Medication management had improved significantly across the services. The team engaged with patients who found it difficult or were reluctant to engage with mental health services. Since the last inspection the service now had a Section 136 suite that met the standards set out in the Royal College Standards. Click here to submit your comments to us. 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. 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. One patient told us there wasnt enough to do at the Willows. We found this across core services and within senior teams. The most common reason for delayed discharges was due to family choices which were beyond the control of the trust. A dashboard of key performance indicators was being developed. The risks and issues described by staff did not always correspond to those reported to and understood by their leaders. We rated families, young people and children services as good because: There were systems in place for reporting incidents and the service was able to demonstrate learning and sharing following incident investigations. Staff were inconsistent in updating the Historical Clinical Risk Management (HCR-20) assessments. However three staff said that information from incidents and learning points was not always fully shared. Staff felt that they had opportunities to develop and were supported to undertake further study. Overall, the pace of change in planning and converting plans into action across the trust was disappointingly slow. A family member spoke about enjoying regular meetings in the service gardens with their relative. This was because the EDU batch refer sending four or five referrals at a time rather than when they arrive. 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. Restraint was used only as a last resort. Staffing levels were adequate at the time of our inspection but staff told us that they had been short staffed for some time and that there were a number of vacancies. Patients and carers confirmed in most services they had not received copies of care plans. 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. Staff made individualised risk assessments which were regularly updated and followed best clinical practice. The 30 bed unit at Stewart House was mixed sex and there were no doors to lock between the male and female sections. The trust leadership team had not ensured that all requirements from the last inspection had been actioned and embedded across all services. 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. Thy are entitled to receive a remuneration of 13,000 per annum each and have . 8 February 2017. The service was meeting its target in this area. Patients told us that appointments usually run on time and they were kept informed when they do not. The trust provided newsletters, quarterly serious incidence bulletins, regular emails from matrons about incidences and lesson learnt. However, ligature points remained. There was effective multidisciplinary working. Staff were suitably trained with the relevant knowledge and skills to carry out their work, had regular appraisals and had access to the information they needed to perform their duties. A report on the inspection was . We did not rate this inspection. Wards had good evidence of multi-disciplinary team working, enabling staff to share information about patients and review their progress. Consent to care and treatment was obtained in line with relevant guidance and legislation. The service had 175 delayed discharges between August 2015 and July 2016, which accounted for 43% of the trusts total delayed discharges. 30 April 2018. Some staff used tools and approaches to rate patient severity and monitor their health. Some key outcomes for children, young people and families using the service were regularly below expectations. Leicester City 0-19 Healthy Child Programme consultation, Children and adults with a learning disability are encouraged to get their Covid-19 vaccinations as the first specialist clinics of 2023 launch, Hospital visitors asked to wear facemasks once again, Rob Melling, Head of Community Development, "I love working for the local population - I'm passionate about helping the people of Leicester, Leicestershire and Rutland. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. They were able to talk about the effectiveness of Listening in Action events which aimed to improve the quality of services. 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. However there was no evidence of clinical audits or monitoring of the service in order to improve care provided to patients and staff were unable to talk about this to inspectors. There were appropriate lone working procedures in place. Leicestershire City Council are proposing to keep Leicestershire Partnership NHS Trust as the provider, as it is a high performing service, and to recommission 0-19HCP by using Section 75 of the National Health Services Act of 2006. Patient records were electronic, up to date and available to the multidisciplinary team to enable an integrated approach to care and treatment. Staff allowed patients time to respond to questions and did not try to hurry them. 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. Community meetings and patient involvement in the services did not always take place. This was a focused, unannounced inspection, to follow up on enforcement action we issued to the trust after our last inspection in November 2018. A programme of work was due to start in forthcoming months, for wards yet to be refurbished. There was a duty worker system in place which meant the service was able to respond quickly to escalating risks if necessary. Staff completed Mental Health Act 1983 (MHA) paperwork correctly and systems were in place for secure storage of legal paperwork, advice and regular audits. Staff routinely referred patients to access additional support for employment, housing, benefits and independent mental health advocacy. We noted a box for discarded needles being left unattended in a communal area. The trust had identified the lack of psychological therapies for patients, and support and training for staff, on their risk register. Therefore, staff could ensure accurate measures of blood pressure were being recorded. However, staff did not consistently record patients views in their care plan or ensure they had received a copy. The majority of care plans were up to date. Patients could not always access a bed in their locality when needed and the trust moved patients between wards and services during episodes of care and following return from leave. Staff supported patients to raise concerns when needed. The trust was not commissioned to provide a female PICU and have identified the need with their commissioners. Wards employed additional healthcare support workers to meet patient needs when needed. Save job - Click to add the job to your shortlist. All areas were very clean, fresh smelling and fit for purpose. 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. Staff had a good understanding of patients needs. Staff received regular supervision and most had received an appraisal in the last 12 months. Watch our short film to find out more: We Are LPT Share From a National Health Service (NHS) organisation Watch on Our strategy The trust had long term plans to address this. Staff received supervisions and appraisal. A further review was an examination of processes and procedures within the trust for reporting investigations and learning from serious incidents requiring investigation. Care plans did not always consider the patient views, and were generic did and not all were recovery focussed. 