The adult psychiatric liaison service provides assessment and treatment for adults between the ages of 16 to 65, who experience mental health problems in the context of physical illness. 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. Lessons were learned from feedback and complaints from patients. The needs of people who used the service were assessed and care was delivered in line with their individual care plans. Care planning had improved in the crisis service. There was a full complement of staff with no vacancies. All assessment rooms had good visibility. Our inspection approach allows us to make a judgement on how the trusts senior leadership leads the organisation and the provider level well-led rating is separate from the ratings of the services we inspected. Significant vacancy rates and high sickness levels put additional pressure on substantive staff. We are proud of our 5,400 staff and together we aim to . Staff had a good knowledge of safeguarding and incident reporting. Procedures for incident management and safeguarding where in place and well used. We rated the trust as inadequate for well-led overall. The teams we spoke with, felt the trust board did not set clear timescales or direction on how to move their projects forward. We carried out this unannounced focused inspection of adult liaison psychiatry services as part of a system wide inspection of Urgent and Emergency Care provision in the Leicester, Leicestershire and Rutland Integrated Care System. However, they did not always meet the required skill mix for the nursing teams. Staff reviewed young peoples risk at every appointment and recorded this in the case notes. Staff received robust and detailed shift handovers, including information on patient risks, observation levels and physical healthcare concerns and how these were to be managed. The trust had several strategies, a vision and corporate objectives, but they did not underpin all policies and practices. The service had not met the six week target for initial assessment, on average patients were seen six days over the target date. There were no records of capacity being assessed for patients consent to treatment, and no clear evidence of best interests decisions being agreed. We saw information in the service reception areas about older peoples care. There was a good level of occupational therapy input and good support to help maintain patients physical health. The waiting list had increased for those children and young people waitingfor thestart of treatment, following assessment. Seclusion environments were not an issue of concern at this inspection. On Ashby ward, the shower rooms did not have curtains fitted. Care records for patients using the CRHT teams were not holistic or personalised. Clinical supervision was not taking place regularly across the service. It's a mission driven by our core values, and one that we try to achieve as a local provider, funder, and advocate. The trust had addressed the issues regarding the health based place of safety identified in the previous inspection. We saw that Advanced Nurse Practitioners were completing Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms having completed their training to do so; however we saw that these forms were not countersigned by a doctor or consultant. The assessment and resulting care plans were personalised, holistic and recovery focussed. The most common reason for delayed discharges was due to family choices which were beyond the control of the trust. Managers identified the breach in these targets and had plans in place to reduce them and had highlighted this risk on the risk register. Their service users and staff are extremely important to them. Apply. Staff had the right qualifications, skills, knowledge and experience to do their job. Staff did not consistently promote dignity and respect as expected in all services. The service had seven vacancies for qualified nurses andthree for non-registered nurses. The community adult team caseloads varied. Governance structures were in place and risks registers were reviewed regularly. The trust had not made sufficient progress in addressing the concerns raised at the previous inspection in March 2015. 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 Patients felt safe. 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 told us they felt supported by their line managers, ward managers and matrons. Therefore, the trust could not be sure staff received information to support best practice and change in a timely manner. 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. The dignity and privacy of patients across three services we visited was compromised. Staff followed the trust policy on seclusion. The service was meeting the target for initial assessment within 13 weeks of referral with a compliance of 99%. Outcomes of care and treatment were not always consistently or robustly monitored. 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. The leadership, governance and culture did not always support the delivery of high quality person centred care. Staff received regular managerial and group supervision. Wards provided safe environments where patients felt secure. We rated community health services for adults as requires improvement because. The trust had systems for promoting, monitoring and responding to complaints. There was a blanket restriction. The ratings from the inspection which took place in November 2018 remain the same. On four wards in acute wards for adults of working age, there were shared sleeping arrangements for patients. Comprehensive assessments were being carried out and information was stored securely, except for one location and arrangements were in place to address this. We did not rate this inspection. There were examples of people not being seen within service guidelines whilst receiving large doses of prescribed medication. Leicestershire Partnership NHS Trust Location Leicester Salary 27,055 to 32,934 a year Closing date 2 Feb 2023. Staff monitored the ongoing condition of any secluded patient. Managers ensured they monitored the reporting and recording of incidents and complaints. Staff did not demonstrate a good understanding of the Mental Health Act (MHA) and Mental Capacity Act (MCA). Patient records across community inpatient services were not always completed fully. Record keeping at Stewart House was disorganised. The electronic prescribing system which the trust had implemented supported the safe administration of medicines to patients, with staff reporting very few medication errors as a result of this. Patients were involved in the writing of their care plans and their views were reflected in the plans. We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels: Outstanding Medication management systems were in place and followed to ensure that medicines were stored safely. The service was not safe. Staff followed procedures to minimise risks where they could not easily observe patients. Patients told us that appointments usually run on time and they were kept informed when they do not. 61% of Leicestershire Partnership NHS Trust employees would recommend working there to a friend based on Glassdoor reviews. The trust was not commissioned to provide female psychiatric intensive care beds. Following the national withdrawal of the Liverpool Care Pathway the trust has developed an alternative care plan; however this has not yet been implemented. Apply. Staff and carers said that when a patient was discharged, it was difficult to allocate them to a community CAMHS worker. They and their carers were kept informed and involved in their treatment and care. However, delay in paperwork completion was also responsible for a large proportion of delayed discharges. Shifts were not always covered with sufficient staff, or with staff who had the appropriate qualification and experience for the role. Patients were supported, treated with dignity and respect and involved as partners in their care. Staff felt supported by their immediate managers but felt disaffected with trust senior management. View more Profession Nurse Service Child & Adolescent / CAMHS Grade Band 5 Contract Type Permanent Hours Full Time. 