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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.

Reports


Inspection carried out on 31 January - 2 February 2017 Unannounced 15 February 2017

During an inspection to make sure that the improvements required had been made

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

Letter from the Chief Inspector of Hospitals

We last inspected this trust in May 2014 and we rated the provider as ‘requires improvement’ overall. In reaching our judgement, we told the trust that they must make improvements to: staffing levels, quality of records particularly risk assessments, management of falls, planning and delivery of care, clinical supervision, governance and risk management processes and risks associated with unsafe or unsuitable premises.

We carried out an announced follow-up inspection of this trust between 31 January – 2 February 2017 and an unannounced inspection on 15 February 2017 to make sure improvements had been made. As part of the inspection, we assessed the leadership and governance arrangements at the trust and inspected the core services that required improvement at the last inspection. We inspected sexual health services, which had not been included at the last inspection, and because we had received a whistle blowing concern. We also included an inspection of Hannah House, part of the community services for children, young people and families because we had received concerns regarding medicines management. We inspected the following services:

  • Community health services for adults;
  • Community services for children, young people and families (Hannah House)
  • Community inpatient services;
  • Sexual Health Services
  • Child and Adolescent Mental Health Wards (Little Woodhouse Hall)

Whilst a number of individual services were judged good, Hannah House was rated as requires improvement, community child, adolescent mental health services (Little Woodhouse Hall) was rated as requires improvement and sexual health was also rated as requires improvement.

We have rated Hannah House at location level and not as part of the overall provider because we did not inspect the whole of the community children, young people, and families’ service.

The overall rating for the provider is good.

Our key findings were as follows:

  • In most areas, medicines were managed appropriately however; arrangements for the safe handling of medicines at Hannah House were not consistent showing omissions in recording.
  • There were high levels of staff sickness at Hannah House, which was affecting areas of the service to run effectively such as cancellation of short breaks. However safe levels of staffing were maintained.
  • Not all staff were clear about the level of safeguarding training undertaken or required particularly staff working with children.
  • Staff could access mandatory training however not, all staff at Little Woodhouse Hall were trained in restraint, and on some shifts there were not enough trained staff to carry out restraint if needed.
  • Not all services had consistent methods for monitoring environmental safety checks.
  • There remained some issues regarding the suitability of premises at Little Woodhouse, although the trust had mitigated a number of risks, not all of the actions were complete.
  • There was a lack of assurance and evidence of staff competence about specific skills needed to care for children and young people at Hannah House due to the lack of recording in competency assessments. Processes to ensure staff working at Little Woodhouse Hall to receive training specific to Child and Adolescent Mental Health services prior to starting work on the unit also required improvement.
  • Governance and assurance processes were in place to measure quality however; these arrangements were not as effective at Hannah House or in child and adolescent mental health inpatient services. As a response to the concerns raised at the announced inspection, an action plan was developed. This had ownership at senior staff levels with appropriate support by the quality lead and clinical lead for the Children’s Business Unit. They reported directly to the executive director of nursing providing assurance that concerns had been recognised at a senior level.
  • There were some inconsistencies in the approach and systems to meet the Fit and Proper Person requirements.
  • There was good staff engagement particularly in adult and inpatient services however staff engagement was variable with morale being lower at Hannah House and Little Woodhouse Hall where there was a feeling of disconnect from the rest of the trust.
  • The trust had a good incident reporting culture in most areas, and there was evidence of improvements following incidents, but systems for sharing information in some services was not as strong.
  • There were processes to ensure good and effective infection prevention and control.
  • Across community, services staffing levels and skill mix were suitable for staff to provide the necessary support to patients. Recruitment was continuing and additional funding for staffing agreed.
  • Patient feedback was good, and surveys confirmed this. Staff treated patients with dignity and compassion, and ensured that patients were involved in the development of their care. Services promoted independence and supporting patients to move to self-care.
  • Patients were able to access the right care at the right time. Services met the individual needs of patients and took into account patient preferences. There were some good examples of where staff met the needs of vulnerable people.
  • There was a stable leadership, which appeared cohesive and worked collectively. The leadership were aware of the challenges to provide a good quality service and identify the actions needed to address these.

We saw several areas of outstanding practice including:

  • The speech and language therapy team had developed an award-winning choir, which helped patients in their speech and language skills and provided social opportunities.
  • Senior therapists saw musculoskeletal (MSK) and rehabilitation patients at the initial assessment. The MSK service in Leeds was trialling alternative models of care both to support increasing demand and support capacity in Primary Care.
  • There was a project to improve patient flow. This involved looking at patient pathways and journeys through the inpatient unit and identifying any delays and ‘blockages’ in the current system which could reduce patient’s length of stay and improve patient flow.

However, there were also areas of poor practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that processes are in place for the safe handling of medicines at Hannah House.
  • Ensure that staff receive appropriate training and development of their competencies, skills and experience at Hannah House.
  • Ensure bank and agency staff working in child and adolescent mental health are trained in the use of restraint.
  • Ensure staff working in child and adolescent mental health receive specialist training in working with young people, in line with quality standards for this type of service.
  • Ensure that governance processes and quality measures are strengthened at Hannah House and the child and adolescent mental health ward.
  • Develop a seclusion policy for young people in crisis.
  • Ensure that all staff are trained in the appropriate level of safeguarding children and adults for their service.

Community Health Services for Adults

  • Ensure systems are consistent to monitor environmental issues in community clinics.

