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Provider: Leeds Community Healthcare NHS Trust Good

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

Good

Updated 28 October 2019

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

  • Safe, effective, caring, responsive and well led were rated as Good
  • Sexual Health services were rated outstanding overall. The service was rated good for safe and caring, and outstanding for effective, responsive and well led. This was an improvement on our last inspection.
  • Children and young people’s services were rated good for safe, effective, caring, responsive and well led. This was an improvement on our last inspection.
  • Inpatient CAMHs services was rated good for caring, requires improvement for safe, effective and responsive. Well led was rated as inadequate This was the same overall rating as the last inspection.
  • Community CAMHs services were rated good for effective and caring, requires improvement for safe, responsive and well led.
  • Dental services were rated good for safe, effective, caring, responsive and well led. This remained the same as the last inspection
  • In rating the trust overall, we took into account the current ratings of the two services not inspected this time and the proportionality of the services to the overall business of the trust.
Inspection areas

Safe

Good

Updated 28 October 2019

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

  • There was an open culture in which safety concerns raised by staff and patients who use service were valued and seen as integral to learning and improvement. In the majority of services staff collected safety information and shared it with colleagues, patients and visitors. The service used information to improve the service.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff understood how to protect patients from abuse and the trust worked well with other agencies to do so
  • Patients were protected from the risk of infections because in the majority of services staff followed best practice guidance.

However,

  • There had been little improvement in the safety and quality of the services provided by the trust since the last inspection with regards to inpatient CAMHs.
  • The inpatient CAMHs unit LWH was not entirely safe and was not fit for the purpose it was being used. The building did not meet national guidance and standards. There was no fire action plan or records that actions required had been followed up by staff.
  • Staff in community CAMHs services had not ensured that clinical premises and equipment which patients used to support care were safe, well equipped, and well maintained. Staff had not assessed ligature risks in either clinical premises we inspected. Clinical equipment including emergency grab bags were not checked and we found examples of equipment which had not been portable appliance tested.
  • Within the CAMHs service there was significant use of bank and agency staff which patients reported was a concern to them.
  • Medication was not always managed and stored safely. Emergency medicines and resuscitation equipment did not reflect nationally recognised guidance within the dental service. Pharmacy audits were not taking place regularly in the inpatient CAMHs unit and where audits were undertaken of medication and equipment staff failed to report concerns and act on them. The clinic room was well equipped in the CAMHs service, but not all equipment was clean, calibrated or in date.
  • Staff in the inpatients CAMHs service did not always follow procedures and national guidance when recording interventions with patients including; the observation of patients, and the use of seclusion, restraint and rapid tranquilisation. Not all staff knew there was a system for monitoring incidents involving the use of rapid tranquilisation
  • The investigation of incidents and near misses was not done in a consistent way across the trust.

Effective

Good

Updated 28 October 2019

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

  • The service made sure staff were competent for their roles. Training and development were a priority for the service. Staff were supported to learn and develop their skills and reported training opportunities made them feel valued and empowered.
  • The majority of staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review, accreditation and research was proactively pursued.
  • There was a holistic approach to assessing, planning and delivering care and treatment to people who used services.
  • The continuing development of staff skills, competence and knowledge was recognised as ensuring high quality care. Staff were supported to acquire new skills and share best practice.
  • Staff, teams and services were committed to working collaboratively and wanted to develop efficient ways to deliver more joined-up care to people who used services.
  • Consent practices and records were actively monitored and reviewed to improve how patients were involved in making decisions about their care and treatment.

However:

  • In the CAMHs inpatient services staff were not always trained in their roles and responsibilities under the Mental Health Act 1983 and in some cases where they were trained they did not use them appropriately or in line with the Mental Health Act Code of Practice.
  • In the CAMHs community and inpatient services most staff had received clinical supervision in the last three months, effective systems were not in place to evidence that staff received regular ongoing supervision. Appraisal rates were consistently below target.

Caring

Good

Updated 28 October 2019

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

  • Staff cared for patients and those close to them with compassion. During the inspection we received positive feedback from patients and those close to them. They told us that staff were friendly, professional, polite, and helpful.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff provided emotional support to patients and those close to them to minimise their distress. The trust had developed leaflets and videos which aimed to ease the anxiety for patients and those close to them.

