leicestershire partnership nhs trust values

Staff did not assess and record the risks posed by medicines stored in patents homes. 56% of individual care plans were not up to date, personalised or holistic. 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. The risks and issues described by staff did not always correspond to those reported to and understood by their leaders. 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. Medication management across four of the five services we inspected was poor, despite reported trust oversight and audit. Lessons were learned from feedback and complaints from patients. Staff were consistently caring, respectful and supportive. Staff told us the trust was a good place to work. Staff monitored the ongoing condition of any secluded patient. Two external governance reviews had been commissioned and undertaken. We found serious concerns with medication disposal, storage, labelling and management of controlled drugs. Following inspection, the trust submitted an action plan to review shared sleeping arrangements. A new chief executive was appointed as a shared role between the two trusts. Managers shared the outcomes and lessons learnt from incidents, complaints and service user feedback at regular staff meetings, where meetings took place. Patients were happy with the care they received and were very complimentary about the staff who cared for them. We looked at the domains of safe, effective and responsive and we did not inspect all of the key lines of enquiry. However, the service was collecting data. The leadership, governance and culture did not always support the delivery of high quality person centred care. On Phoenix ward patients were not allowed access to the garden. We rated wards for people with learning disabilities as requires improvement because The HBPoS did not have designated staff provided by the trust. Staff described various ways in which they received information from the board and other governance meetings. The lack of psychology was an issue highlighted at our 2018 inspection. 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. People knew how to make a complaint as this information was provided in welcome packs. Their service users and staff are extremely important to them. Patients returning from leave from the acute mental health wards were not assured of returning to their original ward. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service. There was a good level of occupational therapy input and good support to help maintain patients physical health. Safeguarding was a high priority with regular safeguarding reviews within each area of speciality and established systems for supporting staff dealing with distressing situations. When staff deemed a patient lacked capacity there was no evidence that the best interest decision-making process was applied. We saw evidence of discharge planning in care plans written by CRHT staff. We reviewed 267 case records and found that, generally, staff completed detailed individualised risk assessments for patients on admission. This had been raised as a concern in the March 2015 inspection and had not been sufficiently addressed. Staff completed risk assessments that were thorough and had been reviewed following incidents. However, staff told us they had little experience of incident reporting within the community childrens services. Patient records across community inpatient services were not always completed fully. This included labelling, disposal, reconciliation and ward level audit. Managers ensured they used regular bank staff to achieve the required safer staffing levels and to promote continuity of care of patients. Download the leadership behaviours booklet or watch the animation below to find out more: Our People Plan shows our dedication to making LPT a great place to work and receive care. Bathrooms and toilets were specified for which gender depending on who was resident at the unit at the time. 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. Data provided by the trust showed there were four episodes of seclusion from February 2016 to July 2016. They did not have alarms or vision panels in the door. 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. Managers ensured they monitored the reporting and recording of incidents and complaints. Staffing skill mix was appropriate to need overall. The community healthcare services provided by Leicestershire Partnership NHS Trust were judged to be good. The matron opened some vault windows via a remote. For example, furniture was light and portable and could be used as a weapon. We observed some very positive examples of staff providing emotional support to people. Managers did not ensure that the staff were receiving regular clinical supervision and had not met the trust target compliance rate of 85%. Staff and carers said that when a patient was discharged, it was difficult to allocate them to a community CAMHS worker. We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. Incidents and near misses were reported and learning from these was shared. This was an issue highlighted at our inspection in 2018. 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. Fire safety was much improved, withfire drills carried out regularly. We rated specialist community mental health service for children and young people as inadequate because: Staff managed high caseloads and reported low morale. This had continued during the pandemic. Staff were up to date with mandatory training and had regular supervision and appraisals. Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. Patient Advice and Liaison Service (PALS). Staff empathised where a person had a negative experience and offered support where necessary. Staff were provided with relevant information to care for patients safely. The group established a deliberate self harm and suicide group in the last year to oversee specific incidents of this nature. ", Daxa Mangia, Mental Health Nurse, The Willows, "I really enjoy my job, helping people to recover - I cannot imagine doing anything else.". The trust provided patients with accessible information on treatments, local services, patients rights and how to complain across all services. Patient views on the quality of the food were variable. However, this was a temporary restriction due to the building works and patient safety. We found: However, we noted one issue that could be improved: We spoke with six members of staff including matrons, team leaders and mental health practitioners and reviewed all the assessment areas the adult psychiatric liaison team uses. Seclusion environments were not an issue of concern at this inspection. There was regular and effective multidisciplinary working. Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. We rated Community health services for adults as good because: We gave an overall rating for community based mental health teams for adults of working age as good because: We rated the community mental health services for children and adolescents overall as requires improvement because: Overall rating for this core service Requires improvement l. We rated community inpatient services as requires improvement because: Overall rating for this core service Requires Improvement l. We rated this core service as requires improvement because: We rated this core service as good because: We rated wards for people with learning disabilities and autism as requires improvement because: Leicestershire Partnership NHS Trust (February 2016) for - PDF - (opens in new window), Leicestershire Partnership NHS Trust (June 2015) for - PDF - (opens in new window), Leicestershire Partnership NHS Trust (November 2014) for - PDF - (opens in new window), Leicestershire: Children's Services Inspections Reports (2012) for - PDF - (opens in new window), Leicester City: Children's Services Inspections Reports (2012) for - PDF - (opens in new window), Rutland: Children's Services Inspections Reports (2011) for - PDF - (opens in new window). Patients could not always access a bed in their locality when needed and the trust moved patients between wards and services during episodes of care and following return from leave. Some key outcomes for children, young people and families using the service were regularly below expectations. Environments were visibly clean and welcoming. 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. The service did not have a system in place to monitor the number of lighters each ward held. Examples were given regarding learning from these. Some staff used tools and approaches to rate patient severity and monitor their health. Discharge planning was considered as part of board rounds although discharge planning paperwork was not used consistently. This was because the EDU batch refer sending four or five referrals at a time rather than when they arrive. One patient told us there wasnt enough to do at the Willows. 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. Beds were not always available for people living in the trusts catchment area. Good CAPTRUST for Institutions. The trust lacked a framework for co-ordinating, endorsing and therefore learning from the very many positive quality projects taking place. There was an effective incident reporting system. There was a lack of storage at Stewart House, the utility/laundry room was used to store cleaning equipment. Five out of 25 care records showed that patient involvement had not been recorded. 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." Inspectors from the Care Quality Commission (CQC) visited five services run by Leicestershire Partnership NHS Trust (LPT) in November and December last year. 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. Staff did not routinely complete detailed, person centred, individualised or holistic care plans about or with patients. Some wards did not meet the Department of Health and Mental Health Act Code of Practice requirements in relation to the arrangements for mixed sex accommodation. egistered general nurses with dedicated time to focus on individual healthcare plans at Stewart House and The Willows. We observed positive interactions between patients and staff. Staff were given feedback after incidents had been reported. Feedback from those who used the families, young people and children services was consistently positive. There was no fridge to keep medicines cool when required. The trust had addressed the issues regarding the health based place of safety identified in the previous inspection. Patients experiencing mental health crisis and distress did not have access to a fully private area in these environments. Care plans and risk assessments did not show staff how to support patients. Staff reported incidents, which were discussed and reviewed by line managers within the teams. Staff ensured that these were updated regularly. In the same service, managers did not always review incidents in a timely way. The trust confirmed after our inspection Advanced Nurse Practitioners used a DNACPR form which had been agreed within NHS East Midlands. Managers shared the outcome of complaints with their ward teams. Staff knew and understood their role in compliance with the Mental Health Act and Mental Capacity Act. o We treat others how we would like to be treated. 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. A high number of outpatient appointments were cancelled. o We are one team and we are best when we work together. Managers used a tool to identify and review staff numbers in accordance with need. The trust had completed ligature risk assessments across all wards, detailing where risks were located and how these should be managed. There was strong local leadership on the community inpatient wards and in the community. The child and adolescent mental health (CAMHS) community teams caseloads were above the nationally recommended amount, although young people had a care co-ordinator. The trust had maintained patients privacy and dignity at Short Breaks Services. Staff did not always feel connected to the wider trust. The teams did not have waiting lists for care coordinators at the time of inspection. Staff made individualised risk assessments which were regularly updated and followed best clinical practice. Staff received feedback on the outcomes on investigation of complaints via their managers. That's what building health equity means to us. However, 323 were waiting for their first appointment through the access team, to complete a core mental health assessment. These included unsafe environments that did not