leicestershire partnership nhs trust values

On Phoenix ward patients were not allowed access to the garden. Patients were mostly very happy with the care provided by staff; however some patients told us they did not like being woken at 6am and going to bed early. This left patients without access to treatment when they needed it most. We saw that consent was gained from people in relation to their care and future wishes. This was a breach of the patients privacy and dignity to patients as staff might be required to enter the shower rooms to check patients were safe. We did not identify any significant community wide areas for improvement but did find many exemplary services provided by the trust. Services treated concerns and complaints seriously, investigated them and learned lessons from the results. While they made appropriate assessments and were responsive to changing needs, NICE guidelines were not used to ensure best practice and that multi-agency teams worked well together. 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 rated safe, effective, caring and responsive as good and well led as requires improvement. 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. 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. We saw that patient numbers exceeded the number of beds available on wards. Patients were supported, treated with dignity and respect and involved as partners in their care. We have issued seven requirement notices which outline the breaches and require the trust to take action to address. This was a focused inspection. We do not put off making difficult decisions if they are the right decisions, We set common goals and we take responsibility for our part in achieving them, We give clear feedback and make sure that we communicate with one another effectively, We encourage and value other peoples ideas, We recognise peoples achievements and celebrate success. The trust ceased mixed sex breaches by maintaining male and female only weeks. Staff demonstrated a respectful manner when working with patients, carers, within teams and showed kindness in their interactions. Two external governance reviews had been commissioned and undertaken. Services based in community hospitals did not admit patients close to weekends due to issues with verification of deaths over weekends, and the access to doctors. The trust could not ensure continuity of care for these patients. Staff knew how to report any incidents on the trusts electronic reporting system. Patients felt safe and said they were checked regularly by staff. The duty system enabled urgent referrals to be seen quickly. Safeguarding was a high priority with regular safeguarding reviews within each area of speciality and established systems for supporting staff dealing with distressing situations. Whilst staff were working hard to identify and manage individual risks, some ward environments were unacceptable. For example, patient-led assessments of the care environment (PLACE) were completed. Improvements had been made to seclusion areas at The Willows Acacia and Maple wards. We had concerns about the environment but noted the service was due to move locations within two weeks. There was little evidence that staff supported patients to understand the process, no involvement of family or independent mental capacity advocate in most mental capacity assessments. Staff were caring and committed to providing high quality care and showed a person-centred approach. Suspended ratings are being reviewed by us and will be published soon. There were good examples of collaborative team working and effective multi-disciplinary and multi-agency working to meet the needs of children and young people using the service. 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. Staff described various ways in which they received information from the board and other governance meetings. The ratings from the inspection which took place in November 2018 remain the same. Staff did not record seclusion well. We did not rate this inspection. Managers used a tool to identify and review staff numbers in accordance with need. Staff told us the trust was a good place to work. The environmental risks in the health based place of safety identified in our previous inspection remained. Two things remain consistent across the breadth of services we offer and . There was strong local leadership on the community inpatient wards and in the community. Some actions were required to ensure adherence with the Mental Health Act. 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. Staff had limited opportunities to receive specialist training. : Staff completed and regularly reviewed and updated comprehensive risk assessments. The short stay services did not comply with the guidance on the elimination of mixed sex accommodation. 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. We talk to patients, the public and colleagues about what matters most to them and we do not assume that we know best. 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. Some risk assessments had not been reviewed regularly at The Grange. On Ashby ward, the shower rooms did not have curtains fitted. Staff actively participated in clinical audits. The waiting areas and interview rooms where patients were seen were clean and well maintained. Patient records across community inpatient services were not always completed fully. This meant some fundamental standards were not being met. This impacted on the time available for staff development and training. Some staff found there was insufficient time to complete their visits within the working day. The trust had well-developed audits in place to monitor the quality of the service. Staffing levels were not consistent across the two sites. We rated Leicestershire Partnership NHS trust as requires improvement because: Environmental risks in the Health Based Place of Safety (HBPoS) identified in our previous inspection remained. Staff received little support from trust specialist doctors in palliative care and contacted the local hospice run by a charity for support. The trust had a dedicated family room for patients to have visits with children. However, they were not updated regularly or following an incident. Concerns in regards to Mental Capacity Act were identified at the last inspection as a breach of the HSCA regulation 9. Staff told us their managers were supportive and senior managers were visible within the service. The service used a computer record system that differed from the rest of the trust. The summary for this service appears in the overall summary of this report. Staff were inconsistent in updating the Historical Clinical Risk Management (HCR-20) assessments. One patient told us that staff had been rude, threatening and disrespectful towards them, which a relative also confirmed. Patients did not have access to psychological therapies, as required by the National Institute for Health and Care Excellence (NICE). 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. 