Creating high quality compassionate care and well-being for all | Leicestershire Partnership NHS Trust - We provide mental health, learning disability and community health services for a population of more than a million people in Leicester, Leicestershire and Rutland. 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. We rated responsive and well led as requires improvement, and safe, effective and caring as good. Some patients told us that staff were polite and respectful and willing to go the extra mile in supporting them. Improvements were needed to make them safer, including reducing ligatures, improving lines of sight and ensuring the safety and dignity of patients. Staff morale was low and they felt disempowered in some areas. The trust had several strategies, a vision and corporate objectives, but they did not underpin all policies and practices. We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. Effective multi-disciplinary team working and joint working did not always take place across services. Staff managed their caseloads effectively; they discussed their caseloads during multi-disciplinary team meetings as well as in supervision. We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. Staff undertook comprehensive assessments and developed high quality care plans. Staff used the mental health clustering tool, which included Health of the Nation Outcome Scales (HoNOS) to assess and record severity and outcomes for all patients. There some gaps in staff receiving regular supervision. Overall community hospital occupancy rates for March 2015 were 94%, which reflected bed pressures in the local region. Information on the trusts vision and values was available at the site and staff appraisals were linked to them. 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. Patients were protected from avoidable harm by sufficient staffing and safeguarding processes. The trust had not ensured all staff had received training in immediate life support. HBPoS and crisis resolution and home treatment (CRHT) team toilets were not visibly clean. Services were planned and delivered in a way that met the current and changing needs of the local population. There was high dependence upon bank and agency staff to ensure safe staffing on the wards. Staff involved patients in the ward review and community meetings. They remained positive when engaging patients in meaningful activities. There were insufficient systems in place to monitor prescriptions. The NHS is founded on principles and values that bind together the diverse communities . Every team we spoke with knew who they reported to and what to report. Patients reported staff treated them with dignity and respect. 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 Leicestershire Partnership NHS trust as requires improvement because: Environmental risks in the Health Based Place of Safety (HBPoS) identified in our previous inspection remained. Governance processes had improved since our last inspection and operated effectively at trust level to ensure that performance and risk were managed well. Two external governance reviews had been commissioned and undertaken. The trust had addressed the issues regarding the health based place of safety identified in the previous inspection. One patient told us there wasnt enough to do at the Willows. We found serious concerns with medication disposal, storage, labelling and management of controlled drugs. 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 Where patients took medicines home with them, staff ensured that they understood their use and storage. View more Profession Occupational Therapist Service Learning Disability Grade Band 6 Contract Type Permanent Hours Full Time. Considerable numbers of records we reviewed during our inspection, were of a poor standard, with substantial and important clinical reviews missing, as recommended by the Mental Health Act Code of Practice. Within mental health services the quality of care plans was variable. Clinic room temperatures were very hot, although one thermometer was above a radiator so would not give an accurate reading. At times, there were insufficient qualified nurses on shift. In addition, staff did not record the maximum dose of medications a patient could have in any 24-hour period. There was good access to interpreters and signers when needed. We observed positive interactions between staff and children and the use of age appropriate language. There were not always enough staff who were suitably qualified and experienced to safely meet patients needs. When staff raised concerns or ideas for improvement, they felt they were not always taken seriously. The medical and senior leadership provision within the looked after children service did not meet the professional requirements outlined in the intercollegiate document for this provision. Advanced Directives had been introduced to enable patients to make decisions now about their long term care. For example, patient-led assessments of the care environment (PLACE) were completed. The services did not have a strategy and there were no service plans. We identified concerns around the storage of medicines in community hospitals, with missing opened or expiry dates across all hospitals. The service is not appropriately commissioned to provide sufficient school nurses to meet the standard service recommendations of one nurse per secondary school and its associated primary schools. We heard from most teams, positive examples of teamwork and multidisciplinary working within teams and services, and with external agencies and key stakeholders. We also inspected the well-led key question at provider level for the trust overall. Records about the use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were inconsistent. Managers changed practice because of this. It's really rewarding. the service is performing well and meeting our expectations. The trust could not always provide a bed locally for patients who required admissions to its mental health wards. We spoke with carers; they all stated that staff responded well when they contacted the service. The trust had robust governance structures and they had assured any potential gaps or overlaps had been considered. 