Community Inpatient Services

  • Replace the patient call system and the falls sensor system at SLIC.
  • Introduce audits to assure the quality of patient records.
  • Continue to review systems to improve response rates for patient feedback.
  • Improve patient participation in self-medication at CICU and SLIC.
  • Consider improving the variety of food and timings of meals at SLIC.
  • Ensure processes are consistent to complete mental capacity assessments for patients who require these.
  • Continue to address the recommendations in the Legionella Risk Assessment.

Sexual Health Services

  • Ensure daily checks of the emergency oxygen bag and areas in the management of medicines.
  • Continue to address the provision of clinical supervision for staff in sexual health services.
  • Ensure key performance indicators are improved to avoid long waiting times in clinics.
  • Consider communicating waiting times in clinics.

Hannah House

  • Ensure processes are in place for environmental safety checks.
  • Ensure learning from incidents and complaints is shared with staff.
  • Ensure daily records of care are completed.
  • Consider Wi-Fi access for children during their stay at Hannah House.
  • Consider how the service engages with families to enable them to contribute to service development.
  • Reduce the number of cancelled short break stays and review the reasons for cancellations.

Trust-wide

  • Review systems to ensure consistency in meeting the Fit and Proper Person requirements.
  • Ensure consistency in recording risks on the risk register in all services.

Ellen Armistead

Deputy Chief Inspector of Hospitals


CQC inspections of services

Service reports published 29 August 2017
Inspection carried out on 31 January to 2 February 2017 During an inspection of Community health inpatient services Download report PDF | 407.83 KB (opens in a new tab)
Inspection carried out on 31/01/2017 During an inspection of Child and adolescent mental health wards Download report PDF | 377.6 KB (opens in a new tab)
Inspection carried out on 31st Jan - 2nd Feb 2017 During an inspection of Community health services for adults Download report PDF | 335.77 KB (opens in a new tab)
Inspection carried out on 31 January 2017 – 2 February 2017 During an inspection of Community health sexual health services Download report PDF | 321.83 KB (opens in a new tab)
See more service reports published 29 August 2017
Service reports published 20 September 2016
Inspection carried out on 16/06/2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 258.07 KB (opens in a new tab)
Service reports published 25 August 2016
Inspection carried out on 9 June 2016 During an inspection of Child and adolescent mental health wards Download report PDF | 231.2 KB (opens in a new tab)
Service reports published 22 April 2015
Inspection carried out on 24-27 November 2014 During an inspection of Specialist community mental health services for children and young people Download report PDF | 305.88 KB (opens in a new tab)
Inspection carried out on 24-27 November 2014 During an inspection of Community dental services Download report PDF | 307.68 KB (opens in a new tab)
Inspection carried out on 24-27 November 2014 During an inspection of Community health inpatient services Download report PDF | 351.87 KB (opens in a new tab)
Inspection carried out on 24-27 November 2014 During an inspection of Community health services for children, young people and families Download report PDF | 293.64 KB (opens in a new tab)
Inspection carried out on 24-27 November 2014 During an inspection of Community health services for adults Download report PDF | 331.27 KB (opens in a new tab)
Inspection carried out on 24-27 November 2014 During an inspection of Child and adolescent mental health wards Download report PDF | 311.94 KB (opens in a new tab)
See more service reports published 22 April 2015
Inspection carried out on 24-27November 2014

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

Whilst a number of individual services were judged good, concerns within community inpatient services, and community child and adolescent mental health services, means that overall we have judged the trust as requires improvement.

The provider was not meeting regulation 15 premises and equipment at Little Woodhouse Hall, and regulation 17(2)(d) good governance within the community children’s and adolescent mental health service. There were concerns with regards to staffing levels across a number of services, and concerns regarding the transcription of medication in district nursing services.

The trust had a good incident reporting culture, and there was evidence of improvements following incidents, but these were not always shared across teams. Staff were positive regarding informing patients if there had been an incident and some were aware of the recently introduced Duty of Candour. Staff could access mandatory training, and the majority of premises were suitable with the exception of Little Woodhouse Hall.

Staff were aware of and used national guidance in the delivery of their care, though there was an inconsistent approach to assessment within the South Leeds Independence Centre (SLIC). Pain relief was effective and patients nutritional and hydration needs were effectively assessed where appropriate. Multidisciplinary team working was effective, as were consent processes with the exception of some do not attempt cardiopulmonary resuscitation (DNACPR) consent at SLIC.

Whilst some audit activity took place, overall the trust needed to improve its plans and overall approach to audit. Some services utilised outcome data, but there were other services particularly in the community where there was limited data to demonstrate the impact of service provision.

Patient feedback was good, and surveys confirmed this. Staff treated patients with dignity and compassion, and ensured that patients were involved in the development of their care. On the whole services promoted independence and supporting patients to move to self care, though this could be developed further on the SLIC.

There was variation in the planning and delivery of services, in particular some length of stay on the SLIC, and waiting times for community children’s and adolescent mental health services. Staff ensured that services met the individual needs of patients and took into account patient preference in most circumstances, and there were some good examples of where staff had looked to meet the needs of vulnerable people.

Locally many staff felt they had good support from their immediate line managers; however morale was low and many staff were uncertain regarding their and their services’ future. There was inconsistency in how and when staff were communicated with regarding changes to their roles and services. Governance of the organisation, whilst improving had been reliant on reassurance, not assurance, and we identified examples of incidents and risks that had not been investigated in a timely fashion, and risk registers which were not effectively produced to afford the necessary controls to reduce or remove risk.

The culture of the organisation whilst reported as open and supportive to learning from incidents reflected a change weary staff group, with above average levels of sickness, including stress related long term sickness.

Leadership was improving; the new chief executive was affecting change to improve access to executive and non executive staff. There were examples of innovation across different services, and numerous examples of staff being recognised for their work and endeavour at local and national award ceremonies.