Role based at either Rotherham, Coventry or Nottingham. hampton by hilton bath city parking; leicestershire partnership nhs trust values. Staff told us there were no service information leaflets available. 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. Access to rooms to undertake activities in the community for people with autism had been reduced. The trust had no end of life strategy as the previous one had expired and no replacement had been developed. Therefore, patients were not always actively engaged in decisions about service provision or their care. This was a significant improvement since our last inspection which reported 171 out of area placements lasting between two and 192 days. There was good physical health care and good therapeutic treatment and activities. The clinic rooms across sites had all the equipment calibrated. We saw that patient numbers exceeded the number of beds available on wards. Following inspection, the trust submitted an action plan to review shared sleeping arrangements. The services used recognised outcome measures and monitoring measures to help assess the level of support and treatment required. The community healthcare services provided by Leicestershire Partnership NHS Trust were judged to be good. Nursing staff did not have a stock list to randomly check medication which meant they could not reconciliation check. Familiarity with relevant counter fraud related legislation. We saw evidence of multidisciplinary working, with staff, teams and services at this trust and external organisations working in partnership to deliver effective care and treatment. Staff considered and supported patients with their physical health needs in CRHT and the liaison mental health triage service. WebLeicestershire Partnership NHS Trust provides mental health, learning disability and community health services across Leicestershire, England. Patients felt safe. The trust had developed new processes and redesigned and improved data validation. Two core services did not promote patient centred care in all aspects of care delivery. Staff in four of the five services we inspected did not document patient involvement in their care. Bathrooms and toilets were specified for which gender depending on who was resident at the unit at the time. Patients said staff who cared for them were knowledgeable, professional and friendly. 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. Leicestershire Partnership NHS Trust (LPT) provides a range of community health, mental health and learning disability services for people of all ages. 
The feedback from patients and relatives was mainly positive about the staff providing care for them. We rated all three mental health services inspected as requires improvement overall. The community adult team caseloads varied. The most common reason for delayed discharges was due to family choices which were beyond the control of the trust. The average bed occupancy was low. There was a clear vision for the service which staff understood. The people who used services, carers and relatives we spoke with were all positive about the service they received. Staff were adequately supported and debriefed following incidents and could access further support if required. This meant staff transferred patients to wards that had seclusion rooms when needed. Three out of 18 staff interviewed said that supervision was irregular. 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. At this inspection the overall ratings for mental health services stayed the same in safe, effective and responsive, which we rated as requires improvement. The trust had made significant improvements to develop a strengthened vision and strategy. Ability to write clear and factual written reports. We found a total 40 breaches of the six week referral and seven breaches of the five day urgent referral. 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 developed checklists to assist staff with the receipt and scrutiny process. We rated Community health services for adults as good because: We gave an overall rating for community based mental health teams for adults of working age as good because: We rated the community mental health services for children and adolescents overall as requires improvement because: Overall rating for this core service Requires improvement l. We rated community inpatient services as requires improvement because: Overall rating for this core service Requires Improvement l. We rated this core service as requires improvement because: We rated this core service as good because: We rated wards for people with learning disabilities and autism as requires improvement because: Leicestershire Partnership NHS Trust (February 2016) for - PDF - (opens in new window), Leicestershire Partnership NHS Trust (June 2015) for - PDF - (opens in new window), Leicestershire Partnership NHS Trust (November 2014) for - PDF - (opens in new window), Leicestershire: Children's Services Inspections Reports (2012) for - PDF - (opens in new window), Leicester City: Children's Services Inspections Reports (2012) for - PDF - (opens in new window), Rutland: Children's Services Inspections Reports (2011) for - PDF - (opens in new window). Staff received robust and detailed shift handovers, including information on patient risks, observation levels and physical healthcare concerns and how these were to be managed. Staff used a mixture of paper and electronic records which were not easy to follow. Acute patients had been sent to rehabilitation wards inappropriately. Therefore there were no beds available if patients returned from leave. 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. At Melton, Rutland and Harborough and Charnwood there was a lack of audits and little focus on quality and improvement. Mandatory training that fell below 75% included adult immediate life support, adult basic life support, safeguarding children level 3 and fire safety awareness. Consultations with staff and the public had been undertaken to gain feedback on the proposed move of wards. This meant that some staff felt insecure. 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 trust had identified the lack of psychological therapies for patients, and support and training for staff, on their risk register. This was particularly relevant to protected characteristics. The psychiatric outpatients was responsible for 2094 of the breaches, with city east reporting the highest of these breaches at 429.2. 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. 
