• Organisation
  • SERVICE PROVIDER

Black Country Healthcare NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider
Important: We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

All Inspections

14 February 2023, 15 February 2023, 16 February 2023

During an inspection of Acute wards for adults of working age and psychiatric intensive care units

Black Country Healthcare NHS Foundation Trust was formerly called Black Country Partnership NHS Foundation Trust. It changed its name in April 2020 when it acquired the mental health services previously run by Dudley and Walsall Mental Health Partnership NHS Trust, which is now Dudley Integrated Health and Care NHS Trust.

Since the merger we have completed one inspection in November 2021. This consisted of how well led the trust was and three mental health services: acute wards for adults of working age and psychiatric intensive care units, mental health crisis services and health-based places of safety and wards for older people with mental health problems. We rated the trust overall and all three mental health services as good. In rating the trust in November 2021, we took into account previous ratings for services not inspected.

Following the inspection in November 2021 we told the trust that it must take action to bring services into line with two legal requirements. This action related to this core service was:

Wards for adults of working age and psychiatric intensive care units

The trust must ensure that all ligatures in the acute wards are removed or mitigated effectively to protect patients from self-harm. (Regulation 12) (1)(d)

We told the trust action it should take to improve:

Wards for adults of working age and psychiatric intensive units: The trust should ensure that all patients are involved in their treatment and care and receive a copy of their care plan.

The trust should consider updating the seclusion room at Macarthur Centre to make the environment more comfortable for patients in seclusion.

At this inspection we inspected one core service: Acute wards for adults of working age and psychiatric intensive care units. We inspected this service following reports of safeguarding incidents to the local authority and police which were being investigated at time of inspection.

In November 2021 we rated this core service as Good overall, requires improvement for safe and Good for effective, caring, responsive and well led.

What people who use the service say

Patients said staff were good and had supported them.

Patients told us they could make drinks and snacks when they wanted to although the kitchen on Ambleside ward was locked. Patients said that when they complained about the lack of variety of food this had improved.

Some patients did not have a copy of their care plan and one patient didn’t know they should have one. Other patients said they were not involved in their care plan. Some patients told us they did not have one to one time with their named nurse.

Patients on Dale ward at Penn hospital and patients at Bushey Fields hospital said there were a lot of activities going on. However, on other wards patients said they were bored and there was nothing to do. Patients at Hallam Street hospital said they did not often get to the resource centre for activities so did not have a chance to meet patients from other wards.

Patients told us that staff were kind, caring and interested in them, they said staff knocked on their door before entering and treated them with respect.

One patient’s relative said staff keep them updated on their family member. Another said that staff treated them and their relative with respect.

We rated this service as requires improvement at this inspection because:

The environment had not fully been adapted to ensure patients safety. However, the trust had undertaken significant work to assess ligature risks, undertake incident surveillance and provided funding to the wards where environmental risk was highest. Staff reduced the risks of blind spots by observing patients closely.

Patients said they did not always have one to one time with nurses, and leave was often cancelled. Doctors could not always attend the ward at night but were available by telephone. However, the wards had enough nurses and doctors to ensure patents were safe.

Staff did not always manage medicines safely and did not show they followed guidance from pharmacists.

The trust had not trained all staff in immediate life support.

Staff did not always develop holistic, recovery-oriented care plans informed by a comprehensive assessment.

Staff were not always able to provide a range of treatments suitable to the needs of the patients in line with national guidance about best practice. This was because there were vacancies for occupational therapists and psychologists on some wards. The ward teams did not always include or have access to the full range of specialists required to meet the needs of patients.

On Friar ward the staff did not always work well together as a multidisciplinary team or with community teams and external providers who would have a role in providing aftercare. Staff across the wards were not aware of the role of the newly formed Complex Care team within the trust.

The service did not always have a bed available locally to a person who would benefit from admission and patients were not always discharged promptly once their condition warranted this.

The governance processes did not always ensure that ward procedures ran smoothly.

However:

Staff assessed and managed risk well and minimised the use of restrictive practices.

The ward environments were clean.

Staff followed good practice with respect to safeguarding.

The trust had reduced the staff turnover rates across the wards.

Managers ensured that staff received supervision and appraisal.

Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

Staff engaged in clinical audit to evaluate the quality of care they provided.

Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

23rd to the 25th November 2021

During a routine inspection

Black Country Healthcare NHS Foundation Trust was formerly called Black Country Partnership NHS Foundation Trust. It changed its name in April 2020 when it acquired the mental health services previously run by Dudley and Walsall Mental Health Partnership NHS Trust, which is now Dudley Integrated Health and Care NHS Trust.

Ratings of services previously run by a trust acquired by another do not carry over to the new trust. This report includes ratings for the three mental health services of the newly formed trust that we inspected this time, and for mental health and community health services run by this trust under its previous name.

We have not taken into account previous ratings for mental health services formerly run by the Dudley and Walsall trust. Information about those services is available on our website pages for that trust under its new name (cqc.org.uk/ provider/RYK/reports).

Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, our usual inspection work has been curtailed by the COVID-19 pandemic, so we inspected only those services where we had cause for concern.

We inspected the overall management of the trust and three mental health services:

• Acute wards for adults of working age and psychiatric intensive care units

• Mental health crisis services and health-based places of safety

• Wards for older people with mental health problems

We rated the trust overall and all three mental health services as good. In rating the trust we took into account previous ratings for services not inspected this time. We rated the trust as good because:

  • The trust was formed in April 2020 at the start of the Covid 19 pandemic and during the implementation of the lockdown measures initiated by the Government. We noted how much time the board had invested in creating the new organisation during the Covid-19 pandemic.
  • The trust board was diverse. Non-executive directors represented different communities and the executive directors presented an effective mix of members from diverse backgrounds and with a wide range of skills and experience. A number of the non-executive directors had a NHS or local authority background which supported good discussions at trust board. The trust was highlighted by a national healthcare journal for having the highest share of black, Asian and minority ethnic very senior managers.
  • The clinical strategy identified key priority areas of focus which were linked to the trust’s vision.
  • Governance processes had been implemented and operated effectively across the organisation to ensure that performance and risk were managed well. There were clear responsibilities, roles and systems of accountability to support good governance and management. There was a positive and open culture across the trust. Staff told us they felt happy and enjoyed their work. There was good staff morale in services. Staff felt respected, supported, and valued and we heard how well the trust supported staff during the COVID-19 pandemic. Leaders modelled positive behaviours, and development of staff was encouraged. There was an extensive wellbeing offer available to staff, including the wellbeing hub offering mental health support, flexible working, and aids on keeping well.
  • There had been good engagement with external stakeholders. The trust had key roles in the development of the local health and social care system working and collaborated with care providers to improve mental health services. The trust engaged with local people who used services in the design of new buildings.
  • The trust had developed a triumvirate management structure across its divisions that was supporting the development and focus on local services. Whilst their structure was new there was good work in developing local governance around quality and safety. A triumvirate approach brings together three managers, including operational, clinical, and managerial, to support change to local areas.
  • The trust had made firm commitments to equality and inclusions. The Cultural Ambassadors programme collected equality data that fed into the trusts plans for equality and inclusions. The staff networks for black and ethnic minorities, disability, and LGBTQ+ were actively supported and had been awarded the Disability Confident Award.
  • Infection prevention and control (IPC) was well managed and monitored. Services were responsive and dealt with frequent changes in IPC requirements during the pandemic.
  • Staff completed and regularly updated environmental risk assessments of all wards areas and removed or reduced the majority of the risks they identified, an exception being in the wards for older people with mental health problems. Staff followed procedures to minimise risks where they could not easily observe patients.
  • Patient involvement in planning care was now in place and the voice of the patient in changes to services had been considered.
  • Patients we spoke to in mental health wards for adults said that staff treated them with respect and dignity. Key workers and occupational therapists were highly praised. Relatives were similar in praise to staff in older people’s wards and thought their family received good care. Relatives and carers understood the need for tighter restrictions during the pandemic. However, the need for improvements were highlighted in the following areas; to be provided with more information about medication and treatment, communication between wards and carers could be improved, and access to care and support slowed the process of discharge.
  • There was a good working relationship between the Mental Health Act (MHA) administration team and the wards, community teams and the executive team. This had continued during the pandemic. The MHA team provided regular reports to the executive team to provide assurance that the MHA was appropriately applied within the trust.
  • Services treated concerns and complaints seriously, investigated them and learned lessons from the results. Managers shared the outcome of complaints with their ward teams.
  • The trust board, heads of departments and senior leaders had access to the information they needed to manage risk, issues and performance across the trust. Staff had easy access to clinical information and were maintaining good quality clinical records.

However:

  • In two of the core services inspected, the environment had not been well maintained. These were across mental health wards for adults of working age and for older people. Maintenance teams had not undertaken repairs in a timely way. However, all areas used by patients were clean. Some patients continued to share bedroom spaces in dormitories. However the trust had clear and timely plans to eliminate dormitories.
  • There were not always sufficient alarms for staff working in the wards for older people. This meant staff could not get help quickly if there was an emergency.
  • The seclusion room at the Macarthur Centre psychiatric intensive care unit was poorly furnished and the toilet and washing facilities needed updating. It did not meet the requirement of the Code of Practice
  • Patients on the acute wards for adults of working age did not have sufficient access to psychology services.

