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Six staff expressed concerns about the proposed move and some said the trust had not communicated information to staff effectively. The summary for this service appears in the overall summary of this report. We saw patients were treated with kindness and compassion. Some medication was out of date and there was no clear record of medication being logged in or out. Staffing levels were not consistent across the two sites. Two external governance reviews had been commissioned and undertaken. The trust was not commissioned to provide female psychiatric intensive care beds. investigations to nominated clients and will be required to work to tight Consent to care and treatment was obtained in line with relevant guidance and legislation. The service had 175 delayed discharges between August 2015 and July 2016, which accounted for 43% of the trusts total delayed discharges. Many staff we spoke with knew who their chief executive was and mentioned them by name. The number of incidents reported by the trust had decreased since the last inspection and serious incident figures remained comparable. There were high vacancy rates. There were safe lone working practices embedded in practice. A full audit was scheduled for the end of June 2019. There was evidence of lessons learnt from incidents being shared with the team. There was little evidence that staff supported patients to understand the process, no involvement of family or independent mental capacity advocate in most mental capacity assessments. Staff received feedback on the outcomes on investigation of complaints via their managers. There were examples of people not being seen within service guidelines whilst receiving large doses of prescribed medication. The quality of data was variable, for example training statistics were not always reliable. One patient told us that staff had been rude, threatening and disrespectful towards them, which a relative also confirmed. Information needed to deliver care was not always readily available when people using community mental health teams presented in crisis out of hours. Not all medicine records included allergy information. The services used recognised outcome measures and monitoring measures to help assess the level of support and treatment required. Staff completed extensive and detailed care plans. No rating/under appeal/rating suspended 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 trust had robust arrangements in place for the receipt and scrutiny of detention paperwork. Two patients discharges were delayed at The Agnes Unit because the commissioners could not find specialist placements. The teams we spoke with, felt the trust board did not set clear timescales or direction on how to move their projects forward. financial crime matters and you will be expected to manage competing priorities Staff told us their managers were supportive and senior managers were visible within the service. Managers completed ligature audits which highlighted what mitigation was in place to reduce the risk for patients. There was strong local leadership on the community inpatient wards and in the community. Cover arrangements for sickness, leave and vacant posts were in place. The community adult team caseloads varied. 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 trusts Board Assurance Framework (BAF) was lengthy, was combined with a corporate risk register and had overdue actions. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. Acute patients had been sent to rehabilitation wards inappropriately. However, they did not always meet the required skill mix for the nursing teams. the service is performing exceptionally well. we have taken enforcement action. However, they were not updated regularly or following an incident. The trust had not ensured all staff had received training in immediate life support. 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 morale in some teams was low, with high levels of stress. The psychiatric outpatients was responsible for 2094 of the breaches, with city east reporting the highest of these breaches at 429.2. Wards for people with dementia had dementia-friendly elements; particularly the activity rooms and there was commitment to build on this. The trust had improved how staff recorded patients physical healthcare, and monitored patients who had ongoing physical healthcare problems. The service did not have any out of area placements, readmissions or delayed discharges. In rating the trust overall, we took into account the current ratings of the 12 services not inspected this time. Staff told us patients were concealing lighters and cigarettes and bringing them onto wards. The trust had begun the process of replacing some beds with more suitable options for the patient group. Staff would still work with people who were on waiting lists so that they received some level of service. 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. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We observed many examples of staff treating patients with care and compassion. We inspected three mental health inpatient services because of the ratings from the previous inspection. Clinical audit was taking place and learning was shared across the service. This could have resulted in an increased risk of incorrect safe and secure handling of medicines and unsafe practice in relation to the administration and prescribing of medicines. For all jobs the cost of any DBS disclosure required will be met by the individual. The dignity and privacy of patients across three services we visited was compromised. Care plans did not always reflect a person centred approach and people who used services and their carers were not routinely involved in CPA reviews. Staff ensured that these were updated regularly. Our judgement is based on a combination of what we found when we inspected, information from our Intelligent Monitoring system, and information given to us from people who use services, the public and other organisations. On Heather ward patients said that there was not enough ventilation on the wards. Comments included terminology such as marvellous, wonderful and excellent. At this inspection, we rated two core services as inadequate, two core services as requires improvement, and one core service as good. Wards did not have a list of stock items. Assessed risks were well-managed and staff showed a good awareness of individual needs and how to respond to them. Based on 112 salaries posted anonymously by Leicestershire Partnership NHS There were good systems for lone-working which included a code word that staff used when they required assistance. The Trust had a number of unfilled positions being covered by long-term bank staff. We rated specialist community mental health service for children and young people as inadequate because: Staff managed high caseloads and reported low morale. There was a risk that young people may not get assessed out of hours in a timely manner by staff with CAMHS experience. Any other browser may experience partial or no support. We found a patient being nursed in the low stimulus area and their liberty was restricted. Accredited Counter Fraud Officer/Specialist (or equivalent qualification recognised by NHS CFA for the purpose of NHS Counter Fraud Specialist Accreditation. 