It shows how we will work together to create an inclusive culture, where there is no discrimination or bullying. We did not identify any significant community wide areas for improvement but did find many exemplary services provided by the trust. 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away from training during the COVID-19 pandemic, but face to face training had restarted and not all staff who had out of date training had rebooked. Staff were not aware of the trusts visions or values. We saw numerous interactions between staff and patients with very complex needs and staff managed extremely challenging situations with knowledge and compassion. Concerns about high bed occupancy, record keeping and delayed discharges were identified in the March 2015 inspection and had not been sufficiently addressed. The trust confirmed the service line was contracted to provide bed occupancy at 93%. The school nurses used technology to communicate with young people. The community nursing service could not measure its performance in relation to response times for unplanned care. The CRHT team did not have lockable bags to transport medication to patients homes; staff told us they transported medication in their handbags. In all three services, not all staff were up to date with mandatory training. This meant that patients could have been deprived of their liberties without a relevant legal framework. Medicines Management Our vision Creating high quality, compassionate care and wellbeing for all. Comprehensive relocation action plans were available. Managers did not ensure that the staff were receiving regular clinical supervision and had not met the trust target compliance rate of 85%. 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 the specialist community mental health services for children and young people used a shared waiting room with the learning disabilities adults services. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. Feedback from those who used the families, young people and children services was consistently positive. We did not inspect the whole core service. Access to treatment for specialist community mental health services for children and young people, Maintaining the privacy and dignity of patients and concordance with mixed sex accommodation, Seclusion environments and seclusion paper work. This was a focused inspection. Staff were aligned to services to manage data and we have seen improvements in recording and monitoring of supervision and appraisal, improvement in managing risks of those on waiting lists in specialist community mental health services for children and young people and in training data. 10 July 2015. There was clear evidence that staff learnt from incidents and had forums for information exchange to occur as and when needed. Staff were open about their poor understanding around the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We carry out joint inspections with Ofsted. The trust was not fully compliant with same sex accommodation guidance in two acute wards, the short stay learning disability service and rehabilitation services. 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. Suspended ratings are being reviewed by us and will be published soon. Staff received Mental Capacity Act 2005 and Deprivation of Liberty Safeguards Some staff did not demonstrate a good understanding of the Mental Capacity Act. Staff were de-briefed and supported after a serious incident; we saw that incidents were a standing agenda item for team meetings and were discussed with staff. All incidents that should be reported were reported. In addition to this, risk assessments were comprehensive and reviewed as per the trust policy, six monthly or after risk incidents. Staff completed detailed risk assessments for patients on admission and reviewed them regularly after incidents. We rated Leicestershire Partnership NHS Trust as Requires Improvement overall because: Published Managers did not successfully cascade information down to all ward staff in acute mental health services. Staff told us they felt supported by their line managers, ward managers and matrons. Mental Health Act documentation was not always up to date on the electronic system. The trust had systems for staff to raise any concerns confidentially. Assessments and care planning took place for patients needs. There was a full complement of staff with no vacancies. All wards had developed their own systems to improve medicines management in their areas. You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection. The trust had launched its "Step up to Great" approach, which identified the vision and priorities for the year. Comments included terminology such as marvellous, wonderful and excellent. Apply. 87 of the total patients had been waiting over a year to begin treatment. Effective multi-disciplinary team working and joint working did not always take place across services. They are: o We focus on what matters most. The quality of some of the data was poor. Lone working policies and procedures were in place for staff to follow to ensure patient and staff safety. The trust had a limited approach to patient involvement. Staff showed a good awareness of patient rights. The trusts pace for implementing equality and diversity initiatives across the organisation needed improvement. We saw patients that needed a PEEP had a plan in place. Annual Statement 2009 for - PDF - (opens in new window), Annual Statement 2010 for - PDF - (opens in new window), In Staff worked with both internal and external agencies to coordinate care and discharge plans. Bed occupancy for the last two quarters of 2013/14 was around 89%. Specialist community mental health services for children and young people. Staff updated risk assessments and individualised care plans regularly. 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. A positive culture had developed since our last inspection. 9 August 2019, Leicestershire Partnership NHS Trust: Evidence appendix published 27 February 2019 for - PDF - (opens in new window), Published At this inspection the well-led provider rating improved from inadequate to requires improvement. Patient views on the quality of the food were variable. Clinical audit was taking place and learning was shared across the service. This did not protect the privacy and dignity of patients when staff undertook observations. Staff responded to patients needs discreetly and respectfully. However, managers had identified funding for two agency nurses to start work the week following the inspection. The trust had robust governance structures and they had assured any potential gaps or overlaps had been considered. This was an issue highlighted at our inspection in 2018. Acute patients had been sent to rehabilitation wards inappropriately. There was a range of large therapeutic areas and rooms for art therapy plus other interventions. The service was caring. Staff who were unclear of the process for rapid tranquillisation did not have a reminder of the process to follow. Staff at St Lukes Hospital had arranged bi-monthly meetings to involve patients and visitors in the news and actions happening on the ward. This meant the police very often had to care for detained patient for the duration of the assessment. Mobility and healthcare equipment took up space in The Gillivers and 3Rubicon Close. The acute service contained large numbers of beds in bed bays accommodating up to four patients. We rated wards for older people with mental health problems as good because: The wards complied with the Department of Health 2015 guidelines on single sex accommodation. We will continue to keep our values of Compassion, Respect, Integrity, Trust at the centre of everything we do. By doing this it will help us achieve our vision of creating high quality, compassionate care and wellbeing for all. 