We rated them as requires improvement because: During the inspection we visited all four wards and observed how staff were caring for patients. The 136 suite at Preston had a shower room which had evidence of mould growing and cracked tiles. Staff in all services were generally described as discreet, respectful, and responsive when caring for patients. We will revisit these services to check that appropriate action has been taken and that quality of care has improved. Consequently, the gym was not fully utilised. People were offered a copy of their care plan. This demonstrated a lack of connection between service delivery and the board. We rated it as requires improvement because: 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. Staff worked with hospices, hospitals, GPs and specialists for advice when needed. While staff were completing comprehensive risk assessments in most cases, there was a small number of patient risk records, which had not been reviewed recently. The service proactively monitored and managed staffing levels to ensure patient safety. Staff working for the home treatment teams provided a range of care and treatment interventions that were informed by best practice guidance and suitable for the patient group. Managers ensured staff received supervision, appraisal and training. Carers told us that staff could sometimes be difficult to get hold off but that they took the time to discuss their loved ones care with them and involved them in decision making where appropriate. There were still two registered nurse vacancies to be filled. Environmental audits did not include all areas of the ward environment which meant that staff were not following trust procedures. Overall, we have rated community health services for adults as Requires Improvement. Before The unit designs were not fit for purpose, they were not being used in the way intended and they persistently failed to meet the basic needs of patients. Staff felt supported by the team on a local level. Crisis Resolution and Home Treatment Team (CRHTT) If youre suffering from an acute mental health problem or crisis, we can provide you with a safe and effective home assessment. The standard operating procedure did not correspond with practice in relation to the clock starting for 12-hour breaches. The trusts visons and values were embedded across the trust. 11 September 2019. Nine evidence based care pathways had been developed and were in the process of being introduced across the service. The service followed best practice guidance on the decontamination and sterilisation of used dental instruments. Staff had a good knowledge of the Mental Capacity and Mental Health Act. Staff requested patients consent to care and treatment in line with the Mental Capacity Act. We were also able to provide training to other providers and colleagues in health and social care in relation to mental health resilience during the Pandemic, to better support mental health understanding in the community too. In the community health services, service redesign had led to restructuring of teams, which had brought smaller teams together. Staff had good access to training to support their roles. However you access the Home Treatment Team, we will work collaboratively with you and the people you identify to understand the current factors that have led to a crisis and to support you to meet the goals you identify. Developmental roles for band five nurses had been implemented for staff wanting to develop into leadership roles. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. A range of activities were provided at resource centres within the hospital grounds. Actions from incidents were discussed in team meetings and at individual supervision to ensure lessons were learnt. In the Integrated Nursing Teams (INTs) in Chorley and South Ribble, and Blackburn with Darwen localities, we found 18 out of 20 patients records where patients had died, that did not have an end of life care plan in place. Involved patients and their families in decisions and had access to good information to make these decisions. Staff knew and upheld the values of the trust: there was lots of evidence on each ward explaining trust values for both staff and patients. We requested documentation audits specifically for the INTs and were informed by the trust that the INTs had not participated in a documentation audit for the 12 months prior to our inspection. Our DHTTs can make referrals where needed to our mental health inpatient wards for individuals who would benefit from a hospital stay. Our ethos is one of honesty, transparency, trust and inclusion, which we feel is key to the pathway of wellbeing. Key performance indicators were used to assess the effectiveness of the service offered to young people. Treatment Team (RITT) 65+ years Specialist Older Adult Services covering Blackpool, Fylde & Wyre. At Pendle House, we saw an electronic notice board accessible to all staff that flagged up best practice guidelines. Managers had oversight on mandatory training levels. Sickness and vacancies accounted for the issues which were managed by bank staff or overtime. Staff were not managing all risks effectively. Our Home Treatment team (Southwark) provides a community-based service to support people, aged 18-65, at home, rather than in hospital. Review now Our location See anything wrong with this listing? An example was given of a service user receiving the same halal microwave meal every day. We were not assured that the trust was collecting meaningful data to understand the scale of the issues apparent across this core service. Access to psychological assessments and ongoing therapy was provided promptly. Telephone: 01686 617 242, Adult and Older People's Mental Health Services, Your Local Dementia Home Treatment Team (DHTT), Nosocomial Covid-19 Patient Safety Review Team, Adult and Older People's Community Services, Learning Disabilities & Neurodiversity Services, Current Jobs at Powys Teaching Health Board. In the multi-disciplinary meeting we attended, a persons