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Provider: Leeds and York Partnership NHS Foundation Trust Good

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

Inspection Summary


Overall summary & rating

Good

Updated 20 December 2019

Inspection areas

Safe

Requires improvement

Updated 20 December 2019

Our rating of safe stayed the same. We rated it as requires improvement because:

  • We rated five of the core services as requires improvement for safe, all of these core services were inspected this time.
  • Although the trusts overall compliance with mandatory training had improved, there were gaps in mandatory training in five of the core services we inspected with safeguarding children level three training being below 75% in two core services. Staff across the long stay/rehabilitation wards did not all receive the same level of mandatory high level physical intervention training including promoting safe and therapeutic services and breakaway, staff on ward 5 received a higher level of training than staff from Asket Place and Asket Croft.
  • Clinical premises where patents received care were not always safe or clean. There were outstanding works to be completed on the long stay/rehabilitation wards to minimise the ligatures present and on ward 5 some ligatures had not been identified on the ligature risk assessment. Some carpets were visibly stained, and hand-washing facilities were not available in all areas where required. Fire and environmental risk assessments were not completed for all patient areas and the seclusion room at Parkside Lodge did not meet the requirements because the intercom system did not work effectively two ways and it did not have adjustable lighting.
  • Staff did not consistently assess and manage risk to patients. Risk assessments were not always updated following incidents or changes to patient need staff did not consistently work with patients and their families and carers to develop crisis plans and crisis plans had not been considered or implemented for all patients who required them.
  • Some staff did not have access to the electronic patient record system were resorting to the use of paper notes and not all paper records had a consistent structure across the service. Information in the electronic record was not easy to navigate and or find information, however plans were in place to replace this system.
  • Staff did not follow national guidance on the use of restrictive interventions in the wards for older people with mental health problems and we found there were blanket restrictions in place within the long/stay rehabilitation wards which had not been entered onto the risk register in line with trust policy.

However:

  • Staff understood how to protect patients from abuse and the services worked well with other agencies to do so.
  • The services had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm
  • The wards and teams had a good track record on safety. The services managed patient safety incidents well and staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned. When things went wrong, staff apologised and gave patients honest information and appropriate support.

Effective

Good

Updated 20 December 2019

  • Our rating of effective improved. We took into account the previous ratings of services not inspected this time. We rated it as good because:
  • The trust had taken action to improve supervision compliance rates with the result medical staff supervision had increased to 92% and non-medical staff to 75%
  • 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.
  • Most staff received an annual appraisal which staff told us were generally constructive and included conversations about professional and career development and action plans developed to achieve development goals
  • Staff in all areas except one of the respite units for people with a learning disability or autism ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Staff across all services from different disciplines worked together as a team to benefit patients. Teams had effective working relationships with staff from services including those who would provide aftercare following the patients’ discharge. They supported each other to make sure patients had no gaps in their care.

However:

  • There was no assurance that staff working with patients with a learning disability or autism had the right knowledge or skills to provide effective care and treatment because there was no training provided in learning disabilities or autism. And not all staff working with patients with dementia in the community based mental health services for older people had received training in dementia.
  • Staff did not routinely use recognised rating scales to assess and record severity and outcomes for patients in the acute wards for adults of working age and psychiatric intensive care units and in community based mental health services for older people.
  • Staff at team level in community mental health services older people did not engage in routine clinical audit in order to evaluate the quality of care they provided and community mental health services for working age adults did not meet their target to implement audits as part of their outcome measures within the planned timescale.