Responsive

Good

Updated 28 October 2019

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

  • There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for patients with multiple and complex needs in sexual health and children and young people’s services.
  • Patients receiving sexual health services could access services in a way and at a time that suited them. There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met these needs and promoted equality. This included patients who were in vulnerable circumstances or who had complex needs.
  • There was a proactive review of complaints. The trust treated concerns and complaints seriously, investigated them and learned lessons from the results. These were used to prevent future recurrence and as a service improvement tool.

However,

  • The design, layout, and furnishings of LWH did not support patients’ treatment, privacy and dignity. The unsuitable nature of the building meant that patients were restricted more than necessary to keep them safe and this did not support their autonomy and privacy.
  • Waiting times had deteriorated significantly in both dental services and community CAMHs since the last inspection.
  • Waiting times for dental services provided at the trust were excessive. The current waiting times from referral to assessment was 24 and 25.6 weeks for adults and children respectively. The waiting times from assessment to general anaesthetic was 8 and 16 weeks for adults and children respectively.
  • Waiting times for community CAMHs services provided by the trust were excessive. The service was not able to see non-urgent patients within an acceptable time. Trust data showed that half of the 905 patients currently on the waiting list waited more than the 12-week target for intervention and 35% of these patients waited for more than 12 weeks for reasons other than their own choice of appointments.
  • Neither premises we inspected in the community CAMHs had examples of information leaflets or posters in languages other than English. Information advising patients that they could have leaflets translated was only available in English.

Well-led

Good

Updated 28 October 2019

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

  • Board members at the trust had the right skills and abilities to run a service providing high-quality sustainable care. Senior leaders had appropriate skills and experience to effectively lead the organisation. The Sexual Health Services provided by the Trust were an example of this
  • Leaders were visible and approachable. This was confirmed by staff at all levels.
  • Staff felt supported, respected and valued and felt proud to work at the trust. The trust had a number of initiatives to reinforce the value of staff in the organisation.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action. The vision, strategy and priorities were widely publicised across all trust locations and were valued based.

However,

  • Leaders understood the challenges facing the trust but could not identify actions needed to address these in all cases. Progress to address the challenges at LWH was slow, lacked pace and there had been little change since the last inspection. This continued to put young people using the service at risk.
  • The trust did not have effective systems and plans to reduce and eliminate risks effectively. The trust had known about serious risks regarding the LWH building where inpatient Child and adolescent Health services were provided and had not made enough changes to improve safety for the Children and Young People in that service
  • There was a lack of robust use of MCA and MHA in inpatient CAHMs services. Records of restrictive interventions were not audited for quality and this had not been identified and addressed through the Trusts monitoring systems.
  • The trust systems to learn from safety incidents were not always carried out consistently. Whilst there was a standard approach to serious incident investigations and a standard report format these were not always adhered too consistently by the staff undertaking the investigation.
  • Though the trust was committed to improving services by learning from when things went well and when they went wrong. More focus was needed to make this Trust wide rather than service based to promote Improvement and innovation.
Checks on specific services

Community health services for adults

Good

Updated 29 August 2017

We rated adult community services as good overall and caring as outstanding.

  • We found that there was good incident reporting and learning from incidents was shared.

  • We saw that record keeping was of a good standard and that information was stored securely.

  • Staffing issues were acknowledged and mitigating actions put in place.

  • Business continuity plans were in place and consistently reviewed.

  • There was a good understanding of the duty of candour regulation and major incident policies amongst all levels of staff.

  • There was evidence care and treatment was based on current guidance, standards and best practice

  • We observed good patient outcomes for example in the significant increase of patients wishes to die at home being facilitated.

  • There was participation in external and internal audits and the results of monitoring were used to improve quality of care.

  • We observed excellent care being delivered by highly motivated staff.

  • Patients were treated with dignity, respect and kindness and were supported in decision making

  • People’s needs were met through the way the service was organised and delivered.

  • Services were planned in line with the needs of the local population offering flexibility, choice and continuity of care.

