Black Country Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

On Ambleside ward, the environment required updating. Some areas across both wards were cluttered. The hospital was not smoke free and patients were permitted to smoke in garden areas on both wards. This had led to a build up of large quantities of disposed cigarette ends and litter in the outdoor spaces. On Langdale, room door signs had been removed during the programme of decoration however the these were not fully removed and the backs were still on the wall exposing sharp edges, and plastic parts that could be removed. Staff were not up to date with their mandatory training requirements and several courses across both wards had low compliance rates. However, staff said they felt supported and listened to and were confident to raise concerns. The service had enough nursing staff and healthcare support workers and managers could quickly obtain bank or agency staff where required. Most bank staff worked regularly on the wards and knew the patient well.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff we spoke with said they felt supported and listened to. They said they were confident to raise concerns and that actions would be put in place.

There was an effective governance process in place to ensure that learning was discussed and improvements implemented where necessary.

Staff told us that there was a culture of learning where there were opportunities to reflect and share learning. Staff told us that that they attended staff meetings, debriefs and reflective learning.

One staff member told us that they did not receive team meeting minutes.

Prior to attending on site, we requested that the trust share our Give Feedback on Care form with all staff. We received anonymous feedback raising concerns around management of staff within the medical team, poor culture and some staff felt that they were unable to speak up.

During our on site assessment, all staff we spoke with told us that they were happy in their role, that they felt supported by their managers and were confident in raising concerns. No staff members told us that they had experienced or witnessed any bullying or harassment. Two staff members told us that they were not aware of Freedom to Speak Up. We did see posters regarding Freedom to Speak Up located on wards.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

On Ambleside, ward areas were clean although some areas looked shabby and worn. The counter tops in the kitchen area were worn and some areas were damaged and in need of replacement.

On both wards, patients stored some of their belongings in store cupboards or staff rooms. There was a large amount of previous patients’ belongings that had also been left in storage rooms on the wards. The rooms were over filled with items and spilled out onto the floor area.

On Langdale, room door signs had been removed during the programme of decoration however the these were not fully removed and the backs were still on the wall exposing sharp edges, and plastic parts that could be removed.

The hospital was not smoke free and patients were permitted to smoke in garden areas on both wards. Staff told us that the hospital planned to go smoke free in the future. Smoking areas on both wards were untidy with large quantities of disposed cigarette ends and litter.

The service had environmental risk assessments in place to ensure the safety of staff and patients on the ward. However, they had not identified all risks that presented on the wards.

The service had enough nursing staff and healthcare support workers. At times, when the wards were busy there were not always enough staff, however managers could quickly obtain bank or agency workers and floating staff were available as a contingency in an emergency.

Staff told us that wards were occasionally short staffed but this was due to unplanned absence or when there was an urgent need for increased observations. Staff told us that when there were shortfalls that managers were responsive in arranging cover through use of bank and agency.

Most bank staff worked regularly on the wards and knew the patients and their risks. Staff said that the use of non-permanent staff did not impact patient care. However, they did not always feel safe on the ward due to the high level of acuity of patients. In the event of an incident or emergency, floating staff could be accessed from the adjacent ward. Staff told us that there was a high level of agency use. Staff on Langdale did not always feel safe while observing the blind spot in the garden area as they could not predict how many patients would be outside at any given time. Staff told us they had completed some physical observation training to help support them in their role.

Managers had recruited to vacancies and developed roles to encourage staff to progress within the service.

Staff had not completed all their mandatory training. On Ambleside there were two mandatory training courses with a low compliance rate. In addition, on Langdale there were twelve courses with a low compliance rate. These courses included essential training such as Mental Capacity Act, Mental Health Act and Adult Basic Life Support training, among others.

The service had moderate rates of bank and agency nursing assistants. Managers limited their use of bank and agency staff and requested staff familiar with the service. The service tried to block book bank and agency staff where possible to provide continuity of care to patients.

Managers made sure all bank and agency staff had a full induction and understood the service before starting their shift. All agency staff worked to a framework in which they were provided with the mandatory training for the ward prior to starting their shifts.

The service had reducing turnover rates. Managers supported staff who needed time off for ill health. Levels of sickness were reducing.

The service did not always have enough staff on each shift to carry out any physical interventions safely. The training records for staff suggest 57 per cent of all staff were trained in the safe use of physical restraints. The trust informed us that all remaining staff were booked for training in October 2024. However, in the meantime this presented a safety risk for staff and patients on the wards.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.