Caring

Good

Updated 20 December 2019

  • We rated 10 out of the 11 core services as good and one core service as outstanding for caring. This takes account of the core services we did not inspect this time.
  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. Feedback from patients confirmed this. Staff understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Staff informed and involved families and carers appropriately and provided patients, families and carers with the tools needed to support ongoing care and recovery.
  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.
  • Staff had improved communication methods to support patients to understand and manage their own care and treatment and condition in the wards for people with a learning disability or autism, at Parkside Lodge, this included the use of a talking care plan to enable a patient to understand their care and treatment and in the acute wards for adults of working age and psychiatric intensive care units staff found ways to communicate with patients who had communication difficulties, an example being, pharmacy staff met directly with patients and their families to help them understand prescribed treatment
  • Staff helped families to give feedback on the service and in the wards for people with a learning disability or autism followed the principles of Ask, Listen, Do in relation to feedback, concerns and complaints and each ward in the forensic service had at least one carers champion who was leading on carer engagement.

Responsive

Good

Updated 20 December 2019

Our rating of responsive stayed the same. We rated it as good because:

  • We rated the specialist deaf community children and adolescent mental health service as outstanding for responsive, and 10 of the 11 core services and the supported living service as good for responsive. This takes account of the core services we did not inspect at this time.
  • The trust treated concerns and complaints seriously, and supported patients and carers to understand how to make complaints. They investigated the complaints thoroughly and cascaded learning.
  • All the services had clear referral procedures and discharge pathways leading out of the services. The trust was working with other stakeholders to address the out of area placements and delayed discharges.
  • The services met the needs of all patients including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support. Buildings and facilities had appropriate access for patients with mobility issues and disabilities. Ward environments had a range of rooms, equipment and facilities available to promote recovery.
  • The trust met the cultural and spiritual needs of patients receiving care and treatment. They were able to provide information in appropriate formats to ensure patients were fully informed about the care they were receiving.
  • The food was of a good quality and patients could make hot drinks and snacks at any time.

However:

  • Ward 5 did not have access to a psychologist for patients care and treatment at the time of our inspection, although other staff were trained in delivering psychosocial interventions to patients.

  • There were three out of area placements and 92 delayed discharges within the wards for older people with mental health problems. However, the service was actively taking steps to address these issues.

Well-led

Good

Updated 20 December 2019

Our rating of well-led stayed the same. We rated it as good because:

  • We rated 8 of the 11 core services as good and one core service as outstanding for well led. This takes account of the core services we did not inspect at this time.
  • The trust had managers at all levels with the right skills , knowledge and abilities to run a service providing high-quality sustainable care.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • Staff knew and understood the values of the trust. Staff were able to give descriptions of how the values were used to underpin both individual and team good practice.
  • The trust was committed to improving services by learning from when things go well and when they go wrong; promoting research and innovation in a number of services.
  • Staff knew who the freedom to speak up guardian was and felt able to raise concerns without fear of retribution.
  • Staff felt respected, supported and valued. They were supported with opportunities for career progression.

However:

  • We rated the long stay/rehabilitation wards for adults of working age as requires improvement for well led.
Checks on specific services

Forensic inpatient or secure wards

Good

Updated 20 December 2019

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • On one ward the junior doctor had not completed the annual physical health checks, however weekly physical checks using the Modified Early Warning Score tool had been completed, by the staff. The reason for this was the appointment of the current junior doctor had been after the due date for the annual checks.
  • One patient had been identified as part of the admission process as needing a specialist bed and this had not been provided in a timely manner.
  • A detained patient was refusing treatment in the form of an injection, while there were notes from the medical team about the injection being necessary to aid their recovery, and the staff were acting legally there was not an individual care plan or advanced decision on how to administer the injection with the use of restraint recording the patient’s wishes.

