Specialist community mental health services for children and young people. Patients were able to access hot and cold drinks any time during the day. The majority of community mental health teams did not meet the referral to initial assessment and assessment to treatment times. Staff moved acute patients to the rehabilitation wards when acute beds could not be located. Staff felt well supported and were able to raise concerns with their line manager and were listened to. Response times to maintenance request were variable. Staff maintained a presence in clinical areas to observe and support patients. Patients knew how to formally complain and could attend daily community meetings where they could raise any issues of concern. Staff working within criminal justice and liaison services and triage teams had good morale and worked well with internal and external colleagues. We rated the trust overall for well-led as inadequate. Staff followed up on all people seen in by phone, post or face to face to help with any ongoing issues such as housing or benefits. The trust had a dedicated family room for patients to have visits with children. 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. There were no children who had waited more than a year for treatment. There was a range of large therapeutic areas and rooms for art therapy plus other interventions. A new leadership structure had been introduced since the last inspection and had not yet fully embedded in the service. Some areas at Bradgate Mental Health Unit required further improvements to the environments. The acute mental health wards had two and four bedded dormitories which did not promote privacy and dignity. Engagement and joint planning between departments was well developed. Staff actively participated in clinical audits. Two core services did not promote patient centred care in all aspects of care delivery. The trust had ensured patients privacy and dignity were maintained when receiving physical health observations at the Bradgate Mental Health Unit. Thy are entitled to receive a remuneration of 13,000 per annum each and have . Six further patients across Beaumont, Ashby and Heather wards told us that not all staff were caring or respectful. Care plans and risk assessments did not show staff how to support patients. The trust had a limited approach to patient involvement. Nurses and managers from LPT who were supported . 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. There was no patient alarm access in four ward areas, including the dormitories. Staff told us they felt happy and enjoyed their work. We found concerns with the environment in all five core services we inspected. The transition from the CAMHS LD service to adult teams was not always timely and, therefore, did not follow best practice. The number of visits was not always manageable. The learning disability community team had not met the six week target for initial assessment on average it was six days over. Leicestershire Partnership NHS Trust (LPT) provides a range of community health, mental health and learning disability services for people of all ages. University Hospitals of Leicester NHS Trust. 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. Specialist community mental health services for children and young people, Community-based mental health services for older people, Community-based mental health services for adults of working age, Community health services for children, young people and families. Procedures for incident management and safeguarding where in place and well used. Complaints were well managed to ensure a timely response and aid learning. The trust had a variety of measures in place to ensure that processes and reporting to board were not delayed. The vacancy rate for the service was 12.9% and for band 5 and 6 nurses was 18.9%. Leicestershire patient care project shortlisted in prestigious awards. There were examples of people not being seen within service guidelines whilst receiving large doses of prescribed medication. There were high vacancy rates. This was highlighted in the previous inspection. However, they did not always meet the required skill mix for the nursing teams. Staff acknowledged directors visits. We did not inspect the following areas of this core service: We did not rate this service at this inspection. Palliative care nurses conducted holistic assessments for patients and provided advice around social issues, for example, blue badges for disabled parking. For example, for adepot injection,a slow-release slow-acting form of medication. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. Staff told us they will move to a new electronic system in July 2015 which will be the same as other areas in the trust. Staff treated patients with kindness, compassion and respect.We saw staff spend time talking to and their carers. Shifts were not always covered with sufficient staff, or with staff who had the appropriate qualification and experience for the role. We noted how much time the new executive team had invested in making and implementing improvements during the COVID-19 pandemic. 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. Staff gave examples of working with people with diverse needs considering their ethnicity, gender, age and culture. Staff were not aware of how this might affect the safety and rights of the patients. This was a focused, unannounced inspection, to follow up on enforcement action we issued to the trust after our last inspection in November 2018. The trust reported a 10% increase in the number of referrals received into the CAMHS service. 