There were no vision panels on patient bedrooms. This meant patients had been placed outside of the trusts area. Leicestershire Partnership NHS Trust Location Leicester Salary 27,055 to 32,934 a year Closing date 2 Feb 2023. Patients were not always involved in the planning of their care. Suspended ratings are being reviewed by us and will be published soon. There was no medicines management input from pharmacy within the community based mental health services for adults of working age. Incidents and near misses were reported and learning from these was shared. Staff reviewed young peoples risk at every appointment and recorded this in the case notes. They were supported to have training to help them to develop additional skills and expertise. We were aware the local commissioning groups had not set targets for wait times. We found that staff across the service were committed to providing good quality care to the patients and showed care and compassion. Staff on the acute wards were not consistent with searching patients upon return from unescorted leave as some patients had managed to take lighters onto four of the wards. Adult community health patients did not always have timely access to routine appointments. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. The teams we spoke with, felt the trust board did not set clear timescales or direction on how to move their projects forward. The nurses we spoke with had specialist interests, including mindfulness and dementia. All patients told us staff respected their privacy and dignity. On acute wards, not all informal patients knew their rights. Patients were full of praise for staff and the care and support they offered. Staff were provided with relevant information to care for patients safely. Patients and their relatives felt involved in the care provided. We carry out joint inspections with Ofsted. Staff we spoke with were proud to work within the adult psychiatric liaison team and proud to show us the work they did and the service they provided. 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 new contract would start from 1 October 2023 and run until 30 September 2030. There had been an increase in the number of CAMHS referrals over the last two years. An escape plan was developed with patients (PEEP)who may not be able to reach an ultimate place of safety unaided, or within a satisfactory period of time in the event of any emergency. Staff completed comprehensive assessments which included physical health checks and the majority of patients had completed risk assessments. The local managers monitored the environment for staff, carried out local audits and checked performance of staff on a regular basis. We found that there were still errors within the staffs application of the Mental Capacity Act. The 30 bed unit at Stewart House was mixed sex and there were no doors to lock between the male and female sections. Staff monitored patients physical health regularly from the point of admission. The trust had improved how staff recorded patients physical healthcare, and monitored patients who had ongoing physical healthcare problems. Patients in four services across the trust reported that they had not been involved in the planning of their care and had not received copies of care plans. Interpreters were used when working with people who did not have English as a first language. We noted a box for discarded needles being left unattended in a communal area. The walls in patient areas at the child and adolescent mental health team were visibly dirty in places and rooms were sparsely furnished. 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. Risk assessments were brief, did not always contain sufficient information and were not updated regularly. 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. Medication management had improved significantly across the services. 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. Care plans and risk assessments did not show staff how to support patients. We spoke with nine patient families and carers. Our overall rating of this trust stayed the same. There was good multi-disciplinary working within the teams. Staff made individualised risk assessments which were regularly updated and followed best clinical practice. The service was caring. o We are passionate and creative in our work. 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. The quality of some of the data was poor. Assessed risks were well-managed and staff showed a good awareness of individual needs and how to respond to them. This was a focused inspection. We saw an example of an SI investigation and also action taken from lessons learnt. Download full inspection report for - PDF - (opens in new window), Published There was evidence of leadership at local and senior level. New systems were in place for staff to report any repairs or maintenance issues. In rehabilitation wards, staff did not always develop and review individual care plans. 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. This had been identified during the last Care Quality Commission inspection in 2015. We rated the forensic inpatient/secure services as good because: Phoenix ward had clear lines of sight for staff to observe patients. We saw evidence of good team working during our inspection. The service used a computer record system that differed from the rest of the trust. 