A psychologist led weekly reflective practice sessions to help staff think about the best way of helping the patient on the ward. This meant that the environment could be unsafe due to space in corridors and lounges being restricted. If we cannot do something, we will explain why. ", Laiqaah Manjra, Corporate Affairs Administrator, "I progressed from being an apprentice to a Corporate Affairs Administrator - the NHS really supports staff development. Services had complied with guidance on eliminating mixed sex accommodation. the service isn't performing as well as it should and we have told the service how it must improve. The trust lacked an overarching strategy which everyone within the trust knew. Incidents and near misses were reported and learning from these was shared. Comments included terminology such as marvellous, wonderful and excellent. There was no fridge to keep medicines cool when required. We saw patients were treated with kindness and compassion. Patients had their own copies of care plans and were involved in their care plan reviews. However, delay in paperwork completion was also responsible for a large proportion of delayed discharges. 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. Staff told us they will move to a new electronic system in July 2015 which will be the same as other areas in the trust. 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away from training during the COVID-19 pandemic, but face to face training had restarted and not all staff who had out of date training had rebooked. The trust confirmed staff delivering end of life care were involved in bi-annual record keeping, safeguarding and clinical supervision audits. Staff received Mental Capacity Act 2005 and Deprivation of Liberty Safeguards Some staff did not demonstrate a good understanding of the Mental Capacity Act. This was a focused, unannounced inspection, to follow up on enforcement action we issued to the trust after our last inspection in November 2018. The local managers monitored the environment for staff, carried out local audits and checked performance of staff on a regular basis. The risks and issues described by staff did not always correspond to those reported to and understood by their leaders. There were high vacancy rates. Staff were unaware of any service specific strategic direction. The overall average compliance rate for supervision of staff in the learning disability wards was 46%. Managers had plans in place to address this issue. Staff treated patients with kindness, compassion and respect.We saw staff spend time talking to and their carers. 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. Medicine management training sessions had been undertaken with inpatient ward sisters and charge nurses. 56% of individual care plans were not up to date, personalised or holistic. A new chief executive was appointed as a shared role between the two trusts. There were clear treatment pathways. There were no pharmacy services within the community mental health teams or crisis team. Since our 2017 inspection, the trust had not fully ensured that clinical premises where patients received care where safe, clean well equipped, well maintained and fit for purpose. Staff recognised and responded to the changing needs of patients with anticipatory medications readily available and care needs assessed and reviewed appropriately. The trust supported a BAME network (black and minority ethnic) however, given the diversity of the geographical area of the trust, they had not significantly developed its agenda or work streams since our last inspection. Staffing levels were adequate at the time of our inspection but staff told us that they had been short staffed for some time and that there were a number of vacancies. One patient on Heather ward claimed that they had previously watched a staff member walking past a distressed patient and did not seek to reassure them or ask what was wrong. Following this inspection the trust were required to ensure teams were adequately staffed to prevent impacts on staff workload and ensure staff completed mandatory training in line with trust requirements.Insufficient progress had been made against these notices. Facilities had been adapted to improve access and systems were in place to support the most vulnerable. Staff told us they felt happy and enjoyed their work. 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. The duty system enabled urgent referrals to be seen quickly. The trust was not fully compliant with same sex accommodation guidance in two acute wards, the short stay learning disability service and rehabilitation services. We received mixed feedback about staffing levels and several staffing reported concerns. The trust had several strategies, a vision and corporate objectives, but they did not underpin all policies and practices. Carers told us they had regular contact with the CRHT team and they were kept involved with their loved ones care. There was a lack of understanding in teams how their own plans, visions and objectives connected with the trusts vision. Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. The trust had launched its "Step up to Great" approach, which identified the vision and priorities for the year. Suspended ratings are being reviewed by us and will be published soon. There were no separate female bedroom areas and no gender specific toilets or bathrooms. We identified medicines management issues, including out of date medication in the acute mental health wards and fridge temperatures were not monitored in community based mental health services for adults. However staff did not appear to be fully aware of services provided and told us there were plans to implement a seven day service in end of life care. All wards had developed their own systems to improve medicines management in their areas. Patients needs were assessed and monitored individually. Morale was found to be poor in some areas and some staff told us that they did not feel engaged by the trust. 