Detention paperwork for those detained under the Mental Health Act was detailed and followed procedures. Staff did not always feel actively engaged or empowered. In rating the trust overall, we took into account the current ratings of the 12 services not inspected this time. 89% of staff had attended their mandatory training; 92% of appropriate staff had received training in safeguarding adults and 90% of staff had completed safeguarding children training. On rehabilitation wards, staff did not care plan the needs of a patient with protected characteristics. Medicine management training sessions had been undertaken with inpatient ward sisters and charge nurses. Staff were given opportunities to expand their knowledge and develop their roles. NG3 6AA, In Patients we spoke with knew how to complain. The trust had robust governance structures and they had assured any potential gaps or overlaps had been considered. This meant the police very often had to care for detained patient for the duration of the assessment. Feedback from those who used the families, young people and children services was consistently positive. They contained items which could pose a danger to staff and patients. Inpatient and community staff reported difficulties with getting inpatient beds. The trust needs to take steps to improve the quality of their services and we found that they were in breach of seven regulations. We rated acute wards for adults of working age and psychiatric intensive care units as requires improvement because: The trust had made improvements to the clinical environments but had not met all the required actions following the previous inspection of March 2015. One patient at Stewart House told us other patients made comments around their protected characteristics and staff had not care planned the needs of the patient. We inspected three mental health inpatient services because of the ratings from the previous inspection. Patients said staff who cared for them were knowledgeable, professional and friendly. the service is performing exceptionally well. The trust had robust arrangements in place for the receipt and scrutiny of detention paperwork. ALT. Staff told us they enjoyed working at the trust and thought they all worked well as a team. The service was not safe. Services had complied with guidance on eliminating mixed sex accommodation. For over 20 years we've ensured that health related grants, policies, and services exist to help give everyone the opportunity to be healthy - especially the most vulnerable. Staff explained to patients their rights under the Mental Health Act on admission and routinely thereafter, although we saw this was not always documented in the patients care notes. There were significant waiting times for a range of further assessments and treatments including psychology, school observations, psychiatric opinion and group work. We did not rate this inspection. Home - Leicestershire Partnership NHS Trust Creating high quality, compassionate care and wellbeing for all. The trust had a range of information displayed on the ward and the hospital site relating to activities, treatment, safeguarding, patients rights and complaint information. Some medication was out of date and there was no clear record of medication being logged in or out. The process for monitoring patients on the waiting list in specialist community mental health services for children and young people had been strengthened since the last inspection. A positive culture had developed since our last inspection. Mental Health Act documentation was not always up to date on the electronic system. The136 suiteis a place of safety for those who have been detained under Section 136 of the Mental Health Act. The needs of people who used the service were assessed and care was delivered in line with their individual care plans. Maintenance teams did not undertake repairs in a timely way and not all areas used by patients were clean. Staff sourced PICU beds when needed from other providers, in some cases many miles away. Find out more. The trust had not fully articulated their vision for how they operated as a trust. Services and care were planned with the local population in mind and to address the individual needs of patients. The service was not meeting its performance targets. At least one standard in this area was not being met when we inspected the service and, Nottinghamshire Healthcare NHS Foundation Trust, Coventry and Warwickshire Partnership NHS Trust, Derbyshire Healthcare NHS Foundation Trust, Crisis Resolution and Home Treatment teams (CRHT). Medication management across four of the five services we inspected was poor, despite reported trust oversight and audit. The scrutiny process was multi-tiered, which included the nurse, Mental Health Act administrator and medical scrutiny. Supervision, appraisals and training compliance did not always meet the trust standard. Patient outcomes were not routinely collected so the quality of the clinical care being delivered could not be measured or benchmarked. Overall, the pace of change in planning and converting plans into action across the trust was disappointingly slow. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Comprehensive assessments were being carried out and information was stored securely, except for one location and arrangements were in place to address this. Leicester; 33,706 to 40,588 a year (pro rata) Leicestershire Partnership NHS Trust; We are looking for a Bank Band 6 Speech and Language Therapist to join our innovative, friendly and well supported team working with children and y. There was a good level of occupational therapy input and good support to help maintain patients physical health. CAPTRUST for Institutions. Staff did not always maintain the privacy and dignity of patients. There was detailed discussion and consideration of patients and carers needs. All hospitals were running at a high bed occupancy level of above 85% which national data has linked to increased risk of bed shortages as well as an increase in healthcare associated infections. there are some services which we cant rate, while some might be under appeal from the provider. In CAMHS community teams waiting times from referral to initial assessment was less than 13 weeks. There were effective methods for obtaining feedback from service users and carers and feedback was acted upon. Records in the HBPoS did not clearly indicate if patients had their rights explained to them. Wards had high numbers of hydraulic style patient beds that were a risk to patients with histories of self-harming behaviour. 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. Care planning had improved in the crisis service. This employer has not claimed their Employer Profile and is missing out on connecting with our community. At this inspection, two of the three mental health services we inspected improved overall. Due to the lack of a trust overarching strategy, the BAF did not provide an effective oversight against strategic objectives, gaps in control and assurance. Patient views on the quality of the food were variable. Following the appointment of a new chief executive a new trust board was formed. Staff did not record consent to treatment, and capacity to consent and best interests decisions when these were needed. It was clear to see the difference the investment and improvements had made since our last visit. Sixty per cent of staff working in the mental health services had attended supervision and 64% of staff working in community health inpatient services. The trust lacked a framework for co-ordinating, endorsing and therefore learning from the very many positive quality projects taking place. Staff told us patients were concealing lighters and cigarettes and bringing them onto wards. Services treated concerns and complaints seriously, investigated them and learned lessons from the results. o We are one team and we are best when we work together. The acute wards for adults of working age had not complied with all of the required actions following the previous inspection of September 2013. The service was not effective. We saw the trust had developed oversight and a vision on how to improve the nine key areas identified by the warning notice. Patient Advice and Liaison Service (PALS). Improvements had been made to the seclusion facilities, and further improvements were planned across the service to improve patient experience and promote privacy and dignity. With the exception of the liaison psychiatry service and the mental health triage car, managers were not supervising or appraising staff within the trusts supervision policy. Detention renewal paperwork had been signed by a doctor prior to them seeing the patient. Patients waiting for their appointment in community based mental health services for adults of working age had access to a room unsupervised which held items which could cause harm. the service is performing badly and we've taken enforcement action against the provider of the service. Reductions in social service provision had led to an increase in referrals to the Community Learning Disability Teams. The trust had not responded in a timely way to eliminate shared sleeping arrangements (dormitories). o We do what we say we are going to do. There had been several serious incidents (SI) within this service in the last year and it was not clear that learning from investigations and actions consistently took place to prevent recurrence. Interview rooms were unsafe. Significant vacancy rates and high sickness levels put additional pressure on substantive staff. Leicester, United Kingdom. Staff were unable to show us evidence of clinical audits or the basis of evidence based practice in end of life services. Suspended ratings are being reviewed by us and will be published soon. They were constantly looking at ways to improve their work and the patient experience of the service. This environment was pleasant and well equipped. 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.) Apply. There were robust lone working procedures in place. Leicestershire Partnership NHS Trust Location Leicester Salary 27,055 to 32,934 a year Closing date 2 Feb 2023. Staff updated risk assessments and individualised care plans regularly. Some facilities lacked essential emergency equipment. Patients families and carers were positive about the care provided. We found a high number of concerns not addressed from the previous inspections. Managers used a tool to identify and review staff numbers in accordance with need. However, we found: We rated the child and adolescent mental health wards as requires improvement because: We rated community-based mental health services for older people as good because: We rated learning disability and autism community services as good because: We gave an overall rating for forensic/secure wards of requires improvement because: We rated Leicestershire Partnership NHS Trust long stay / rehabilitation mental health wards for working age adults as requires improvement because: Overall rating for this core service Good. The trust encouraged staff at most levels of the organisation to develop and deliver ideas for service delivery, improvement and innovation. Staff had a good knowledge of safeguarding. This monthly award is about recognising members of staff who have gone the extra mile. Patients were able to access hot and cold drinks any time during the day. Staff received regular supervision and most had received an appraisal in the last 12 months. These reports were presented in an accessible format. This included environmental improvements, shared sleeping accommodation, response times to maintenance issues, care planning and access to relevant