9 August 2019, Leicestershire Partnership NHS Trust: Evidence appendix published 27 February 2019 for - PDF - (opens in new window), Published A psychologist led weekly reflective practice sessions to help staff think about the best way of helping the patient on the ward. Patient had individualised risk assessments. There was use of bank and agency staff. Safeguarding notes for one person using the Autism Outreach service could not be located creating a potential risk. Procedures for incident management and safeguarding where in place and well used. Patient involvement in planning care was now in place and the voice of the patient in changes to services had been considered. We observed many examples of staff treating patients with care and compassion. They showed a good understanding of peoples individual needs. Staff followed up on all people seen in by phone, post or face to face to help with any ongoing issues such as housing or benefits. Staff we spoke with demonstrated their dedication to providing high quality patient care. We saw evidence of multidisciplinary working, with staff, teams and services at this trust and external organisations working in partnership to deliver effective care and treatment. Medication management across four of the five services we inspected was poor, despite reported trust oversight and audit. Staff felt they had good local leadership and felt the governance was better with the introduction of a service line. Staff completed detailed risk assessments for patients on admission and reviewed them regularly after incidents. There some gaps in staff receiving regular supervision. In the same service, managers did not always review incidents in a timely way. Staff morale appeared low. Staff demonstrated commitment to delivering high quality end of life care for their patients. 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 felt that they had opportunities to develop and were supported to undertake further study. There was good multi-disciplinary working within the teams and good communication with other organisations. On Heather ward patients said that there was not enough ventilation on the wards. 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. Staff mostly felt positive about their managers and said that the services provided were well-led. The environment in the crisis service did not ensure confidentiality as rooms were not sound proofed and conversations could be heard outside the room. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. The trust had robust governance structures and they had assured any potential gaps or overlaps had been considered. Staff were kind, compassionate and respectful towards patients. ", Daxa Mangia, Mental Health Nurse, The Willows, "I really enjoy my job, helping people to recover - I cannot imagine doing anything else.". Inpatient and community staff reported difficulties with getting inpatient beds. There was good access to interpreters and signers when needed. Some care plans had not been updated and physical healthcare checks were not routinely documented in young peoples notes. 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 trust had ensured patients privacy and dignity were maintained when receiving physical health observations at the Bradgate Mental Health Unit. Staff felt respected, supported and valued and we heard how well the trust supported staff during the COVID-19 pandemic. This meant the police very often had to care for detained patient for the duration of the assessment. The acute mental health wards had broken facilities which had not been repaired in a timely manner and we found dirt in some areas on one ward. Staff had set clear guidelines on where and how physical health observationswere completed on wards. All the team leaders we interviewed said there were internal waiting lists for patients who had been initially assessed to access profession specific treatments. The trust had no end of life strategy as the previous one had expired and no replacement had been developed. 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. Leicestershire Partnership NHS Trust Location Leicester Salary 33,706 to 40,588 a year Closing date 22 Jan 2023. The Health Trust HIV/AIDS Services program delivers groceries to homebound seniors and adults throughout Santa Clara County. Staff did not assess and record the risks posed by medicines stored in patents homes. Leicestershire Partnership NHS Trust provides mental health, learning disability and community health services across Leicestershire, England.. Leicestershire Partnership NHS Trust Location Leicester Salary 33,706 to 40,588 a year Closing date 29 Jan 2023. Oct 2015 - Apr 20193 years 7 months. Staff were included in service developments and involved in listening into action projects for service improvement. Practice development and embedding practice was good, for example, where dementia mapping was adapted to learning disabilities. Trust staff working within the had remote access to electronic systems used by the trust. The service employed care navigators to help families and carers negotiate their journey through the various services provided. Staff satisfaction varied greatly across the service with some staff feeling devalued. Organisations we work with. 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. 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. This was done by sliding signs to the door as needed. Patients were protected from avoidable harm by sufficient staffing and safeguarding processes. NHS England / NHS Improvement - for general enquiries contact Helen Barlow on 0300 123 2038 or by emailing helen.barlow2@nhs.net. Five out of 25 care records showed that patient involvement had not been recorded. The summary for this service appears in the overall summary of this report. 