The target was for urgent referrals to be seen within five working days and at the time of our inspection, staff saw patients within eight days. We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels: Outstanding improvement measures to support the urgent care pathway and address the issues raised at the last inspection. Overall, we have judged that community health services for children, young people & families is Good. Our crisis assessment and treatment teams (CATT) are a mental health service based in the community. Crisis teams can: visit you in your home or elsewhere in the community, for example at a crisis house or day centre visit you in hospital if you're going on leave or being discharged In addition, at the Junction compliance with clinical and management supervision was low. Please ask if you would like this support. As part of each inspection, we look at the way health services provide care and treatment to people. Teams were well-led by committed managers and staff felt respected and supported. During the inspection we received feedback from 35 patients. The ward environment was safe and clean. While detention papers had been checked by the receiving nurse and scrutinised by an administrator, on three out of four relevant records, we did not find evidence of medical scrutiny to make sure the clinical grounds for detaining patients were made out. This issue had been added to the trusts risk register which showed it had been identified as problem. We also found some gaps in the recording of observations on some wards. 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. Implemented best practice guidelines such as routine outcome measures to plot patients progress and experience (and had taken part in Royal College of Psychiatrists' Quality Network for Inpatients (QNIC) reviews). We found this was not consistently applied across the site. Families and carers were involved in this process where appropriate. The service had direct access to a vascular surgeon where they could arrange urgent appointments and the service could order diagnostic tests prior to the patient attending the appointment to enable the consultant to have sight of all information at the time of consultation. It's the responsibility of a Gunzenhausen home architect to transform human needs and desires into visual concepts and habitable structures. The Central Home treatment team also provide intervention to Willow House the Crisis support house based in Chorley, The Haven service at times there will be a need for the . Patients using the service told us that they were treated with dignity and respect and described the staff as caring and helpful. Patients told us they were involved in decisions about their care and were encouraged to participate in meetings to develop and manage their care and discharge. Pharmacists inputted into wards on a daily basis. A separate gardening project aimed at providing vocational qualifications and employment opportunities to patients. This usually took place within 24 hours. Comprehensive risk assessments for patients were completed and reviewed and clear crisis plans were in place where patients were assessed as. All locations which we visited were fully accessible for wheelchair users and those with limited mobility. They followed good practice with respect to young peoples competence and capacity to consent to or refuse treatment. Community-based mental health services for adults of working age. 12 hour shift + 5. within the community health services for adults, staff did not do all that was reasonably practicable to mitigate the risks of patients developing pressure ulcers on their caseload. Patients were well cared for on Longridge ward. The trust was part of a multiagency group that had developed and implemented a policy for the use of section 135 and 136 across the Lancashire area. The staffing establishment in the MHCS had been increased following a scoping exercise that looked at the staffing levels necessary to meet the needs of people who used the service, based on agreed trajectories. Designed and Developed by: Cube Creative 2021. Patients felt that there were not enough staff on the wards and that staff did not always have time to speak to them. Staff were not consistently reporting these breaches. Staff actively involved patients and families and carers in care decisions, where possible, including working together to produce an impressive wall display to remind patients of ten key rights when attending care programme approach meetings. Health visitors used tablet computers to access records and document contacts while in clinic settings or during family visits. The ratings for the child and adolescent ward in all domains had improved to good. This meant that young people might wait as long as three days to be seen by a specialist at a weekend. Moss View had a ligature risk audit, which related to the HDRU only. The low number of risk assessments for clinic locations and the fact that they were not complete or comprehensive meant the potential risks were not being clearly identified or addressed. Staff were able to manage the development of the service they provided. However, there were plans in place to addressall of the issues associated with the physical environment and ligature risks, and a programme of work was underway. Service users' experiences with help and support from crisis resolution teams. Staffing pressures meant that supervision and team meetings did not happen as regularly as scheduled. The service had flexible opening times including evening and weekends to cater for its population and also good dispersal of satellite services for easy access. This had resulted in significant issues with recruitment and high levels of sickness. View photos. Patient information was available to staff, it was stored securely, and was readily