The waiting areas and interview rooms where patients were seen were clean and well maintained. Risk management in services required improvement. We want to hear from you on how to improve our service and provide the best care possible. 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. Therefore there were no beds available if patients returned from leave. The service did not have a system in place to monitor the number of lighters each ward held. There was use of bank and agency staff. Staff were adequately supported and debriefed following incidents and could access further support if required. Staff in four of the five services we inspected did not document patient involvement in their care. The trust provided newsletters, quarterly serious incidence bulletins, regular emails from matrons about incidences and lesson learnt. For example, for adepot injection,a slow-release slow-acting form of medication. Patients were able to access hot and cold drinks any time during the day. The environment in specialist community mental health services for children and young people, and community based mental health services for adults of working age was not suitable, did not promote safe practice and was not well maintained. The trust leadership team had not ensured that all requirements from the last inspection had been actioned and embedded across all services. . 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. We use cookies to improve your experience on our website. Due to the lack of a trust overarching strategy, the BAF did not provide an effective oversight against strategic objectives, gaps in control and assurance. Some patients told us that staff were polite and respectful and willing to go the extra mile in supporting them. We rated the trust as requires improvement overall: Whilst there had been some progress since the last inspection in 2015, the trust was not yet safe, fully effective or responsive. This was done by sliding signs to the door as needed. Maintenance teams did not undertake repairs in a timely way and not all areas used by patients were clean. Please contact Sonja Whelan on 07525 723336 or email Sonja.whelan@leicspart.nhs.uk. Staff undertook comprehensive assessments and developed high quality care plans. Lone working policies and procedures were in place for staff to follow to ensure patient and staff safety. We don't rate every type of service. Medicine management training sessions had been undertaken with inpatient ward sisters and charge nurses. : Staff completed and regularly reviewed and updated comprehensive risk assessments. Access to rooms to undertake activities in the community for people with autism had been reduced. Staff were unable to show us evidence of clinical audits or the basis of evidence based practice in end of life services. Adult liaison psychiatry services are delivered by the mental health trust across three acute hospital sites at Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital. In rating the trust overall, we took into account the current ratings of the 12 services not inspected this time. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence. There were risk assessments and plans in place to keep people and staff safe. Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Reductions in social service provision had led to an increase in referrals to the Community Learning Disability Teams. Safeguarding was a high priority with regular safeguarding reviews within each area of speciality and established systems for supporting staff dealing with distressing situations. A programme of work was due to start in forthcoming months, for wards yet to be refurbished. In the same service, managers did not always review incidents in a timely way. Patients and carers confirmed in most services they had not received copies of care plans. The trust provided patients with accessible information on treatments, local services, patients rights and how to complain across all services. Staff completed detailed individualised risk assessments for patients on admission and updated these regularly and after incidents. Ward matrons were looking into these alleged incidents. However, we were concerned that ligature risks remained in these bedrooms. There was no medicines management input from pharmacy within the community based mental health services for adults of working age. The trust needs to take steps to improve the quality of their services and we found that they were in breach of seven regulations. Nursing staff had large caseloads. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. The trust had high numbers of vacancies for registered nurses. The waiting times in community based mental health services for adults of working age were long and breached targets. They showed a good understanding of peoples individual needs. The service did however, complete local audits and produced action plans for improvement in care. Staff did not ensure that mental capacity assessments and best interest decisions were consistently documented in care records. 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. That's what building health equity means to us. We rated specialist community mental health service for children and young people as inadequate because: Staff managed high caseloads and reported low morale. The offer is for 250 to be paid through payroll and subject to tax and National Insurance and is non pensionable. Staff informed us there was a safeguarding lead to refer to when guidance was needed. The service still had challenges in recruiting sufficient staff which meant that the service, in particular community nursing, was understaffed at times impacting on staff satisfaction and compromising patient care. Managers had plans in place to address this issue. The trust admitted male patients to female areas of the mixed wards when male beds were unavailable. 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. The behaviours we expect to see at LPT are: This framework is also intended to join up all elements of our people management, from job design to recruitment and selection, induction and ongoing professional development to appraisals, in order to ensure we are as consistent and effective as possible. Crisis and relapse care plans were in place for the people that used services. Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels and some poor ward environments. We noted, however, that staff maintained close observation when this occurred and considered this less stressful for patients than sourcing out of area beds. However, this was a temporary restriction due to the building works and patient safety. 