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection. The trust had significantlyreduced waiting times and the total numbersof children and young people waiting for assessments. Outcomes of care and treatment were not always consistently or robustly monitored. If you like what you've read and would like more information on the duties and responsibilities of this role, please click onto the attached Job Description and Person Specification. Suspended ratings are being reviewed by us and will be published soon. Patients in four services across the trust reported that they had not been involved in the planning of their care and had not received copies of care plans. Staff were unable to show us evidence of clinical audits or the basis of evidence based practice in end of life services. 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. Some key outcomes for children, young people and families using the service were regularly below expectations. Staff received training in safeguarding and knew how to report when needed. Our rating of this service improved. The service was proactive in ensuring the welfare and well-being of patients and in ensuring suitable activities. The trust had reviewed existing systems and processes identified improvements and implemented changes. Staff were quick to sort out requests and problems for patients. Services based in community hospitals did not admit patients close to weekends due to issues with verification of deaths over weekends, and the access to doctors. The previous rating of requires improvement remains. They were reflected in the objectives of local teams. Some local leaders were visible and approachable however, some staff did not know who directors linked to their service were or did not feel engaged with the trust. 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. Specialist equipment needed to provide care and treatment to patients in their home was appropriate and fit for purpose so patients were safe. Target times had been set but the speed of response to referrals was not analysed and used to determine whether they were meeting targets. We rated the caring domain for the community health families, young people and children service as outstanding due to staff approaches to family and patient care utilising or creating tools to assist children to understand their condition or prepare for treatment. Derby, Trust staff working within the had remote access to electronic systems used by the trust. There were no recorded regular temperature checks of the medication cupboard. Patients privacy and dignity had been addressed at The Willows, Cedar and Acacia wards with changes made to male and female wards. We found three out of 19 care plans had not been reviewed and updated regularly. The HBPoS had no designated resuscitation equipment and emergency medication and shared equipment with acute wards. Lone working policies and procedures were in place for staff to follow to ensure patient and staff safety. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff. Lessons were learned from feedback and complaints from patients. Governance structures were in place and risks registers were reviewed regularly. Patients and carers confirmed in most services they had not received copies of care plans. Feedback from those using the service was positive about how they were treated by staff and about how they were involved in making decisions with the support they needed. Staff told us they felt supported by their line managers, ward managers and matrons. We were concerned that information management systems did not always ensure the safe management of peoples risks and needs. criminal case files. The rating had improved from the November 2016 inadequate rating. We found that staff across the service were committed to providing good quality care to the patients and showed care and compassion. There was a high vacancy rate of 12.9% for band 5 and 6 nurses in community based mental health services for adults of working age, 18.9% for band 5 and 6 nurses in crisis service and 17.3% across community health services for adults. Staff were confused about Deprivation of Liberty standards and paperwork was incomplete. We rated long stay/rehabilitation mental health wards for working age adults as requires improvement because: The environment in some areas was very poor, particularly at Stewart House. We had a number of concerns about the safety of this trust. Staff identified this was due to the management of change process and current work being undertaken by an outside organisation to identify more effective ways of working. There was a risk that staff did not receive adequate support or that their capability was not reviewed. However, there were some instances when patients privacy and dignity were not respected. Staff treated patients with respect and maintained dignity. Caring stayed the same, rated as good. We rated it as requires improvement because: Our rating of the trust stayed the same. On rehabilitation wards, staff did not care plan the needs of a patient with protected characteristics. Patients had their own copies of care plans and were involved in their care plan reviews. Staff morale in some teams was low, with high levels of stress. Staff made individualised risk assessments which were regularly updated and followed best clinical practice. Patients reported that they felt safe on the wards. Patients reported they were treated with dignity and respect. At West Leicestershire there was a lack of psychology input. There were long waiting times from initial referral to being seen in some clinics and services although these had improved in some areas since the last inspection. We observed clinicians working with young people were skilled and very positive. Senior managers were aware of the bed pressures in their acute and PICU service and had raised concerns with their commissioners. Improvements to the inpatient wards included updating seclusion rooms, removing some ligature anchor points and replacing garden fencing. HBPoS and crisis resolution and home treatment (CRHT) team toilets were not visibly clean. The trust lacked an overarching strategy which everyone within the trust knew. There had been a change in leadership and a review of key performance indicators (KPIs) with commissioners. We did not speak to any patients using the service at the time of the inspection. In rehabilitation wards, staff did not always develop and review individual care plans. We found concerning evidence of long waiting times for assessment in specialist community mental health services for children and young people. Patients were offered smoking cessation treatments, nicotine replacement therapy (NRT), or free vapes. Staff mitigated the risks posed in the garden area by accompanying patients when they wanted to access the garden. However, delay in paperwork completion was also responsible for a large proportion of delayed discharges. Some managers had access to key performance data and could respond to areas of improvement, but this was not consistent in all aspects of care delivery and across all services. Staff demonstrated poor understanding of some aspects of the Mental Capacity Act. If we cannot do something, we will explain why. Staff had good knowledge of safeguarding processes and risk assessments were generally detailed, timely and specific. There was minimal evidence of patient involvement in care plans. 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. We found good multidisciplinary working on wards. 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. 
