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Provider: Leeds and York Partnership NHS Foundation Trust Requires improvement

Read reports from our previous inspection of Leeds and York Partnership NHS Foundation Trust, published on 16 January 2015.

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We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 27 April 2018

  • We rated three of the 11 core services as requires improvement overall. Our ratings took into account the previous ratings of services not inspected this time. Our decisions on overall ratings take into account factors including the relative size of services and we use our professional judgement to reach a fair and balanced rating.
  • The rating for the acute mental health wards for adults of working age and psychiatric intensive care unit had gone down, and the rating had gone down in one additional key question in the wards for people with a learning disability or autism. This suggested that these services had got worse since the last inspection. The requires improvement rating remained the same for the forensic and low secure services overall, and in the same key questions.
  • Issues that contributed to the breach of regulation at the last inspection in July 2016 had not been fully resolved at this inspection; in some services clinical supervision rates remained low and patient records were not always maintained in a consistent manner. Training compliance remained an area of concern in the forensic and low secure services.
  • The wards for people with a learning disability or autism was rated as requires improvement for caring as patients’ communication needs were not always assessed, nor were adaptive communication strategies used to enable patients to participate fully in their treatment and care. Also on these wards, blanket restrictions were in place, patients had limited access to psychological therapies and therapeutic activities, and there was an inconsistent approach to assessing risk and care planning for patients with epilepsy.
  • The National Inpatient Centre for Psychological Medicine was rated as requires improvement for responsive at this inspection because the premises were not suitable for the purpose they were being used. The trust still had no timescale or confirmed plans for the proposed new location for the service..
  • We had concerns relating to staff monitoring patients’ physical health following rapid tranquilisation in accordance with national guidance, best practice, trust policy and medicine administration on the acute wards for adults of working age with a mental health problem and the psychiatric intensive care unit.

However:

  • We rated the trust as ‘good’ in caring, responsive and well-led. Our rating for the trust took into account the previous ratings of services not inspected this time.
  • The trust rating in the well led key question at the trust level improved since the last inspection in July 2016.
  • The crisis and the health based place of safety core service had improved from requires improvement to good overall, and good in all five key questions at this inspection.
  • The supported living service had improved from requires improvement to good overall; outstanding in caring and good in safe, effective, responsive and well led.
  • The National Inpatient Centre for Psychological Medicine was rated as outstanding in effective and caring at this inspection.
  • All services now complied with the eliminating mixed sex guidance.
  • Mandatory training compliance across all the services had improved since the last inspection and remained on an upward trajectory. As at 30 September 2017, the overall training compliance for trust wide services was 90% against the trust target of 85%.
  • Non-medical staff appraisal rates had increased since the last inspection to 80% though they remained below the trust compliance rate. Appraisal rates were on an upward trajectory from September 2017 to January 2018.
  • Systems were effective to ensure that documentation was in place and readily available demonstrating that directors met the fit and proper person requirement, regulation 5 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
  • There was good practice in relation to the application of the Mental Health Act and the Mental Capacity Act. Audits were completed to monitor the compliance with these Acts.
  • Governance systems were established to assess, monitor, and improve the quality and safety of the service, and manage risk, and operated effectively across the trust and were embedded in locally in most services.
  • The trust responded to requests for information from the Care Quality Commission and reported all incidents to the national reporting and monitoring systems, in a timely way.
  • Medication administration and storage, and physical health monitoring had improved.
Inspection areas

Safe

Requires improvement

Updated 27 April 2018

  • We rated three of the 11 mental health core services as requires improvement for safe. This includes the core services that we did not inspect at this time.
  • Staff did not always maintain patient records in a consistent manner, with some information stored in different locations within the electronic recording system or on paper systems.
  • We had concerns relating to training and staffing on some wards in the forensic core service.
  • We had concerns relating to blanket restrictions and access to outside space identified across the inpatient wards for people with a learning disability or autism.
  • We had concerns relating to staff monitoring patients’ physical health following rapid tranquilisation in accordance with national guidance, best practice, trust policy and medicine administration on the acute wards for adults of working age with a mental health problem and the psychiatric intensive care unit.