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. In CAMHS community teams waiting times from referral to initial assessment was less than 13 weeks. Therefore, if a female needed a psychiatric intensive care unit they were sent out of area. Patients were full of praise for staff and the care and support they offered. 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. We saw the trust had developed oversight and a vision on how to improve the nine key areas identified by the warning notice. Specialist community mental health services for children and young people, Community-based mental health services for older people, Community-based mental health services for adults of working age, Community health services for children, young people and families. Managers shared the outcome of complaints with their ward teams. 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. Staff maintained a presence in clinical areas to observe and support patients. Staff followed infection control practices and maintained equipment through regular servicing. The trust had maintained patients privacy and dignity at Short Breaks Services. The 30 bed unit at Stewart House was mixed sex and there were no doors to lock between the male and female sections. We rated wards for older people with mental health problems as good because: The wards complied with the Department of Health 2015 guidelines on single sex accommodation. We were aware the local commissioning groups had not set targets for wait times. The trust had begun the process of replacing some beds with more suitable options for the patient group. Clinic rooms were overstocked with medications. For example, furniture was light and portable and could be used as a weapon. Some facilities lacked essential emergency equipment. We rated it as good because: Leicestershire Partnership NHS Trust: Evidence appendix published 30 April 2018 for - PDF - (opens in new window), Published Staff gave examples of working with people with diverse needs considering their ethnicity, gender, age and culture. 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. This had previously been identified on the CQC inspection in March 2015. Patients returning from leave from the acute mental health wards were not assured of returning to their original ward. Managers completed ligature audits which highlighted what mitigation was in place to reduce the risk for patients. Since the last inspection the service now had a Section 136 suite that met the standards set out in the Royal College Standards. Data could not be relied upon to measure service performance or improvement.Data collection and interpretation did not include key pieces of information for example number of delayed or missed visits. There were good systems for lone-working which included a code word that staff used when they required assistance. 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. Managers ensured they monitored the reporting and recording of incidents and complaints. Staff demonstrated poor understanding of some aspects of the Mental Capacity Act. We reviewed 267 case records and found that, generally, staff completed detailed individualised risk assessments for patients on admission. Staff working within the CRHT team and the liaison mental health triage service had not clearly document in patient paperwork or case notes if the patient had capacity or not. 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 were not meeting targets for the assessment and assessment to treatment of urgent referrals and six week routine referrals. Between August 2015 and July 2016, there were 60 delayed discharges across the service. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. Find out more. The trust had a patient involvement centre, which was pleasant, well-equipped and supported involvement from friends and family. A further review was an examination of processes and procedures within the trust for reporting investigations and learning from serious incidents requiring investigation. Staff felt supported by their immediate managers but felt disaffected with trust senior management. We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. We rated families, young people and children services as good because: There were systems in place for reporting incidents and the service was able to demonstrate learning and sharing following incident investigations. Care records for patients using the CRHT teams were not holistic or personalised. The ward had an up to date ligature risk audit, staff mitigated the risks on the ward by observing patients. There was good multi-disciplinary working within the teams. The service had not met the six week target for initial assessment, on average patients were seen six days over the target date. Good We observed positive interactions between staff and children and the use of age appropriate language. We inspected adult psychiatric liaison services as part of Mental Health Crisis and Health Based Places of Safety core service. However, there were some instances when patients privacy and dignity were not respected. 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 trust employed registered general nurses (RGN) to assist with assessment and management of physical healthcare needs for patients. Supervision, appraisals and training compliance did not always meet the trust standard. There were not always enough staff who were suitably qualified and experienced to safely meet patients needs. Staff were confused about Deprivation of Liberty standards and paperwork was incomplete. Cleaning products in a cupboard in the waiting area was unlocked, which posed a risk to the young people. Patients families and carers were positive about the care provided. Staff were given feedback after incidents had been reported. Staff received regular supervision and most had received an appraisal in the last 12 months. Staff had not routinely recorded whether they had given patients copies of their care plans and we saw this in a considerable number of patient records we sampled. Staff allowed patients time to respond to questions and did not try to hurry them. Patients privacy and dignity had been addressed at The Willows, Cedar and Acacia wards with changes made to male and female wards. The trust confirmed that these were reinstalled after the inspection had taken place. Recruitment was in progress for 10 new healthcare support workers. Waiting times and lists remained of concern, and this had been identified in the previous inspection. This impacted on staffs ability to assess and treat young people in a timely manner. 