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). Overall we saw good multidisciplinary working and generally peoples needs, including physical health needs, were assessed and care and treatment was planned to meet them. Managers ensured they used regular bank staff to achieve the required safer staffing levels and to promote continuity of care of patients. Flu and Covid-19 are currently circulating at high levels and are likely to continue to increase in coming weeks. There were clear treatment pathways. Leicestershire Partnership NHS Trust Is this your company? Services had supplies of emergency medication available and this was accessible to staff. We saw information in the service reception areas about older peoples care. We saw evidence of multidisciplinary working, with staff, teams and services at this trust and external organisations working in partnership to deliver effective care and treatment. Staff treated people who used the service with respect, listened to them and were compassionate. Staff reported incidents, which were discussed and reviewed by line managers within the teams. Our rating of this service improved. At this inspection, two of the three mental health services we inspected improved overall. In community based mental health teams for older people five of six services breached national targets from referral to assessment. At the time of inspection, there were a total of 647 children and young people currently waiting to be seen in specialised treatment pathways. Patients had the use of their mobile phones on the ward. Managers ensured they monitored the reporting and recording of incidents and complaints. The offer is for 250 to be paid through payroll and subject to tax and National Insurance and is non pensionable. Patient Advice and Liaison Service (PALS). Three patients told us of times when staff had been rude, threatening and disrespectful towards them. Morale was found to be poor in some areas and some staff told us that they did not feel engaged by the trust. Staff interacted with patients in a responsive and respectful manner at all times and showed a good understanding of individual needs. The trust recognised this was not an appropriate target and was working with commissioners to negotiate a more appropriate target. Staff were not meeting the trusts target compliance rate for annual appraisals and mandatory training. Patients were not subject to sharing facilities with opposite genders as found in the previous inspection. At this inspection the overall ratings for mental health services stayed the same in safe, effective and responsive, which we rated as requires improvement. Inspectors from the Care Quality Commission (CQC) visited five services run by Leicestershire Partnership NHS Trust (LPT) in November and December last year. The matron opened some vault windows via a remote. We rated them as requires improvement because: During the inspection, our inspection teams carried out the following activities across 11 wards in the services: During our well-led inspection, we spoke with 32 senior leaders of the organisation and looked at a range of policies, procedures and other governance documents relating to the running of the trust. Where patients did not access multimedia, families and carers said there was less communication with the service. Senior managers were aware of the bed pressures in their acute and PICU service and had raised concerns with their commissioners. There could be risks posed by the use of different recording systems across teams as staff may not all have access to all records. 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. Staff felt supported by their immediate managers but felt disaffected with trust senior management. It was clear to see the difference the investment and improvements had made since our last visit. The IAPT service was not meeting the Key Performance Indicators (KPIs) set by commissioners in relation to access targets' - meaning they were not getting the expected quota of referrals per population head. We carry out joint inspections with Ofsted. Computer systems were not shared across GP surgeries so information sharing did not happen effectively. They were constantly looking at ways to improve their work and the patient experience of the service. We have four core values: Compassion, Respect, Integrity, Trust. At Melton, Rutland and Harborough, City East and City West CMHTs m. At City West in conjunction with the young onset dementia assessment service staff developed a digital app for younger who were developing dementia. There were not enough registered staff at City West and this was identified as a risk on the service risk register. The waiting times in community based mental health services for adults of working age were long and breached targets. The service had 175 delayed discharges between August 2015 and July 2016, which accounted for 43% of the trusts total delayed discharges. 83% of staff received mandatory training. A carers group was available to give support. On Phoenix ward patients were not allowed access to the garden. Staff showed caring attitudes towards their patients. People using the service may not be able to get the speed of telephone response they needed in a crisis. Three out of 18 staff interviewed said that supervision was irregular. Patients waiting for their appointment in community based mental health services for adults of working age had access to a room unsupervised which held items which could cause harm. Suspended ratings are being reviewed by us and will be published soon. We did not inspect the whole core service. There was no medicines management input from pharmacy within the community based mental health services for adults of working age. Infection prevention and control (IPC) was well managed and monitored and services were responsive to deal with frequent changes in IPC requirements during the pandemic. Patients own controlled drugs were not always managed and destroyed appropriately. Patients were not always involved in the planning of their care. The patient incident team carried out a review of serious incident reporting and made changes to improve the reporting process, categorise incidents in a better way and improved reporting of safeguarding. One patient on Heather ward claimed that they had previously watched a staff member walking past a distressed patient and did not seek to reassure them or ask what was wrong. All ward ligature risk assessmentshad beenreviewed and were located on each ward together with mitigation summaries. Staff and carers said that when a patient was discharged, it was difficult to allocate them to a community CAMHS worker. The trust had not fully addressed the issues of poor lines of sight in wards. In response, the Care Quality Commission undertook a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. Most patients spoke positively about their care and said they were involved. All assessment rooms had good visibility. Medication management systems were in place and followed to ensure that medicines were stored safely. The trust had made improvements to the clinical environments since the last CQC inspection. Patients were involved in the writing of their care plans and their views were reflected in the plans. 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 in practice. However, we found: We rated the child and adolescent mental health wards as requires improvement because: We rated community-based mental health services for older people as good because: We rated learning disability and autism community services as good because: We gave an overall rating for forensic/secure wards of requires improvement because: We rated Leicestershire Partnership NHS Trust long stay / rehabilitation mental health wards for working age adults as requires improvement because: Overall rating for this core service Good. community based metal health services for adults of working age, mental health crisis services and health-based places of safety. This could pose a risk to patients and staff. 