However:

  • Each ward had an annual environmental risk assessment and ligature risk management plans were in place.
  • The trust complied with guidance from the Department of Health on eliminating mixed-sex accommodation in hospitals.
  • Mandatory training compliance across all the services had improved since the last inspection and remained on an upward trajectory. As at 30 September 2017, the overall training compliance for trust wide services was 90% against the trust target of 85%.
  • Risk assessments and risk management plans were in place for patients and reviewed regularly and when the risk had changed.
  • Systems and processes to safeguard people from abuse were effective. Staff understood how to protect patients from abuse and worked closely with the trust’s safeguarding team to ensure concerns and alerts were escalated appropriately.
  • The trust managed infection prevention and control well. Services generally controlled infection risk well and staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Staff reported incidents and near misses; this was encouraged by the trust. Most staff reported getting feedback from incidents and that wider learning was shared.
  • We rated eight of the 11 core services, the National Inpatient Centre for Psychological Medicine, and the supported living services, as good for safe.

Effective

Requires improvement

Updated 27 April 2018

  • Our rating of effective has gone down. We took into account the previous ratings of services not inspected this time. We rated effective as requires improvement because:
  • We rated four of the 11 mental health core services as requires improvement for effective. This includes the core services that we did not inspect at this time.
  • Whilst supervision compliance was on an upward trajectory across the trust and the trust was taking action to address this, supervision compliance was still low on some wards.
  • We had concerns that on the inpatient wards for people with a learning disability, patients had limited access to psychological therapies and therapeutic activities, and there was an inconsistent approach to assessing risk and care planning for patients with epilepsy.
  • We had concerns on the acute inpatient mental health wards and psychiatric intensive care units that information in patient’s care plans was generic and not individualised to the patients’ needs, with limited information on capacity assessments. There were gaps in the routine monitoring of patients physical observations.

However:

  • We rated the effective key question for the National Inpatient Centre for Psychological Medicine as outstanding, and seven of the 11 core services and the supported living service as good.
  • Patients had access to a multidisciplinary team to support them with their care and treatment.
  • Local audits and clinical audits were completed and action taken to make improvements.
  • Staff had training on the Mental Health Act and Mental Capacity Act and most demonstrated a good understanding of the Acts. There were resources available to provide further support in relation to the application of the Acts.
  • Whilst there were issues in some services relating to care plans being generic and not individualised to patients’ needs, comprehensive assessments and care plans were completed and reviewed regularly.

Caring

Good

Updated 27 April 2018

Responsive

Good

Updated 27 April 2018

Well-led

Good

Updated 27 April 2018

Checks on specific services

Wards for people with a learning disability or autism

Requires improvement

Updated 27 April 2018

  • The information needed to deliver patient care was not available to all relevant staff.
  • Staff did not maintain appropriate records of patients’ care and treatment.
  • There was limited evidence of patient involvement in decisions about the care and treatment provided by the service. There was limited evidence of that staff on Parkside Lodge and 3 Woodlands Square assessed patients’ communication needs, or used adaptive communication strategies to enable patients to participate fully in their treatment and care. Care plans did not address patients’ specific communication needs.
  • There were blanket restrictions on each unit.
  • The trust did not ensure staff were suitably supervised and appraised to carry out their role effectively.
  • The trust did not provide care and treatment based on national guidance. Patients had limited access to psychological therapies and therapeutic activities.
  • There was an inconsistent approach to assessing risks related to patients with epilepsy.
  • Whilst staff were clear on the concept of whistleblowing and the trust process for raising concerns, not all staff felt that they would be able to raise concerns without fear of retribution.

However:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • The trust now complied with guidance from the Department of Health on eliminating mixed-sex accommodation in hospitals.
  • The trust provided mandatory training in key skills to all staff and made sure everyone completed it. The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 18 November 2016

We rated Long stay/rehabilitation mental health wards for working age adults as good because:

  • Staff treated patients with kindness and respect. Interactions between staff and patients were warm and supportive. Patients were actively involved in the development of their care plans. Patients and staff told us that there were good links with the advocacy service.

  • Staff ensured that patients engaged in meaningful activities whilst on the wards. Patients had a range of activities they could participate in and some patients were able to cater for themselves. Staff provided a range of activities and were instrumental in applying for local community grants that were available for groups wanting to encourage people to walk more.

  • Medication was prescribed in line with best practice and National Institute for Health and Clinical Excellence guidelines.

  • The service had introduced individual digital tablets to patients. The tablets contained an app called U- Motif and allowed patients to take more control over their care through a platform that enabled communication with their clinician.

  • Staff were knowledgeable in the application of the Mental Health Act. They received support from the central Mental Health Act administration team where appropriate. Staff also understood the principles of the Mental Capacity Act.

  • Staff were skilled in de-escalation techniques and this meant there was a low level of restraint used in the service.