How we carried out the inspection

During the inspection, our inspection teams carried out the following activities across 11 wards in the three core services inspected:

• reviewed 49 care records

• reviewed 44 medication records

• interviewed 52 staff and 10 managers

• interviewed 14 patients

• spoke with 13 family members or carers of patients

• checked 14 clinic rooms

• attended 7 meetings

During our well-led inspection, we spoke with 50 senior leaders of the organisation and looked at a range of policies, procedures and other governance documents relating to the running of the trust.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

Patients we talked to that used the wards for adults of working age told us that they were cared for in a dignified and caring manner. They told us that staff treated them with respect and tried to include them in their care where possible. Patients spoke highly of their key workers and occupational therapists on the wards. Some patients told us that they were not given enough information about their medication or treatment, and some patients were not given a copy of their care plan.

Relatives and carers of people who had used the wards for older adult felt that their loved one was receiving good care from the hospital. They said that nurses should have more help and that they earned every penny.

Most of the carers we spoke to stated that communication was a particular problem between the ward and relatives and carers. Access to follow on care and support appeared to slow down patient’s discharge.

Relatives and carers said although Covid restrictions on the wards felt quite tight it appeared to have prevented Covid in the hospitals.

Due to concerns about the pandemic and possibility of cross infection inspectors were not able to accompany staff on community visits and therefore were unable to speak to patients who were been looked after by the crisis teams.

29th and 30th June 2021

During an inspection of Acute wards for adults of working age and psychiatric intensive care units

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of the services

We received a number of notifications relating to the acute inpatient mental health services for adults. These related to the quality of care, staff attitudes and engagement with patients.

Due to the nature of the notifications we decided to visit two locations within the service. These were Hallam Street Hospital and Bushey Fields Hospital. Whilst there we visited 5 wards. The wards we visited were Abbey, Friar and Charlemont wards at Hallam Street Hospital and Wrekin and Clee wards at Bushey Fields Hospital

We did not rate this service at this inspection. The previous rating of requires improvement remains

Staff had completed and regularly updated risk assessments of all wards areas. however the trust had not removed or reduced any risks they identified. The trust used regular bank and agency staff to fill shortfalls in staffing. Staff had not completed risk assessments for each patient on admission / arrival, using a recognised tool. When staff had completed a risk assessment, they had not always reviewed this regularly, including after any incident. Risk assessments were not always completed in the electronic record. Patient notes were not comprehensive. All full time staff could access information easily but bank and agency staff were unable to access the electronic patient record. Staff had not always completed a comprehensive mental health assessment of each patient on admission or soon after. We found examples where mental health risk assessments had been used from previous admissions. Patients had not had their physical health assessed soon after admission and regularly reviewed during their time on the ward. Staff had not always developed comprehensive care plans for each patient that met their mental and physical health needs. Care plans were not always personalised, holistic and recovery-orientated. Staff had not always explained to each patient their rights under the Mental Health Act in a way that they could understand. Informal patients had had restrictions applied to them preventing them from leaving the wards unsupervised. Staff did not always support patients to understand and manage their own care treatment or condition. Patients said there was a difference in the support that they received from the day staff and the night staff. Patients said that night staff were not as caring as day staff and did not offer the same level of support. Staff did not always understand and respect the individual needs of each patient. Staff did not always involve patients or give them access to their care planning and risk assessments. Some staff told us that they were less sure of the organisations visions and values since the trust merged twelve months ago. Governance processes did not always operate effectively at team level and performance and risk were not always managed well. The introduction of the electronic recording system had been problematic. Staff did not collect or analyze data about outcomes and performance in all areas.

We had significant concerns about the care and safety of people using the service and wrote to trust under section 31 Health and Care Act 2014. We asked the trust to provide an action plan detailing how they had addressed each of the concerns identified or how they planned to address immediately. The trust responded with a robust action plan detailing action they had and were taking to deal with all of the concerns we had identified.

How we carried out the inspection

During the inspection we undertook five ward tours and clinic checks, we also looked at communal dining and therapy areas.

We spoke with nine patients and five carers to discuss their experiences.

We interviewed two service managers, a discharge coordinator, four ward managers, a modern matron, seven qualified nurses, seven health care assistants, two doctors, one occupational therapist, two student nurses, a house keeper and a ward administrator.

We attended one ward review. We also reviewed 9 sets of patients notes, incident forms from across all five wards, ligature risk assessments from both locations, audit paperwork and assorted policy documents.

Tuesday 26/11/2019 to 28/11/2019

During an inspection of Community-based mental health services for adults of working age

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding. Though the service received a large number of referrals, the number of patients waiting for an appointment for longer than trust set-targets of 18 weeks was low.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. Care plans and sessions had been developed specifically to engage individuals. Thought had been given to patients’ interests and past experience to develop sessions and identify placements where they could use their skills. Patients told us that this reduced anxiety and made them feel like they were fully involved and, in some cases, having a positive influence at their placements.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude patients who would have benefitted from care.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Tuesday 26/11/2019 to 28/11/2019

During an inspection of Specialist community mental health services for children and young people

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. Clinical premises where patients were seen were now safe and clean. Previous problems with storage of medicines had been solved. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff now developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit and benchmarking to evaluate the quality of care they provided. Staff at Sandwell CAMHS participated in a multi-agency thematic inspection to audit how well local agencies worked together in an area to protect children.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Patients and carers we spoke with said they actively involved them in care decisions.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • The service was now well led and had put effective governance processes in place to ensure that procedures relating to the work of the service ran smoothly.

Tuesday 26/11/2019 to 28/11/2019

During an inspection of Acute wards for adults of working age and psychiatric intensive care units

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Acute wards at Hallam Street were based over two levels, they had blind spots and ligature risks. Ligature risk assessments were complete for each ward and identified each risk with mitigation. Staff completed enhanced observations to manage risks but said the environments were challenging when trying to support acutely unwell patients.
  • Supervision rates were low for two of the wards between 20% and 50%. The trust recording systems for clinical supervision were not reliable. Managers told us there were delays with the system updating information they provided around supervision and training.
  • staff used restrictive and controlling behaviours towards informal patients wanting to go off the wards for short periods.
  • There was inconsistent leadership support for staff on two wards due to ward manager vacancies and changes within management.
  • Staff did not always record fridge and room temperatures, or act to manage temperatures that had exceeded or were not within the recommended temperature range. We found gaps in the cleaning records on two wards where staff had not recorded dates when the clinic rooms were cleaned.

However,

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

Tuesday 26/11/2019 to 28/11/2019

During an inspection of Specialist eating disorders service

We rated it as good because:

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was sufficient for staff to give each patient the time they needed. Staff managed referrals to the service well and ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers if appropriate. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions as appropriate.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait long to start treatment. The criteria for referral to the service did not exclude people who would have benefitted from care.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Tuesday 26/11/2019 to 28/11/2019

During an inspection looking at part of the service

Our rating of the trust improved. We rated it as good because:

09 July to 30 August 2018

During a routine inspection

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

Our rating of the trust went down. We rated it as requires improvement because:

  • Not all trust properties were clean, well-furnished and fit for the purposes of modern mental health care services. Not all staff always followed infection control procedures. Staff at Pond Lane had poor working conditions. They worked in an untidy, unclean environment with no ambient temperature control.
  • Staff were not consistent in following best practice in the use of restrictive practices. Staff on Dale Ward carried out blanket searches which were not in line with the trust policy. Patients on the psychiatric intensive care unit were only able to smoke at set times.
  • Staff did not manage medicines consistently well in two services. They did not store or keep them at the correct temperatures.
  • Staff in some services did not follow good practice in the development and use of care plans. They did not review care plans regularly and some care plans in wards for people with learning disabilities or autism, did not pay sufficient regard to the monitor of physical healthcare needs of patients relating to diet and weight gain.
  • Not all staff across services received regular managerial and clinical supervision or had an identified clinical supervision supervisor.
  • We found issues of staff knowledge in the Mental Capacity Act and Gillick Competence in some services. Staff working with children and young people in the Early Intervention Service did not have a clear understanding of Gillick Competence or understand where and why this would be applied.
  • In parts of the trust, clinical staff had to use three different electronic recording systems – together with keeping paper notes. This meant that notes were cumbersome and difficult to navigate for people who do not work regularly in the service. However, staff we spoke with were always able to find the information we requested. The trust had plans to implement an electronic patient records system.
  • We did not find evidence of a robust recruitment process for all executive directors. When the planned TCT merger ended the trust found itself without a substantive leadership team and with support from NHSI interim appointments were made from amongst senior managers within the trust.
  • The governance systems from ward to board were not sufficiently strong to have identified and rectified a number of risks. These included environmental risk assessments which were not always location specific, actions on the risk register that had not been taken and the problems with information governance. We concluded that this was a legacy of the aborted merger. During the period when work was under way to createTransforming Care Together, governance was led by the acquiring trust. When plans to merge ended, this left Black Country Partnership Foundation NHS Trust without a substantive governance lead to direct and develop new systems. The trust had since taken action to strengthen their governance structure by making a senior appointment to lead governance and improve its systems.
  • The trust used root cause analysis approach to review serious untoward incidents and mortality lacked consistent challenge at the executive level before reports were signed off. The trust had action plans in place to address this issue.
  • The role of Freedom to Speak Up Guardian was held by a trust board member and that could lead to a conflict of interest for the post holder. This had been reviewed and new plans were in place to seek an external solution.