therapies in certain services. The services used recognised outcome measures and monitoring measures to help assess the level of support and treatment required. The dignity and privacy of patients across three services we visited was compromised. Improvements were needed to make them safer, including reducing ligatures, improving lines of sight and ensuring the safety and dignity of patients. It is about making a real and sustainable difference for our patients and supporting our staff to deliver safe, high quality care every day. Care plans were not always holistic and person centred. This could pose a risk as patients were unsupervised in this area. We rated the caring domain for the community health families, young people and children service as outstanding due to staff approaches to family and patient care utilising or creating tools to assist children to understand their condition or prepare for treatment. Mandatory training that fell below 75% included adult immediate life support, adult basic life support, safeguarding children level 3 and fire safety awareness. People using the service had limited access to psychological therapies and there were no psychologists working within the service. The CRHT team did not have lockable bags to transport medication to patients homes; staff told us they transported medication in their handbags. There was no medicines management input from pharmacy within the community based mental health services for adults of working age. Some staff had not received their mandatory training, supervision or appraisal. At our last inspection we raised concerns that an insufficient number of nursing staff in community health services for adults had received appropriate statutory and mandatory training. Staff were not supervised in line with the trust's policy. Staff were passionate about their roles and enjoyed working with the client group. Managers had introduced a duty clinician to manage caseload sizes and reduce patients risks. This had improved since the last inspection in March 2015. Our patients are at the heart of all we do and we believe that 'Caring at its Best' is not just about the . We rated the trust as inadequate for well-led overall. Some patients continued to share bedroom spaces in dormitories, and personal belongings were stored on the floor because of limited storage provided by the trust. There was no fridge to keep medicines cool when required. received 41 comment cards from patients that were available for patients to complete during the time of our inspection. Staff had received specialist child safeguarding training and were able to make referrals when appropriate. We use cookies to improve your experience on our website. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. When staff raised concerns or ideas for improvement, they felt they were not always taken seriously. Staff carried out physical health checks on admission.Ongoing physical healthcare was provided by a local GP who visited two days a week and was available in case of an emergency. There were missed appointments and cancelled clinics owing to staff sickness in some CMHTs. No rating/under appeal/rating suspended Some local leaders were visible and approachable however, some staff did not know who directors linked to their service were or did not feel engaged with the trust. We did not identify any significant community wide areas for improvement but did find many exemplary services provided by the trust. However, the service was collecting data. The trust had a major incident policy to deal with any major incidents or breakdown in service provisions. Care records for patients using the CRHT teams were not holistic or personalised. Six staff expressed concerns about the proposed move and some said the trust had not communicated information to staff effectively. Managers changed practice because of this. They remained positive when engaging patients in meaningful activities. The service was meeting its target in this area. The trust had made improvements to the clinical environments since the last CQC inspection. Young people and their carers spoke positively about the CAMHS service. On four wards in acute wards for adults of working age, there were shared sleeping arrangements for patients. Patient access to psychology and occupational therapy was less than expected on acute wards and rehabilitation wards due to the number of staff vacancies in therapy positions. At Rutland Memorial Hospital shifts were covered by using more than 20% temporary staffing. 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. In rehabilitation services, staff had effective working relations with the new rehabilitation community transition support team created in response to the pandemic to facilitate faster discharges from the wards. Staff did not always feel connected to the wider trust. We rated wards for people with learning disabilities as requires improvement because We will be working with them to agree an action plan to improve the standards of care and treatment. We gave an overall rating for mental health crisis services and health-based places of safety of requires improvement because: Overall we rated this core service as requires improvement because: We do not give an overall rating for specialist services. Nottingham, Staff reviewed young peoples risk at every appointment and recorded this in the case notes. Nursing staff interacted with patients in a caring and respectful manner. Risks to people who used the service and staff were assessed and managed. Managers shared the outcomes and lessons learnt from incidents, complaints and service user feedback at regular staff meetings, where meetings took place. The trust was told to address the arrangements for eliminating dormitories at our last inspection in 2018 and work had started on one ward in March 2021. Risk assessments