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St Andrew's Healthcare - Birmingham Good

Inspection Summary


Overall summary & rating

Good

Updated 28 August 2018

We rated St Andrew’s Healthcare Birmingham as good because:

  • Staff treated patients well, taking the time to listen to their concerns and were sensitive to patient issues. Patients said they felt staff understood their individual needs. Patients told us they were actively involved in care planning and risk assessment and this was evident in care plans.
  • Staff ensured that the admission process informed and orientated patients to the ward and the service. Staff displayed posters in communal areas alerting patients to the daily activities and meetings for the ward.
  • Staff completed comprehensive care plans which demonstrated good practice. We saw evidence that staff followed National Institute for Health and Care Excellence guidance when providing therapy and prescribing medication.
  • A dedicated physical healthcare team provided effective and timely physical healthcare to patients. The team provider tailored services to meet the needs of individual people and services were delivered in a way to ensure flexibility, choice and continuity of care.
  • Managers ensured that staff received mandatory training. Staff were appraised annually and supervised monthly.
  • Managers ensured shifts were covered by enough staff of the right grades and experience, and that staff maximised shift-time on direct care activities.
  • The provider demonstrated a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met these needs and promoted equality. The provider used interpreters to ensure that patients could communicate if they did not speak or understand English. The provider also worked with catering so that the food provided met patients’ cultural needs with respect to diet. The provider had a RACE (Race, Culture and Ethnicity) group which looked at ways that patients from different ethnic backgrounds could be supported. The chaplaincy department ran an awareness session on Ramadan and worked with catering on what foods to serve post fasting.
  • Staff provided information in other languages and there were some examples of wards buying in newspapers, CDs and books in different languages to enable patients to keep connected to their cultural identity. The chaplaincy department carried out an exercise to establish patient feedback on how the provider met their spiritual needs.
  • Managers planned the services to integrate with other organisations and the local community and ensured that services meet people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

However:

  • The provider had not mitigated all risks posed to the quality of stored medication by broken air conditioning. On Hurst ward, and in the separate physical healthcare clinic room, the ambient room temperature was 29.8 degrees centigrade. In the months of May and June 2018, the provider had recorded temperatures above the maximum 25 degrees centigrade on each day between 5 May 2018 and the day of the inspection, yet had continued to dispense medication from these rooms. There was a risk that medication may become less effective if stored at the incorrect temperature.
  • The seclusion room on Speedwell ward had been damaged on 8 June 2018 and therefore was not in use. Hurst seclusion room was not in use due to the air conditioning not working. This meant that, if staff decided that a patient should be secluded, they would have to use the facility on another ward.
  • Managers had not ensured a safe environment on Speedwell. The lock to the staff office door had been damaged on 1 June 2018. This meant that staff had to use a key to lock the door rather than it locking automatically on closing. There was a risk that staff may forget to lock the door as they entered or left the office. This could allow patients to access confidential information. Also, it would take staff longer to respond to incidents because staff had to lock themselves in the office and so would have to unlock the door to get out to attend an incident.
  • On Lifford and Edgbaston wards there was a delay in referrals to urology for two patients who had markers indicating they could have prostate cancer. This meant that there was a risk of a delay in diagnosing a potentially treatable cancer.

  • Staff had not completed appropriate care plans for one patient on Speedwell ward, with complex needs and behavioural issues. We found there was no positive behavioural support plan for staff to follow and an inconsistent approach to assessment and care planning for this patient. Staff demonstrated a lack of understanding of the patient’s needs.
Inspection areas

Safe

Requires improvement

Updated 28 August 2018

We rated safe as requires improvement because:

  • The seclusion room on Speedwell ward had recently been damaged and therefore was not in use. Hurst seclusion room was not in use due to the air conditioning not working. If patients needed seclusion they would have to use the facility on another ward. Moving distressed patients through wards and corridors to alternative seclusion rooms carried a risk of harm to patients and staff. The provider had arranged repairs to both seclusion facilities but staff had been waiting for over a month for repairs to be carried out.
  • Managers had not ensured a safe environment on Speedwell ward. The lock to the staff office door had been damaged meaning that staff had to use a key to lock the door. There was a risk that staff may forget to lock the door as they entered or left the office, leaving patients able to access confidential information, or that it would take staff longer to respond to incidents due to having to unlock the door.
  • The provider had not mitigated all risks posed by broken air conditioning. On Hurst ward and in the separate physical healthcare clinic room the ambient room temperature was 29.8 degrees centigrade. In the months of May and June 2018 the provider had recorded temperatures above the maximum 25 degrees centigrade from 5 May 2018 to the time of inspection, yet had continued to dispense medication from these rooms. There is a risk that medication may become less effective if stored at the incorrect temperature.

However:

  • The layout of all wards allowed staff to observe of all parts of the wards.
  • Managers had completed ligature risk assessments, identified all ligature risks and mitigated against these through observation procedures.
  • Staff completed risk assessments of every patient on admission and updated these regularly and after every incident.
  • Doctors provided medical cover day and night and could attend the ward quickly in an emergency.
  • Managers ensured that staff had received and were up to date with appropriate mandatory training and the mandatory training rate for staff was 93%.
  • The provider focused on reducing restrictive practice. From the evidence we reviewed, we concluded that staff used restraint only after de-escalation has failed and using correct techniques, all permanent and regular bank staff were trained in the management of actual or potential aggression.

Effective

Good

Updated 28 August 2018

We rated effective as good because:

  • Staff completed care plans that demonstrated good practice. We reviewed 42 care records and 41 evidenced this. We saw evidence that staff took account of National Institute for Health and Care Excellence guidance when prescribing medication.