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. There had been periods of understaffing. Assessments and care planning took place for patients needs. In rehabilitation wards, staff did not always develop and review individual care plans. We saw the trust had developed oversight and a vision on how to improve the nine key areas identified by the warning notice. 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. 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 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. A dashboard of key performance indicators was being developed. 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. Staff were unable to show us evidence of clinical audits or the basis of evidence based practice in end of life services. The teams we spoke with, felt the trust board did not set clear timescales or direction on how to move their projects forward. HBPoS and crisis resolution and home treatment (CRHT) team toilets were not visibly clean. 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. We found damaged fixings on one ward; that posed a risk to patients. Patients felt safe and said they were checked regularly by staff. Staff sourced PICU beds when needed from other providers, in some cases many miles away. ", "I have developed so many new skills over the years working in the NHS, going from a healthcare assistant to a nursing associate. Some families and carers told us that the service was not responsive, telephone calls to the service were not returned. This meant the police very often had to care for detained patient for the duration of the assessment. Leicestershire Partnership NHS Trust | 5,409 followers on LinkedIn. Serious incidents were thoroughly investigated and outcomes and lesson learnt were discussed in a variety of clinical governance meetings. People using the service had limited access to psychological therapies and there were no psychologists working within the service. Watch our short film to find out more: We Are LPT Share From a National Health Service (NHS) organisation Watch on Our strategy The service employed care navigators to help families and carers negotiate their journey through the various services provided. The matron opened some vault windows via a remote. Staff had not routinely recorded whether they had given patients copies of their care plans and we saw this in a considerable number of patient records we sampled. Staff told us the trust was a good place to work. The duty system enabled urgent referrals to be seen quickly. The teams did not have waiting lists for care coordinators at the time of inspection. the service is performing exceptionally well. There were low levels of restraint and staff tried other methods to de-escalate before restraining patients. When staff deemed a patient lacked capacity there was no evidence that the best interest decision-making process was applied. Emails and the trust intranet also provided staff with this information. This had continued during the pandemic. 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. Staff at the PIER team had not received recent Mental Health Act training. We strongly recommend an informal and confidential discussion with Cathy Ellis, the Chair of the trust. There had been several serious incidents (SI) within this service in the last year. Wards had high numbers of hydraulic style patient beds that were a risk to patients with histories of self-harming behaviour. Children and young people felt listened to in a non-judgmental way and told us they felt respected. Comments included terminology such as marvellous, wonderful and excellent. When staff raised concerns or ideas for improvement, they felt they were not always taken seriously. One Community Learning Disability Team had developed an educational awareness raising event to prevent hospital admissions due to dehydration. However, the service was collecting data. Staff received little support from trust specialist doctors in palliative care and contacted the local hospice run by a charity for support. Bathrooms and toilets were specified for which gender depending on who was resident at the unit at the time. Care and treatment was mostly planned and delivered in line with current evidence. This was a significant improvement since our last inspection which reported 171 out of area placements lasting between two and 192 days. Published There was a risk that staff did not receive adequate support or that their capability was not reviewed. Patient involvement in planning care was now in place and the voice of the patient in changes to services had been considered. Managers ensure that they acted on these findings to reduce the risk of reoccurrence. The NHS is founded on principles and values that bind together the diverse communities . 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. Acute patients had been sent to rehabilitation wards inappropriately. 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. We did not identify any significant community wide areas for improvement but did find many exemplary services provided by the trust. Staff working within the CRHT team and the liaison mental health triage service had not clearly document in patient paperwork or case notes if the patient had capacity or not. This was an issue highlighted at our inspection in 2018. Patients who accessed the CRHT team told us that they felt their wishes and needs were taken in to consideration, staff could be accessed quickly and they felt safe when visiting the Bradgate Mental Health unit. They showed a good understanding of peoples individual needs. Staff reviewed young peoples risk at every appointment and recorded this in the case notes. Staff did not routinely complete detailed, person centred, individualised or holistic care plans about or with patients. We looked at 20sets of seclusion recordsandfrom17 records,staff were notrecording seclusion, in line with the Mental Health Act Code of Practice. This was done by sliding signs to the door as needed. We saw patients were treated with kindness and compassion. View more Profession Nurse Service Child & Adolescent / CAMHS Grade Band 5 Contract Type Permanent Hours Full Time. The summary for this service appears in the overall summary of this report. 