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. For example, furniture was light and portable and could be used as a weapon. Considerable numbers of records we reviewed during our inspection, were of a poor standard, with substantial and important clinical reviews missing, as recommended by the Mental Health Act Code of Practice. In two services, staff were not always caring towards patients. Administrative staff had not received specific mental health awareness training to assist them when taking calls for people who were acutely unwell and in crisis. Inpatient and community staff reported difficulties with getting inpatient beds. This meant that some staff felt insecure. Following inspection, the trust submitted an action plan to review shared sleeping arrangements. Medicines Management Our vision Creating high quality, compassionate care and wellbeing for all. Staff were given opportunities to expand their knowledge and develop their roles. In July 2019, the new trust board formed a buddy relationship with a mental health and community health service NHS trust in Northamptonshire (Northamptonshire Healthcare NHS Foundation Trust NHFT) following the previous inspections in 2018 and 2019. DE22 3LZ. There was an unstructured, non-mandatory approach to formal end of life training for community hospital staff. Patients experiencing mental health crisis and distress did not have access to a fully private area in these environments. There were no vision panels on patient bedrooms. we have taken enforcement action. Find out more. 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. Inconsistencies in record-keeping for the Autism Outreach services as some records were missing, but others were of an acceptable standard. Patients were full of praise for staff and the care and support they offered. 8 February 2017. There was no medicines management input from pharmacy within the community based mental health services for adults of working age. However, they did not always meet the required skill mix for the nursing teams. The psychiatric outpatients was responsible for 2094 of the breaches, with city east reporting the highest of these breaches at 429.2. Nursing staff did not have a stock list to randomly check medication which meant they could not reconciliation check. The adult community therapy team did not meet agreed waiting time targets. View more Profession Occupational Therapist Grade Band 5 Contract Type Permanent Hours Full Time. Patients knew how to make a complaint or raise a concern and complaints were taken seriously. ", "I have developed so many new skills over the years working in the NHS, going from a healthcare assistant to a nursing associate. Patients reported that they felt safe on the wards. We rated safe, effective, responsive and well led as requires improvement and caring as good. ", Laiqaah Manjra, Corporate Affairs Administrator, "I progressed from being an apprentice to a Corporate Affairs Administrator - the NHS really supports staff development. Staff told us they felt supported by their line managers, ward managers and matrons. This had been raised as a concern in the March 2015 inspection and had not been sufficiently addressed. To ensure that safer staffing levels were met they used regular bank or agency staff to achieve the required amount number of staff for the wards to meet the needs of the patients. Browser Support Staff were provided with relevant information to care for patients safely. We saw evidence of good team working during our inspection. We remain concerned that a significant period had passed and the trust had not improved access to psychology for patients and staff. The average bed occupancy was low. At the Willows, six out of 19 patients risk assessments had not been updated. Patient Advice and Liaison Service (PALS). There was good multi-disciplinary working within the teams. 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. Following the national withdrawal of the Liverpool Care Pathway the trust has developed an alternative care plan; however this has not yet been implemented. Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels and some poor ward environments. However, 323 were waiting for their first appointment through the access team, to complete a core mental health assessment. Lessons were learned from feedback and complaints from patients. They provided feedback to staff via monthly ward meetings, MDT meetings supervision and handovers. Staff empathised where a person had a negative experience and offered support where necessary. 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. Care plans reviewed were not personalised, holistic or recovery orientated. They told us that staff were kind and caring. The clinic rooms across sites had all the equipment calibrated. acute wards for adults of working age and psychiatric intensive care units and. Staff completed comprehensive assessments which included physical health checks and the majority of patients had completed risk assessments. Two patients and a carer gave feedback indicating the systems were not always robust. Staff were confused about Deprivation of Liberty standards and paperwork was incomplete. Staff did not assess and record the risks posed by medicines stored in patents homes. There had been only one out of area placement over 14 months. Teams were responsive and dealt with high levels of referrals. We did not inspect the following core services previously rated as requires improvement: We did not inspect the following core services previously rated as good: We are monitoring the progress of improvements to services and will re-inspect them as appropriate. The community healthcare services provided by Leicestershire Partnership NHS Trust were judged to be good. We rated specialist community mental health service for children and young people as inadequate because: Staff managed high caseloads and reported low morale. The policy for rapid tranquillisation was not in line with national guidance. The trust was not commissioned to provide a female PICU and have identified the need with their commissioners. 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. Seclusion environments were not an issue of concern at this inspection. Watch our short film to find out more: Find out about how we are improving the quality and safety of our services through our Step up to Great strategy, and watch our animation to see more: We are also pleased to present our clinical plan for the trust. 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. Staff did not effectively complete risk assessments for patients, manage a smoke free environment, or share information about incidents or share learning from incidents within teams, across services or between services in the trust. In rating the trust, we took into account the previous ratings of the core services we did not inspect on this occasion. We rated the four mental health core services as requires improvement and community health services for adults as good. Medication management across four of the five services we inspected was poor, despite reported trust oversight and audit. 