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. We found a total 40 breaches of the six week referral and seven breaches of the five day urgent referral. Care records were up to date and holistic. Maintenance teams did not undertake repairs in a timely way and not all areas used by patients were clean. Potential risks were taken into account when planning community health services. Staff reported incidents, which were discussed and reviewed by line managers within the teams. Improvements were needed to make them safer, including reducing ligatures, improving lines of sight and ensuring the safety and dignity of patients. Some care plans had not been updated and physical healthcare checks were not routinely documented in young peoples notes. The lack of psychology was an issue highlighted at our 2018 inspection. Not all patient records showed a full assessment of need, including physical health needs or up to date care plans. Staff did not always feel actively engaged or empowered. We will continue to keep our values of Compassion, Respect, Integrity, Trust at the centre of everything we do. The Trust had a number of unfilled positions being covered by long-term bank staff. We saw evidence of good team working during our inspection. The trust had a major incident policy to deal with any major incidents or breakdown in service provisions. When staff deemed a patient lacked capacity there was no evidence that the best interest decision-making process was applied. However, they were not updated regularly or following an incident. There were delays in maintenance and repairs in some areas. A new leadership structure had been introduced since the last inspection and had not yet fully embedded in the service. This had been raised as a concern in the March 2015 inspection and had not been sufficiently addressed. It's a mission driven by our core values, and one that we try to achieve as a local provider, funder, and advocate. At West Leicestershire there was a lack of psychology input. The service did however, complete local audits and produced action plans for improvement in care. The service was proactive in ensuring the welfare and well-being of patients and in ensuring suitable activities. Managers ensured they monitored the reporting and recording of incidents and complaints. This had continued during the pandemic. A dual paper and electronic recording system meant that some information was not accessible to all of the staff that might need it. Curtains were missing from bed spaces and staff did not wait for an answer from patients before entering rooms on acute wards. Concerns about high bed occupancy, record keeping and delayed discharges were identified in the March 2015 inspection and had not been sufficiently addressed. When staff raised concerns or ideas for improvement, they felt they were not always taken seriously. These services were: We inspected all key lines of enquiry in two domains (safe and well-led) in a third service. It's really rewarding. Staff recognised and responded to the changing needs of patients with anticipatory medications readily available and care needs assessed and reviewed appropriately. Capacity assessments were not decision specific. The trust had significantlyreduced waiting times and the total numbersof children and young people waiting for assessments. We rated wards for people with learning disabilities as requires improvement because There was an extensive wellbeing offer available to staff. Staff did not record consent to treatment, and capacity to consent and best interests decisions when these were needed. The feedback from patients and relatives was mainly positive about the staff providing care for them. This impacted on patients requiring care. Facilities had been adapted to improve access and systems were in place to support the most vulnerable. Requires improvement From today (04/01/2023) we are once again asking all visitors to our hospitals, outpatient departments and inpatient wards to wear facemasks unless they are exempt. Care records for patients using the CRHT teams were not holistic or personalised. Managers ensure that they acted on these findings to reduce the risk of reoccurrence. 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. The trust had no psychiatric intensive care unit (PICU) for female patients. They later told us that this had been an ongoing concern for around five years. Patients were full of praise for staff and the care and support they offered. The new contract would start from 1 October 2023 and run until 30 September 2030. The NHS is founded on principles and values that bind together the diverse communities . The trust could not always provide a bed locally for patients who required admissions to its mental health wards. We rated Leicestershire Partnership NHS Trust as Requires Improvement overall because: Published Complaints were well managed to ensure a timely response and aid learning. On Ashby ward, the shower rooms did not have curtains fitted. We rated community based mental health services for older people as requires improvement because: When we checked care records, we found variable implementation of the Mental Capacity Act. Mandatory training that fell below 75% included adult immediate life support, adult basic life support, safeguarding children level 3 and fire safety awareness. Smoking cessation had been successful across most wards in the Bradgate Mental Health Unit.The trust had re-drafted the smoke free policy following on patient and staff consultation. This did not demonstrate a consistent temperature, had been maintained to assure the safety and efficacy of the medicines. Patients had access to advocacy. Incidents were on the agenda at the clinical governance meetings. Staff had a good knowledge of safeguarding and incident reporting. Staff did not always have time to attend clinical supervision sessions and patient information systems were inconsistently utilised and did not always enable effective working. These reports were presented in an accessible format. Patient Advice and Liaison Service (PALS). Nursing staff interacted with patients in a caring and respectful manner. We do not put off making difficult decisions if they are the right decisions, We set common goals and we take responsibility for our part in achieving them, We give clear feedback and make sure that we communicate with one another effectively, We encourage and value other peoples ideas, We recognise peoples achievements and celebrate success. Two patients and a carer gave feedback indicating the systems were not always robust. We were concerned that information management systems did not always ensure the safe management of peoples risks and needs. Inpatient and community staff reported difficulties with getting inpatient beds. Download the leadership behaviours booklet or watch the animation below to find out more: Our People Plan shows our dedication to making LPT a great place to work and receive care. One patient told us that staff had been rude, threatening and disrespectful towards them, which a relative also confirmed. 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. 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. 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