  • The service provided a pathway for unregistered staff to gain a national vocational qualification level 3 in health and social care.

  • There was strong local leadership across the wards, which staff and patients confirmed. All staff we spoke with felt supported by their colleagues and held them in positive regard. The ward managers had enough autonomy to run their wards.

However

  • Compliance with mandatory training was below the trust requirement of 90% for the long stay and rehabilitation services.

  • Capacity assessments for treatment for detained patients were not always recorded in their file.

  • Supervision was not always provided in line with the trusts policy.

  • Oxygen cylinders were not checked regularly and replaced when they had been used.

Community mental health services with learning disabilities or autism

Good

Updated 18 November 2016

We rated community mental health services for adults with learning disabilities or autism as good because:

  • Staff included patients and carers in their care and treatment. Patients and carers felt involved in their care. Leeds autism diagnostic service involved a patient in training videos which were used in staff training to show living with autism from an individual’s perspective.

  • Care and treatment was delivered in line with best practice evidence and guidance. Staff followed guidance and recommendations when prescribing medication and physical health monitoring was completed. A range of recognised psychological therapies were available.

  • Reasonable adjustments were made for people with learning disabilities or autism. We saw that teams were flexible in location and times of appointments, assessments were delivered in different languages to meet patient needs and adjustments were made such as, the time of fire alarms to reduce the impact and distress of patients attending clinics.

  • Teams worked with primary care community health services to improve physical health for adults with learning disabilities. Staff delivered training and supported GP surgeries in improving the uptake and quality of annual health checks and health action plans for patients with learning disabilities.

  • Staff participated actively and regularly in research to review, evaluate and improve services for adults with learning disabilities or autism.

  • Processes and systems were embedded to ensure reporting of incidents, completion of risk assessments and appropriate safeguarding of adults was in place.


Acute wards for adults of working age and psychiatric intensive care units

Requires improvement

Updated 27 April 2018

Our overall rating of this service went down. We rated it as requires improvement because:

  • Staff did not do all that was reasonable practicable to mitigate risks to the health and safety of patients. Staff did not monitor patients’ physical health needs following use of rapid tranquilisation in accordance with national guidance and trust policy. Not all patients received a physical health check in a timely manner. Staff did not monitor patients’ physical health observations consistently.
  • Patients’ care needs were not individualised and care plans did not provide clear and current information to enable staff to deliver consistent, personalised support. There was a lack of information about what de-escalation techniques staff should use for patients in a crisis, and to try to avoid the need for restraint.
  • Patient information was stored in different formats, updates about care interventions were not always contemporaneous and did not always reflect the current care provisions the patient received.
  • Staff did not always follow good practice and policy for the storage and administration of medicines. There were areas of the ward environment in need of attention with regards to cleanliness and maintenance.

However:

  • Patients and carers gave predominantly positive feedback about the staff and the care they received. There were opportunities for patient and carers to give feedback about, and influence the service.
  • Staff felt supported in their roles and had regular supervisions, training, and opportunities for personal development. There was a multidisciplinary team in place at the service to provide support and treatment to patients.
  • The trust had identified where improvements were required within the service which supported our findings also. There was work underway or planned to use clinical audits to try to make improvements.

Child and adolescent mental health wards

Good

Updated 27 April 2018

  • Our rating of this service stayed the same. We rated it as good because:
  • The service had made improvements since our last inspection. They were now clear about what constituted seclusion and seclusion paperwork was filled in correctly and reviews carried out on time.
  • There were adequate staffing levels to ensure patients were well looked after and got one to one time with staff.
  • The service provided a safe environment and risks were managed well. Patients told us they felt safe on the ward. All patients had an up to date risk assessments that was updated when risks changed.
  • There was effective multi-disciplinary team working evident on the ward.
  • Patients and their carers gave positive feedback about the ward and the service they received. Staff involved patients in decision about their care. They engaged with and supported families and carers where appropriate. Staff contacted them with updates on patient progress and invited them to ward rounds.
  • Staff told us that they felt supported by the ward manager and the senior leadership team were visible. Although there had previously been a high vacancy rate, these gaps were now filled and staff felt more positive because of this.
  • The ward had been inspected and was awaiting accreditation with the Quality Network for Inpatient child and adolescent mental health services.
  • The ward was involved in a research project to validate a recovery measure for use in tier four, child and adolescent mental health services.

However:

  • On the day of our visit the ward was very hot. Staff informed us that this was due to the fact that there were no controls for the heating; there was only the option to have it on or off with no temperature thermostat. Staff reported they had raised this as an issue before but nothing had been done about it.