were completed and care plans implemented to keep patients safe and promote wellbeing. In all three services, not all staff were up to date with mandatory training. We observed clinicians working with young people were skilled and very positive. Consultations with staff and the public had been undertaken to gain feedback on the proposed move of wards. The trust had developed checklists to assist staff with the receipt and scrutiny process. However there were significant problems with key areas of governance in relation to the management of prescriptions. We don't rate every type of service. Staff were kind, compassionate and respectful towards patients. There was an effective incident reporting system. Beds were not always available for people living in the trusts catchment area. Staff used "my care plan" documents to obtain patients views on their care. Updated 22 June 2022. We did not speak to any patients using the service at the time of the inspection. We noted how much time the new executive team had invested in making and implementing improvements during the COVID-19 pandemic. This meant that patients could have been deprived of their liberties without a relevant legal framework. A programme of work was due to start in forthcoming months, for wards yet to be refurbished. One patient on Thornton ward told us that while staff did knock, they did not wait for a response before entering, which had resulted in staff walking into their room while they were changing their clothes, compromising their privacy and dignity. Ward teams did not hold regular team meetings. Potential risks were taken into account when planning community health services. Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. Bed occupancy for the last two quarters of 2013/14 was around 89%. The perception of staff that learning disabilities services were a low priority for the Trust since they had moved into the adult mental health directorate. 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. Staff told us their managers were supportive and senior managers were visible within the service. Improvements to the inpatient wards included updating seclusion rooms, removing some ligature anchor points and replacing garden fencing. 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. The trust could not always provide a bed locally for patients who required admissions to its mental health wards. The rating had improved from the November 2016 inadequate rating. Care and treatment was mostly planned and delivered in line with current evidence. Medicines Management Our vision Creating high quality, compassionate care and wellbeing for all. Patients were not always involved in the planning of their care. Their service users and staff are extremely important to them. Therefore, if a female needed a psychiatric intensive care unit they were sent out of area. In addition to this, risk assessments were comprehensive and reviewed as per the trust policy, six monthly or after risk incidents. We observed positive interactions between patients and staff. At this inspection, we looked at adult liaison psychiatry services at the Leicester Royal Infirmary site. The service did not have any out of area placements, readmissions or delayed discharges. Wards did not have a list of stock items. Staff morale appeared low. The single point of access made contacting the service easy for both patients and health professionals and enabled referrals into the service to be triaged and assigned from one central point. A family member spoke about enjoying regular meetings in the service gardens with their relative. The leadership, governance and culture did not always support the delivery of high quality person centred care. New positions such as medicines administration assistants and link nurses to support wards were in place in certain areas, but ward staff still described irregular pharmacy visits and a lack of pharmacy oversight in medicines management. University Hospitals of Leicester NHS Trust. Three out of 18 staff interviewed said that supervision was irregular. All areas were very clean, fresh smelling and fit for purpose. Staffs were dedicated, passionate and patient focused. Environments were visibly clean and welcoming. The average bed occupancy was low. If we cannot do something, we will explain why. There had been only one out of area placement over 14 months. Staff had not received any specialist training on crisis intervention. We noted a box for discarded needles being left unattended in a communal area. That's what building health equity means to us. The trust did not have seclusion rooms on all wards. The trust had maintained patients privacy and dignity at Short Breaks Services. 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. 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. Patients occasionally attended the service. The HBPoS did not have access to a dedicated clinic room. Staff responded to patients needs discreetly and respectfully. An announcement has been made on the outcome of this appointment. Staff demonstrated a good knowledge of the Mental Capacity Act and consent however this was not routinely documented in care records. Managers completed ligature audits which highlighted what mitigation was in place to reduce the risk for patients. We were pleased to hear about the trusts investment in well-being events and initiatives for staff, such as valued star award, choir, yoga and time out days. 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. Assessments took place using nationally recognised assessment tools and staff provided a range of therapeutic interventions in line with National Institute for Health and Care Excellence (NICE). Say we are going to do was planned and delivered in line with current evidence-based guidance, standards, practice... 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