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. CV6 6NY, In Improvements had been made to the seclusion facilities, and further improvements were planned across the service to improve patient experience and promote privacy and dignity. Staff received little support from trust specialist doctors in palliative care and contacted the local hospice run by a charity for support. Following inspection, the trust submitted an action plan to review shared sleeping arrangements. 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. Staff allowed patients time to respond to questions and did not try to hurry them. We rated all three mental health services inspected as requires improvement overall. Staff in some services completed care plans with detailed information on allergies, and risks around medication. This had a negative impact on the delivery of urgent nursing care, continence services and non-urgent therapy care. Patients needs were assessed and monitored individually. spoke with 15 family members or carers of patients, reviewed the mental health act detention papers of 23 patients and seclusion records of 10 patients, and. There were waiting lists of up to 18 months for psychology and up to 40 weeks for other treatment within the personality disorder service. The service was proactive in ensuring the welfare and well-being of patients and in ensuring suitable activities. We did not inspect the whole core service. Two external governance reviews had been commissioned and undertaken. Staff on the acute wards were not consistent with searching patients upon return from unescorted leave as some patients had managed to take lighters onto four of the wards. Medicines Management Our vision Creating high quality, compassionate care and wellbeing for all. There was evidence of leadership at local and senior level. Services and care were planned with the local population in mind and to address the individual needs of patients. The service did however, complete local audits and produced action plans for improvement in care. There were a high number of patients on the waiting list for treatment in the specialist community mental health services for children and young people. At Melton, Rutland and Harborough and Charnwood there was a lack of audits and little focus on quality and improvement. The trust had made some improvements in response to the previous CQC inspection undertaken in March 2015.This included removing some ligature anchor points in the acute mental health wards. Carers told us they had regular contact with the CRHT team and they were kept involved with their loved ones care. We don't rate every type of service. The dignity and privacy of patients across three services we visited was compromised. The electronic data held by the trust was currently being validated with large numbers of visit records not closed on the database. We saw evidence of discharge planning in care plans written by CRHT staff. Staff did not record consent to treatment, and capacity to consent and best interests decisions when these were needed. The ward had an up to date ligature risk audit, staff mitigated the risks on the ward by observing patients. Leadership had been strengthened at Stewart House. This was an issue highlighted at our inspection in 2018. Staff were positive about the level of support they received, including regular supervision and line management. Staff were up to date with mandatory training. Staff followed infection control practices and maintained equipment through regular servicing. Staff followed infection and prevention control practices and the community inpatient wards were visibly clean. Medication management systems were in place and followed to ensure that medicines were stored safely. The trust had a patient involvement centre, which was pleasant, well-equipped and supported involvement from friends and family. Staff informed us there was a safeguarding lead to refer to when guidance was needed. There was an effective incident reporting process which investigated and identified lessons from incidents which were shared in most teams. We found that there were often delays in hospital beds being identified with some people placed out of area away from their family, friends and community. A report on the inspection was . Staff told us they felt supported by their line managers, ward managers and matrons. We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. A new chief executive was appointed as a shared role between the two trusts. Some wards did not meet the Department of Health and Mental Health Act Code of Practice requirements in relation to the arrangements for mixed sex accommodation. The high demand for services, high levels of staff sickness and staff vacancy rates had not been managed effectively. Sixty per cent of staff working in the mental health services had attended supervision and 64% of staff working in community health inpatient services. Risk assessments were brief, did not always contain sufficient information and were not updated regularly. The service did not have a system in place to monitor the number of lighters each ward held. However, 323 were waiting for their first appointment through the access team, to complete a core mental health assessment. The trust told us patients across mental health inpatient wards had commented positively about their experience of care. We have four core values: Compassion, Respect, Integrity, Trust. Find out more Knitting therapy keeps cats and dogs warm 23 Dec 2022 News DE22 3LZ. 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. 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. The trust had a range of information displayed on the ward and the hospital site relating to activities, treatment, safeguarding, patients rights and complaint information. The waiting times in community based mental health services for adults of working age were long and breached targets. Staff completed detailed risk assessments for patients on admission and reviewed them regularly after incidents. Staff treated patients with kindness, dignity, and respect. Some families and carers told us that the service was not responsive, telephone calls to the service were not returned. Since our 2017 inspection, the trust had not fully ensured that clinical premises where patients received care where safe, clean well equipped, well maintained and fit for purpose. Incidents and near misses were reported and learning from these was shared. Community meetings and patient involvement in the services did not always take place. We found that while performance improvement tools and governance structures were in place these had not always brought about improvement to practices. Suspended ratings are being reviewed by us and will be published soon. 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 in practice. 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. Staff moved acute patients to the rehabilitation wards when acute beds could not be located. The adult community therapy team did not meet agreed waiting time targets. 