  • The leadership, governance and culture supported the delivery of person centred care and staff were committed to the delivery of high quality patient care.

  • Staff felt supported and valued in adult community services; there was an open and transparent culture.

  • The vision and values are well developed and encompassed key elements such as compassion, dignity and equality. The vision and the strategy were aligned.

However, the trust should:

  • Ensure dementia awareness is incorporated into mandatory training.

  • Clarify in safeguarding children training records which level has been attained.

  • Continue to monitor environmental issues in community clinics

Child and adolescent mental health wards

Requires improvement

Updated 28 October 2019

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

  • The service was not providing consistently safe care. The unit continued to not meet national guidance and standards, and did not ensure that patients could be cared for safely at all times. Medicines and equipment were not managed safely. Restrictive interventions and observations were not recorded correctly. Staff had not recognised the implementation of blanket restrictions which were not based on individual patient risks.
  • The service did not have effective processes in place to ensure good adherence to the Mental Health Act and the Mental Health Act Code of Practice. We found a recent example of a patient who had been detained without the use of the Act. Paperwork in relation to Section 17 leave from the ward was incorrect.
  • The service was not providing care consistently in a way that was responsive to people’s needs. Staff did not plan for discharge well. The design, layout, and furnishings of the unit did not support patients’ treatment, privacy and dignity. The limitations of the unit meant that additional restrictions for patients were in place to manage safety.
  • The service was not well-led. Our findings from the other key questions demonstrated that governance processes did not operate effectively at ward level and that performance and risk were not managed well. The trust had not taken enough timely action when CQC and other organisations have raised concerns about the suitability of the building in which this service is located over a number of years. The trust did not effectively monitor key areas of risk and performance in mental health care and had not ensured that policies and procedures to support good care were reflective of national guidance.

However:

  • Staff were consistently caring. Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. Staff involved patients in care planning and supported patients to understand and manage their care, treatment or condition. Staff involved families and carers appropriately.
  • Except for adherence to the Mental Health Act, the service provided effective care. Staff assessed the physical and mental health needs of all patients and developed care plans which were personalised, holistic and reflective of identified needs. The unit team included the full range of specialists required to meet the needs of patients and staff were able to provide a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. Staff worked effectively with external teams and organisations.
  • The service had a positive culture. Staff knew the values of the trust and how these were applied in everyday practice. Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

Community dental services

Good

Updated 28 October 2019

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

  • Staff were encouraged to complete mandatory training relevant to their roles. Training rates were good. The clinics were clean, uncluttered and hygienic. Systems and processes were in place to help protect patients from abuse. There were sufficient numbers of staff to treat patients safely and effectively. The service had a good safety record and staff were familiar with the process for reporting significant events.
  • The clinicians provided care, treatment and advice in line with nationally recognised guidance. Staff were competent for their roles and had regular appraisal and supervision. The staffing skill mix delivered effective care, dental hygiene therapists and extended duty dental nurses were used to assist with the increasing complexity of patient need. Multidisciplinary working was well embedded within the culture of the service. The dental team worked with the trusts learning disability team to ensure the patient journey was as smooth as possible. Staff were aware of the importance of obtaining and recording informed consent and were fully aware of the principals of the Mental Capacity Act.
  • Staff treated patients with dignity and respect. Patients told us that staff were friendly, professional, polite and helpful. Staff provided emotional support to patients to enable them to receive dental treatment. The service had developed videos and leaflets to help children familiarise themselves with the dental environment prior to their first visit. Staff had sufficient time to discuss treatment and provide support to patients and made reasonable adjustments accordingly. Patients and / or their carers were fully involved in decisions about treatment.
  • All clinics which we visited were fully accessible. The service had access to hoists and a wheelchair tipper. Translation services were readily available for patients whose first language is not English. Patients individual needs were attended to, to ensure they were able to receive dental treatment.
  • There was a clearly defined management structure and systems in place to developed leadership. The service had a vision of what it wanted to achieve, and this was in line with the newly acquired contract. Staff morale was good across the service and they felt appreciated and supported by managers. There were governance arrangements in place to help with the smooth running of the service and manage risk. The service engaged well with staff and patients to help continually improve the service.