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. Managers ensured they monitored their staffs compliance with mandatory training using a tracker system. 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. Staff documented seclusion well in most services, compared to our last inspection. Designated staff were not provided by the trust. Records in the HBPoS did not clearly indicate if patients had their rights explained to them. Consultations with staff and the public had been undertaken to gain feedback on the proposed move of wards. No rating/under appeal/rating suspended The community healthcare services provided by Leicestershire Partnership NHS Trust were judged to be good. Managers ensured they used regular bank staff to achieve the required safer staffing levels and to promote continuity of care of patients. On Kirby ward there was no evidence of Section 132 rights read on detention in 54% of records reviewed. The patients did not consistently have their physical healthcare monitored or recorded, unless there were identified problems. There's no need for the service to take further action. The trust did not ensure that they meet set target times for referral to initial assessment, and assessment to treatment in the majority of teams. Interpreters were used when working with people who did not have English as a first language. This was a significant improvement since our last inspection which reported 171 out of area placements lasting between two and 192 days. specialist community mental health services for children and young people. There were problems with access to the electronic system owing to ongoing building works. However, they did not always meet the required skill mix for the nursing teams. CV6 6NY, In This was highlighted in the previous inspection. At the Agnes Unit, staff did not always record the physical health of patients who had been given rapid tranquilisation. Patients reported that they felt safe on the wards. We found a patient being nursed in the low stimulus area and their liberty was restricted. 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. Leicester, United Kingdom. Staff worked with both internal and external agencies to coordinate care and discharge plans. We work in partnership with a range of NHS organisations, local government and other bodies and are ultimately accountable to the secretary of state for health. Funding had been secured for increased staff with specialist skills. We saw evidence of good team working during our inspection. For example, issues found in risk assessments, care plans and environmental concerns had been addressed in some services, but not all since our last inspection. On four wards in acute wards for adults of working age, there were shared sleeping arrangements for patients. Some actions were required to ensure adherence with the Mental Health Act. Thy are entitled to receive a remuneration of 13,000 per annum each and have . 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. There was strong local leadership on the community inpatient wards and in the community. o We do what we say we are going to do. Adult liaison psychiatry services are delivered by the mental health trust across three acute hospital sites at Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital. Staff were kind, caring and compassionate and treated patients with dignity and respect. We carried out this unannounced focused inspection of adult liaison psychiatry services as part of a system wide inspection of Urgent and Emergency Care provision in the Leicester, Leicestershire and Rutland Integrated Care System. We did not rate this inspection. there are some services which we cant rate, while some might be under appeal from the provider. However, 323 were waiting for their first appointment through the access team, to complete a core mental health assessment. We use cookies to improve your experience on our website. Acute patients had been sent to rehabilitation wards inappropriately. Multidisciplinary team work both internal and external to the service was effective and patients were supported to make informed decisions about their care. Outcomes of care and treatment were not always consistently or robustly monitored. Staff and senior leaders could not articulate the trusts direction of travel and how this was co-ordinated. Patients were positive about their care and treatment and said staff were caring and understanding and respectful. The phones on each ward were in communal areas; the phone on Griffin ward had not been moved since the last inspection, although it had a privacy hood installed. There were clear responsibilities, roles and systems of accountability to support good governance and management. Patients social, emotional and religious needs were met and relatives valued the emotional support they received. Plans were shared with family and carers. Where patients took medicines home with them, staff ensured that they understood their use and storage. . The136 suiteis a place of safety for those who have been detained under Section 136 of the Mental Health Act. o We are passionate and creative in our work. We felt this contributed to senior staff views that pace of change in the trust was slow. We rated well-led as inadequate, safe, effective, and responsive as requires improvement and caring, as good. Due to the large caseloads in community health service, the number of visits that were required was not always manageable. At this inspection the well-led provider rating improved from inadequate to requires improvement. The offer is for 250 to be paid through payroll and subject to tax and National Insurance and is non pensionable. Staff interacted with patients in a caring and respectful manner. We found that there were still errors within the staffs application of the Mental Capacity Act. Staff were de-briefed and supported after a serious incident; we saw that incidents were a standing agenda item for team meetings and were discussed with staff. Beds were not always available for people living in the trusts catchment area. Some areas at Bradgate Mental Health Unit required further improvements to the environments. 