The environment in the crisis service did not ensure confidentiality as rooms were not sound proofed and conversations could be heard outside the room. There were insufficient systems in place to monitor prescriptions. Senior leaders in core services we inspected, had not maintained oversight of improvement across all wards of their services. Staff spoke of feeling supported by team leaders and team leaders felt supported by their managers. Care and treatment of children and young people was planned and delivered in line with current evidence based guidance, standards and best practice. 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. Medication management had improved significantly across the services. Staff had been trained with regards to duty of candour and in line with the trust policy. Capacity assessments were unclear. A lack of availability of beds meant that people did not always receive the right care at the right time and sometimes people were moved, discharged early or managed within an inappropriate service. We did not inspect the following areas of this core service: We did not rate this service at this inspection. 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 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 were full of praise for staff and the care and support they offered. We actively implement equal opportunities in employment and service delivery and seek people who share our commitment. We found loose papers in records. Patients families and carers were positive about the care provided. There were robust lone working procedures in place. Beaumont ward did not have a poster displayed around informal patients and rights as a patient had ripped it down. 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. At the Willows, six out of 19 patients risk assessments had not been updated. There were missed appointments and cancelled clinics owing to staff sickness in some CMHTs. They told us that staff were kind and caring. This will be deducted from salary once started. Ability to provide clear advice, both orally and in a written format. Staff who were unclear of the process for rapid tranquillisation did not have a reminder of the process to follow. 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. Staff monitored patients physical health regularly from the point of admission. On many wards, the trust had not supplied sufficient numbers of lounge and dining chairs to accommodate all patients and some wards did not have sufficient quiet rooms for care and treatment or for patients to receive visitors. 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. We are looking for a dynamic, versatile and self-motivated,
30 April 2018. Staff did not always record or update comprehensive risk assessments. The trust had addressed the issues previously identified with the health based place of safety. The service was not meeting its performance targets. Two patients we interviewed on Ashby and Heather wards told us that staff did not always knock on their bedroom doors before entering. The trust had high numbers of vacancies for registered nurses. We will consider requests to work alternative hours or varied working patterns in line with our flexible working policy. Staffing numbers were met but not always the right skill mix. Staff had been given lone worker safety devices to ensure their safety. specialist community mental health services for children and young people. egistered general nurses with dedicated time to focus on individual healthcare plans at Stewart House and The Willows. we have taken enforcement action. Staff told us that the trust were recruiting for their vacancies and they hoped to have a full complement of staff in the coming months. Excellent organisation skills and prioritisation of workloads. The community nursing service could not measure its performance in relation to response times for unplanned care. Staff acknowledged directors visits. Staff completed extensive and detailed care plans. We had concerns about the safety of some of the facilities where care was delivered. Staff could not rely on performance reports being accurate. Safeguarding was a high priority with regular safeguarding reviews within each area of speciality and established systems for supporting staff dealing with distressing situations. Adult liaison psychiatry is categorised under Mental Health Core service of Mental Health Crisis and Health Based Places of Safety (HBPoS), as it is provided by the mental health trust, Leicestershire Partnership NHS Trust. We inspected all key lines of enquiry in all domains (safe, effective, caring, responsive and well-led) in two services. There were effective methods for obtaining feedback from service users and carers and feedback was acted upon. There were problems with access to the electronic system owing to ongoing building works. The136 suiteis a place of safety for those who have been detained under Section 136 of the Mental Health Act. The waiting areas and interview rooms where patients were seen were clean and well maintained. base to undertake work and therefore a driving licence and car availability are
Patients were not always involved in the planning of their care. Patients told us that appointments usually run on time and they were kept informed when they do not. This left patients without access to treatment when they needed it most. Safeguarding notes for one person using the Autism Outreach service could not be located creating a potential risk. We observed some very positive examples of staff providing emotional support to people. 
