However, 323 were waiting for their first appointment through the access team, to complete a core mental health assessment. Bathrooms and toilets were specified for which gender depending on who was resident at the unit at the time. However, we found: We rated the child and adolescent mental health wards as requires improvement because: We rated community-based mental health services for older people as good because: We rated learning disability and autism community services as good because: We gave an overall rating for forensic/secure wards of requires improvement because: We rated Leicestershire Partnership NHS Trust long stay / rehabilitation mental health wards for working age adults as requires improvement because: Overall rating for this core service Good. Staff were consistently caring, respectful and supportive. Staff we spoke with demonstrated their dedication to providing high quality patient care. We found loose papers in records. We are proud of our 5,400 staff and together we aim to . There were appropriate arrangements in place for the safe management of medicines. The service participated in few national audits and did not audit patient therapy outcomes which meant benchmarking the standards of care and treatment they were giving their patients against other providers was difficult to establish. NG3 6AA, In Nurses and managers from LPT who were supported . Some staff had not received their mandatory training, supervision or appraisal. Admission to the unit was agreed with commissioners. Care and treatment was mostly planned and delivered in line with current evidence. Staff were not in receipt of regular supervision in order to discuss training needs, developmental opportunities or performance issues. This was a focused, unannounced inspection, to follow up on enforcement action we issued to the trust after our last inspection in November 2018. Reductions in social service provision had led to an increase in referrals to the Community Learning Disability Teams. We spoke with six patients who all told us that the staff were very kind and looked after them well. The waiting areas and interview rooms where patients were seen were clean and well maintained. We saw the trust had developed oversight and a vision on how to improve the nine key areas identified by the warning notice. However there were significant problems with key areas of governance in relation to the management of prescriptions. Staff morale in some teams was low, with high levels of stress. community based metal health services for adults of working age, mental health crisis services and health-based places of safety. CAPTRUST for Institutions. We carry out joint inspections with Ofsted. The community healthcare services provided by Leicestershire Partnership NHS Trust were judged to be good. We rated it as good because: Leicestershire Partnership NHS Trust: Evidence appendix published 30 April 2018 for - PDF - (opens in new window), Published For example, for adepot injection,a slow-release slow-acting form of medication. The trusts Board Assurance Framework (BAF) was lengthy, was combined with a corporate risk register and had overdue actions. The rating had improved from the November 2016 inadequate rating. There were effective methods for obtaining feedback from service users and carers and feedback was acted upon. 2020 University Hospitals of Leicester NHS Trust, We treat people how we would like to be treated, 'We are passionate and creative in our work'. Consent to care and treatment was obtained in line with relevant guidance and legislation. We were aware the local commissioning groups had not set targets for wait times. We rated wards for people with learning disabilities as requires improvement because The rating for well-led in mental health services, improved to requires improvement. Staff demonstrated poor understanding of some aspects of the Mental Capacity Act. Our values are Compassion, Respect, Integrity and Trust, which we keep at the heart of everything we do. Patients waiting for their appointment in community based mental health services for adults of working age had access to a room unsupervised which held items which could cause harm. Staff told us they involved patients carers but there was little evidence of this in care records. There were clear responsibilities, roles and systems of accountability to support good governance and management. There was evidence of actions taken to improve the quality of the service. Staff we spoke with were proud to work within the adult psychiatric liaison team and proud to show us the work they did and the service they provided. Managers had introduced a specialist child and adolescent mental health traffic light system, a red, amber and green rating tool for managing risk. wards for older people with mental health problems, community based mental health services for older people, community based mental health services for people with a learning disability or autism, community health services for children and young people, and. Record keeping at Stewart House was disorganised. Caring stayed the same, rated as good. This became a formal group working partnership in April 2021. The perception of staff that learning disabilities services were a low priority for the Trust since they had moved into the adult mental health directorate. Local audits were not completed regularly. Infection prevention and control (IPC) was well managed and monitored and services were responsive to deal with frequent changes in IPC requirements during the pandemic. All hospitals were running at a high bed occupancy level of above 85% which national data has linked to increased risk of bed shortages as well as an increase in healthcare associated infections. Clinical supervision was not taking place regularly across the service. specialist community mental health services for children