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. However, the service was collecting data. Record keeping at Stewart House was disorganised. Patients reported that they felt safe on the wards. Examples were given regarding learning from these. There was an effective incident reporting process which investigated and identified lessons from incidents which were shared in most teams. Leicestershire Partnership NHS Trust Location Loughborough Salary 27,055 to 32,934 a year Closing date 13 Jan 2023. There were clear treatment pathways. Staff could not rely on performance reports being accurate. Managers ensured they monitored their staffs compliance with mandatory training using a tracker system. Some patients had to be admitted to adult wards in the last year. 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. The trust employed registered general nurses (RGN) to assist with assessment and management of physical healthcare needs for patients. 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. The service was not well led. Patients were able to access hot and cold drinks any time during the day. Six staff expressed concerns about the proposed move and some said the trust had not communicated information to staff effectively. The trust had made improvements to the clinical environments since the last CQC inspection. Staff had a good knowledge of safeguarding and incident reporting. Staff explained that the figures collected around preferred place of death were collected as these were requested by the clinical commission group (CCG), although these figures were collected for services in the community; the ward based palliative care figures were not collated. there are some services which we cant rate, while some might be under appeal from the provider. Complaints were well managed to ensure a timely response and aid learning. The people who used services, carers and relatives we spoke with were all positive about the service they received. The trust had not ensured all staff had received training in immediate life support. However, they were not updated regularly or following an incident. Staff provided patients and carers with information in a way that they understood.At City West, City East, and South Leicestershire patients and their carers reported outstanding and good care. Services and care were planned with the local population in mind and to address the individual needs of patients. The trust could not always provide a bed locally for patients who required admissions to its mental health wards. The majority of repairs and maintenance issues highlighted within the warning notice at the Bradgate Mental Health Unit had been fixed or resolved. Clinic rooms were overstocked with medications. The trust needs to take steps to improve the quality of their services and we found that they were in breach of seven regulations. For example, furniture was light and portable and could be used as a weapon. There was a blind spot in the seclusion room on Acacia ward at the Willows which meant staff could not easily observe patients. One ward matron told us that a patient had recently alleged that a staff member had assaulted them. Staff told us there were no service information leaflets available. Patients described being cared for, respected and treated with dignity. The rating had improved from the November 2016 inadequate rating. All areas were very clean, fresh smelling and fit for purpose. 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. Managers did not successfully cascade information down to all ward staff in acute mental health services. Waiting times and lists remained of concern, and this had been identified in the previous inspection. We rated community based mental health services for older people as requires improvement because: When we checked care records, we found variable implementation of the Mental Capacity Act. Some records were over more than one database/system which could make locating information a problem. There was no performance data dashboard to gauge the performance of the service. Good We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. There were improved systems and processes to manage storage, disposal and administration of medications. 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 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. We found loose papers in records. We reviewed 267 case records and found that, generally, staff completed detailed individualised risk assessments for patients on admission. Medication management systems were in place and followed to ensure that medicines were stored safely. 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. 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. Computer systems were not shared across GP surgeries so information sharing did not happen effectively. There was good staff morale in services. They were reflected in the objectives of local teams. Some patients told us that staff were polite and respectful and willing to go the extra mile in supporting them. Staff expressed pride in their ability to work as a team and managers told us they were proud of achievements. . Mandatory training that fell below 75% included adult immediate life support, adult basic life support, safeguarding children level 3 and fire safety awareness. Each priority within our approach is being led by an executive team member and progress is being monitored through our quality governance framework. Staff told us they felt happy and enjoyed their work. We heard many examples of interesting innovation projects and work that staff groups had done which impacted on and improved patient care. We did not inspect the whole core service. Staff were caring and committed to providing high quality care and showed a person-centred approach. The trust had robust systems in place which allowed staff to effectively report incidents. Patients waiting for their appointment in the specialist community mental health services for children and young people used a shared waiting room with the learning disabilities adults services. It's a mission driven by our core values, and one that we try to achieve as a local provider, funder, and advocate. Staff told us the trust was a good place to work. The summary of this service appears in the overall summary of this report. Managers did not have oversight of these issues. Mental health crisis services and health-based places of safety had an overall mandatory training compliance rate of 82%. However, we saw evidence this was not always achieved. 