However:

  • We concluded that the trust board was re-establishing its control of performance following the aborted merger. The trust board operated collaboratively, that meant executives and non-executive directors shared responsibility and liability for decision-making. Apart from the lapses we identified on this inspection, the board had a reasonable understanding of performance, which appropriately covered and combined people’s views with information on quality, operations, and finances.
  • The trust board were visible across the trust. We observed meetings chaired by the chief executive and heard from staff that they knew who the leaders of the trust were.
  • The trust’s vision and values pre-dated the previous plans to merge. The trust planned to refresh them with staff engagement. Staff had an understanding of the vision and values in relation to local services.
  • The trust had an equality strategy in place which they were refreshing in collaboration with patients and staff for collaborative ownership and effectiveness.
  • The trust communicated well with patients, carers, staff and stakeholders. The majority of staff groups felt they knew what was happening in the organisation. Families and carers described a varied experience of communication with staff in the trust but were praising of the support they received from the carers team.
  • The trust strived to improve quality and innovation, for example, the epilepsy improvement group to ensure that all inpatients with epilepsy had a care plan to manage the condition with standard documentation across all learning disability units.
  • The trust were proactive in attempts to employ people across many of the core services but recruitment of staff remained a challenge.
  • The trust recognised its staff in a number of ways, through a simple thank you to formal awards.
  • There was a culture of learning and research across the trust.

09 July to 30 August 2018

During an inspection of Wards for older people with mental health problems

  • The environments were clean and tidy. The ward layout meant staff did not find a good line of sight and there were ligature risks on all wards, staff mitigated these risks with good observation practice.
  • Risk assessments were completed and updated when risks changed.
  • Staff reported incidents using the trust’s database. Lessons learnt were used to make improvements to services.
  • Multi-disciplinary teams worked for the good of the patient. We saw the involvement of inpatient and community
  • teams as well as other local hospitals working together to provide good care.
  • Patients had access to a range of therapies provided by a range of staff employed by the trust.
  • Staff cared for patients with respect and compassion. Their interactions with patients showed their understanding of the patient group and their needs. Patients and carers gave positive feedback about the staff and the wards. They gave feedback on the service.
  • Staff involved patients in the planning of their care they involved carers and relatives if appropriate to support with care planning.
  • Staff assessed and monitored patients’ physical health throughout their admission. Patients had access to professionals specialising in aspects of physical care such as podiatrist.
  • There was a range of rooms available for patient use for activities and access to a garden at both sites. Patients also used the facilities at the Lighthouse at Edward Street Hospital.
  • Ward managers were always visible on the wards, staff said they were passionate, knowledgeable and supportive of the staff.
  • All managers promoted a positive culture throughout the service, staff felt valued and appreciated by them.

09 July to 30 August 2018

During an inspection of Community mental health services with learning disabilities or autism

Our rating of this service stayed the same. We rated it as good because:

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • The teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with services outside the organisation. Patients were able to see a psychiatrist in a timely manner and were seen urgently if required.
  • Staff ensured that patients received any necessary assessment of their physical and mental health needs and provided a range of care and treatment interventions suitable for the patient group. Staff in the promoting access to main stream health services team (PAMHS) were proactive in ensuring that patients’ physical healthcare needs were being met and supported patients to live healthier lives.
  • Staff used the Mental Capacity Act appropriately to determine if a patient had the capacity to make a specific decision. Staff gave patients every possible assistance to ensure they had the capacity to consent to treatment before they assumed that the patient lacked the mental capacity to make this decision.
  • Staff attitudes and behaviours when interacting with patients showed that they were respectful and responsive. Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. Staff informed and involved families and carers appropriately and provided them with support when needed.
  • All information provided was in a form accessible to the patient group. Staff provided patients with easy-read documentation to understand their treatment. Staff knew how to access interpreters for patients who required this service.
  • Patient’s received responsive care from the service. The teams followed up with patients who did not attend appointments and supported them to attend in the future. Patients knew how to complain or raise concerns, and staff knew how to handle complaints appropriately.
  • Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed, were visible in the service and staff found them approachable. Staff knew and understood the trust’s vision and values. Staff felt respected, supported and valued. Staff spoke highly of the service manager. Staff felt positive and proud about working for the trust and their team.
  • The provider had a comprehensive schedule of meetings and reporting systems to ensure good governance of the service. Staff had access to up to date information about the work of the services they used. Staff participated in benchmarking and quality improvement initiatives and had opportunities to participate in research.

However:

  • Staffing levels could not be increased to accommodate an increase in caseload or acuity of the patient group. This meant that some staff were managing high caseloads. Staff caseloads were not formally reviewed and the service did not use a caseload management tool.
  • More than half of the records reviewed did not contain a holistic, person-centred care plan that demonstrated the patient’s goals, treatment aims or detailed involvement across the multidisciplinary team. Patients were not routinely offered a copy of their care plan.
  • Staff were not fully documenting when a best interests meeting had taken place for a patient who lacked capacity to make a decision.
  • Staff did not routinely inform people using the service how they could access independent advocacy.
  • Some patients referred to speech and language or physiotherapy were waiting longer than expected to receive an assessment.

09 July to 30 August 2018

During an inspection of Mental health crisis services and health-based places of safety

Our rating of this service stayed the same. We rated it as good because:

  • There were high levels of experienced staff who had undertaken a complete mandatory training programme. Regular monthly meetings ensured that staff received feedback after serious incidents and were kept up to date about improvements to the service. Care records were up to date and contained holistic and individualised information relating to care.
  • All records we checked contained comprehensive assessments including an assessment of physical health. Staff followed best practice guidance issued by national organisations such as the National Institute for Health and Care Excellence. There was a full range of mental health disciplines available to patients across the service. Staff had good knowledge of the Mental Health Act and Mental Capacity Act and how they were relevant to their service users.
  • We observed care being delivered by staff who were professional and knew their patient’s needs. They were able to tailor care delivery to the specific needs of the individuals and were aware of a wide range of impact factors such as history, culture, gender and individual ability. Where possible patients were involved in the development of their own care. Where appropriate families and carers were also involved.
  • All services we inspected were compliant with targets set by the trust in relation to referral to treatment times. The crisis and liaison services could respond quickly to urgent referrals. Information about this service and local services to support patients was available in a range of languages. Patients we spoke to were aware of how to make a complaint and felt that they would be comfortable to do so if they needed to.
  • Staff understood their roles and how they related to the trusts core values. Managers were visible and well respected. Staff felt well respected and valued by the trust. All staff we interviewed stated that they were proud of the work that they did and felt that the trust supported their development.

However

  • Some of the environments we inspected presented risks. The electronic and paper recording systems were cumbersome and difficult to navigate.
  • There had been some issues with communication with teams outside of the trust.
  • The liaison team had lost its specialist interview rooms at the local hospital where they were based. This meant that they were conducting interviews and assessments in rooms more suited to physical health care delivery.

09 July to 30 August 2018

During an inspection of Acute wards for adults of working age and psychiatric intensive care units

Our rating of this service went down. We rated it as requires improvement because:

  • The ward environments at Hallam Street Hospital were not always clean and staff did not always follow infection control procedures. The wards had numerous blind spots and ligature risks, the wards were over two floors which meant staff used increased patient observation levels. Staff told us they were challenging environments to manage acutely unwell patients.
  • Staff did not always ensure that emergency equipment was in kept order. On two wards we found that the emergency equipment bag was not in order and staff did not document that medical equipment was routinely maintained and cleaned.
  • Staff did always follow safe medicine management procedures. Staff were unsure of the procedures to follow when the temperature of the clinical rooms were above recommended range.
  • One door on the psychiatric intensive care unit was not anti barricade, which meant that patients could barricade themselves in the room. Following an incident this room was no longer used by patients.
  • Staff on Dale Ward carried out searches on all patients; regardless of the level of risk. This blanket approach to searching patients was not in line with trust policy.
  • Staff mandatory training compliance did not always meet the trust target of 85%. Information governance and fire safety training compliance levels were below 75%.
  • Staff did not assess patients’ mental capacity in line with the Mental Capacity Act. We saw evidence that Mental Capacity Act documentation was not completed appropriately and that patients’ assessments were not decision specific.
  • Not all staff had regular clinical supervision and one third of staff on the psychiatric intensive care unit did not have an identified clinical supervisor.

However:

  • The ward environments at Penn Hospital and Macarthur Unit were clean and well maintained.
  • The wards complied with guidance on mixed-sex accommodation and had areas specifically for male and female patients.
  • Staff completed a risk assessment for every patient on admission and updated these as needs changed or incidents occurred. We saw evidence for this in the 31 care and treatment records we reviewed.
  • Patients had appropriate access to physical healthcare. Nursing staff and doctors monitored patients’ physical health throughout admission.
  • Staff attitudes and behaviours showed that they treated patients with dignity and respect.
  • Staff were supported to take care of well-being whilst at work. The trust recognised staff and volunteers’ success within the service through annual achievement awards.

