People using the service may not be able to get the speed of telephone response they needed in a crisis. Staff and senior leaders could not articulate the trusts direction of travel and how this was co-ordinated. Staff used a mixture of paper and electronic records which were not easy to follow. There had been periods of understaffing. Staff felt that they had opportunities to develop and were supported to undertake further study. The community therapy rehabilitation unit at Hinckley did not have a defibrillator in the unit for staff to use in an emergency despite staff having been trained how to use one. 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. Patients were mostly very happy with the care provided by staff; however some patients told us they did not like being woken at 6am and going to bed early. Some wards and community teams did not store or manage medicines safely. Community mental health services with learning disabilities or autism, Wards for older people with mental health problems. Staff were not aware of how this might affect the safety and rights of the patients. Patients and carers confirmed in most services they had not received copies of care plans. Staff were inconsistent in updating the Historical Clinical Risk Management (HCR-20) assessments. Care plans did not always consider the patient views, and were generic did and not all were recovery focussed. Staff in some services completed care plans with detailed information on allergies, and risks around medication. Claim your Free Employer Profileto start telling your employer brand story to reach top talent. Whilst staff were working hard to identify and manage individual risks, some ward environments were unacceptable. We found the average wait times for patients presenting with a mental health crisis or specific mental health needs were between 1.5 hours and 1.9 hours. In community based mental health teams for older people five of six services breached national targets from referral to assessment. Through effective workforce planning we will nurture and support our staff to progress and flourish, offer them opportunities to deliver care through new models and in new roles. Palliative care nurses conducted holistic assessments for patients and provided advice around social issues, for example, blue badges for disabled parking. Staff had not managed all risks to patients in services. Since the last inspection the service now had a Section 136 suite that met the standards set out in the Royal College Standards. Staff carried out physical health checks on admission.Ongoing physical healthcare was provided by a local GP who visited two days a week and was available in case of an emergency. There were processes in place for reporting and learning from incidents. There was an unstructured, non-mandatory approach to formal end of life training for community hospital staff. Nursing staff did not have a stock list to randomly check medication which meant they could not reconciliation check. 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. We rated it as requires improvement because: When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. This meant staff transferred patients to wards that had seclusion rooms when needed. There was highly visible, approachable and supportive leadership. Therefore, staff could ensure accurate measures of blood pressure were being recorded. Patients were able to access hot and cold drinks any time during the day. There was no evidence of patient involvement recorded in some of the notes. There was a range of large therapeutic areas and rooms for art therapy plus other interventions. The trust could not ensure continuity of care for these patients. The clinic rooms across sites had all the equipment calibrated. The waiting times in community based mental health services for adults of working age were long and breached targets. 42% of staff on Phoenix ward and 27% Griffin ward had received clinical supervision. We had concerns about how environmental risks at CAMHS community sites were being assessed and managed. We rated community health inpatient services as requires improvement because: Despite considerable effort with recruiting new members of staff, staffing was the top concern for all senior nurses and there was still a significant reliance on agency staff to fill shifts which could not be covered internally. Leadership had been strengthened at Stewart House. Staff knew who the most senior managers were in the organisation but these managers had not visited the service and staff had no contact with them. Some patients continued to share bedroom spaces in dormitories, and personal belongings were stored on the floor because of limited storage provided by the trust. The HBPoS had no designated resuscitation equipment and emergency medication and shared equipment with acute wards. There were risk assessments and plans in place to keep people and staff safe. The trust supported a BAME network (black and minority ethnic) however, given the diversity of the geographical area of the trust, they had not significantly developed its agenda or work streams since our last inspection. However, managers had identified funding for two agency nurses to start work the week following the inspection. The trust had a limited approach to patient involvement. Where patients took medicines home with them, staff ensured that they understood their use and storage. At this inspection, we looked at adult liaison psychiatry services at the Leicester Royal Infirmary site. Staff working within criminal justice and liaison services and triage teams had good morale and worked well with internal and external colleagues. It shows how we will work together to create an inclusive culture, where there is no discrimination or bullying. Staff reported they felt supported by their colleagues and managers. Staff described various ways in which they received information from the board and other governance meetings. The teams were able to respond quickly when patients or carers telephoned with problems. The integrated therapy and nursing teams and the primary care coordinators in conjunction with the night service had clear focus on keeping patients safe and well in their own homes. 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. In rating the trust, we took into account the previous ratings of the ten core services not inspected this time. There was an effective duty system in place to provide rapid access to support. This was an issue highlighted at our inspection in 2018. Patient outcomes for people using trust services were very good and the trust was able to demonstrate that their services had a positive impact through good data collection and review mechanisms. o We are one team and we are best when we work together. We rated the trust overall for well-led as inadequate. There was a risk that staff did not receive adequate support or that their capability was not reviewed. Demand for neurodevelopment assessments remained high. Two patients we interviewed on Ashby and Heather wards told us that staff did not always knock on their bedroom doors before entering. Staff were up to date with mandatory training and had regular supervision and appraisals. Risks to people who used the service and staff were assessed and managed. 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. There was an effective incident reporting process which investigated and identified lessons from incidents which were shared in most teams. This did not protect the privacy and dignity of patients when staff undertook observations. 