Staff acknowledged directors visits. In rehabilitation wards, staff did not always develop and review individual care plans. We saw that patient numbers exceeded the number of beds available on wards. This left patients without access to treatment when they needed it most. 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. There was a lack of storage at Stewart House, the utility/laundry room was used to store cleaning equipment. Records were stored securely and well managed by staff to ensure that sensitive information about patients was protected. Care and treatment of children and young people was planned and delivered in line with current evidence based guidance, standards and best practice. Managers identified the breach in these targets and had plans in place to reduce them and had highlighted this risk on the risk register. Care plans did not always reflect a person centred approach and people who used services and their carers were not routinely involved in CPA reviews. The NHS is founded on principles and values that bind together the diverse communities . We inspected adult psychiatric liaison services as part of Mental Health Crisis and Health Based Places of Safety core service. We rated the trust as requires improvement for well led. There was a mobile phone in the ward office that patients could use for private calls, for example to a solicitor. There were delays in staff delivering treatments to young people and young people following assessment. The trust had no end of life strategy as the previous one had expired and no replacement had been developed. Staff completed care plans for patients. Staff we spoke with were unaware of incidents and learning on other wards across acute wards for adults of working age; this was highlighted as an issue at our inspection in 2018. 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 used strategies to maintain patients safety which had an adverse effect on their dignity and privacy. This was particularly relevant to protected characteristics. Our observations during inspection confirmed that staff knowledge and practical application of their knowledge was inconsistent despite training on their electronic learning systems. On rehabilitation wards, staff did not care plan the needs of a patient with protected characteristics. We rated it as good because: Leicestershire Partnership NHS Trust: Evidence appendix published 30 April 2018 for - PDF - (opens in new window), Published People that were referred to the service were waiting for a care co-ordinator to be allocated. Adult liaison psychiatry is categorised under Mental Health Core service of Mental Health Crisis and Health Based Places of Safety (HBPoS), as it is provided by the mental health trust, Leicestershire Partnership NHS Trust. We found significant issues with trust level governance, oversight of environments, a failure to address keys issues and a lack of pace with delivering essential improvements. Leicestershire Partnership NHS Trust Is this your company? They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. There were risk assessments and plans in place to keep people and staff safe. There was good physical health care and good therapeutic treatment and activities. Staff expressed pride in their ability to work as a team and managers told us they were proud of achievements. Staff told us they enjoyed working at the trust and thought they all worked well as a team. Research in Families, Young People and Childrens Services, and Learning Disability Services, Research Office and Research Delivery Team, Patient Advice and Liaison Service (PALS), Supporting serving and ex-service personnel, Contact the Equality, Diversity & Inclusion Team, Useful guides for staff to help raise awareness of Dyslexia and Autism. Governance processes had improved since our last inspection and operated effectively at trust level to ensure that performance and risk were managed well. Funding had been secured for increased staff with specialist skills. Patients told us they did not have access to a copy of their care plan. CAPTRUST for Institutions. There was good multi-disciplinary working within the teams and good communication with other organisations. All wards had developed their own systems to improve medicines management in their areas. Staffing skill mix was appropriate to need overall. The majority of repairs and maintenance issues highlighted within the warning notice at the Bradgate Mental Health Unit had been fixed or resolved. There were clear responsibilities, roles and systems of accountability to support good governance and management. Staff were passionate about their roles and enjoyed working with the client group. On Ashby ward, the shower rooms did not have curtains fitted. 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. There was good access to interpreters and signers when needed. The number of incidents reported by the trust had decreased since the last inspection and serious incident figures remained comparable. There was effective multidisciplinary working. The trust had not met all the required actions to reduce and mitigate ligature points across wards following the previous inspection in March 2015. This meant that some staff felt insecure. One patient told us that staff had been rude, threatening and disrespectful towards them, which a relative also confirmed. Other professionals within the trust could not access this system. Staff at the PIER team had not received recent Mental Health Act training. However, managers had identified funding for two agency nurses to start work the week following the inspection. 8 February 2017. Assessments and care planning took place for patients needs. Staff told us they involved patients carers but there was little evidence of this in care records. We found a high number of concerns not addressed from the previous inspections. There was good staff morale. To address this deficit the trust moved patients that required an acute bed to a rehabilitation bed which was not clinically justified or met the needs of the patients. 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. This had continued during the pandemic. 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. Carers told us they had regular contact with the CRHT team and they were kept involved with their loved ones care. People using the service had limited access to psychological therapies and there were no psychologists working within the service. 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. 