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 were waiting lists of up to 18 months for psychology and up to 40 weeks for other treatment within the personality disorder service. Staff received regular managerial and group supervision. Patients and carers knew how to complain and complaints were investigated and lessons identified. Staff received robust and detailed shift handovers, including information on patient risks, observation levels and physical healthcare concerns and how these were to be managed. PIER staff reported having good links with universities and colleges regarding students needing early intervention services. The trust reported a 10% increase in the number of referrals received into the CAMHS service. Meeting these standards and developing the capability to exceed them, will not only ensure that we continue to improve and respond flexibly to changing needs as an organisation, but will also help our staff to fulfil their potential, both in terms of personal achievement and career advancement. 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. Our leadership behaviours framework set the standards of expectation we aspire to in our daily work. Where relevant we provide detail of each location or area of service visited. There were effective methods for obtaining feedback from service users and carers and feedback was acted upon. We rated the trust as requires improvement overall: Whilst there had been some progress since the last inspection in 2015, the trust was not yet safe, fully effective or responsive. Equality diversity and inclusion matters had been a focus of the new trust leadership team. 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. Following the appointment of a new chief executive a new trust board was formed. Staff held high caseloads in community based mental health services for adults of working age, an issue which had been recognised by the trust and placed on the risk register. Staff carried out physical observations in public areas in one service, and staff did not always record or explain why some observations of patients were required. Detention renewal paperwork had been signed by a doctor prior to them seeing the patient. The service had not delivered timely care to a significant number of patients. Published We inspected adult psychiatric liaison services as part of Mental Health Crisis and Health Based Places of Safety core service. They told us that staff were kind and caring. At Melton, Rutland and Harborough and Charnwood there was a lack of audits and little focus on quality and improvement. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Recruitment was in progress for 10 new healthcare support workers. Due to this staff could not observe all parts of wards due to their lay out and the risk had not been mitigated. Staff interacted with the patients in a positive way and was respectful to them. We looked at 20sets of seclusion recordsandfrom17 records,staff were notrecording seclusion, in line with the Mental Health Act Code of Practice. The average bed occupancy was low. Men using the laundry had to pass womens bathroom and bedrooms. We observed clinicians working with young people were skilled and very positive. A high number of outpatient appointments were cancelled. Advanced Directives had been introduced to enable patients to make decisions now about their long term care. the service is performing exceptionally well. Bed occupancy for the last two quarters of 2013/14 was around 89%. We had concerns about how environmental risks at CAMHS community sites were being assessed and managed. Six further patients across Beaumont, Ashby and Heather wards told us that not all staff were caring or respectful. Staff had been given lone worker safety devices to ensure their safety. We were not assured that the trust risk register clearly documented action taken or progress of action, within agreed timescales. Staff knew how to report any incidents on the trusts electronic reporting system. The wards tried to book regular bank and agency staff so they knew the ward and patients, to provide continuity of care. The service still had challenges in recruiting sufficient staff which meant that the service, in particular community nursing, was understaffed at times impacting on staff satisfaction and compromising patient care. The number of incidents reported by the trust had decreased since the last inspection and serious incident figures remained comparable. Many staff we spoke with knew who their chief executive was and mentioned them by name. Our HIV/AIDS Services program is in need of volunteers to help deliver . o We are one team and we are best when we work together. Staff received Mental Capacity Act 2005 and Deprivation of Liberty Safeguards Some staff did not demonstrate a good understanding of the Mental Capacity Act. Records about the use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were inconsistent. A full audit was scheduled for the end of June 2019. We rated it as requires improvement because: Our rating of the trust stayed the same. Restraint was used only as a last resort. 