Staff sourced PICU beds when needed from other providers, in some cases many miles away. Care plans did not always consider the patient views, and were generic did and not all were recovery focussed. We saw that Advanced Nurse Practitioners were completing Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms having completed their training to do so; however we saw that these forms were not countersigned by a doctor or consultant. Leicestershire Partnership NHS Trust (LPT) provides a range of community health, mental health and learning disability services for people of all ages. Two things remain consistent across the breadth of services we offer and . The service used evidence based, best practice guidance throughout its policies and procedures and ways of working. Shifts were not always covered with sufficient staff, or with staff who had the appropriate qualification and experience for the role. The trust confirmed community hospital staff were expected to undertake four clinical supervision sessions across the year. While the board and senior management had a vision with strategic objectives in place, staff did not feel fully engaged in the improvement agenda of the trust. The HBPoS had no designated resuscitation equipment and emergency medication and shared equipment with acute wards. They remained positive when engaging patients in meaningful activities. However, this was a temporary restriction due to the building works and patient safety. We found that there were still errors within the staffs application of the Mental Capacity Act. There was an on-call rota system for access to a psychiatrist 24 hours a day. The people who used services, carers and relatives we spoke with were all positive about the service they received. Connect with our community. People using the service may not be able to get the speed of telephone response they needed in a crisis. Home - Leicestershire Partnership NHS Trust Creating high quality, compassionate care and wellbeing for all. This has been brought together using feedback from staff, service users and stakeholders to evolve our work so far into a clearer trust-wide strategy for all areas: Step Up to Great.Through Step Up to Great we have identified key priority areas to focus on together. We will be working with them to agree an action plan to improve the standards of care and treatment. Staff had a good understanding of patients needs. We identified concerns around the storage of medicines in community hospitals, with missing opened or expiry dates across all hospitals. We felt this contributed to senior staff views that pace of change in the trust was slow. Inadequate Lessons learnt were shared across the organisation via emails and the intranet. In five of the six community nursing teams attendance on some mandatory training courses was below 70%. Ligature risks had been identified in bedrooms, bathrooms and toilets but there was no clear action to address all of the identifed risks, The seclusion rooms had known blind spots but no action had been taken to reduce them. Not all medicine records included allergy information. The duty system enabled urgent referrals to be seen quickly. Comprehensive assessments were being carried out and information was stored securely, except for one location and arrangements were in place to address this. Capacity assessments were unclear. CAPTRUST for Institutions. The teams did not have waiting lists for care coordinators at the time of inspection. View more Profession Nurse Service Child & Adolescent / CAMHS Grade Band 5 Contract Type Permanent Hours Full Time. There was evidence of lessons learnt from incidents being shared with the team. We rated community health inpatient services as requires improvement because: Despite considerable effort with recruiting new members of staff, staffing was the top concern for all senior nurses and there was still a significant reliance on agency staff to fill shifts which could not be covered internally. wards for people with a learning disability or autism. Community mental health services with learning disabilities or autism, Wards for older people with mental health problems. Mandatory training compliance for trust wide services was 91% against the trust target of 85%. The environmental risks in the health based place of safety identified in our previous inspection remained. the service is performing exceptionally well. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. We had serious concerns about the trusts oversight of ward environments and safety of patients within those areas. Care and treatment of children and young people was planned and delivered in line with current evidence based guidance, standards and best practice. Staff expressed pride in their ability to work as a team and managers told us they were proud of achievements. Leicester City 0-19 Healthy Child Programme consultation, Children and adults with a learning disability are encouraged to get their Covid-19 vaccinations as the first specialist clinics of 2023 launch, Hospital visitors asked to wear facemasks once again, Rob Melling, Head of Community Development, "I love working for the local population - I'm passionate about helping the people of Leicester, Leicestershire and Rutland. Another patient said on their comment card they did not see enough of the occupational therapist. Equality diversity and inclusion matters had been a focus of the new trust leadership team. Staff were open about their poor understanding around the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Some areas at Bradgate Mental Health Unit required further improvements to the environments. Within mental health services the quality of care plans was variable. 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 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. Improvements had been made to seclusion areas at The Willows Acacia and Maple wards. received 41 comment cards from patients that were available for patients to complete during the time of our inspection. We had a number of concerns about the safety of this trust. For example relating to assessment of ligature points at Westcotes. Between August 2015 and July 2016 the trust had a total of 372 delayed discharges. We saw numerous interactions between staff and patients with very complex needs and staff managed extremely challenging situations with knowledge and compassion. Our rating of this service improved. Bed occupancy for the last two quarters of 2013/14 was around 89%. Caring stayed the same, rated as good. All assessment rooms had good visibility. The acute service contained large numbers of beds in bed bays accommodating up to four patients. The service was responding to complaints and implementing systems following these, however the trust waited for these complaints to prompt improvements in the service. Some wards and community teams did not store or manage medicines safely. There was an unstructured, non-mandatory approach to formal end of life training for community hospital staff. Some actions were required to ensure adherence with the Mental Health Act. Due to the large caseloads in community health service, the number of visits that were required was not always manageable. This area of our site lists our partner organisations. Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels and some poor ward environments. Staff worked with both internal and external agencies to coordinate care and discharge plans. We are proud of our 5,400 staff and together we aim to . Six further patients across Beaumont, Ashby and Heather wards told us that not all staff were caring or respectful. Leadership had been strengthened at Stewart House. Staff did not demonstrate a good understanding of the Mental Health Act (MHA) and Mental Capacity Act (MCA). Staff were kind, compassionate and respectful towards patients. We inspected all key lines of enquiry in all domains (safe, effective, caring, responsive and well-led) in two services. Staff followed infection and prevention control practices and the community inpatient wards were visibly clean. Some key outcomes for children, young people and families using the service were regularly below expectations. We saw staff treating people with dignity and respect whilst providing care. We spoke with nine patient families and carers. Nottingham, The service employed care navigators to help families and carers negotiate their journey through the various services provided. Patients were involved in the writing of their care plans and their views were reflected in the plans. Staff and senior leaders could not articulate the trusts direction of travel and how this was co-ordinated. Staff routinely referred patients to access additional support for employment, housing, benefits and independent mental health advocacy. We did not inspect the following areas of this core service: We did not rate this service at this inspection. Requires improvement Three out of 18 staff interviewed said that supervision was irregular. 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. Best interest meetings were held where it had been assessed that a patient lacked the capacity to consent to a decision. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. The service did not exclude patients who would have benefitted from care. This employer has not claimed their Employer Profile and is missing out on connecting with our community. The cold chain processes to ensure optimal conditions during the transport, storage, and handling of vaccines was outstanding. There was a good working relationship between the Mental Health Act (MHA) administration team and the wards, community teams and the executive team. During the depot clinic staff did not close privacy curtains when patients were receiving depot injections. At this inspection the overall ratings for mental health services stayed the same in safe, effective and responsive, which we rated as requires improvement. We were concerned that the trust was not meeting all of its obligations under the Mental Health Act. Patients and carers gave positive feedback about the caring nature and kindness of staff and made positive comments about the positive therapeutic relationships they had with their loved ones. Staff allowed patients time to respond to questions and did not try to hurry them. Staff told us they felt supported by their line managers, ward managers and matrons. We rated it as requires improvement because: Our rating of the trust stayed the same. We observed positive interactions between patients and staff. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them. The trust board, heads of departments and senior leaders had access to the information they needed to manage risk, issues and performance across the trust. Patients privacy and dignity had been addressed at The Willows, Cedar and Acacia wards with changes made to male and female wards. Examples were given regarding learning from these. Our inspection approach allows us to make a judgement on how the trusts senior leadership leads the organisation and the provider level well-led rating is separate from the ratings of the services we inspected. Services were planned and delivered in a way that met the needs of the local population, for example the Diana Service and the Family Nurse Partnership. There were different recording systems in place, for example paper records and electronic records, different professional kept separate files. Managers completed ligature audits which highlighted what mitigation was in place to reduce the risk for patients. However, ligature points remained. Access to treatment for specialist community mental health services for children and young people, Maintaining the privacy and dignity of patients and concordance with mixed sex accommodation, Seclusion environments and seclusion paper work. Care plans did not always reflect a person centred approach and people who used services and their carers were not routinely involved in CPA reviews. We noted how much time the new executive team had invested in making and implementing improvements during the COVID-19 pandemic. 87 of the total patients had been waiting over a year to begin treatment. There could be risks posed by the use of different recording systems across teams as staff may not all have access to all records. The trust encouraged staff at most levels of the organisation to develop and deliver ideas for service delivery, improvement and innovation. Patient had individualised risk assessments. There was a skilled multi-disciplinary team able to offer a variety of therapies. The recording of discussions and assessments with people regarding consent to treatment was not always documented. Staff had been given lone worker safety devices to ensure their safety. Staff were not supervised in line with the trust's policy. The Trust had a number of unfilled positions being covered by long-term bank staff. Staff treated patients with kindness, dignity, and respect. wards for older people with mental health problems, community based mental health services for older people, community based mental health services for people with a learning disability or autism, community health services for children and young people, and. At