Wards for older people with mental health problems

Good

Updated 20 December 2019

Our rating of this service stayed the same. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. Staff knew how to report incidents, safeguarding concerns and handle complaints and used lessons learned from investigating them to improve the service.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
  • Staff engaged in clinical audit to evaluate the quality of care they provided and make improvements when necessary.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They involved patients and families and carers in care decisions.
  • Staff provided patients with good access to the community such as support to attend group walks, local services and family celebration events.
  • Staff had not placed patients in seclusion or long-term segregation within the last 12 months.
  • The provider promoted equality and diversity into its day to day work. The provider had a black and minority ethnic worker and staff shift patterns could be adapted to allow staff of the Muslim faith to participate in Ramadan. Staff within the service showed their support for the lesbian, gay, bisexual and transgender community by attending pride and Rainbow Alliance events.
  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.
  • The wards were on track to meet their key performance indicators with compliance figures ranging between 89 and 97%.
  • Innovative practices were taking place within the service. They included the use of psychological formulation based on the Newcastle model, dementia care mapping, drop in sessions to provide advice and guidance around physical health and behaviours that challenge and training workshops for staff in relation to palliative care.

However, we found the following issues that the service needed to improve:

  • Staff did not follow national guidance on the use of restrictive interventions including rapid tranquilisation. Physical observations were either not carried out at all or not within the required frequency, paperwork was not fully completed, body maps were not always undertaken, and staff were unaware that olanzapine was a rapid tranquilisation medicine. Staff did not update risk assessments and risk management plans following the administration of rapid tranquilisation medicine.
  • The service’s use of bank and agency staff was high. Within the 12 months prior to our inspection, 1458 shifts had been covered by bank and agency staff. There were also three out of area placements and 92 delayed discharges within the service. However, we saw evidence that the service was actively taking steps to address these issues.
  • Staff were not up to date with all modules of their mandatory training. Only 66% of staff had completed their safeguarding children level 3 training.
  • The process for enabling agency staff to have access to the provider’s electronic records system was lengthy and complicated as they needed to be trained in its use and then be set up on the system.
  • On two occasions, weekly controlled drugs audits had not been completed on ward 1. However, we found the stocks of controlled drugs were correct at the time of our inspection.
  • One patient and two carers who spoke with us said that they or their loved ones possessions had been stolen from their bedrooms or that the safe in their bedroom had been broken into. These incidences related to wards 1 and 2. However, staff reported any missing or stolen items as incidents and routinely advised patients and carers how to safely store items

Long stay or rehabilitation mental health wards for working age adults

Requires improvement

Updated 20 December 2019

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

  • The service did not always provide safe care. There were some ligature risks on Ward 5 that had not been identified. Patients did not all have a crisis contingency plan in place.
  • There were gaps in the mandatory training that staff received. The monitoring of high dose antipsychotic medication was unclear and inconsistently recorded.
  • There were some blanket restrictions in place at Asket Croft and on Ward 5. These had not been ‘entered onto the risk register ‘as their policy stated that they should and also did not have ‘a demonstratable action plan in order to resolve the issue’.
  • The service did not work to a recognised model of mental health rehabilitation on Ward 5 Some patients had excessive lengths of stay on Ward 5 and there were delayed discharges on all of the wards. The trust had oversight of this and these patients were being monitored by the trust at team meetings, monthly discharge meetings and monthly delayed transfer of care meetings.
  • Governance processes did not operate effectively at ward level and performance and risk were not always managed well.

However:

  • The wards were clean and there were enough nursing and medical staff in place and staff managed risks to patients and themselves. Staff followed good practice with respect to safeguarding. They minimised the use of restrictive practices.
  • Managers ensured that staff received supervision and appraisals.
  • The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff at Asket Croft and Asket House, planned and managed discharges well and liaised well with services that would provide aftercare.
  • The rehabilitation and recovery team on site at the Asket Place provided all patients with intensive support and rehabilitation and were integral in providing a successful rehabilitation pathway for the patients. They provided care coordination during their stay and after discharge to ensure they had the right support when transitioning back into the community.