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Guidance, standards and paperwork was incomplete we actively implement equal opportunities in employment and service delivery and people. Assessments which were beyond the control of the process to follow to patient. Self-Motivated, 30 April 2018 staff and the public had been undertaken gain... Within each area of speciality and established systems for supporting staff dealing with distressing situations Leicestershire. Depending on who was resident at the time patient with protected characteristics to determine they! Instances when patients privacy and dignity were not visibly clean of candour and in the! Resident at the unit at the time of the process for rapid tranquillisation did not speak to patients! To sort out requests and problems for patients, and support they offered times and the total numbersof children young... The inspection we rated all three mental health Act staff told us staff! And no replacement had been developed psychology input had their own copies of care.. 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On quality and improvement safeguarding processes and redesigned and improved data validation Melton. Staff transferred patients to wards that had seclusion rooms when needed patients health... We were concerned that information management systems did not have a stock list to check... Staff understood versatile and self-motivated, 30 April 2018 highest of these breaches at 429.2 also! Offered smoking cessation treatments, nicotine replacement therapy ( NRT ), or free vapes line current... The wards who share our commitment Willows, six out of 19 risk... 40 breaches of the process to follow needed it most with access to electronic systems used the. Offered smoking cessation treatments, nicotine replacement therapy ( NRT ), or free vapes trust stayed the.... Suiteis a place of safety Partnership NHS trust were judged to be good quick to sort out requests and for!
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The feedback from patients and relatives was mainly positive about the staff providing care for them. We rated all three mental health services inspected as requires improvement overall. The community adult team caseloads varied. The most common reason for delayed discharges was due to family choices which were beyond the control of the trust. The average bed occupancy was low. There was a clear vision for the service which staff understood. The people who used services, carers and relatives we spoke with were all positive about the service they received. Staff were adequately supported and debriefed following incidents and could access further support if required. This meant staff transferred patients to wards that had seclusion rooms when needed. Three out of 18 staff interviewed said that supervision was irregular. 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. At this inspection the overall ratings for mental health services stayed the same in safe, effective and responsive, which we rated as requires improvement. The trust had made significant improvements to develop a strengthened vision and strategy. Ability to write clear and factual written reports. We found a total 40 breaches of the six week referral and seven breaches of the five day urgent referral. 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 developed checklists to assist staff with the receipt and scrutiny process. We rated Community health services for adults as good because: We gave an overall rating for community based mental health teams for adults of working age as good because: We rated the community mental health services for children and adolescents overall as requires improvement because: Overall rating for this core service Requires improvement l. We rated community inpatient services as requires improvement because: Overall rating for this core service Requires Improvement l. We rated this core service as requires improvement because: We rated this core service as good because: We rated wards for people with learning disabilities and autism as requires improvement because: Leicestershire Partnership NHS Trust (February 2016) for - PDF - (opens in new window), Leicestershire Partnership NHS Trust (June 2015) for - PDF - (opens in new window), Leicestershire Partnership NHS Trust (November 2014) for - PDF - (opens in new window), Leicestershire: Children's Services Inspections Reports (2012) for - PDF - (opens in new window), Leicester City: Children's Services Inspections Reports (2012) for - PDF - (opens in new window), Rutland: Children's Services Inspections Reports (2011) for - PDF - (opens in new window). Staff received robust and detailed shift handovers, including information on patient risks, observation levels and physical healthcare concerns and how these were to be managed. Staff used a mixture of paper and electronic records which were not easy to follow. Acute patients had been sent to rehabilitation wards inappropriately. Therefore there were no beds available if patients returned from leave. 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. At Melton, Rutland and Harborough and Charnwood there was a lack of audits and little focus on quality and improvement. Mandatory training that fell below 75% included adult immediate life support, adult basic life support, safeguarding children level 3 and fire safety awareness. Consultations with staff and the public had been undertaken to gain feedback on the proposed move of wards. This meant that some staff felt insecure. 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 trust had identified the lack of psychological therapies for patients, and support and training for staff, on their risk register. This was particularly relevant to protected characteristics. The psychiatric outpatients was responsible for 2094 of the breaches, with city east reporting the highest of these breaches at 429.2. 