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. Our patients are at the heart of all we do and we believe that 'Caring at its Best' is not just about the . Patient records across community inpatient services were not always completed fully. Staff felt supported by their immediate managers but felt disaffected with trust senior management. Patients reported staff treated them with dignity and respect. 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. Palliative care nurses conducted holistic assessments for patients and provided advice around social issues, for example, blue badges for disabled parking. Multi-disciplinary teams and inter agency working were effective in supporting patients. We found: However, we noted one issue that could be improved: We spoke with six members of staff including matrons, team leaders and mental health practitioners and reviewed all the assessment areas the adult psychiatric liaison team uses. Staff support systems were in place and there was a drive to engage with staff. Risks to people who used the service and staff were assessed and managed. There were no children who had waited more than a year for treatment. Therefore, if a female needed a psychiatric intensive care unit they were sent out of area. Medication management had improved significantly across the services. At the Agnes Unit, staff did not always record the physical health of patients who had been given rapid tranquilisation. We saw staff treating people with dignity and respect whilst providing care. Potential risks were taken into account when planning community health services. 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. This area of our site lists our partner organisations. A high number of outpatient appointments were cancelled. the service isn't performing as well as it should and we have told the service how it must improve. Nursing staff did not have a stock list to randomly check medication which meant they could not reconciliation check. Staff told us the trust was a good place to work. We rated wards for people with learning disabilities as requires improvement because Staff monitored the ongoing condition of any secluded patient. There was an extensive wellbeing offer available to staff. Updated 22 June 2022. However, there were some instances when patients privacy and dignity were not respected. 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 . One patient on Thornton ward told us that while staff did knock, they did not wait for a response before entering, which had resulted in staff walking into their room while they were changing their clothes, compromising their privacy and dignity. the service is performing well and meeting our expectations. There was a duty worker system in place which meant the service was able to respond quickly to escalating risks if necessary. Staff were up to date with mandatory training. Interpreters were available. We were aware the local commissioning groups had not set targets for wait times. The trust had improved how staff recorded patients physical healthcare, and monitored patients who had ongoing physical healthcare problems. Until then there is a danger information is not shared or fully available to all staff seeing a person. The child and adolescent mental health (CAMHS) community teams caseloads were above the nationally recommended amount, although young people had a care co-ordinator. Senior managers were aware of the bed pressures in their acute and PICU service and had raised concerns with their commissioners. Staff were positive about the support they received from their local leaders and managers but were less connected with senior leadership and management teams in the children, young people and families services. Click here to submit your comments to us. The trust encouraged staff at most levels of the organisation to develop and deliver ideas for service delivery, improvement and innovation. Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. Patient involvement in planning care was now in place and the voice of the patient in changes to services had been considered. Resuscitation bag, defibrillator and fire drill checks in the CAMHS LD service were not recorded. Interview rooms were unsafe. The Health Trust HIV/AIDS Services program delivers groceries to homebound seniors and adults throughout Santa Clara County. We are proud of our 5,400 staff and together we aim to . There was a range of large therapeutic areas and rooms for art therapy plus other interventions. Beaumont ward did not have a poster displayed around informal patients and rights as a patient had ripped it down. The cold chain processes to ensure optimal conditions during the transport, storage, and handling of vaccines was outstanding. Staff working for the adult psychiatric liaison team developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. Apply. In addition to this, risk assessments were comprehensive and reviewed as per the trust policy, six monthly or after risk incidents. In rehabilitation wards, staff did not always develop and review individual care plans. ALT. Significant vacancy rates and high sickness levels put additional pressure on substantive staff. It is generally accepted that when occupancy rates rise above 85%, it can start to affect the quality of care provided to patients and the orderly running of the hospital. We inspected all key lines of enquiry in all domains (safe, effective, caring, responsive and well-led) in two services. We spoke with six patients who all told us that the staff were very kind and looked after them well. Care records showed that physical health examinations were completed upon admission and there was ongoing monitoring of physical health across the trust. They contained items which could pose a danger to staff and patients. Some seclusion rooms had environmental concerns at Belvoir and Griffinunits, and Watermead wards. Staffing levels did not meet requirement in some community teams. The trust had maintained patients privacy and dignity at Short Breaks Services. There was clear evidence that staff learnt from incidents and had forums for information exchange to occur as and when needed. The trust had no psychiatric intensive care unit (PICU) for female patients. Some staff used tools and approaches to rate patient severity and monitor their health. There was effective communication between the service and other healthcare professionals. Staffing was on the risk register for many of the locations we visited. 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