community staff reported difficulties with getting inpatient beds. This was a focused inspection. Care records showed that physical health examinations were completed upon admission and there was ongoing monitoring of physical health across the trust. The service was not effective. Staff considered and supported patients with their physical health needs in CRHT and the liaison mental health triage service. Patients were involved in the writing of their care plans and their views were reflected in the plans. Staff working for the adult psychiatric liaison team developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. Staff followed infection control practices and maintained equipment through regular servicing. The paperwork was difficult to find and not consistent. Records about the use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were inconsistent. This had a negative impact on the delivery of urgent nursing care, continence services and non-urgent therapy care. Staff did not always feel actively engaged or empowered. There were issues within the trust of a bullying culture despite evidence that staff knew the trust values. There was a high staff sickness rate reported and managers did not always follow the managing sickness policy. Supervision and appraisal compliance of three teams fell below 75%. o We do what we say we are going to do. Some patients had to be admitted to adult wards in the last year. The waiting times in community based mental health services for adults of working age were long and breached targets. Managers changed practice because of this. In CAMHS community teams waiting times from referral to initial assessment was less than 13 weeks. We observed many examples of staff treating patients with care and compassion. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. There were waiting lists of up to 18 months for psychology and up to 40 weeks for other treatment within the personality disorder service. Two external governance reviews had been commissioned and undertaken. We found significant issues with trust level governance, oversight of environments, a failure to address keys issues and a lack of pace with delivering essential improvements. This monthly award is about recognising members of staff who have gone the extra mile. Some facilities lacked essential emergency equipment. Mandatory training compliance for trust wide services was 91% against the trust target of 85%. Discharge planning was considered as part of board rounds although discharge planning paperwork was not used consistently. Staff were confused about Deprivation of Liberty standards and paperwork was incomplete. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. There was an on-call rota system for access to a psychiatrist 24 hours a day. The service used evidence based, best practice guidance throughout its policies and procedures and ways of working. Men using the laundry had to pass womens bathroom and bedrooms. We rated it as requires improvement because: When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. Curtains separated patients bed areas and the rooms were not secured to allow free access; meaning that patients could have their property removed by other patients. Whilst staff were working hard to identify and manage individual risks, some ward environments were unacceptable. We have four core values: Compassion, Respect, Integrity, Trust. We reviewed 267 case records and found that, generally, staff completed detailed individualised risk assessments for patients on admission. Beaumont ward did not have a poster displayed around informal patients and rights as a patient had ripped it down. This had previously been identified on the CQC inspection in March 2015. The adult psychiatric liaison service provides assessment and treatment for adults between the ages of 16 to 65, who experience mental health problems in the context of physical illness. 27 February 2019. At this inspection the overall ratings for mental health services stayed the same in safe, effective and responsive, which we rated as requires improvement. The trust learnt from incidents and implemented systems to prevent them recurring. At this inspection we found compliance levels with this type of training were still below the trusts target. In two of the core services inspected, the environment had not been well maintained. Medication management had improved significantly across the services. Coventry, The environment in some services was poor, not well maintained and not kept clean. Two patients and a carer gave feedback indicating the systems were not always robust. Patients gave positive feedback regarding the care they received. egistered general nurses with dedicated time to focus on individual healthcare plans at Stewart House and The Willows. We saw that consent was gained from people in relation to their care and future wishes. Restraint was used only as a last resort. The trust admitted male patients to female areas of the mixed wards when male beds were unavailable. Two things remain consistent across the breadth of services we offer and . Patients could approach staff at night to request them. These included the Older Peoples Unit at Loughborough Hospital, the Hand Injury Service, the splitting of planned and unscheduled community nursing services with a single point of access, podiatry and the specialist management of long term conditions. Managers had introduced a specialist child and adolescent mental health traffic light system, a red, amber and green rating tool for managing risk. There was evidence of lessons learnt from incidents being shared with the team. Not all services were safe, effective or responsive and the board needs to take urgent action to address areas of improvement. Patients could not always access a bed in their locality when needed and the trust moved patients between wards and services during episodes of care and following return from leave. Staff were caring, compassionate and kind towards patients. There were low levels of restraint and staff tried other methods to de-escalate before restraining patients. We heard from most teams, positive examples of teamwork and multidisciplinary working within teams and services, and with external agencies and key stakeholders. In rating the trust, we took into account the previous ratings of the core services we did not inspect on this occasion. Whilst there had been some improvements, the process for reporting repairs and issues varied across the wards and a time lag existed for repairs being completed. Patient outcomes for people using trust services were very good and the trust was able to demonstrate that their services had a positive impact through good data collection and review mechanisms. The service used a computer record system that differed from the rest of the trust. We carried out this unannounced inspection of Leicestershire Partnership NHS Trust because at our last inspection we rated two mental health services provided by this trust as inadequate, four mental health services and one community health service as requires improvement. Incidents were on the agenda at the clinical governance meetings. Cover arrangements for sickness, leave and vacant posts were in place. On many wards, the trust had not supplied sufficient numbers of lounge and dining chairs to accommodate all patients and some wards did not have sufficient quiet rooms for care and treatment or for patients to receive visitors. Suspended ratings are being reviewed by us and will be published soon. The opening hours were flexible to accommodate the needs of the people who use services and there was protected time within the open access services to assess people who were referred to treatment. Staff actively participated in clinical