09 July to 30 August 2018

During an inspection of Wards for people with a learning disability or autism

Our rating of this service stayed the same. We rated it as good because:

  • All wards had detailed risk assessments and used these to keep patients safe. Ligature risks were managed well by staff who used detailed plans to manage patients care. Rooms were clean and well maintained and the clinic room was fully equipped to meet the needs of patients.
  • Staff managed medication well. They had good support from the pharmacists and ensured medication was administered in a safe way to patients.
  • Staff used national guidance including that set out by the National Institute for Health and Care Excellence to provide care for patients. Staff ensured care plans had been completed with input from patients and had updated them on a regular basis as patient needs changed.
  • Staff treated patients with compassion and patients we spoke to said that staff looked after them and helped them Staff ensured patients had good access to advocacy. They made referrals or encouraged patients to refer themselves where possible.
  • Patients always had their own bed to return to following a period of leave. Managers kept beds open for patients during the transition phase to new placements to ensure this was a smooth process for patients.
  • Patients had access to an excellent range of easy read materials. We saw these were completed in both pictures and written language depending on the needs of each individual patient. Medication leaflets had a photograph of the medication box and medicines to support patients to understand what they had been prescribed and why.
  • Staff felt supported in their roles. Staff reported that managers and senior staff at a local level were supportive and approachable. Managers used a dashboard to monitor staff performance including mandatory training and supervision.

However:

  • Levels of clinical supervision for staff were low for qualified staff and healthcare assistants at Penrose House and for qualified staff at Daisy Bank due to staff sickness and there was no one available to provide this.
  • Staff stored old copies of care plans and reports in patient files at Penrose House which made the files cumbersome and difficult to navigate.
  • The activity programmes at Penrose House and Daisy Bank were limited and staff needed to ensure these were taking place.
  • The wards did not complete audits of the Mental Capacity Act and actions in the Mental Health Act audits had not been completed. Staff had completed paperwork appropriately and this had not directly impacted on patients but had the potential to do so if not improved.
  • Daisy Bank and Penrose House had delayed discharges at the time of the inspection. These were due to issues outside of their control such as suitable placements not being available for patients with complex needs. We saw that staff did what they could to keep the process moving for patients. As part of the Transforming Care Programme, overseen by NHS England, Daisy Bank closed post-inspection that meant they had no delayed discharges.
  • Daisy Bank had not had permanent leadership over a period of 18 months and this had impacted on morale of the staff and patient care however the trust made the decision to close this ward in September 2018.

09 July to 30 August 2018

During an inspection of Specialist community mental health services for children and young people

  • There were concerns regarding the environment at Pond Lane and Edward Street. Staff within the Early Intervention Service at Pond Lane worked in an untidy and unclean environment. There were concerns around infection control and medication storage temperatures at Pond Lane.
  • Environmental risk assessments were not completed for all sites. Where actions were identified within completed risk assessments, these were not always completed to ensure office areas were clean, safe and tidy environments to enable staff to carry out their duties safely.
  • Staff did not adhere to their own policy on medicine storage. Medicines were not stored at an appropriate temperature at Pond Lane and staff did not take appropriate action when these exceed specified ranges.
  • Staff within the Early Intervention Service did not have a clear understanding of Gillick competence and understand when and why this would be applied. This could have led to competent young people not being appropriately involved in their care.
  • The service did not ensure actions identified on the risk register were completed. Actions identified where signed as completed when they had not been.

However:

  • Child and Adolescent Mental Health Services and Crisis and Home Treatment teams had suitable premises to see young people. Environments had been decorated with children and young people at the centre. Staff had used their knowledge of young people and feedback from people using the service to create a suitable therapeutic environment.
  • Staff managed medication well. They had good support from the pharmacists and ensured medication was administered in a safe way to young people.
  • Staff provided care and treatment based on national guidance and care pathways were in line with the recommendations of the National Institute for Health and Care Excellence. Staff followed guidelines for a range of issues including best practice in administration of medication, psychological, family and behavioural therapies and interventions in mental health conditions.
  • Staff across the service treated young people with respect, care and compassion. Young people and their families spoke positively about the care and treatment from staff and the service.
  • Staff had good relationships and worked well with each other to achieve good outcomes for young people. Managers and senior staff at a local level were visible, supportive and approachable.

10th March 2018

During an inspection of Wards for people with a learning disability or autism

  • We found that the service provided good care and support to patients. Where there had been errors or areas of poor practice these had been addressed and action plans put in place to ensure these would not happen again.

  • All staff had received Managing Actual and Potential Physical Aggression training and understood the need to use de-escalation techniques with patients. Restraint was used as a last resort to ensure patients and staff did not come to harm. Staff had guidance on how to use this through the patient’s person centred physical intervention plans, which were detailed, and person centred.

  • Staffing levels were good and managers could adjust this to meet the needs of patients. This meant the unit used bank and agency staff when patients needed additional observations or support. Where possible this involved using people who had previous knowledge of the unit.

  • Staff ensured each patient had individualised care plans, which reflected the patients likes, dislikes and preferred activities. Patients had a structured programme of daily activities both on the ward and in the community.

  • Staff felt well supported by managers who had a visible presence on the unit. Managers knew patients and had a good understanding of their individual needs.

    However:

  • There had been issues where staff did not engage with patients in a positive way and used strategies to manage patient behaviour, which was not good practice. The trust acted quickly to stop this and prevent it happening again in the future

17 to 19 October 2016

During an inspection of Wards for people with a learning disability or autism

We rated wards for people with a learning disability and autism as good because:

  • During this most recent inspection, we found that the services had addressed the issues that had caused us to rate wards for people with a learning disability and autism as requires improvement under the safe domain following the November 2015 inspection.

  • We saw many improvements to the services since our inspection in November 2015. On all of the wards we looked at ligature points were risk assessed and where identified were adequately mitigated. Staff were made aware of both the ligature risk assessment and the mitigation plan for each ward.

  • Emergency bags and ligature cutters were easily accessible to all staff.

However

  • Safe food storage was not practiced on all of the wards that we inspected.

17-20 October 2016

During an inspection of Community health services for children, young people and families

We rated the service as good overall because:

The caseloads of health visitors were being monitored and managed well. Action was taken to ensure health visitor’s caseloads were manageable, in line with national guidance. Staffing levels in health visiting had improved since our last inspection. The caseload of the Family Inclusion Team had been reduced by transferring the care of some families to other members of the health visiting team.

The equipment provided for children used at home was being maintained in line with manufacturer’s maintenance requirements.

Improvements had been made to record keeping including the use of tracer cards when notes were transferred to another service.

Staff were ensuring children were safe by notifying the safeguarding team of any concerns using the trust’s incident reporting system.

Assessment and care planning was based on evidence-based guidance

There was a clear approach to monitoring, auditing and benchmarking the quality of children’s’ services and the outcomes for people receiving care and treatment.

Staff had the skills, knowledge and experience to deliver effective care and treatment

Staff worked with other agencies in multi disciplinary teams to ensure the care children received was well co-ordinated.

Staff provided age appropriate care. They took time to interact with children and young people and their families and took account of children’s individual physical, emotional and social needs.

Staff recognised when children and families needed additional support. Staff helped families to understand the treatment provided and enabled them to make decisions around the care they received. Families were involved in planning care and treatment and could access interpreters and other support when required.

The clinical commissioning group (CCG) were developing a strategy to meet the needs of local families. Clinicians and managers from the children and family service were actively working with the CCG to develop services.

The service worked with social services and education providers to meet the needs of Children and Young People in the area, particularly children with complex needs, life-limiting conditions and disabilities.

Children waited longer than the trust’s target of 8 weeks from referral to treatment target but met the national waiting time standards for providing timely access to initial assessment, diagnosis and treatment

Health visiting services were meeting the targets for child development checks

Issues identified at the last inspection which required improvement had been addressed by managers in the trust.

There were good governance arrangements in place which meant incidents, audits, national guidelines and risks were discussed and the appropriate actions were taken.

The performance of the service was managed and action was taken to improve performance

Leaders had the capacity, capability, and experience to lead effectively

However,

The trust was not achieving targets for level 2 and 3 safeguarding training The proportion of staff who had completed the training had fallen since our last inspection from 88.2 % for level 2 and 93.3% for level 3 to 82% and 79% respectively. This meant 34 of eligible staff had not completed level 2 training and 31 staff had not completed level 3.

Children were referred to other teams within the trust but there were no shared records. Each service kept their own information about a child’s needs. Information was held in paper records. An IT system which supported information sharing was not in place and the service could not share information with GPs.

Not all services were accessible at one location for example speech therapy was not provided at the Sunflower Centre where other therapy services and the Children’s Assessment Unit was based.

The pathway for the Family Inclusion Team and the access thresholds was not clear and there was a risk that some families in need might not receive the level of service they required.

The Board did not have a designated executive lead for children. A non executive lead had been identified.

A strategy was being developed with the local Clinical Commissioning group but this was not yet in place.

Senior leaders were not visible to all staff.

The trust used a system of restorative supervision but the role of this form of supervision was not clear within the trust’s supervision policy. Restorative supervision was provided in addition to routine supervision for staff the trust believed needed additional support.

17 October 2016

During an inspection of Forensic inpatient or secure wards

We have rated forensic inpatient/secure ward as good overall because:

  • Following our inspection in November 2015 we rated the service as ‘good’ for Effective, Caring, Responsive and Well led. Since that inspection, we have received no information that would cause us to re-inspect these key questions or change the ratings.