  • Staff offered recommended psychological therapies for post-traumatic stress, sex offender work, anger management and recognising emotions, fire setting work, and support to patients who self-harm.

  • A dedicated physical healthcare team provided effective and timely physical healthcare to patients. Staff used recognised rating scales to assess and record severity and outcomes such as the Health of the Nation Outcome Scales for secure services, the Beck Depression Inventory, the Beck Anxiety Inventory, the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM). Occupational therapists used the Vonda Du Toit Model of Creative Ability and the Model of Human Occupation. Lead occupational therapists were involved in the writing of latest research using these tools alongside local universities.

  • Clinical staff participated actively in clinical audit of care records, we saw that care plans and positive behavioural support plans were updated in line with these audits. The provider also involved patients in the decisions about which areas should be audited.

  • Staff participated in regular effective multi-disciplinary meetings and effective handovers. We observed a multi-disciplinary meeting which was very patient focused. We observed a handover and saw a dedicated handover template with key areas to be discussed for each patient at the start and end of each shift, including risks, behaviour, patient’s presentation and a “positive message”.

  • Staff had effective working relationships with other teams and stakeholders. The provider told us about joint working with two local NHS trusts to support patients along the recovery pathway and out into the community.

However:

  • Staff had not completed appropriate care plans for one patient on Speedwell ward, with complex needs and behavioural issues. We found there was no positive behavioural support plan for staff to follow and an inconsistent approach to assessment and care planning for this patient. Staff demonstrated a lack of understanding of the patient’s needs.

Caring

Good

Updated 28 August 2018

We rated effective as good because:

  • Staff treated patients well, taking the time to listen to their concerns and were sensitive to patient issues. Patients told us that they felt staff understood their individual needs. Patients told us they were actively involved in care planning and risk assessment and this was evident in care plans.
  • Patients reported that they felt staff understood their individual needs.
  • Staff ensured that the admission process informed and orientated patients to the ward and the service. Staff displayed posters in communal areas alerting patients to the daily activities and meetings for the ward.
  • Patients told us they were actively involved in care planning and risk assessment and this was evident in care plans.
  • Patients had access to advocacy and there were posters displayed near the ward telephone giving details of how they could be contacted.
  • The two carers that we spoke with told us they felt involved in their relative’s care. There was a visitors’ suite near the hospital entrance and families could also use the café with their relative.
  • Patients were encouraged to give feedback on the service they received at weekly community meetings and via a patient feedback survey.

However:

  • Patients told us the provider occasionally had too few staff on duty to fulfil requests for leave that required a staff member to escort the patient.
  • Patients on Edgbaston ward felt there was a “them and us” culture between staff and patients, but they acknowledged that managers were working with staff and patients to dispel this.

Responsive

Outstanding

Updated 28 August 2018

We rated responsive as outstanding because:

  • The provider tailored services to meet the needs of individual people and delivered them in a way to ensure flexibility, choice and continuity of care. One example was the employment of a teacher who linked with local education providers to support patients to build skills relevant for when they moved on from services. In addition, patients had access to a physical healthcare suite which mirrored healthcare services in the community. Patients made their own appointments and were seen outside the ward environment.
  • The provider understood the needs of different groups of people and delivered care in a way that met these needs and to promote equality and diversity. This included access to quiet areas for prayer and access to appropriate cultural diets. The provider also had an established RACE (Race, Culture and Ethnicity) group who reviewed ways in which patients from different ethnic backgrounds could be supported. Chaplaincy staff held cultural awareness sessions and provided advice and guidance to catering staff on food to serve post fasting.
  • The provider encouraged patients to personalise their bedrooms and supported patients to have access to games consoles and items which supported their recovery. This included furnishing bedrooms with sensory equipment to help patients relax.
  • Staff provided information in an accessible format and ensured patients had access to other forms of media in different languages. This included newspapers, CD’s and books to enable patients to keep in touch with their cultural identity.
  • The provider actively reviewed complaints and involved patients and staff in how they were resolved and responded to, improvements were made as a result across the service.
  • Managers planned the services to integrate with other organisations and the local community and ensured that services met people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs. The provider had worked with local stakeholders to form a “Reach Out” group to look at local care provision, and establish recovery orientated discharge pathways. This enabled patients to continue using the skills they learnt in when discharged into the community.

Well-led

Good

Updated 28 August 2018

We rated well-led as good because:

  • Managers ensured that team objectives reflected the organisation’s vision and values. Managers displayed their ward values on the walls in patient areas and patients had been involved in writing these values.

  • Staff knew who the most senior managers in the organisation were and these managers visited the wards on a regular basis. Managers ensured that staff received mandatory training and were appraised annually and supervised monthly. Managers ensured that shifts were covered by enough staff of the right grades and experience, and staff maximised shift-time on direct care activities.

  • Staff participated in clinical audits and patients were also involved in suggesting which aspects of care should be prioritised for audit.

  • Staff reported incidents and managers ensured that staff learnt from incidents, complaints and patient feedback.

  • Staff told us they knew how to use the whistle-blowing process and felt able to raise concerns without fear of victimisation. The majority of staff spoke of having good morale, job satisfaction and sense of empowerment. Staff told us the provider had excellent resources for external staff support such as counselling services. Pastoral care for staff was also provided by the chaplaincy service.

However:

  • The provider had made some changes to the roles and responsibilities of staff in the senior management team and not all staff were aware of these changes.

Checks on specific services

Wards for people with a learning disability or autism

Good

Updated 28 August 2018

Forensic inpatient or secure wards

Good

Updated 28 August 2018