In rehabilitation wards, staff did not always develop and review individual care plans. The trust provides adult end of life care services in community in-patient wards and community nursing services seven days per week. Every team we spoke with knew who they reported to and what to report. With the exception of the liaison psychiatry service and the mental health triage car, managers were not supervising or appraising staff within the trusts supervision policy. At this inspection, two of the three mental health services we inspected improved overall. 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. Staff reviewed young peoples risk at every appointment and recorded this in the case notes. They are: o We focus on what matters most. The trust had no psychiatric intensive care unit (PICU) for female patients. We heard from most teams, positive examples of teamwork and multidisciplinary working within teams and services, and with external agencies and key stakeholders. The recording of discussions and assessments with people regarding consent to treatment was not always documented. Staff updated risk assessments and individualised care plans regularly. Comprehensive relocation action plans were available. The Step up to Great strategy identified key priority areas of focus which were linked to the trusts vision. Staff and senior leaders could not articulate the trusts direction of travel and how this was co-ordinated. The trust admitted male patients to female areas of the mixed wards when male beds were unavailable. The phones on each ward were in communal areas; the phone on Griffin ward had not been moved since the last inspection, although it had a privacy hood installed. The service had not met the six week target for initial assessment, on average patients were seen six days over the target date. We saw numerous interactions between staff and patients with very complex needs and staff managed extremely challenging situations with knowledge and compassion. This could pose a risk as patients were unsupervised in this area. There were clear responsibilities, roles and systems of accountability to support good governance and management. We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels: Outstanding There was good access to interpreters and signers when needed. Patients reported that they felt safe on the wards. One family member told us their relative could be challenging but they felt they were well cared for. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect. There was a duty worker system in place which meant the service was able to respond quickly to escalating risks if necessary. In the same service, managers did not always review incidents in a timely way. That's what building health equity means to us. There were appropriate lone working procedures in place. Records were stored securely and well managed by staff to ensure that sensitive information about patients was protected. 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 acute service contained large numbers of beds in bed bays accommodating up to four patients. Find out more Knitting therapy keeps cats and dogs warm 23 Dec 2022 News The trust had a dedicated family room for patients to have visits with children. 42% of staff on Phoenix ward and 27% Griffin ward had received clinical supervision. 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. Children and young people felt listened to in a non-judgmental way and told us they felt respected. 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. Connect with our community. Care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. Across teams risk assessments were not always completed and updated. At the time of inspection, there were a total of 647 children and young people currently waiting to be seen in specialised treatment pathways. We heard positive reports of senior staff feeling able to approach the executive team and the board. Lessons were learned from feedback and complaints from patients. The trust could not be sure that all staff. Staff told us they felt happy and enjoyed their work. Browser Support Staff were inconsistent in updating the Historical Clinical Risk Management (HCR-20) assessments. We found concerns with the environment in all five core services we inspected. 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. Staff applied for Deprivation of Liberty Safeguards prior to assessing patients capacity to consent. We found a high number of concerns not addressed from the previous inspections. 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. The trust had significantlyreduced waiting times and the total numbersof children and young people waiting for assessments. The trust had several strategies, a vision and corporate objectives, but they did not underpin all policies and practices. The majority of repairs and maintenance issues highlighted within the warning notice at the Bradgate Mental Health Unit had been fixed or resolved. Staff reported incidents, which were discussed and reviewed by line managers within the teams. Staff had not received any specialist training on crisis intervention. 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. Staff demonstrated good knowledge of the Mental Capacity Act 2005. Administrative staff had not received specific mental health awareness training to assist them when taking calls for people who were acutely unwell and in crisis. Patients were involved in the writing of their care plans and their views were reflected in the plans. Staff gave examples of working with people with diverse needs considering their ethnicity, gender, age and culture. We would expect patient involvement to be embedded at all levels of the trust, across as many departments as possible, in planning, review, evaluation and delivery. Staff had not managed all risks to patients in services. Risk assessments were brief, did not always contain sufficient information and were not updated regularly. There were no children who had waited more than a year for treatment. 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. Some risk assessments had not been reviewed regularly at The Grange. We spoke with five patients on long stay or rehabilitation wards; they told us they felt very well supported, and staff and were kind, caring, and respectful. Staff ensured that these were updated regularly. This left patients without access to treatment when they needed it most. Some key outcomes for children, young people and families using the service were regularly below expectations. This practice stopped once we drew attention to it. This impacted on the time available for staff development and training. The service participated in few national audits and did not audit patient therapy outcomes which meant benchmarking the standards of care and treatment they were giving their patients against other providers was difficult to establish. Improvements to the inpatient wards included updating seclusion rooms, removing some ligature anchor points and replacing garden fencing. The Trust had a number of unfilled positions being covered by long-term bank staff. Staff were unaware of any service specific strategic direction. 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. Staff knew how to report any incidents on the trusts electronic reporting system and could raise concerns for the trust risk registers. Managers did not ensure that the staff were receiving regular clinical supervision and had not met the trust target compliance rate of 85%. The psychiatric outpatients was responsible for 2094 of the breaches, with city east reporting the highest of these breaches at 429.2. The trust had identified the lack of psychological therapies for patients, and support and training for staff, on their risk register. Leicestershire Partnership NHS Trust This is an organisation that runs the health and social care services we inspect Overall: Requires improvement Services have been transferred to this provider from another provider Services have been transferred to this provider from another provider All Inspections 12 April 2022 Leicestershire Partnership NHS Trust Location Loughborough Salary 27,055 to 32,934 a year Closing date 13 Jan 2023. Patients were protected from avoidable harm and abuse, systems were in place to investigate incidents and concerns and staff received suitable training in safety systems. 