capacity was considered in every situation and discussed. In some cases staff were still being slotted into positions in the team. Some staff used an electronic records system called ECR where as others used a paper based system. This site needs JavaScript to work properly. How to access the service. Also, some equipment in the clinic room had passed the expiry date for use. Patients individual care and treatment was planned using best practice guidance. However, the governance structure from senior management level to ward level was in the process of being developed and was still in draft form at the time of our inspection. Performance issues were escalated to the relevant monitoring committee and the board through clear structures and processes. Currently there are 343 home treatment services. Guild Lodge was utilising recovery-based models of care such as My Shared Pathway and Recovery Star, though implementation was inconsistent across the wards. Patients frequently experienced cancellations to escorted leave and activities. Staff could describe incidents that had been reported and identified actions taken in response. Print this page The service participated in National Institute for Health and Care Excellence audits such as the use of waterlow scales and end of life care. Staff were kind, caring and compassionate and supportive of people using the service. Physical restraint was rarely used as staff were confident in the use of de-escalation techniques. the trust had a number of established methods to promote engagement and communication with staff. Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. Ashton Under Lyne, Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. Adult crisis and home treatment teams Every area in England will have a 24/7 mental health crisis service by 2021. We found this was not consistently applied across the site. Staffing levels and skill mix within the MHCS meant they were able to meet the needs of people accessing the crisis services. You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection. Evidence of a monitoring system was provided by the Lancaster and Morecambe team, however there was no evidence available for Chorley and South Ribble team. 020 3228 3500. Trust records showed, as of March 2015, only 54% of all staff had received appraisals for the year 2014 to 2015. The purpose of the crisis support units was to provide short term support for patients for up to 23 hours as an alternative to hospital admission, or whilst awaiting a hospital bed. The ward had enough nurses and doctors. The routinehealth visitorcontact became part of thehealth visitorcontract in April 2014, however, ithad beenagreed with commissioners that this would be introduced on an incremental scale starting with those deemed most vulnerable (ie highlighted by Childrens Centres and Midwives). The ward did not participate in national audits to monitor outcomes of some of the conditions that were being treated, for example, hip fracture and sentinel stroke national audit programme. The 136 suites were generally in keeping with the standards in the Mental Health Act and its code of practice. We also had significant concerns that governance systems in place for the oversight of the 136 suites and stays over 23 hours in mental health decision units were not effective. Staff did not always interact proactively and positively with patients. People's diverse needs were integrated in policies and proactively taken into account when devising protocols. The Mental Health Act and Mental Capacity Act were implemented and monitored effectively: regular audits and a centralised team ensured detained patients had their rights explained properly and regularly. Avondale Unit, The Royal Preston Hospital Tref Preston Cyflog 33,706 - 40,588 per annum, pro rata Cyfnod cyflog Yn flynyddol Yn cau 14/03/2023 23:59. . Staff demonstrated that they knew the organisations visions and values, and were supportive of them. We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels: Outstanding Wards used regular bank and agency staff where possible. To service A&E department and Medical Assessment Wards. The trust had experienced challenges with staffing levels due to the relocation of some wards to the newly opened Harbour service, which was being proactively managed. The board was not aware of these issues, which were not in line with best practice guidance and the Mental Health Act (MHA) Code of Practice (CoP). Compliance with clinical supervision and yearly appraisals for nursing staff was poor. To provide mental health assessments and advice for clients who are in-patients on medical wards within the Acute Trusts, Conduct comprehensive risk and mental health assessments to a standardised level of best practice, To offer advice and support to colleagues within the Acute Trusts, Ensure appropriate signposting/referral onto relevant statutory and non-statutory agencies as identified, including Single Point of Access (SPOA), Perinatal Community Mental Health Teams (PCMHT), Home Treatment Teams (HTT), Substance Misuse Services and Housing and Emergency Social Services Team in response to client need. This had a direct impact on patient care. There were good personal safety protocols in place including lone working practices. Planning and delivery of service took patients individual needs and circumstances into consideration. The audit was of poor quality as it was not comprehensive, itemised or specific. Managers ensured that these staff received training and appraisals. This resulted in difficulties for staff because patients witnessed and heard of others smoking. There was a range of facilities and activities available on and off-site, although access was limited when there were staffing shortages. We rated it as good because: Download easy to read version for - PDF - (opens in new window), Lancashire Care NHS Trust: Evidence appendix published 11 September 2019 for - PDF - (opens in new window), Published Clinical evidence summary tables. Published Enter your postcode below to discover what is happening in your region. Feedback from patients who used the services was positive, regarding how staff treated patients and their families. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the service user. 01772 716 565; Send email; Visit website; View Accessibility Symbols The inspection was carried out by one inspector, one specialist advisor, one pharmacy inspector and an Expert by Experience. Psychological therapies were available. There was a governance framework to support the delivery of care. Information provided by the trust showed staff had not received the expected supervisions and appraisals. NIHR Lancashire Clinical Research Facility Avondale Unit, Sharoe Green Lane, Fulwood Preston, PR2 9HT . We are keen to include the whole psychological professions workforce in the region. Bookshelf While staff ensured that they were recording most of safeguards relating to seclusion, we found one example where staff had not recorded that parents or carers were informed of one seclusion episode. Staff followed the trust's values of teamwork, compassion, integrity, respect, and intelligence when carrying out their work. This had resulted in significant issues with recruitment and high levels of sickness. Taking place on Wednesday 24th May 2023 in Manchester City Centre. Information supplied before the inspection indicated a culture of systemic bullying; however, we found no evidence of this. Patients did not have privacy for phone calls as public phones were located in communal areas and not all had a hood. A patient had been detained at the Orchard without the safeguards afforded by the Mental Health Act or Mental Capacity Act; 12 detained patients had been given medication that had not been included on the relevant consent to treatment documentation; the trusts Mental Capacity Act and Deprivation of Liberty Safeguards policy did not give an accurate definition of the meaning of capacity within the Act. A ligature risk audit identifies places to which patients might tie something to strangle themselves and plans actions to mitigate the risks to the patient. We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. We observed staff attending to patients in a kind and caring manner, with dignity and respect and this was confirmed with patient led assessment results being better than the national average in many areas. 29 Occupational Therapy jobs in Preston available on Monster. Information supplied by Lancashire & South Cumbria NHS Foundation Trust, Report an issue with the information on this page, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Lancashire & South Cumbria NHS Foundation Trust. However, we found that escorted leave and ward activities did not always take place as planned and patients did not always have regular one to one sessions with their named nurse. This was the first urban crisis resolution and home treatment team in Wales, but shortly after it had been set up and before it could be evaluated fully, the decision was made to extend it to the rest of Cardiff and thus the second team began its work in June 2006. Multi-disciplinary team meetings and handovers allowed the exchange of professional opinion and suggestions for onward treatment. All clinic rooms were fully equipped. Treatment? Whilst some of our residents require lifelong care, our specialised programmes and care planning allow all our residents the opportunity to maintain existing skills or to develop new ones with the aim of progressing to less supported accommodation. There was evidence of multi-agency and patient focus groups to inform delivery of services which resulted in a more integrated approach to service delivery via the intensive home support service. Sixsmith J, Callender M, Hobbs G, Corr S, Huber JW. Services were being delivered in line with adherence to the Mental Health Act 1983, the Code of Practice and the Mental Capacity Act 2005. This meant that people were empowered to access help and support directly when they needed to, 24 hours a day, seven days a week. The health-based places of safety had 26 incidents in the 12 months leading up to our inspection where people had been deemed as needing admission but a bed was not found within the 72 hour assessment period of section 136. 2020 Jun;27(3):246-257. doi: 10.1111/jpm.12573. To find out more, click here, Crisis Resolution Home Treatment Team Blackpool (25-65), North West 6 days ago Applied Saved. Debriefing included input from a psychologist. We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of this service. Ligature risk assessments and reviews of the environment had been carried out. Our Home Treatment Teams(HTT) area community-based service set up to support you if you are experiencing severe mental health issues and require crisis support. Staff were seen to interact in a professional and caring manner with their patients, with time and attention being given to all. We spoke with four senior managers at the Harbour and looked at a range of policies, procedures and other documents relating to the running of the service. The teams help . Home Treatment - operates 8am to 8pm 7 days a week Provides intensive support in the community for people with acute mental health difficulties for a period of up to 6-8 weeks. This meant that patient safety was important and communicated to the senior management team. We found the ward action plan resulting from the health, safety and environmental audit at the Platform. Translation services were available if required. To begin your own journey at Avondale, let us help you choose a vocational course (VET), undergraduate or postgraduate degree that's right for you! The service received 238 compliments within the last 12 months. The ward layout was well planned in the Harbour services: the layout used space to good effect. Staff were supported by means of supervision and appraisal processes, to identify additional training requirements and manage performance. In Lancaster and Leyland there were patients waiting for up to 12 months for transfer to community mental health teams. It