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. This had a negative impact on the delivery of urgent nursing care, continence services and non-urgent therapy care. Although this issue had been recognised by the trust, it had not been addressed quickly or effectively. 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). Staff treated patients with compassion, dignity and respect. The service had seven vacancies for qualified nurses andthree for non-registered nurses. 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. the service is performing exceptionally well. The teams did not have waiting lists for care coordinators at the time of inspection. Staff considered and supported patients with their physical health needs in CRHT and the liaison mental health triage service. We are looking at different ways to indicate the outcomes of our monitoring in the future. There was good multi-disciplinary working within the teams and good communication with other organisations. Mobility and healthcare equipment took up space in The Gillivers and 3Rubicon Close. Two core services did not promote patient centred care in all aspects of care delivery. The high demand for services, high levels of staff sickness and staff vacancy rates had not been managed effectively. Between August 2015 and July 2016 the trust had a total of 372 delayed discharges. There were safe lone working practices embedded in practice. This report describes our judgement of the quality of care provided by Leicestershire Partnership NHS Trust. Patients described being cared for, respected and treated with dignity. 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 trust confirmed contracts for patient transport and local authority care packages were monitored and work was ongoing with partner organisations to improve services for patients. Staff were given feedback after incidents had been reported. Organisations we work with. 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. Staff had access to quick guides in their clinical areas to ensure they were aware of how to manage risks. The work in neighbourhoods reduced travel for people and reduced barriers for people to gain support. We observed positive interactions between patients and staff. The trust had systems for staff to raise any concerns confidentially. This meant that patients were not protected from receiving unsafe treatment. We rated Leicestershire Partnership NHS Trust as Requires Improvement overall because: Published There was a range of large therapeutic areas and rooms for art therapy plus other interventions. The service was responding to complaints and implementing systems following these, however the trust waited for these complaints to prompt improvements in the service. The summary of this service appears in the overall summary of this report. The walls in patient areas at the child and adolescent mental health team were visibly dirty in places and rooms were sparsely furnished. In most services, we were concerned with the lack of evidence in care plans which showed patients and carers had been consulted and involved in their care. The community healthcare services provided by Leicestershire Partnership NHS Trust were judged to be good. We are proud of our 5,400 staff and together we aim to . Patients returning from leave from the acute mental health wards were not assured of returning to their original ward. Staff recognised and responded to the changing needs of patients with anticipatory medications readily available and care needs assessed and reviewed appropriately. Lessons were learned from feedback and complaints from patients. Staff were consistently caring, respectful and supportive. Designated staff were not provided by the trust. Feedback from those who used the families, young people and children services was consistently positive. Managers completed ligature audits which highlighted what mitigation was in place to reduce the risk for patients. Crisis and relapse care plans were in place for the people that used services. This left patients without access to treatment when they needed it most. the service is performing badly and we've taken enforcement action against the provider of the service. All the people who used services and the carers spoken to were happy with the service they had received and spoke positively about their interactions with staff. 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. 2020 University Hospitals of Leicester NHS Trust, We treat people how we would like to be treated, 'We are passionate and creative in our work'. Carers told us they had regular contact with the CRHT team and they were kept involved with their loved ones care. These reports were presented in an accessible format. Inadequate Five of the six services in this core service were in breach of these targets. The environmental risks in the health based place of safety identified in our previous inspection remained. 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. 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. There were no separate female bedroom areas and no gender specific toilets or bathrooms. Staff at St Lukes Hospital had arranged bi-monthly meetings to involve patients and visitors in the news and actions happening on the ward. Care and treatment was planned and delivered in line with evidence based guidance and standards, and systems were in place to ensure trust policies reflectedthe latest guidance. 61% of Leicestershire Partnership NHS Trust employees would recommend working there to a friend based on Glassdoor reviews. Staff were given opportunities to expand their knowledge and develop their roles. The trust had not made sufficient progress in addressing the concerns raised at the previous inspection in March 2015. Staff actively participated in clinical audits. In the dormitories, observation mirrors were situated so that staff could observe patients without having to disturb them. Patients told us that staff listened and empathised with them. Your information helps us decide when, where and what to inspect. Between August 2015 and July 2016, there were 60 delayed discharges across the service. These included the Older Peoples Unit at Loughborough Hospital, the Hand Injury Service, the splitting of planned and unscheduled community nursing services with a single point of access, podiatry and the specialist management of long term conditions. We found concerns with the environment in all five core services we inspected. Staff routinely referred patients to access additional support for employment, housing, benefits and independent mental health advocacy. Patients were frequently not discharged when ready due to transport problems or difficulties putting care packages in place. Therefore, staff could ensure accurate measures of blood pressure were being recorded. There had been several serious incidents (SI) within this service in the last year. Staff told us they felt supported by their line managers, ward managers and matrons.
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