accessible. We are a multi-disciplinary team of healthcare professionals offering a holistic and intensive period of care. Staff involved patients and their carers in the care and treatment they received. We saw a piece of work analysing the main reasons for staff sickness absences and considering how these could be addressed. Children and adolescents had to long waits for appointments. You can talk to PALS who provide confidential advice and support to patients, families and their carers, and can provide information on the NHS and health related matters. which is extremely helpful in helping maintain community links and allowing individuals autonomy. Staff used this information to effectively plan peoples care and make sure that when patients were discharged, all necessary and relevant information was available. Staff had a good awareness of the incident reporting process. Powys Despite this, we found a committed competent staff group who were patient focussed. The ward staff knew how to report incidents and as a result improvements were made to ensure patients were safe. Inspection team . This meant that nursing staff did not receive the appropriate support and professional development needed to carry out their duties effectively and managers were unable to review their staffs competency or assess the quality of staff performance. Regular environmental quality checks were conducted and patients were able to discuss and resolve environmental issues in community meetings. 2022 Jun;21(2):166-167. doi: 10.1002/wps.20958. There was evidence of delivering services to meet patients needs. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. The NHS Friends and Family Test results showed the majority of patients would recommend the department to their family and friends. Of the 23 care plans reviewed it was seen that capacity was addressed. Records we saw were comprehensive, patient centred and used recognised assessment tools for monitoring pain, nutrition, hydration and skin condition. Reported, investigated, and responded to ward incidents, using clear processes to safeguard young people. The crisis support units were intended to accommodate patients for up to 23 hours. Staff assessed and managed risk well. Staff generally assessed and managed risk well. This had the potential to put people who use the service and staff members at risk. Our primary aim is based on the recognition that people recover more quickly if treated at home in familiar surroundings, with friends and family close by. The team usually includes a number of mental health professionals, such as a psychiatrist, mental health nurses, social workers and support workers. Insufficient staffing levels on HDRU had been identified and noted on the local risk register. Patients in the 136 suites had their mental capacity assessed regularly. Patients had their risks assessed on admission and on an ongoing basis. Patients had access to a range of services to meet their needs. Review of meeting notes on Marshaw ward confirmed that leave was cancelled owing to staffing issues. Podiatry services had implemented a one stop assessment for patients who may require nail surgery which resulted in a reduction of additional appointments for patients and an increase in podiatry staff availability. 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. There were not sufficient numbers of suitably trained staff. We saw that multidisciplinary working was in place, the ward had input from therapists and a dedicated pharmacist. Crisis Resolution and Home Treatment Team (CRHTT) If you're suffering from an acute mental health problem or crisis, we can provide you with a safe and effective home assessment. The service dealt with complaints promptly, positively and efficiently. Staff completed care plans to a good standard and patients received regular formal reviews of their care. This integrated service is for people with severe and complex mental and behavioural disorders such as schizophrenia, bipolar affective disorder, and severe depressive disorder. the service is performing badly and we've taken enforcement action against the provider of the service. This impacted upon patients privacy and dignity. Patients with minor injuries were triaged by staff who were not clinically trained. Full information about our regulatory response to the concerns we have described will be added to a final version of this report, which we will publish in due course. They reviewed patients risk regularly and they responded appropriately when risk changed. Ten ex-HTT patients were interviewed on the care they had received, using thematic analysis of semi-structured interviews. the trust had a dedicated team to investigate serious incidents, all of whom had additional qualifications in root cause analysis. The main aim of our team is to help you manage and resolve your crisis through assessment and treatment in your home environment. OA Single Point of Access - for referrals operates 9-5 Monday to Friday. Mental health practitioner home treatment team jobs in Preston, Lancashire - February 2023 - 2505 current vacancies - Jooble Need a winning CV for your job search? MeSH Outcomes included written apologies to patients, improving patients understanding of policies and practices, adding issues and outcomes to Guild Lodges share the learning document, improving information, guidance and publicity, and supervision of staff. The existing ratings from our inspection in June 2019 remain in place. The procurement process and mobilisation of new teams created some obstacles and challenges for the staff andalso some changes in the services systems. 