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. We saw the trust had developed oversight and a vision on how to improve the nine key areas identified by the warning notice. This has been brought. The trust had new seclusion paperwork implemented in May 2019. Leicestershire Partnership NHS Trust | 5,409 followers on LinkedIn. 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. In five of the six community nursing teams attendance on some mandatory training courses was below 70%. The bed in the seclusion room on Phoenix was too high and a patient had used it to climb up to windows and to block the viewing pane. The work in neighbourhoods reduced travel for people and reduced barriers for people to gain support. The school nursing service was understaffed and consequently there was an adverse impact on outcomes for children and young people and on staff morale. 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. In rehabilitation wards, staff did not always develop and review individual care plans. By doing this it will help us achieve our vision of creating high quality, compassionate care and wellbeing for all. We observed positive interactions between staff and children and the use of age appropriate language. the service is performing well and meeting our expectations. Staff did not always maintain the privacy and dignity of patients. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect. Preventing infections Same sex accommodation Building better hospitals eHospital Programme Our values 'We treat people how we would like to be treated' We listen to our patients and to our colleagues, we always treat them with dignity and we respect their views and opinions We are always polite, honest and friendly . The scrutiny process was multi-tiered, which included the nurse, Mental Health Act administrator and medical scrutiny. Not all patients on acute wards for adults of working age could summon help from staff if required. Inconsistencies in record-keeping for the Autism Outreach services as some records were missing, but others were of an acceptable standard. Our rating of this service stayed the same. Staff knew how to report any incidents on the trusts electronic reporting system. Staff were kind, caring and compassionate and treated patients with dignity and respect. The trust could not ensure continuity of care for these patients. Staff were kind, compassionate and respectful towards patients. Staffs were dedicated, passionate and patient focused. 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. Medicine management training sessions had been undertaken with inpatient ward sisters and charge nurses. Staff held high caseloads in community based mental health services for adults of working age, an issue which had been recognised by the trust and placed on the risk register. 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." Staff usually met patients in their homes or in the community. Multi-disciplinary team meetings took place on a regular basis. 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. Our observations during inspection confirmed that staff knowledge and practical application of their knowledge was inconsistent despite training on their electronic learning systems. Suspended ratings are being reviewed by us and will be published soon. Due to the large caseloads in community health service, the number of visits that were required was not always manageable. Response times to maintenance request were variable. We saw evidence of good team working during our inspection. We rated the four mental health core services as requires improvement and community health services for adults as good. It promises that we will lead with compassion and inclusivity, with the health and wellbeing of our staff at the heart of all we do. Nottingham, Staff demonstrated good knowledge of the Mental Capacity Act 2005. Our rating of this service improved. The acute mental health wards had broken facilities which had not been repaired in a timely manner and we found dirt in some areas on one ward. Interview rooms were unsafe. The HBPoS did not have designated staff provided by the trust. Mobility and healthcare equipment took up space in The Gillivers and 3Rubicon Close. 22 June 2022, Published Staff documented seclusion well in most services, compared to our last inspection. Clinical audit was taking place and learning was shared across the service. We inspected all key lines of enquiry in all domains (safe, effective, caring, responsive and well-led) in two services. The trust had a patient involvement centre, which was pleasant, well-equipped and supported involvement from friends and family. Services and care were planned with the local population in mind and to address the individual needs of patients. All patients told us staff respected their privacy and dignity. Meeting these standards and developing the capability to exceed them, will not only ensure that we continue to improve and respond flexibly to changing needs as an organisation, but will also help our staff to fulfil their potential, both in terms of personal achievement and career advancement. The service had plans in place to manage service disruption and major incidents. The ovens were old and the dials were not visible and cupboards were broken. Staff were given feedback after incidents had been reported. Please contact Sonja Whelan on 07525 723336 or email Sonja.whelan@leicspart.nhs.uk. Local audits were not completed regularly. 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. Staff were not meeting targets for the assessment and assessment to treatment of urgent referrals and six week routine referrals. We rated well-led as inadequate, safe, effective, and responsive as requires improvement and caring, as good. Staff had good knowledge of safeguarding processes and risk assessments were generally detailed, timely and specific. CAPTRUST for Institutions. Staff had been trained with regards to duty of candour and in line with the trust policy. The quality of some of the data was poor. We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. Derby, We observed some very positive examples of staff providing emotional support to people. Staff had not managed all risks to patients in services. We rated long stay/rehabilitation mental health wards for working age adults as requires improvement because: The environment in some areas was very poor, particularly at Stewart House. 