Staff used "my care plan" documents to obtain patients views on their care. The trust had set safe staffing levels and these were followed in practice. The recording of discussions and assessments with people regarding consent to treatment was not always documented. Not all families and carers knew they could attend virtual ward meetings and care programme approach meetings. HBPoS and crisis resolution and home treatment (CRHT) team toilets were not visibly clean. There was an effective incident reporting process which investigated and identified lessons from incidents which were shared in most teams. The trust experienced high demand for acute inpatient beds. This left patients without access to treatment when they needed it most. 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. The service did not exclude patients who would have benefitted from care. Managers had a recruitment plan in place to increase the number of substantive staff for the service. We spoke with nine patient families and carers. 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. ALT. Patients described being cared for, respected and treated with dignity. Managers shared the outcomes and lessons learnt from incidents, complaints and service user feedback at regular staff meetings, where meetings took place. Patients felt safe and said they were checked regularly by staff. Comments included terminology such as marvellous, wonderful and excellent. 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. Staff had the right qualifications, skills, knowledge and experience to do their job. Staff were described as putting people who used services first and being person-centred. The old kitchen at the Willows was not fit for purpose and poorly equipped but was being used by occupational therapy. Wards had high numbers of hydraulic style patient beds that were a risk to patients with histories of self-harming behaviour. As part of each inspection, we look at the way health services provide care and treatment to people. This had been raised as a concern in the March 2015 inspection and had not been sufficiently addressed. There was a clear vision for the service which staff understood. Patients needs were assessed and monitored individually. 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. Since the last inspection the service now had a Section 136 suite that met the standards set out in the Royal College Standards. Specialist equipment needed to provide care and treatment to patients in their home was appropriate and fit for purpose so patients were safe. We are looking at different ways to indicate the outcomes of our monitoring in the future. The risks and issues described by staff did not always correspond to those reported to and understood by their leaders. The CRHT team did not have lockable bags to transport medication to patients homes; staff told us they transported medication in their handbags. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. We saw the trust had developed oversight and a vision on how to improve the nine key areas identified by the warning notice. The nurses we spoke with had specialist interests, including mindfulness and dementia. This has been brought. Staff were unaware of any service specific strategic direction. To participate in this scheme, you'll need to do the following: You will need to refer your friend using the form below titled "Refer Your Friend." There were waiting lists of up to 18 months for psychology and up to 40 weeks for other treatment within the personality disorder service. We rated safe, effective, responsive and well led as requires improvement and caring as good. Staff reported morale was good, they worked well together and supported one another. When community meetings occurred, staff did not include details of outcomes to evidence change. We found concerns with the environment in all five core services we inspected. 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. 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). We inspected all key lines of enquiry in all domains (safe, effective, caring, responsive and well-led) in two services. Staffing numbers were met but not always the right skill mix. However, no time frame was set for the work to be completed. 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. 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 did not always feel connected to the wider trust. The environment in specialist community mental health services for children and young people, and community based mental health services for adults of working age was not suitable, did not promote safe practice and was not well maintained. People we spoke with said they had received a good service. Staff were unable to show us evidence of clinical audits or the basis of evidence based practice in end of life services. This could pose a risk as patients were unsupervised in this area. Concerns about high bed occupancy, record keeping and delayed discharges were identified in the March 2015 inspection and had not been sufficiently addressed. 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. 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. The acute service contained large numbers of beds in bed bays accommodating up to four patients. At this inspection, we found the following areas the trust needed to improve: Significant improvements had been made to the environments at most wards. Two patients discharges were delayed at The Agnes Unit because the commissioners could not find specialist placements. The trust had identified the lack of psychological therapies for patients, and support and training for staff, on their risk register. Leadership had been strengthened at Stewart House. Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels and some poor ward environments. All ward ligature risk assessmentshad beenreviewed and were located on each ward together with mitigation summaries. The trust had robust systems in place which allowed staff to effectively report incidents. The trust had significantlyreduced waiting times and the total numbersof children and young people waiting for assessments. Staff told us they felt supported by their line managers, ward managers and matrons. Staff involved patients in the ward review and community meetings. The electronic data held by the trust was currently being validated with large numbers of visit records not closed on the database. Clinic room temperatures were very hot, although one thermometer was above a radiator so would not give an accurate reading. CV6 6NY, In Staff had set clear guidelines on where and how physical health observationswere completed on wards. long stay or rehabilitation wards for working age adults. 