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 was specialist training available for each care pathway. We identified a number of issues of concern in relation to the child and adolescent mental health services provided by the trust in the community. Carer involvement and support with care plans and signposting to further community support for carers. Proposals were made for greater psycho-and occupational-therapeutic inputs to manage long-term care, and for provision of peer-support within HTTs. All ward areas were visibly clean and clutter free. 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 were unsure of the future of the unit and therefore the direction and strategy was also unclear. Electronic notes were clear, concise and care planning processes were evident. Regular governance meetings were held and performance data was on display in teams. Patients and staff on most wards raised concerns about the food describing it as poor quality. Staff had access to performance dashboards to monitor progress and improve service provision. Staff were positive about the new system. The Fylde Coast rapid intervention and treatment team had changed their operational hours as a result of vacancies and safe staffing levels. 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. Religious needs were not always met in a timely manner even though there were spiritual care facilities on site. Robust systems were not in place to ensure that certain patients were automatically referred to the tribunal or that the corresponding legal authority to administer medication to community treatment order patients were kept with the medicine chart and reviewed by nurses administering medication, leading to incidents of staff giving medication without legal authorisation. 1006024). Effective managerial operational meetings took place where incidents were discussed, team performance was reviewed and staffing and sickness in teams was considered. We saw some examples of excellent practice which meant people were able to stay in the community. They worked collaboratively with the young person and their family and always sought their agreement. There is no consensus on what HTTs "do", and a considerable lack of data on whether they deliver patient-relevant meaningful care. It became routine in September 2014, again with the expectation that the number contacted would increase each quarter. The risks associated with prolonged stays in section 136 suites and decision units were not recognised. Caseloads in universal services for children and young people were weighted to ensure a standardised approach to decision making across the trust and the weighting of each child was clearly identified on the electronic care record (ECR). Feedback from patients who used the services was positive, regarding how staff treated patients and their families. which is extremely helpful in helping maintain community links and allowing individuals autonomy. Send email. Complaints were dealt with promptly and monitored across the childrens and families network. Home Treatment Team We provide home treatment services to adults living in the community who require intensive, daily support and who are at risk of being admitted to an inpatient unit (for example, a ward). 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. official website and that any information you provide is encrypted Bronllys Hospital When you hire an architectural designer, you are not only hiring someone for their architectural services, but also to manage and coordinate other parties involved in the project. Actions in relation to complaints were often recorded as an apology being offered or expectations managed, but there was no evidence of investigation of systemic issues and wider changes. This included their mental and physical health, potential risks and social situation. Published Our rating of services went down. At this inspection we reviewed the safe, caring and well-led domains in full. Electronic rostering was used to support staff management and staffing was reviewed regularly to ensure there was enough staff with the relevant skills to deliver safe patient care. There were a small number of minor issues picked up in our clinic check including some stock medication exceeding suggested amounts and some unnecessary clutter. We inspected the four acute wards for adults of working age and two psychiatric intensive care units for adults of a working age based at the Harbour. Health visiting and school nursing teams worked to deliver the Healthy Child Programme and two of the five contacts were delivered using the Ages and Stages evidenced based screening tool. Managers reviewed individual and team performance. Assessments had always been completed well within the 72 hours required by the MHA and Code of Practice but not always within the trusts four hour target. Their aim is to cause minimum disruption to a person's life whilst meeting their needs in the early stages of acute psychiatric presentations. Executive management visibility in the community health services was low, although staff felt listened to and supported by local managers. The building works had finally commenced to address these concerns at the time of our inspection. The services had good structures, processes, and systems in place to manage current and future performance and ensure quality to drive improvements. However, because this was a focused inspection we did not re-rate the individual key questions or the overall service. All the wards we visited had information boards which showed patients and their visitors the staff who worked on the wards and also the different uniforms they might see. GPs were not given regular updates regarding any plans specific to patient care such as treatment interventions or information about patients being discharged from the teams. Physical health care issues were clearly documented in care plans and where necessary results and interventions were recorded. The problems with the health-based places of safety and mental health decision units were symptomatic