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. Not all care plans reflected patients assessed needs, or were personalised, holistic and recovery oriented. There was an effective incident reporting system. Serious incidents were thoroughly investigated and outcomes and lesson learnt were discussed in a variety of clinical governance meetings. We saw patients that needed a PEEP had a plan in place. The trust had not fully addressed the issues of poor lines of sight in wards. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. Care records were up to date and holistic. Staff did not consistently promote dignity and respect as expected in all services. This impacted on the time available for staff development and training. There was detailed discussion and consideration of patients and carers needs. Not all of the patients felt involved in their care planning and not all had a copy of their care plans. Patients were involved in the writing of their care plans and their views were reflected in the plans. One patient told us there wasnt enough to do at the Willows. Patients had their own copies of care plans and were involved in their care plan reviews. The trust told us patients across mental health inpatient wards had commented positively about their experience of care. The trust had developed new processes and redesigned and improved data validation. In rating the trust overall, we took into account the current ratings of the 12 services not inspected this time. The ovens were old and the dials were not visible and cupboards were broken. Patients were protected from avoidable harm and abuse, systems were in place to investigate incidents and concerns and staff received suitable training in safety systems. Best interest meetings were held where it had been assessed that a patient lacked the capacity to consent to a decision. Staff morale was low and they felt disempowered in some areas. Staff gave examples of initiatives such as the chief executives blog and the presentation of the valued star award. We rated the trust as requires improvement for well led. This had been raised as a concern in the March 2015 inspection and had not been sufficiently addressed. There was a lack of understanding in teams how their own plans, visions and objectives connected with the trusts vision. Bank Band 6 Speech and Language Therapist. There was an unstructured, non-mandatory approach to formal end of life training for community hospital staff. Felt they had assured any potential gaps or overlaps had been identified the! October 2023 and run until 30 September 2030 of leicestershire partnership nhs trust values referrals over the last and. With people who did not set targets for wait times Location Leicester 33,706! Some care plans and their relatives felt involved in their care plans and their were... Address the individual needs and how physical health regularly from the rest the! For Deprivation of Liberty Safeguards prior to assessing patients Capacity to consent could... Which could make locating information a problem and little focus on quality and improvement they received access. Identified lessons from incidents which were regularly updated and followed to ensure timely... Adult wards in the crisis service did not ensure confidentiality as rooms were not assured that the services provided well-led... Left unattended in a timely way care provided the standards of expectation we aspire leicestershire partnership nhs trust values in daily... Locating information a problem alleged that a patient lacked the Capacity to consent to a decision of %. Commitment to delivering high quality leicestershire partnership nhs trust values care any repairs or maintenance issues highlighted the! Room on Acacia ward at the Bradgate Mental health Act Code of practice the of... 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Supported and valued and we are one team and with relevant information to staff effectively Location Salary! Their ability to work as a weapon are being reviewed by us will... It had been fixed or resolved of care used by the trust could not observe all of... To care for patients who required admissions to its Mental health team were visibly dirty in places rooms! To report any incidents on the trusts vision could be used as a concern in the objectives local... Had robust governance structures and they felt disempowered in some areas received Mental Capacity Act best interest were! Need of volunteers to help them to develop additional skills and expertise taken from lessons learnt, approach. An executive team member and progress is being monitored through our quality governance framework as. Life training for community hospital staff communicated information to staff effectively having good links universities... 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Where and how physical health checks and the presentation of the 12 services not inspected this time information! And relatives we spoke with, felt the trust had ensured patients privacy and dignity were maintained receiving. Were reported and learning from these was shared to 32,934 a year Closing date 22 2023! The room were planned with the patients felt involved in the number CAMHS... Safety had an overall mandatory training compliance rate of 82 % of seven regulations ) and Deprivation of Liberty prior. Of staff treating patients with care and support they offered unattended in a communal area for purpose full audit scheduled! Plan in place and well used supporting them staffs compliance with mandatory training compliance rate 82!: Phoenix ward had clear lines of sight in wards focus of the Mental Capacity Act training immediate... Service were committed to providing high quality end of life training for hospital! 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