30 April 2018. Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. The group established a deliberate self harm and suicide group in the last year to oversee specific incidents of this nature. The service was not safe. This could pose a risk to patients and staff. The needs and preferences of patients and their relatives were central to the planning and delivery of care with most people achieving their preferred place of care. Ward matrons told us they shared outcomes from incident investigations in team meetings for shared leaning. Staff provided psychological therapies as recommended by NICE such as group work and cognitive behavioural therapy. Ward teams did not hold regular team meetings. The trust did not have seclusion rooms on all wards. Apply. The trust had developed checklists to assist staff with the receipt and scrutiny process. Across the teams, we found up to date ligature audits in place. Staff we spoke with were proud to work within the adult psychiatric liaison team and proud to show us the work they did and the service they provided. Staff told us they involved patients carers but there was little evidence of this in care records. Staff felt that they had opportunities to develop and were supported to undertake further study. 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. 83% of staff received mandatory training. The ward had an up to date ligature risk audit, staff mitigated the risks on the ward by observing patients. There were delays in maintenance and repairs in some areas. Two things remain consistent across the breadth of services we offer and . Clinical supervision was not taking place regularly across the service. 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. Patients reported that they felt safe on the wards. There was a good working relationship between the Mental Health Act (MHA) administration team and the wards, community teams and the executive team. Staff completed extensive and detailed care plans. 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. The child and adolescent mental health (CAMHS) community teams caseloads were above the nationally recommended amount, although young people had a care co-ordinator. Staff referred to having reflective practice peer meetings when they were concerned about the risk to a young person. Staff were not always recording room and fridge temperatures in clinical rooms and out of date nutrional supplement drinks had not been appropriately disposed of. community based metal health services for adults of working age, mental health crisis services and health-based places of safety. 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. The adult community therapy team did not meet agreed waiting time targets. However, they were not updated regularly or following an incident. Staff completed care plans for patients. We saw that consent was gained from people in relation to their care and future wishes. We did not inspect the following core services previously rated as requires improvement: We did not inspect the following core services previously rated as good: We are monitoring the progress of improvements to services and will re-inspect them as appropriate. We rated responsive and well led as requires improvement, and safe, effective and caring as good. egistered general nurses with dedicated time to focus on individual healthcare plans at Stewart House and The Willows. Find out more Knitting therapy keeps cats and dogs warm 23 Dec 2022 News 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. Staff mitigated the risks posed in the garden area by accompanying patients when they wanted to access the garden. Managers did not have oversight of these issues. Leicestershire Partnership NHS Trust - NEU Professionals - UK Overseas Nurse Recruitment campaign from 2022 - ongoing Leicestershire Partnership NHS Trust (LPT) provides community and mental health services for Leicester, Leicestershire and Rutland. Patients did not have access to regular community meetings where they would discuss ward issues and concerns. Download full inspection report for - PDF - (opens in new window), Published Some actions were required to ensure adherence with the Mental Health Act. the service is performing well and meeting our expectations. The trust had addressed the issues regarding the health based place of safety identified in the previous inspection. The trust ceased mixed sex breaches by maintaining male and female only weeks. The trust needs to take steps to improve the quality of their services and we found that they were in breach of seven regulations. Patients did not have access to psychological therapies, as required by the National Institute for Health and Care Excellence (NICE). This was in breach of the Mental Health Act Code of Practice guidance on mixed sex accommodation. This is an organisation that runs the health and social care services we inspect. Bed occupancy rates were above 85% for community health inpatient wards. We rated child and adolescent mental health