Community-based mental health services for older people

Requires improvement

Updated 20 December 2019

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

  • Clinical premises where patients were seen were not always safe and clean. Fire and environmental risk assessments were incomplete or out of date for a number of buildings.
  • Staff did not complete and regularly review risk assessments for all patients. Risk management plans and crisis plans had not been completed or considered for all patients.
  • Staff did not complete care plans for all patients. Care plans that were created are varied in terms of quality, they were not always holistic or recovery-oriented and did not consistently evidence involvement of patients or carers. Staff did not consistently use recognised rating scales to assess and record severity and outcomes for patients.
  • Staff mandatory training compliance was low in a number of courses and there was no clear plan to drive improvement. Not all staff working with patients with dementia had received specific training in dementia. Staff at team level did not engage in clinical audit in order to evaluate the quality of care they provided.
  • Methods of gaining feedback from patients and their families and carers varied between teams and some patients and carers we spoke with were unsure how they could give feedback.
  • Whilst leaders had good oversight and understanding of areas for development within the service it was not always clear how they planned to make improvements. Staff at a team level did not have access to the service’s risk register.

However:

  • Staff provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients, including both mental and physical health needs.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received regular supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly. The criteria for referral to the service did not exclude people who would have benefitted from care.
  • The service was well led and staff felt respected, supported and valued.

Wards for people with a learning disability or autism

Requires improvement

Updated 20 December 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

  • The service did not always provide safe care. Staff and managers had not ensured that regular fire evacuation drills took place and that fire risk assessments were reviewed for all wards. The seclusion room at Parkside Lodge was not compliant with requirements because it did not have a two-way intercom.
  • Staff at 2 and 3 Woodland Square had not ensured patient risk assessments were reviewed and updated on patients’ admission. They did not ensure that risks to patients’ physical health and well-being were assessed, managed and mitigated sufficiently. This included pressure care, bowel care and epilepsy care. Care plans did not contain all the information needed to ensure staff met patients’ needs to keep them safe and well.
  • Patients’ care and treatment records did not contain all the information needed. Three patients had bed rail assessments that provided no information why a bed rail was required to keep patients’ safe. Two patient records did not contain mental capacity assessments and/or a record of a best interest meeting in relation to resuscitation and physical health.
  • The service had not improved access to therapeutic activities or psychological therapies.
  • 2 and 3 Woodland Square did not have adequate cooling systems in the clinic room to maintain a consistent recommended temperature range. Staff did not follow the trust’s policy on storage of medicines.
  • The trust did not provide staff with training on learning disabilities or autism. There was no assurance they had the right skills or knowledge to meet patients’ needs effectively.
  • Only 52% of eligible staff had received training in safeguarding children level three.

However:

  • Staff at 2 and 3 Woodland Square undertook comprehensive medicines reconciliation processes prior to and on patients’ admission.
  • Parkside Lodge had employed a speech and language therapist and they had completed communication assessments of all patients.
  • Staff planned and managed discharge well. They worked with other services who provided aftercare.
  • The service received 34 compliments in 12 months and carers provided positive feedback about how staff involved them in patients’ care and treatment.
  • Staff felt respected, support and valued.

Community-based mental health services for adults of working age

Good

Updated 20 December 2019

Our rating of this service stayed the same. We rated it as good because:

  • They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude patients who would have benefitted from care.

However

  • Clinical premises where patients received care were not always safe or clean. Staff could not be assured by accuracy of the equipment as they had not always been calibrated.
  • Fire and environmental risk assessments were not all up to date and were scheduled to be completed.

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

Good

Updated 20 December 2019

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and patients had access to doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and protected patients from abuse.
  • Staff ensured patients had a comprehensive assessment of their mental and physical health needs. They provided a range of treatments suitable to the needs of the patients and in line with national guidance. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Not all staff had easy access to electronic patient record and not all paper records had a consistent structure across the service.
  • Not all patient safeguarding concerns were reported to the trust’s safeguarding team and not all patient medications were stored in line with trust policy.
  • Staff did not use recognised rating scales to assess and record severity of outcomes and they did not always inform and involve families and carers appropriately.
  • Not all patient care plans reflected the needs identified in the assessment and some were not up-to-date.
  • The trust did not adhere to best practice in implementing a smoke free environment

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.

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 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.


Reference: not found

Updated 8 January 2016