Community-based mental health services for adults of working age

Good

Updated 18 November 2016

We rated community-based mental health services for working age adults good because:

  • The community-based mental health services for working age adults were safe because teams had sufficient staff to protect patients from avoidable harm and abuse. Managers supported staff to be open and honest and carried out thorough investigations when something went wrong. Staff recognised and responded appropriately to identified risks to patient safety.

  • The community based mental health services for working age adults were effective because patients received care and treatment that met their needs. Staff were appropriately skilled, experienced and supported by managers to develop their practice. Staff used best practice guidelines to deliver effective care and treatment. Staff had regard for the Mental Capacity Act and ensured they protected the rights of patients detained under the Mental Health Act. Staff worked with a range of other teams and services to co-ordinate patients’ discharge and took patients’ needs into account.

  • The community based mental health services for working age adults were caring because patients and carers told us they felt supported by staff. Staff treated patients and carers with dignity and respect. Patients felt involved in their care and we saw staff supported patients with kindness and compassion during their interactions.

  • The community based mental health services for working age adults were responsive because the service was reviewing the way it organised and delivered care. This was focused on making improvements to meet the needs of working age adults in the local population. The teams provided short term interventions as well as long term. This meant patients had better access to services and timely discharges. Patients had timely access to the service and the trust were meeting their targets to assess patients from referral.

  • The community based mental health services for working age adults were well-led because staff were proud of the service they delivered to patients and their carers. The teams had a culture that focused on improvements to deliver high quality person-centred care. All teams were involved in individual projects and used a quality improvement methodology to share good practice across the localities.

However;

  • The East,North East team could not always ensure their building was secure due to the length of time the electric door at the entrance remained open. There were concerns that staff had high caseloads and this had an impact on staff morale. The service had caseloads outside of recommended guidance from the Department of Health 2002. The lone working procedures could not always ensure staff safety during community visits which meant staff could be left vulnerable.

  • Physical health monitoring and recording was inconsistent throughout the teams. Some teams were able to monitor bloods more effectively than others were.

  • There were concerns that patients who were referred to the psychology service waited up to 20 weeks for psychological therapies. This meant that patients did not have timely access to specific treatments to meet their needs.

  • Staff were not up to date with their mandatory training and teams had not reached the trust target of 90% in areas such as Mental Health Act and Mental Capacity Act training. Appraisal rates had not met the trust targets and supervision rates varied across the teams.

Community-based mental health services for older people

Good

Updated 18 November 2016

We rated community-based mental health services for older people good because

:

  • The community based mental health services for older people were safe because teams had sufficient staff to protect patients from avoidable harm and abuse. Managers supported staff to be open and honest and carried out thorough investigations when something went wrong. Staff recognised and responded appropriately to identified risks to patient safety.

  • The community based mental health services for older people were effective because patients received care and treatment that met their needs. Staff were appropriately skilled, experienced and supported by managers to develop their practice. Staff used best practice guidelines to deliver effective care and treatment. Staff had regard for the Mental Capacity Act and ensured they protected the rights of patients detained under the Mental Health Act. Staff worked with a range of other teams and services to co-ordinate patients’ discharge and took patients’ needs into account.

  • The community based mental health services for older people were caring because patients and carers told us they felt supported by staff. Staff treated patients and carers with dignity and respect. Patients felt involved in their care and  staff supported patients with kindness and compassion during their interactions.

  • The community based mental health services for older people were responsive because the service was reviewing the way it organised and delivered care. This focused on making improvements to meet the needs of older people in the local population. This was in response to recent feedback from people who used the services and analysis of the service following transformation to an ageless service four years ago. Patients had timely access to the service and the trust were meeting their targets to assess patients from referral.

  • The community based mental health services for older people were well led because staff were proud of the service they delivered to patients and their carers. The teams had a culture that focused on improvements to deliver high quality person-centred care. All teams were involved in individual projects and used a quality improvement methodology to share good practice across the localities.

However;

  • There were concerns that staff had high caseloads and this had an impact on staff morale. The service had caseloads outside of recommended guidance from the Department of Health 2002. The East, North East team could not always ensure their building was secure due to the length of time the electric door at the entrance remained open. The lone working procedures could not always ensure staff safety during community visits, which meant staff, could be left vulnerable.

  • Physical health monitoring and recording was inconsistent throughout the teams. Some teams were able to monitor bloods and electro-cardiograms more effectively than others were.