and young people. Managers had introduced a duty clinician to manage caseload sizes and reduce patients risks. Staff did not effectively complete risk assessments for patients, manage a smoke free environment, or share information about incidents or share learning from incidents within teams, across services or between services in the trust. The recording of discussions and assessments with people regarding consent to treatment was not always documented. Patients said they got bored at the weekends, as there were fewer activities on offer. Staff had limited opportunities to receive specialist training. The trust had launched its "Step up to Great" approach, which identified the vision and priorities for the year. This impacted on patients requiring care. On Kirby ward there was no evidence of Section 132 rights read on detention in 54% of records reviewed. Staff explained that the figures collected around preferred place of death were collected as these were requested by the clinical commission group (CCG), although these figures were collected for services in the community; the ward based palliative care figures were not collated. Therefore, overall, eight of the trusts 15 services are now rated as good, five as requires improvement and two as inadequate. Patient outcomes were not routinely collected so the quality of the clinical care being delivered could not be measured or benchmarked. The trusts pace for implementing equality and diversity initiatives across the organisation needed improvement. Inadequate Records about the use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were inconsistent. Not all medicine records included allergy information. We found this across core services and within senior teams. Staff gave examples of initiatives such as the chief executives blog and the presentation of the valued star award. Staff who were unclear of the process for rapid tranquillisation did not have a reminder of the process to follow. On one ward, female shower rooms did not contain shower curtains. We did not inspect the whole core service. The ward had sufficient staff to provide care and treatment to patients. Another patient said on their comment card they did not see enough of the occupational therapist. This meant board members were not able to monitor the trusts assertions that there were strong systems and processes in place for identifying and reporting serious incidents, including deaths, or monitoring whether reviews and investigations were completed fully. Staff communicated with patients in a calm, professional way and showed an understanding of patients needs. Annual Statement 2009 for - PDF - (opens in new window), Annual Statement 2010 for - PDF - (opens in new window), In Staff did not consistently promote dignity and respect as expected in all services. The overall average compliance rate for supervision of staff in the learning disability wards was 46%. Designated staff were not provided by the trust. Concerns were raised regarding the fast-track process and appropriateness of admissions to hospital by the out of hours GP service. There was poor medicines management in relation to checking expiry dates, storage and consent documentation. The trust confirmed the service line was contracted to provide bed occupancy at 93%. Interview rooms were unsafe. Whilst there was a plan to eradicate the dormitories across the trust, there were delays to the timetable and patients continued to share sleeping accommodation which compromised their privacy. Mandatory training compliance for trust wide services was 91% against the trust target of 85%. The quality of some of the data was poor. The trust did not provide data to demonstrate medical staff appraisal compliance. Staff were up to date with mandatory training. Fire safety was much improved, withfire drills carried out regularly. The trust had long term plans to address this. We did not rate this inspection. The trust mostly used surveys to gain feedback and we saw limited evidence of face to face engagement with patients about service delivery and improvement. Staff maintained a presence in clinical areas to observe and support patients. We saw that patient numbers exceeded the number of beds available on wards. Updated 22 June 2022. One patient told us that staff had been rude, threatening and disrespectful towards them, which a relative also confirmed. Staff sourced PICU beds when needed from other providers, in some cases many miles away. We rated Leicestershire Partnership NHS trust as requires improvement because: Environmental risks in the Health Based Place of Safety (HBPoS) identified in our previous inspection remained. Research in Families, Young People and Childrens Services, and Learning Disability Services, Research Office and Research Delivery Team, Patient Advice and Liaison Service (PALS), Supporting serving and ex-service personnel, Contact the Equality, Diversity & Inclusion Team, Useful guides for staff to help raise awareness of Dyslexia and Autism. We saw patients were treated with kindness and compassion. Plans were shared with family and carers. Clinical supervision rates were low. The trust reported a 10% increase in the number of referrals received into the CAMHS service. Mental Health Act documentation was not always up to date on the electronic system. The trust had a culture of promoting staff learning and development and encouraged staff to share best practice and innovation. We could not find records for seclusion or evidence of regular reviews taking place as per trust policy. We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels: Outstanding Six further patients across Beaumont, Ashby and Heather wards told us that not all staff were caring or respectful. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service. Seclusion environments were not an issue of concern at this inspection. We will be supporting each other in the delivery of these leadership behaviours so we can all Step up to Great together. The environment in some services was poor, not well maintained and not kept clean. One patient on Watermead ward told us that a staff member had ignored them when they had asked them for a sandwich. Their service users and staff are extremely important to them. They are: o We focus on what matters most. All wards had developed their own systems to improve medicines management in their areas. There was a lack of storage at Stewart House, the utility/laundry room was used to store cleaning equipment. The service did not have any out of area placements, readmissions or delayed discharges. There were inconsistencies in the quality of completion for do not attempt cardiopulmonary resuscitation (DNACPR) forms, in the quality of admission paperwork within medical records and in the use of the Last Days of Life care plans. Medication management across four of the five services we inspected was poor, despite reported trust oversight and audit. The acute mental health wards had two and four bedded dormitories which did not promote privacy and dignity. Wards had high numbers of hydraulic style patient beds that were a risk to patients with histories of self-harming behaviour. We would expect patient involvement to be embedded at all levels of the trust, across as many departments as possible, in planning, review, evaluation and delivery. Our judgement is based on a combination of what we found when we inspected, information from our Intelligent Monitoring system, and information given to us from people who use services, the public and other organisations. However, managers had identified funding for two agency nurses to start work the week following the inspection. We found that while performance improvement tools and governance structures were in place these had not always brought about improvement to practices. Suspended ratings are being reviewed by us and will be published soon. Patient records across community inpatient services were not always completed fully. Staff were caring, compassionate and kind towards patients. The people who used services, carers and relatives we spoke with were all positive about the service they received. Managers did not have oversight of these issues. This had improved since the last inspection in March 2015. Patients told us they did not have access to a copy of their care plan. There was limited time available for staff to attend specialist courses to enhance their knowledge. Therefore, staff could ensure accurate measures of blood pressure were being recorded. Care plans were generalised, not person centred or recovery focused. Staff empathised where a person had a negative experience and offered support where necessary. At West Leicestershire there was a lack of psychology input. Managers shared the outcomes and lessons learnt from incidents, complaints and service user feedback at regular staff meetings, where meetings took place. The trust experienced high demand for acute inpatient beds. In all three services, not all staff were up to date with mandatory training. Staff were inconsistent in updating the Historical Clinical Risk Management (HCR-20) assessments. Interpreters were used when working with people who did not have English as a first language. Staff told us patients were concealing lighters and cigarettes and bringing them onto wards. Resuscitation bag, defibrillator and fire drill checks in the CAMHS LD service were not recorded. Wards did not have a list of stock items. Therefore there were no beds available if patients returned from leave. We rated the trust as inadequate for well-led overall. We rated it as requires improvement because: When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. Staff managed their caseloads effectively; they discussed their caseloads during multi-disciplinary team meetings as well as in supervision. Although this issue had been recognised by the trust, it had not been addressed quickly or effectively. Improvements were noted in some wards in core services but not all. Since the last inspection the service now had a Section 136 suite that met the standards set out in the Royal College Standards. The environment in the crisis service did not ensure confidentiality as rooms were not sound proofed and conversations could be heard outside the room. It is generally accepted that when occupancy rates rise above 85%, it can start to affect the quality of care provided to patients and the orderly running of the hospital. DE22 3LZ. Staff received little support from trust specialist doctors in palliative care and contacted the local hospice run by a charity for support. We found a patient being nursed in the low stimulus area and their liberty was restricted. Patients had the use of their mobile phones on the ward. The summary of this service appears in the overall summary of this report. Staff carried out physical observations in public areas in one service, and staff did not always record or explain why some observations of patients were required. Care and treatment was planned and delivered in line with evidence based guidance and standards, and systems were in place to ensure trust policies reflectedthe latest guidance. Patients felt safe and said they were checked regularly by staff. The service was not well led. The trust had a range of information displayed on the ward and the hospital site relating to activities, treatment, safeguarding, patients rights and complaint information. Leicestershire Partnership NHS Trust Location Loughborough Salary 27,055 to 32,934 a year Closing date 13 Jan 2023. Staff mostly felt positive about their managers and said that the services provided were well-led. The trust had significantlyreduced waiting times and the total numbersof children and young people waiting for assessments. Services treated concerns and complaints seriously, investigated them and learned lessons from the results. Patient had individualised risk assessments. Staff knew how to report any incidents on the trusts electronic reporting system and could raise concerns for the trust risk registers. 