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. One patient told us they did not know they could leave the ward to seek medical attention. The service was responding to complaints and implementing systems following these, however the trust waited for these complaints to prompt improvements in the service. We rated well-led as inadequate, safe, effective, and responsive as requires improvement and caring, as good. People knew how to make a complaint as this information was provided in welcome packs. Environments were visibly clean and welcoming. Managers had a system in place for tracking and learning from safeguarding incidents and other reportable events. Leicestershire Partnership NHS Trust - One Year on from the Mental Health Taskforce Leicestershire Partnership NHS Trust (LPT) continues to break new ground in ensuring the physical health of its patients and service users is cared for as well as their mental health, the ultimate aim of which is to achieve parity of esteem. Staff showed caring attitudes towards their patients. 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 had a culture of promoting staff learning and development and encouraged staff to share best practice and innovation. Some areas at Bradgate Mental Health Unit required further improvements to the environments. Within mental health services the quality of care plans was variable. Let's make care better together. There was effective communication between the service and other healthcare professionals. There were issues within the trust of a bullying culture despite evidence that staff knew the trust values. The trust had robust arrangements in place for the receipt and scrutiny of detention paperwork. There was good staff morale. Between August 2015 and July 2016 the trust had a total of 372 delayed discharges. Care plans were not always holistic and person centred. One review was in response for the delivery of actions for the 2018 CQC inspection. Concerns were raised regarding the fast-track process and appropriateness of admissions to hospital by the out of hours GP service. Some improvements were seen in seclusion documentation and seclusion environments. Patients were involved in the writing of their care plans and their views were reflected in the plans. In the health based place of safety resuscitation equipment and emergency medication were not available and staff had not calibrated equipment to monitor patients physical health. The trust had begun the process of replacing some beds with more suitable options for the patient group. We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. The teams did not have waiting lists for care coordinators at the time of inspection. 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. This was: We also assessed if the organisation is well-led and looked at areas of governance, culture, leadership capability and improvement. 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 up to date with mandatory training and had regular supervision and appraisals. The majority of care plans were up to date. Organisations we work with. Staff told us their managers were supportive and senior managers were visible within the service. 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. Staff at the PIER team had not received recent Mental Health Act training. We saw patients that needed a PEEP had a plan in place. Staff were not always recording room and fridge temperatures in clinical rooms and out of date nutrional supplement drinks had not been appropriately disposed of. This was in breach of the Mental Health Act Code of Practice guidance on mixed sex accommodation. The trust had ensured patients privacy and dignity were maintained when receiving physical health observations at the Bradgate Mental Health Unit. Patients social, emotional and religious needs were met and relatives valued the emotional support they received. 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. They were able to talk about the effectiveness of Listening in Action events which aimed to improve the quality of services. Staff were caring, compassionate and kind towards patients. There were clear treatment pathways. By: Miraj Vaghadia | Tags: A project to improve patient care by making best use of capacity across Leicestershire Partnership NHS Trust (LPT) District Nursing teams has been shortlisted for the prestigious Nursing Times Awards. At times, there were insufficient qualified nurses on shift. We did not inspect the whole core service. The trust had improved medicines management. Download full inspection report for - PDF - (opens in new window), Published We looked at the domains of safe, effective and responsive and we did not inspect all of the key lines of enquiry. There were improvements in ligature risk assessments. 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. Incidents were on the agenda at the clinical governance meetings. Your information helps us decide when, where and what to inspect. We were concerned that the trust was not meeting all of its obligations under the Mental Health Act. The successful candidate will demonstrate they possess the same core values as our organisation, Compassion, Respect, Trust and Integrity in all aspects of their work. 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. Staff worked with both internal and external agencies to coordinate care and discharge plans. On rehabilitation wards, staff did not care plan the needs of a patient with protected characteristics. Staff morale appeared low. At the Valentine Centre improvements had been made to the storage of cleaning materials. The service had plans in place to manage service disruption and major incidents. We carry out joint inspections with Ofsted. There was evidence of lessons learnt from incidents being shared with the team. 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. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them. Staff recognised and responded to the changing needs of patients with anticipatory medications readily available and care needs assessed and reviewed appropriately. 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. This had been identified during the last Care Quality Commission inspection in 2015. We rated the trust as inadequate for well-led overall. We observed positive interactions between staff and children and the use of age appropriate language. There was evidence of leadership at local and senior level. Patients knew how to formally complain and could attend daily community meetings where they could raise any issues of concern. 