of an acute care pathway that did not function effectively. Physical health assessments were completed on admission. The CQC have received assurance that the trust have put in place actions to address these issues with an action plan in place to complete the ligature risk assessments on each ward. Following consultation with a range of staff and stakeholders, the trust had recently developed a new governance structure from board to senior management level to support the implementation of its five-year strategic plan. Patients were not always given their rights under the Mental Health Act in line with the code of practice guidance. In order that as a mental healthcare provider, we not only provide care, support and advance wellbeing and independence for individuals who reside at Avondale. Staff involved with the crisis support units and crisis/home treatment teams were impacted to some degree by reorganisation within this core service which led to uncertainty. Our Home Treatment team (Southwark) provides a community-based service to support people, aged 18-65, at home, rather than in hospital. Contacts we observed showed information provided to children and families was clear and tailored to the individual child. Within the community based mental health services for adults of working age, risk management plans did not contain detailed information about how to manage specific risks and the legal authority to administer medication to patients on a community treatment order were not kept with the medicine charts. Celebrate with us on Wednesday 24th May in Manchester City Centre to find out more, click here -, AHP and Psychological Professions Collaboration to Support Art, Drama and Music Therapists! the trusts strategy had been developed with the populations specific health needs in mind, the trust had a dedicated equality and diversity lead to ensure the protected characteristics of the population were considered, the trust had identified that some wards did not meet the needs of the patient groups and had plans in place to move these to more appropriate buildings, arrangements for children and young people transitioning to adult mental health services had improved since our last inspection, the trust had a clear vision, supported by six values. The service did not always have enough nursing staff to meet patients needs. 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. We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. We are fully committed to ensuring that all people have equality of opportunity to . Risk assessments completed with the police were not present on 40% of the records we looked at. Patients with more complex healthcare needs were supported to attend specialist hospital appointments. Some of these ligature risks had not been identified through local audits. Clipboard, Search History, and several other advanced features are temporarily unavailable. All patients underwent a thorough assessment of need, care plans were holistic and recovery oriented and included physical health assessments, these were completed in collaboration with the patients, progress was regularly reviewed. This resulted in a reliance on the use of agency and bank staff to ensure patients were kept safe. People referred to the MHCS were usually seen within four hours of referral. There was no routine antenatal contact by the health visiting team where breastfeeding support and advice should be given. The Clinical Director for the children and families network provided a monthly quality and performance report to the Quality and Safety sub-committee and performance was monitored against a variety of targets and data. People did not have to be admitted to hospital when they were prescribed clozaril as staff carried out monitoring in the person's own home. We have two pathways: supported early discharge and admission avoidance. Staff were not always recording whether patients had been given copies of their care plan. Staff had been advised to assess capacity and that patients were then detained in their best interests, but this is not a lawful deprivation of liberty. J Ment Health. This was a focused inspection with emphasis on specific key lines of enquiry within the safe domain, the responsive domain and the well-led domain. Patients also complained about the no smoking policy, blanket restrictions on mobile technology and disrupted sleep owing to the practice of 15 minute observations at night for all patients in medium secure wards. Due to on going transformation work at the trust, the business case for staffing against activity had been placed on hold. Relatives were encouraged to stay with their loved ones while they were cared for on the ward and a named nurse was assigned to the patient and family. Some staff had been expected to continue to work on a month-by- month contract and long-standing well trained staff were looking for alternative roles. Although staff we spoke with told us they had received some supervisions and appraisals these were not carried out in line with the trust policy. Many services were being delivered from less than ideal locations that were not owned by the trust. This had not improved since our last inspection. This meant that the use of blanket restrictions was low and patients freedoms were proportionate to the level of risk. Treating mental health crises at home: Patient satisfaction with home nursing care. Monday to Sunday between 8:00 and 20:00 on telephone 01284 719724 or from 20:00 to 9:00 telephone 0300 123 1334. Staff supervision rates had been low over the last 12 months. Wedgwood Unit, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds IP33 2QZ. Patients were generally positive about the care and treatment they received from staff. Staff in all services were generally described as discreet, respectful, and responsive when caring for patients.