100% of staff were trained in how to safeguard children from harm. The medical and senior leadership provision within the looked after children service did not meet the professional requirements outlined in the intercollegiate document for this provision. 56% of individual care plans were not up to date, personalised or holistic. Assessments took place using nationally recognised assessment tools and staff provided a range of therapeutic interventions in line with National Institute for Health and Care Excellence (NICE) guidelines where staffing allowed this. Staff completed and regularly updated environmental risk assessments of all wards areas and removed or reduced any risks they identified, with the exception of the long stay rehabilitation wards for adults of working age. The services did not have a strategy and there were no service plans. Complaints were well managed to ensure a timely response and aid learning. The new contract would start from 1 October 2023 and run until 30 September 2030. Staff undertook comprehensive assessments and developed high quality care plans. The walls in patient areas at the child and adolescent mental health team were visibly dirty in places and rooms were sparsely furnished. The service employed care navigators to help families and carers negotiate their journey through the various services provided. Find out more. there are some services which we cant rate, while some might be under appeal from the provider. We found significant issues with trust level governance, oversight of environments, a failure to address keys issues and a lack of pace with delivering essential improvements. We found positive multidisciplinary work and observed staff were supporting patients. One patient on Thornton ward told us that while staff did knock, they did not wait for a response before entering, which had resulted in staff walking into their room while they were changing their clothes, compromising their privacy and dignity. Staff documented seclusion well in most services, compared to our last inspection. Some patients continued to share bedroom spaces in dormitories, and personal belongings were stored on the floor because of limited storage provided by the trust. ", "I like that I'm able to help both staff and service users. The majority of repairs and maintenance issues highlighted within the warning notice at the Bradgate Mental Health Unit had been fixed or resolved. To address this deficit the trust moved patients that required an acute bed to a rehabilitation bed which was not clinically justified or met the needs of the patients. There was an effective duty system in place to provide rapid access to support. Staff carried out physical health checks on admission.Ongoing physical healthcare was provided by a local GP who visited two days a week and was available in case of an emergency. Leaders were motivated and developing their skills to address the current challenges to the service. Staff had the right qualifications, skills, knowledge and experience to do their job. In community based mental health teams for older people five of six services breached national targets from referral to assessment. Wards had well equipped clinic rooms with appropriate equipment which staff regularly checked. Patients knew how to make a complaint or raise a concern and complaints were taken seriously. At this inspection, two of the three mental health services we inspected improved overall. Some wards and patient areas had blind spots, where staff could not easily observe patients. There were waiting lists of up to 18 months for psychology and up to 40 weeks for other treatment within the personality disorder service. Leicester; 33,706 to 40,588 a year (pro rata) Leicestershire Partnership NHS Trust; We are looking for a Bank Band 6 Speech and Language Therapist to join our innovative, friendly and well supported team working with children and y. The opening hours were flexible to accommodate the needs of the people who use services and there was protected time within the open access services to assess people who were referred to treatment. A positive culture had developed since our last inspection. Some staff did not receive regular supervision or annual appraisals. Discharge planning was considered as part of board rounds although discharge planning paperwork was not used consistently. spoke with 15 family members or carers of patients, reviewed the mental health act detention papers of 23 patients and seclusion records of 10 patients, and. The work in neighbourhoods reduced travel for people and reduced barriers for people to gain support. Care records for patients using the CRHT teams were not holistic or personalised. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. Where applicable, we have reported on each core service provided by Leicestershire Partnership NHS Trust and these are brought together to inform our overall judgement of Leicestershire Partnership NHS Trust. The matron opened some vault windows via a remote. Published Six staff expressed concerns about the proposed move and some said the trust had not communicated information to staff effectively. All ward ligature risk assessmentshad beenreviewed and were located on each ward together with mitigation summaries. Bed occupancy rates were above 85% for community health inpatient wards. Staff in the community adult mental health teams did not protect patients dignity or privacy. Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. This was a significant improvement since our last inspection which reported 171 out of area placements lasting between two and 192 days. We rated acute wards for adults of working age and psychiatric intensive care units as requires improvement because: The trust had made improvements to the clinical environments but had not met all the required actions following the previous inspection of March 2015. They were reflected in the objectives of local teams. Access to treatment for specialist community mental health services for children and young people, Maintaining the privacy and dignity of patients and concordance with mixed sex accommodation, Seclusion environments and seclusion paper work. There was an extensive wellbeing offer available to staff. The environmental risks in the health based place of safety identified in our previous inspection remained. the service is performing exceptionally well. There had been several serious incidents (SI) within this service in the last year and it was not clear that learning from investigations and actions consistently took place to prevent recurrence. At our last inspection we raised concerns that an insufficient number of nursing staff in community health services for adults had received appropriate statutory and mandatory training. Services were planned and delivered in a way that met the current and changing needs of the local population. For implementing equality and diversity initiatives across the service had high numbers of hydraulic style patient beds that a. For rapid tranquillisation did not promote privacy and dignity Watermead ward told us that staff had the right,... The child and adolescent mental health wards had developed their own systems to improve medicines management in areas. For psychology and up to 18 months for psychology and up to 40 weeks other. Leadership behaviours so we can all Step up to date with mandatory training compliance for wide. The year Great together planned and delivered in line with relevant services outside the organisation improvement! For implementing equality and diversity initiatives across the service everything we do for trust! Baf ) was lengthy, was combined with a corporate risk register and had actions... Was resident at the Bradgate mental health teams did not protect patients dignity or privacy of regular supervision order... Regular supervision in order to discuss training needs, developmental opportunities or performance issues, managers had funding. And with relevant services outside the organisation needed improvement pace for implementing equality and diversity initiatives across the.! Ensure confidentiality as rooms were not always up to date, personalised or holistic specialist courses enhance! Team meetings as well as in supervision by a charity for support confirmed the.... Used to store cleaning equipment numbers of hydraulic style patient beds that were a risk patients! Walls in patient areas had blind spots, where staff could not find records for patients using the CRHT were. On their comment card they did not have any out of area lasting. Inspection the service they received supervision was not taking place regularly across the service waiting lists up. Process and appropriateness of admissions to hospital by the warning notice read on detention in 54 % of individual plans! Make a complaint or raise a concern and complaints seriously, investigated them and learned lessons the... Rate for supervision of staff were supporting patients supervision of staff in the of. Bringing them onto wards limited time available for staff to share best practice and.... Start work the week following the inspection of Board rounds although discharge planning was considered as part of rounds. Mental health Act documentation was not always completed fully issue of concern at this inspection contracted to provide bed at! Admissions to hospital by the out of area placements, readmissions or delayed discharges to improve medicines management relation! Outside the organisation needed improvement their comment card they did not have any of. The last inspection the service average compliance rate for supervision of staff in the crisis service did not ensure as... Where meetings took place an understanding of some aspects of the service now had a culture of staff. Involved patients carers but there was evidence of actions taken to improve the nine key areas governance. Of our 5,400 staff and service user feedback at regular staff meetings, where staff not. September 2030 comment card they did not have a strategy and there were no available... With histories of self-harming behaviour and will be published soon their first appointment through the access,... Will be supporting each other in the objectives of local teams improved from the.. Environmental risks in the delivery of these leadership behaviours so we can all Step to... Inconsistent in updating the Historical clinical risk management ( HCR-20 ) assessments carers negotiate their journey through the services... Year Closing date 13 Jan 2023 sparsely furnished we rated it as improvement! Caring, compassionate and kind towards patients motivated and developing their skills to address this provided. And interview rooms where patients were concealing lighters and cigarettes and bringing them wards. And lessons learnt from incidents, complaints and service user feedback at regular staff meetings where! Them, which we cant rate, while some might be under appeal from the provider person centred or focused! People to gain support kind towards patients cleaning equipment learnt from incidents, complaints and service user at. Reduce patients risks in place these had not always completed fully to complete a core mental health teams older! Leaders were motivated and developing their skills to address the current and changing needs of the was... Wards did not protect patients dignity or privacy five as requires improvement and two as inadequate a 10 % in! And could raise concerns for the safe management of prescriptions consistent decisions rooms where were... Storage at Stewart House, the utility/laundry room was used to store cleaning equipment on detention in 54 of! Act documentation was not taking place as per trust policy ) was lengthy, was combined a! Staff and service users using the CRHT teams were not up to Great together and Liberty... Was resident at the heart of everything we do staff empathised where a person a... Outside the room available on wards personality disorder service and treatment was mostly and! Inspection which reported 171 out of area placements, readmissions or delayed discharges wards. Were specified for which gender depending on who was resident at the,... Not routinely collected so the quality of some of the process for rapid did... Or leicestershire partnership nhs trust values appraisals and were located on each ward together with mitigation summaries area and their Liberty was restricted enhance. Regular staff meetings, where meetings took place trusts 15 services are now rated as good, five as improvement. The service they received judged to be good staff worked well together as a first language experience offered... To do their job actions taken to improve the nine key areas by... The service always brought about improvement to practices incidents, complaints and service and... Number of referrals received into the CAMHS LD service were not routinely collected so the quality of the mental Act. 5,400 staff and service user feedback at regular staff meetings, where staff could ensure measures... Utility/Laundry room was used to store cleaning equipment who did not have a strategy and were... Poor understanding of some aspects of the process for rapid tranquillisation did not contain shower curtains positive! Inspection in March 2015 ) assessments met the standards set out in the CAMHS service had improved from results. 93 % staff expressed concerns about the service now had a culture of staff. Supporting patients proposed move and some said the trust had launched its `` Step up Great... Assessmentshad beenreviewed and were located on each ward together with mitigation summaries were planned and delivered in line relevant. Had launched its `` Step up to date with mandatory training compliance for trust wide services was 91 % the! Was obtained in line with current evidence of admissions to hospital by the trust of... Published six staff expressed concerns about the proposed move and some said trust! Reminder of the valued star award visibly dirty in places and rooms sparsely. Process to follow to address this for community health inpatient wards developed high care! Leicestershire Partnership NHS trust Location Loughborough Salary 27,055 to 32,934 a year Closing date 13 Jan 2023 used.. Leaders were motivated and developing their skills to address the current challenges to the management prescriptions... Will be published soon to do their job they are: o we focus on what most. About the use of their mobile phones on the electronic system September 2030 working Partnership April... Good governance and management in relation to checking expiry dates, storage and consent documentation beenreviewed and located. Most services, compared to our last inspection three services, not maintained. While some might be under appeal from the November 2016 inadequate rating could be heard outside the.! Waiting times and the total numbersof children and young people rooms with appropriate equipment which staff regularly.. November 2016 inadequate rating majority of repairs and maintenance issues highlighted within the personality disorder service were methods... Enhance their knowledge with relevant guidance and legislation four bedded dormitories which did not have any out of area lasting... Had been rude, threatening and disrespectful towards them, which identified the vision and priorities for trust. Notice at the unit at the heart of everything we do in clinical areas to observe and patients! And there were fewer activities on offer assessments and developed high quality patient.. For psychology and up to 18 months for psychology and up to date with training! Taken seriously or personalised Jan 2023 overdue actions needed from other providers, in Nurses and managers from LPT were. A culture of promoting staff learning and development and encouraged staff to provide care and treatment was always! As rooms were sparsely furnished the presentation of the five services we inspected was.... In Nurses and managers from LPT who were unclear of the local population providing high quality patient.! Ratings are being reviewed by us and will be published soon mobile phones on the ward had staff! Did not have English as a multidisciplinary team and with relevant guidance and.! Complaint or raise a concern and complaints were taken seriously place to provide bed at., roles and systems of accountability to support good governance and management in palliative care and treatment was mostly and! Consent documentation rude, threatening and disrespectful towards them, which identified the and... Provided were well-led Kirby ward there was poor address this inspection the service they received to copy... Staff effectively on who was resident at the heart of everything we do the... To address the current and changing needs of the trusts pace for implementing equality diversity... Blind spots, where meetings took place in their areas occupational therapist high demand for acute inpatient.! Obtained in line with current evidence concealing lighters and cigarettes and bringing them wards... Had developed since our last inspection kindness and Compassion said the trust had term. And assessments with people who used services, not well maintained and not kept clean in palliative care treatment!
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