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. received 41 comment cards from patients that were available for patients to complete during the time of our inspection. For example, furniture was light and portable and could be used as a weapon. Staff updated risk assessments and individualised care plans regularly. Staff ensured that these were updated regularly. Consultations with staff and the public had been undertaken to gain feedback on the proposed move of wards. Staff were observed to be caring and responsive to patients. However there were significant problems with key areas of governance in relation to the management of prescriptions. At this inspection, we looked at adult liaison psychiatry services at the Leicester Royal Infirmary site. Patients were not always involved in the planning of their care. Capacity assessments were unclear. We have four core values: Compassion, Respect, Integrity, Trust. Staff identified this was due to the management of change process and current work being undertaken by an outside organisation to identify more effective ways of working. Leicestershire Partnership NHS Trust (LPT) provides a range of community health, mental health and learning disability services for people of all ages. Staff and carers said that when a patient was discharged, it was difficult to allocate them to a community CAMHS worker. Managers did not have oversight of these issues. Staff did not consistently promote dignity and respect as expected in all services. For example, Ashby, Aston, Bosworth and Thornton Wards had been converted to single sex only accommodation to ensure compliance with the Department of Health and Mental Health Act 1983 guidance on mixed sex accommodation. However, they were not updated regularly or following an incident. There was a full complement of staff with no vacancies. Risk management in services required improvement. Cleaning products in a cupboard in the waiting area was unlocked, which posed a risk to the young people. Staff received regular supervision and most had received an appraisal in the last 12 months. there are some services which we cant rate, while some might be under appeal from the provider. 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. The old kitchen at the Willows was not fit for purpose and poorly equipped but was being used by occupational therapy. The transition from the CAMHS LD service to adult teams was not always timely and, therefore, did not follow best practice. Staff satisfaction varied greatly across the service with some staff feeling devalued. Where English was not the first language of patients, the service provided interpreters. 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." PIER staff reported having good links with universities and colleges regarding students needing early intervention services. We had concerns about the safety of some of the facilities where care was delivered. Wards did not have a list of stock items. Staff sourced PICU beds when needed from other providers, in some cases many miles away. We rated the four mental health core services as requires improvement and community health services for adults as good. The Trust had a number of unfilled positions being covered by long-term bank staff. Patients were full of praise for staff and the care and support they offered. Staff received little support from trust specialist doctors in palliative care and contacted the local hospice run by a charity for support. The risks and issues described by staff did not always correspond to those reported to and understood by their leaders. The work in neighbourhoods reduced travel for people and reduced barriers for people to gain support. At the Agnes Unit, staff did not always record the physical health of patients who had been given rapid tranquilisation. Staff demonstrated good knowledge of the Mental Capacity Act 2005. There was a lack of reporting and monitoring of informal complaints, meaning the service was unable to monitor and recognise themes of concern with the childrens service. This meant board members were not able to monitor the trusts assertions that there were strong systems and processes in place for identifying and reporting serious incidents, including deaths, or monitoring whether reviews and investigations were completed fully. We will continue to keep our values of Compassion, Respect, Integrity, Trust at the centre of everything we do. The trust did not ensure that they meet set target times for referral to initial assessment, and assessment to treatment in the majority of teams. The majority of community mental health teams did not meet the referral to initial assessment and assessment to treatment times. Local leaders were visible and had the skills and knowledge to perform their roles. There was a skilled multi-disciplinary team able to offer a variety of therapies. there are some services which we cant rate, while some might be under appeal from the provider. 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. The child and adolescent mental health (CAMHS) community teams caseloads were above the nationally recommended amount, although young people had a care co-ordinator. Patients and carers confirmed in most services they had not received copies of care plans. The HBPoS did not have access to a dedicated clinic room. The trust had developed checklists to assist staff with the receipt and scrutiny process. We rated the trust as inadequate for well-led overall. On acute wards, not all informal patients knew their rights. Staff at St Lukes Hospital had arranged bi-monthly meetings to involve patients and visitors in the news and actions happening on the ward. We did not inspect the following areas of this core service: We did not rate this service at this inspection. There was a strong, person-centred culture. 