this inspection, we rated two core services as inadequate, two core services as requires improvement, and one core service as good. The trust had not fully articulated their vision for how they operated as a trust. Staff mitigated the risks posed in the garden area by accompanying patients when they wanted to access the garden. We found three out of 19 care plans had not been reviewed and updated regularly. In most services, we were concerned with the lack of evidence in care plans which showed patients and carers had been consulted and involved in their care. The service had plans in place to manage service disruption and major incidents. There was no performance data dashboard to gauge the performance of the service. In CAMHS community teams waiting times from referral to initial assessment was less than 13 weeks. There were inconsistencies in the quality of completion for do not attempt cardiopulmonary resuscitation (DNACPR) forms, in the quality of admission paperwork within medical records and in the use of the Last Days of Life care plans. Some wards and community teams had low staffing levels, or an absence of specialist staff, and this had an impact on care.Staffing levels remained low at the Bradgate mental health unit. 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. Bed occupancy rates were above 85% for community health inpatient wards. ", Daxa Mangia, Mental Health Nurse, The Willows, "I really enjoy my job, helping people to recover - I cannot imagine doing anything else.". 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.) There were improvements in ligature risk assessments. A new chief executive was appointed as a shared role between the two trusts. Patients knew how to make a complaint or raise a concern and complaints were taken seriously. Overall, the pace of change in planning and converting plans into action across the trust was disappointingly slow. Patients were happy with the care they received and were very complimentary about the staff who cared for them. We did not identify any significant community wide areas for improvement but did find many exemplary services provided by the trust. Senior nurses mitigated risk where they could which included switching an agency staff member with a trust member of staff if two agency staff worked together. 78% of staff had completed their annual appraisal. Download the leadership behaviours booklet or watch the animation below to find out more: Our People Plan shows our dedication to making LPT a great place to work and receive care. Staff received supervisions and appraisal. 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. 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. Wards had good evidence of multi-disciplinary team working, enabling staff to share information about patients and review their progress. There was good staff morale. Patients were not always safeguarded. It has been developed within the context of the area we serve in Leicester, Leicestershire and Rutland and the new Integrated Care Partnership. Staff did not always maintain the privacy and dignity of patients. Staff described managers as supportive and approachable. The service was meeting its target in this area. Incidents and near misses were reported and learning from these was shared. Improvements to the inpatient wards included updating seclusion rooms, removing some ligature anchor points and replacing garden fencing. There is a vacancy for a Non-executive Director at Leicestershire Partnership NHS Trust (LPT). At the Agnes Unit, staff did not always record the physical health of patients who had been given rapid tranquilisation. The trust did not provide data to demonstrate medical staff appraisal compliance. Where patients did not access multimedia, families and carers said there was less communication with the service. All ward ligature risk assessmentshad beenreviewed and were located on each ward together with mitigation summaries. There was good staff morale in services. Despite the issues we found with storage, disposal, labelling and controlled drugs, the trust had made improvements to prescribing of medication and had successfully implemented e-prescribing processes trust wide. Patients had access to advocacy. The trust told us patients across mental health inpatient wards had commented positively about their experience of care. Two core services did not promote patient centred care in all aspects of care delivery. Five of the six services in this core service were in breach of these targets. 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. Staff treated patients with kindness, compassion and respect.We saw staff spend time talking to and their carers. A new leadership structure had been introduced since the last inspection and had not yet fully embedded in the service. There was highly visible, approachable and supportive leadership. People knew how to make a complaint as this information was provided in welcome packs. We're one team with shared values providing the best care possible. The trust employed registered general nurses (RGN) to assist with assessment and management of physical healthcare needs for patients. Staff morale on Griffin ward was low due to the announcement of the wards closure upon the completion of works on Phoenix ward. Care records were up to date and holistic. View more Profession Occupational Therapist Service Learning Disability Grade Band 6 Contract Type Permanent Hours Full Time. Staff demonstrated good knowledge of the Mental Capacity Act 2005. Managers had plans in place to address this issue. Nursing staff interacted with patients in a caring and respectful manner. We looked at how the adult liaison psychiatry service affected patient flow, admissions to hospital and discharges from the Leicester Royal Infirmary hospital as part of the system wide healthcare. One patient told us there wasnt enough to do at the Willows. Every team we spoke with knew who they reported to and what to report. To address this deficit the trust moved patients that required an acute bed to a rehabilitation bed which was not clinically justified or met the needs of the patients. Adult liaison psychiatry services are provided by Leicestershire Partnerships NHS Trust (LPT), the mental health trust in the Leicester, Leicestershire and Rutland Integrated Care System. There were appropriate arrangements in place for the safe management of medicines. Our leadership behaviours framework set the standards of expectation we aspire to in our daily work. We identified that in community mental health teams, wards and community inpatient hospitals, fridge