Oldbury Birmingham

Updated 16 January 2023

Oldbury Birmingham is a 15 bed specialist inpatient service for men aged 18 and upwards, who have mental health issues and a learning disability or autism. Some people may be detained under the Mental Health Act (MHA) and some may have complex needs that are not being met in their current placement. Some people were detained under the MHA with conditions from the Ministry of Justice. At the time of this inspection there were 12 people at the service, and all were detained under the MHA.

At the time of our inspection, a registered manager was in place.

Oldbury Birmingham is registered with the CQC to carry out the following regulated activities:

• Treatment of disease, disorder or injury.
• Assessment or medical treatment for persons detained under the 1983 Mental Health Act.
• Diagnostic and screening procedures.

Since our last inspection, the provider has changed. Oldbury Birmingham was previously inspected by the CQC in June 2017 (inspection report published 28 July 2017). This is our first inspection since the location was registered to a new provider, Coveberry Limited.

What people who use the service say

We spoke with six people who lived at the hospital. Four people either preferred or were comfortable to speak with us by themselves, and two people asked a member of staff to support them, saying that they were supportive. All six people were able to converse with us without the use of communication aids.

Five out of six people told us they came from the West Midlands and most were local to Birmingham and the Black County. All spoke of being discharged back to their local area and could name the areas they wished to live. One person did not like being so far away from his family and would either like to return to his home area or stay locally. Two out of six people said they did not know their discharge plan and one said they did not have a date. Although one person who did not know their discharge plan, they spoke of speaking with staff about moving to a residential placement. Three people were able to describe their plans to us. All spoke of staff from community services in supporting them.

All people said the food was of a good quality and they had the choice of making their own meals. All said they could take leave into the community and did not say it was ever cancelled. They talked about a variety of activities on offer, both in the hospital and the community, including going to a community college and staff supporting them to access a job they wanted to do with animals. However, one person said they got bored at weekends. All were able to personalise their room with items they liked, including family pictures. People said staff supported and encouraged them with their pastimes, including time spent in the community. However, one person said staff had told him that his possessions were ‘clutter’ and needed to be tidied up.

People said the hospital was generally clean and tidy however, one person said their room needed decorating but were aware the whole hospital was being decorated. They also described some damage to the walls that needed to be repaired. They agreed we could take photos of the damage.

People described having access to external physical healthcare and using services including a GP, dentist, and optician. All said their physical healthcare was looked after and one person described how staff had supported them to overcome their fears of physical interventions and had been able to have their blood pressure taken and receive their COVID-19 vaccination and boosters.

All people knew the new manager and were able to raise concerns freely. All knew who the members of the multidisciplinary team were and said they were visible. All people had an idea of what they needed to do to move back into the community and treatment supported this. One person was able to describe in detail how they had improved the way they were able to manage their distress, not get upset with other people and how incidents had reduced where he is near ready for discharge back to his previous placement.

However, two people used the term “being bullied” at the hospital and one said staff had an attitude. All were verbal interactions with staff. One person felt that staff were wrong not to restrain another person after they assaulted a member of staff, saying they should not have been allowed to carry on walking around the area while staff observed. They also said they do not like new staff starters who have to shadow experienced staff when learning to observe him. He said staff told him that they have to do it and he did not like the way he was spoken to. However, he felt safe at the service. Another person described bullying and not being treated well by staff, referring to the way he was spoke to. Another person said staff picked on him when he was minding his own business, saying that when other people who use the service get upset, staff try and bring him into the argument, and he does not like it. But, all three were able to describe that staff, including the hospital also treated them with kindness. The other three people said that staff always treated them with kindness and respect. They described being treated with dignity and told us staff were approachable. They were able to describe positive experiences and activities with staff.

Updated 16 January 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

• The service strived to support people to have the maximum possible choice, control, and independence, be independent and they had control over their own lives.
• Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.
• People were supported by staff to pursue their interests.
• Staff supported people to achieve their aspirations and goals.
• The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
• Staff did everything they could to avoid restraining people. The service recorded when staff restrained people. However, we did not see evidence in staff meetings about learning from incidents.
• People had a choice about their living environment and were able to personalise their rooms.
• People benefitted from the interactive and stimulating environment
• The service made reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go.
• Staff supported people to play an active role in maintaining their own health and wellbeing.
• Staff supported people to take part in activities and pursue their interests in their local area.
• Staff enabled people to access specialist health and social care support in the community.
• Staff supported people to make decisions following best practice in decision making but this was limited due to the longstanding speech and language therapy vacancy which reduced peoples confidence and ability to speak up for themselves.
• Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

• Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
• Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.
• Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Although staff had training available on how to recognise and report abuse there were low completion rates.
• People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.
• People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right Culture:The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

• People received good quality care, support, and treatment because trained staff and specialists could meet their needs and wishes.
• People were supported by staff who understood best practice in relation to the wide range of strengths, impairments, or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.
• Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.
• Staff placed people’s wishes, needs, and rights at the heart of everything they did.
• People and those important to them, including advocates, were involved in planning their care.
• Staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate.
• The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.
• People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.
• Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity.
• However, the poor quality of the ward environment meant care provided was not always dignified. For example, when people had to use old or dirty furniture.

SUMMARY

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

• People were protected from abuse and poor care. The service had enough, appropriately skilled staff to meet people’s needs and keep them safe.
• People were supported to be independent and had control over their own lives. Their human rights were upheld.
• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.
• People’s risks were assessed regularly and managed safely. People were involved in managing their own risks whenever possible.
• If restrictive practices were used, there was a reporting system in place and there were comprehensive reviews to try and reduce the use of these practices.
• People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
• People’s care, treatment, and support plans reflected their sensory, cognitive, and functioning needs.
• People received care, support and treatment that met their needs and aspirations. Care focused on people’s quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
• The service provided care, support and treatment from trained staff and specialists able to meet people’s needs. Managers ensured that staff had relevant training, regular supervision, and appraisal.
• People and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983, and the Mental Capacity Act 2005.
• People were in hospital to receive active, goal oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support they went home.
• Staff supported people through recognised models of care and treatment for people with a learning disability or autistic people. Leadership was good, and governance processes helped the service to keep people safe, protect their human rights and provide good care, support, and treatment.

However,

• People were cared for in an environment that was not always clean and in which some of the furnishings were damaged. We found that a fridge and cupboards where food was stored were dirty and the covering on some chairs was ripped.
• Although the provider had a decorator on site decorating the environment, and they organised more furniture to be delivered during this inspection. However, some of this replacement furniture was dirty.
• There were blind spots on the ward that were not mitigated with mirrors or CCTV. We saw that one of the mirrors staff had put up to try to mitigate a blind spot was not fully fixed to the wall and could be easily removed.
• Some training completion rates were low. Training rates basic life support was 60% and the highest training completion rate for the providers restraint training modules which was 61%.
• Some staff told us they did not always feel valued or supported by managers and that this contributed to them feeling stressed at work.
• The service did not operate regular team meetings. Some staff told us they rarely had team meetings and minutes of meetings provided to us showed these had happened every 4 months.

Updated 16 January 2023

Updated 28 July 2017