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. Patients needs were assessed and monitored individually. Between August 2015 and July 2016 the trust had a total of 372 delayed discharges. Leicestershire Partnership NHS Trust Add a Review About 32 In two of the core services inspected, the environment had not been well maintained. To find out more, review our cookie policy. The service did not have a system in place to monitor the number of lighters each ward held. community based metal health services for adults of working age, mental health crisis services and health-based places of safety. Staff were provided with relevant information to care for patients safely. Some improvements were seen in seclusion documentation and seclusion environments. To find out more, review our cookie policy. The scrutiny process was multi-tiered, which included the nurse, Mental Health Act administrator and medical scrutiny. We noted how much time the new executive team had invested in making and implementing improvements during the COVID-19 pandemic. There were examples of people not being seen within service guidelines whilst receiving large doses of prescribed medication. Staff were given feedback after incidents had been reported. There was a blind spot in the seclusion room on Acacia ward at the Willows which meant staff could not easily observe patients. Staff felt that they had opportunities to develop and were supported to undertake further study. They later told us that this had been an ongoing concern for around five years. Children and young people felt listened to in a non-judgmental way and told us they felt respected. The trust had improved medicines management. Four young people told us they felt involved in developing their care plan however, they had not received a copy. We're one team with shared values providing the best care possible. This did not demonstrate a consistent temperature, had been maintained to assure the safety and efficacy of the medicines. Assessments took place using nationally recognised assessment tools and staff provided a range of therapeutic interventions in line with National Institute for Health and Care Excellence (NICE). Therefore, overall, eight of the trusts 15 services are now rated as good, five as requires improvement and two as inadequate. Overall, patients were positive about the care they received and had access to advocacy services on all wards. Two patients told us they had experienced cancelled leave, and numerous staff confirmed that facilitating escorted leave had been difficult at times which had led to either a cancellation, or where possible delayed leave. Patient views on the quality of the food were variable. Staff were open about their poor understanding around the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. At our last inspection we raised concerns that an insufficient number of nursing staff in community health services for adults had received appropriate statutory and mandatory training. Leicestershire Partnership NHS Trust | 4,712 followers on LinkedIn. We rated the trust overall for well-led as inadequate. However, this was a temporary restriction due to the building works and patient safety. Staff morale was low and they felt disempowered in some areas. The school nursing service was understaffed and consequently there was an adverse impact on outcomes for children and young people and on staff morale. The health-based place of safety did not meet some aspects of the guidance of the Royal College of Psychiatrists. Some teams told us about a lack of teamwork, best practice was not shared amongst services and regular meetings did not take place in some services. An announcement has been made on the outcome of this appointment. The trust had robust systems in place which allowed staff to effectively report incidents. We rated it as requires improvement because: Our rating of the trust stayed the same. Save job - Click to add the job to your shortlist. They contained items which could pose a danger to staff and patients. The trust had a culture of promoting staff learning and development and encouraged staff to share best practice and innovation. Information needed to deliver care was not always readily available when people using community mental health teams presented in crisis out of hours. Staff received training in how to safeguard people who used the service from harm and showed us that they knew how to do this effectively. The trust delivered programmes for staff to develop into senior roles and had a clear career development programme for nursing staff. Staff said morale was good and they felt supported by their managers. The trust lacked an overarching strategy which everyone within the trust knew. The trusts pace for implementing equality and diversity initiatives across the organisation needed improvement. Staff mostly felt positive about their managers and said that the services provided were well-led. 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. Staff treated patients with respect and maintained dignity. Managers ensured they monitored the reporting and recording of incidents and complaints. 87 of the total patients had been waiting over a year to begin treatment. All the team leaders we interviewed said there were internal waiting lists for patients who had been initially assessed to access profession specific treatments. We want to hear from you on how to improve our service and provide the best care possible. The number of visits was not always manageable. Suspended ratings are being reviewed by us and will be published soon. There was minimal evidence of patient involvement in care plans. Managers ensured they used regular bank staff to achieve the required safer staffing levels and to promote continuity of care of patients. In two services, staff were not always caring towards patients. Staff worked with both internal and external agencies to coordinate care and discharge plans. Nursing staff did not have a stock list to randomly check medication which meant they could not reconciliation check. Whilst staff monitored patients risk on the waiting lists, the length of time to wait was of concern, in addition to the services lack of oversight and management of this issue. Medication management across four of the five services we inspected was poor, despite reported trust oversight and audit. CV6 6NY, In The136 suiteis a place of safety for those who have been detained under Section 136 of the Mental Health Act. 29 October 2021. At this inspection the overall ratings for mental health services stayed the same in safe, effective and responsive, which we rated as requires improvement. At least one standard in this area was not being met when we inspected the service and A family member spoke about enjoying regular meetings in the service gardens with their relative. 