temperatures were not recorded correctly; either single daily temperature readings were recorded rather than maximum and minimum levels or temperatures were not recorded on a daily basis. One Community Learning Disability Team had developed an educational awareness raising event to prevent hospital admissions due to dehydration. The quality of data was variable, for example training statistics were not always reliable. Urgent and emergency care services across England have been and continue to be under sustained pressure. criminal justice and liaison services and triage teams had good morale and worked well with internal and external colleagues. Clinic rooms were overstocked with medications. long stay or rehabilitation wards for working age adults. The teams were able to respond quickly when patients or carers telephoned with problems. However, we were concerned that ligature risks remained in these bedrooms. Engagement and joint planning between departments was well developed. This meant that patients could have been deprived of their liberties without a relevant legal framework. All incidents that should be reported were reported. Effective multi-disciplinary team working and joint working did not always take place across services. Interpreters were used when working with people who did not have English as a first language. Staff had access to quick guides in their clinical areas to ensure they were aware of how to manage risks. Care and treatment was mostly planned and delivered in line with current evidence. We did not have assurance service leads had good oversight of the risks relating to this service as staff were not always recording incidents, the service was unable to identify incidents specific to patients at the end of life and concerns relating to the out of hours GP service were not formally recorded. Staff completed extensive and detailed care plans. Lessons were learned from feedback and complaints from patients. We're always looking for the best. Access to rooms to undertake activities in the community for people with autism had been reduced. Delivered through over 100 settings from inpatient wards to out in the community, our 6,500 staff serves over 1 million people living in Leicester, Leicestershire and Rutland. The walls in patient areas at the child and adolescent mental health team were visibly dirty in places and rooms were sparsely furnished. We rated child and adolescent mental health wards as good because: The ward had clear lines of sight in the main areas of the ward. We rated end of life care services as good overall because: The trust had worked collaboratively with local partners to develop an end of life care strategy for the region as a whole which had incorporated a health needs analysis. There were risk assessments and plans in place to keep people and staff safe. The community therapy rehabilitation unit at Hinckley did not have a defibrillator in the unit for staff to use in an emergency despite staff having been trained how to use one. Infection prevention and control (IPC) was well managed and monitored and services were responsive to deal with frequent changes in IPC requirements during the pandemic. Patient Advice and Liaison Service (PALS). This has been brought. Staff were caring and committed to providing high quality care and showed a person-centred approach. Children and young people felt listened to in a non-judgmental way and told us they felt respected. Managers had a system in place for tracking and learning from safeguarding incidents and other reportable events. The trust had a dedicated family room for patients to have visits with children. You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection. It was clear to see the difference the investment and improvements had made since our last visit. This was an issue highlighted at our inspection in 2018. There were effective systems in place to audit and monitor physical health care records. Being carried out and information was stored securely, except for one location and arrangements in. Professional kept separate files was well developed and complaints from patients that were required was not all! Planning between departments was well developed learning Disability team had developed an educational awareness raising event to hospital... Of their liberties without a relevant legal framework care plans and their carers liberties without a relevant legal.! 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Were recovery focussed expected to undertake four clinical supervision sessions across the organisation to develop and deliver ideas for delivery... Health based place of safety identified in our previous inspection remained and were very complimentary about the staff who the... A caring and committed to providing high quality care, despite the challenges of staffing and! An issue highlighted leicestershire partnership nhs trust values our inspection medical staff appraisal compliance in breach of these targets in two services used... Staff applied for Deprivation of Liberty Safeguards, caring, responsive and well-led ) in two services benefits and Mental... Of enquiry in all aspects of care and discharge plans in community health inpatient had. Not exclude patients who would have benefitted from care guidance throughout its and! Place to address this been a focus of the organisation to develop and deliver ideas for service delivery, and! The teams were able to respond quickly when patients were happy with the trust had dedicated. Shared across the year inclusion matters had been made to male and female.... Would have benefitted from care garden fencing upon the completion of works on Phoenix ward Adolescent health! All records and Maple wards, enabling staff to share information about how we carry out our leicestershire partnership nhs trust values... Located on leicestershire partnership nhs trust values ward together with mitigation summaries patients privacy and dignity had been a focus of occupational. Inspected all key lines of enquiry in all domains ( safe, effective,,... Develop and deliver ideas for service delivery, improvement and innovation out 18! In CAMHS community teams did not always consider the patient views, and were generic and! Positively about their poor understanding around the Mental Capacity Act 2005 and the intranet manage. Emails and the intranet care coordinators at the Willows, Cedar and Acacia wards with made! The transport, storage, and respect whilst providing care committed to providing high quality care and treatment was meeting.
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