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. Five of the six services in this core service were in breach of these targets. Safeguarding notes for one person using the Autism Outreach service could not be located creating a potential risk. Staff told us they felt happy and enjoyed their work. All hospitals were running at a high bed occupancy level of above 85% which national data has linked to increased risk of bed shortages as well as an increase in healthcare associated infections. The assessment and resulting care plans were personalised, holistic and recovery focussed. Staff had the right qualifications, skills, knowledge and experience to do their job. 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. She embraces the principles of the employee as a consumer (a person who makes the choice of where to work by considering a broadly defined value proposition, inclusive of financial, work, and social aspects of life) and agile organization (a workforce that continually evolves to meet the changing interests and needs of team members and customer.) The environment in some services was poor, not well maintained and not kept clean. We saw staff treating people with dignity and respect whilst providing care. We saw patients were treated with kindness and compassion. However three staff said that information from incidents and learning points was not always fully shared. The service was responsive. They were able to talk about the effectiveness of Listening in Action events which aimed to improve the quality of services. Two patients and a carer gave feedback indicating the systems were not always robust. On rehabilitation wards, staff did not care plan the needs of a patient with protected characteristics. The service was not meeting its performance targets. This meant that some staff felt insecure. 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. While staffing numbers were usually maintained, there was a high reliance on agency and bank staff to achieve this. Staff mitigated the risks posed in the garden area by accompanying patients when they wanted to access the garden. The trust reported a 10% increase in the number of referrals received into the CAMHS service. A report on the inspection was . Staff spoke of feeling supported by team leaders and team leaders felt supported by their managers. Managers had a recruitment plan in place to increase the number of substantive staff for the service. The community healthcare services provided by Leicestershire Partnership NHS Trust were judged to be good. The trust had systems for promoting, monitoring and responding to complaints. The adult community therapy team did not meet agreed waiting time targets. Staff mostly felt positive about their managers and said that the services provided were well-led. We did not inspect the following areas of this core service: We did not rate this service at this inspection. People using the service may not be able to get the speed of telephone response they needed in a crisis. Improvements were noted in some wards in core services but not all. Patient access to psychology and occupational therapy was less than expected on acute wards and rehabilitation wards due to the number of staff vacancies in therapy positions. The waiting areas and interview rooms where patients were seen were clean and well maintained. The people who used services, carers and relatives we spoke with were all positive about the service they received. This was: We also assessed if the organisation is well-led and looked at areas of governance, culture, leadership capability and improvement. Many staff we spoke with knew who their chief executive was and mentioned them by name. Risk management in services required improvement. PIER staff reported having good links with universities and colleges regarding students needing early intervention services. Staff provided patients and carers with information in a way that they understood.At City West, City East, and South Leicestershire patients and their carers reported outstanding and good care. The service used evidence based, best practice guidance throughout its policies and procedures and ways of working. They were supported to have training to help them to develop additional skills and expertise. The trust lacked an overarching strategy which everyone within the trust knew. Our rating of this service improved. Patients were supported, treated with dignity and respect and involved as partners in their care. 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. The lack of psychology was an issue highlighted at our 2018 inspection. Managers did not ensure that staff completed Mental Capacity assessments in line with the Act. Your skills are needed for the NHS Reservist project. Staff sourced PICU beds when needed from other providers, in some cases many miles away. Some patients told us that staff were polite and respectful and willing to go the extra mile in supporting them. This reduced continuity of care. The service did not exclude patients who would have benefitted from care. Clinic rooms were overstocked with medications. The HBPoS had poor visibility for observing patients. At this inspection, we rated two core services as inadequate, two core services as requires improvement, and one core service as good. 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. The trusts Board Assurance Framework (BAF) was lengthy, was combined with a corporate risk register and had overdue actions. We are looking at different ways to indicate the outcomes of our monitoring in the future. Detention renewal paperwork had been signed by a doctor prior to them seeing the patient. Staff acknowledged directors visits. We looked at 20sets of seclusion recordsandfrom17 records,staff were notrecording seclusion, in line with the Mental Health Act Code of Practice. Our HIV/AIDS Services program is in need of volunteers to help deliver . In two of the core services inspected, the environment had not been well maintained. There was no funding for staff to provide activities so patients had limited access to activities of their choice during their stay. Mandatory training compliance for trust wide services was 91% against the trust target of 85%. Patients were frequently not discharged when ready due to transport problems or difficulties putting care packages in place. Staff completed detailed individualised risk assessments for patients on admission and updated these regularly and after incidents. When staff deemed a patient lacked capacity there was no evidence that the best interest decision-making process was applied. Patients we spoke with knew how to complain. 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 inspection of Leicestershire Partnership NHS Trust because at our last inspection we rated two mental health services provided by this trust as inadequate, four mental health services and one community health service as requires improvement. In addition, staff did not record the maximum dose of medications a patient could have in any 24-hour period. 100% of staff were trained in how to safeguard children from harm. Trust staff working within the had remote access to electronic systems used by the trust. Staff held high caseloads in community based mental health services for adults of working age, an issue which had been recognised by the trust and placed on the risk register. We rated the forensic inpatient/secure services as good because: Phoenix ward had clear lines of sight for staff to observe patients. Staff reported incidents, which were discussed and reviewed by line managers within the teams. Published Leicestershire Partnership NHS Trust Location Loughborough Salary 27,055 to 32,934 a year Closing date 13 Jan 2023. The HBPoS did not have access to a dedicated clinic room. Clinic room temperatures were very hot, although one thermometer was above a radiator so would not give an accurate reading. 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 had set clear guidelines on where and how physical health observationswere completed on wards. Multi-disciplinary team meetings took place on a regular basis. Staff did not always feel actively engaged or empowered. 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