However:

  • The current waiting times from referral to assessment was 24 and 25.6 weeks for adults and children respectively. The waiting times from assessment to general anaesthetic was 8 and 16 weeks for adults and children respectively. Staff were aware that these waiting times required improvement and they had implemented consultant led assessment clinics that were supporting reducing the waiting times. Any patient who needed urgent attention would be prioritised.
  • Emergency medicines and resuscitation equipment did not reflect nationally recognised guidance. We raised this during the inspection and was also reiterated post-inspection. We were later advised that action had been taken to address the lack of buccal midazolam and masks for the self-inflating bags.
  • An audit of the quality of X-rays had not been carried out since 2011.

Community health sexual health services

Outstanding

Updated 28 October 2019

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

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided a holistic patient centred approach to planning and delivering care and treatment, proving high quality care. All staff were actively engaged in monitoring the effectiveness of the service to improve quality and outcomes for patients. Innovative and evidence-based techniques were used to improve the service. Staff development was a priority for the service and there was evidence of strong collaborative working.
  • Staff consistently treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. Staff recognised the importance of providing emotional support, health and relationship advice and this was routinely offered to patients, families and carers.
  • The service had the individual needs of patients central to the planning and delivery of care. Services were flexible and used innovative approaches to ensure the services met the needs of people needing them. There was active engagement with other agencies to support those most vulnerable to access services at the right time and there was a proactive approach to understanding the needs of those using the service. Significant work had been done and was ongoing to ensure people could access services in a timely way.
  • Leaders were passionate about the service, this was reflected in the highly motivated staff we spoke with. Staff were proud of the service they provided and felt valued and supported. There was a focus on staff development and continuous improvement. The service was clearly focused on the needs of patients using the service, feedback was proactively sought and used to inform service development. The service engaged well with patients and there was strong evidence of collaborative working with other teams and agencies.

Specialist community mental health services for children and young people

Requires improvement

Updated 28 October 2019

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

  • Staff did not consistently manage safety well. Staff had not ensured that clinical premises where patients received care and clinical equipment used to support care were safe, well equipped, and well maintained. Patient risks were not assessed and managed well. Patients on waiting lists were not monitored to detect changes in risk. Not all staff had received the basic training to keep patients safe.
  • The service was not consistently responsive to patients’ needs. Waiting times for interventions including therapy and specific assessments exceeded agreed targets.
  • The service was not consistently well-led. Our findings from the other key questions demonstrated that governance processes did not operate effectively at team level, but performance and risk were managed well. Managers had not ensured that clinical premises and equipment were safe. Not all staff had received their mandatory training or an annual appraisal.

However:

  • The service was providing effective care. Treatment and care for patients was in line with national guidance. The teams included or had access to the full range of specialists required to meet the needs of patients under their care. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • Staff were caring. Staff were attentive and treated patients and families with compassion and kindness. Staff involved patients and families in making decisions about their care and in shaping the future of the service.

Community health services for children, young people and families

Good

Updated 28 October 2019

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

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • Young people were treated according to national guidance, including those from the National Institute for Health and Care Excellence (NICE) and Royal College of Paediatrics and Child Health.
  • Policies and procedures were based on national guidelines.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.

  • The 0-19 service provided a wide range of health promotion activities for children and young people and their parents.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them.
  • Staff cared for patients with compassion. Feedback from parents confirmed that staff treated their children well and with kindness.

  • The trust planned and provided services in a way that met the needs of local people.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • We observed effective leadership at a local level, team meetings were professionally managed with engagement from staff attending.
  • There had been significant improvements in the areas we had previously identified as a concern at Hannah House. These included safe staffing, medicines management, evidence of competencies, safeguarding training and supervision and lack of oversight management.
  • At our last inspection we had concerns about the management oversight of Hannah House. We saw that at this inspection there was an interim manager who had worked in the unit for a significant time and had put into place actions identified previously.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
  • The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

  • Community paediatric medical staff fell below trust targets for mandatory training.

Community health inpatient services

Good

Updated 29 August 2017

When the community inpatients service at Leeds Community Healthcare NHS Trust was last inspected in November 2014, we rated the services as requires improvement overall.