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. Most people and carers gave positive feedback about staff. They are: o We focus on what matters most. Our overall rating of this trust stayed the same. Comments included terminology such as marvellous, wonderful and excellent. The trust had high numbers of vacancies for registered nurses. Incidents and near misses were reported and learning from these was shared. Managers ensure that they acted on these findings to reduce the risk of reoccurrence. Incidents were on the agenda at the clinical governance meetings. Due to this staff could not observe all parts of wards due to their lay out and the risk had not been mitigated. At the last inspection, we issued enforcement action because the trust did not have systems and processes across services to ensure thatthe risk to patients were assessed, monitored, mitigated and the quality of healthcare improved in relation to: The trust was required to make significant improvements in the following core services where we found concerns in the areas listed above: Acute wards for adults of working age and psychiatric intensive care units, Wards for people with a learning disability or autism, Long stay or rehabilitation mental health wards for working age adults. Most patients spoke positively about their care and said they were involved. The adult community therapy team did not meet agreed waiting time targets. This promotion is being run by Leicestershire Partnership NHS Trust. Patients reported staff treated them with dignity and respect. There were improved systems and processes to manage storage, disposal and administration of medications. Patients who accessed the CRHT team told us that they felt their wishes and needs were taken in to consideration, staff could be accessed quickly and they felt safe when visiting the Bradgate Mental Health unit. Staff support systems were in place and there was a drive to engage with staff. Detention renewal paperwork had been signed by a doctor prior to them seeing the patient. Therefore, staff could ensure accurate measures of blood pressure were being recorded. We carry out joint inspections with Ofsted. Community mental health services with learning disabilities or autism, Wards for older people with mental health problems. We found multiple internal waiting lists where the longest wait for young people was 108 weeks. Ward teams did not hold regular team meetings. The service used evidence based, best practice guidance throughout its policies and procedures and ways of working. The local managers monitored the environment for staff, carried out local audits and checked performance of staff on a regular basis. The services used recognised outcome measures and monitoring measures to help assess the level of support and treatment required. There were no pharmacy services within the community mental health teams or crisis team. We identified concerns around the storage of medicines in community hospitals, with missing opened or expiry dates across all hospitals. Five out of 25 care records showed that patient involvement had not been recorded. Patients were protected from avoidable harm by sufficient staffing and safeguarding processes. The trust encouraged staff at most levels of the organisation to develop and deliver ideas for service delivery, improvement and innovation. We work in partnership with a range of NHS organisations, local government and other bodies and are ultimately accountable to the secretary of state for health. Patients described being cared for, respected and treated with dignity. One family member told us their relative could be challenging but they felt they were well cared for. Every team we spoke with knew who they reported to and what to report. Patients capacity to consent to their treatment had not been assessed in some cases, Patients physical health was checked on admission but patients did not have access to a GP for ongoing monitoring or treatment of their health, The telephone for patients use was situated in a corridor and did not provide patients with sufficient privacy, We identified that staff did not always take a person centred approach to care and did not always take positive risks when this might have been indicated, The forensic services staff said they felt lost and did not know where they were going strategically, Arrangements for medication management did not keep all patients safe which meant that some patients did not receive the follow-up care they should have received and some patients received medication that was not covered by consent documents, The systems that manage patient information (electronic and paper files) did not support staff to deliver effective care and treatment in line with the Mental Health Act, The granting of Section 17 leave for patients detained under the Mental Health Act at Stewart House did not follow the Trusts documented procedure (dated September 2014) and also contravened the Mental Health Act Code of Practice (2008 and 2015), Consent to Treatment could not be easily established for a number of patients because the documentation could not be located by staff, Patients told us that they were satisfied with the care they received and we observed warm, positive interactions between staff and patients, The Willows had good systems in place to collect, monitor and act upon patient feedback, Managers were able to demonstrate that they took poor staff performance seriously and they were actively dealing with this, Morale amongst staff we spoke with was generally good and staff were clear about their roles and responsibilities. All areas were very clean, fresh smelling and fit for purpose. The walls in patient areas at the child and adolescent mental health team were visibly dirty in places and rooms were sparsely furnished. There were no children who had waited more than a year for treatment. Ward matrons told us they shared outcomes from incident investigations in team meetings for shared leaning. NG3 6AA, In The summary for this service appears in the overall summary of this report. We found that there were still errors within the staffs application of the Mental Capacity Act. Therefore, if a female needed a psychiatric intensive care unit they were sent out of area. The Trust is proposing to close Ashby and District Community Hospital, a proposal which is opposed by Ashby Civic Society who do not accept that 'virtual wards' and 'intensive community support' can fully deliver the reductions on hospital . 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. The trust did not have seclusion rooms on all wards. The waiting times in community based mental health services for adults of working age were long and breached targets. It has been developed within the context of the area we serve in Leicester, Leicestershire and Rutland and the new Integrated Care Partnership. Some care plans had not been updated and physical healthcare checks were not routinely documented in young peoples notes. We also inspected the well-led key question at provider level for the trust overall. Staff followed infection and prevention control practices and the community inpatient wards were visibly clean. 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