  • There were concerns that patients who were referred to the psychology service waited up to 20 weeks for psychological therapies. This meant that patients did not have timely access to specific treatments to meet their needs.

  • Staff were not up to date with their mandatory training and teams had not reached the trust target of 90% in areas such as Mental Health Act and Mental Capacity Act training. Appraisal rates had not met the trust targets and supervision rates varied across the teams.

Forensic inpatient/secure wards

Requires improvement

Updated 27 April 2018

  • Substantive staff frequently moved wards at short notice to fill shifts on Rose Ward, which required a full staffing complement due to the acuity of their patients. When this happened, there was a risk that the staff team on Rose Ward would not have the specialist skills necessary to care for patients with a personality disorder.
  • Compliance with mandatory training and supervision rates were a concern at our last inspection in July 2016. At this inspection, staff were still not fully compliant with all mandatory training in key skills. On four of the six wards we inspected staff compliance with clinical supervision was below 65%. Appraisal rates for two wards were also below 65%. This meant staff might not have the necessary skills or support to provide patients with safe and effective care and treatment.
  • Although the trust had systems and processes in place to assess, monitor and improve the quality of the service, they were not used to the full extent possible. Staff use of electronic systems for updating patients’ records was not always consistent with some information stored in different locations within the system. Rotas, low staffing levels and supervision records were not always adequately reported or updated.

However:

  • Each ward had a yearly environmental risk assessment. There were ligature risk management plans in place, which staff managed through observation to mitigate the risks. Patients we spoke with felt safe on the wards and felt staff provided appropriate levels of support.
  • Staff had training to recognise and report abuse. They understood how to protect patients from abuse and worked closely with the trust’s safeguarding team to ensure they referred concerns and alerts appropriately.
  • Staff carried out a comprehensive assessment to identify patients’ mental and physical health needs. Care plans clearly showed patients worked in partnership with staff in decisions about the care and treatment provision. Staff reviewed the plans regularly and involved other specialists when needed.
  • Activity co-ordinators and occupational therapy staff planned and organised a wide range of regular weekly activities. Patients were able to maintain links with the wider community and had access to educational, recreational and work opportunities.

Mental health crisis services and health-based places of safety

Good

Updated 27 April 2018

  • Risks to patients were assessed and mitigated. Staffing levels were calculated using a recognised staffing tool. Staff knew about different types of abuse and were confident about reporting concerns. Male and female accommodation was separated with the use of locked doors.
  • People who were referred to the crisis assessment service had mental health assessments carried out. Physical health checks were offered to patients who were admitted to the crisis assessment unit. Staff had regular supervision and appraisals. Staff understood their roles and responsibilities in relation to the Mental Health Act and Mental Capacity Act. Audits were carried out to ensure section 136 documentation was completed correctly.
  • Patients and carers said staff were kind and approachable. Staff supported patients appropriately. Agency staff were not used in the core service allowing for consistency of care.
  • There was good evidence of detailed discharge planning taking place on the crisis assessment unit. The crisis assessment unit continued to have a positive impact on the length of stay and discharges on the acute wards, as well as a positive impact on readmissions to the trust within 28 days. Staff supported patients to access services which may benefit them. Complaints were logged and investigated. People who made a complaint were given feedback.
  • Staff who worked in the crisis assessment service said they felt supported by senior staff members. The staff were aware of the trust’s values. Audits were carried out throughout the service to ensure a good rating was maintained.

Wards for older people with mental health problems

Good

Updated 18 November 2016

We rated wards for older people with mental health problems as good because:

  • Staff completed comprehensive assessments of patients’ needs, incorporating any specialist care needs. Assessments included nutritional screening and physical health checks. We saw that patients had detailed risk assessments and corresponding management plans for how to manage any risks. Staff reviewed care plans and risk assessments regularly and updated them in response to patients’ needs. Patients and relatives were involved in these reviews.

  • Wards one and two were undergoing refurbishment to improve the environment in line with good practice for dementia environments. Wards were clean and tidy. Staff completed a number of environmental checks including infection control and health and safety. There were many different rooms and areas for patients to spend time on the wards. Patients had access to an outside garden area via ward on the ground floor. Patients and their relatives felt the environment was safe.

  • Staff were knowledgeable about what incidents to report and felt confident in reporting. Incidents reports were detailed and contained clear information about actions that had been taken in response to each incident. Staff reported any safeguarding concerns as necessary to help ensure patients were protected from harm.