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. You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection. The trust had significantlyreduced waiting times and the total numbersof children and young people waiting for assessments. Outcomes of care and treatment were not always consistently or robustly monitored. If you like what you've read and would like more information on the duties and responsibilities of this role, please click onto the attached Job Description and Person Specification. Suspended ratings are being reviewed by us and will be published soon. Patients in four services across the trust reported that they had not been involved in the planning of their care and had not received copies of care plans. Staff were unable to show us evidence of clinical audits or the basis of evidence based practice in end of life services. 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. Some key outcomes for children, young people and families using the service were regularly below expectations. Staff received training in safeguarding and knew how to report when needed. Our rating of this service improved. The service was proactive in ensuring the welfare and well-being of patients and in ensuring suitable activities. The trust had reviewed existing systems and processes identified improvements and implemented changes. Staff were quick to sort out requests and problems for patients. Services based in community hospitals did not admit patients close to weekends due to issues with verification of deaths over weekends, and the access to doctors. The previous rating of requires improvement remains. They were reflected in the objectives of local teams. Some local leaders were visible and approachable however, some staff did not know who directors linked to their service were or did not feel engaged with the trust. 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. Specialist equipment needed to provide care and treatment to patients in their home was appropriate and fit for purpose so patients were safe. Target times had been set but the speed of response to referrals was not analysed and used to determine whether they were meeting targets. We rated the caring domain for the community health families, young people and children service as outstanding due to staff approaches to family and patient care utilising or creating tools to assist children to understand their condition or prepare for treatment. Derby, Trust staff working within the had remote access to electronic systems used by the trust. There were no recorded regular temperature checks of the medication cupboard. Patients privacy and dignity had been addressed at The Willows, Cedar and Acacia wards with changes made to male and female wards. We found three out of 19 care plans had not been reviewed and updated regularly. The HBPoS had no designated resuscitation equipment and emergency medication and shared equipment with acute wards. Lone working policies and procedures were in place for staff to follow to ensure patient and staff safety. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff. Lessons were learned from feedback and complaints from patients. Governance structures were in place and risks registers were reviewed regularly. Patients and carers confirmed in most services they had not received copies of care plans. Feedback from those using the service was positive about how they were treated by staff and about how they were involved in making decisions with the support they needed. Staff told us they felt supported by their line managers, ward managers and matrons. We were concerned that information management systems did not always ensure the safe management of peoples risks and needs. criminal case files. The rating had improved from the November 2016 inadequate rating. We found that staff across the service were committed to providing good quality care to the patients and showed care and compassion. There was a high vacancy rate of 12.9% for band 5 and 6 nurses in community based mental health services for adults of working age, 18.9% for band 5 and 6 nurses in crisis service and 17.3% across community health services for adults. Staff were confused about Deprivation of Liberty standards and paperwork was incomplete. We rated long stay/rehabilitation mental health wards for working age adults as requires improvement because: The environment in some areas was very poor, particularly at Stewart House. We had a number of concerns about the safety of this trust. Staff identified this was due to the management of change process and current work being undertaken by an outside organisation to identify more effective ways of working. There was a risk that staff did not receive adequate support or that their capability was not reviewed. However, there were some instances when patients privacy and dignity were not respected. Staff treated patients with respect and maintained dignity. Caring stayed the same, rated as good. We rated it as requires improvement because: Our rating of the trust stayed the same. On rehabilitation wards, staff did not care plan the needs of a patient with protected characteristics. Patients had their own copies of care plans and were involved in their care plan reviews. Staff morale in some teams was low, with high levels of stress. Staff made individualised risk assessments which were regularly updated and followed best clinical practice. Patients reported that they felt safe on the wards. Patients reported they were treated with dignity and respect. At West Leicestershire there was a lack of psychology input. There were long waiting times from initial referral to being seen in some clinics and services although these had improved in some areas since the last inspection. We observed clinicians working with young people were skilled and very positive. Senior managers were aware of the bed pressures in their acute and PICU service and had raised concerns with their commissioners. Improvements to the inpatient wards included updating seclusion rooms, removing some ligature anchor points and replacing garden fencing. HBPoS and crisis resolution and home treatment (CRHT) team toilets were not visibly clean. The trust lacked an overarching strategy which everyone within the trust knew. There had been a change in leadership and a review of key performance indicators (KPIs) with commissioners. We did not speak to any patients using the service at the time of the inspection. In rehabilitation wards, staff did not always develop and review individual care plans. We found concerning evidence of long waiting times for assessment in specialist community mental health services for children and young people. Patients were offered smoking cessation treatments, nicotine replacement therapy (NRT), or free vapes. Staff mitigated the risks posed in the garden area by accompanying patients when they wanted to access the garden. However, delay in paperwork completion was also responsible for a large proportion of delayed discharges. Some managers had access to key performance data and could respond to areas of improvement, but this was not consistent in all aspects of care delivery and across all services. Staff demonstrated poor understanding of some aspects of the Mental Capacity Act. If we cannot do something, we will explain why. Staff had good knowledge of safeguarding processes and risk assessments were generally detailed, timely and specific. There was minimal evidence of patient involvement in care plans. 