Birmingham and Solihull Mental Health 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

Systems were in place to manage safeguarding incidents and staff were trained in safeguarding people from abuse. Staff demonstrated good knowledge and understanding of safeguarding, all staff we spoke with were able to describe the actions they would take to keep people safe. People told us they felt safe at the hospital. The service had processes in place to identify risks and communicated these to staff effectively. Staff discussed with the multidisciplinary team people’s changing risks. People’s care plans and risk assessments were updated where needed and discussed in handovers between shifts. The environment was safe, and the provider completed risk assessments. Where needed action was taken to reduce risks. There were enough staff employed to meet the assessed safe staffing levels and staff had recently been recruited to fill vacancies. The provider trained staff in meeting people’s needs and in safety. Sufficient staff had not completed Immediate Life Support training, however this was booked. The ward was clean. The provider trained staff in infection prevention and control.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

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.

One person said they did not always receive an apology from staff when things went wrong. People said that one staff member could be abrupt and rude to them sometimes and also to other staff. However, people told us they felt safe at the hospital.

Systems were in place to manage safeguarding incidents and staff were trained in safeguarding people from abuse. Staff demonstrated good knowledge and understanding of safeguarding, all staff we spoke with were able to describe what actions to take to keep people safe and what and how to report. Training records showed that the provider trained staff in safeguarding people from harm and abuse. The provider had trained 100% of staff in safeguarding adults from abuse and harm at level 1, 86% at level 2 and 90% at level 3. The provider had trained 89% of staff in safeguarding children from abuse and harm at level 2 and 90% at level 3.

We observed a member of staff speaking abruptly to people and telling them to leave the lounge door open. This was so that staff could observe them when in the lounge, but it was said in a manner which people did not like. We observed other staff spending time talking with people and helping them to feel safe.

People said there was a daily meeting where they planned the day and any activities. They also said they could raise any concerns at these meetings and in regular community meetings with staff. People said they were involved in their care planning, risk assessments and making decisions about their care and said that staff supported them to be as independent as possible. People said they were involved in their risk assessments. Relatives told us they were invited to their relative’s care planning meetings and their views were listened to.

Staff understood the risks to individuals and discussed these as a staff team. They told us how they involved individuals to manage and reduce their risks and restrictions on them. The multidisciplinary team reviewed people’s risk assessments following incidents.

We observed in the multidisciplinary team meeting that the team discussed how to involve the person in taking positive risks and taking responsibility for their care and treatment. The provider had a search policy in place. This should state when and how people are to be searched and under which legislation to protect people's human rights. This policy stated the different types of searches that staff could carry out and when these would be considered. This was also included in the environmental risk assessment for the ward.

People told us the environment was well maintained and furnished. They said they could personalise their bedrooms.

We observed that the environment was clean and well maintained. Each person had their own bedroom and ensuite shower and toilet, so they did not have to share facilities.

Records showed that portable electrical appliances were tested when needed so they were safe to use. Staff had completed checks of the clinic room and there were cleaning records for assurance. Where there were issues, these were recorded, and action taken to ensure the safety of people who used the service. Records showed that equipment for emergency life support use was regularly checked to ensure it was in date and would be accessible when needed. Managers had assessed the environmental risks relating to the ward in March 2024. This included all risks related to people using the service, their visitors, and staff when on the ward and when using the day service facility. The risk assessment detailed what was in place to reduce risks to people’s safety. Managers had completed a ligature risk assessment of the ward in March 2024. This showed how risks were reduced using individual risk assessment and increasing individual observation levels where needed.

People told us there were not always enough staff. They said that some staff particularly bank staff did not have training in eating disorders. People said this meant that staff made inappropriate comments about eating which affected their recovery. They also said that staff did not always know what portions they needed or what snacks they could have as part of their plan. Relatives told us that when bank staff did not have appropriate training this had affected their relative’s recovery.

Staff said that the number of staff had improved since last year. However, there were still times when there were not enough staff and sometimes, they had to go to support other wards within the Barberry site. This meant that there were fewer staff than allocated at times on Cilantro ward. Staff said they had e-learning on working with people with eating disorders and the dietician provided specific training on portion control. Staff told us they had training in how to give food via naso gastric tube. This included shadowing other staff who were trained, and they had to meet competencies before they were signed off to do this. The trust told us in the requested data that staff vacancies for Cilantro ward were as low as 1.7% which was below the trust target for vacancies of 6%. The West Midlands Provider Collaborative told us they had provided training to staff in working with people who have an eating disorder. This included funding to provide training to bank staff who worked regularly on the ward.

We observed staff spending time with people talking with them. In the multidisciplinary team meeting staff understood people’s needs and were knowledgeable in supporting people who have an eating disorder. We observed the evening mealtime. Some staff spoke with people supporting them and recognised the mealtime was difficult for them. However, some staff had minimal interaction with people during the meal and afterwards.

The induction checklist for Cilantro ward did not include anything specific to support staff working with people with an eating disorder. However, the provider showed us data which stated that 16 staff had attended training over two days in October 2023. This included input from the dietician, psychological aspects of having an eating disorder, portion control, dining room guidance, support at mealtimes, refeeding guidance, and medical emergencies in eating disorders (MEED) guidance. The provider showed us evidence that staff had been assessed as competent to administer naso gastric feeds to people where needed. The provider told us that only 70% of eligible staff had received training in resuscitation specifically immediate life support training. Given the potential changing medical needs of people who have an eating disorder this may not always ensure that there are suitably trained staff on duty to respond to a medical emergency. However, the provider told us that staff were booked to attend this training. The provider told us that 84% of staff had received an annual appraisal, 64% of staff that had received regular clinical supervision and 70% of staff had received management supervision. The supervision figures were lower than the provider would expect, however staff also had access to bi-weekly reflective practice/formulation sessions but not all staff had updated this on the system. Staff told us the system was difficult to use and they had not always been able to update their supervision on to this. Staff told us they found the reflective practice sessions helpful.

People said the ward was always clean. They said staff spent time cleaning the ward and there was access to hand gel.

We observed the ward was clean. Staff had access to antibacterial hand gel, and we observed staff using this.

Records showed that staff completed cleaning tasks and signed to say this was done. The provider told us that 100% of staff had completed infection prevention and control training at level 1 and 94% of staff had completed training at level 2. Staff completed infection control audits and action was taken where needed to make improvements.

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