However:

  • Our rating of the safe key question remains requires improvement. This was because following our inspection of this service in November 2015, we asked the trust to ensure that training was provided to increase staff awareness of the Mental Health Act code of practice. During our inspection in October 2016, we found that less than 60% of qualified and unqualified staff had received this training. This was below the NHS national training standards and the trust's training compliance target.

17-20 October 2016

During an inspection of Specialist community mental health services for children and young people

We rated the service as good overall because:

The caseloads of health visitors was being monitored and managed well. Action was taken to ensure health visitor’s caseloads were manageable, in line with national guidance. Staffing levels in health visiting had improved since our last inspection. The caseload of the Family Inclusion Team had been reduced by transferring the care of some families to other members of the health visiting team.

The equipment provided for children used at home was being maintained in line with manufacturer’s maintenance requirements.

Improvements had been made to record keeping including the use of tracer cards when notes were transferred to another service.

Staff were ensuring children were safe by notifying the safeguarding team of any concerns using the trust’s incident reporting system.

Assessment and care planning was based on evidence-based guidance

There was a clear approach to monitoring, auditing and benchmarking the quality of children’s’ services and the outcomes for people receiving care and treatment.

Staff had the skills, knowledge and experience to deliver effective care and treatment

Staff worked with other agencies in multi disciplinary teams to ensure the care children received was well co-ordinated.

Staff provided age appropriate care. They took time to interact with children and young people and their families and took account of children’s individual physical, emotional and social needs.

Staff recognised when children and families needed additional support. Staff helped families to understand the treatment provided and enabled them to make decisions around the care they received. Families were involved in planning care and treatment and could access interpreters and other support when required.

The clinical commissioning group (CCG) were developing a strategy to meet the needs of local families. Clinicians and managers from the children and family service were actively working with the CCG to develop services.

The service worked with social services and education providers to meet the needs of Children and Young People in the area, particularly children with complex needs, life-limiting conditions and disabilities.

Children waited longer than the trust’s target of 8 weeks from referral to treatment target but met the national waiting time standards for providing timely access to initial assessment, diagnosis and treatment

Health visiting services were meeting the targets for child development checks

Issues identified at the last inspection which required improvement had been addressed by managers in the trust.

There were good governance arrangements in place which meant incidents, audits, national guidelines and risks were discussed and the appropriate actions were taken.

The performance of the service was managed and action was taken to improve performance

Leaders had the capacity, capability, and experience to lead effectively

However,

The trust was not achieving targets for level 2 and 3 safeguarding training The proportion of staff who had completed the training had fallen since our last inspection from 88.2 % for level 2 and 93.3% for level 3 to 82% and 79% respectively. This meant 34 of eligible staff had not completed level 2 training and 31 staff had not completed level 3.

Children were referred to other teams within the trust but there were no shared records. Each service kept their own information about a child’s needs. Information was held in paper records. An IT system which supported information sharing was not in place and the service could not share information with GPs.

Not all services were accessible at one location for example speech therapy was not provided at the Sunflower Centre where other therapy services and the Children’s Assessment Unit was based.

The pathway for the Family Inclusion Team and the access thresholds was not clear and there was a risk that some families in need might not receive the level of service they required.

The Board did not have a designated executive lead for children. A non executive lead had been identified.

A strategy was being developed with the local Clinical Commissioning group but this was not yet in place.

Senior leaders were not visible to all staff.

The trust used a system of restorative supervision but the role of this form of supervision was not clear within the trust’s supervision policy. Restorative supervision was provided in addition to routine supervision for staff the trust believed needed additional support.

17 – 19 October 2016

During a routine inspection

We have changed the overall rating for the Black Country Partnership NHS Foundation Trust from requires improvement to good because:

  • We were impressed by the trusts response to the CQC inspection report that was published in April 2016. The trust had remained open and transparent regarding their action plan to meet the requirement notices from the inspection of November 2015.
  • We found the quality and consistency of risk assessments and care plans had improved and that physical healthcare was embedded across the trust. We saw the trust was effectively engaged with patients, carers and staff.
  • The trust had improved staffing levels and reduced vacancies in the health visiting team and acute wards for adults of working age. The trust had also introduced and embedded modern matrons across services and staff we spoke with talked of the positive impact they had made.
  • We saw the trust continued to go above and beyond in some of their services to meet patient and carer needs. We were impressed by feedback about the carers group and the work they had undertook to support more than 600 families of people living in Sandwell who have mental health problems.
  • The trust can continue to be proud of the caring nature of staff and teams working with people. Consistently across the trust, people were treated with respect and dignity. We noted this, particularly in, community mental health teams for adults of working age, and specialist community mental health teams for children and young people, where we rated the caring domain as outstanding.

However:

  • We found that electronic patient care records were not embedded across the trust and there was variation of how records were kept.
  • Although there was a plan for implementing Mental Health Act training across the trust, the take up of training remained variable since the inspection of November 2015. Some policies related to the Mental Health Act were out of date although this issue was remedied immediately by the trust when we brought it to their attention.

We will continue to work with the trust to agree an action plan to assist them in improving the standards of care and treatment.

17-19 October 2016

During an inspection of Specialist community mental health services for children and young people

We have changed the rating for community mental health services for children and young people from requires improvement to good because:

  • During our inspection in November 2015 we asked the trust to ensure that care records contained detailed and consistent information about the people that used their services. During the October 2016 inspection, we found care plans and risk assessments that were holistic and reflected the strengths and needs of young people using the services.
  • We asked the trust to ensure that a person's relative or carer’s involvement in the care planning/management plan process was evident within care records where appropriate. During our inspection in October 2016, families that we spoke with told us that staff involved them in the care planning process, and their views were respected and valued. We found evidence in care records supporting this.
  • During our inspection in November 2015 we asked the trust to ensure that services had adequate staff to function fully, including weekends. We found in October 2016 that the trust had reduced staffing vacancies, plans were in place for further recruitment and staff sickness levels were below the trust and national average.
  • During our November 2015 inspection, we asked the trust to store patient records securely. We found at our inspection in October 2016 that records were stored securely and care record tracking systems were in place.
  • The trust was asked to ensure that consent to care and treatment and consideration to Gillick competency was consistently recorded within the care records of people using services. We found this had been completed during our inspection in October 2016.
  • We asked the trust to ensure that staff received well structured annual appraisals. During our inspection in October 2016, we found that performance in this area had improved and the average staff appraisal rate across all the services visited was 93%.
  • During our inspection in November 2015, we asked the trust to ensure that statutory and mandatory training compliance was monitored and that outstanding areas of non-compliance were addressed. In October 2016 the average training compliance across the services visited was above the NHS national training standard and plans were in place to address areas below trust targets.
  • We asked the trust in November 2015 to ensure that toys used by young people attending services were cleaned and records were maintained of this process. During our inspection in October 2016, we found that that cleaning records and audits had been introduced and were complete and up to date.
  • Treatment pathways for children and young people were evidence based. Staff delivered treatment in line with national guidance and quality standards.
  • Referral to treatment waiting times were within national guidelines. Staff monitored waiting lists for changes in the well-being of children and young people and made urgent appointments available when required.
  • The trust monitored outcomes for patients using standardised measures. Local managers and the service group director reviewed key performance indicators to measure the effectiveness of services.
  • Staff adhered to lone working procedures and alarms had been fitted to interview rooms.
  • Children, young people and their families were given the opportunity to give feedback about services provided. Young people were involved in the recruitment of staff and in service development initiatives.

However:

  • Staff did not always report incidents that required reporting. This meant that senior trust staff were not able to investigate all issues affecting the safe delivery of services or identify lessons to be learned and improvements to be made.
  • Electronic systems for processing referrals from the point of access to the community teams were not always effective. This meant there could be a delay for a child or young person accessing services.

17-19 October 2016

During an inspection of Community-based mental health services for adults of working age

We changed the overall rating for community-based mental health services for adults of working age from requires improvement to good because:

  • At the last inspection, we found that not all services had access to emergency equipment. This had been an issue for the Wolverhampton complex care team north. During this inspection, we found that improvements had been made and all services had access to emergency equipment including defibrillators and oxygen.
  • During the inspection in November 2015, we found that the fridge temperatures in the Wolverhampton complex care team north had not been routinely checked and this could lead to harm to patients. During this inspection we found that the trust had installed fridge-monitoring equipment, which was linked to the mental health hospital, so that temperatures could be monitored at all times.
  • The trust had addressed the issues of waiting times in the single point of referral service and they were now meeting their targets for completing assessment. The other services did still have waiting lists, but these were closely monitored and had already been assessed for risk during the initial assessment. Patients on the list had access to a duty worker should they need to speak to someone for advice.
  • At the last inspection, there were issues with Mental Health Act paperwork and the legal status of patients being recorded on prescription charts. We found that these issues had been resolved with support from the trust's Mental Health Act team.
  • At the previous inspection, we found that these services used a range of systems to record patient information. This was still the case and the trust still need to fully resolve this issue however we found that this was mitigated due to staff communication and the weekly multidisciplinary team meetings that took place which included ward staff, community teams and the crisis team.