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. We spoke with carers; they all stated that staff responded well when they contacted the service. The child and adolescent mental health (CAMHS) community teams caseloads were above the nationally recommended amount, although young people had a care co-ordinator. They showed a good understanding of peoples individual needs. Staff did not always follow trust policies and procedures when they needed to search patients or their bedrooms to keep them safe from harm. Two patients and a carer gave feedback indicating the systems were not always robust. Practice development and embedding practice was good, for example, where dementia mapping was adapted to learning disabilities. This employer has not claimed their Employer Profile and is missing out on connecting with our community. Staff explained that the figures collected around preferred place of death were collected as these were requested by the clinical commission group (CCG), although these figures were collected for services in the community; the ward based palliative care figures were not collated. 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. On Phoenix ward patients were not allowed access to the garden. Staff were kind, compassionate and respectful towards patients. We were concerned that the trust was not meeting all of its obligations under the Mental Health Act. Safeguarding notes for one person using the Autism Outreach service could not be located creating a potential risk. Cleaning products in a cupboard in the waiting area was unlocked, which posed a risk to the young people. The trust had significantlyreduced waiting times and the total numbersof children and young people waiting for assessments. The trust needs to take steps to improve the quality of their services and we found that they were in breach of seven regulations. Staff were not meeting targets for the assessment and assessment to treatment of urgent referrals and six week routine referrals. Leicestershire Partnership NHS Trust Add a Review About 32 Four young people told us they felt involved in developing their care plan however, they had not received a copy. Three out of 18 staff interviewed said that supervision was irregular. Staff knew and understood their role in compliance with the Mental Health Act and Mental Capacity Act. Staff knew how to report any incidents on the trusts electronic reporting system and could raise concerns for the trust risk registers. We found loose papers in records. There could be risks posed by the use of different recording systems across teams as staff may not all have access to all records. Your skills are needed for the NHS Reservist project. Staff followed procedures to minimise risks where they could not easily observe patients. Staff supported patients to raise concerns when needed. Managers had a system in place for tracking and learning from safeguarding incidents and other reportable events. The 30 bed unit at Stewart House was mixed sex and there were no doors to lock between the male and female sections. Senior leaders in core services we inspected, had not maintained oversight of improvement across all wards of their services. We found damaged fixings on one ward; that posed a risk to patients. 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. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. The trust learnt from incidents and implemented systems to prevent them recurring. The trust was not commissioned to provide a female PICU and have identified the need with their commissioners. Following inspection, the trust submitted an action plan to review access to call alarms. Staff told us the trust was a good place to work. While the board and senior management had a vision with strategic objectives in place, staff did not feel fully engaged in the improvement agenda of the trust. Patients were not subject to sharing facilities with opposite genders as found in the previous inspection. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff. The lack of psychology was an issue highlighted at our 2018 inspection. Staff morale was low and they felt disempowered in some areas. : Staff completed and regularly reviewed and updated comprehensive risk assessments. Staff were up to date with mandatory training. Flexible working arrangements allowed staff to work effectively in teams, particularly when there were not enough staff in some professional groups such as speech and language therapists, occupational therapists and psychologists. Staff managed their caseloads effectively; they discussed their caseloads during multi-disciplinary team meetings as well as in supervision. We did not rate this inspection. There was detailed discussion and consideration of patients and carers needs. Save job - Click to add the job to your shortlist. There's no need for the service to take further action. Patients and carers knew how to complain and complaints were investigated and lessons identified. We are proud of our 5,400 staff and together we aim to . We found good multidisciplinary working on wards. The trust recognised this was not an appropriate target and was working with commissioners to negotiate a more appropriate target. Record keeping at Stewart House was disorganised. Often patients were admitted to hospital out of the area especially if they need a more intensive support. Staff knew the vision and values of the trust and agreed with these. The high demand for services, high levels of staff sickness and staff vacancy rates had not been managed effectively. Patients were involved in the writing of their care plans and their views were reflected in the plans. Apply. Ligature risks had been identified in bedrooms, bathrooms and toilets but there was no clear action to address all of the identifed risks, The seclusion rooms had known blind spots but no action had been taken to reduce them. The quality of clinical supervision was variable across the trust. Fire safety was much improved, withfire drills carried out regularly. The trust had robust arrangements in place for the receipt and scrutiny of detention paperwork. Leicestershire Partnership NHS Trust | 4,712 followers on LinkedIn. We will continue to keep our values of Compassion, Respect, Integrity, Trust at the centre of everything we do. Bathrooms and toilets were specified for which gender depending on who was resident at the unit at the time. We found a total 40 breaches of the six week referral and seven breaches of the five day urgent referral. There was a skilled multi-disciplinary team able to offer a variety of therapies. Staff told us they worked as a team and enjoyed their jobs. We were not assured that the trust risk register clearly documented action taken or progress of action, within agreed timescales. This has been brought together using feedback from staff, service users and stakeholders to evolve our work so far into a clearer trust-wide strategy for all areas: Step Up to Great.Through Step Up to Great we have identified key priority areas to focus on together. Emails and the trust intranet also provided staff with this information. Staff received training in safeguarding and knew how to report when needed. Staff did not always record or update comprehensive risk assessments. Clinical audit was taking place and learning was shared across the service. Within mental health services the quality of care plans was variable. We strongly recommend an informal and confidential discussion with Cathy Ellis, the Chair of the trust. We talk to patients, the public and colleagues about what matters most to them and we do not assume that we know best. Due to this staff could not observe all parts of wards due to their lay out and the risk had not been mitigated. Local audits were not completed regularly. The longest wait was 108 weeks for four patients to access group work or outpatients. Nursing staff had large caseloads. The trust had completed ligature risk assessments across all wards, detailing where risks were located and how these should be managed. 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. 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