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. Environments were visibly clean and welcoming. The medical and senior leadership provision within the looked after children service did not meet the professional requirements outlined in the intercollegiate document for this provision. Risk management in services required improvement. Staff had good knowledge of safeguarding processes and risk assessments were generally detailed, timely and specific. We're always looking for the best. Staff said this made them feel safe whilst visiting patients at home or whilst undertaking activities with patients in the community. There were insufficient systems in place to monitor prescriptions. We spoke with nine patient families and carers. This does not comply with the guidance from the Royal College of Psychiatrists. Advanced Directives had been introduced to enable patients to make decisions now about their long term care. We found positive multidisciplinary work and observed staff were supporting patients. For example, furniture was light and portable and could be used as a weapon. Staff showed caring attitudes towards their patients. We strongly recommend an informal and confidential discussion with Cathy Ellis, the Chair of the trust. Patients and their carers were not involved in care planning and care programme approach (CPA) reviews. We rated it as requires improvement because: Our rating of the trust stayed the same. 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. There had been periods of understaffing. Interpreters were used when working with people who did not have English as a first language. Staff did not document physical health checks for patients detained under section 136 in the HBPoS. We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. 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 trusts Board Assurance Framework (BAF) was lengthy, was combined with a corporate risk register and had overdue actions. 61% of Leicestershire Partnership NHS Trust employees would recommend working there to a friend based on Glassdoor reviews. Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels and some poor ward environments. There was a risk that young people may not get assessed out of hours in a timely manner by staff with CAMHS experience. We did not have assurance service leads had good oversight of the risks relating to this service as staff were not always recording incidents, the service was unable to identify incidents specific to patients at the end of life and concerns relating to the out of hours GP service were not formally recorded. However, Griffin did not. These services were: We inspected all key lines of enquiry in two domains (safe and well-led) in a third service. This employer has not claimed their Employer Profile and is missing out on connecting with our community. There was a full complement of staff with no vacancies. Three patients told us of times when staff had been rude, threatening and disrespectful towards them. Comments included terminology such as marvellous, wonderful and excellent. There was strong local leadership on the community inpatient wards and in the community. Patients returning from leave from the acute mental health wards were not assured of returning to their original ward. Staff were not in receipt of regular supervision in order to discuss training needs, developmental opportunities or performance issues. 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. 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. This was a breach of the patients privacy and dignity to patients as staff might be required to enter the shower rooms to check patients were safe. CAPTRUST for Institutions. 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. The service was caring. There was no funding for staff to provide activities so patients had limited access to activities of their choice during their stay. There were delays in staff delivering treatments to young people and young people following assessment. Computer systems were not shared across GP surgeries so information sharing did not happen effectively. There was no fridge to keep medicines cool when required. People that were referred to the service were waiting for a care co-ordinator to be allocated. 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. We saw information in the service reception areas about older peoples care. However, this was a temporary restriction due to the building works and patient safety. The clinic rooms across sites had all the equipment calibrated. Staff received regular managerial and group supervision. 10 July 2015. The cold chain processes to ensure optimal conditions during the transport, storage, and handling of vaccines was outstanding. Information needed to deliver care was not always readily available when people using community mental health teams presented in crisis out of hours. This report describes our judgement of the quality of care provided by Leicestershire Partnership NHS Trust. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. Demand for neurodevelopment assessments remained high. We work in partnership with a range of NHS organisations, local government and other bodies and are ultimately accountable to the secretary of state for health. Leicestershire Partnership NHS Trust (LPT) provides a range of community health, mental health and learning disability services for people of all ages. The service had seven vacancies for qualified nurses andthree for non-registered nurses. Governance processes had improved since our last inspection and operated effectively at trust level to ensure that performance and risk were managed well. We rated the four mental health core services as requires improvement and community health services for adults as good. Staff received supervisions and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. Another patient said on their comment card they did not see enough of the occupational therapist. Managers had introduced a duty clinician to manage caseload sizes and reduce patients risks. The trust had a limited approach to patient involvement. The service had not delivered timely care to a significant number of patients. Staff were described as putting people who used services first and being person-centred. In rating the trust, we took into account the previous ratings of the ten core services not inspected this time. Staff routinely referred patients to access additional support for employment, housing, benefits and independent mental health advocacy. This had previously been identified on the CQC inspection in March 2015. We reviewed data and documentation including three patients care records and risk assessments. Admission to the unit was agreed with commissioners. Staff told us patients were concealing lighters and cigarettes and bringing them onto wards. Such as marvellous, wonderful and excellent to discuss training needs, opportunities. Felt respected their choice during their stay very complex needs and staff extremely. And individualised care plans and their views were reflected in the community people families!, Edge, Safari once we drew attention to it operated effectively at trust level to ensure that staff! Benefits and independent mental health teams presented in crisis out of hours in timely. 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