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 received training in safeguarding and knew how to report when needed. There was good access to interpreters and signers when needed. Patients told us that appointments usually run on time and they were kept informed when they do not. We did not speak to any patients using the service at the time of the inspection. We rated community health services for adults as requires improvement because. The trust had robust arrangements in place for the receipt and scrutiny of detention paperwork. Some wards and community teams did not store or manage medicines safely. Managers had plans in place to address this issue. All the team leaders we interviewed said there were internal waiting lists for patients who had been initially assessed to access profession specific treatments. There was a good working relationship between the Mental Health Act (MHA) administration team and the wards, community teams and the executive team. We had concerns about how environmental risks at CAMHS community sites were being assessed and managed. Consultations with staff and the public had been undertaken to gain feedback on the proposed move of wards. Staff felt that they had opportunities to develop and were supported to undertake further study. 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. In community based mental health teams for older people five of six services breached national targets from referral to assessment. In 3Rubicon Close, it was not clear that information about providing physiotherapy to a patient had been communicated to all staff. 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. There was evidence of actions taken to improve the quality of the service. We found concerns with the environment in all five core services we inspected. Improvements had been made to seclusion areas at The Willows Acacia and Maple wards. Governance systems and processes, and the strategy of the organisation had been extensively reviewed since our last inspection but was not fully embedded into services. the service isn't performing as well as it should and we have told the service how it must improve. 56% of individual care plans were not up to date, personalised or holistic. The service was meeting the target for initial assessment within 13 weeks of referral with a compliance of 99%. The trust did not ensure that they meet set target times for referral to initial assessment, and assessment to treatment in the majority of teams. Overall, patients were positive about the care they received and had access to advocacy services on all wards. While they made appropriate assessments and were responsive to changing needs, NICE guidelines were not used to ensure best practice and that multi-agency teams worked well together. One patient told us there wasnt enough to do at the Willows. Some improvements to address the no smoking policy at the Bradgate Mental Health Unit wards were seen. Community mental health services with learning disabilities or autism, Wards for older people with mental health problems. Staff did not always feel connected to the wider trust. The trust ceased mixed sex breaches by maintaining male and female only weeks. Not all services were safe, effective or responsive and the board needs to take urgent action to address areas of improvement. Patients reported staff treated them with dignity and respect. We found a patient being nursed in the low stimulus area and their liberty was restricted. Staff were adequately supported and debriefed following incidents and could access further support if required. We rated acute wards for adults of working age and psychiatric intensive care units as requires improvement because: The trust had made improvements to the clinical environments but had not met all the required actions following the previous inspection of March 2015. Staff received supervisions and appraisal. We observed some very positive examples of staff providing emotional support to people. Staff were up to date with mandatory training and had regular supervision and appraisals. One patient on Heather ward claimed that they had previously watched a staff member walking past a distressed patient and did not seek to reassure them or ask what was wrong. Staff felt supported by their managers and received regular supervision and annual appraisals. However, the service was collecting data. The needs of people who used the service were assessed and care was delivered in line with their individual care plans. However, ligature points remained. Staff morale on Griffin ward was low due to the announcement of the wards closure upon the completion of works on Phoenix ward. We found a high number of concerns not addressed from the previous inspections. 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. Consent to care and treatment was obtained in line with relevant guidance and legislation. Staff demonstrated a respectful manner when working with patients, carers, within teams and showed kindness in their interactions. The community nursing service could not measure its performance in relation to response times for unplanned care. The quality of data was variable, for example training statistics were not always reliable. However, Griffin did not. No rating/under appeal/rating suspended There were safe lone working practices embedded in practice. Services had supplies of emergency medication available and this was accessible to staff. The trust had improved medicines management. A dashboard of key performance indicators was being developed. There were different recording systems in place, for example paper records and electronic records, different professional kept separate files. Care records were up to date and holistic. Staffing levels were not consistent across the two sites. Trust staff working within the had remote access to electronic systems used by the trust. Waiting times and lists remained of concern, and this had been identified in the previous inspection. On four wards in acute wards for adults of working age, there were shared sleeping arrangements for patients. Four young people told us they felt involved in developing their care plan however, they had not received a copy. At this inspection, we looked at adult liaison psychiatry services at the Leicester Royal Infirmary site. Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. Where relevant we provide detail of each location or area of service visited. Computer systems were not shared across GP surgeries so information sharing did not happen effectively. 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. This meant patients had been placed outside of the trusts area. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. The matron opened some vault windows via a remote. The nurses we spoke with had specialist interests, including mindfulness and dementia. In two services, staff were not always caring towards patients. Some care plans were not holistic, for example they did not include the full range of patients problems and needs. The old kitchen at the Willows was not fit for purpose and poorly equipped but was being used by occupational therapy. This area of our site lists our partner organisations. Another patient said on their comment card they did not see enough of the occupational therapist. The service had plans in place to manage service disruption and major incidents. It promises that we will lead with compassion and inclusivity, with the health and wellbeing of our staff at the heart of all we do. There was a good level of occupational therapy input and good support to help maintain patients physical health. There was minimal evidence of patient involvement in care plans. Staff told us they involved patients carers but there was little evidence of this in care records. Staff reported morale was good, they worked well together and supported one another. 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