became routine in September 2014, again with the expectation that the number contacted would increase each quarter. Patients had an assessment of their needs, and a plan of care was developed in response to this. Patients therefore remained in the health-based place of safety longer than necessary. Patients felt they were afforded sufficient privacy and dignity. For Trust values to be evident in all aspects of service delivery and interactions with service users, carers, colleagues and peers. However, in some other mental health services, staffing levels were not adequate or staff were not suitably qualified to meet patients needs. Staff engaged in clinical audit to evaluate the quality of care they provided. However there were shifts that operated below the expected establishment. The ECR system required more time to complete details and entries made had to be transferred to other systems which increased the risk of errors and extra work for staff. This is because: We were not assured that all lessons learnt were being identified in the root cause analysis investigations we reviewed or areas identified for improvement were being monitored. The https:// ensures that you are connecting to the Work on enhancing the garden areas is underway and we are looking to become far more self-sufficient over the coming year planting more fruit and veg to help with growing our own, reducing our carbon footprint and getting active. Families engaged with the Childrens Integrated Therapy and Nursing Servicewere involved in writing their childs care plan. We are the Research team based at the Lancashire Clinical Research Facility at Royal Preston Hospital. Not all staff had received appropriate specialised training. They followed good practice with respect to young peoples competence and capacity to consent to or refuse treatment. Designed and Developed by: Cube Creative 2021. Not all young people had an up to date current risk assessment present in their care records. Outcomes were monitored to ensure changes were identified and reflected to meet patients needs. They were open and honest about these issues. Priory Hospital Preston is a 38-bedded independent mental health hospital, specialising in the management and treatment of acute mental ill health and eating disorders. Patients dignity was protected wherever possible and we found medications were administered privately, in treatment rooms where possible. Staffing levels were sufficient to ensure the safety of patients. Access to dieticians and speech and language therapists were available and staff were positive about their working relationships. Regular checks of prescribing, medication and stock levels were undertaken. Patients had comprehensive risk assessments completed. Staffing concerns meant people sometimes had to wait to see a doctor. A recent audit confirmed these improvements. To act as a Key Member of the Worcestershire Crisis Resolution and Home Treatment Service.. To undertake professional mental state assessments and crisis interventions, making decisions. Comprehensive assessment processes, holistic care plans and risk assessments were in place and young people felt involved in the care planning process. They were kept up to date about their teams performance. Feedback from people who use the service was positive. This had not improved since our last inspection. Service and service type . Staff morale was low. This had led to an impact on the quality of care staff delivered and the loss of a number of experienced staff members. This was shown by the number of environmental issues we found across services that compromised the safety of patients. This occurred when patients had been assessed as needing inpatient admission, but there were no beds available. 9.3 Community mental health teams; 9.4 Assertive outreach (assertive community treatment) 9.5 Acute day hospital care; 9.6 Vocational rehabilitation; 9.7 Non-acute day hospital care; 9.8 Crisis resolution and home treatment teams; 9.9 Intensive case management; 10. We found the majority of records reviewed at the Royal Blackburn Hospital did not contain patient views or evidence that patients had been given copies of their care plans. The Home Treatment Team is likely to meet with you initially, following your contact with one of our triage and assessment teams. Consent practices and records were monitored and reviewed to improve how patients were involved in making decisions about their care. Managers and clinicians had put good governance systems in place which managed risk effectively. Compliance rates in individual teams ranged from 29% (6 out of 15 staff) in the Blackburn with Darwen CITNS team to 100% in the 0-19 South Ribble East team (19 staff). This included increased staffing for community teams and closer working relationships with partner agencies. Buildings were clean and well maintained. 10.2 Abbreviations; 10.3 Early intervention . Additionally, we had concerns about the use of mental health decision units for patients under 18 years old. There was effective multi-disciplinary team working. Epub 2019 Nov 18. Read more about the collaboration here , Don't forget to HOLD THE DATE for our NWPPN 10 Year Celebration Event! Emergency equipment was accessible to all and was maintained appropriately. We also saw blinds were not used in the male dormitory to protect patients privacy and dignity as staff and visitors when entering the ward area were able to see into this area. Patients individual care and treatment was planned and best practice guidance was implemented, ensuring outcomes were monitored and reviewed. Staff took the time to listen to patients and to understand their needs. BMC Psychiatry. If you would like this information in large print, audio, Braille, alternative format or a different language, please contact Customer Services and we will do our best to help. Patients in the crisis support units and crisis/home treatment teams were presumed to have capacity to make decisions about their care and treatment.
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