17-19 October 2016

During an inspection of Mental health crisis services and health-based places of safety

We changed the rating for mental health crisis services and health based place of safety from requires improvement to good because:

  • During our last inspection in November 2015 we asked the trust to make improvements to care plans. We asked that care plans were holistic and recovery orientated. We also asked the trust to ensure health checks were carried out and physical health needs were being monitored.The trust had made significant improvements by the time of our October 2016 inspection. Care plans had improved. They were holistic, patient led and included patient preferences. Staff carried out weekly audits of care plans to improve quality. Staff were supported by psychology in developing the care planning skills through training and reflective practice.
  • During our last inspection in November 2015, we asked the trust to ensure that care and treatment was provided in a safe way for patients. By the time of our October 2016 inspection, the issues identified had improved. For example, staff carried out environmental risk assessments and developed plans to reduce any risks identified. Risk assessments were completed and regularly reviewed and updated.
  • During our last inspection in November 2015, we asked the trust to improve the method of transporting medication to patients in the community. By the time of our October 2016 inspection, we found that the trust issued staff with lockable medication bags, which was a safe way to transport medications to patients in the community. We also asked the trust to ensure emergency equipment was available to staff at the Crisis Resolution Home Treatment Team in Oldbury and this had been implemented.

However:

  • At the time of our October 2016 inspection, patient records were still in electronic and written form and kept in a number of different trust locations, which meant that they were still not accessible to all.
  • During our November 2015 inspection, we told the trust they should ensure that there were arrangements in place to monitor adherence to the Mental Health Act and Mental Capacity Act to ensure that it was being applied correctly. At the time of our October 2016 inspection, there were still errors and omissions in the recording of information. The trust Mental Health Act administrator audited the information, but the results of the audits did not appear to filter down to clinical staff.

17th to 20th October 2016

During an inspection of Acute wards for adults of working age and psychiatric intensive care units

We changed the rating for safe from requires improvement to good because:

  • At the last inspection, we found that the ward environments at hallam street hospital, abbey ward, charlemont ward and friar ward, did not have clear lines of sight that allowed staff to observe all areas. We found that improvements had been undertaken and that all blind spots had been mitigated with mirrors. The stairwells had been decorated and new lighting had been installed to improve visibility.
  • At the previous inspection, we found a large amount of ligature risks on the wards at hallam street. We spoke with the managers of these wards and were informed that these had been identified in ligature audits. Upon re-inspection, we found that the trust had considered a number of solutions to this issue. They were unable to make changes to the environment due to the nature of their agreement with the owners of the building. This meant that these risks could not be fully eliminated. In order to address this, the trust had developed a document that identified all ligature risks and gave staff clear guidance on how each should be managed. This document included photographs of each risk and clear step by step directions.
  • At the last inspection, we found that the wards at hallam street were not well presented. The walls and carpets were stained and there was an unpleasant odour throughout the ward areas. Some of the furniture in the day rooms was ripped and was in poor condition. During the follow up inspection, we found that all three wards were clean and well presented. Carpets had been changed and there was evidence that these were regularly cleaned. Decorating had been undertaken, doors had been replaced and new splash guards had been fitted in all bathroom, W.C. and kitchen areas. New furniture had been purchased and was in good condition. Overall the environment felt clean and well presented.
  • At the inspection in 2015, there were staff vacancies in all wards across the service. We found that this had been addressed and several rounds of recruitment had been undertaken. We found that staff vacancies had been reduced in the 12 months since the previous inspection and were now at reasonable levels. The service had also developed links with agency staff and have developed a preferred staff list. This meant that there was a list of people who worked at the units regularly, had undertaken trust training programmes and were very familiar with the wards and patients.

17 and 18 October 2016

During an inspection of Wards for older people with mental health problems

We have changed the rating for effective from requires improvement to good because:

  • During our inspection in November 2015, we asked the trust to ensure that regular training in the Mental Health Act (MHA) and Mental Capacity Act (MCA) was provided for staff. At the October 2016 inspection, we found that staff demonstrated good knowledge of the Mental Health Act and Mental Capacity Act principles.
  • A trust safeguarding, Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) lead nurse practitioner was available to support wards and reviewed all Mental Capacity Act and DoLS applications.
  • During our November 2015 inspection, we asked the trust to store patient records securely. We found at our inspection in October 2016 that records were store securely and only accessible to staff.
  • We asked the trust to improve the audit process in relation to checks on emergency equipment. During this inspection, we found that that trust had implemented a more robust audit schedule and that wards were adhering to this.
  • Staff that we spoke with were able to describe good working relationships with local external agencies in order to offer support for patients during discharge.
  • The trust gave staff opportunities to develop in their roles. Staff were supervised and appraised regularly.

However:

  • While staff we spoke with on salter ward demonstrated good knowledge of the MHA in practice, only 50% of staff had completed training, which, was significantly lower than meadow and chance wards.
  • Staff told us they had received supervision on a one-to-one basis. However, this was not consistently recorded and documented.
  • Patient records were split between doctor’s notes and nursing care notes. Some patient information was not consistently stored in the same place in records. This made it difficult to find patient information quickly.

16th November – 20th November 2015

During an inspection of Wards for older people with mental health problems

we rated Black Country Partnership NHS Foundation Trust as Good because:

  • The trust had implemented “Safe wards”. This initiative focused on reducing conflict by using simple techniques shown to reduce conflict such as, soft words, positive words, mutual help meetings and setting clear mutual expectations.
  • The quiet wards concept were used to enhance well-being and create a calm environment. This is implemented by not raising voices or shouting across rooms or corridors, putting mobile phones on silence and closing doors quietly. Leaflets were available on the ward promoting these initiatives and patient and relative involvement.
  • Assessments used to manage risk were present and complete. The care plans were formed from a two part process including a risk assessment and care plan that looked at further treatments that could be offered.
  • Multi disciplinary team working was evident between the inpatient and community teams. Social workers from the local authority had attended the weekly ward reviews. There was joint working between the community teams and the ward promoted good quality of care and discharge planning.
  • During the inspection process we observed kind and caring interactions between staff and patients. Community meetings were held monthly, offering patients, relatives and carers the opportunity to have their say in the care they received and effect change. At the meeting, patients’ had discussed the lack of variety on offer for vegetarians. Staff discussed this with the catering team who were looking at devising a new menu.
  • PLACE data 2015 for the older people’s wards at Penn and Edward Street hospitals were as follows: Dignity, privacy and well-being 92% at Edward Street and 95% at Penn hospital, which were both above the national average.
  • The overall PLACE data for 2015 the trust scored 91% for dignity, privacy and well-being, which is about the same as the national average.

However:

  • Although staff were completing checks on the resuscitation equipment on the ward, the trust policies that were in place for supporting patients who require resuscitation were out of date. The last review date was due to take place in 2014. This meant that staff may not be up to date on any changes to the policies. Monthly resuscitation audits had not been regularly taking place. The last recorded checks took place in October 2015. Prior to this, entries were made in March 2015 and December 2014.
  • Although the patient care records were kept securely in a locked cabinet in the ward office, two out of the three wards visited had other confidential information stored in the dining/lounge area of the ward in an open glass cabinet and were not secure. The information in the files related to physical health, fluid balance and activity folders, they held details of patients’ name, date of birth and National Health Service number.
  • There were three sets of care records for each patient. This meant that information may not have been captured in all three records and a possibility of information being missed by agency staff not familiar with the ward. However, some of the risk assessments were placed on datix, which is the trust database.

16th-20th November 2015

During an inspection of Acute wards for adults of working age and psychiatric intensive care units

We rated Acute wards for adults of working age and psychiatric intensive care units as good because:’

  • All wards had a range of activities that took place seven days a week. Patients were engaged by staff in a motivated and enthusiastic way.
  • Patients were involved in the development of their care. All care plans were written using collaborative language and reflected the opinions of the patient where possible.
  • There was evidence of a motivated staff group. We found examples where staff had gone over and above what was expected in the development and delivery of care in the service
  • There was evidence of a programme of continual improvement. ‘Safewards’ was being introduced across all Wards. Staff were members of national groups linked to their areas of work.

However :

  • Staff were working to develop solutions to some challenges presented by the environment, particularly at Hallam Street Hospital at Abbey ward, Charlemont ward and Friar ward.

16/11/2015

During an inspection of Forensic inpatient or secure wards

We rated the Forensic inpatient/secure wards as good because:

  • The security specifications regarding fencing, environmental searches and access to the clinic met the National Minimum Standards.
  • Staff knew how to report and record risk incidents, near misses, raise safeguarding alerts and there had been no serious incidents in the past 12 months. All staff had personal electronic alarms and access to ligature cutters, which were available at strategic points around the clinic. Staff were up to date with physical interventions training (restraint) and knew how to implement.
  • Patients’ care and treatment was aligned with National Institute for Health and Care Excellence guidance, the Mental Health Act Code of Practice (MHA CoP) (2015), Transforming Care (NHS England 2015) and the British Institute of Learning Disabilities (BILD). Patients had their needs assessed and their care planned and delivered in line with evidence-based guidance, standards and best practice.
  • The multidisciplinary team worked well together. Each profession contributing towards patients’ care and treatment from their expert professional perspective.
  • All patients had relevant and detailed risk management plans, which followed a positive behaviour support model. This is aligned with the Mental Health Act Code of Practice (2015), and ‘Positive and Safe’ (Department of Health 2014).
  • Seclusion was used rarely and rapid tranquillisation was not used and facilities complied with national standards and the Mental Health Act Code of Practice (MHA CoP 2015).
  • The clinic was clean and cleaning records were up to date and displayed on the wards’ walls.
  • Medicines were safely stored and safely managed.
  • We observed staff treating patients with kindness, dignity, compassion and respect and staff spoke to us in respectful terms about patients.
  • There was a clear vision and set of values in the Trust.