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. Patients were offered smoking cessation treatments, nicotine replacement therapy (NRT), or free vapes. Managers ensured they monitored their staffs compliance with mandatory training using a tracker system. We saw evidence of good team working during our inspection. The recording of discussions and assessments with people regarding consent to treatment was not always documented. essential. Staff described managers as supportive and approachable. Care plans did not always consider the patient views, and were generic did and not all were recovery focussed. The trust had developed checklists to assist staff with the receipt and scrutiny process. Staff were given feedback after incidents had been reported. 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. To ensure that safer staffing levels were met they used regular bank or agency staff to achieve the required amount number of staff for the wards to meet the needs of the patients. We are looking at different ways to indicate the outcomes of our monitoring in the future. 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. There was evidence of items being submitted to the trust risk register where appropriate. Safeguarding notes for one person using the Autism Outreach service could not be located creating a potential risk. The teams did not have waiting lists for care coordinators at the time of inspection. In five of the six community nursing teams attendance on some mandatory training courses was below 70%. 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. Ability to provide clear advice, both orally and in a written format. Staff had not managed all risks to patients in services. Service planning was not being managed in a systematic way. The HBPoS did not have access to a dedicated clinic room. This left patients without access to treatment when they needed it most. GCSE English Language & Mathematics at Grade C and above or equivalent. Comprehensive assessments were being carried out and information was stored securely, except for one location and arrangements were in place to address this. Effective multi-disciplinary team working and joint working did not always take place across services. There were delays in staff delivering treatments to young people and young people following assessment. Patient outcomes were not routinely collected so the quality of the clinical care being delivered could not be measured or benchmarked. There was highly visible, approachable and supportive leadership. There were improved systems and processes to manage storage, disposal and administration of medications. The most common reason for delayed discharges was due to family choices which were beyond the control of the trust. Staff completed comprehensive assessments which included physical health checks and the majority of patients had completed risk assessments. Staff interacted with people in a positive way and were person centred in their approach. Some staff found there was insufficient time to complete their visits within the working day. By doing this it will help us achieve our vision of creating high quality, compassionate care and wellbeing for all. 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. 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. Staff showed high levels of motivation and morale, felt part of a positive team and felt well supported and trained. Assessments and care planning took place for patients needs. In two services, staff were not always caring towards patients. Experience of conflict resolution/ demonstration of negotiation skills including experience of conducting formal Interviews Under Caution and taking formal statements. A dashboard of key performance indicators was being developed. Staff empathised where a person had a negative experience and offered support where necessary. The quality of the data produced was poor and staff needed to correct the data when reports were produced. The adult community therapy team did not meet agreed waiting time targets. hampton by hilton bath city parking; leicestershire partnership nhs trust values. We found a total 40 breaches of the six week referral and seven breaches of the five day urgent referral. We spoke with six patients who all told us that the staff were very kind and looked after them well. There was a range of large therapeutic areas and rooms for art therapy plus other interventions. Staff in four of the five services we inspected did not document patient involvement in their care. We noted a box for discarded needles being left unattended in a communal area. We found good multidisciplinary working on wards. Most patients spoke positively about their care and said they were involved. One patient told us they did not know they could leave the ward to seek medical attention. There was a good level of occupational therapy input and good support to help maintain patients physical health. There were delays in maintenance and repairs in some areas. They did not have alarms or vision panels in the door. 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. Medication management systems were in place and followed to ensure that medicines were stored safely. We observed care being delivered in a kind and caring way, by staff who demonstrated compassion and experience. The Trust is proposing to close There was poor medicines management in relation to checking expiry dates, storage and consent documentation. 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. Patients using the CRHT team had limited access to psychological therapies and there were no psychologists working within the CRHT team. Staff treated people who used the service with respect, listened to them and were compassionate. The trust had reviewed existing systems and processes identified improvements and implemented changes. They later told us that this had been an ongoing concern for around five years. the service isn't performing as well as it should and we have told the service how it must improve. Staff were not aware of the trusts visions or values. For example, furniture was light and portable and could be used as a weapon. This impacted on the time available for staff development and training. The school nurses used technology to communicate with young people. Staff involved patients in the ward review and community meetings. Risk management in services required improvement. Patients and their relatives felt involved in the care provided. the service is performing well and meeting our expectations. Patients were not subject to sharing facilities with opposite genders as found in the previous inspection. This impacted on staffs ability to assess and treat young people in a timely manner. Staff provided psychological therapies as recommended by NICE such as group work and cognitive behavioural therapy. Staff reported incidents, which were discussed and reviewed by line managers within the teams. The successful candidate will deliver specialist fraud We rated community health services for adults as requires improvement because. However, we were concerned that ligature risks remained in these bedrooms. Some patients continued to share bedroom spaces in dormitories, and personal belongings were stored on the floor because of limited storage provided by the trust. 360 Assurance is a NHS hosted service (hosted by Staff we spoke with demonstrated their dedication to providing high quality patient care. wards for people with a learning disability or autism. The acute mental health wards had two and four bedded dormitories which did not promote privacy and dignity. 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