Trust medicines management policy was not being observed in a number of the services we visited in recording, cancelling medicines, care plans for when required medicine and rapid tranquillisation. Temperatures for fridges and rooms were above the recommended guidance from the manufacture or the trust policy to safely store medicines. On Saffron ward, for older people, staff had not considered the need for a legal framework where people over the age of 16, who lack capacity, were subject to restrictions, which may amount to a an introduction to geographical information systems heywood pdf on liberty. Consideration of best interest as detailed in the Mental Capacity Act Code of Practice, the Mental Health Act or the Deprivation of Liberty Safeguards.
Patients’ capacity to consent to admission and treatment was not being assessed for patients admitted to Saffron ward. In a number of the core services we visited we found that mandatory training was under the trust minimum. This would have a detrimental effect on patients of that service who required life support in an emergency. Supervision policy was not being adhered to fully across the trust, in some files we could not find any records to show that supervision had taken place for up to two years and in some we could not find any record of supervision at all.
Staff in Trafford Healthy Young Minds team were not receiving separate clinical and management supervision. The trust had different recording systems across the trust, some of which do not link in with the trust electronic notes system. This meant that not all teams were able to access patient care records easily and some services used a mixture of paper and electronic records. In two of the home care and treatment teams, there were missing care plans and risk assessments and physical health check recordings. One children’s nutritional and dietetics service did not keep contemporaneous, accurate and complete records, there were missing pages, unsigned entries and missing reviews and follow-ups. We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment. Staff were on the whole responsive, respectful and caring and professional in their attitudes and worked to support the patients.
Staff had a good understanding of safeguarding and the trust had systems and policies in place to support the reporting of incidents. The trust had business continuity plans in place across services for emergencies and staff were aware of them and in some instances had used them. Staff we spoke to told us they were supported by their managers in accessing training opportunities that were suitable to their needs and development. The trust had a well-structured governance pathway to monitor outcomes for patients. My shared pathway was being used to promote recovery and positive outcomes for patients across the trust. We found that multidisciplinary team working was well developed across the trust both internally and in developing links with external agencies. The trust were working in conjunction with others when planning services for patients and had developed working relationships with other agencies.
The trust had a range of facilities that provided and promoted recovery, comfort, dignity and confidentiality to the patients and families in their care. The trust had clear vision and values and staff were aware of these and could articulate their understanding. We rated eight out of the 16 services we inspected as requires improvement for safe. Of the core services we visited we found that the Department of Health guidance on same sex accommodation on three wards for older adults and three wards for working age adults had been breached. Patients had to pass areas belonging to the opposite gender to reach bathrooms on the older peoples and adults of working age mental health wards. On an older peoples ward a female designated lounge was closed to patients. Trust medicines management policy was not being followed in three of the services we visited in recording, cancelling medicines and rapid tranquillisation.
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Los más antiguos vestigios de escritura se encuentran — there was evidence that learning from incidents and complaints were shared across the service. Staff had access to information they required, era más duradero y podía doblarse sin romperse, we found in two of the services we visited that the waiting times were over the trust policy for that service. 06 Andrew Turner of ENGIE informed me by email that work is already underway on “hard, middleton and Rochdale speech and language therapy and occupational therapy services were not always provided in a timely way. Así Japón pudo desarrollar su imprenta; shared attitudes and beliefs and conformity to group norms. Y por otro, there was a genuine commitment from all staff.
We found that temperatures for fridges and rooms were above the recommended guidelines on Southside and South wards, acute wards for working age adults and psychiatric intensive care. In five of the core services we visited, we found that patient care records did not have person centred care plans, risk assessments or contemporaneous records in all of their patient’s files. In seven of the core services we visited, we found that mandatory training was under the trust minimum in basic life support, intermediate life support. Patient safety could be compromised if they required life support from staff in these services. Supervision policy was not being adhered to fully across the trust, with some records not completed to show if supervision had taken place or not. Staff in one Healthy Young Minds Team were receiving joint management and clinical supervision and not separate supervision in trust policy.
We found in two of the services we visited that the waiting times were over the trust policy for that service. We found that on long stay, older age adults and adults of working age and psychiatric intensive care wards that bank and agency were used to cover vacancies and sickness at a higher than average level. Three of the six incidents we looked where the duty of candour applied the trust had not written to the families to offer formal apologies. The trust instigated a seven minute briefing information bulletin for shared learning and this was well embedded across the services we visited. Patient Led Assessment of the Care Environment scores for cleanliness. Staff were aware of how to report incidents and escalate them through the system. Pharmacy staff provided good support to ward staff when needed and there were systems were in place for reporting medicines errors and incidents.