promote the dignity of patients; insufficient staffing levels to safely meet patients needs; inadequate arrangements for medication management; concerns regarding seclusion and restraint practice: insufficient clinical risk management. Staff had the right qualifications, skills, knowledge and experience to do their job. The trust had made some improvements in response to the previous CQC inspection undertaken in March 2015.This included removing some ligature anchor points in the acute mental health wards. Concerns about high bed occupancy, record keeping and delayed discharges were identified in the March 2015 inspection and had not been sufficiently addressed. On Bosworth ward patient privacy was compromised when staff and patients entered the clinic room during examinations because there was no privacy curtain in place. We had a number of concerns about the safety of this trust. Patients knew how to make a complaint or raise a concern and complaints were taken seriously. We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. The trust had a patient involvement centre, which was pleasant, well-equipped and supported involvement from friends and family. The introduction of activities co-ordinators at Coalville Hospital had improved the patients experience on the ward and increased the activities that were conducted on a day to day basis. We rated safe, effective, responsive and well led as requires improvement and caring as good. Some actions were required to ensure adherence with the Mental Health Act. Staff gave examples of working with people with diverse needs considering their ethnicity, gender, age and culture. 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. All the team leaders we interviewed said there were internal waiting lists for patients who had been initially assessed to access profession specific treatments. Senior managers were aware of the bed pressures in their acute and PICU service and had raised concerns with their commissioners. All incidents that should be reported were reported. Patients told us that appointments usually run on time and they were kept informed when they do not. We found that staff across the service were committed to providing good quality care to the patients and showed care and compassion. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. We found that while performance improvement tools and governance structures were in place these had not always brought about improvement to practices. Best interest meetings were held where it had been assessed that a patient lacked the capacity to consent to a decision. The service had seven vacancies for qualified nurses andthree for non-registered nurses. Community meetings and patient involvement in the services did not always take place. Restraint was used only as a last resort. Patients knew how to formally complain and could attend daily community meetings where they could raise any issues of concern. There was a lack of understanding in teams how their own plans, visions and objectives connected with the trusts vision. There was good multi-disciplinary working within the teams and good communication with other organisations. At this inspection the overall ratings for mental health services stayed the same in safe, effective and responsive, which we rated as requires improvement. Improvements had been made to seclusion areas at The Willows Acacia and Maple wards. Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels and some poor ward environments. Staff held multidisciplinary team meetings weekly and these were attended by a range of mental health professionals. 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. Click here to submit your comments to us. Staff were quick to sort out requests and problems for patients. Nursing staff had large caseloads. The ovens were old and the dials were not visible and cupboards were broken. We found that there were still errors within the staffs application of the Mental Capacity Act. Governance systems and processes, and the strategy of the organisation had been extensively reviewed since our last inspection but was not fully embedded into services. 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. Multi-disciplinary team meetings took place on a regular basis. Staff used a mixture of paper and electronic records which were not easy to follow. We're here for you Learn More Scroll We've got you covered Use our service finder to find the right support for your mental health and physical health. 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. Staff were visible in the communal ward areas and attentive to the needs of the patients they cared for. Bed occupancy for the last two quarters of 2013/14 was around 89%. Patient outcomes were not routinely collected so the quality of the clinical care being delivered could not be measured or benchmarked. There was an unstructured, non-mandatory approach to formal end of life training for community hospital staff. Managers identified the breach in these targets and had plans in place to reduce them and had highlighted this risk on the risk register. During the depot clinic staff did not close privacy curtains when patients were receiving depot injections. We will be supporting each other in the delivery of these leadership behaviours so we can all Step up to Great together. Staff were given opportunities to expand their knowledge and develop their roles. Some seclusion rooms had environmental concerns at Belvoir and Griffinunits, and Watermead wards. Some families carers said that the meals were unhealthy. This meant some fundamental standards were not being met. Whilst staff were working hard to identify and manage individual risks, some ward environments were unacceptable. Adult community health patients did not always have timely access to routine appointments. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff. In all instances police transported the patient to the HBPoS. 10 July 2015. Leaders were motivated and developing their skills to address the current challenges to the service. 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. We rated child and adolescent mental health wards as good because: The ward had clear lines of sight in the main areas of the ward. 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