  • Patients spoke highly of the staff and said they were treated with kindness and respect. Relatives were also complimentary about the staff and said theysupported them in their role as carers. We saw positive and caring staff interactions with patients. Patients and relatives were able to give feedback via community and carers meetings that took place. Patients had access to advocacy support on the wards.

  • Although there were times when staff were pressured, there were suitable amounts of staff at the service to meet patient’s needs. Patients and relatives said staff were always present and visible. Our observations supported this. We saw activities took place which staff encouraged patients to participate in.

  • Staff felt positive in their roles and spoke highly of the support they received from colleagues and managers. We saw managers were visible on the wards. Staff were knowledgeable about the patients they supported and their needs. Managers praised staff attitude and resilience.

  • There was useful information on display for patients, relatives and visitors about the service. This included information about how to make complaints. Patients and relatives said they would feel comfortable speaking with staff if they had any complaints to make. Relatives said any issues had been resolved in the past where they had raised them. We saw complaints were dealt with thoroughly.

  • Governance meetings took place regularly for senior staff to discuss relevant information about the service. This included learning from incidents. Information from these was fed down to ward based staff in team meetings. Staff participated in clinical audits and we saw that any shortfalls were rectified where identified.

However:

  • Staff did not always keep robust records in relation to patient care. There was incomplete and omitted information in relation to patients who required their dietary intake to be monitored. Also, because bank and agency staff did not have access to the trust’s electronic system, in some instances temporary staff had recorded details of care interventions separately to the patient’s main care records.

  • There were shortfalls in some mandatory training compliance and the service had not met the trust target. The areas with lowest compliance were the Mental Capacity Act training, Mental Health Act legislation training and safeguarding children. Three wards were short of the trust target for appraisals and not all wards had met trust supervision targets.

  • Staff demonstrated a good understanding of relevant legislation such as the Mental Capacity Act and the Mental Health Act. However, nursing staff deferred to doctors to make formal assessments of capacity. Capacity assessments did not always show what attempts had been made to support patients with making informed decisions before assessing capacity.

  • Staff did not always undertake the necessary checks to ensure patient safety. They did not take the appropriate action in response to excessive temperatures of fridges where drugs were stored. We found some omissions in prescription charts which staff had not identified. Although staff regularly checked emergency equipment, action was not always taken when shortfalls were identified.

  • From information available, we could not always be clear how results from clinical audits were used to drive improvement at service level.

Other specialist services

Good

Updated 27 April 2018

  • The trust had acted upon our feedback from our previous inspection and the service had made improvements in the safety of patient care.
  • Safety was a high priority for the service. Staff had measures in place to monitor the safety and quality of the service and took timely action when changes were needed. Staff regularly assessed and monitored risks to patients, and protected them from avoidable harm and abuse.
  • The service provided care, treatment and support that was based on the best available evidence and achieved good outcomes for patients. The outcomes exceeded the expectations of patients and made a real difference to the quality of their lives. Patients were fully involved in decisions about their care and treatment and all patients had clear discharge plans.
  • The service had a strong, visible person-centred culture. Staff respected their relationships with people who used the service and empowered patients to be partners in their care. Care plans were personalised and contained meaningful goals for individual patients. Feedback from people who used the service was consistently positive and we observed staff that were kind, caring, respectful, and compassionate.
  • The service had a clear pathway and model of care that provided flexibility for staff to plan and deliver care to meet the needs of individual patients. The service provided an integrated person-centred pathway of care, which provided continuity of care for people with severe and complex needs and people in vulnerable circumstances. Staff planned and managed admissions and discharges to the service so that patients had timely access to the service and were discharged successfully.
  • The service was well-led with a culture that promoted the delivery of high quality and person-centred care. There was high levels of staff satisfaction and motivation. Staff felt proud to work at a service where managers were visible and supported their learning and development needs. Senior staff were knowledgeable and understood the issues the service faced and continued to take action to address the challenges.

However:

  • Staff did not routinely complete care plans for all patients who were prescribed as required medication.
  • The premises were not suitable for the purpose they were being used; the ward did not have enough space and facilities to support occupational therapy, physiotherapy, and recreational activities. Staff and patients used communal areas and rooms for multiple purposes which impacted on places for visitors and quiet areas, and access to outside space. The kitchen area did not suit the needs of people who required lowered facilities. Patients’ bedrooms did not contain anywhere for patients to keep their belongings secure. Whilst the managers recognised the limitations of the environment and the difficulties to secure a long-term estates strategy remained on the trust risk register, the trust still had no timescale or confirmed plans for the proposed new location for the service.

Reference: not found

Updated 8 January 2016