However:

  • There were a number of potential ligature points throughout the three wards and in the adjoining areas of the clinic and the physical layout of the ward meant there were not clear lines of sight. The configuration of the clinic was circular. This meant that corridors curved so it was not possible to see very far without physically moving and following the curve of the corridor.
  • Staff we spoke with understood the Mental Capacity Act (MCA) and how mental capacity is decision specific and can fluctuate. The trust has policies to support staff in understanding the MCA, however, low numbers of staff had attended Safeguarding Adults Level 2 and Level 3 training and no staff had attended Mental Capacity Act training.
  • The Trust Seclusion policy was not fully compliant with the MHA CoP (2015) in terms of ending seclusion.

16-20 November

During an inspection of Specialist community mental health services for children and young people

We rated specialist community services for children and young people as requires improvement because:

  • The trust did not ensure that all staff working with children and young people had disclosure and barring services (DBS) checks every three years as required in the 2014 trust disclosure and barring policy.
  • Staffing vacancies at the Sandwell crisis team and Wolverhampton crisis and home treatment teams were high at63% and70% respectively. At the time of our inspection the Wolverhampton crisis and home treatment team had been placed on the Trust's risk register due to insufficient staffing. The CAMHS services had six consultant psychiatrists. This was below the recommendations by The Royal College of Psychiatrists for building and sustaining specialist CAMHS, (CR182) 2013.
  • Interview rooms at the Lodge Road Child and Adolescent Mental Health Services (CAMHS) service did not have alarms fitted. Alarms had been removed and were stored in the administrative area of reception.
  • Toys in use by young people were not regularly checked and cleaned across all services. Equipment used to monitor the physical health of young people using services was not always adequately maintained. 
  • The Sandwell CAMHS crisis team was on the trust risk register due to uncertainty about its funding as from March 2016. The child and family services team had placed themselves on the trust risk register due to increasing waiting times for appointments following initial assessment.
  • There were inconsistencies in how the lone working policy was implemented.
  • Incidents had occurred where dictation tapes had gone missing containing information on medication and risks for young people. All information needed to deliver care was not always stored securely and available to staff when they needed it.
  • Of the 30 care records reviewed across the CAMHS service, 23% did not have a risk assessment present, 60% of risk assessments that were present were not completed to a required standard and 47% of care records did not contain a care plan. In records where care plans were completed these were found to lack the views of the young people using the service. There was not always evidence of personalisation or holistic care planning and care plans did not always contain the full range of needs of young people using the service. Care plans did not evidence the involvement of young people and their families. 91% per cent of care plans reviewed in the Sandwell CAMHS team, the Key team and the Wolverhampton child and family service had no evidence of the young person having been given a copy. Medical records did not always evidence parental responsibility.
  • A child protection database was in use at Sandwell CAMHS service, of the eleven cases reviewed, 45% had no details completed for the named clinician.
  • There had been no specific recent training for CAMHS staff regarding Gillick competence, and staff understanding of this was variable. There was no evidence of assessment of Gillick competency within all files reviewed at Lodge road CAMHS service, or assessments of capacity and competence at the key team in Wolverhampton.
  • The trust had a compliance target for mandatory training of 95%. All CAMHS clinical staff were required to attend safeguarding children level three training. The average attendance rate for this training across all teams was 50-80%. All staff did not receive yearly appraisals, 76% of staff across the teams visited had an appraisal in the preceding year.

However:

  • The Pierce suicide intent scale and the Health of The Nation Outcome Scale for Children and Adolescents (HoNOSCA) was being used within the CAMHS services to provide an outcome measure for rating the severity of needs and the effectiveness of treatment.
  • The Sheffield Learning Disabilities Outcome Measure (SLDOM) was being used within the inspire service for children with learning disabilities
  • A range of psychological therapies were available for children and young people and their families within the CAMHS service.
  • Observations carried out during the inspection process showed that staff attitudes and behaviours when interacting with young people and their carers was respectful, responsive and provided appropriate practical and emotional support.

16th- 20th November 2015

During an inspection of Community-based mental health services for older people

We rated community based mental health services for older people as outstanding because:

  • Staff had good knowledge of safeguarding. They were trained to level three and identified risks and appropriate referrals were recorded.
  • Each care and treatment record contained detailed risk assessments and risk management plans. These were reviewed regularly.
  • Patients had access to advocacy services and staff knew how to support patients to make sure they had access.
  • Patient information leaflets explaining how to complain were available in all locations. Staff knew how to respond to complaints.
  • Each team followed appropriate national institute for health and care excellence guidelines; these included the use of low-dose antipsychotics in people with dementia and dementia,supporting people with dementia and their carers in health and social care.
  • In order to meet the needs of the local population, the treatment and recovery unit had developed a Punjabi cognitive stimulation group. A further cognitive stimulation group had been developed in partnership with West Bromwich Albion football club.
  • Staff told us they felt their managers were approachable and supportive.
  • There was no occupational therapy or psychotherapy input within community-based mental health services for older people. The treatment and recovery unit and the groves day centre had no psychology input.
  • Patients were not formally involved in the development of services or in staff interviews.

16 - 20 November 2015

During an inspection of Wards for people with a learning disability or autism

We rated wards for people with a learning disability and/or autism as good because:

  • Care and treatment was delivered in a person centred, kind, respectful and considerate way.
  • Care Programme Approach and ward reviews were carried out in a timely manner.
  • Patients told us they felt safe and were satisfied with the care they received.
  • There were care plans and risk assessments in place for patients.
  • Staff managed patient behaviours effectively and only used medication when they needed to.
  • Arrangements for medication management kept patients safe.
  • There were robust systems in place to record incidents and learning from incidents was routinely shared.
  • Patients had regular contact with a range of health professionals to promote their physical health and well-being.
  • Different professions worked effectively together to assess the needs of patients and to support patients’ care and treatment.
  • The use of the Mental Health Act was good across the service. The documentation we reviewed in detained patients’ files was mostly up to date and could be accessed easily.
  • Staff received regular supervision and an annual appraisal.
  • Patients and their relatives told us that staff treated them with kindness, dignity and respect.
  • There was an active chaplaincy service which supported patients with their spiritual needs.
  • Patients took part in regular therapeutic and leisure activities.
  • Cultural diets and needs were catered for.
  • Staff told us they felt valued and supported by the Trust and felt confident they could report their concerns.
  • Morale amongst staff we spoke with was generally good and staff were clear about their roles and responsibilities.
  • Local leadership was available and supportive to staff.

However:

  • There was no reasonable assurance or plan to mitigate the risks of ligature points. Ligature cutters were not accessible at Orchard Hills and Pond Lane.
  • There was no risk assessment for a patient at risk of self-harm.
  • Staff at Orchard Hills did not follow the search policy to ensure the risks to patients’ safety were balanced with their rights and preferences.
  • The emergency bag was not accessible to all staff at Orchard Hills.
  • Orchard Hills did not comply with the guidance on same sex accommodation.
  • Safe food storage was not always practiced at Orchard Hills.
  • The systems that managed patient information did not always support staff to deliver effective care and treatment.
  • Staff did not always receive the specialist training for their role to ensure they knew how to meet the needs of all patients.
  • Staff knowledge of the MHA and MCA varied across the service.
  • Records did not reflect that patients or their relatives had been involved in developing their care plans or had been given a copy, though most people told us they had been involved.
  • Some ward areas were not accessible to patients with mobility needs.
  • There were delayed discharges.

16 – 20 November 2015

During an inspection of Community-based mental health services for adults of working age

We rated the community based mental health services for adults of working age as requires improvement because:

  • Medication was not properly stored at Complex Care North. Fridge temperatures were not routinely checked. This could have led to harm to patients who used the services.
  • There was no emergency equipment at Complex Care North.

  • Measures for summoning assistance were not robust across all the teams. Single Point of Referral had systems that we found were ineffective.

  • Single Point of Referral service had no contingency plan to deal with unexpected staff shortages. This could have meant patients who used services were waiting longer to be seen.

  • High referrals and excessive waiting times were present in the Single Point of Referral team for people waiting to be assessed. This meant patients who used services waited long periods to be seen. There were no processes in place to monitor patients whilst they were waiting.

However:

  • Staff received training, appraisals and supervision.

  • Staff felt confident to raise any concerns.

  • Crisis plans were detailed in the notes we viewed.

  • Processes were in place to deal with sudden deteriorations in people’s health, they would be referred to the Crisis team for urgent assessments.

  • Urgent access to psychiatrists was possible.
  • Incidents and complaints were reported and we saw that learning from these took place. Apologies were given to patients if things went wrong.

  • Physical health monitoring occurred on an on-going basis.

  • Good working relationships existed with other agencies. Shared protocols were in place with General Practitioners.

  • Health of the Nation outcome scales (HONOS) were used. This was primarily to ascertain care clusters for individuals. HONOS ratings determined future care pathways and treatments.

  • The environments were fit for purpose. Information leaflets were available. These covered areas such as how to complain, medications, what to expect. They were available in languages other than English. Interpreters were used.