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. One Community Learning Disability Team had developed an educational awareness raising event to prevent hospital admissions due to dehydration. The trust reported a 10% increase in the number of referrals received into the CAMHS service. 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. Inpatient and community staff reported difficulties with getting inpatient beds. Shifts were not always covered with sufficient staff, or with staff who had the appropriate qualification and experience for the role. Leicestershire Partnership NHS Trust (LPT) provides a range of community health, mental health and learning disability services for people of all ages. We observed some very positive examples of staff providing emotional support to people. We heard from most teams, positive examples of teamwork and multidisciplinary working within teams and services, and with external agencies and key stakeholders. Staffing levels were not consistent across the two sites. Within the end of life service 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. The trust had long term plans to address this. However there were significant problems with key areas of governance in relation to the management of prescriptions. Therefore, overall, eight of the trusts 15 services are now rated as good, five as requires improvement and two as inadequate. There was evidence of leadership at local and senior level. This promotion is being run by Leicestershire Partnership NHS Trust. People knew how to make a complaint as this information was provided in welcome packs. These services were: We inspected all key lines of enquiry in two domains (safe and well-led) in a third service. The trust had a variety of measures in place to ensure that processes and reporting to board were not delayed. Watch our short film to find out more: We Are LPT Share From a National Health Service (NHS) organisation Watch on Our strategy This was an issue highlighted at our inspection in 2018. At the Valentine Centre improvements had been made to the storage of cleaning materials. Therefore, the trust could not be sure staff received information to support best practice and change in a timely manner. Suspended ratings are being reviewed by us and will be published soon. The lack of psychology was an issue highlighted at our 2018 inspection. We saw that consent was gained from people in relation to their care and future wishes. Staff were aware of the reporting policy and procedure and could give examples of when this was carried out. The group established a deliberate self harm and suicide group in the last year to oversee specific incidents of this nature. Employees also rated Leicestershire Partnership NHS Trust 3.1 out of 5 for work life balance, 3.6 for culture and values and 3.7 for career opportunities. It promises that we will lead with compassion and inclusivity, with the health and wellbeing of our staff at the heart of all we do. We found concerning evidence of long waiting times for assessment in specialist community mental health services for children and young people. The scrutiny process was multi-tiered, which included the nurse, Mental Health Act administrator and medical scrutiny. This could have resulted in an increased risk of incorrect safe and secure handling of medicines and unsafe practice in relation to the administration and prescribing of medicines. 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. There was good physical health care and good therapeutic treatment and activities. A programme of work was due to start in forthcoming months, for wards yet to be refurbished. Managers had a recruitment plan in place to increase the number of substantive staff for the service. Staff completed risk assessments that were thorough and had been reviewed following incidents. Patients using the CRHT team had limited access to psychological therapies and there were no psychologists working within the CRHT team. Patients and their relatives felt involved in the care provided. Clinical supervision rates were low. 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. This monthly award is about recognising members of staff who have gone the extra mile. Nursing staff did not have a stock list to randomly check medication which meant they could not reconciliation check. Staff told us the trust was a good place to work. Detention paperwork for those detained under the Mental Health Act was detailed and followed procedures. Staff acknowledged directors visits. Sixty per cent of staff working in the mental health services had attended supervision and 64% of staff working in community health inpatient services. Staff knew the vision and values of the trust and agreed with these. : Staff completed and regularly reviewed and updated comprehensive risk assessments. Our HIV/AIDS Services program is in need of volunteers to help deliver . 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. Detention renewal paperwork had been signed by a doctor prior to them seeing the patient. Staff had limited opportunities to receive specialist training. 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