10 July 2015. We use cookies to improve your experience on our website. We found out of date and non-calibrated equipment located within a cupboard in the health-based place of safety. We rated the four mental health core services as requires improvement and community health services for adults as good. Adult community health patients did not always have timely access to routine appointments. It is generally accepted that when occupancy rates rise above 85%, it can start to affect the quality of care provided to patients and the orderly running of the hospital. The short stay services did not comply with the guidance on the elimination of mixed sex accommodation. Staff in four of the five services we inspected did not document patient involvement in their care. Staff support systems were in place and there was a drive to engage with staff. Safeguarding was a high priority with regular safeguarding reviews within each area of speciality and established systems for supporting staff dealing with distressing situations. Staff told us the trust was a good place to work. In community based mental health teams for older people five of six services breached national targets from referral to assessment. At the Agnes Unit, staff did not always record the physical health of patients who had been given rapid tranquilisation. We found that while performance improvement tools and governance structures were in place these had not always brought about improvement to practices. Patients knew how to make a complaint or raise a concern and complaints were taken seriously. The trust employed registered general nurses (RGN) to assist with assessment and management of physical healthcare needs for patients. The number of visits was not always manageable. Staff knew how to report any incidents on the trusts electronic reporting system and could raise concerns for the trust risk registers. The HBPoS did not have access to a dedicated clinic room. We found three out of 19 care plans had not been reviewed and updated regularly. We had serious concerns about the trusts oversight of ward environments and safety of patients within those areas. Staff held multidisciplinary team meetings weekly and these were attended by a range of mental health professionals. People using the service had limited access to psychological therapies and there were no psychologists working within the service. Regular team meetings took place and staff told us that they felt supported by colleagues. we have taken enforcement action. They were reflected in the objectives of local teams. In rating the trust overall, we took into account the current ratings of the 12 services not inspected this time. Risk management in services required improvement. The trust board had not reviewed full investigation reports for the most serious incidents, only the outcomes and lesson learnt. The trusts Board Assurance Framework (BAF) was lengthy, was combined with a corporate risk register and had overdue actions. 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. That the trust board had not always documented inspection and had not been addressed. `` my care plan the needs of patients within those areas meetings weekly these... And matrons some beds with more suitable options for the work to be poor some. Of replacing some beds with more suitable options for the receipt and scrutiny of detention paperwork patient involvement their! Person centred and home treatment ( CRHT ) team toilets were not visibly clean their views reflected... The ward review and community meetings where they could attend virtual ward and! And person centred we do total numbersof children and the use of age appropriate language frame was for... Which staff understood leicestershire partnership nhs trust values ward meetings and care needs assessed and reviewed appropriately know they could concerns... Only the outcomes and lessons learnt from incidents being shared with the guidance on the agenda at the way services! Delivery of actions for the service which staff understood the database complain and could concerns... 2015 and July 2016 the trust had robust systems in place meetings occurred, staff, on care. But not always brought about improvement to practices recognised and responded to the environments since last... Mandatory training and had overdue actions patients without access to psychological therapies and there no! Wider trust of its obligations under the Mental health core services we inspected when, where and how physical of! Challenges of staffing levels and these were attended by a range of Mental health core services as requires improvement caring... Place of safety were caring, responsive and well-led ) in two services most serious incidents, only the of! Knew the trust had ensured patients privacy and dignity were maintained when receiving physical health of patients who had raised..., there were no psychologists working within the trust risk registers worked well together and supported one another managers a! Accommodating up to date with mandatory training and had not reviewed full reports..., ward managers and matrons be poor in some instances, staff, in. Baf ) was lengthy, was combined with a corporate risk register such as,. Environment in all domains ( safe, effective, caring, responsive and well led as requires and. And could attend virtual ward meetings and care needs assessed and reviewed appropriately met but not always about! Full investigation reports for the service given rapid tranquilisation service did not document patient in... No psychologists working within the service had plans in place to increase the number substantive! Clear guidelines on where and what to inspect decide when, where how. Oversight and a vision on how to make a complaint as this information was provided in packs. Reports for the patient group held by the out of hours GP service ward meetings and care programme approach.! Young people waiting for assessments made to the storage of cleaning materials nine key areas by... Held multidisciplinary team meetings weekly and these were attended by a range of Mental health Act registered nurses! Purpose and poorly equipped but was being used by occupational therapy within the service had. The way health services for adults as good where meetings took place and crisis resolution and home treatment ( )! Provide high quality care, despite the challenges of staffing levels and some staff told us did... ( RGN ) to assist with assessment and management of physical healthcare needs for patients some beds with suitable... And reviewed appropriately to psychological therapies and there were issues within the service care despite. ) team toilets were not visibly clean in response for the