We asked the provider to make the following improvements at that time:-

  • Ensure staffing levels and skill mix is suitable for staff to effectively provide the necessary support to patients.

  • Ensure emergency drugs can be accessed quickly in an emergency.

  • Ensure drug fridge temperatures are maintained appropriately.

  • Ensure equipment is appropriately maintained and fit for use.

  • Ensure resuscitation procedures and practice are reviewed and the use of best practice is implemented, for example Resuscitation Council guidance.

  • Ensure initial assessments are promptly undertaken and care plans are person centred on all units.

  • Ensure ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) forms are completed in-line with trust policy.

  • Ensure discharge-planning processes and decisions are more focused and time-stated.

At this inspection, we found the provider had made all of the improvements required.

We visited three locations.

  • the South Leeds Independence Centre (SLIC)

  • the Community Intermediate Care Unit (CICU)

  • the Community Neurological Rehabilitation Centre (CNRC)

We rated community inpatient services as good because:

  • Services were planned and delivered to meet the needs of all patients using them. There were systems to ensure patients were protected from avoidable harm and abuse. Safety performance was monitored, incidents were reported and lessons learnt.

  • The service managed staffing effectively and services had enough competent staff with the appropriate skills, experience and training to keep patients safe and deliver effective care and treatment. Staff were well motivated and knowledgeable. Staff teams and services worked together effectively to deliver good care.

  • Emergency medicines and equipment for use in a medical emergency were fit for use and quickly accessible in an emergency. Medicines management was effective.

  • Equipment was appropriately maintained and fit for use.

  • Patient care and treatment was planned and delivered in line with current guidance; patients had good outcomes because they received effective care and treatment.

  • Consent to care and treatment was obtained in line with current legislation and guidance. Do not attempt cardiopulmonary resuscitation (DNACPR) forms were completed in-line with trust policy.

  • Patients were able to access the right care at the right time. Initial assessments and discharge-planning processes were promptly undertaken on all three units.

  • New care planning documentation had recently been introduced; care plans were person centred.

  • Resuscitation procedures and practice had been reviewed and were in line with best practice.

  • Staff involved and treated patients and their families with compassion, kindness, dignity and respect. People and their families understood the care and treatment choices available to them and were involved in making decisions about their care and treatment. Staff supported patients and their families to cope emotionally with their care and treatment.

  • Reasonable adjustments were made to ensure people with disabilities, or those in vulnerable circumstances, could access services on an equal basis.

  • The service had a low number of complaints and a high number of compliments; there was a complaints process and the service was proactive in dealing with any complaints received.

  • The leadership, governance and culture promoted the delivery of high-quality person-centred care. The new leadership teams, which had been put in place since the last inspection, were making effective changes.

  • The services had clear visions, values and strategies and staff in all areas were aware of these.

  • There were systems and processes in place for managing governance and risk, with a clear a focus on learning and improving. Appropriate actions had been put in place to mitigate identified risks in the services.

However:-

  • There was no internal system to record delayed discharges from the South Leeds Independence Centre and Community Intermediate Care Unit until January 2017. This meant there was no way to know if discharges were timely or the reasons for any delays until this process was put in place.

  • Response rates for the friends and family test were low. One of the trust’s quality priorities was to increase patient survey response rates.

  • At the South Leeds Independence Centre, the call bell system and falls sensors were on a ‘linked system’. Senior staff told us the system was not fit for purpose.The falls sensors did not always trigger the audible alarm if patients stood up. This meant patients could be at risk of falling and suffering harm. Managers were aware of this and told us there were plans to replace the system. The call bell system relied on staff carrying a handset around with them. Staff then responded to patients who heard staff on a loudspeaker in their room. Staff told us this method of responding to patients usually caused more anxiety and confusion for patients.

  • There was no evidence to show that the recommendations identified in the most recent legionella risk assessments at all three locations had been followed up and appropriate actions taken. This included ensuring staff were appropriately trained in the control and management of legionella.

  • Staff caring for patients with dementia did not always have up-to-date appropriate training in dementia care.