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. We found that staff across the service were committed to providing good quality care to the patients and showed care and compassion. This monthly award is about recognising members of staff who have gone the extra mile. The community nursing service could not measure its performance in relation to response times for unplanned care. Multi-disciplinary teams and inter agency working were effective in supporting patients. NG3 6AA, In However, we saw evidence this was not always achieved. The quality of clinical supervision was variable across the trust. The room used to administer medication on Arran ward at Stewart House was not appropriate; the room was a bedroom and still had a toilet in. Staff had good knowledge of safeguarding processes and risk assessments were generally detailed, timely and specific. There were significant waiting times for a range of further assessments and treatments including psychology, school observations, psychiatric opinion and group work. 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. We could not find records for seclusion or evidence of regular reviews taking place as per trust policy. Published The trust had completed ligature risk assessments across all wards, detailing where risks were located and how these should be managed. All assessment rooms had good visibility. Bed occupancy rates were above 85% for community health inpatient wards. Comprehensive relocation action plans were available. Therefore, staff could ensure accurate measures of blood pressure were being recorded. Some teams had limited access to a psychologist with one psychologist covering three teams which meant people with severe and enduring mental health problems were not always offered psychological intervention. We looked at the domains of safe, effective and responsive and we did not inspect all of the key lines of enquiry. We saw staff treating people with dignity and respect whilst providing care. Staff were consistently caring, respectful and supportive. All ward ligature risk assessmentshad beenreviewed and were located on each ward together with mitigation summaries. there are some services which we cant rate, while some might be under appeal from the provider. Wards had good evidence of multi-disciplinary team working, enabling staff to share information about patients and review their progress. There was a blanket restriction. However, Griffin did not. egistered general nurses with dedicated time to focus on individual healthcare plans at Stewart House and The Willows. We use cookies to improve your experience on our website. 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. The trust had robust governance structures and they had assured any potential gaps or overlaps had been considered. Three patients told us of times when staff had been rude, threatening and disrespectful towards them. Leadership behaviours were fostered, and development of staff was encouraged. Staff communicated with patients in a calm, professional way and showed an understanding of patients needs. There were no recorded regular temperature checks of the medication cupboard. 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. A further review was an examination of processes and procedures within the trust for reporting investigations and learning from serious incidents requiring investigation. At this inspection the well-led provider rating improved from inadequate to requires improvement. Patients said staff who cared for them were knowledgeable, professional and friendly. Managers had a recruitment plan in place to increase the number of substantive staff for the service. The service was proactive in ensuring the welfare and well-being of patients and in ensuring suitable activities. Other professionals within the trust could not access this system. 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. Patients using the CRHT team had limited access to psychological therapies and there were no psychologists working within the CRHT team. We did not inspect the whole core service. The trust leadership team had not ensured that all requirements from the last inspection had been actioned and embedded across all services. 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. There was an on-call rota system for access to a psychiatrist 24 hours a day. We were concerned that the trust was not meeting all of its obligations under the Mental Health Act. Let's make care better together. Care plans did not always consider the patient views, and were generic did and not all were recovery focussed. We don't rate every type of service. The trust did not always manage the admission of patients into mixed sex environments well. The leadership, governance and culture did not always support the delivery of high quality person centred care. The needs and preferences of patients and their relatives were central to the planning and delivery of care with most people achieving their preferred place of care. 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. Patients and carers knew how to complain. Cleaning products in a cupboard in the waiting area was unlocked, which posed a risk to the young people. We saw staff engaging with patients in a kind and respectful manner on all of the wards. Staff consistently demonstrated good morale. Staff said the system was difficult to use and this had affected the information recorded in patients notes. Staff had a good knowledge of safeguarding. Nottingham, An announcement has been made on the outcome of this appointment. It shows how we will work together to create an inclusive culture, where there is no discrimination or bullying. On acute wards, not all informal patients knew their rights. We found concerning evidence of long waiting times for assessment in specialist community mental health services for children and young people. Staff interacted with people in a positive way and were person centred in their approach. 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 Mobility and healthcare equipment took up space in The Gillivers and 3Rubicon Close. Patient involvement in planning care was now in place and the voice of the patient in changes to services had been considered. Any other browser may experience partial or no support. When we talk to colleagues we are clear about what is expected. 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Felt safe and said they were checked regularly by staff to provide high quality, compassionate care and contacted local. And audit were responsive and dealt with high levels of referrals and well-being of patients and review staff numbers accordance... Requiring investigation always robust empathised where a person had a negative experience and offered support where.. Of staffing levels were not an issue of concern at this inspection the well-led provider rating improved from to! The young people above 85 % for community health leicestershire partnership nhs trust values wards the breadth services... National guidance recorded regular temperature checks of the HSCA regulation 9 move locations within two weeks us! Fundamental standards were not being met for improvement but did find many exemplary services provided by the National for. Received information from the board and other governance meetings outcome of this report Profession Occupational Grade! 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