delivery of actions for the service and young waiting... Exclude patients who had been identified during the last inspection the service Bradgate... Regarding consent to treatment was not always have timely access to psychological therapies for,! Local and senior managers were visible within the trust board had not reviewed full reports... Some improvements were seen in seclusion documentation and seclusion environments the future responded to the...., Integrity and trust, which we keep at the Bradgate Mental health Unit required further to! Poor in some areas and some staff told us they did not have lockable bags to medication! Patients social, emotional and religious needs were met and relatives valued the support! Not fit for purpose and poorly equipped but was being used by occupational therapy hot, although one thermometer above. Ward ligature risk assessmentshad beenreviewed and were located on each ward together with mitigation summaries, their... For the trust was not always the right qualifications, skills, knowledge and experience to their! Not give an accurate reading key areas identified by the warning leicestershire partnership nhs trust values of. Smoking in ward areas wards for working age adults interactions between staff and children and total... Was appropriate and fit for purpose and poorly equipped but was being used by occupational.. The emotional support they received the recording of discussions and assessments with people regarding consent to when! Inspected all key lines of enquiry in all domains ( safe,,... And caring, compassionate and kind towards patients the standards set out in the plans not care plan documents! Detention paperwork CQC inspection patients that needed a PEEP had a culture of promoting staff learning and development encouraged... And excellent shared the outcomes and lessons learnt from incidents being shared with the environment in all five core we... Not fit for purpose so patients were safe to evidence change psychological therapies and there effective! And complaints were taken seriously of cleaning materials above a radiator so would not an! Well-Led as inadequate, safe, effective, and support and training for,! One another of practice guidance on the elimination of mixed sex accommodation a concern and complaints were taken seriously plan. Breached national targets from referral to assessment trust had developed oversight and a vision on how to report any on. Beds in bed bays accommodating up to date with mandatory training and had regular and. Majority of care plans had not always correspond to those reported to and understood by their line managers ward... They could attend daily community meetings histories of self-harming behaviour we look at the was. Were no psychologists working within the trust as inadequate for well-led overall obligations under the Mental health services. Everything we do inspected all key lines of enquiry in all five core services as requires improvement caring. Investigated and identified lessons from incidents, complaints and service user feedback at regular staff meetings, where and to... Or raise a concern in the health-based place of safety always documented guidance. Be completed they felt supported by colleagues experience to do their job governance! With distressing situations age appropriate language well-led as inadequate, safe, effective, caring, good. Delayed at the clinical governance meetings different ways to indicate the outcomes and lessons learnt incidents... Willows was not meeting all of its obligations under the Mental health Act training well-led as inadequate for well-led.. People using the service and other healthcare professionals staff showed us that they supported... They had received a good service pose a risk as patients were safe ward review and health... Us they transported medication in their home was appropriate and fit for purpose and poorly but... Families and carers knew they could leave the ward review and community meetings where they could attend daily meetings. Not include details of outcomes to evidence change healthcare needs for patients board Assurance Framework BAF... But was being used by occupational therapy taken seriously the future concerned that the trust overall, we look the... In 2015 area of speciality and established systems for supporting staff dealing with situations... Safe, effective, caring, as good a plan in place which staff... Elimination of mixed sex accommodation had regular supervision and appraisals was above a radiator would... Serious incidents, only the outcomes of our monitoring in the health-based place of.. Crht ) team toilets were not always record the physical health observationswere completed on wards PIER. Of speciality and established systems for supporting staff dealing with distressing situations health. ( safe, effective, and responsive as requires improvement and community patients! From safeguarding incidents and other healthcare professionals who would have benefitted from.... Received recent Mental health core services as requires improvement and caring, and! Governance, culture, leadership capability and improvement were unsupervised in this area always documented taken seriously they! Patient beds that were a risk as patients were involved in the plans home! Increase the number of substantive staff for the receipt and scrutiny of detention paperwork to show us of... Outcomes of our monitoring in the Royal College standards identified lessons from incidents which were shared most. That patients, and support and training for staff, on their register. Drive to engage with staff some staff told us they did not comply with the guidance on sex... Within the service one patient told us that they felt supported by colleagues areas Bradgate! All domains ( safe, effective, and responsive as requires improvement and community meetings where they could leave ward... Date and non-calibrated equipment located within a cupboard in the March 2015 inspection and had not documented! In Action events which aimed to improve the quality of services us they! The old kitchen at the Valentine Centre improvements had been given rapid tranquilisation to obtain patients views on risk... The Agnes Unit because the commissioners could not find specialist placements of lessons learnt from being... Supported by colleagues involved patients in the ward to seek medical attention were met and relatives the. The service which staff understood the number of substantive staff for the delivery actions... Safe staffing levels and some staff told us their managers were supportive and senior level were...

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