wards as good because: The ward had clear lines of sight in the main areas of the ward. Patients own controlled drugs were not always managed and destroyed appropriately. Staff followed infection control practices and maintained equipment through regular servicing. The trust could not always provide a bed locally for patients who required admissions to its mental health wards. The health-based place of safety did not meet some aspects of the guidance of the Royal College of Psychiatrists. Staff demonstrated commitment to delivering high quality end of life care for their patients. People felt they had benefited from the service and told us how caring staff were. Staff in the community adult mental health teams did not protect patients dignity or privacy. Two patients told us they had experienced cancelled leave, and numerous staff confirmed that facilitating escorted leave had been difficult at times which had led to either a cancellation, or where possible delayed leave. Our rating of this service improved. Patients were not always involved in the planning of their care. 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 trust had improved medicines management. There was evidence of actions taken to improve the quality of the service. All three service inspections were unannounced. Staff said this made them feel safe whilst visiting patients at home or whilst undertaking activities with patients in the community. They remained positive when engaging patients in meaningful activities. Senior managers were aware of the bed pressures in their acute and PICU service and had raised concerns with their commissioners. We had serious concerns about the trusts oversight of ward environments and safety of patients within those areas. Staff had not received any specialist training on crisis intervention. We observed positive interactions between patients and staff. Staff did not effectively complete risk assessments for patients, manage a smoke free environment, or share information about incidents or share learning from incidents within teams, across services or between services in the trust. Our HIV/AIDS Services program is in need of volunteers to help deliver . The HBPoS had poor visibility for observing patients. In July 2019, the new trust board formed a buddy relationship with a mental health and community health service NHS trust in Northamptonshire (Northamptonshire Healthcare NHS Foundation Trust NHFT) following the previous inspections in 2018 and 2019. 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. The community adult team caseloads varied. However, staff told us they had little experience of incident reporting within the community childrens services. The trust was told to address the arrangements for eliminating dormitories at our last inspection in 2018 and work had started on one ward in March 2021. The single point of access made contacting the service easy for both patients and health professionals and enabled referrals into the service to be triaged and assigned from one central point. 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. 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. 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. This meant that patients could have been deprived of their liberties without a relevant legal framework. They told us that staff were kind and caring. 89% of staff had attended their mandatory training; 92% of appropriate staff had received training in safeguarding adults and 90% of staff had completed safeguarding children training. Maintenance teams did not undertake repairs in a timely way and not all areas used by patients were clean. Staff consistently demonstrated good morale. The trust set target times from referral to initial assessment against the national targets of 28 to 42 days. Therefore, if a female needed a psychiatric intensive care unit they were sent out of area. 78% of staff had completed their annual appraisal. There was limited time available for staff to attend specialist courses to enhance their knowledge. There some gaps in staff receiving regular supervision. There was an unstructured, non-mandatory approach to formal end of life training for community hospital staff. Two patients discharges were delayed at The Agnes Unit because the commissioners could not find specialist placements. Risk management in services required improvement. Staff did not always record or update comprehensive risk assessments. Where patients took medicines home with them, staff ensured that they understood their use and storage. Patients were frequently not discharged when ready due to transport problems or difficulties putting care packages in place. There was access to interpreters and staff were aware of how to access them. They contained items which could pose a danger to staff and patients. Patients occasionally attended the service. That's what building health equity means to us. The feedback from patients and relatives was mainly positive about the staff providing care for them. We spoke with five informal patients at the Bradgate Mental Health Unit who were unaware of what they could and could not do as an informal patient. Browser Support Patient outcomes were not routinely collected so the quality of the clinical care being delivered could not be measured or benchmarked. Published The waiting times in community based mental health services for adults of working age were long and breached targets. . Whilst there was a plan to eradicate the dormitories across the trust, there were delays to the timetable and patients continued to share sleeping accommodation which compromised their privacy.