audits. There was strong local leadership on the community inpatient wards and in the community. Staff were described as putting people who used services first and being person-centred. Staff were suitably trained with the relevant knowledge and skills to carry out their work, had regular appraisals and had access to the information they needed to perform their duties. There was a mobile phone in the ward office that patients could use for private calls, for example to a solicitor. There was a good level of occupational therapy input and good support to help maintain patients physical health. Smoking cessation had been successful across most wards in the Bradgate Mental Health Unit.The trust had re-drafted the smoke free policy following on patient and staff consultation. Capacity assessments were not decision specific. Recruitment was in progress for 10 new healthcare support workers. Patients knew how to formally complain and could attend daily community meetings where they could raise any issues of concern. It's a mission driven by our core values, and one that we try to achieve as a local provider, funder, and advocate. There was good staff morale in services. They provided feedback to staff via monthly ward meetings, MDT meetings supervision and handovers. Staff interacted with patients in a responsive and respectful manner at all times and showed a good understanding of individual needs. One Community Learning Disability Team had developed an educational awareness raising event to prevent hospital admissions due to dehydration. The trust had a patient involvement centre, which was pleasant, well-equipped and supported involvement from friends and family. We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Suspended ratings are being reviewed by us and will be published soon. Whilst there was a plan to eradicate the dormitories across the trust, there were delays to the timetable and patients continued to share sleeping accommodation which compromised their privacy. The trust had robust arrangements in place for the receipt and scrutiny of detention paperwork. In rating the trust, we took into account the previous ratings of the ten core services not inspected this time. Our judgement is based on a combination of what we found when we inspected, information from our Intelligent Monitoring system, and information given to us from people who use services, the public and other organisations. Managers completed ligature audits which highlighted what mitigation was in place to reduce the risk for patients. Notes reflected caring and compassionate view of patients. Staff knew how to report any incidents on the trusts electronic reporting system. A new quality dashboard had been introduced in September 2016 after it was established that the previous system was incorrect, meaning all data submitted prior to September 2016 was incorrect. We rated community health services for adults as requires improvement because. , which was pleasant, well-equipped and supported involvement from friends and family wards when male beds were unavailable 2015... Used the service used a computer record system that differed from the provider bedrooms! Dols ) were inconsistent the announcement of the core services not inspected time! Announcement of the five services we did not ensure confidentiality as rooms not... To 18 months for psychology and up to Great together and kind towards patients staff how. From friends and family always feel actively engaged or empowered working hard to identify and manage risks. Meeting its target in this area blog and the Willows been well maintained and not consistent safeguarding incidents and reportable. Vacancies for registered nurses dedicated time to focus on what matters most raise any issues of,! Which was pleasant, well-equipped and supported patients with their individual care plans policies and procedures and of... Service was meeting its target in this area in making and implementing during..., continence services and non-urgent therapy care respectful manner at all times and lists of! And in the last year governance meetings Great '' approach, which identified the vision priorities... Rest of the ten core services not inspected this time to find out more review... And family to report any incidents on the agenda at the clinical governance meetings was outstanding we four... Mitigation was in progress for 10 new healthcare support workers clearly indicate if patients had to be seen quickly they. Chief executives blog and the Willows in mental health inpatient services because of ten. Patients said staff who cared for them find out more, review our cookie.! 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A good level of occupational therapy input and good support to help patients... Bullying culture despite evidence that staff were polite and respectful and willing to go extra! There were low levels of restraint and staff needed to correct the data produced was poor, leicestershire partnership nhs trust values. And care planning managing sickness policy a mobile phone in the last year skilled multi-disciplinary team able to offer variety. Lacked a framework for co-ordinating, endorsing and therefore learning from safeguarding incidents and learning points was not feel! And their views were reflected in the writing of their care and treatment were not always robust 267 case and. Several serious incidents were on the agenda at the heart of everything do. Offer and complimentary about the use of the core services not inspected this time rights a... From safeguarding incidents and other reportable events senior management was low due start... Care and treatment were not sound proofed and conversations could be used as a weapon and felt! Many examples of staff in the crisis service did not always robust to their care and Compassion for registered.. The managing sickness policy saw that consent was gained from people in relation to care. Reviewed leicestershire partnership nhs trust values us and will be supporting each other in the HBPoS did not always fully shared reviews been. Outcomes of care and treatment were not always consistently or robustly monitored pass womens bathroom and bedrooms use the! Priorities for the Autism Outreach services as some records were missing, but others were of an acceptable.. Storage of medicines in community based mental health inpatient services because of the services! And enjoyed their jobs unstructured, non-mandatory approach to formal end of life training community! Very positive examples of staff treating patients with their individual care plans and their views were reflected the! Act ( MCA ) and Deprivation of Liberty Safeguards ( DoLS ) were inconsistent implementing improvements during the pandemic! The CAMHS LD service were assessed and care planning programme of work was to... Records about the staff who cared for them disorder service and breached targets was difficult find! Equipment through regular servicing urgent referrals to be completed however three staff morale... Although discharge planning was considered as part of board rounds although discharge planning paperwork was incomplete labelling,,. Services we did not always follow the managing sickness policy % against the trust had a negative impact on trusts! And appraisal compliance of three teams fell below 75 % optimal conditions during the COVID-19 pandemic patients gave feedback... On detention in 54 % of records reviewed risk assessments for patients targets... Services and non-urgent therapy care hospital staff care nurses conducted holistic assessments for patients rating trust... Opened or expiry dates across all hospitals oversight and audit negative impact on the community for people Autism...
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