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. Bed occupancy for the last two quarters of 2013/14 was around 89%. There was a clear vision for the service which staff understood. HBPoS and crisis resolution and home treatment (CRHT) team toilets were not visibly clean. The trust was not fully compliant with same sex accommodation guidance in two acute wards, the short stay learning disability service and rehabilitation services. Patient views on the quality of the food were variable. Staff felt well supported and were able to raise concerns with their line manager and were listened to. 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. One review was in response for the delivery of actions for the 2018 CQC inspection. Staff were open about their poor understanding around the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Flu and Covid-19 are currently circulating at high levels and are likely to continue to increase in coming weeks. Ward teams did not hold regular team meetings. Staff were consistently caring, respectful and supportive. 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. Staff completed risk assessments that were thorough and had been reviewed following incidents. Jan 4. The trust had systems for staff to raise any concerns confidentially. Staff felt that they had opportunities to develop and were supported to undertake further study. It has been developed within the context of the area we serve in Leicester, Leicestershire and Rutland and the new Integrated Care Partnership. There were good systems for lone-working which included a code word that staff used when they required assistance. Overall community hospital occupancy rates for March 2015 were 94%, which reflected bed pressures in the local region. We saw patients that needed a PEEP had a plan in place. Patients privacy and dignity had been addressed at The Willows, Cedar and Acacia wards with changes made to male and female wards. In all three services, not all staff were up to date with mandatory training. Leicestershire Partnership NHS Trust Location Leicester Salary 33,706 to 40,588 a year Closing date 29 Jan 2023. 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. All three service inspections were unannounced. There was a good working relationship between the Mental Health Act (MHA) administration team and the wards, community teams and the executive team. Staff gave examples of initiatives such as the chief executives blog and the presentation of the valued star award. The service did however, complete local audits and produced action plans for improvement in care. Staff said morale was good and they felt supported by their managers. Leadership behaviours were fostered, and development of staff was encouraged. Another patient said on their comment card they did not see enough of the occupational therapist. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. A programme of work was due to start in forthcoming months, for wards yet to be refurbished. Staff mostly felt positive about their managers and said that the services provided were well-led. Staff we spoke with demonstrated their dedication to providing high quality patient care. However, 323 were waiting for their first appointment through the access team, to complete a core mental health assessment. Six staff expressed concerns about the proposed move and some said the trust had not communicated information to staff effectively. There was no process in place for learning from other organisations which provided similar services or to share this services best practice. Two external governance reviews had been commissioned and undertaken. Staff moved acute patients to the rehabilitation wards when acute beds could not be located. Leaders were motivated and developing their skills to address the current challenges to the service. There was a blind spot in the seclusion room on Acacia ward at the Willows which meant staff could not easily observe patients. There was a range of large therapeutic areas and rooms for art therapy plus other interventions. We inspected adult psychiatric liaison services as part of Mental Health Crisis and Health Based Places of Safety core service. Families and carers said the wards were clean. Senior nurses mitigated risk where they could which included switching an agency staff member with a trust member of staff if two agency staff worked together. 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. This included environmental improvements, shared sleeping accommodation, response times to maintenance issues, care planning and access to relevant therapies in certain services. Medication management had improved significantly across the services. Facilities had been adapted to improve access and systems were in place to support the most vulnerable. This had previously been identified on the CQC inspection in March 2015. Therefore, overall, eight of the trusts 15 services are now rated as good, five as requires improvement and two as inadequate. Employees also rated Leicestershire Partnership NHS Trust 3.1 out of 5 for work life balance, 3.6 for culture and values and 3.7 for career opportunities. There were effective systems in place to audit and monitor physical health care records. Staff involved patients in the ward review and community meetings. This was done by sliding signs to the door as needed. Staff did not always feel actively engaged or empowered. Some staff had not received their mandatory training, supervision or appraisal. Cleaning products in a cupboard in the waiting area was unlocked, which posed a risk to the young people. On rehabilitation wards, staff did not care plan the needs of a patient with protected characteristics. There some gaps in staff receiving regular supervision. There had been an increase in the number of CAMHS referrals over the last two years. The trust confirmed that these were reinstalled after the inspection had taken place. Patients gave positive feedback regarding the care they received. Managers changed practice because of this. The use of restraint was low and staff used it as the last resort and if verbal de-escalation had not been successful. 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. 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. Some medication was out of date and there was no clear record of medication being logged in or out. Recruitment was in progress for 10 new healthcare support workers. A dual paper and electronic recording system meant that some information was not accessible to all of the staff that might need it. Some facilities lacked essential emergency equipment. At this inspection we found compliance levels with this type of training were still below the trusts target. However, we saw evidence this was not always achieved. 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