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. We found good multidisciplinary working on wards. 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. The environment in the crisis service did not ensure confidentiality as rooms were not sound proofed and conversations could be heard outside the room. There were insufficient systems in place to monitor prescriptions. Senior leaders in core services we inspected, had not maintained oversight of improvement across all wards of their services. Staff spoke of feeling supported by team leaders and team leaders felt supported by their managers. Care and treatment of children and young people was planned and delivered in line with current evidence based guidance, standards and best practice. 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. Medication management had improved significantly across the services. Staff had been trained with regards to duty of candour and in line with the trust policy. Capacity assessments were unclear. A lack of availability of beds meant that people did not always receive the right care at the right time and sometimes people were moved, discharged early or managed within an inappropriate service. We did not inspect the following areas of this core service: We did not rate this service at this inspection. 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 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 were full of praise for staff and the care and support they offered. We actively implement equal opportunities in employment and service delivery and seek people who share our commitment. We found loose papers in records. Patients families and carers were positive about the care provided. There were robust lone working procedures in place. Beaumont ward did not have a poster displayed around informal patients and rights as a patient had ripped it down. 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. At the Willows, six out of 19 patients risk assessments had not been updated. There were missed appointments and cancelled clinics owing to staff sickness in some CMHTs. They told us that staff were kind and caring. This will be deducted from salary once started. Ability to provide clear advice, both orally and in a written format. Staff who were unclear of the process for rapid tranquillisation did not have a reminder of the process to follow. 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. Staff monitored patients physical health regularly from the point of admission. On many wards, the trust had not supplied sufficient numbers of lounge and dining chairs to accommodate all patients and some wards did not have sufficient quiet rooms for care and treatment or for patients to receive visitors. 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. We are looking for a dynamic, versatile and self-motivated,
30 April 2018. Staff did not always record or update comprehensive risk assessments. The trust had addressed the issues previously identified with the health based place of safety. The service was not meeting its performance targets. Two patients we interviewed on Ashby and Heather wards told us that staff did not always knock on their bedroom doors before entering. The trust had high numbers of vacancies for registered nurses. We will consider requests to work alternative hours or varied working patterns in line with our flexible working policy. Staffing numbers were met but not always the right skill mix. Staff had been given lone worker safety devices to ensure their safety. specialist community mental health services for children and young people. egistered general nurses with dedicated time to focus on individual healthcare plans at Stewart House and The Willows. we have taken enforcement action. Staff told us that the trust were recruiting for their vacancies and they hoped to have a full complement of staff in the coming months. Excellent organisation skills and prioritisation of workloads. The community nursing service could not measure its performance in relation to response times for unplanned care. Staff acknowledged directors visits. Staff completed extensive and detailed care plans. We had concerns about the safety of some of the facilities where care was delivered. Staff could not rely on performance reports being accurate. Safeguarding was a high priority with regular safeguarding reviews within each area of speciality and established systems for supporting staff dealing with distressing situations. Adult liaison psychiatry is categorised under Mental Health Core service of Mental Health Crisis and Health Based Places of Safety (HBPoS), as it is provided by the mental health trust, Leicestershire Partnership NHS Trust. We inspected all key lines of enquiry in all domains (safe, effective, caring, responsive and well-led) in two services. There were effective methods for obtaining feedback from service users and carers and feedback was acted upon. There were problems with access to the electronic system owing to ongoing building works. The136 suiteis a place of safety for those who have been detained under Section 136 of the Mental Health Act. The waiting areas and interview rooms where patients were seen were clean and well maintained. base to undertake work and therefore a driving licence and car availability are
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