  • Trust vision and values translated to care provided. Staff knew who the senior managers were in the trust and felt supported.
  • Staff knew how to safeguard people who used services.
  • Administration staff supported the clinical staff. Clinical staff maximised the time spent providing care.

  • Research and audits took place meaning the service was committed to improvements.

16-20 November 2015

During an inspection of Mental health crisis services and health-based places of safety

We rated mental health crisis services and health-based place of safety as requires improvement because:

  • The Crisis and resolution home treatment (CRHTT) team did not have emergency equipment such as automated external defibrillators and oxygen on site.
  • Observation levels carried out by staff at Hallam street 136 suite to manage the potential risk of ligature points compromised patients’ privacy and dignity when using the facilities.
  • The kitchen area had open access to boiling water from the instant water boiler fitted to the wall. Portable appliance tests to electrical equipment used such as toaster and instant water boiler were not carried out to ensure they were safe to be used.
  • The flats used by CRHTT as crisis beds at ‘P3’ were not risk assessed before patients were admitted. The CRHTT did not complete, update or review detailed risk assessments. We could not find evidence from both health based places of safety that they carried out risk assessments when patients were admitted to the 136 suite.
  • The CHRTT did not have robust arrangements for safe storage of medicines. There was no safe and secure transportation of medicines procedure that was followed. Medicines stocks were not consistently checked.
  • Three out of nine care plans we reviewed for (CRHTT) were not holistic and recovery orientated. They did not fully address the needs identified in the assessment stage.
  • Records across all teams were not well organised and different team members could not access patients’ records when needed. There no clear systems of records management in the health based places of safety.
  • We could not find records in the 136 suites that showed physical healthcare needs were assessed and supported. Records viewed in all teams showed that there was no clear monitoring of physical health needs.
  • Staff in the Home treatment team (HTT) and CRHTT did not receive regular supervision. The HTT did not have regular staff meetings. Training records indicated that staff had not received training in Mental Health Act (MHA) and the Code of Practice.
  • The teams did not have arrangements in place to monitor adherence to the MHA and Mental Capacity Act to ensure that it was being applied correctly.
  • Some patients told us they were not given copies of their care plans and some copies of care plans that we saw were not signed by patients. The teams did not have information leaflets specific to their teams on how the services were run.
  • Staff spoken with in the Home treatment team were not aware of how to access advocacy services for patients. Patients and their families told us that they were not aware of how to access advocacy services when needed.
  • The systems or methods to monitor the effectiveness of quality and safety of the service provided were not effective and robust enough. The inspection team identified such areas where improvements were required.
  • Staff were not participating in a range of quality improvement and innovative practice initiatives.

However:

  • All the places we visited were clean and well maintained. Staff practiced good infection control procedures such as hand hygiene to ensure that patients and staff were protected against the risks of infection.
  • The staffing levels in each team were appropriate ensuring patient safety. The caseloads were low in each team. All teams had no patients on waiting list to be allocated to nurses. This meant that patients were not waiting long to be seen by nurses.
  • Training records showed that staff received safeguarding training. They demonstrated a good understanding of how to identify and report any abuse. Patients and their relatives told us that they felt safe with staff from all the teams.
  • The teams had an effective way of recording incidents, near misses and never events. They knew how to recognise and report incidents through the reporting system.
  • Staff received training in areas such as cognitive behavioural therapy (CBT) and solution focussed therapy. The teams held regular reflective practice sessions with the psychologist to discuss areas of practice specific to their roles.
  • All teams had regular and effective multi-disciplinary team meetings that discussed patients’ needs in detail to ensure that patients got the treatment they needed. The teams had good working links with the external organisations such as GPs, acute hospitals, independent organisations, local authorities, and police.
  • We observed good interactions between staff and patients. Staff were polite, kind, respectful and compassionate.
  • Patients and their families were complimentary about the attitudes of staff and the support that they received. Staff showed that they understood the individual needs of patients and could describe how they supported patients with a wide range of needs.
  • Staff involved patients in their clinical reviews and care planning and encouraged them to involve relatives and friends if they wished.
  • The teams were meeting their targets for referral to assessment times. The teams could respond on time and effectively when patients required crisis and routine care. The teams had access to interpreters when needed. Staff could to tell us how they could access interpreting services.
  • Patients knew how to raise concerns and make a complaint. Patients told us they felt they would be able to raise concerns should they have one and were confident that staff would listen to them.
  • Staff knew and agreed with the trust’s values. Staff knew who the most senior managers in the trust were. These managers had visited the teams. Staff told us that they knew how to use the whistle blowing process and felt free to raise any concerns.
  • Staff were open and transparent when things went wrong. They were aware of duty of candour and were able to give us examples of having been open and honest when mistakes had been made, apologising for mistakes, and learning from them.

16th – 20th November 2015

During an inspection of Community mental health services with learning disabilities or autism

we rated community mental health services for people with learning disabilities as good because:

  • Staff adhere to infection control policies. Hand wash facilities were available. The patient areas were clean, well presented and tidy.
  • All new referrals were dealt with on the day they were received. Urgent referrals were seen on the day. Other referrals were discussed at the weekly meeting and seen within a two week target time.
  • Staff used evidence based tools and assessments to measure needs and risk. Outcome measures were used to assess the effectiveness of treatment and the services took part in audits to improve the quality of care.
  • Staff worked well with other services to meet all the needs of the patients.
  • All three sites had safe nursing staff levels. There was a good compliment of allied healthcare staff at each site. This included speech and language therapists, psychologists, occupational therapists and behaviour support nurses.
  • All patients that had home visits had a risk assessment in place.
  • Research and audits took place meaning the service was committed to quality improvement
  • Physical health monitoring occurred on an on-going basis
  • Staff had good knowledge of safeguarding
  • However: There was a lack of administration staff at Orchard Hill and staff told us this had an impact on other professionals’ time.

16 - 20 November 2015

During an inspection of Community health services for children, young people and families

Overall rating for this core service

The overall rating for this core service was requires improvement.

We found areas of safety to require improvement. For example, we saw that clinical equipment within patients’ homes was not consistently maintained. We also saw risks in relation to staffing levels in the Health Visiting Team.

The service had robust safeguarding procedures in place, and that learning from incidents was being shared with staff in a number of formats including by email and through discussion at team meetings, however not all staff had received appropriate safeguarding children training.

We rated the effectiveness of services as good. Evidence based practice was delivered across all services and that national programmes of care were followed. Staff assessed patient needs thoroughly before care and treatment started and staff took part in competency based training programmes.

Across all community Children, Young People and Families services staff provided an outstanding level of caring. When speaking to children, parents and carers they were continually positive about the care that was provided and the way that staff treated them. People told us and we saw that staff went the extra mile when they provided care. Staff were committed to empowering young people through providing them with appropriate information and support to enable them to make decisions around the care they received. Children, young people and their carers told us that they were treated with compassion, dignity and respect. They were involved in discussions about treatment and care options and able to make decisions. Information was provided in a number of formats to enable young people to understand the care available to them and help them to make decisions about the care they wanted to receive. Staff within services went beyond the remits of their role to overcome obstacles on numerous occasions to ensure the needs of the child, family and carers were met.

The core service were responsive to people’s needs. They were tailored to the needs of local populations and most staff were able to access training specific to the needs of the populations they supported. Care was provided from a number of settings and at flexible times to increase the accessibility of the service being provided.

We concluded that the core service required improvement in the well-led domain. There was disconnect between the senior management team and staff within community Children, Young People and Families services. We saw strong local leadership with the majority of staff we spoke to telling us that they felt supported by their direct line manager, but less so from senior managers or the executive team. For example, senior managers had not supported the Health Visiting team with additional resources to manage a caseload that had quadrupled in size over the last 12 months. Staff were struggling to cope daily and we were not assured children and families were protected against abuse and avoidable harm. Leaders were unaware of significant issues threatening delivery of safe and effective care.

16th – 20th November 2015

During a routine inspection

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

We found that the Black Country Mental Health Partnership NHS Foundation Trust was performing at a level which led to a judgement of Requires Improvement.

The provider failed to consistently ensure that all people receiving a service were protected from potential harm due to poor environments at hallam street hospital and not consistently checking and maintaining equipment used by patients.

We found that systems to manage information governance were inconsistent; record keeping and archiving of patients files were of concern in some areas. We also found that training in the mental health act & mental capacity act was not a mandatory requirement on an ongoing basis.

The provider scored below the national average with regards to staff recommending the Trust as a place to work. Some of the staff that we spoke with felt disengaged from improvements that the leadership team are trying to embed. However, we saw evidence that the Trust is attempting to engage more effectively with staff by developing initiatives such as 20/20 events where staff were invited to participate in interactive workshops that focussed on the trusts strategic goals and objectives for the future.

We were impressed by the leadership at board level but identified that there was work required to ensure that the leadership at ward or team level was of a similar standard. The trust had implemented systems to monitor quality, safety and risk and the various committees and sub-committees which fed into the senior team enabled this. However, these processes were not fully embedded throughout the organisation.

The Trust can be proud of the caring culture within the staff group. We saw consistent evidence of people who use Trust services being treated with dignity, kindness and respect. We also saw some very good examples of services responding to the individualised and often complex needs of the patients.

We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.

Mental Health Act Commissioner reports

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. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.